How digital pathology provides faster answers
Eye on Innovation
Almost four years ago, Mayo Clinic launched the Digital Pathology Program, a major pathology initiative. Phase 2 of this multi-phase rollout has recently been completed, which involved the implementation of cutting-edge digital equipment and software, and converting glass slides of patient samples into digital images. The conversion enables pathologists and laboratory technologists to view, store, retrieve, and share medical images more universally, without waiting for glass slides to be retrieved and delivered. This has significantly improved patient care because pathologists can now discuss cases with clinicians and surgeons in real time.
James Jakub, M.D., an oncological surgeon specializing in breast cancer and melanoma at Mayo Clinic’s Florida campus, offers a recent example of how the conversion has enhanced his practice. “I had a patient in from Miami, waiting for me in the clinic, and I was going to meet her for a surgical consultation,” he says. “We already reviewed her glass slides here, and I had looked at the report. But there were specific nuances, in terms of her diagnosis, I still needed to know that would really take me one way or the other on my recommendations to her. And I couldn't get a great sense of those nuances from the written report alone.”
To gain clarity, Dr. Jakub needed to consult with the attending pathologist on the case. In the pre-digital era, if he were to call the pathologist, that person would have to put in a request for the patient’s glass slides to be pulled and delivered. This typically took one or two days, or longer. “But in this case, when I called the breast pathologist, she just asked for the clinic number of my patient’s specimen images and pulled them right up on her computer,” he says. “Then I asked her my specific question and she confirmed my clinical recommendation while we were on the phone.”
After the brief phone call, Dr. Jakub was able to walk back to his patient and give her a “very concise recommendation,” he says. “As opposed to telling her, ‘Well, we may take path A, or we may take path B, but I need pathology to review your slides first. I’ll get back to you in a few days.’ So, for me, that’s the big difference — being able to call or video meet with the pathologist and have a verbal discussion in real time while they look at the patient’s images. No more waiting for glass slides to be pulled or phone tag, which delays answers to anxiously waiting patients.”
What if the consulting pathologist is unavailable and a surgeon has a patient waiting for word on their next treatment plan? In the analog days, this, too, created delay issues because glass slides from a patient case might be inaccessible.
“A pathologist practicing with analog workflows may shuttle glass slides between their office, trainees, medical secretaries, and several others,” says Joaquin Garcia, M.D., chair of the Department of Anatomic Pathology at Mayo Clinic and co-chair of Phase 2. “By converting glass slides into digital assets, we can expand consultation capabilities and improve diagnostic workflows. When you’re in a situation like Dr. Jakub’s, when he has a waiting patient, he doesn’t have a day or two days. He was about to see the patient.”
Miglena Komforti, D.O., a surgical pathologist at Mayo Clinic’s Florida campus specializing in disease of the breast, was used to dealing with the “cumbersomeness” of glass slides — up to 100 of them for a single patient case. Which is why, for her, the transition to digital images has been a godsend.
“These glass slides are very valuable things,” she says. “You've cut out a part of the patient's body and you've made it into a little block of paraffin, then a slide. But these materials degrade, and it doesn’t take very long. A year later, the slide could look completely bleached and, if it wasn't stored properly, you would not be able to read it. So now, we are scanning and digitizing each slide, and then we have it indefinitely, in great shape, and they’re accessible immediately.”
Besides “immortalizing” patient specimens via digital scanners, the technology also allows pathologists to view and compare multiple slides simultaneously, on one screen, instead of having to put each one under a microscope, single file.
Dr. Komforti continues, “Digital pathology has truly revolutionized the way we practice. It has allowed me to have a quicker turnaround time on consults and enhanced productivity. And it gives me more accurate annotation of distance of the margin to the cancer, and size of the cancer.”
At Mayo Clinic’s Florida campus, a multidisciplinary breast conference convenes every week. It’s a time when experts from, for example, medical oncology, radiation oncology, breast surgery, breast pathology, and study collaborators, come together to discuss patient cases. The Digital Pathology Program has made these conferences more productive and efficient.
“At these meetings, a medical oncologist or a radiation oncologist or surgeon will say, ‘Hey, I have this case to discuss, I need another opinion, here's the accession number (for the digital images),’ and we start talking about the case,” says Dr. Jakub. “And now, pathology can just log in and pull up the digital slides and they'll say, ‘Hey, here's what I see, and here’s why I think it's this kind of cancer.’ So it's allowed us to get the pathologist engaged in real time without having to ask them a week in advance, ‘I want to discuss this case next week, can you pull the slides for me?’ We can now discuss cases instantly while looking at the images together.”
Dr. Komforti chimes in from the pathologist’s side: “Looking up older material (glass slides) used to take forever. The same with pulling cases for a conference — that used to be quite cumbersome as well. But not anymore. I can reach my colleagues in Rochester and Arizona and get an immediate consult regarding a challenging case.
“In essence, I have the top experts in the world at my fingertips. This not only benefits the patient — because they get the most appropriate diagnosis — but also they get it without any delay. Obviously, this is great for patient care.”
What’s next? Phase 3, which will formally launch this spring. Dr. Garcia will also be co-chairing this phase.
“In Phase 2, we positioned ourselves to practice digital pathology at scale,” he says. “In Phase 3, we will transform the clinical practice by leveraging artificial intelligence (AI) and the Digital Pathology Platform. The shared digital pathology ecosystem will enable patients and providers to access novel tools and technologies to better characterize and understand disease — and the pathway to restoring health.”
Tying together the expertise and curiosity of Mayo Clinic autoimmune neurology researchers with eager patients who have rare disease and are looking for answers, the innovative collaboration benefits both patients affected by MOGAD and scientists on the front lines of discovery.
VEXAS syndrome is a severe autoinflammatory disease that results in a spectrum of rheumatologic and hematologic conditions. The underlying cause of newly identified VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome — somatic mutations in the UBA1 gene of blood cells — was discovered at the National Institutes of Health (NIH) in 2020. Within six months, Mayo Clinic Laboratories was able to add a UBA1 test to the MayoComplete panel, as the team simultaneously worked on a single gene assay to allow doctors to test specifically for UBA1 mutations to screen patients for VEXAS syndrome. The team opted for a droplet digital PCR test — a novel and highly accurate approach to testing for UBA1 gene mutations.
Since March 2019, Paul Jannetto, Ph.D., director of the Metals Laboratory at Mayo Clinic, along with his colleagues across the enterprise and his laboratory staff, have developed, validated, and implemented an artificial intelligence (AI)-augmented test with algorithms designed to interpret kidney stone FTIR spectra. With more than 90,000 kidney stones analyzed each year at Mayo Clinic, this new AI-assisted test has streamlined lab processes and improved patient care.