Digital Pathology can strengthen remote diagnostics in India, says Expert | The Financial Express

Digital Pathology can strengthen remote diagnostics in India, says Expert

According to Dr. Chadha, digital pathology helps in increasing the safety of diagnostics by reducing the risk of patient misidentification and enables access to second opinions across remote geographies.

Digital Pathology can strengthen remote diagnostics in India, says Expert
According to the company, the pathlabs will provide accessible, high-quality diagnostics services and hopes to bridge the existing gaps in the market specifically related to conception and the needs of women and their children. (File)

The digital intervention has played a crucial role in transforming the healthcare sector. Undoubtedly, technology has certainly been a blessing amidst the covid-induced global crisis. In diagnostics, the technological transformation has opened new doors of opportunities.

According to an Edelweiss report, Indian diagnostics is one of the fastest-growing markets in the healthcare industry. The segment is projected to be estimated at $9 billion and grow at a CAGR of approximately 10 percent by 2025.

Meanwhile, several industry experts emphasise that increased awareness about health, change in people’s outlook towards illness, and prioritisation of preventive testing, and digital interventions among various other factors have become key drivers of growth of the country’s diagnostic sector.

“We are practicing pathology in a historical moment. Some call it the ‘third revolution’ in pathology. The first was when IHC was introduced. The second was when molecular diagnostics was incorporated into pathology. The third is whole slide imaging or more popularly known as Digital Pathology, which has given rise to computational pathology and artificial intelligence usage in pathology and patient management. Digital pathology, an image-based environment for the acquisition, management and interpretation of pathology information supported by computational techniques for data extraction and analysis is the present and future,” Dr. Kirti Chadha, Chief Scientific Officer, Metropolis Healthcare Limited told Financial Express.com.

The diagnostic industry can be categorised into two categories–Pathology and Radiology. Interestingly, Pathology accounts for nearly 58 percent of the revenue of the industry it is usually related to testing of all major kinds of diseases.

What is Digital Pathology?

Digital Pathology is a crucial part of pathology that focuses on data management based on information generated from digitised specimen slides.

Also known as whole slide imaging (WSI), is relatively a new technology that allows the digitization of an entire glass slide, producing a digital image for review.

“It facilitates an image-based environment which helps in acquisition, management, and interpretation of pathology information, supported by computational techniques for data extraction and analysis of the present and future,” Dr. Chadha said.

According to experts, digital pathology utilises virtual microscopy, and glass slides are converted into digital slides that can be viewed, managed, shared, and analysed on a computer. Industry experts have emphasised that the field of digital pathology is growing as it is aimed that achieving efficient and cheaper diagnoses, prognosis, and prediction of diseases due to the success in Artificial Intelligence and Machine Learning.

According to a 2020 study published in The Journal of Clinical Medicine, Digital Pathology is on the verge of becoming a mainstream option for routine diagnostics.

The study has revealed that although faster whole-slide image scanning has highlighted its crucial role, its implementation on a large scale on technical, logistical, and financial levels is still a challenge.

“Telepathology was the electronic transmission of pathological images from one location to another, for the purpose of interpretation and diagnosis by means of a remote-controlled microscope. It has been used internationally for many years, mostly in small-scale deployments for limited clinical use (e.g. frozen sections). Whole slide imaging (WSI) is a relatively new technology that allows the digitization of an entire glass slide, producing a digital image for review. The adoption of WSI is progressing,” Dr. Chadha said.

Advantages and Disadvantages of Digital Pathology

According to Dr. Chadha, digital pathology helps in increasing the safety of diagnostics by reducing the risk of patient misidentification and enables access to second opinions across remote geographies.

“Pathologists often don’t have as detailed knowledge of the advantages and limitations of this technology compared to their expertise in pathology or histotechnology which they are now working on developing and making quick progress. When introducing DP, pathologists should ensure the quality of their diagnosis with digital pathology is equivalent to the current standard by using conventional light microscopy,” Dr. Chadha said.

She also emphasised that the adoption of digital pathology can increase the safety of a diagnostic service in other ways, example by reducing the risk of patient misidentification, or increasing access to second opinions across remote geographies.

However, Whole slide imaging devices are medical devices hence instrument manufacturers are required to obtain regulatory approval before selling a device for diagnostic use.

“Pathologists should ensure the instruments they use have regulatory approval for the intended use. Deviation from regulatory guidelines is equivalent to ‘off-label’ use of a medicine – pathologists and institutions should do their own risk assessment of ‘off-label’ use. In addition, a validation and verification procedure will be relevant regardless of regulatory approval,” she added.

She also revealed that the information and knowledge needed to stay abreast with current best practices and new research can be overwhelming across a wide spectrum of anatomic and clinical pathology.

“Since many of our clinical colleagues are subspecialized, pathologists should also have the corresponding subspecialty access or expertise which through digital pathology is easier to weave into the hospitals and laboratories through cloud offsite experts,” she added.

However, there are some disadvantages too.

“…expensive equipment, lack of standards and lab information systems that are not yet ready to support digitalization at least not universally unlike traditional pathology & histopathology operations. However, all these bridges are being built with each passing year and soon Digital pathology will also become standard of care in advanced laboratory medicine era as it is the backbone on which all the AI algorithms for various clinical diseases will be practiced for patient diagnosis and management through precision medicine,” she pointed out.

Global Market of Digital Pathology

According to Dr. Chadha, pathologists are at the front and center of precision medicine. Studies have pointed out that digital pathology is on the verge of becoming a mainstream option for routine diagnostics. According to Markets and Markets research, the global digital pathology market is valued at an estimated USD 736 million in 2021 and is projected to reach USD 1,371 by 2026 at a CAGR of 13.2 percent during the forecast period.

According to the report, the key drivers of this growth is due to factors like increasing adoption of digital pathology to increase lab efficiency, an uptick in cancer cases, and growing applications of digital pathology.

Moreover, players like Danaher and Hamamatsu Photonics, Inc., reportedly held a dominant market share last year. According to a report by Grand View Research, these companies are taking various strategies like new product development, extensive collaborative strategies, and M&A to gain a higher market share. The report also highlighted that the global digital pathology market size was estimated at USD 882.7 million in 2020 and is expected to reach USD 926.9 million in 2021.

What is India’s Position in Digital Pathology Space?

Undoubtedly, the rapid digitisation of the Indian Healthcare system has improved the diagnostics, preventive and medical facilities that patients receive. Meanwhile, the National Digital Health Mission, launched in August 2020, has in many ways given a digital touch to the healthcare infrastructure of the country.

According to industry experts, pharma companies find the digitised slides useful to build models for companion diagnostic drugs, clinical trials, and for predicting underlying molecular/genetic alterations. Experts claim that for India, in crucial areas like the development of cytology screening tools for specific cancers like cervical cancer, digital pathology can be a game changer. Moreover, digital pathology can also help in overcoming the challenge of trained anatomic pathologists shortage, especially in Tier 2 and Tier 3 cities.

Dr. Chadha emphasised that digital pathology can strengthen the presence of remote pathology in India, bridging the geographic divide for quality diagnostic services.

“It will enable both the expert pathologists and healthcare practitioners to study the case of a patient from a rural or any region via digital remote access of images on a password-protected repository, aiding them to make accurate diagnosis and actioning the right treatment for a patient,” she added.

However, she also emphased that there is a need for policymakers to regulate the standardisation and quality check.

“Remote reporting of pathology is not yet permitted by the National Accreditation Board for Testing and Calibration Laboratories (NABL), which I believe is being reviewed currently. Digital pathology will also become a standard of care in advanced laboratory medicine era as it is the backbone on which all the AI algorithms for various clinical diseases will be practiced for patient diagnosis and management through precision medicine,” she said.

Although India has many many whole slide imaging scanners installed in both public and private sectors along with skilled pathologists, there are still several challenges.

“…standardization, quality audit and formalization of a legal road map needs to be put in place for the pathologists & service providers to augment the traditional process flow. Government, policy makers, well-resourced institutions, and industry bodies can support us by including it in their three-year plans, which can be beneficial for the multi-specialty healthcare narrative in the long run,” Dr. Chadha said.

What lies ahead?

Dr. Chadha also maintained that the recent announcement of inclusion of new Current Procedural Terminology (CPT) test codes by the College of American Pathologists (CAP) has brought enormous excitement and also realisation of the advent of the ‘Digital Age of Pathology’.

Moreover, this will lead to the inclusion of more CPT codes soon and this will rationalise the use of digital reporting.

“We need to set the rules and guidelines, support the tool, optimize resources, and include digital pathology as a part of routine laboratory diagnostics. Digitization of processes in Pathology can help in seamless functioning, and by extending value-added support to the healthcare ecosystem in the country and around the world, and most importantly during pandemic times,” she added.

ALSO READ | SRL Diagnostics and Skye Air Mobility collaborate to transport pathology samples using drone logistics

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First published on: 30-10-2022 at 10:19:03 am
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