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Digital Pathology: A Global Review

We are excited to introduce you to guest blogger Dr. Talat Zehra. Dr. Zehra is a Consultant Histopathologist and Assistant Professor at Jinnah Sindh Medical University, Karachi, Pakistan. She completed her fellowship with College of Physicians and Surgeons Pakistan (CPSP). Her fields of interest include digital pathology and the use of artificial intelligence in tissue image analysis. She is also a member of the educational committee of Digital Pathology Association (DPA). In her blog post, she highlights the issues regarding delayed adoption of digital pathology in developing parts of the world which contain most of the bulk of world disease but are less equipped with novel diagnostic modalities.

Developing parts of the world contribute to about two thirds of the world population, where the bulk of the global burden of cancer incidence annually occur. About 65% of all cancer deaths occur in developing countries. Developing nations are also still struggling from endemic diseases like tuberculosis (TB), malaria, typhoid and cutaneous leishmaniasis. Delayed diagnosis in some of these diseases are associated with increased morbidity and mortality. For example, in the case of cerebral malaria, it can be lethal due to late diagnosis. Regarding TB, according to the World Health Organization (WHO), in Pakistan, every year around half a million new cases of TB are diagnosed. In 2019, 87% of new TB cases occurred in the 30 high TB burden countries. Eight countries accounted for two thirds of the new TB cases: India, Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh and South Africa. Narrowing in on Pakistan, typhoid is one of the most common causes of intestinal perforation in young people. Once the intestinal perforation develops if it is not treated timely then it can be fatal.

All of the diseases discussed above are deeply penetrated in our part of the world due to many reasons, some of them being poor sanitation and low socioeconomic condition of people. They are curable but associated with increased morbidity and mortality due to delayed diagnosis for many reasons. One reason I want to emphasize is the scarcity of expert pathologists. Pakistan is a country of over 220 million people with less than 1,000 pathologists, including both hematologists and histopathologists who are primarily concerned with the diseases mentioned above. Delayed diagnosis is more common in rural areas which account for around 70% of the population.

According to WHO, Pakistan’s annual incidence of cancer cases is around 180,000 and this incidence is increasing every year. Oral cancer is one of the alarming cancers in Pakistan due to it being the most common cancer in males and second most common in females in 2020. This cancer incidence is increasing in the young population due to increased use of tobacco in this age group. Oral cancer is preventable not only by stopping tobacco usage but by also having the premalignant lesions identified, biopsied and treated promptly. This can be a lifesaver. Late detection of oral lesions and breast cancer lesions are a growing concern. The role of a pathologist is equally important in all premalignant and malignant lesions with the clinicians.

Digital pathology can be helpful in this scenario as pathologists can easily conduct remote pathology of small biopsies, which do not require expert grossing techniques. This workflow could save both time and money for all stakeholders - patients, clinicians and pathologists. Integration of AI will further revolutionize pathology but it is a second step after successful implementation of digital pathology which requires large validation studies before implementation. The biggest challenge is the high cost of scanners which is beyond the scope of most of the low resource organizations in economically developing countries. Regulatory challenges and training of staff are other challenges that also need to be addressed.

COVID-19 changed how we think about everything, and we saw a fast adoption towards digital techniques in many parts of the world. We saw an exponential adoption of digital pathology during this pandemic as it offered pathologists the opportunity of working remotely. But unfortunately some practitioners, especially the low resource organizations in developing parts of the world, are struggling to adopt this technology to maintain their workload as it was before this deadly pandemic.

Having discussed this overview, I want to request world leader organizations in this field to come to our parts of the world. Let’s shake hands with the pathologists, technologists and IT experts as we are the potential source of big data, not only for endemic cases but also for tumor cases. The fuel of our era is data to make disease models, disease trends and predict the disease outcome. This in turn will open the new horizon of treatment modalities and patient care in the sense of personalized medicine. So it is a win-win situation. Let’s synergize each other’s efforts and humanity should be the ultimate winner.

Our sincerest gratitude goes to Dr. Zehra for sharing her thoughts on digital pathology and challenges presented in the developing parts of the world. Do you have a topic you would like to share? Just email Kristin at to be our next guest blogger.

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