Real-world digital pathology: considerations and ruminations of four young pathologists

Correspondence to Dr Filippo Fraggetta, Department of Pathology, Gravina Hospital, 95126 Caltagirone, Sicilia, Italy; filippofra@hotmail.com Digital pathology offers the opportunity to improve all aspects of pathology by introducing recent technical advancements in daily diagnostic practice.1 Its introduction in routine work, especially as part of a fully digitised workflow, allows for the creation of a smoother, traceable and interconnected environment where primary diagnoses can be rendered directly on digital slides.2 Besides its main use as a diagnostic tool, however, digital pathology has a role in enhancing education of trainees and in research activities.3 In this letter, we present the impressions of two pathology residents and two young pathologists after exposing them to a fully digital workflow. [...]digital pictures document each stage of specimen life (figure 2).2 4 5 These are automatically shown in the laboratory information system (LIS), giving operators an opportunity to (1) quickly notice if an error occurs, (2) determine exactly when it happened and thus (3) amend it and take actions to prevent similar future errors. The integrated adoption of pathologist-guided and/or artificial intelligence (AI)-assisted segmentation of tissue structures and cell components conjugates the suitability of analytical methods proper of single-cell resolved science (eg, clustering analyses, dimensionality reduction methods) with spatial information, offering an unprecedented level of insight into the biology of normal and diseased tissues.6 High-resolution tissue imaging based on new generation slide scanners further extends the inference of pieces of information beyond the quantitative analysis of cell morphotype/phenotype and cell–cell or cell–contexture interactions, opening a window over topographic organisation of nuclear content and related mechanobiology.7 The possibility to exploit in situ transcriptional analyses to discover and validate the correspondence between emerging digital patterns and the underlying molecular networks represents the current edge of tissue-driven research, with genome-level assays making their way into the field.8 In the scenario of such a multiomics harmonisation—now including what we can identify as pathomics—preanalytical phases and quality controls of surgical pathology lab best practices represent the cornerstones. The confluence of mergeable digital pathology data into repositories for proper comparison and data analy