From Microscopes to Monitors: The Historic Digital Evolution of Pathology

For centuries, the field of pathology has been defined by a single instrument: the microscope. But according to William Westra, MD, vice chair of Anatomic Pathology at Moffitt Cancer Center, the field is currently undergoing a "historic transition" that is reshaping not just the tools doctors use, but their very professional identity.

In an interview, Westra detailed how the shift from physical glass slides to digital imaging and Artificial Intelligence is revolutionizing patient care and diagnostic speed.

A Shift in Identity

Since its inception, pathology has been synonymous with the lens. "When you talk about [pathology historically], you're talking about the microscope, and the microscope goes back hundreds of years," Westra explained. "The development of my field, pathology is pretty much the development of the microscope."

Because of this deep history, the move to digital platforms represents more than just a software upgrade. "This truly represents a historic transition in platforms—not just as a transition in technology, but a transition in identity," said Westra. "Our identity was really linked to the microscope."

While the core process of analyzing tissue remains, the method of observation has been entirely reimagined. Instead of placing glass slides on a microscope stage, pathologists now use digital scanners. "These create high-resolution images that I can look at, not through the lens of the eyepiece of a microscope, but on my computer monitor," Westra said. "This makes all the difference."

Precision at the Speed of Light

Once an image is digitized, it becomes a playground for advanced computation. For a diagnostic pathologist like Westra, this translates to immediate gains in accuracy and speed.

"If I need to measure the distance of a tumor from a margin, or the depth of invasion of a tumor, I used to have to take out an instrument, fumble around with it. It’d take me minutes. Now, I can do it on the computer, and it’s just a fraction of a second."

Beyond simple measurements, the digital platform allows for the integration of AI algorithms that can detect cancer and assign objective tumor grades. Westra noted that being on the "cutting edge" of this novel field is significantly increasing the efficiency of diagnostic pathologists across the board.

Dissolving Geographic Borders

One of the most profound impacts of digital pathology is the elimination of the logistical hurdles associated with physical slides. In the past, preparing for multidisciplinary tumor boards or seeking a second opinion involved a "cumbersome" process of manual retrieval and physical shipping.

"Ordinarily, I would have people run down to the slide storage room, find those slides, bring them back to me, and I would look at them under a microscope to select the slides I want to show and take a picture of them," Westra recalled.

Now, that process is instantaneous. This efficiency extends globally. In the past, consultation cases required a "very complicated mail delivery system" to move glass slides across the country.

"We did a study where that process of turning around the console case would take about a week," says Westra. "Now, with digital pathology, it takes a matter of minutes because these images can just be sent digitally over the internet. It makes a vast difference in terms of how we as a department of pathology operate."

The Future: Deep Learning and Personalized Medicine

Looking ahead, Westra sees digital pathology as the key to unlocking the next level of oncology. Because these images are available for deep learning, AI can identify nuances that the human eye might miss.

"It’s going to be able to identify critical biomarkers in terms of predicting behavior and predicting response to specific therapies in a way that I just can’t do by looking through a microscope at glass slides," Westra says.

Ultimately, this evolution is about the patient. As Westra concluded, "It’s not only going to change diagnostic pathology, but it’s going to transform personalized medicine for patients... It's really leading us into the next generation of the practice of pathology and patient care."