Putting Some Numbers to Digital Pathology Adoption Trends by Pathologists

I recently posted two guest blog notes by Steve Potts, Ph.D., focusing on the more rapid adoption of digital pathology by veterinary pathologists than MD pathologists (see: Veterinary Pathologists Adopting Digital Pathology Faster than MDs; Reasons Why DVM Pathologists Are Adopting Digital Pathology Faster Than MD Pathologists). Coincidentally, an article has just been published in Laboratory Economics entitled Adoption Trends in Digital Pathology (Volume 5, No. 6, June 2010) that provides survey data on this topic. I copy it in its entirety below.

Nearly everyone agrees that digital imaging will play a big role in pathology in the future. Academic medical centers, commercial labs and large independent pathology labs are rapidly installing digital pathology systems. But its use in reimbursable clinical diagnostics is currently limited. Twenty-two percent of pathology groups and labs currently have a digital imaging system in place, according to LE’s Digital Pathology Trends Survey conducted in June. Ten-percent plan to add a system within 12 months and another 10% within the next 12-to-24 months.

Today, education and training is the most common use for labs using digital pathology. The biggest barrier to more clinical use is the cost of scanning digital slides, which don’t eliminate the need to first prepare glass slides. Among surveyed labs using digital pathology, 72% are using it for education and/or training, according to LE’s Digital Pathology Trends Survey. Sixty-three percent use it for second opinions and/or consultations, and 62% for quantitative immunohistochemistry for HER2 scoring. In terms of market share, 44% of digital pathology users have an Aperio system; BioImagene has a 16% share; Ventana, 9%; and Olympus, 8%. Other vendors have a combined 23% share, including Nikon, Leica Microsystems and Dmetrix.

More than half of surveyed labs without digital pathology cited “too expensive” as a barrier to adoption. Another 36% said traditional pathology/microscope works fine and 23% had LIS integration concerns. Only 15% said digital pathology systems were too slow and only 3% had concerns about image resolution. Meanwhile, Amanda Lowe, principal of Digital Pathology Consultants...believes the limited menu of FDA-cleared tests is a bigger issue than our survey suggests. “There’s no doubt that if the FDA would ‘gold stamp’ digital pathology on the clinical diagnostic end, it would help significantly,” she says.

In an email to me, Jondavid Klipp, the founder and editor of Laboratory Economics provides additional information about this trend: Roughly 500 commercial labs, pathology groups and academic medical centers have a digital pathology system/scanner in place. Digital pathology utilization for clinical diagnostics in United States is extremely limited, currently less than 1% of all slides.

One of the drivers for adoption of digital pathology by veterinary pathologists, emphasized by Steve Potts in his guest blogs, was that many of them work for pharmaceutical companies. They are thus heavily involved in drug toxicology studies as part of basic research studies and clinical trials. In such settings, global image networks have been established by these companies for sharing and storing animal and human whole slide tissue images. It is thus readily apparent that a far more convincing business case can be made for the deployment of digital pathology systems in Big Pharma than can be made for a pathology group working in, say, a mid-size community hospital. Note the barriers to adoption cited by the pathologists above. Here's a quote from Steve's first note:

Nearly all of the top 15 pharmaceutical companies have completed multisite-integration with digital pathology. The result of such conversions is that a pathologist working in one location can access slides at any other one or participate in an informal peer review or pathology working group.

Comments

[Steve Potts, Flagship Biosciences]

Even with more rapid adoption in the pharma industry for some uses as I mentioned in my vet pathology adoption article, I would estimate that less than 3% of the total slides created in pharma each year are actually fully digitized. So there is a long way to go in all sectors. I agree with Ajit's comments on 40x scanning -- 40x has to get faster and easier for greater adoption in regulated uses.

[Ajit Alles]

We have bought a digital slide scanner, but have found it somewhat temperamental. It is quite slow when scanning at 40X and the focus at high mags is not good,although it does a beautiful job at low mag. Any little variation in the slide thickness or coverslipping medium throws it off. I don't see this replacing standard microscopes anytime soon. It's great for education and conferences and for taking pictures for reports. The only other use I see is if histology services get shipped overseas.

I have heard that someone is offering a service where you provide them with the tissue and they fly it overseas (India, I think)processing it onboard the plane so that it's ready to cut when it reaches its destination. Once there, the slides are made, scanned and the US pathologist can view the "slides" online. So for the present, if a group doesn't do much teaching or conferences, it would be cheaper and more useful to buy a good microscope camera