Breast Pathology Through the Digital Lens

Digital pathology (DP) has significantly transformed breast pathology at Mount Sinai Hospital by enhancing diagnostic accuracy, collaboration, and education. The institution has integrated the Philips IntelliSite Pathology Solution (PIPS) for primary diagnostic use, which allows for high-resolution whole slide imaging (WSI) of surgical pathology slides. The workflow involves the scanning of glass slides to create digital images, which are then reviewed and annotated by pathologists. Key benefits of this workflow include immediate slide sharing with colleagues, efficient sign-outs, improved detection of low-positive immunohistochemical staining, and detailed measurements of tumors and margins. The ability to access a digital archive for retrospective case reviews further enhances diagnostic capabilities. However, limitations persist, including challenges in visualizing small calcium oxalate crystals and the need for manual interpretation of certain stains. Although the process of digitizing slides initially increased turnaround times, this has been mitigated by increased staffing and scanner availability. Additionally, the transition to DP has already paved the way for artificial intelligence, serving as a benchmark to develop algorithms for prognostic and predictive biomarkers, predict immunotherapy response, and thus transform cancer care. The overall impact of DP on breast pathology is overwhelmingly positive, with continued efforts to address its limitations.