The diagnosis of cancer is becoming more complex. The menu of tests and procedures has exploded as new technologies have evolved and clinicians are now demanding more from radiologists and pathologists. We are seeing a clear shift in how the battle against cancer is waged, from being focused on each department’s contribution to being standardized, involving integrated care processes where the outcomes are monitored. We are also entering an era of personalized medicine that is creating opportunities for precision treatment: to shoot cancer with silver bullets instead of “trial and error medicine.” Personalized medicine is based on genome sequencing, which involves completely new levels of data that need to be analyzed and made actionable. These new challenges in cancer diagnosis are increasing the demand for integration across different specialties. Efficient collaboration and sharing of data are necessary to make decisions based on a broader view of the disease and provide accurate and actionable reports to the clinician.
Cancer care today is still largely characterized by a departmental approach with limited exchange of information due to separate IT systems and isolated, not yet digitized workflows. Pathology is involved in almost all cancer diagnoses and is currently experiencing rapid advancements as more and more pathologists adopt digital review. The digitization of pathology is an enabler and a prerequisite for increased collaboration across specialties, since digital images allow pathologists and radiologists to share and access cases and reports bi-directionally. As pathology goes digital, it is becoming the last puzzle piece needed to complete a total digital and integrated diagnostics workflow between radiology and pathology that will truly change cancer care as we know it today.
Integrated cancer care over departmental workflows
There are several drawbacks to having separate IT systems and departmental workflows. Firstly, it involves a higher risk for unnoticed discordances between reports. For example, in a previous SciMetrika study, the radiological-pathological discordance causing missed or delayed diagnosis was estimated at 5% of all new breast cancer cases in the US in 2010. Another disadvantage is that physicians with little interaction with other groups also tend to generate reports that are biased due to a certain nearsightedness with respect to disease—for example, a cardiologist attributing most symptoms to cardiovascular disease. These drawbacks probably cost healthcare billions each year and impact patient outcomes negatively.
With integrated IT systems, pathologists and radiologists could cross-check and cross-validate that a lesion that was seen radiographically is represented by the tissue that was sampled. Collaboration speeds up diagnosis and improves the precision of their respective diagnoses, as well as directing the physician to the most appropriate therapies for the patient, particularly in complex cases. Most radiologists and pathologists say they are interested in the other’s imaging and report data, but face a barrier as this information often needs to be fetched from a separate IT system or, in the case of pathology, has previously not been digitally accessible.
Pathology is going digital
The rise of digital pathology, along with IT systems and workflows that span over both radiology and pathology, is enabling integrated cancer care, which provides physicians with a broader view of the disease and facilitates discussions, such as in a MDT context. Adding pathology to the digital toolbox is an important first step toward capitalizing on the benefits of integrated diagnostics.
Integrated diagnostics is defined as the seamless collaboration among diagnostic specialists with the goal of reducing the time and expense involved in diagnostic processes and providing clinicians with practical, actionable results. As pathology becomes digitized, all of the necessary technology to realize integrated diagnostics is now available. This is also mentioned in literature—for example, in a 2012 BMC Medicine article, lead author James Sorace stated that:
“… the opportunity for pathology-radiology integration to improve patient care is great, and more importantly, the tools to achieve this exist.”
In addition to integrated IT solutions, one must also develop integrated workflows spanning across disciplines as it is the workflows that determine the way integrated diagnostics can be conducted. In the future, some hospitals will probably establish physical (or virtual) integrated diagnostics centers that are responsible for collating a joint report to the clinician. These centers would consider both radiological and pathological expertise, correlate the findings and describe the diagnosis and suggested treatment to clinicians in a structured and actionable way. Integrated diagnostics centers will allow for a more streamlined patient pathway with fever visits, better resource planning and followed-up outcomes.
Even if most hospitals are currently focusing on digitizing pathology as a first step towards integrated diagnostics and do not aim to develop integrated diagnostic centers within the coming three years, it is crucial to select a future-proof digital pathology solution that can support an integrated approach. Such a solution should support enterprise workflows, be open for integrations and not be dedicated to specific scanner types or other systems.
The diagnosis of cancer is truly becoming more complex and requires increased collaboration and sharing of patient data between specialties. Increased collaboration between radiologists and pathologists could speed up diagnosis, increase accuracy and improve patient outcomes, as well as contributing to better decision-making in other areas. Along with the digitization of pathology, integrated IT systems and cross-departmental workflows are key components to realizing the benefits of integrated diagnostics. Digitizing pathology is the last puzzle piece and an important step in this direction, and the decision of what type of solution to choose should be made carefully.
View a presentation of Sectra's solution for integrated diagnostics
Inspiration and sources
- Markowitz, L. E.; Dunne, E. F.; Saraiya, M.; Lawson, H. W.; Chesson, H.; Unger, E. R.; Centers for Disease Control Prevention (CDC); Advisory Committee on Immunization Practices (ACIP) (2007). “Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP)”