Because of ongoing advances in gene sequencing and the data analytics needed to interpret that information, new approaches to clinical care are becoming available to physicians and pathologists
COLD SPRING HARBOR, NEW YORK—Internationally-recognized as a leader in bringing together the brightest minds in genetics, the Banbury Center at the Cold Spring Harbor Laboratory (CSHL) produced a three-day conference here last week to explore the future state of anatomic pathology and identify opportunities in genetic medicine and image sciences that play to the strengths of the nation’s pathology laboratories.
“Evolution and Revolution in Anatomic Pathology: Automation, Machine-Assisted Diagnostics, Molecular Prognostics, and Theranostics” was the title, and the meeting’s organizers were CSHL and the Department of Pathology and Laboratory Medicine at Northwell Health.
Cold Spring Harbor Laboratory Founded in 1890
The Cold Spring Harbor Laboratory has a long history and an enviable reputation. It was founded in 1890 to train teachers in biology. However, by 1904, the laboratory’s mission had been expanded to include research in genetics. In 1924, the research mission was further enlarged to include quantitative biology—in particular, physiology and biophysics.
It was in 1968 that Nobel laureate James Watson, then a professor at Harvard University, accepted the directorship of the Cold Spring Harbor Laboratory while also keeping his professorship at Harvard University. Watson served at some level of leadership until 2008, when he became Chancellor Emeritus. Currently CSHL laboratory houses about 200 research-related personnel.
Experts Included Pathologists and Laboratory Informatists
Taking the lead as co-chairs of this conference were James M. Crawford, MD, PhD, Chair, Department of Pathology and Laboratory Medicine at Hofstra Northwell School of Medicine in Hempstead, NY; and Partha Mitra, PhD, and Michael Wigler, PhD, both professors at Cold Spring Harbor Laboratory. Participants included experts in oncology, pathology, genomic sciences, computer sciences, information technology, safety and quality, and FDA regulation.
“Two things are happening in medicine and anatomic pathology today,” stated Crawford. “First, ongoing and rapid advances in a host of technologies are making it possible for providers to deliver care in new ways and improve patient outcomes. It is important for pathologists and medical laboratory professionals to understand these technologies and incorporate them into clinical practice in useful ways.
Technology Developments Specific to Anatomic Pathology
“Second, and more specific to anatomic pathology, there are technology developments that have the potential to transform anatomic pathology operations and services,” he continued. “Three examples are:
• “Automation designed to optimize standardization of human tissue preparation and processing;
• “Biomarker mapping at the two-dimensional and three-dimensional level, including single-cell and spatially-resolved genomics;
• “Application of machine-learning to digital images, including machine-assisted diagnosis.”
Crawford, Mithra, and Wigler emphasized that, over the three days of this conference, attention would be devoted to the probable impact these disruptions will have on diagnostics, prognostics, and theranostics.
Each presentation, and the discussion that followed, lived up to the promise of those goals. Representative of the topics were these presentations:
• High Throughput Histology Pipeline and Informatics—Partha Mitra described how his research team, as part of its work in mapping connections in the brain, are building the tools to automate, speed up, and improve the quality of the processing of tissue and the production of slides.
• Data Integrity and Interoperability and the Need to Agree on Standards for the Generation of Quantitative Data from Anatomic Pathology—Richard Levenson, MD, Professor and Vice Chair for Strategic Technologies in the Department of Pathology and Laboratory Medicine at the University of California, Davis, reviewed the needs of anatomic pathology versus the current availability of information technologies that can capture the huge volumes of data from digital pathology images, along with storing it and analyzing it under the direction of the pathologist.
• Preanalytical Processing: the Biospecimen Quality Initiative—Carolyn Compton, MD, Chief Medical Officer at the ASU Complex Adaptive Systems Institute, Arizona State University in Tempe. Compton’s message was that there continues to be great—and in some cases unacceptable—variability in how tissue specimens are collected, transported to the lab, and handled within the lab during processing and production of slides. For the pathology profession to keep pace with the increasing quality standards (and quality expectations of physicians, payers, and patients), it is essential that pathologists take active steps to reduce this variability and demonstrate that only high quality specimens are processed into slides and images.
In keeping with the practices and traditions of the working groups that meet at the Banbury Center at the Cold Harbor Springs Laboratory, this was not a one-off event. The experts at this conference will follow-up in specific ways.
White Paper on Anatomic Pathology to Be Produced
“Now that we have identified pilot projects and collaborations for overcoming specific barriers that were the subject of the discussions over the past three days, work will continue in the following ways,” explained Crawford. ‘One, a white paper to be written by meeting participants will describe the advantages of moving the field of anatomic pathology in these directions. It will also describe the collaborative approach to addressing those obstacles that must be overcome.
“Two, a working group and its structure will be developed for tracking progress in this field, with the express intent of working with existing organizations and thought leaders to leverage the ideas discussed at this meeting,” he continued. “Three, to provide the resources to enable these necessary advances to become reality, this team will identify sources of funding for such efforts.”
Helping Academic and Community Pathology Groups
This group plans to reconvene at appropriate intervals to review the progress of pilot projects, organize the publication of these efforts in peer-reviewed medical journals, and identify the resources necessary to help both academic and community pathology groups successfully incorporate these new technologies into their daily clinical practice.
Pathologists and pathology practice administrators interested in obtaining a copy of this white paper when it is published should contact the office of James M. Crawford, MD, PhD, at the Northwell Health Laboratories.