Thoughts?

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LBJLA23

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Just read this in a blog. Fantasy or possibility? Would in vivo microscopy be read by radiology or us?


"Possible future: Some day, whole slide imagers will be ubiquitous in pathology labs throughout the U.S. They will scan our slides quickly and in multiple contiguous focal planes, thus retaining all the morphologic data that exists in “analog” form. The quality of the whole slide imaging will be so good that pathologists will have no need to review the original slides. Our workflow will be entirely digital and physical proximity of the histology lab and the pathologist will no longer matter. Artificial intelligence algorithms will interpret the scanned slides and will flag the urgent diagnoses. At first computer assisted diagnosis will make pathologists’ jobs easier and we will be able to do more work faster and extract more information from morphology than we could before. However, eventually pathologists will have less to do as the computers become smarter and faster. At some point slide interpretation will no longer be done by human beings, since AI can do everything they do faster and are less prone to error. Furthermore, they will learn to identify complex patterns with diagnostic and prognostic relevance which are beyond human perception. Patterns such as chromatin distribution, reconstructed 3D tissue architecture, and quantification of nuclear contour irregularity.

Here is another possible future: In vivo microscopy will improve to the point where it matches the resolution of histology, thus precluding the need for ex vivo microscopic interpretation. In conjunction with improvements in metabolic imaging and exosomal DNA analysis, histology will have nothing to contribute beyond the information which can be obtained in vivo. Whole slide imaging will become a redundant concept since there will no longer be slides to scan. Pathologists, radiologists, and clinicians who do endoscopy will compete for the professional right to interpret these in vivo images which will render most biopsies unnecessary"
 
You don’t have to read beyond your introductory two lines.
Who else? Who has shown any of the entrepreneurial spirit that would put closure to that paradigm?
Don’t put your money on the Aspbergers Association of Accomodating
Pathologists.
 
There WILL be technology that drastically reduces the number of biopsies. There are so many pre-analytic issues with what we do, there is definitely a lot of room for improvement. Instead of investing money in "slide screening" companies, I would be investing in companies that are thinking beyond slides.
 
There WILL be technology that drastically reduces the number of biopsies. There are so many pre-analytic issues with what we do, there is definitely a lot of room for improvement. Instead of investing money in "slide screening" companies, I would be investing in companies that are thinking beyond slides.

What technology are you referring too? CT colonography? Colonoscopies won't be stopping anytime soon and biopsies are diagnostic. Everything is biopsied these days from what I've seen, especially in Derm and GI. Don't see that changing anytime soon.
 
One day we will have digital AI super intelligence that simultaneously can guide 10,000 server robots that administer healthcare to entire country. Humans become obsolete. We all die off. Necrons rule the planet. This could happen to.
 
Live-imaging was the backbone method for my phd. Yes live-imaging or in vivo microscopy could be a thing, but at present we are limited to a depth that really only permits visualization of cellular detail in the superficial-most layers of skin. It doesn't make sense to pursue over standard histology for clinical practice at present. One way I could see it being helpful is if it provides some additional information would not be obtained via standard histological sections. For example, metabolic (fluorescent?) probes could be helpful in cytologic specimens - right now we primarily use nuclear detail, but metabolic activity may also be a feature we can use to distinguish neoplastic from benign processes.

To answer your other question though, my sense is that studies on the cellular scale would be relegated to the field of pathology.
 
Live-imaging was the backbone method for my phd. Yes live-imaging or in vivo microscopy could be a thing, but at present we are limited to a depth that really only permits visualization of cellular detail in the superficial-most layers of skin. It doesn't make sense to pursue over standard histology for clinical practice at present. One way I could see it being helpful is if it provides some additional information would not be obtained via standard histological sections. For example, metabolic (fluorescent?) probes could be helpful in cytologic specimens - right now we primarily use nuclear detail, but metabolic activity may also be a feature we can use to distinguish neoplastic from benign processes.

To answer your other question though, my sense is that studies on the cellular scale would be relegated to the field of pathology.

I am sure you are far more knowledgeable in such an area than I. One comment, though, caught my attention. When you mention metabolic activity as a
benign/malignant discriminators. Isn’t this very, very analogous to PET scans?
I’ve been out of the game for a long time but, damn, they were not too good.
It seems i recall they were good at mets but also found lots of red herrings. And they cost a fortune.
 
I am sure you are far more knowledgeable in such an area than I. One comment, though, caught my attention. When you mention metabolic activity as a
benign/malignant discriminators. Isn’t this very, very analogous to PET scans?
I’ve been out of the game for a long time but, damn, they were not too good.
It seems i recall they were good at mets but also found lots of red herrings. And they cost a fortune.

yes I agree, I could easily see this being confounded by a number of reactive and regenerative processes. One advantage with doing this on ex-vivo specimens is that many of the off-the-shelf probes that are currently available for research purposes, would not have to be validated for safety for in vivo administration. There is are a good number of probes available for interrogation of multiple organelles.
 
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