136: Trends in Digital Pathology and AI Integration | Podcast with Alae Kawam, DO, FCAP

“It used to take 40 minutes, now it takes 15” - this is what Dr. Alae Kawam said about her AI-powered prostate biopsy evaluation workflow.  

In this energizing episode of the Digital Pathology Podcast recorded at PathVisions 2024, Dr. Alae Kawam joins me to reflect on where pathology is headed—from AI-assisted prostate diagnostics to direct-to-digital imaging and beyond. Together, we unpack what’s working, what still feels clunky, and why standardization, staffing flexibility, and smarter AI are critical to the next phase of pathology adoption.

🧠 Key Highlights:

• [00:01:00] Foundation models finally reach real-world pathology
  
  
  
• [00:02:00] Direct-to-digital imaging vs. glass hesitation
  
  
  
• [00:03:00] AI in prostate diagnosis: Gleason grading + time saved
  
  
  
• [00:04:00] The “eyeball method” vs. reproducible AI precision
  
  
  
• [00:05:00] DICOM and radiology’s standardization lessons
  
  
  
• [00:06:00] The ROI debate: business, operations & wellness
  
  
  
• [00:08:00] Staffing retention driving real-world digitization
  
  
  
• [00:09:00] New paths to part-time work with digital options
  
  
  
• [00:10:00] Networking, community & raising the online voice of pathology
  
  

#DigitalPathology #AIinDiagnostics #PathologyWorkflow #DirectToDigital

Transcript

Trends in Digital Pathology and AI Integration

Introduction to Digital Pathology

Alae: [00:00:00] I'm here with Alex Zuraw from Digital Pathology Place, and I love talking to Alex because she's really good at getting all the ideas and summarizing them and telling us what we need to care about in the digital pathology world. As we know digital pathology, there's a lot going on. 

Aleks: All right.

Key Highlights from the Conference

Alae: So what are the highlights that you feel are from you, you learned from this meeting?

Aleks: There are two things. I think there are three, but I don't know if I remember the third one.

High-End Foundation Models in Pathology

Aleks: So first thing is highend real work on foundation model made it to this conference. Meaning it's getting to the pathologist so it's not just, some research thing floating in the air. We actually have integrations with software, with image viewing software that can access the models, both vision models.

And vision text models. So I think this is a new trend going on that I'm seeing is being communicated clearly. Another thing is.

Direct to Digital Pathology

Aleks: The direct-to-digital pathology. I've seen several companies doing direct-to-digital [00:01:00] imaging. People are still a little hesitant, and by people, us pathologists, because we're used to glass, there is a strong push towards direct to digital, which would put us as a specialty, right where radiology was.

When they started digitizing, actually, they were in a different situation where they had. The option to digitize images before they were able to view them digitally. So they had to analogize images and print the film. They were in an opposite position. We are in a position where we are digitizing analog, but there is a trend happening to do the direct-to-digital, which I think is gonna increase adoption very much.

Integrating AI in Pathology

Aleks: And the third thing, figuring out how to integrate AI. Lot more people. Embrace AI. There are different apps that are being trusted by pathologists. The question now is, okay, how do I integrate it into my daily workflow? And I have seen some solution to this problem already. [00:02:00] Some people are still struggling, but there are already, there is a.

Trend in the direction that it's gonna be visible directly in your digital workflow. 

Alae: There was a couple vendors who were actually building it in and they're like, yeah, we can integrate into…

Aleks: Yes. 

Alae: …into Epic, for example, and we can work on this and that. So AI is happening, everybody, it's just a matter of you know… 

Aleks: We're still looking at it so you don't have to worry that it's gonna be like an automatic sign out or anything.

Alae: Yeah. So it's actually pretty cool.

AI in Prostate Cancer Diagnosis

Alae: One of the vendors inside in the exhibition hall actually has the, an AI kind of algorithm built in. So it'll triage your cases. So okay, here's the prostate cancer case. It already measured the core for you. It measured the amount of cancer. It gives you the percentage in a prostate core.

This excites me because as a general surgical pathologist sit down and measure each core like manually. I'm measuring the core. I'm you're measuring…

Aleks: I'm making faces… 

Alae: But Yeah, you're measuring and you're also eyeballing at the same time. So reproducibility is always an issue because you give it to two different pathologists, you get two different answers.

And then, what's nice about the AI [00:03:00] is it does it automatically gives you the percentage. And then even gives you a Gleason grade.

Aleks: Yes.

Alae: So it, it was actually pretty cool. And then all I have to do is yes, I agree. This is a three, three or three four or four three. And I'm always arguing myself with myself whenever I'm doing a process, a four three or a three four.

'cause sometimes it's not so clear

Aleks: To me like estimating the visually is beyond the physiological visual capability of a human. 

Alae: So why do we do it? 

Aleks: And I don't know, was it Mr. Gleason or Miss Gleason that invented the scoring? 

Alae: I feel like it was a Mr. 

Aleks: They had some which double check super natural visual capabilities to actually estimate that.

Alae: Yeah. Yeah. 

Aleks: And it's a very granular, like it's a seven, seven point scale, right?

Alae: Look, the technology exists to get rid of that like gray zone that you way, you're more able to accurately diagnose these kinds of cancers. Going back to this AI thing that's integrated into, the system. It does triages it for you and then you actually review it.

You get a chance to review it. It generates a [00:04:00] report and then you agree click, done. Normally it takes me like at least 40 minutes to get through prostate biopsy. 'cause usually one to two trace, you're looking at 40 slides or so. 'cause they sample the prostate extensively.

And here I can do that in 15 minutes. So if you're thinking like, okay, how do I, business model this is efficient. This is a lot faster and it saves you time.

Aleks: More pleasant for the pathologist as well. It gives the pathologist more confidence in whatever they're signing out.

Alae: And for the patient, most importantly the patient. You're getting excellent. You're getting the exact measurement of the core. You're getting the exact measurement of, you're not getting an eyeball thing, not to scare patients away or anything, but sometimes you, you end up eyeballing things.

Aleks: And it's that. Pathology specific. Yeah. It's like any image-based or visual specialty before you have the tools. This is how we've been doing this. And a lot of us is still doing it that way. Yeah. And that's the best we can do. But if we can do better with tools and with technology, then I think we should

Standardization in Digital Pathology

Alae: And, so one thing that you actually mentioned, [00:05:00] going digital… 

Aleks: like direct to digital for tissue. 

Alae: Yes, direct to digital. Dicom, the standardization of medical imaging. I think, radiology had to do it first where medical imaging had to go through this process. And everyone was like, oh yeah.

Nobody questions radiology, how they did it, why they did it. But here we're getting a lot of questions. What's our return on investment? What's this, that, and the other thing. Yeah. Not realizing that it actually is the equivalent of radiology. So we actually had a couple speakers. From SAM

Aleks: Society of Imaging Informatics in Medicine.

Alae: Yes. 

Aleks: And they have a lot of radiologists, but they start having more and more pathologists as well. 

Alae: Yeah. Again, it's an image to… 

Aleks: listen to those recordings.

Alae: It's an image. So there has to be some type of standard, standardization of these kinds of images that are coming in. So that was actually nice, that there's that movement, that standardization and that parallel with radiology.

So that I think to me was something like, okay, like we're headed towards the standardization realm. We're not just like talking oh, we're gonna do it. We're gonna make it official and we're gonna do it. And we're gonna do it well. So that was really refreshing. Those are like the things that I noticed and learned about.

The Importance of Digital Pathology Adoption

Alae: Obviously we're always making the case for digital [00:06:00] because it's not being adopted enough and everyone wants to make it. It sounds like a lot of the presidents that we had speak want to make it the standard. And I remember talking to you about this, remember the first time we met, I was like, let's make digital pathology just pathology. 

Aleks: Just pathology. Nobody says digital radiology, right? They had a long journey as well. So if we can capitalize on what they have learned and leverage what they had, then we're gonna be faster. 

Alae: Yeah. And I think the joke was is like make it the not gluten-free option. Like it's the option.

Aleks: Yeah. Yeah. 

Alae: It's not the gluten free option. 

Aleks: Exactly. 

Alae: It was the option. Yeah. And think about it like everything goes digital. You have databases of information, you've got AI models that are learning from this information. Just the opportunity is so vast. And I feel like there's two different ways of thinking.

There's like the pathologist way of thinking which is like, how's this going to make better patient care in the end? It's more efficient workflow, more accurate diagnoses. Obviously, and then there's like the business side or there's like actually two sides to the business side.

Aleks: Yeah. 

Alae: There's the return on investment… 

Aleks: And everything has to meet. 

Alae: It's interesting 'cause it's like you have the [00:07:00] business side of so there's the return on investment, there's the money, but then there's like the operational side. It's, there's just so many things and I can't. Help but not mention the wellness side.

Aleks: I wanted to say that… 

Alae: Great minds think alike. Great minds think alike. So the wellness side. The flexibility, staffing is an issue. Everyone's suffering from being understaffed, right? 

Aleks: Yes. 

Alae: And that was mentioned so many times during this conference. Staffing issues, obviously wellness, I, yeah, for an extent.

Aleks: Let me tell me your story. I was talking to a lab manager from  Epic Lab, they told me, oh, we're losing two pathologists. And then one more is retiring. But we're now here to figure out how to go digital because those two pathologists who actually like are going away, they would be happy to work part-time if it was digital.

So they're basically making it happen to keep the pathologist that they already know and worked with in the company, in the lab. So I thought this is a really, [00:08:00] it was the first time when I have experienced this being a driver of digitization. Usually, like I try to promote it because I work from home and this is a game changer for me.

I have two little kids and like at this time of my life, if. Somebody wants to recruit me away and they tell me there is no option for digital. I don't even talk to them, but it was like I was not in a position to require that for somebody to actually go digital and these two pathologists who want to go away, but say, okay, we're gonna stay part-time if you give us digital.

Basically drove the adoption, drove the digitization of that lab. 

Alae: And it's nice cause I actually was talking to some vendors. And you can choose to kind of transition into digital. You don't have to make your complete platform digital. You can actually make certain parts of your workflow digital.

Obviously for it to go completely would be more efficient. But there are vendors out there who are actually like, you don't have to do everything digital. Here's what you can choose to do. Digital,

Aleks: You can think of part of your workflow with. 

Alae: Yeah. So like when you have, look, the reality is there are some pathologists. [00:09:00]

That their experience, their years of experience, is invaluable. We can't lose them as a company. Whatever that company was. Or an organization too valuable to let go of. 

Aleks: And if they're the company, and to the patients who are gonna diagnose them?

Alae: That too. It and it takes time to make a pathologist like, yes, you do residency.

Yes, you do fellowship. But I have to say, as a new pathologist myself, it does take time to get that diagnostic comfort, like you know your stuff. But it takes time to really get to that level of okay, I can do this, with my, eyes closed. Don't do it with your eyes closed, everybody

Aleks: For an image-based specialty, no, I would not recommend that either.

Alae: Don't do that.

Aleks: But, but yeah, just basically to be fluent, be confident in yourself. And also that level of confidence allows you to ask questions when you know you need to ask questions. Because at the beginning, like you wanna ask questions about everything you reach a certain level of, okay, I'm confident in doing this.

This I have to take to somebody else. And you don't need to take it to somebody else because you can send them an image.

Alae: Exactly. Exactly. So a lot of advantages, not just on sign out level, but [00:10:00] on the large scale function. 

Aleks: The global care level.

Pathologists' Online Presence and Networking

Aleks: I would say a super cool aspect about PathVisions.

For me personally, as somebody who's pretty active online, I meet people that I met online in real life, and then we just see each other. I'm like, okay, we've never met. But we are actually friends. And that's what happened with us at the previous meeting. We were already in touch online, and I think this online activity, there's more and more of that.

Pathologists are becoming from being this like kind of invisible specialty are coming out. Online, LinkedIn is the main platform for medical professionals where they are active, creating awareness, and basically showing everybody in the world that pathology is the gateway to care. Like without pathology, you don't know what the care is gonna be.

I love that about PathVisions, about DPA and above, Beyond the Scope so everybody can look. Listen to this podcast.

Alae: Yes, please listen to Beyond the Scope. And please if you don't follow Alex [00:11:00] already, please follow her. 

Aleks: Thank you so much. 

Alae: Like you said, it's a great way to meet people and network people, opportunities.

Whether you're looking to grow in your career, make pathology friends, or just on… 

Conclusion and Future Events

Aleks: Or meet us next year. It's gonna be in… 

Alae: San Diego. 

Aleks: San Diego. You can be here in person with us and be interviewed for the Beyond The Scope Podcast. Also maybe for the Digital Pathology Podcast. Which is my book. 

Alae: Awesome. Thank you so much.

Aleks: Thank you much so much. 

Alae: Thank you. Thank you. Thank you.