Since 1850, doctors have been examining patients’ tissues through a microscope. But in recent years, that’s no longer the case: pathology has now been almost completely digitized. In addition, specific stains and DNA analysis now provide much more information—from cancer subtype to predictions about whether medication will be effective.
Although the microscope was invented in 1590, Antoni van Leeuwenhoek became known around 1670 for his improved version with much stronger lenses. It then took almost two hundred years before microscopes made their way into hospitals.
Although the microscope was invented in 1590, Antoni van Leeuwenhoek invented an improved version with stronger lenses, suitable for looking at cells and tissues, at around 1670. It then took almost two hundred years before microscopes made their way into hospitals.
Doctors examined tissues through the microscope and could, for example, recognize cancer, because cancer cells have a different appearance and grow through other tissues. This is the pathologist’s field of expertise. But after 175 years of peering, they no longer look through the microscope themselves: the computer does, showing a digital image on a screen.
Staining proteins
This digitization also paved the way for AI. ‘Pathology and AI go well together because smart computers are particularly suited for pattern recognition’, says pathologist Avital Amir from Radboudumc. ‘In the clinic, we already use AI in pathology for diagnosing breast cancer and prostate cancer. But most applications are still in the research phase.’
In addition to digitization, pathology has also taken off over the past thirty years thanks to specific tissue stains. Amir: ‘This way we recognize the type of cancer and, for example, we now distinguish between as many as one hundred subtypes of lymphoma. We can also see where a metastasis originated, such as from the large intestine or the lung. And we stain proteins that occur more frequently or are missing on tumor cells. That provides more certainty in a cancer diagnosis.’
Source: Radboudumc Heritage Archive
Estimating treatment benefit
Furthermore, molecular diagnostics have made great progress over the past fifteen years. Radboudumc now employs seven so-called clinical molecular biologists in pathology. They look for abnormalities in a tumor’s genetic material and can estimate in advance whether a therapy will be effective. This allows them to see, for example, whether immunotherapy will be beneficial. That contributes to more targeted treatment.
Despite all these new developments in digitization, specific staining, and genetic analysis, the basic staining of tissue has remained the same since about 1880: the so-called H&E stain. It colors cell nuclei and cytoplasm, revealing cell structures. ‘I estimate that we still assess about eighty percent of all tissues purely based on this staining’, Amir says. Many modern developments indeed, but the basic stain is here to stay.
Image at the top of this item: Radboudumc Heritage Archive, Jan van Teeffelen, 1986.
-
Want to know more about these subjects? Click on the buttons below for more news.
More information
Annemarie Eek
wetenschapsvoorlichter
