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Digital Pathology Podcast

Aleksandra Zuraw, DVM, PhD
Digital Pathology Podcast
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229 episodes

  • Digital Pathology Podcast

    236: Quality, Teaching, and AI: A Practical Shift in Pathology

    25/04/2026 | 35 mins.
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    Where is AI in pathology actually becoming useful right now? In this episode of DigiPath Digest, I review 4 new PubMed papers across digital pathology, whole slide imaging (WSI), computational pathology, medical education, forensic pathology, and breast cancer AI. We look at a deep learning tool for coronary artery stenosis measurement in forensic autopsies, an AI-powered digital pathology model for renal pathology education, an open-source quality control tool for prostate biopsy whole slide images, and a breast cancer stage prediction model built for resource-constrained settings using low-magnification H&E slides. I also share updates on the upcoming second edition of Digital Pathology 101 and the decision to make AI paper summaries public on the podcast feed to help busy pathology professionals stay current. 
    Highlights
     
    [01:28] Update on the upcoming second edition of Digital Pathology 101 and the release of public AI paper summaries for faster literature review.

    [05:22] Paper 1: Deep learning for coronary artery stenosis evaluation in forensic autopsies using whole slide imaging. Why objective stenosis measurement matters, how the model outperformed visual estimates, and why this could affect adoption in forensic pathology.

    [15:18] Paper 2: AI-powered digital pathology with case-based teaching in renal education. A practical discussion on annotated digital slides, flipped classroom learning, and how digital pathology can improve pathology education and diagnostic reasoning.

    [21:34] Paper 3: Open-source AI for quantitative quality control in prostate biopsy whole slide images. Why WSI quality control matters, what PathProfiler measures, and how automated QC can support remote pathology workflows.

    [32:38] Paper 4: Breast cancer stage prediction from H&E whole slide images in resource-constrained settings. A look at low-magnification AI, vision transformers, and what moderate performance can still mean when access to advanced testing is limited.

    [45:06] Closing thoughts, invitation to vote for future AI paper summaries, and a final reminder to download Digital Pathology 101. 
    Resources
    Paper 1: Development of a deep learning-based tool for coronary artery stenosis evaluation in forensic autopsies using whole slide imaging
    PubMed: https://pubmed.ncbi.nlm.nih.gov/41998396/

    Paper 2: Integrating AI-Powered Digital Pathology With Case-Based Teaching: A Novel Paradigm for Renal Education in Medical School
    PubMed: https://pubmed.ncbi.nlm.nih.gov/41995002/

    Paper 3: Application of an open-source AI tool for quantitative quality control in whole slide images of prostate needle core biopsies - a retrospective study
    PubMed: https://pubmed.ncbi.nlm.nih.gov/41994924/

    Paper 4: Deep-learning-based breast cancer stage prediction from H&E-stained whole-slide images in resource-constrained settings
    PubMed: https://pubmed.ncbi.nlm.nih.gov/41993946/

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  • Digital Pathology Podcast

    229: Spatial Omics and AI for Clinically Actionable Cancer Biomarkers

    20/04/2026 | 22 mins.
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    Paper Discussed in this Episode:
    Spatial omics and AI for clinically actionable cancer biomarkers. Reitsam NG. PLoS Med 2026; 23(4): e1005049.
    Episode Summary: In this deep dive, we explore how artificial intelligence and spatial omics are fundamentally rewriting the rules of cancer diagnostics. We break down a 2026 editorial that challenges a deceptively simple question driving modern oncology: Is a tumor "positive" or "negative" for a biomarker? As targeted cancer therapies evolve, this binary thinking is failing us. We discuss why mapping where and how much of a therapeutic target exists is crucial, and how AI is stepping in to solve the reproducibility issues human pathologists face when making borderline diagnostic calls.
    In This Episode, We Cover:
    • The Illusion of "Positive" vs. "Negative": Why the basic premise of modern cancer therapies—like antibody-drug conjugates (ADCs)—often falls apart in reality when we ignore the spatial heterogeneity of a tumor.
    • The Power of Computational Pathology: How AI is transforming subjective, qualitative estimates into continuous, reproducible data, scaling the quantification of complex biomarkers like PD-L1 and TROP2.
    • "Virtual" Proteomics: The fascinating concept of using AI models to infer high-dimensional spatial information and immune maps directly from standard, routine H&E stained slides.
    • The HER2 Bottleneck: A real-world look at the breast cancer drug T-DXd, which now demands pathologists distinguish between "HER2-low" and "HER2-ultralow". While human agreement drops below 70% at these fuzzy decision boundaries, AI steps up with a staggering ~97% sensitivity.
    • Three Shifts for the Future: Why clinical trials and routines must adopt continuous measures (like percentage of expressing cells), demand longitudinal repeat testing at disease progression, and utilize adaptive trial platforms.
    • Bridging the Gap to Reality: The massive hurdles preventing widespread adoption—such as equipment costs exceeding $250,000 and massive data storage needs. We discuss why a hybrid workflow that bolsters routine pathology with deployable AI is the best path forward to prevent widening global health disparities.
    Key Takeaway: The future of precision oncology isn't just about finding new drug targets; it’s about fundamentally changing how we measure them. By moving away from rigid binary thresholds and using AI to map the continuous, spatial reality of tumors, we can unlock the true potential of targeted therapies. However, achieving this diagnostic ecosystem requires overcoming significant financial and systemic hurdles—such as updating reimbursement pathways and proficiency testing—to ensure these life-saving insights are accessible across all healthcare settings.
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  • Digital Pathology Podcast

    230: Artificial Intelligence in Clinical Oncology: Multimodal Integration and Translational Development

    20/04/2026 | 20 mins.
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    Paper Discussed in this Episode: Artificial intelligence in clinical oncology: Multimodal integration and translational development. Ruichong Lin, Zhenhui Zhao, Zhonghai Liu, Jin Kang, Kang Zhang, Xiaoying Huang, Yunfang Yu. Cancer Letters 2026; Volume 649, 218493.
    Episode Summary: In this journal club deep dive, we explore how cutting-edge AI is fundamentally rewriting the rules of cancer diagnostics. We examine a comprehensive 2026 review on clinical oncology that highlights the shift from narrow, single-modality algorithms to highly sophisticated multimodal AI. We discuss how machines are learning to cross-reference patient charts, genomic data, and medical imaging simultaneously to achieve unprecedented feats—like accurately predicting tumor mutations without ever performing a physical biopsy. Plus, we explore the controversial but necessary world of "computational hallucinations" or synthetic data, which is currently being used to solve diagnostic blind spots.
    In This Episode, We Cover:
    • The Fragmentation Bottleneck: Why keeping radiology, pathology, genomics, and clinical history in isolated silos limits our ability to treat the whole patient, and why single-modality AI suffers from severe diagnostic "tunnel vision".
    • Cross-Modal Attention & Non-Invasive Biopsies: How models like LUCID essentially mimic the deductive reasoning of a multidisciplinary tumor board. By utilizing cross-modal attention mechanisms, LUCID dynamically shifts focus between CT scans, routine labs, and text-based clinical charts to predict EGFR gene mutations in lung cancer entirely non-invasively.
    • Graph Neural Networks (GNNs) & Tumor Social Networks: A look at the NePSTA framework, which uses GNNs and spatial transcriptomics to treat the tumor microenvironment like a mathematical topology. By mapping the "social network" of cells, it can rapidly molecularly subtype notoriously ambiguous central nervous system (CNS) tumors in minutes.
    • Computational Hallucinations: Introducing MINIM, a generative AI foundation model that creates statistically valid, photorealistic synthetic medical images (like optical CT or chest X-rays) for rare diseases based on textual descriptions. We discuss how intentionally generating these synthesized images solves the critical "data scarcity" problem and directly improves real-world diagnostic accuracy.
    • The Reality Check - Distribution Shifts: The dangerous logistical reason why an AI model boasting near-perfect accuracy at a massive urban academic center might fail completely in a rural clinic due to differing scanner calibrations and population demographics. We emphasize why the field must transition away from retrospective "vanity metrics" and toward clinically trustworthy prospective validation.
    • The Virtual Cell Paradigm: A staggering look into the near future where AI constructs completely accurate, computationally interactive digital twins of a patient's cancer. This framework allows doctors to test different drug regimens and simulate cellular responses mathematically in silico before ever administering medicine to the actual patient.
    Key Takeaway: Multimodal AI proves that cancer diagnostics must go beyond isolated data points. By dynamically synthesizing highly fragmented clinical information and utilizing synthetic imaging to overcome rare disease data scarcity, AI is pushing oncology into an era of robust, individualized molecular phenotyping. Ultimately, these innovations are replacing risky, invasive testing with prec
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  • Digital Pathology Podcast

    231: The Future of Bone Marrow Biopsy: Omics and AI Integration

    20/04/2026 | 20 mins.
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    Paper Discussed in this Episode: Advancements in bone marrow biopsy: the role of omics and artificial intelligence in hematologic diagnostics. Maryam Alwahaibi and Nasar Alwahaibi. Front. Med. 2026; 13:1772478.
    Episode Summary: In this journal club deep dive, we explore a paradigm shift in hematopathology, moving from 19th-century visual assessments to the cutting edge of precision medicine. We examine a 2026 review that unpacks how combining artificial intelligence with multi-omics technologies is transforming the traditional bone marrow biopsy from a static, subjective snapshot into a live, interactive, predictive 3D map. We ask: What happens when deep learning can predict underlying genetic mutations just by analyzing the visual shape and texture of a cell?.
    In This Episode, We Cover:
    The Breaking Point of Traditional Diagnostics: Why the 150-year-old gold standard of H&E staining and human visual assessment is hitting a biological and operational wall, plagued by subjectivity, high variability, and observer fatigue.
    The Multi-Omics Multiverse: Moving beyond standard genomics to unpack the complex biological machinery of the marrow, including:
    Epigenomics: The biological "switches," like DNA methylation, that control cell fate and can kick off malignant transformation without altering the underlying DNA sequence.
    Lipidomics: How cellular fats form specialized signaling rafts that actively remodel the marrow's communication network.
    Microbiomics (The Gut-Marrow Axis): How systemic inflammation driven by gut dysbiosis acts like a massive "traffic jam" that indirectly disrupts local bone marrow homeostasis and blood cell production.
    AI as the Ultimate Analytical Partner: How artificial intelligence serves as a bridge between physical tissue morphology and high-dimensional molecular data. We discuss AI tools like MarrowQuant for objective cellularity mapping and the Continuous Index of Fibrosis (CIF) that replaces clunky human guesswork with a granular, predictive metric.
    Predicting Genotype from Phenotype: The revolutionary capability of deep learning models to predict underlying genetic mutations (like TET2 or del 5q MDS) purely from the subvisual, spatial arrangement and shape of cells on a standard slide.
    Roadblocks and Solutions: Why this technology isn't universally adopted yet. We break down the "black box" problem of AI, the brittleness of algorithms in different clinical settings, and how innovations like Federated Learning and Explainable AI (using heat maps) are overcoming these hurdles.
    Key Takeaway: The integration of AI and multi-omics is redefining our understanding of bone marrow diseases. By uncovering invisible molecular machinery and objectively translating it through transparent algorithms, we are moving away from subjective human bottlenecks toward a highly personalized, predictive model of hematologic care.

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  • Digital Pathology Podcast

    228: GPT-5 and Gemini 2.5 Pro read pathology slides - here is how they did…

    11/04/2026 | 24 mins.
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    I did something I've never done before for this episode — I went live from the middle of a national park. This is DigiPath Digest #42, broadcasting from the Great Sand Dunes National Park in Colorado via Starlink from my family road trip. Yes, it actually worked. And so did the papers.
    This episode covers four papers that all ask the same uncomfortable question from different angles: how close is AI to being genuinely useful in real pathology practice — and what's still standing in the way? From LLMs interpreting cervical Pap smears, to AI guiding breast cancer treatment decisions from a simple H&E slide, to a practical roadmap for bringing generative AI into oncology workflows — this one covers a lot of ground.
    I also introduced something new: my AI-powered paper summary podcast subscription. For $7 a month, AI hosts summarize digital pathology literature in a journal-club style so you can stay current without spending hours reading abstracts. I walk through how it works and why I built it.
    What we cover:
    [00:00] Going live from the wilderness — Starlink, sand dunes, and a very cold morning
    [02:01] How I use AI-generated audio summaries to prep for each DigiPath Digest
    [03:19] Paper 1: Can LLMs like ChatGPT and Gemini interpret cervical cytology? Spoiler: ~47–48% exact concordance — promising, but not there yet
    [10:23] Bonus: My new AI-powered paper summary subscription — $7/month, journal-club style
    [14:05] Paper 2: AI in oral oncology — CNNs for early lesion detection, multimodal prognostics, and the real barriers still blocking clinical adoption
    [20:28] Paper 3: Generative AI in oncology — from chat tools to agentic EHR-integrated assistants, and why augmentation is the goal, not automation
    [25:35] Paper 4: Computational pathology in breast cancer — predicting BRCA1/2, HER2, Oncotype DX, and treatment response from standard H&E slides
    [31:39] Final thought: the floor just got raised for all of us — how I think about new technology in pathology
    Resources & Links:
    Paper 1 – LLMs & Cervical Cytology (PubMed): https://pubmed.ncbi.nlm.nih.gov/41931983/
    Paper 2 – AI in Oral Oncology (PubMed): https://pubmed.ncbi.nlm.nih.gov/41930554/
    Paper 3 – Generative AI in Oncology Practice (PubMed): https://pubmed.ncbi.nlm.nih.gov/41930309/
    Paper 4 – AI & Digital Pathology in Breast Cancer (PubMed): https://pubmed.ncbi.nlm.nih.gov/41930306/
    Watch on YouTube: https://www.youtube.com/live/O2hOU4gM0Bk?si=oH8iJ8HiBb29USG3
    Digital Pathology Place: https://www.digitalpathologyplace.com
    Support the show
    Get the "Digital Pathology 101" FREE E-book and join us!

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About Digital Pathology Podcast

Aleksandra Zuraw from Digital Pathology Place discusses digital pathology from the basic concepts to the newest developments, including image analysis and artificial intelligence. She reviews scientific literature and together with her guests discusses the current industry and research digital pathology trends.
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