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What makes digital pathology feel so hard to enter, even for smart people already working around it?

In this special USCAP conversation, Stephanie Fullerton from Hamamatsu turns the tables and interviews me about Digital Pathology 101 — the book I wrote for people who are starting or continuing their digital pathology journey.

We talk about why the book is not meant to be an exhaustive manual, but a practical framework. A way to help people see the full picture, ask better questions, and understand how the pieces of digital pathology fit together.

One of the biggest themes in this conversation is that digital pathology is a team effort. It is not just pathology. It involves scanners, software, image analysis, engineers, vendors, and people who often do not speak the same professional language.

That matters because sometimes getting the right answer starts with asking the right question.

We also talk about the challenge of translating expert knowledge into beginner-friendly language, why vendors often become guides as labs go through digital transformation, and why I think a shared vocabulary can make implementations smoother and more collaborative. Toward the end, we shift into the fun side of USCAP: signed book giveaways, stickers, pins, and ways to make connections at the conference.

Topics discussed

• [00:03] Why Stephanie interviewed me this time, and the idea behind Digital Pathology 101
• [01:07] What the book is actually for: a framework, not a one-size-fits-all manual
• [04:07] The hardest part of writing for beginners without talking down to them
• [06:26] Why digital pathology implementation feels like a mountain, and how to lower the barrier
• [08:15] Why a shared vocabulary matters in digital pathology teams
• [09:44] Translating between pathologists, engineers, vendors, and marketing
• [11:26] Why vendors and partners often become guides during digital transformation
• [12:33] Who the book is for, including students and early-career professionals
• [13:33] Book signing, giveaways, and where to find me at USCAP
• [19:05] Stickers, pins, and why small things can help start real conversations at conferences

Resources mentioned

• Digital Pathology 101
• Hamamatsu Booth 312 at #USCAP2026 in San Antonio, Texas
• My histology and microscopy videos on YouTube

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What happens when AI looks strong in a paper, but the workflow still isn’t ready?

In DigiPath Digest #40, I reviewed five recent papers across kidney pathology, oral and maxillofacial pathology, glioma biomarker prediction, digital twins in neuro-oncology, and a major European colorectal cancer cohort. A common theme kept coming back: good performance is not the same thing as real-world readiness.

We started with kidney biopsies and the challenge of assessing interstitial fibrosis and tubular atrophy, where AI shows promise but still does not fully agree with humans. That led into a bigger point I keep seeing in digital pathology: our “ground truth” is often based on human interpretation, and human interpretation has variability too.

From there, I looked at AI in oral and maxillofacial pathology, where the field is still early and one major bottleneck is the lack of strong public datasets. Then I discussed a systematic review on adult-type gliomas showing that multimodal models performed better than unimodal ones, which makes sense when you think about how pathologists actually work: we do not diagnose from one input alone.

I also covered a systematic review on digital twins in neuro-oncology. The idea is exciting, but the paper makes it clear that reproducibility, public code, multimodal integration, and external validation are still limiting factors.

And finally, I talked about a paper I really liked: a large European colorectal cancer cohort built across 26 biobanks in 12 countries. That kind of harmonized, quality-checked dataset matters. A lot. Because better AI starts with better data.

In this episode, I discuss:

• Why AI vs human comparisons are harder than they first look
• the “gold standard paradox” in pathology
• Why multimodal AI keeps outperforming unimodal models
• What is holding digital twins back from broader use
• Why curated multicenter datasets are so important for digital pathology research

Resources mentioned:

• Digital Pathology 101 pdf copy
• Pathology AI Makeover Course
• DigiPath Digest AI-powered paper summaries

Papers discussed:

• https://pubmed.ncbi.nlm.nih.gov/41830415/
• https://pubmed.ncbi.nlm.nih.gov/41826004/
• https://pubmed.ncbi.nlm.nih.gov/41824546/
• https://pubmed.ncbi.nlm.nih.gov/41823607/
• https://pubmed.ncbi.nlm.nih.gov/41820399/

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If AI can detect patterns we cannot see, how do we know when its answers are clinically trustworthy?

In this episode of DigiPath Digest #39, I explore a big-picture question in digital pathology and medical AI. Many models now match or even exceed human performance in specific diagnostic tasks. But most of that evidence comes from controlled or retrospective datasets. So what happens when we try to bring these tools into real clinical workflows?

I review four recent papers that help frame this challenge and point toward the next steps for trustworthy AI in healthcare.

You will hear about the role of prospective validation, real-world effectiveness, transparent reporting standards, and multimodal data integration as recurring themes across these studies.

Key Highlights

00:00 – Introduction
What do we do when AI detects signals that humans cannot see? The core challenge is verifying those outputs before trusting them in clinical decision making.

03:32 – AI Across the Healthcare Continuum
A narrative review shows AI achieving clinician-level performance in well-defined imaging tasks, including digital pathology. But most evidence comes from retrospective or controlled environments, and prospective validation remains limited.

08:34 – Multi-Omics and AI in Gastric Biopsy Diagnostics
Morphology alone cannot fully capture molecular heterogeneity or predict disease progression. Integrating genomics, proteomics, metabolomics, and other omics with AI is shifting gastric pathology toward data-driven precision gastroenterology.

13:38 – Hyperspectral Imaging for Real-Time Surgical Guidance
Spectral imaging can analyze tissue composition during surgery without staining, freezing, or contact with the tissue. Studies show promising sensitivity for detecting malignancy and supporting intraoperative decision making.

17:20 – REFINE Reporting Guideline for Foundation Models and LLMs
An international consensus guideline introduces a 44-item reporting checklist to standardize how AI studies are described. The goal is transparent, reproducible, and comparable research in medical AI.

22:35 – Big Takeaway
AI should be viewed as clinical decision support, not a replacement for clinicians. Real-world validation, ethical governance, and reproducible research standards will determine how these tools enter pathology workflows.

References (Articles Discussed)

Artificial Intelligence in Healthcare: From Diagnosis to Rehabilitation
https://pubmed.ncbi.nlm.nih.gov/41755929/

Transforming Gastric Biopsy Diagnostics: Integrating Omics Technologies and Artificial Intelligence
https://pubmed.ncbi.nlm.nih.gov/41751306/

From Image-Guided Surgery to Computer-Assisted Real-Time Diagnosis with Hyperspectral and Multispectral Imaging
https://pubmed.ncbi.nlm.nih.gov/41750768/

REFINE Reporting Guideline for Foundation and Large Language Models in Medical Research
https://pubmed.ncbi.nlm.nih.gov/41762555/

If you enjoy staying current with digital pathology and AI research, this episode will help you connect the dots between promising algorithms and practical clinical adoption.

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