Pathology is changing fast—and if you’ve ever felt like the transition from a physical microscope to a digital screen is a bit daunting, this episode is for you.
Lumea CEO James Thackeray sits down with Dr. Osama Khan, an anatomical pathologist, to talk about what it’s actually like to move away from the glass. Dr. Khan isn’t just talking about tech; he’s talking about how digitization changes the way we educate students, how we talk to and better empower our patients, and how we advocate for the profession.
They dive into the “how-to” of starting your digital journey (like how you don’t have to do it all at once), the reality of AI as a teammate rather than a replacement, and why the future of cancer care might just depend on our ability to go digital. It’s a candid, insightful look at where we’re headed. Tune in now:
Transcript
James Thackeray
Welcome to PathPulse, the Digital Diagnostic podcast. This podcast showcases pioneers, innovators, and forward-thinking individuals within the digital pathology arena who are making a difference in day-to-day use. I’m James Thackeray, and in today’s episode, we’re delving into a personal journey that mirrors the broader evolution of our field: “My journey in digital pathology from training in a traditional workflow to transitioning into a digital environment.”
And we are really honored to have our guest today. I’m excited to get into it. Dr. Osama Khan, a dual US and Canadian board-certified anatomic pathologist and staff pathologist at Natera, where he spearheads digital pathology solutions. So I’m really excited to have you, Dr. Khan. If you don’t mind, introduce yourself to our listeners and give us a little bit more background. We’re excited to get into this.
Osama Khan
Sure. Well, thank you very much, James, for having me as a guest on your podcast and for the kind introduction. I really appreciate that. Yeah, so a little bit about me, as you kind of mentioned, I am a board-certified anatomic pathologist. I completed my training in anatomical pathology in Canada, at the University of Ottawa. And I had five years there, and then I transitioned to a fellowship, a genitourinary pathology fellowship at Stanford University.
And, you know, I think that part of my journey was unique, because, obviously, it was in two different countries, but also it was in two different types of workflows. And I’m sure we’ll get into it. But, you know, when I was in Canada, it was more of that kind of traditional workflow, which, you know, the majority of pathology training programs are. You know, having glass slides, microscopes, you know, showing cases to colleagues.
And then when I transitioned to fellowship, you know, we were completely digital. We had a bit of a hybrid situation where there are still some glass slides, but it was at a very unique time. I basically had started my fellowship at that detail end of COVID. And that was a very, obviously, unique challenge from, you know, with patients and the medical, kind of, community in general. But something really positive got spun out, and that was the adoption of digital pathology, as we had to really adopt different workflows as pathologists and in training programs. So I’m sure we’ll go into that a little bit more.
And then, you know, through that, too, I kind of, you know, saw my unique passion for, you know, digital solutions and working in a digital pathology environment. Being in the heart of Silicon Valley, you had all these different opportunities. And, you know, with some, you know, really good networking and patients, I was able to transition into an industry position as a staff pathologist at Natera, which is a global leader in cell-free DNA testing, where I work in the oncology and genomics space. So, you know, I’m really looking forward to talking a little bit more about each one of these areas. Yeah, that’s kind of my overview and hopefully gives you a good idea as to that journey aspect of my background.
James Thackeray
Well, thank you for that. And this is going to be exciting. This is great because you really do have a unique perspective from really from the timing of when you started to what you came into during your fellowship at Stanford during COVID.So let’s start there, because I have a lot I want to get to.
But let’s start with where you started and being trained in the traditional ways in pathology, and then making that transition. Maybe just talk through what that was like. I understand that COVID probably forced us into that. But if you looked at challenges from that transition, kind of talk us through that and then what you saw maybe right away that you were like, “Oh, this is so much better,” or at least you could see where digital could take you.
Osama Khan
Yeah, I mean, it’s a great question. And you know, I think when you are starting in a, you know, we’re using the word “traditional” workflow versus a digital workflow, only because there is a digital workflow. But before, it was just a “pathology workflow.” And so I think, you know, to be honest, I guess I was naive, I didn’t know any better.
And you know, you know, digital pathology wasn’t, you know, it wasn’t fully integrated in a lot of, you know, training programs and also like hospital systems. So it was a great time to kind of, you know, really learn kind of the bread and butter of what pathology is.
And, you know, so, you know, going through that traditional workflow, you still did learn kind of what pathology is. But, you know, there were certain challenges that you saw in a traditional workflow. And the only reason I’m talking about it from a challenging perspective is, you know, obviously, I did transition into that digital workflow, which you’re mentioning.
So I think one of the big things is, you know, you do have physical glass slides. And so, when you have physical glass slides, you need to have a microscope. So you are kind of, know, geographically, I guess you are tied to your microscope, and you have to have, you know, your slides, you have to store them, you have to track them kind of manually, you know, and when you’re looking at with glass slides, you have you know, the unfortunate mishaps can happen. You can actually break slides, you can lose slides.
And so that’s like one of the things that, you know, can be a bit of a challenge. And when you transition into a digital workflow, you know, everything is whole slide imaging. It’s very high quality, and it’s stored in the cloud. So you can, you know, yes, the memory is kind of your, kind of your limiting factor, but it frees up a lot of space as well.
And, you know, in hospitals as well, that’s one of the biggest things is, know, space is really a commodity and a lot of the time you can only keep, you know, imagine a hospital that’s had cases for over 30 years, you’re gonna have to, as a pathologist, sometimes if there’s a recurrence of a tumor, you might need to take a look at a slide and how do we, a previous slide, and how do you retrieve them?
So often, you know, a lot of the slides get put off-site into secure storage locations, and you have to retrieve them, which takes time and can affect kind of turnaround times. And so when you have a digital system, you know, it’s right there. You can go into your archive, you can pull up different cases, and logistically, it is a lot quicker and kind of prevents that slide transport kind of aspect of retrieving cases.
And then, like we mentioned, turnaround time, too. Traditionally, I mean, you know, if you are having to get a second opinion with cases too, you have to, if you’re going to be showing it to a colleague in the hospital, that might be easier.But if you have to get a consult from another kind of—if we were in Canada, I needed to get, you know, a consult for someone in the US, you would have to ship your slides. So there is that, you know, you have that, um, part of the workflow that’s going to take time, and there could be, you could lose samples, and, you know, slides could break.
But in a digital system, you know, you could essentially you’ve become from local, you’ve become global now. And all you really need to do is somebody needs to have a digital viewer. They might not have your same platform, but you know, and this is why you can get second opinions from anywhere in the world. And I think that that’s so powerful because you know, I mean, we’re here in the US and we obviously love our colleagues, but there’s a lot of international expertise out there, too. And now you’re leveraging that aspect because you’ve gone digital. And I think that’s so powerful.
And, you know, I’ve experienced that as well, you know, reviewing cases internationally, but also sending out cases, which is great. And I think one of the things, too, is we’re talking about, you know, at the end of the day, pathology is a medical specialty. So we are in the business, I guess I would say, of patient care. So, having, you know, increasing your diagnostic accuracy and collaboration, I think when you transition from a traditional workflow, both of those aspects just become reinforced and enhanced. And so, you know, when you have a traditional workflow, you’re still collaborating, and we have diagnostic accuracy, but you’re limited to the glass slide.
And so you need to go into somewhere physical and in-person, double scope a case, potentially collaborate again, we’re mailing slides, and you’re limited to what you can see in a light microscope. And so that’s your, you’re only limited to kind of what the details you can see, whereas digitally, now, we have such amazing platforms that can scroll up to 40X times, really high LED background screens where, you know, it really enhances the quality and that in itself will enhancediagnostic accuracy, especially when you’re looking at, you know, cases at a cellular level. And I think that that’s something that’s very important.
And then, you know, lastly, I would say, you know, once you have that digital platform, then you’re able to add on, and I’m sure we’ll talk about it, but having a really robust digital system will allow you to then start putting on top of it like AI algorithms, and integrating AI. So I think that’s one of the things that I saw is when I got to Stanford, it was already there.And I was forced to adapt during a challenging time, but I think it’s probably one of the highlights of my career so far, because I was able to kind of adapt as a pathologist in a very challenging time.
And being a GU fellow, one of the things that was my bread and butter is looking at prostate biopsies. And I know at Lumea, James, they have a very, very robust kind of prostate platform. And I think that really helped me as well is to look at cases from a different mindset during my training. And I think I would say it definitely made me a better pathologist.
James Thackeray
That’s so great. Thank you. So let’s dive in a little deeper on something you said. We talk a lot about collaboration and diagnostic accuracy, where that can take you, because I think that is so important, especially where so much of the diagnostic space is underserved.
I think we can all agree we don’t have as many pathologists as we once did, and that any efficiency we can bring to that will only enhance diagnostics throughout the world. I think that collaborative effort that you talked about is so important.
But maybe expand—you know, we always think of digital pathology when we’re thinking technology enhancements as a way to get to artificial intelligence. So for sure, I want to talk about that, but maybe highlight other things that digital pathology actually enables from a technology advancement.
You kind of mentioned some things there. I just tried to tease out a little bit more because I think we instantly go to AI, and I do think that’s a huge driver. But even collaborating with radiology, for example, or I just want to get your feedback on how do we tie some of these different virtual or digital technologies together in your mind? Or how do you see that playing out?
Osama Khan
Yeah, mean, that’s, I mean, it’s great. I think what you’ve started to actually touch upon is the inherent collaborative and multidisciplinary nature of the nature of the specialty. And so as a pathologist, I’m not looking at these cases siloed, right?We’re, you know, integrating multiple types of data points. And that in itself can be very powerful when you’re digitizing workflows, is “How do we integrate all that information?”
And I think once you start having a digital platform, then what it does is it allows you to digitize the other aspects of your workflow. So one would be EHR, the retrieval of information. Having a platform that can link directly to the EHR so you don’t have to fish for that information and open up another tab. That’s definitely one thing. The other thing too is, we are, you’re absolutely right, you talked about radiology.
Radiology is a great specialty that definitely is as image-based as we are, but they’re fully digitized. They don’t have the opportunity to have a microscope. But we are definitely looking at the imaging. What did the image show? Did they get the lesion in the right area? You’re making that clinical, like a pathoradiologic correlation, often.
And so if you are also having another digital platform, then you could easily integrate that as well. And so if you kind of think about it, this is how I like to think about it, too, is I think I love sports. And so one of the things I like to do is make an analogy to like a quarterback. And I think a pathologist, I would say, is definitely a quarterback. We are there to kind ofcall the plays, I would say. And why I say that is, you have a team. But you are the one that’s kind of quarterbacking the actual decisions.
And so what you’re going to do is you’re going to call the play and draw on the different aspects of your team and integrate them in order to kind of have a successful outcome. And I think that that’s kind of when we talk about mindset shift, that’s what ends up happening. When you start adopting these digital technologies, you don’t work in a silo anymore.You start to actually integrate all of these different components—that you’re doing as it is—but it’s increasing your efficiency, and you don’t have to have, you know, five, six, seven tabs open at one time. You can easily integrate it.
And from there, you know, it’s really important for patient care because then it ensures that you also don’t miss anything and that you’re doing things in a very regimented manner.
And I think that that’s what the pathology specialty is. So, as long as you can, when you’re adopting a digital workflow, you should mimic your regular workflow and try to adopt that. So that’s kind of how I see the benefits of digitizing a workflow. It kind of helps bring in all that collaboration.
James Thackeray
Well, you said it so well. It’s bringing pathology, as a specialty, out of the silo nature that it probably, or at least many have thought it historically has been. I used to, I mean, I’ve worked with so many phenomenal pathologists over the years, and it’s almost like bringing the specialty out of the basement of the hospital to really be the centerpiece of diagnostics in a way that it…it probably is there, but now all this technology only enhances the ability for you to manage that entire diagnostic workflow.
So it gets me excited, sorry, as you can tell, because I think it’s where the pathologist should be, right? It’s not only that, and I guess maybe this is where my question would go next, is: the role that the pathologist now plays into not just the original diagnosis, but into, even, therapeutics and ancillary downstream testing, and kind of maybe talk to us a little bit about that.
Obviously, you work for an organization that does a lot of really cool stuff on that side of it. So maybe we transition to the role of a pathologist in association with that part of the diagnostic journey, if you will.
Osama Khan
Yeah, so I mean that really goes into like a question I get on a daily basis. I’m sure you’ve kind of have heard that too, youknow, “Will AI replace a pathologist?”, right? And so with that, most of the time, it’s always a resounding “No,” depending on who you are. Just kidding, but I think that’s really important because that goes to show you how complexcancer and oncology is. We have very complex staging when it comes to cancer, and we’ve now only gotten more complex, as you had mentioned.
And I think one of the central roles of a pathologist is actually being involved in those ancillary testing. So moleculartesting, biomarker testing, and now, where I work, is MRD testing, molecular residual disease testing.
And I think that, you know, I think when it comes to patient care, you know, the pathologists now, it’s not just about, you know, “What is the cancer,” right? And just your diagnostic impression. It’s like, okay, let’s get more specific and personalized to the patient. What does this cancer show? What is its immunohistochemistry profile? What is its molecular profile?
And that is commonly tied to some sort of patient personalized therapeutic regimen. And so that’s really important, now we can actually get a specific insight as to what type of cancer it is. And I think that testing those biomarkers, it’s the pathologist, right? We are the ones; it’s easy to order them, but who’s interpreting them? So it’s definitely a pathologist. And that’s one of the things that we are responsible for at tumor boards, giving the result of those biomarker testing.
And I think that, you know, when it comes to AI, this is definitely something that, you know, like this biomarker testing, there’s a lot, now, of AI algorithms that are being approved, such as like HER2 for breast, ERPR. There’s many more that are getting kind of FDA approval, almost on a daily basis, in specific, like specific cancer types.
And so I think that, you know, one of the things that it does is it increases, it also increases the pathology specialty and the advocacy for patients because they now know that pathologists is central in a lot of these areas. And so kind of transitioning to kind of what I do now is we’re kind of, I would say that we’re, and I always put this in quotes, but we’re at the “end” of the patient’s kind of cancer journey, in the sense that we know the patient has cancer. We’re now going to test them for molecular residual disease and see if there’s any cancer left in the patient.
And so how that works is in our body, when cells die, they give off something called cell-free DNA. And that’s something that we can detect. It has a very short half-life. And so if we can detect it, we can really say that it is there because of theshort half-life.
Tumors do the same thing. When a cancer is inside a patient’s body, they actually put something into the blood called CT DNA, circulating tumor DNA. And that is something that you can actually test. And so that is something that we can test it in the tissue and in the blood. We can then track that patient over time and see if that patient has had a recurrence, where you can then, if the circulating tumor DNA has increased, we can then the oncologist can then potentially initiate treatment at an earlier time.
Or, I think on the flip side, if the patient doesn’t actually demonstrate any circulating tumor DNA, you may be able to deescalate therapy, know, toxic chemotherapy or radiation. So I think that’s another kind of, you know, area that’s really, really important, is MRD. And we, you know, I’m sure we’ll get into it too.
One of the reasons why I was kind of recruited to this role was that they wanted to digitize their entire molecular workflow. And that’s kind of where I stepped in and helped to validate a digital pathology system. We have two sites, one in California and one in Austin, and where they’re both completely digitized. It’s actually a very, very unique workflow in the molecular space. Not a lot of institutions are doing that. So I’ve been really fortunate to kind of lend my expertise into that MRD molecular workflow.
James Thackeray
That’s so helpful. And I really appreciate that latter half of the patient journey perspective, because that still is part of this whole journey, right? It just may be a later stage. That’s really an interesting point.
I think Natera is a little bit ahead of the curve on the molecular side of it, and I think others are quickly joining the game of digitizing that workflow, or at least digitizing the molecular as much as they can. But give us the why behind that. Would you like to tell us what that potentially might be able to do if you have a digital platform on that side of things?
Osama Khan
Yeah, that’s a great question. And I think, at the end of the day, what it comes down to is enhancing workflows. And at each stage of the—so, generally, how a molecular workflow kind of works is, you know, you’ll receive the actual patient’s block, you will then that often we request the best representation of the patient’s tumor.
The institution sends us the block, we will actually cut it in-house, we’ll stain it, and then it will be ready for the pathologist’s review, and it will be digitized and scanned. And then, after, we have something called macrodissection. And macrodissection is actually, we annotate the tumor from the pathology side, and the macrodissector is what they do.
They’re trained to actually scrape the annotated areas in the tumor and then put them in tubes, and it gets sent downstream for extraction and downstream testing. And so one of the things that digital kind of a digital workflow for is that we’reable to review cases a lot quicker. We’re able to, you know, I always tell people, “If you like art, then pathology may be the specialty for you.” And I kind of jokingly say it like, “I’m drawing all day long.”
But I think what we’re doing is actually we are looking at these tumors at a very high resolution, and we are able toannotate these to the tumor area at a more, you know, at a high level. And I say that because, you know, how I had mentioned that a lot of these patients, the MRD testing is at the end of a patient’s journey. A lot of these patients have already had surgery, they’ve had molecular testing, and they’ve also probably had neoadjuvant treatment.
So the tumor that we’re looking at is not how it looked before, and that can give a lot of challenges. There’s a lot of areas of fibrosis, necrosis, and, you know, good for the patient, but sometimes there is no tumor left.
But, from our perspective, that’s not good for molecular workflow because we are looking for a certain percentage of tumor nuclei, and having a digital platform can really enhance that and increase your accuracy because we’re able to see it at a higher quality.
And then also, the other thing, too, is we’re also able to then collaborate as well. We have consultants on site. We also have some remote pathologists. They can actually log into those systems, can also help us review cases, but we can alsocollaborate on challenging cases.
So very much the same as in the academic diagnostic world, we’re still using some of the bread and butter pathology kind of training techniques that we have learned to still do it in kind of an industry, you know, kind of in an industry setting.
And then lastly, we always talk about it. I’ll use the word AI. So there is, because you have a robust digital system, you are then able to add on things like immunohistochemistry, biomarker testing, and that’s an added application that you can add onto your digital platform that can just help increase the patient’s kind of MRD testing journey.
James Thackeray
That’s so great. This has been such a unique perspective because of your individual journey, and then ending with this technology organization where you are currently. If we were to try, I can already tell that we’d love to have you back because I have like 10 other questions going on in my head right now.
But just as kind of final thoughts or advice, what would you share to other fellow pathologists that we haven’t covered or that you’d like to just highlight? “Now this is actually a positive,” or “This is what it could become when it comes to digital pathology.”
Osama Khan
One thing I’ll say, James, is I always try to be very positive. And, you know, I always tell people who do contact me, like, “Hey, we’re looking to kind of start our digital pathology journey.” And I say, “Listen, you can do it.” You know, it is definitely doable.” And again, I referenced COVID, right? We came out of a very challenging time. It’s crazy to think it’s almost been five years, but during that time, we had to adapt. And we were forced to do it, at least at Stanford, but a lot offacilities had to change their workflows.
So I know that pathologists and their greater pathology, kind of histology team, they can definitely be successful in adopting digital pathology because we’ve shown that we can do it.
And, you know, we’ll talk about those specific barriers, and we can get into like regulations and, you know, buy-in from different people.
But at the end of the day, I know that one of the things that we can do as a pathology community is we can adapt.
And that’s one of the kind of positive messages I’ll say is, “Once you kind of adapt and integrate into a digital pathology workflow, you’ll never go back.” And so it’s just taking that first step.
And you know, people are here, everybody on your podcast. These are all key opinion leaders. They’re all people who arechampions of digital pathology. They’re out there. You know, don’t be afraid to ask. We talk about collaboration. Ask a question. Collaborate with people. You know, we’re also, yeah, we may have expertise, but we’re also learning, you know,every day new things are happening. So, you know, I would just say like, don’t be afraid to take a chance. I mean, you know, everyone will definitely, at some point, experience digital pathology if they haven’t already.
And that’s my positive message: that everyone can do it.
James Thackeray
Well, you certainly feel your optimism, and we appreciate it. We appreciate your insights on this journey thus far, which is just getting started for you. I feel like there’s many amazing years in your career, especially with the direction that you’re going. So we really hope to have you back on another podcast. But thank you again, Dr. Khan, for your time. It’s been a pleasure.
Osama Khan
Thank you so much, James. Yes. And I look forward to chatting with you soon.
James Thackeray
Great, thank you.
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