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. 2025 Mar 8.
doi: 10.1007/s00428-025-04064-y. Online ahead of print.

Implementing digital pathology: qualitative and financial insights from eight leading European laboratories

Xavier Matias-Guiu  1 , Jordi Temprana-Salvador  2 , Pablo Garcia Lopez  3 , Solene-Florence Kammerer-Jacquet  4 , Nathalie Rioux-Leclercq  4 , David Clark  5 , Christian M Schürch  6   7 , Falko Fend  6 , Sven Mattern  8 , David Snead  9   10 , Nicola Fusco  11 , Elena Guerini-Rocco  11 , Federico Rojo  12 , Marie Brevet  13 , Manuel Salto Tellez  14   15 , Angelo Dei Tos  16 , Thomas di Maio  17 , Silvia Ramírez-Peinado  18 , Elizabeth Sheppard  19 , Huw Bannister  20 , Anastasios Gkiokas  21 , Mario Arpaia  22 , Ons Ben Dhia  23 , Nazario Martino  24
Affiliations
Free article

Implementing digital pathology: qualitative and financial insights from eight leading European laboratories

Xavier Matias-Guiu et al. Virchows Arch. .
Free article

Abstract

Digital Pathology (DP) revolutionizes the diagnostic workflow. Digitized scanned slides enhance operational efficiency by facilitating remote access, slide storage, reporting and automated AI image analysis, and enabling collaboration and research. However, substantial upfront and maintenance costs remain significant barriers to adoption. This study evaluates DP's financial and qualitative value, exploring whether the long-term financial benefits justify investments and addressing implementation challenges in large public and private European laboratory settings. A targeted literature review, semi-structured interviews, surveys, and a net present value (NPV) model were employed to assess DP's impact on clinical practice and laboratory financials. Qualitative findings validate the key benefits of DP, including optimized workflow, enhanced logistics, and improved laboratory organization. Pathologists reported a smooth integration, improved training, teaching, and research capabilities, and increased flexibility through remote work. Collaboration within multidisciplinary teams was strengthened, while case examination efficiency and access to archival slides were notably improved. Quantitative results indicate that DP demonstrates strong financial potential, achieving cost recovery within 6 years. DP investment results in a 7-year NPV of + €0.21 million (m) driven by increased productivity and diagnosis volumes. Although the high upfront costs for scanners, training, and system integration pose a significant barrier to the adoption of DP, larger institutions are better positioned to leverage economies of scale. This study underscores the importance of sustained financial support to cope with the initial investment and regional collaboration in driving widespread adoption of DP. Expanding reimbursement policies for pathology procedures could significantly reduce financial barriers.

Keywords: Digital pathology; Economic outcomes; Pathologist perception; Workflow impact.

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Conflict of interest statement

Declarations. Conflict of interest: Prof. Matias-Guiu declares Lectures with fees and associated travel expenses from Roche Farma, Qiagen, Ferrer Internacional, Novartis, Menarini, Biocartis, Agilent-Dako, Leica, Reig Jofre, Sysmex, MSD, Astra-Zeneca, BMS, GSK, Clovis. Eisai, and participation in Advisory Boards for Astra-Zeneca, Lilly, Amgen, GSK, Janssen, Illumina, MSD, Daiichi Sankyo, Inc, Abbvie. Dr. Jordi Temprana Salvador received advisory fees from MSD, lectures with fees and associated travel expenses from Roche and 3dhistech and travel accommodation and expenses, grants from Palex. Pablo Garcia Lopez has received travel accommodation and expenses from Palex. Prof Kammerer-Jacquet declares relevant relationships (grants, advisory fees) with AstraZeneca, MSD and BMS. Prof. Rioux-Leclercq has no relevant conflict of interest. Prof. David Clark has no relevant conflict of interest. Prof. Christian Schürch is a cofounder and shareholder of Vicinity Bio GmbH and is a scientific advisor to and has received research funding from Enable Medicine, Inc., all outside the current work. Prof. Falko Fend has received speaker and advisory board honoraria, travel support or research grants from AetherAI, AstraZeneca, EUSAPharma, StemlineMenarini, and ThermoFisher Scientific. Dr. Sven Mattern has no relevant conflict of interest. Prof. Snead declares that he is a Director and Shareholder of Histofy Ltd. Coventry UK Company number 13732208 and receives an honoraria from Astra Zeneca. N.F. has received honoraria for consulting, advisory role, speaker bureau, travel, and/or research grants from Merck Sharp & Dohme (MSD), Merck, Novartis, AstraZeneca, Roche, Menarini Group, Daiichi Sankyo, GlaxoSmithKline (GSK), Gilead, Sysmex, Veracyte Inc., Sakura, Leica Biosystems, Lilly, Pfizer, ThermoFisher, and Abbvie. Prof. Elena Guerini-Rocco declares relevant relationship (advisory fees, honoraria, travel accommodation and expenses, grants and non-financial support): AstraZeneca, Exact Sciences, GSK, Illumina, MSD, Novartis, Roche, StemlineMenarini, Sophia Genetics, ThermoFisher Scientific. Federico Rojo declares relevant relation relationship (advisory fees, honoraria, travel accommodation and expenses, grants and non-financial support): AstraZeneca, Merck, GSK, BMS, MSD, Novartis, Roche, Menarini-Stemline, AbbVie, Sophia Genetics, Daiichi-Sankyo, Gilead, Pfizer, Lilly. Prof. Marie Brevet is a scientific advisor to Tribun Health & Ummon healthTech and has received research funding from MSD and honoraria from AstraZeneca. Manuel Salto-Tellez is a scientific advisor to Mindpeak and Sonrai Analytics and has received honoraria recently from BMS, MSD, Roche, Sanofi, AstraZeneca, Abbie, and Incyte. He has received grant support from Phillips, Roche, MSD, and Akoya. None of these disclosures are related to this work. Prof. Dei Tos declares advisory fees from Bayer, GSK, Novartis, and Roche and Logibiotech. Elizabeth Sheppard is an employee of AstraZeneca and has stock ownership in the company. Thomas di Maio is an employee of AstraZeneca and has stock ownership in the company. Huw Bannister is an employee of AstraZeneca and has stock ownership in the company. Silvia Ramírez-Peinado is an employee of AstraZeneca. Anastasios Gkiokas is an employee of Alira Health. Ons Ben Dhia is an employee of Alira Health. Nazario Martino is an employee of Alira Health. Mario Arpaia is an employee of Alira Health.

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