Inside the Asian Society of Digital Pathology | Podcast with Junya Fukuoka, MD, PhD

Aleks: So how is digital pathology currently different in Asia?

Junya: We need something in Asia because, there was nothing in Asia at that moment and I initiated this movement. We are trying to create those, patient advocacy as a committee. I think, like I say, importance of the pathology is that we need to be visible.

Who really needs improvement of the [00:01:00] medicine.

Aleks: I’m here we are at PathVisions 2024, the… 

Junya: Right… 

Aleks: DPA Congress conference, annual conference, and I’m here with Junya Fukuoka. What is your position at the Asian Society of Digital Pathology that was recently founded? Are you the president?

Junya: I am serving as a president at this moment. Yeah. I initiated this movement.

About a year and a half ago, and then I just, talked to my friend, they’re also the. Same as me, the believer of the digital pathology and then there you know suddenly agree with their idea, oh, let’s start this. Yeah, we need something in Asia. ’cause there was nothing in Asia at that moment.

And all of those people who want to know, who wants to learn something. And about the digital pathology and those advanced technology they have to go either in Europe or America.

Aleks: So you’re also a practicing pathologist, [00:02:00] right? 

Junya: Yes, I am. Yes. 

Aleks: Tell me about where you practice, what’s your specialty, and a little bit about you about the president of the Asian Society of Digital Pathology.

Junya: I’m not like a that kind of president. 

Aleks: But you are, and today is the president election day. So they were interviewing the DPA podcast people, The Beyond the Scope people were interviewing all the past. Presidents of the Digital Pathology Association.

Junya: Okay. Yeah. I would take a president of the DPA as well next year.

Aleks: Exactly. So, yeah.

Junya: Anyway I am a practicing pathologist. I have two affiliation now. One is professor of the Nagasaki University. It’s a national university. I mainly do research and education there.

But of course, and I do the practice as well. And also the other one is Kameda Medical Center.

That is one of the largest, hospital inside, Japan. Nearby to Tokyo. And I do have those, many fellows there are doing a practice. And we are 100% digital diagnosis. 

Aleks: That’s what Andre works, [00:03:00] right?

Junya: Yes. He is my right arm.

Aleks: So Andrey Bychkov is a pathologist as well.

Who I met online many times couple of years ago. But in person at USCAP this year, he presented the use of ChatGPT poster, which was a survey. Of over a hundred pathologists, and I took part of the survey as well.

Junya: So you recognize that he gave a poster. 

Aleks: I have the poster. A physical poster at home.

Junya: Yeah. Before that me, many people said he, does he exist? He might be a chap, right? With a faces. Yeah. So this is how we started and that’s how I do a practice as well. So I do it as, diagnosis and I’m teaching, I’m doing research. 

Aleks: Asian Society of Digital Pathology, who are the members? Of the society, how many countries does it encompass and how is it gonna be?

’cause it’s brand new. You just guys have had the first annual meeting, I dunno if you can call it annual meeting, because it has not been a year since [00:04:00] the… 

Junya: And you’re congress actually. 

Aleks: Annual congress. So who are the members? And how are you guys gonna be active in Asia? Not only spreading the world, actually being boots on the ground and increasing adoption of digital pathology.

Junya: So the, a little bit over half are pathologists actually. Yeah. So we started from the pathology side and we have a computer scientist and we have many vendor as a member and also a student, resident. There are many, actually young people are actually currently a member of the ASDP.

And we are expanding this, not only to those pathologists and also the vendors. We’ll expand on this, hopefully to the patient and also some of oncologists because that’s important.

Junya: We are trying to create those, patient advocacy as a committee to really, the start communicating with the patient.

Because I think, like I say, importance of the pathology is that, [00:05:00] we need to be visible to the patient who really needs the improvement of the medicine. And we are like, let’s say, providing final diagnosis as, as a very important final judgment of the disease. But, the not many patient does not know, do not know about us. They feel like, let’s say, oh, oncologist are making final diagnosis. We need to just, the be visible and what we are doing by…

Aleks:  What we’re doing is a gateway to treatment. It’s without this diagnosis, there is no treatment. The oncologist is not gonna know.

What to treat you for.

Junya: That’s true. That’s, there you go. So yes. So that has to be known to the people.

Aleks: So how are you guys gonna do it? Let me give you a little bit of context because I was asking myself this question like, is there a way for the patients to drive adoption? Because obviously there is a patient benefit if there, it’s something required by the patients.

It has a different way in the [00:06:00] patient care and healthcare system than a doctor asking for. A nicer tool to work on if they actually can do the work on the old tool as well if it comes from the patient. But that was my question, like if we are still like an invisible specialty how do they even know that?

And my point was like that they can get access to their the image of their tissue. And I was asking around like, how could the patient in the US do that? And the official route is, oh, you ask, like you fill a form and you get a glass slide? I’m like, okay, because the image is actually created by the hospital.

It may be the property of the hospital. And first of all, they may not be able even to digitize if they didn’t go digital, or they may not wanna release this image to you. So if you have this glass slide and you wanna share it with someone, like where are you gonna digitize it? How do you guys see it?

How do you see the patient advocacy [00:07:00] programs? Which angle do you wanna approach it from?

Junya: Actually, there are many different approaches. I believe so. We are just, start thinking. Which one is the most effective? But, first thing we can tell is that, like you said, we cannot share glass slides to multiple people.

So this is like one slide, which, pathologist made a diagnosis. They want to keep it ’cause this is a record, under the cap, the guidelines, those rules, they say that we have to keep those 10, the slides for 10 years. So you cannot easily pass to the many people.

That’s a different story. 

Aleks: And even if you want to, it’s gonna take forever. So it is. I recently interviewed a lawyer who was a medical malpractice lawyer. She started using PathPresenter. 

Junya: Yeah. 

Aleks: For cases where pathologists involved, because she said that the process of showing the glass slide to multiple pathologists, this would take months.

Junya: True 

Aleks: …or even up to years true shipping. Getting the information back from the pathologist because it was not digital.

Junya: I actually did the consultation [00:08:00] yesterday, and so it’s so easy because it’s a data images, right? You just, anonymize and send to the resource who is specialized in that, field.

How many days I get, the answer is just one hour.

See, just hour.

Aleks: Yeah. Because it’s easy.

Junya: It is… 

Aleks: …they look at it and they know because they have the expertise. They let you know. Whatever way of communicating it can be instantaneous, almost.

Junya: So this is a direct benefit to the patient, right?

Because we would gonna provide a better diagnosis and a quicker way. And also, this really decides the strategy of the treatment, right? So this is the direct benefit for the patient. So I think like this information is so important for the patient, but this is not really. Split.

So we need to, inform that, okay, we are, digital pathology is helping patient to improve the practice in this way. First one is easiest, one is, consultation, of course, including everything. Yeah, that’s probably the direct benefit.

Junya: And also second one is maybe [00:09:00] AI. Some of the tasks like counting something or evaluating or reproducing something, which is not doable by human, it’s not really the task of the human.

We are using calculator for everything, right? We cannot use let’s say, just in a head to calculate all of those complex numbers. Because we know the calculator does a reproducible and accurate answer. It’s the same thing. The name of the AI is actually exaggerated name. It’s too much actually.

So it’s a computer calculation. But it does better the task, rather than eye board judgment. So we are gonna use it and then provide the data is definitely giving a better answer. For those things, which we are clear that, these are definitely better the human eyes, we need to use those devices.

But, and for that patient has to know it is the, situation and, we need voices from the patient. We need those, that the abration by those accurate computer analysis or whatever, let’s say for breast cancer we [00:10:00] need to have those calculation of the, the immunochemistry for the biomarkers.

But you know that probably, that, inter observer variability of those accounting is… 

Aleks: We’re 70% concordant. We’re so concordant. It means 30% percent, 

Junya: 30%, no, right? 

Aleks: This is not comparison. 

Junya: So that’s the reality. Maybe even less for the some of demos. 

Aleks: Yeah, probably. 

Junya: This is a reality. We have to do something on it, but, we need a… I have a strong

Aleks: I have a strong opinion on… 

Junya: Right you do.

Aleks: …trying to, I call it guesstimation. And like you try to train people to guesstimate better. It’s physiologically impossible. For a human to be consistent at those guesstimations there. So to me, like I want AI to do that for us. 

Junya: Sure. 

Aleks: And then the human observer, the pathologist is looking okay, is it actually analyzing in the right spot?

Is it analyzing the right cells? But you don’t need to count them or guesstimate.

Junya: So there’s a lot of things we already know that then a computer is better than human for some of the tasks. I’m not talking about the whole task. [00:11:00] It’s impossible by the computer. It just use those, tasks.

But to do so, we need to digitize. So digital pathology is a gate to have those improvement. So we are, just sharing all of those information to the people who really needs those reach or to the knowledge. And in our society is a society who does those education to the people who needs, including patients.

Aleks: So how is digital pathology currently different in Asia than in Europe and in North America? And how do you think you’re gonna be driving the adoption differently? Because it’s a different world. Asia I visited once, and it’s a different world, like multiple, multiple levels culturally, developmentally, like a lot of countries, a lot of space.

Also, like North America is two countries, so… 

Junya: Yeah, it’s true. 

Aleks: Yeah. How is it, what are the differences in, how are you gonna be…

Junya: One word? Is diversity.  [00:12:00] So there is no other area, has this many diversity. So that’s Asia. So we have a multiple language even do not use no alphabet letter either.

Aleks: I need to pause here. 

Junya: Okay. 

Aleks: About the different languages. We have a special assistant that is actually Okay. You said it’s mandatory for the Asian society. It is. This is a life transcription and translation, and we’re currently running me being transcribed into English on one side and it is showing in Japanese, so this is obviously available for all the different languages, which I think is.

What a unifying tool for an area where there’s no way, there is gonna be the same level of understanding in English for people who have different backgrounds, different educational systems and like everything is different. So yeah, AI and technology making, making it possible to unite and get people together from such diverse [00:13:00] regions.

Junya: I feel like this diversity usually and consider as a negative factor, I took it as a positive opportunity. So by overcoming this diversity, we can use this, knowledge and the tips to many different things. So this is, you said, as you said, we are using digital device and actually AI behind, right?

But we use this type of the knowledge to multiple different things. Consider this as a type of the chat bot for the, to help the pathology diagnosis. Who has a limited knowledge, right? Who has limited resources, but we have those, help of the chatbot who already was trained with, the expert ideas.

Then you could have a differential diagnosis right away. Something like that. So you need help. So you need to have a skill to judge if this is how nation good, true, answer. So that’s another story. But definitely you would have a better source of the, information provided by those technologies.

So I [00:14:00] think gonna say, this is the kind of a tips that we can use for multiple different ways and Asia is, as I said, it’s a full of the diversity and to provide the knowledge to pro, to unify the the practice. It’s very difficult. But if we do that… 

Aleks: Can you even do that?

Junya: I believe so.

I believe so. Because what we are doing is similar, we know, do the patient care and then know choices. I know that so many. Of course there are some difference by the country. Because, the regulation, whatever their insurance, the system. But basically what we do is having quite a limited choices for the treatment most of the time.

So then that, it’s the same story. We use those, devices to really standardize the practice. So whatever you go then that you need to know what’s the advancement, what’s available in which country that does not harm you. You need to know about. And then you are not in that level. If you are in the developing country and you do not have those advanced technology, [00:15:00]  but you still know already that this is available in which country, you do a the house airport to install those.

As much as possible with whatever the method is, maybe negotiation to the government, whatever, there should be a lot of way, but what is most important is information. Right information and localized language. So that’s how we are providing, that’s how we are thinking. How to, the function, the ASDP or those society are.

Aleks: So before we talk about annual conference that I wanna ask you about, there are two technologies that I would like to ask your opinion on and how do you think they might help or might not help in Asia? One thing is working with static images. So this is something I’ve noticed when I interviewed Dr. Talat Zehra  from Pakistan, and she is dedicated to research on doing AI on static images. And basically what she said. There are no resources for scanners, but you can have a camera and you can have a static image. [00:16:00] And now there are algorithms available that have been developed on the whole slide, images from all those scanners, but they can run on static images and that’s something that is a lot more accessible to the diagnosing pathologists.

Do you think this is gonna to pick up, is it already picking up in other countries? Do you see it being used or…

Junya: yeah, I think… 

Aleks: Not necessarily AI, but like leveraging static. Images because I think the moment scanners, a couple of years ago, it was all scanner hype, whole slide images. But there are many countries, it’s a prohibitive cost.

Junya: Sure.

Aleks: But digitizing of images, you can basically use your phone. So tell me your, your opinion on that.

Junya: You know what whatever, of course, there’s a difference between the wholesale image and static images. I did the same thing for the static images before I installed the wholesale images.

It is a process. If you don’t have those resources, if you don’t have, the budget, you have to, the, do it, through the. Static image and it’s fine. There should be the time and opportunity for you to install [00:17:00] if you are really willing to, and wishing and hoping and keep negotiating to the, your hospital or government, wherever it always salary away pops up.

And then you’ve just install it. But beforehand how you prepare yourself. Whatever you can do, you cannot just directly jump to the very expensive, scanner at all. But if you’re doing the, those similar things onto the a static image, that’s already the digital pathology. This is a process what we all did, so you know, what she’s doing is not so much different from us.

Yeah. It’s already in process.

Aleks: Another thing that I have witnessed one time in Africa when I visited Ethiopia is something, I don’t know if it’s officially called like that, but like jumping over a technology step, I saw that with the telephones in Africa, so obviously Europe and North America, there were telephone lines, right?

Everybody had the normal line telephones, right? And that was not the case in Africa. They basically didn’t do it. They waited and then suddenly [00:18:00] everybody had cell phones. 

Junya: Correct. 

Aleks: So they basically skipped this whole mega infrastructure investment because they just didn’t have the resources.

But then. A consumer technology came to play and you said that you just said that, oh, suddenly something appears and you can embark on a journey that like others need to take an intermediate. Step or so, and I see it in digital pathology. I see it with the direct to digital imaging. What I’ve seen, there were several vendors doing either direct fresh tissue imaging, like for example, Muse Microscopy.

There is digital staining from unstained slides. There are like different technologies around making digital images available directly from tissue and basically, skipping the scanner step. What are your thoughts on that?

Junya: That is a very good point. So I would say, those skipping old and complex processes I can say, look at the tissue. We, how we look at, the microscope, we have to fix [00:19:00] it. We will embed it into the paraphin, and just, do the dissection.

Aleks: A lot of work…

Junya: It’s a lot of work and also a lot of those work has to have highly skilled humans, yeah.

Which is very difficult to have as a resources. And those poor resource country, they don’t have it. Then the internet, it’s the same story as you said, for the smartphone. They can skip it, just go directly, go jump to the pseudo. Know H&E created from like a Muse you said, 

Aleks: Yeah. That’s uv. And also UV light, right? Generating the image there is, there are options to generate fluorescent images. But yeah, the Muse one is the device that’s commercially available. I think that’s the most mature right out of the other solutions that they’ve seen.

Junya: There are several others doing similar.

So those, the approach, let’s say one in, in America is with called Phoebe. It’s also the similar, the approach, whatever the device, use, and you can skip those, processing of the the tissue, to [00:20:00] creating a tissue and also block and then the, but you could, get those images right away.

Aleks: Yeah. 

Junya: And that was shortcut the TAT as well.

Aleks: Yeah. 

Junya: So those new technology may develop well in the low resource country because of the experience, because they basically don’t have approach to the one we have in laboratory. And they’re like smartphone, it’s happening.

Let’s say, I will give you an example. So inside Asia, before we established a society, we didn’t know much about what’s going on inside Asia. We know after the research among the whole Asian country, who was that there are several country inside Asia who does show very much advance in digital.

Aleks: Yeah.

Junya: Like, in Kuwait, or Saudi Arabia and of course, South Korea. In China…

Aleks: Can you estimate the level of adoption in terms of how many what percentage of hospitals are digital for pathology?

Junya: Yeah. And especially for in Kuwait it’s about 50% [00:21:00]. 

Aleks: Oh, my goodness half of the,

Junya: See, look at, in the US it’s less than 5%, right?

Let’s say Japan, we started digital pathology very early days. But if you look at, the institution who use digital pathology for the practice. About 1%. Okay. Believe me.

Aleks: So it’s a spread. Yeah. A crazy spread. Like half of the, it is half the hospitals in Kuwait. Amazing. Yeah. So yeah. Diversity again, it is in everything. So how was. The Congress, your annual Congress. I am holding the flyer for the second one. And we’re gonna invite you to the second one, but let’s talk about the first one. When was it?

Junya: It was in this year, October 2nd to fourth.

So we established society this year. 

Aleks: a month ago.

Junya: Yeah. Actually the society establishment was in February in Singapore.

But then when we just succeed to open up the bank account is so recent. So we couldn’t get even member, 

Aleks: The member due. 

Junya: Yeah, exactly. [00:22:00] The whole like gonna say August.

So we have only two months before the onsite event. We got over 400 attendee and all of the 45 booths are sold out.

And actually that attendee came from 29 countries.

Aleks: Oh my goodness.

Junya: Yeah. And the, there was enough. 

Aleks: Do you know how many countries are in Asia? 

Junya: In Asia?  About 50 plus something.

Okay. Yeah. And also, one more thing is that we hit abstract. Application about 90 something, 91, I believe.

Aleks: Oh my goodness. Almost a hundred abstracts.

Junya: Yes. For the first year. 

Aleks: This is amazing. 

Junya: And we did rebuild old the abstract and decide which one to go to the, or the stuff. And to figure out most of the science level was quite high.

It’s almost equivalent. Maybe some are even better. Than the one we see in America, Europe. That’s…

Aleks: This is amazing. 

Junya: You know that we didn’t know that, we had many talented people, almost like a superstar in this field. But we didn’t know each other because they’re going to America [00:23:00] and Europe to attend to the meeting. So we have no network. We didn’t know anybody, inside Asia. But now we start knowing each other, start making network. And this network is a source. Of the old, the new idea, brainstorming. Now you get an idea how we would contribute to this field.

Aleks: This is amazing. Basically, unifying all those people and like getting all those developments in one place and the success of your first meeting, like 400 on your first that you like gathered in the less than half a year.

It just speaks for the need of a specific Asian society. And now with the networking, your guys are gonna grow exponentially and it’s gonna be amazing. I’m so happy for you. 

Junya: Thank you.

Aleks: Okay, so if anybody is interested, and you should be, the Asia Society of Digital Pathology Annual Congress. Next year is October 10th to the 12th in Mumbai, India.

I hope to be there as well.

Junya: Yeah. Check our website, [00:24:00] which is ASDP.AI become a member? ‘

Aleks: Cause they’re advanced .AI

Junya: Ai. Yeah, of course. There you go. And also, I would tell you if you are from the Asia, if you are also considering a global researcher or global doctor. This is not our society. This is a society of yours.

And you can contribute, you can be a member, contribute as much as possible. Because this is designed for you. It’s not ours. I initiated that. This is all and all for the people who is excited about this, who needs this. Why we have this success was all of those, dedicated, board members and committee members and other member, even not a member or student, even student, they contributed to build.

Aleks: That is amazing. I think we need to make pathology cool so that we can have more pathologists and so that the patients are also think that pathologist is an important doctor, thank you so much. Thank you for starting the Society and thank you so much for joining me today for this conversation.

Junya: Thank you.

Aleks: See you at the ASDP [00:25:00] Congress next year.

Alright.