CIPI Connections: Driving Innovation in Pathology with Rajendra Singh, MD, FCAP

Dr. M. E. de Baca:
Welcome to CIPI Connections, the podcast of the College of American Pathologists' Council on Informatics and Pathology Innovation. Here we connect you with the leaders and committees shaping the future of pathology.  

Today I'm glad to bring Dr. Raj Singh to CIPI Connections. Dr. Singh is the Director of Dermatopathology and Digital Pathology at Summit Health in New Jersey and is the founder of Path Presenter, a global platform with over 70,000 users in 170 plus countries. Recognized worldwide as an innovator and educator, he has received the Lifetime Achievement Award from the College of American Pathologists and has been named to the Pathologist Power List multiple times. He currently serves as co-chair of the WHO Computational Pathology Committee and is a member of both the DPA Education Committee and the CAP Digital and Computational Pathology Committees. Dr. Singh's work bridges traditional histopathology with cutting-edge digital and AI technologies, reshaping how pathology is practiced, taught, and shared across the globe.  

So Dr. Singh, it's really a pleasure to have you here today and have a chance to chat. Before anything else, the things you do are so fascinating. I'd really like to know what first pulled you toward pathology and how did that path ultimately lead to your launching a company like PathPresenter?

Dr. Raj Singh:
Yeah, so thank you Dr. de Baca for inviting me to like to present what I've done in the past and this is a great honor. So like for when it comes to pathology like we all know like pathology is a very colorful kind of visual kind of field. So we are looking at all these astrology images and so many different kinds of visual things all day. But if you if I step back a little bit like I'm more of a black and white person. And what I mean by black and white person is I like something that is very, very sure and with certainty. And that I think is what made me come to pathology because pathology is all very factual. It is very evidence-based. It's not like you give a list of differential diagnosis and then maybe this one, maybe that one. But when you look at pathology, pathology is very direct. You always have to give something that can be used for predicting, like making the diagnosis, giving the patient some very specific treatment. So since the beginning of my career, I've been building apps, websites, using YouTube to present to a lot of people, build videos and presentations. So technology has always been a very, very strong part of what I think can help us do our jobs in a much better way. And because of that kind of a pathway, like trying to teach the maximum number of people, trying to do my job in the best possible manner and then using technology. When all of this comes together, that led to the building of PathPresenter. Because PathPresenter, what it does, it allows us to use technology to enhance what we do on a daily basis. So in 2017 and 18, I had collected around 2,000 slides, whole slide images of dermatopathology. And these were like interesting cases of dermatopathology. And I just wanted to put them on the cloud so that people could access these cases from anywhere and find these cases for teaching themselves dermatopathology and I talked to a lot of companies to like help me out to put this whole slide images on the cloud and make them accessible to everybody but there was all these companies did not want to help us out because it was just a project educational project of putting slides and then let's say a person is looking for a specific case they type in the diagnosis and they can pull out that slide and see the slide. So when nobody was ready to help out, I said like I'll have to build this myself. So then I hired an engineer and then the two of us got together and then built this web portal where we put up these 2,000 slides on the cloud and then allowed anybody to log into that web portal and see those images. But as soon as this went online, like I started getting emails from all around the world that "Raj, you've already put in like 2000 slides of dermpath. Why don't we, we can give you slides from breast pathology. We can give you slides of prostate pathology why don't you add these to your to your library." And the library grew to 30,000 slides so hosting 30,000 on the slides on the cloud and then maintaining that web portal was a very very expensive affair and it was very difficult to sustain that kind of thing for a project so I was trying to figure out what to do about this basically and luckily a couple of institutions including MSKCC, OSU these people reached out and they said that can we use your software to do the teaching in our own department. And that is what gave the idea that if I can rebuild this software in a way that it can be licensed out to institutions, then I can get money that will allow me to host this 30,000 slides for free. PathPresenter.net is a live platform that is completely free to anybody around the world. So there are 70,000 users that use PathPresenter.net today. And there is no fee involved in using the platform. And that fee is coming from because we build this company that uses that same technology that can be licensed out to institutions.

Dr. M. E. de Baca:
It sounds like instead of having like an aha moment, this isn't there, I should build it. You just were building on organically on all the things that you had been doing and then had almost this field of dreams sort of situation that you built it and then they came and then you were drinking from the fire hose. I'm going to switch just a little bit. If you look at what you're talking about, you've been very creative during your whole profession. But do you think that pathology or medicine actually trains people to follow rules or to be creative? And if it was to just follow rules, how did you unlearn that?

Dr. Raj Singh:
If you look at the short answer to this, it's like, yes, medicine will always ask us to follow rules because you're dealing with patient lives. So when you're dealing with patient lives, discipline and having some kind of a very... organic approach to like dealing with how do you how do you are going to treat the patient is like almost like the big pillar that health care is dependent on but when you actually practice health care you know that whenever you're dealing with patients or even when you're dealing with histology every patient is different so like yes the rules are very very important but when it comes to dealing with patients the rules don't follow the textbooks.

Dr. M. E. de Baca:
Yeah, I'm glad you remind me of that. I always talk about innovation and creativity, and I don't couch it in the words that I think are always in the back of my mind. And first of all, we have to make sure that we hold to our oath and do no harm. So thanks for reminding everyone there. But since you are bridging clinical practice and innovation, what do you think is the most misunderstood thing about how pathology actually fits into health care?

Dr. Raj Singh:
I think the most important misconception that I see is that patients don't realize the importance of pathology or a pathologist in their healthcare, in their journey. Like 70 to like, we have heard the statistics many times that 70 to 80% of diagnosis is based on a pathology report. Like if you look at cancer, 100% of diagnosis is based on a pathology report. If you look at any kind of even benign tumors, malignant tumors, infectious processes, most of the times it is based on a pathology report, but the patient never realizes that all is treatment, all his or her treatment, everything is based on what the pathologist is doing in the back end. And I think that is something not very well understood in the healthcare space, that pathology is not like a sideline, it is the foundation of medicine. It is really the foundation of how people treat patients. It is the foundation of how patients are going to go through their entire journey of the disease. And I think that thing needs to come out in a very bigger way that yes, Patients are getting the right treatment, but all the treatment is actually coming from some department in pathology that is giving them the report, the clinician, the oncologist or anybody that report to like to decide what kind of treatment is best for the patient.

Dr. M. E. de Baca:
So time flies when you're doing a podcast. If you think about five years or 10 years from now, what do you think the impact your work will have on patients or on pathology overall?

Dr. Raj Singh:
Like not only my work, I think like if you look at the entire space of pathology, like right now, if you look at like what impact is pathology going to have or what impact do pathologists will have, including myself, like pathologists today are sitting on a ton of data. It's not only about anatomic pathology data, we are sitting on clinical lab data, we are sitting on molecular data, we are sitting on genomic data. And that data is like very, very vital for all the technological advances that are going to happen in the next 10 years. Like people are talking about AI models for diagnosis, but they're also talking about AI models that can help in prediction of prognosis, prediction of treatment. You look at pharma companies, they want to build companion diagnostic drugs based on the molecular alteration of a patient's tissue. And that is one thing I always try to convey when I'm even giving a conference that for pathologists that they need to really take control of this whole stuff. If they don't take control of the data and how this data is being used to like do all this different kinds of stuff or like how this data is even being used to treat the patients, somebody else is going to come and take charge. So for pathologists like having a very good approach to how this data is managed, how this data is controlled and how this data is being used, not only about AI, like even without the AI, like every diagnosis, every treatment is now being based on. The histology, it is being based on the genome. Genomic report, it is based on the molecular report. It is based on the clinical data. So it doesn't always have to be about AI basically, but all this information comes from pathology and we really need to take care of how this data is being used and we stay in charge of it. And if we do that, pathology is going to be the most important like aspect of the entire healthcare system.

Dr. M. E. de Baca:
I really like that. Thank you. I frequently say that pathologists are the foundation of medicine and that we won't be seen if we don't get to the podium. But I'd like to thank you for your leadership and for actually building the platform. I look forward to seeing you at CAP25. We can be in the space together playing with PathPresenter and some of the fun and exciting surprises that will be shown at the annual meeting. Thanks for all you do, Dr. Singh.

Dr. Raj Singh:
Thank you very much. I look forward to it. And I really would invite everybody to come to the meeting because there's a lot of spectacular stuff that we will show at the meeting. It's not only about digital pathology, it will be a lot about how people can test drive AI models and all of that. And the surprise will come when you come to the CAP annual meeting 2025.

Dr. M. E. de Baca:
Thanks for joining us for insights, updates, and the people behind the innovation. This has been CIPI Connections, where ideas meet action in pathology.