Aleks: [00:00:00] Pathology is the gateway to treatment. I like to call them unsung heroes of medicine.

Dr. Yuri: You really can learn rare tumors and rare presentations of common tumors because this is when this pathologist struggles the most.

Aleks: But that would be super cool for me as a patient because I would have an option to basically look at my case on the internet

Dr. Yuri: And eventually we’ll help patients to make better diagnosis or better.

Aleks: Welcome my digital pathology trailblazers.

Aleks: Today my guest is Dr. Yuri Nikiforov, and he is the founder and president of World Tumor Registry. And the World Tumor Registry, as the name says, is a World Registry of Tumors. And the first time I heard about it was from Dr. Andrey Bychkov, who is, who is he Yuri, in this project? He’s an editor, right?

Dr. Yuri: Yes. He’s one of the chief editors for the [00:01:00]] Thyroid WTR.

Aleks: Exactly. So I met him in person. And there is a little video that we created, but today we’re gonna go more in-depth into what it is, why Yuri, you, and the team created it. But let’s start with you. Tell the digital pathology trailblazers who you are. What’s your background, and how did you end up where you are right now in your pathology career?

Dr. Yuri: I am in Pittsburgh, Pennsylvania, and I am here runs the division of Molecular and Genomic Pathology. I am AP pathologist by training with interest in thyroid pathology. And my, my research clinical interest is in, in thyroid pathology and in molecular diagnostics. So that’s my background.

And I’m originally from Belarus. And been living in the United States for many years. Very interested in obviously [00:02:00] a pathology education in really seeing young generation of pathologists come in, and taking over and pushing a field forward. And one of the reason why I got interested in creating something new was exactly that, to really promote pathology education worldwide.

Aleks: And I don’t know if people see, I don’t have my thyroid, ’cause I did have thyroid cancer and before this podcast we were talking like, how could we get hold of my slides? So maybe next time I go to Poland I will try to find them and I will document it and then we can put it in the World Tumor Registry.

Aleks: But so let’s talk about what it is. Let’s start with what it is. I have it on the screen for those who are listening. If you go to YouTube, you’re gonna see everything that we’re talking about also in visuals. But yeah, why, [00:03:00] how, what is it? What is it

Dr. Yuri: Your concern about World Tumor Registry as a sort of Wikipedia of human tumors.

At least that’s how we want it to be at the end when we complete this project. And like Wikipedia, anyone in the world can freely access it. Just type worldtumorregistry.org and open it, through Google or as a driver and start browsing or contribute cases if you would.

Similar to the Wikipedia that we all know. It’s a free available resource where many people can contribute the digital slides information related to them. But it is, but the difference is that, it is highly curated. It is. It is curated and annotated by the editors, by a group of experts in the field [00:04:00] from different countries in the world to be sure that the diagnosis is correct and all information provided is also correct.

Aleks: And your goal is to have all the possible tumors in the world because of your expertise. You started with the thyroid, right? And I see that the next candidates would be breast and lung cancer. We can do the demos and start talking about… about what’s already there based on thyroid tumors.

Dr. Yuri: Correct. Our first project is thyroid because it’s it, this is a prototype a few years that we create to show what really harvest, we see the future of this project and the next exactly. In the next two that we are about to announce. That we start building them. We’ll be breast and lung in general.

In general’s idea is that the World Tumor Registry [00:05:00] is, will be a collection of individual tumor type. We will build all the way until we have all 18 major tumor type. Here in the collection, and when the visitors will come to the website and they will look at it, you can click on any of the tumor type.

Now you can click on thyroid, for example. And it’ll take you to the thyroid tumor registry and then you can start searching it. You can search it by diagnosis. If you want to see how specific tumor type looks, you will go ahead, click on to diagno… search by diagnosis, and you open this field.

And here you can go ahead. You have to acknowledge yes that you will not use it for direct diagnostic care. What? Why? Why? Why we really wanted to create it. And what is the difference between this and many other databases existed? This is a true world collection of. Tumors, it’s contributed from [00:06:00] many different countries, from almost all the regions.

And this is our goal. One of the big questions that we want to be sure of is if the tumors, if the human tumors look exactly the same in different countries of the world. I’m glad that you show this map. This is map of thyroid editors, as you can see… 

Aleks: Yeah. There’s a map on the website from with dots where all the editors, and we’re gonna talk about the editors and the process because the, everybody can contribute, like you said, but there are specific rules how to contribute. Yeah it’s all over the world.

Dr. Yuri: Yeah, so it’s all over the world and even, we have editors located in the different regions and they also will solicit cases from their name, even neighboring countries.

The idea is that most countries and most regions in the world are included and covered by it. And then when you search, [00:07:00] for example, tumor type, you can, if you, for example, go and say 9apillary carcinoma, for example, in that box on the top. Yes. So it’ll show you that, the representation of papillary carcinoma.

And then, for example, you can search by geographic region. Let’s say you want to see how this tumor look in specific region as the world, let’s say in Asia. Sorry. You can go and you can filter it. You can filter it by region or by age, for example, or by gender. And really select those cases that are, would be closest to your home or closest to your population or to the age groups that you want to see.

And then you can click on individual thumbnail. And basically it opens the slide. You can click on any exam. Okay. Yeah. 

Aleks: Let’s check this one. Papillary carcinoma. You basically have a whole slide image viewer. And the interesting thing, like you [00:08:00] don’t have to log into this, you don’t have to give like any credential and you have the information about this particular tumor that we just searched for.

So it was Asia papillary carcinoma, and you can just go and browse this whole slide image. And there is a bunch of case information. What kind of information do you guys include in those cases?

Dr. Yuri: So we provide information on diagnostic features. So this is in Infiltrative follicular variant.

So how to diagnose it. This is… then we share information about where region it is from. For example, this is from Asia, and Oceania from China. Then basic demographic information. For example, this is I what, 40 something year old? Female. With no family history with no specific [00:09:00] environmental setting.

And then tumor stage is a certain stage, cytology, and in many cases genetics and immunohistochemistry if available. So it really give you a sense of how the tumor look and also what diagnostic or immunohistochemical or molecular characteristics as this tumor has. Also want to stress that at the end of this sort of, metadata strip, you will see also contributor and editor.

So we encourage pathologists from all over the world to submit. Your own cases, cases from your practice into this global resource and contribute to the world collection of tumors from your region and your name as the name of contributor will be acknowledged. And, credit will be given to you as the contributor, as the owner of this specific [00:10:00] slide.

Not slide, but case.

Aleks: Case. So let’s say I will find my tumor slides or maybe even the block as we were talking about, to get the IHC and get the molecular information. If we do these… these exams. But then what happens? Gimme one second. 

Dr. Yuri: So what happened? You go to the, again, WTR website.

To the if you can go to the landing page and you scroll first, you can search and then you see submit. Submit keys. This little bit above. 

Aleks: Okay. Yeah, I see. Submit case.

Dr. Yuri: Submit case. Okay. And then you look at the world map and you select the editor that is, located closer to you, closer to your region. 

Aleks: Closer to me.

Dr. Yuri: See, you can click on any of this. You select one editor and you click on a circle.

Aleks: Let me check. So there’s one close to Poland, [00:11:00] and this is Czech Republic. Okay. And Dr. Ales Ryska is the editor.

Dr. Yuri: Oh, so you see, you click on it and it show you this field where you can put your name and already pre-populated… pre-populated message that Dr. Ryska, I would like to, I’m interested to become a contributors. Please send me the link and you click, “I’m not on Robot”, and you submit it. Okay. And the editor will receive your email.

And will send you a link. Using that link, you have to, you can go in, you as a contributor, you have to register, but it’s only…

It’s very, it take you two minutes, you register and you are ready to upload the keys into the World Tumor Registry. After you upload the case, it’ll go to the editor. For review and he or she will let you know if case is complete or you need more information, your quality is acceptable, [00:12:00] and so on and so forth.

And if everything is looks good, he or she will send it to, for final approval to the editorial board. And when it’s approved, it’ll be appear in a public folder and available for everybody to search to, to see, and to learn from that case.

Aleks: So a few questions here. First of all, I need to upload that whole slide image of this case, right?

Dr. Yuri: Got it. 

Aleks: Do we have any requirements? What kind of image does it need to be? What magnification is 20x? Okay. Or does it need to be 40x or are we flexible?

Dr. Yuri: All very good questions. We require 40x magnification. We are building it for the future. We eventually will have AI help in recognizing and matching the images.

So we require 40x resolution. I know that it’s a limitation for some areas but again. [00:13:00] We have to, it has to be, this is the only requirement that we have. This the case, get they identified during the uploading and also will be further reviewed by editors to be sure that there is no patient identifiers are present.

We require a number of metadata, like patient age, gender. Minimal, there is no requirement. If some of this information is not available, this is not a problem to still to upload it. Fundamentally, we need a high quality representative digital slide. In order to accept this case to the WTR.

Aleks: So once I get my slide, get hold of my slides, I will have a way to digitize them.

But what if somebody does not, can contribute a case, but they don’t have an option to digitize? Is there an option to send them somewhere for digitization? Did you guys think about it? 

Dr. Yuri: Yes 

Aleks: Did you have cases like that? [00:14:00]

Dr. Yuri: We are actively thinking about it. And I want to remind everyone that. WCR is a still pretty young organization.

We, we were incorporated as a nonprofit in 21, but we went live in March of this year, 2024. So this is a our list to create centers, like you said, for digitalization, particularly in the areas of the world where. Scanners are not so easy to find right now. It works in a way that, that the who would, who has an interest in rare case, has to contact the editor and ask editor to scan the slide on the behalf, which, we, we virtually all the editors can do.

Aleks: So basically if I wanted, let’s say I can send my slides to Dr. Ryska and he has the ability to digitize them.

Dr, Yuri: That’s correct. 

Aleks: Which, I would be a contributor [00:15:00] and a patient at the same time, but that would be super cool for me as a patient because I would have an option to basically look at my case on the internet, I would know that it’s mine because I submitted it. Other people would not know that it’s mine. That’s correct. But but let’s say let’s talk about it because let’s say somebody let’s say I was diagnosed with I think it was follicular carcinoma. So I can go there and find follicular carcinomas and ask a pathologist.

Can you show me the features of the tumor?

Dr. Yuri: That’s correct. This educational resource has several potential user groups of potential users. Yes. Let’s talk about them. Obviously the main still pathologists, pathology, trainees, because we believe that this [00:16:00] will be enormously helpful resource.

For people who are in training, particularly when we are talking about learning some rare tumor types because. A number, there are a number of common tumor types, but there are some very rare, I give an example is angiosarcoma, thyroid angiosarcoma. I’ve been practicing for close to 30 years. 

Aleks: That’s fine.

Dr. Yuri: In real life, I’ve seen maybe two cases of to of thyroid angiosarcoma, and then here, now if you look at the registry, if you, for example, want, we can also take a look and we see we already have several cases. If you can go to yes. Tumor type and. You will see common then uncommon tumors.

Second group

Aleks: common, and then we have uncommon, and I see the angio… angiosarcoma

Dr. Yuri: and you click on Angiosarcoma.

Aleks: We search and there are literally, what, five cases? 1, 2, 3, 5. 

Dr. Yuri: Already you see five. And I, again, I tell you in all my practice, I’ve seen two [00:17:00] cases. 

Aleks: How many years have you been practicing, Yuri? 

Dr. Yuri: I’ve practicing a good number of years and just out of, curiosity, if you go on in the upper right corner, you can switch to like, to a different Yes.

Click on the next. It’s like next format. Yeah. This one.

Aleks: So we can switch on a list mode. We can see the thumbnails of those tumors. We can have a list with that is sorted by metadata and we can see which country these tumors come from.

Dr. Yuri: Exactly. You see it’s from Brazil, United States, South Africa.

So from really, that’s what really, so again, I mean talking and you can click on any of these cases. For example, to further to look, so basically this is a rare tumor and imagine pathology trainees going through there. Educational activities and [00:18:00] they want to learn how thyroid angiosarcoma looks, that would be the amazing resource. There are already five cases and at that will be many more because we are still at relatively early stage and you see how this tumor looks. That what patient age and how you see immunohistochemistry here, how it is, and even in Histochemical slide.

So truly is, this is the way. That’s where we feel that it’ll be a major breakthrough in, in, in training and education. So because you really can learn rare tumors and rare presentations of common tumors because this is when this pathologist struggles the most. Okay. So one application is for pathologists, pathology trainees, and even practicing pathologists when they see something that they’re not sure what is this.

And we also may later talk about another search engine, which use microscopic features. I think it’s also very exciting. [00:19:00] Or we can look now. 

Aleks: Yes. So currently we can search by basically by the metadata, by text by organ. Currently we have thyroid, but there is already other candidates.

Oh, question, how long did it take you to assemble the thyroid and how many cases do we have there at the moment?

Dr. Yuri: So if you. Go again. Start from the very beginning. You will see it’s 800 something cases. But this all good question. Questions. It took us about a year to assemble the editorial board. And prepare the backbone platform, which now will take much less time to start uploading keys.

But finishing this sort of, you can see, so one, one group of users are pathologist and pathology trainees who can search it by diagnosis. And we already saw how we can, who can search [00:20:00] specific cohorts, what are specific cohorts, for example, in. Thyroid. We know that there are tumors that develop in children after Chernobyl accident.

Okay. Yes. So if you…

Aleks: I suspect mine was from this cohort.

Dr. Yuri: And this tumors they look little bit differently. That will be another very important application. If you, now there are about 20, 20 cases of tumors in post Chernobyl. Somebody can go and look specific on this cohort. And to your question, how do you find is a total case is eight to five.

So we have. Now 800 plus cases. The goal is eventual goal. When this registry will be full thyroid register, we expect to have between three to 4,000 cases and at with all this information from all over the world.

Aleks: Per organ?

Dr. Yuri: Yes, for per organ. So it’ll be only for thyroid, so it’ll be. 10 unjust sarcomas [00:21:00] and 10 plus the thyroblastoma, which are exceedingly rare tumors.

And there will be hundreds of common tumor types from all over the world that you can search. You can search by location, by region of the world. By age group, by environmental setting, but any by anything you want to really come closest to something that you really want to study and understand better.

Aleks: So how do we find this posture novel cohort? 

Dr. Yuri: There are several ways to do it. One you see here is written environmental setting. 

Aleks: Yes. 

Dr. Yuri: Go there and check if, click and see if it’s expand and will show you the posture. Noble,

Aleks: It just says environmental setting. Yes. I don’t know what else. 

Dr. Yuri: So this is one way to do it.

The second, the easiest way is if you go back to the screen when we, there is a three different search options.

Aleks: Search specific cohorts. [00:22:00]

Dr. Yuri: Right click on search specific cohorts.

Aleks: Oh, and there is poster novel thyroid tumor view cases.

Dr. Yuri: Okay. And right now there is only one, but eventually will be more.

And then you click on this. I’m not sure usually why it takes a long time, but it should be close to 20 cases we have now. 

Aleks: Yes. 

Dr. Yuri: Specifically on this. 

Aleks: Yes. It’s 21. I see it. See, this is typical case. So I’m reading one typical case of poster novel pediatric thyroid cancer developed early five to seven years after exposure mixed follicular or popular.

So my I had my tumor diagnosed when I was. 20, maybe 21. Now I’m 40 years old. Would this still qualify? And I was born in 84 and the catastrophe was in 86.

Dr. Yuri: The, you were in a [00:23:00] very vulnerable age because the young child, children were at the time of Chornobyl, the high, the higher risk of developing cancer, it’s still low, but it’s higher.

Follicular carcinoma is not very, is not most typical, but I suspect that you probably had follicular variant of papillary carcinoma. This is more likely…

Aleks: I will find it now. I’m so motivated to go back to the hospital and get the blocks.

Dr. Yuri: And also, by the way, most of the tumors associated with radiation exposure, they’re driven by gene fusions, not by point mutations.

So for that reason, this is also another indirect. Indirect evidence that this is like more likely to be associated with radiation explosion.

Aleks: So if I get hold of it and we can do molecular the NextGen sequencing, then we will be able to, say with higher probability that it was associated with the Chornobyl catastrophe. [00:24:00]

Dr. Yuri: That’s correct. 

Aleks: Interesting. Yeah. Go ahead.

Dr. Yuri: If we go back and we complete this sort of discussion of how it’s helpful for trainees, so for even practice and pathologists, yes. If you go, please go back to screen to the screen where there are three search options and I just want to show another and we look at the third option.

So imagine the situation when pathologist or pathology trainees. Look at the case. Look at the tumor, and not sure there are some. Features that are recognizable on the microscope as there is, but she or he is not sure what really we are dealing with. This is an help help, which eventually we hope to supplement with the AI function, but now with, human intelligence.

Dr. Yuri: So this is a classifier based on the, my 30 years of experience in looking in diagnosing thyroid tumors. But also, you should go ahead and just fill out this few questions patient age. [00:25:00]

Aleks: So for example… 

Dr. Yuri: family history, let’s say, and then history. Simple. Same tumor capsule? Yes. No. Growth pattern.

Aleks: Yes. 

Dr. Yuri: Features of  nuclei. If you want, you can click. It’ll be random, and if you go through it and just click… 

Aleks: I know I did have a capsule. I remember.

Aleks: So I actually I had to I had one of my thyroid lobe removed with the tumor, and then I remember taking it. To my anatomic pathology professor at vet school in ros, and he, we would look at it together under the microscope and he showed me the tumor, he showed me the capsule and he showed me how it was actually crossing the capsule.

That’s why I need to go back to the surgery room and had the other… 

Dr. Yuri: Alex, let’s slope removed. Let’s try to say, okay. Tumor capsule, clip capsule. Small fourth of capsule invasion only. Okay. [00:26:00] Then that’s continue growth pattern.

So you said that follicular, so let’s assume that it’s follicular.

Aleks: I, I think so. 

Dr. Yuri: Follicular. Less than 1% papilla. Okay. You click then cell shape. Typically it’s the first one. cuboidal or polygonal shape, you can click on it. Then we continue cytoplasm. Typically it’s as in ensinophilic cytoplasm. Okay.

Aleks: Okay.

Dr. Yuri: And remember that you don’t even need to click on all of them. Then nuclear appear.

Nuclear appearance. Here is a question that is, it was monomorphic uniform or it was significant variability in size and shape. Let’s say it was Monomorphic uniform or. Okay. And then nuclear size, small if we believe that this was 40 kilo carcinoma, small and nuclear shape round, [00:27:00] and nuclear contour smooth.

And again, you see there are multiple round. And smooth and nuclear chromatin. Let’s say first or second, let’s clamped course. Let’s use the second one.

Aleks: And nuclear, a chromatin-clamped course. Okay.

Dr. Yuri: Okay. And then nuclear wall. Let’s skip. Let’s say you are not sure what to do. Let’s do the experiment.

You don’t say anything. And then human necrosis, you didn’t have, so last one, “No Necrosis” some of my body snow. That’s pretty much enough Then. Then scroll to the bottom. And click. Scroll to the bottom and click.

Dr. Yuri: Predict, diagnosis.

Aleks: Predict. Okay. Okay. 93% thyroid, follicular carcinoma, minimally invasive.

Dr. Yuri: Okay. [00:28:00] And then you can click on the this view and it takes you to this tumor type in the registry, and you can see then how this tumor looks. This is the helping tool that we are building for pathologies to make them better, not only learn, but also better diagnose cancer. Okay.

Aleks: Okay, so we have 13 cases here that we can look at, and that was, almost 20 years ago.

So I don’t remember anything else from that one slide. I will, I’ll try to find them at home, but, okay. Fantastic. 

Dr. Yuri: But can you talk conversation, so this is one group of users. This is a pathology, trainees, and practicing pathology. The second group of users. We believe that it’ll be helpful for cancer researchers who can really come.

And study to see how tumor looks on the microscope [00:29:00] associate them with the metadata, with the age, with the location, I mean with the geographic region, with environmental setting, and so on and so forth. And then the third group of user we believe are clinicians and patients. So if patient come to clinician a patient get diagnosed with a rare tumor I dunno, hynanicin trabecular tumor and patient wants to know how this tumor looks and how, like you said, based on what… what features it was diagnosed. Theoretically, clinician even can open the case and show an example and this patient, a patient even by herself or by himself can look and if they’re interested and to understand how this tumor diagnosed and how they look on the microscope.

Aleks: I think surprisingly more people that… that currently are even aware that they can look at it, will be interested. And I’ve recently heard a pathologist, [00:30:00] Dr. Lijah Jospeh, I think I mentioned this in a couple of episodes already. She started doing, clinics, pathology clinics for patients where she would invite the patients and she would do it either with the oncologist or just invite the patient and sit with them on a multi-headed scope. And I’m gonna have her on the podcast to talk about it as well.

But they were very interested in learning okay, how these cells look like, what does it make it malignant and not only this, I don’t know if I have the book in the back. Does that is Dr. Marilyn Bui and she wrote this book, The Healing Art of Pathology. I think because the accessibility of those slides is not that great, like compared with radiology, you always get your the x-ray of wherever bone you broke, right?

And then it heals and you’re good most of the time. And cancer [00:31:00] is a very mentally difficult to handle diagnosis. It used to be like a death sentence. Now we know a lot more and we know it’s not, but in many cases it still is. And on a psychological level for the patient seeing those images and like being able to figure out, even without the medical knowledge, but talking to somebody who looks and diagnoses those because pathology is the gateway to treatment and the pathologists are like. I dunno. I like to call them the unsung heroes of medicine. Nobody… very few people talk to their pathologist.

You usually, unless it’s a it’s a cytopathologist where they’re actually involved in the procedures. Usually patients don’t talk to them, but this pathology diagnosis, this image that they look at either under the microscope [00:32:00] or if they’re doing digital work, then on a digital slide is basically what determines what’s gonna happen next.

So I think patients are gonna be a big user group as well, and I don’t, I cannot predict how it’s gonna be used by them, but I think it’s gonna be something important for…

Dr. Yuri: We hope so. 

Aleks: …dealing with the disease Yes. And giving them access. To the image, even if it’s, not their very image, but the same type of disease and showing the features and explaining is gonna have a big impact on how to deal with the disease.

Many people don’t know. What cancer actually means.

Dr. Yuri: I can tell you even more. We are now entertaining. Another very interesting option actually two. We are thinking that in maybe six, seven months from now, when you go and look at the case, if you would like, for example, click on any of these cases, just. I just want to tell you [00:33:00] what we are thinking about.

Okay. So you open a case and you learn how to diagnose it. You learn features, but then next to the diagnosis you see here, popular carcinoma, minimally invasive. Next to it, there will be two buttons. Buttons. One will be linked to the video, how to diagnose, where it’ll be a person who will describe.

How really this type of cancer is diagnosed and, but most, even more exciting. The next it will be treatment. It’ll be a video. It’ll be a video to the link to YouTube channel, WTR YouTube channel where the chronologist or endocrin oncologist or surgeons will describe how this tumor type is typically treated.

This is even more information that we are going to embed and provide for the users.

Aleks: This is gonna be super empowering both for the for the doctors [00:34:00] and for the patients, especially now in the… In the time of ai, of accessibility of all information, it’s no longer like the doctor is no longer the gatekeeper of the information.

The doctor is your guide into, okay, what are the options an ultimately, you decide what the options are and you can decide for the classical treatment, you can decide for a totally alternative treatment. They like, there are cases of everything. And the doctor is now your guide. So I think it’s gonna be such a great unifying tool for physicians, pathologists oncologists and cancer patients. I think it’s… 

Dr. Yuri: That’s what we hope for and we hope for people recognize the importance of it and help and support also us and support of our mission.

Dr. Yuri: Because one of the fundamental principles of the, [00:35:00] of this organization is. We want to build tools that will be forever stay free for all users.

We don’t want to introduce any kind of limitations, subscription fee or something. We want to really be sure that this resource. Remain free for every month. For those pathologists who cannot afford textbooks or subscriptions to different diagnostic tools, they still will be able to freely use it, see cases that occur close to their regions, and make better diagnosis, as like you said, which is a basis for better treatment and for better patient outcome.

Aleks: I think it’s a good time to to call to this action because it’s end of the year. No, but taxes are in March, right? But still, it’s end of the year giving time, Thanksgiving in the US as of the time of this recording and Christmas coming up soon. So if you or your organization [00:36:00] like cancer treatment and fighting cancer is a cause that you wanna contribute to, there is an option to donate to keep it free forever.

We were talking last time that it, it costs significant amount of money to put this all together and maintain it. And it’s all based on donations. I did a small donation. I’m gonna do another one later, but. In the show notes or in the description of the video, we’re gonna or on the website, where can we find this link to donate?

Dr. Yuri: If you just look at the landing page, you should see a donate button, which is pretty prominently displayed. If you go to the landing page of the website,

Aleks: So when you go to the website, you can see on the right, in the right upper corner, you can donate and you will get a receipt. Is this donation tax deductible?

Yes, it is. [00:37:00] And you can claim donation as deduction. So for all those it’s a nonprofit and you can donate in different forms. And I’m gonna link this in that show notes and description as well, but it’s very visible on the website.

Aleks: And let’s talk about the website because this, for those who are familiar with the digital pathology software, like when I looked at it, I knew what it was built on.

It’s super clean, easy to navigate website that hosts like normal website. Components like about us, resources and all different things. But the most important thing is that it hosts whole slide images. Let’s talk about your partner in building this website, Yuri.

Dr. Yuri: Yes. That’s very important and we spend a significant amount of time, I mean we, token to different vendors and we ended up partnering this PathPresenter.

Which really we [00:38:00] like and I believe is one of the national international leaders. So in the. Manage… managing in building the system to manage digital slides. And they, and we work with them closely to build the platform as you can. If you, when, remember when we look at the cases, they still look differently because we applied a lot of customization.

We really ask to build this metadata part, which is a very different, and many search. Search options are very difficult, but the backbone of it and the how we can navigate and enlarge the slide and how they’re stored and how they’re managed. This is a PathPresenter platform.

Aleks: Super intuitive, super easy to navigate.

PathPresenter, you can have a free account on PathPresenter as well, but you have to log in. This is something where you don’t need to log in, you can just go and look at those cases. [00:39:00] I will be going on this website every now and then to basically show things on my YouTube channel as well.

And always mentioning you and giving you a shout-out. I think it’s a fantastic resource.

Dr. Yuri: Thank you. We appreciate, have any small, bigger support because again, we don’t have any, any commercial angle, we all care only about education and about providing a free resource for everyone. So any small, biggest support we can get, we deeply appreciate.

Aleks: Yuri, one question. Educational support and there is a very high quality standard implemented in submitting those cases. So let’s talk a little bit more about your editorial board and who they are and how are they curated those cases?

Dr. Yuri: So maybe we can go back to the sort of this map of the world and the the list of editors [00:40:00] who are there.

This… all editors, they’re basically, they’re volunteers. They are not getting paid in any way or form for this. So these are pathologists who are, have usually have a significant experience and are experts in that particular tumor type. So that’s the only requirement is that they have to be geographically diverse.

And not only geograph generally we are looking for diverse group of individuals, but they are all pathologists, practicing pathologists who typically practice in a relatively large centers, become experts and basically function as not only contributors, not only as submit their own cases, but they collect cases when somebody would like to submit the case, as we went before with you, [00:41:00] they select an editor submits the keys when receives the case. She or he will review it and look for. For first of all, image has to be good quality. Second image has to represent the diagnostic entity. If not, then they ask to submit more cases.

If it’s invasion not clear, please submit case with invasion. And when it’s fully, then all look at metadata. Certain cases need immunohistochemistry for diagnosis. Many cases don’t need. So when … when the editor is responsible to be sure that contributor provide all information needed to diagnose the case…

And at that point she or he will submit this case to the editorial board with the note. If it’s a typical case, they say typical case ready for publication, or they submit and they say case need, editorial board discussion. I can tell you for example, today, few us [00:42:00] earlier, we had a editorial board meeting and one interesting detail maybe will be interested for your audience.

There is very limited amount of very limited windows a day. Where you can have meetings where all editor can, parti… editors can participate. I can tell you we had it at eight o’clock of Easter standard time in the United States. You can do it from seven to nine. That’s your pretty much window. 

Aleks: Okay.

Dr. Yuri: Because this is a time when Andrey Bychkov and Zhiyan Liu in China they have the end of the day, they have 10, 11 o’clock and that’s pretty much the otherwise.

Aleks: Okay. I’m showing them on the screen here.

Dr. Yuri: Yeah.

Aleks: And Andrey was the person who told me about the World Tumor Registry in the first place. At USCAP in March.

Dr. Yuri: Yes. 

Aleks: When you guys launched. 

Dr. Yuri: And Zhiyan Liu is, she’s from China. She doing the amazing job also recruiting the young pathologists who are contributors. The difficult cases go to [00:43:00] the full editorial board of 21 people of review. So many cases still go directly from the editor to me as a chairperson, and I really would release them for publication.

Some will go through the discussion of the whole editorial board if the difficult cases. And when we agree on it, we then we go ahead and we we post it for public use.

Aleks: Wow. So how long does it take to let’s say, to submit a case that requires the full editorial review?

Dr. Yuri: If you’re talking about the contributor contribute case, really upload the case.

If you have a normal internet speed takes two to three minutes, add the metadata, takes several more minutes. When you have all information at hand, it’ll take you 10 minutes to upload the keys. Not a major. It’ll take editor depending on the how easy or how complex is the case. [00:44:00] Five to half an hour of time to really curate the case.

And then basically scenario goes up to the chairperson. It’ll take me another five minutes to get it, maybe to edit the note and it’ll go to the public side. Sometimes some cases require much longer time. It going back and forth. Editor, send back to the contributor, please add you stay.

Quality is not very good sometimes. Very simple thing. They scan the case, but the cover slip was dirty and there is too much dirt on the scan. We ask, could you please clean it? And you resubmit. So sometimes it take longer. But overall, like you said, and I’m glad that you feel that way, that we try to build a very intuitive system, which is a lot of areas are pre-populated, most of them are not.

Aleks: I love that you guys have already the email prepared, thats the best.

Dr. Yuri: Yes. So we really are trying to be very conscientious of people time. [00:45:00]

Dr. Yuri: But if you have an interesting case or rare case or from the countries that is underrepresented, please consider to contribute because it is all come to a common good to pathology education around the world, and eventually will help patient to make better diagnosis or better treatment.

Aleks: I love it. Thank you so much for joining me. Thank you for presenting this more in depth.

Aleks: And of course it’s the giving season, so here donate button if, cancer research, cancer treatment, cancer diagnosis is something that you wanna contribute to. This is a fantastic place to put some resources behind and I’m gonna link to this in the show notes.

Thank you so much. I am super excited about the development. We definitely need to meet maybe in a year or whenever you guys have new features about treatment and everything you told me about. And I wanna keep showing you to the people and also [00:46:00] make the patients aware that there is something like that.

Maybe they can if they know about it, they can also talk to their doctors, to their pathologist and say, “Hey, would it be possible to contribute the case?” Of course, if they feel comfortable, it’s gonna be de-identified. But it can help pathologists all over the world. It can help other patients, doctors, and together we can basically.

Cure cancer. Maybe we cannot cure cancer, but we can definitely contribute to better treatment, better diagnosis, treatment and patient care. And awareness. Awareness and education. Is the keyword here. Thank you so much.

Dr. Yuri: Thank you. Was pleasure being with you.

Aleks: Thank you so much for staying till the end.

It means you are a true digital pathology trailblazer. And as I said, if cancer research, cancer treatment, better cancer diagnosis is something that you care about. Visit the World Tumor Registry [00:57:00] website and find this donate button. Any donation, no merit. The amount will make a difference. And this is the first resource I’m encountering that actually unites everybody who’s involved in cancer patient care.

It unites the physicians, oncologists, and pathologists, and gives the patient also access to the information that is used. To diagnose their disease and determine treatment, you will be hearing more about it. So stay tuned and I’ll talk to you in the next episode.