"Pathologists in Venice - Real World Cases for an Immersive Training Experience": Education, Gaming, and Show.

The meeting gathered 112 participants from all around the world ( Fig. 1 ). The event was set in the breathtaking venue of the “Angels Hall” of the S.S. Giovanni and Paolo Hospital in Venice ( Fig. 2 ). Four worldwide acknowledged experts in different fields of pathology met there, namely: Prof. Liron Pantanowitz (cytopathology), Prof. Fatima Carneiro (gastrointestinal - GI - pathology), Prof. Stuart J. Schnitt (breast pathology), and Prof. Angelo Paolo Dei Tos (soft tissue pathology). The event was structured in four sections, each of which consisted of a didactic lecture by the expert followed by an interactive gaming session involving case quizzes and discussions. As for the latter gaming segment, each expert was assisted by the following case manager for the design of the gaming session and its exposure: Dr. Stefano Marletta (Prof. Pantanowitz), Prof. Matteo Fassan and Dr. Valentina Angerilli (Prof. Carneiro), Dr. Vincenzo L'Imperio (Prof. Schnitt), and Dr. Elena Bellan (Prof. Dei Tos). Throughout the whole proceedings, the content was enriched with lightshows, music, fog machines, and videos created by the directors. Fig. 1 Infographic illustrating the characteristics of the participants in the “Pathologists in Venice” event. Fig. 1 Fig. 2 A 360-degree projection system let the experts show their presentations, challenging case discussions, gamification, and shows (A). The venue: the wonderful “Angels Hall” of the SS. Giovanni and Paolo Hospital (A). The adjacent room where coffee breaks and lunches were served, in the wonderful location of S.S. Giovanni and Paolo Hospital in Venice (C). Fig. 2 Infographic illustrating the characteristics of the participants in the “Pathologists in Venice” event. A 360-degree projection system let the experts show their presentations, challenging case discussions, gamification, and shows (A). The venue: the wonderful “Angels Hall” of the SS. Giovanni and Paolo Hospital (A). The adjacent room where coffee breaks and lunches were served, in the wonderful location of S.S. Giovanni and Paolo Hospital in Venice (C).

The international meeting “Pathologists in Venice: Real World Cases for an Immersive Training Experience” successfully brought internationally recognized opinion leaders in various fields of pathology to Venice. Its innovative design, based on the use of WSIs and state-of-the-art technologies in an interactive lecture and gaming format, provided a great opportunity for participants from around the world to engage with experts and colleagues on emerging issues in current pathology practice.

Nowadays, practicing pathologists' routine workflow is overwhelmed by a constant increase in the predictive data required for targeted therapies, the non-stop evolution of disease classifications, and the widespread shortage of professionals. In this setting, technology such as DP, WSI, and AI play a critical role in relieving physicians from cumbersome tasks and enabling them to share challenging cases with experienced colleagues. Additionally, telepathology and web-based platforms are highly beneficial for educational purposes, enhancing physicians' access to dedicated datasets and expanding their knowledge. 13 In light of these developments, the gaming sessions at the aforementioned Venice meeting, including the real-time navigation of WSIs using PathPresenter exemplify how DP can be exploited to showcase real-world cases for educational purposes. Like previous pathology interactive symposia, 14 , 15 the gaming design of this congress was surely one of the contributors to its success by continuously engaging the attendees. In addition, the conference provided an invaluable opportunity for participants to relate with global opinion leaders in pathology. In the modern era of progressively expanding technology and molecular-driven classifications, two main themes emerged from the meeting: (i) as stressed by the GI talk of Prof. Carneiro and the soft-tissue presentation of Prof. Dei Tos, a reasoning-guided approach is essential to handling intriguing cases, regardless of the complexity of the novel classification systems; and (ii) the AI revolution in pathology is already underway, and physicians should accordingly begin to embrace these tools to enhance their own diagnostic performance and reduce routine workload, as underpinned by Prof. Pantanowitz's and Prof. Schnitt's lectures in cytopathology and breast pathology, respectively. Indeed, several questions remain to be addressed, such as the adoption of generative AI to support diagnosis reporting and dataset creation, as well as the identification of proper morphological features and reliable biomarkers to deal with some “gray zone” pathology cases. Nevertheless, the main take-home message of the meeting was that integrating a morphology-based approach with newer technology such as DP and AI are the key to facing the most challenging issues in pathologists' daily practice.

In recent decades, digital pathology (DP) and whole slide imaging (WSI) have revolutionized the way pathologists approach histology and cytology cases. 1 Initially limited to research purposes, significant efforts have recently been made by the international community to validate the use of DP and WSI for primary diagnosis. 2 , 3 Beyond the ability to zoom, navigate, and manipulate digital slides on computer monitors, one of the main strengths of DP and WSI is the ease of remotely sharing cases (i.e., telepathology). 4 In the current era of precision medicine, where physicians are expected to provide extensive predictive quantitative data alongside pathological diagnoses, telepathology enables them to quickly obtain trusted second opinions from experienced colleagues on challenging cases and machine learning allows them to provide accurate image analysis. 5 , 6 Additionally, scanning and storing WSI facilitates the creation of extensive teaching datasets for educational purposes, allowing students, residents, and graduated professionals to easily access and explore private or public digital slide repositories. 7 , 8 In this setting, combining WSI with modern informatics tools has the potential to widen DP education for a myriad of use cases including training in residency programs and continuing education meetings. Finally, digitized slides facilitate the application of artificial intelligence (AI)-based algorithm, whose disruptive impact is already changing pathologists' workflow. 9 , 10 , 11 , 12 Leveraging the advances of WSI and the current ubiquity of DP, an international meeting titled “Pathologists in Venice: Real World Cases for an Immersive Training Experience” was organized by Medica (Milan) and held in Venice, Italy, on December 12–13, 2024. The event featured four globally recognized opinion leaders in various fields of pathology, referred to as the “experts.” This meeting aimed to provide participants with the opportunity to benefit from the experts' lectures on crucial, compelling, and cutting-edge issues in daily practice. Additionally, using an innovative DP platform coupled with scanned WSIs, engaging interactive gaming sessions were designed to challenge attendees with dilemmas posed by the speakers, ultimately enhancing their learning and participation experience.

The Authors declare no conflict of interest.

Each session was opened by a keynote lecture by the masters, addressing pivotal topics related to specific advances, triumphs, and challenges in different fields of pathology. • Cytopathology: The meeting began with the lecture “Evolving Horizons in Cytopathology” by Prof. Pantanowitz, who reviewed current commercial and next-generation applications of DP and AI that deal with cytological specimens. By focusing on his experience with AI-assisted Pap test screening, which represents the most investigated field of DP cytology so far, Prof. Pantanowitz underlined how computer-based tools may safely lessen pathologists' screening workload without compromising accuracy, along with improving their turn-around times. • GI pathology: Later that day, Prof. Carneiro delivered a brilliant lecture entitled “Pearls and Pitfalls in Gastrointestinal Pathology.” During her comprehensive talk, Prof. Carneiro outlined how common and rare pathological findings in gastric cancer may stump both expert GI pathologists and general pathologists in practice. By reporting real-world scenarios, she elegantly showed how a practical approach relying on morphology and occasionally ancillary studies (e.g., immunophenotypic findings) is key to figuring such challenging situations out. • Breast pathology: Prof. Schnitt opened the conference the next day with his lecture entitled “Breakthroughs in Breast Pathology: A Transformative Journey”. Using an evidence-based approach, Prof. Schnitt highlighted how the adoption of AI systems is capable of enhancing a pathology professionals' ability to perform many breast pathology time-consuming tasks, such as the detection of microinvasion in ductal in situ carcinoma, identification of small metastatic foci in axillary lymph nodes, and reliably scoring HER2, among others. • Soft tissue pathology: The lecture series was concluded in the afternoon with Prof. Dei Tos's talk “Frontiers of Soft Tissue Pathology: Exploring Key Advances and Diagnoses.” In his lecture, he focused on possible pitfalls in soft tissue pathology, explaining the key features that can help distinguish benign from atypical and malignant lesions in this challenging field of pathology. Prof. Dei Tos ended his presentation with a moving tribute to Prof. Christopher Fletcher, one the greatest soft tissue pathologists ever, who had recently passed away. Cytopathology: The meeting began with the lecture “Evolving Horizons in Cytopathology” by Prof. Pantanowitz, who reviewed current commercial and next-generation applications of DP and AI that deal with cytological specimens. By focusing on his experience with AI-assisted Pap test screening, which represents the most investigated field of DP cytology so far, Prof. Pantanowitz underlined how computer-based tools may safely lessen pathologists' screening workload without compromising accuracy, along with improving their turn-around times. GI pathology: Later that day, Prof. Carneiro delivered a brilliant lecture entitled “Pearls and Pitfalls in Gastrointestinal Pathology.” During her comprehensive talk, Prof. Carneiro outlined how common and rare pathological findings in gastric cancer may stump both expert GI pathologists and general pathologists in practice. By reporting real-world scenarios, she elegantly showed how a practical approach relying on morphology and occasionally ancillary studies (e.g., immunophenotypic findings) is key to figuring such challenging situations out. Breast pathology: Prof. Schnitt opened the conference the next day with his lecture entitled “Breakthroughs in Breast Pathology: A Transformative Journey”. Using an evidence-based approach, Prof. Schnitt highlighted how the adoption of AI systems is capable of enhancing a pathology professionals' ability to perform many breast pathology time-consuming tasks, such as the detection of microinvasion in ductal in situ carcinoma, identification of small metastatic foci in axillary lymph nodes, and reliably scoring HER2, among others. Soft tissue pathology: The lecture series was concluded in the afternoon with Prof. Dei Tos's talk “Frontiers of Soft Tissue Pathology: Exploring Key Advances and Diagnoses.” In his lecture, he focused on possible pitfalls in soft tissue pathology, explaining the key features that can help distinguish benign from atypical and malignant lesions in this challenging field of pathology. Prof. Dei Tos ended his presentation with a moving tribute to Prof. Christopher Fletcher, one the greatest soft tissue pathologists ever, who had recently passed away. In the months leading up to the meeting, each master provided their respective manager with 10 challenging WSI cases, which were then uploaded to the PathPresenter platform. This tool enabled real-time navigation and annotation of scanned slides, as well as the ability to link and incorporate them online with PowerPoint presentations ( Fig. 3 a). During the onsite gaming sessions, the PathPresenter format allowed masters and their assigned case managers to seamlessly switch between PowerPoint slides and WSI. Concurrently, a specific multiple-choice question for each case was displayed separately using the Mentimeter application. This interactive polling software allowed quizzes and real-time polls to be integrated into presentations. Participants were invited to scan QR codes on their smartphones and tablets to select their answers ( Fig. 3 b). For each gaming session, attendees were ranked based on the number of correct answers and the speed of their selections, with winners in each field being awarded at the end of the meeting. Fig. 3 Example of gaming session with cases presented by the expert: Prof. Schnitt showing a sample in which double immunohistochemistry could help distinguish two different components of the investigated lesion (A). After each case, a few seconds were dedicated to a specific question related to it for which the attendees had the chance to participate through their smartphones (B). After the question, the expert took the chance to explain the reasons for the correct and wrong answers through the employment of WSI and PathPresenter (c). At the end of each session, futuristic videos with music were projected through the entire hall to provide a further immersive show experience to the audience (D). Fig. 3 Example of gaming session with cases presented by the expert: Prof. Schnitt showing a sample in which double immunohistochemistry could help distinguish two different components of the investigated lesion (A). After each case, a few seconds were dedicated to a specific question related to it for which the attendees had the chance to participate through their smartphones (B). After the question, the expert took the chance to explain the reasons for the correct and wrong answers through the employment of WSI and PathPresenter (c). At the end of each session, futuristic videos with music were projected through the entire hall to provide a further immersive show experience to the audience (D). The gaming sessions unfolded as follows: • Cytopathology: Supported by Dr. Marletta, Prof. Pantanowitz showed a collection of cytology smears and/or touch preparations and cell block WSIs of difficult samples such as non-diagnostic liver, high-grade lung neuroendocrine carcinoma with mixed small and large carcinoma, and para-pharyngeal meningioma. The cytopathology competition was won by Dr. Claribel Cardozo from the United Kingdom. • GI pathology: With the collaboration of Dr. Angerilli, Prof. Carneiro and Prof. Matteo Fassan challenged the audience with a series of benign and malignant pitfalls from the GI tract, including clear/glass change in gastric glands, appendiceal endometriosis, and NSAID-induced enteropathy and diaphragm disease. The session was won by Dr. Stefano Gobbo from Italy. • Breast pathology: In concert with Dr. L'Imperio, Prof. Schnitt presented a series of breast pathology cases providing insights into the key diagnostic elements that could help distinguish specific breast lesions from their mimickers. Interestingly, some of these unique cases, characterized by hallmark morphological and molecular alterations, in recent years, have further revised and expanded breast tumor classification. The breast competition was won by Dr. Aoife Maguire from Ireland and by Dr. Alice Vanzati from Italy. • Soft tissue pathology: Dr. Bellan's assistance allowed Prof. Dei Tos to show different cases of soft tissue pathology specifically selected because they are known to challenge pathologists owing to their overlap with other entities. They demonstrated how ancillary techniques such as immunohistochemistry and molecular analysis are complementary to morphological assessment of these lesions ( Fig. 3 c). Moreover, a discussion ensued on the role of the newly defined molecularly based entities, that stemmed from some of the cases presented in this session. This gaming phase was won by Dr. Jacopo Asti from Italy. Cytopathology: Supported by Dr. Marletta, Prof. Pantanowitz showed a collection of cytology smears and/or touch preparations and cell block WSIs of difficult samples such as non-diagnostic liver, high-grade lung neuroendocrine carcinoma with mixed small and large carcinoma, and para-pharyngeal meningioma. The cytopathology competition was won by Dr. Claribel Cardozo from the United Kingdom. GI pathology: With the collaboration of Dr. Angerilli, Prof. Carneiro and Prof. Matteo Fassan challenged the audience with a series of benign and malignant pitfalls from the GI tract, including clear/glass change in gastric glands, appendiceal endometriosis, and NSAID-induced enteropathy and diaphragm disease. The session was won by Dr. Stefano Gobbo from Italy. Breast pathology: In concert with Dr. L'Imperio, Prof. Schnitt presented a series of breast pathology cases providing insights into the key diagnostic elements that could help distinguish specific breast lesions from their mimickers. Interestingly, some of these unique cases, characterized by hallmark morphological and molecular alterations, in recent years, have further revised and expanded breast tumor classification. The breast competition was won by Dr. Aoife Maguire from Ireland and by Dr. Alice Vanzati from Italy. Soft tissue pathology: Dr. Bellan's assistance allowed Prof. Dei Tos to show different cases of soft tissue pathology specifically selected because they are known to challenge pathologists owing to their overlap with other entities. They demonstrated how ancillary techniques such as immunohistochemistry and molecular analysis are complementary to morphological assessment of these lesions ( Fig. 3 c). Moreover, a discussion ensued on the role of the newly defined molecularly based entities, that stemmed from some of the cases presented in this session. This gaming phase was won by Dr. Jacopo Asti from Italy. Alongside the educational content of the program, the meeting also featured an entertaining show. An established collaboration between the faculty and organizers set the stage for dazzling scenography. An extensive backstage informatics work, relying on the employment of publicly available generative AI-programs, was the key for the design and realization of a backbone show structure of the whole meeting. Combined with the use of the PathPresenter platform, such a format allowed the audience to enjoy a seamless transition between lectures, gaming sessions, and navigation of WSIs in real-time directly on the venue's walls, enhancing their viewing experience. Additionally, the masters and quiz winners were announced in an Oscars-like fashion, complete with suspenseful music. To cap off the first day, a stunning computer-generated video depicted the masters arriving in a futuristic Venice for the year 2100, aligning the content with the cutting-edge AI topics discussed ( Fig. 3 d).