Hiroyuki Kusano, Takayuki Shiomi
Digital pathology has rapidly expanded over the past decade, driven by advances in whole-slide imaging and increasing demand for remote and data-integrated diagnostic workflows. However, many implementations remain limited to partial digitization, without fundamentally transforming laboratory and diagnostic processes. In this review, we examine digital transformation in pathology as a systems-level redesign encompassing workflow optimization, digital infrastructure, and networked diagnostic services. Using the implementation at International University of Health and Welfare (IUHW) Narita Hospital as an illustrative example, we describe how a digital-first approach can be integrated into routine clinical practice. Key elements include continuous laboratory workflows aligned with slide digitization, comprehensive digital infrastructure enabling seamless access to diagnostic data, and networked systems that support multi-institutional collaboration and subspecialty consultation. We further discuss how digital pathology extends beyond clinical diagnosis to support education and research, transforming traditional slide archives into accessible data resources, and outline practical considerations for implementation, including workflow redesign, user adoption, and institutional coordination. Finally, by comparing the IUHW Narita experience with other large-scale implementations, we discuss generalizable principles for digital transformation in pathology, including workflow-driven design, data integration, interoperability, and network-based diagnostic models.