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A monocular microscope used to view tissue samples in the past.
In today’s laboratories equipped with digital pathology systems, patient biopsies that have undergone various processing steps can be digitised and viewed on a computer screen, referred to as whole slide images – for example, this image of a breast ductal carcinoma in situ can be visualised on a screen.The history of pathology in Singapore began with the arrival of Dr George Alexander Finlayson in Singapore on 12 May 1903 to take up the appointment of Municipal Bacteriologist to handle the serious public health situation and infections in Singapore. In addition to treating infectious diseases, he also carried out histopathological examinations on tissue specimens and post-mortem autopsies.
Proposals by the colonial authorities for the formation of a “Pathological Department” began in 1905. The earliest record of the Department of Pathology was in 1907, at a site opposite the present College of Medicine Building.
The department survived two world wars, the second of which affected services severely. However, pathology services have since evolved and grown over the years into what is now SGH’s Division of Pathology.
Formed on 1 June 2016, the SGH Pathology Division encompasses the Departments of Anatomical Pathology, Clinical Pathology, Microbiology, and Molecular Pathology. This consolidation and reorganisation of multiple laboratories combine their strengths into larger departmental entities of different pathology subspecialties, underpinning all aspects of medical practice in the institution.
The cornerstone of modern medicine, pathology remains essential for diagnosis of diseases and patient management. Pathology services offered today have changed with the times to respond to the needs of today. Besides cancer, the majority of diseases now relate to ageing and chronic medical conditions.
Apart from increasing productivity, managing daily operational issues and continually expanding clinical test menus for patient care, the Division is able to respond quickly to clinical requests and tap into emerging technologies that can aid pathology service delivery.
Recently, SGH and Royal Philips established the SGH Digital and Computational Pathology Centre of Excellence to advance pathology practices by aiming to implement a fully digital histopathology workflow and deploying artificial intelligence (AI) to increase productivity and enhance patient care. Not only will full digitisation save over 12,000 man-hours each year, it will allow SGH to further its research in AI. AI-based tools can assist pathologists in diagnosing diseases such as cancer, the leading cause of death in Singapore.
Infectious disease outbreaks continue to occur. But the nature of these diseases has changed. While community-acquired diseases like cholera and dysentery are now well-controlled, multi-drug resistant bacteria and emerging infectious pathogens are challenges in recent years. These include novel diseases such as Nipah virus in 1999, Severe Acute Respiratory Syndrome (SARS) in 2003, H1N1 in 2009, Zika in 2016, and the current Coronavirus Disease 2019 (COVID-19).
In 2003, during the SARS outbreak, the virology laboratory was able to culture the virus, confirming it to be the new SARS virus, and could quickly develop an in-house polymerase chain reaction (PCR) test, which was instrumental in diagnosing cases before any commercial kits were available.
Recognising the need for new diagnostic platforms using molecular tests to supplement conventional ones, the Molecular Pathology laboratory was set up in July 2006. This enabled rapid diagnosis of infectious diseases, including novel infections. The Molecular Pathology laboratory was well prepared when COVID-19 arrived in Singapore, and used an in-house PCR test to diagnose the first COVID-19 case in Singapore on 23 January 2020. Besides infectious diseases, molecular tests are now used in cancer management. Next-generation sequencing (NGS) can detect tumour biomarkers in cancer cells, enabling more specific diagnosis and individualised treatment for patients.
Just as the Pathology Department was set up at the turn of the 20th century to address the dire public health situation at that time, the Division of Pathology today strives to keep abreast of developments and technological advancements to meet current and anticipated future laboratory needs of our patients.