Digital twin manifesto for the pathology laboratory.

This manuscript presents a manifesto developed by a multifaceted board of stakeholders aimed at guiding the implementation of Digital Twin (DT) technology in pathology laboratories. DTs, already transformative in other sectors, hold substantial promise for enhancing operational efficiency, diagnostic accuracy, and quality of care in pathology. We provide a comparative analysis of traditional versus DT-enhanced workflows across critical steps including accessioning, grossing, processing, embedding, cutting, staining, scanning, diagnosis, and archiving. The framework highlights measurable gains such as up to 90% reduction in labeling errors, 20-30% improvements in slide quality, and 30-50% reductions in diagnostic turnaround time. Alongside these benefits, we address key implementation challenges including upfront infrastructure costs, workforce adaptation, and data security concerns. A practical, phased deployment strategy is proposed-centered on LIS integration, IoT sensors, AI modules, and robust data governance. Estimated setup costs for a medium-sized laboratory range between USD 100,000 and USD 200,000, with a phased rollout timeline of 12-24 months. Supporting technologies like robotic process automation (RPA), collaborative robotics, and edge computing are also discussed as enablers of successful DT adoption. The manifesto closes by identifying critical research gaps, including the need for longitudinal studies evaluating DTs' clinical and economic impacts, integration within existing hospital IT systems, and ethical implications of AI-assisted diagnostics. Through this collective vision, we provide a realistic and actionable roadmap to drive the transition toward predictive, efficient, and digitally optimized pathology laboratories.