Concordance between whole-slide imaging and light microscopy for routine surgical pathology

Campbell, W. Scott; Lele, Subodh M.; West, William W.; Lazenby, Audrey J.; Smith, Lynette M.; Hinrichs, Steven H.

doi:10.1016/j.humpath.2011.12.023

Cited by 82 publications

(72 citation statements)

References 26 publications

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“…In the present study, we noted a significant improvement in accuracy, which we believed to be the result of improved training and experience when the efforts changed from a feasibility study toward the development of an actual clinical service. The adjusted WSI major discrepancy rate in our study of 2.7% (2 of 74) by case is similar to the Bauer et al 8 results of 1.65% (5 of 303) and to the Campbell et al 13 results of 1.5% (3 of 212) for primary diagnosis. The results of these studies and ours are notably better than the average agreement rates found in the Pantanowitz et al 17 statistical meta-analysis of the publications to date, given in the College of American Pathologists guidelines for WSI validation, which showed WSI to be 3% (89% versus 92%) less accurate than GS examination, which is noteworthy because the clinical trial presented here was on intrinsically more difficult, consultation cases.…”

Section: Commentsupporting

confidence: 90%

“…Other possible explanations for that result include changes related to practice behavior, such as spending more time on the WSI, novelty-induced interest, or, potentially, viewing cases at higher magnifications. Studies of nonconsult-grade cases among multiple subspecialties, [7][8][9]13,14 and consult-grade cases among a single subspecialty 3,15,16 have been published previously. The only other study 12 that addresses consult-grade cases of multiple subspecialties, to our knowledge, showed a 91% agreement rate (48 of 53) between WSI and GS interpretation for a population of cases selected for difficulty from an outside institution.…”

Section: Commentmentioning

confidence: 99%

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Interinstitutional Whole Slide Imaging Teleconsultation Service Development: Assessment Using Internal Training and Clinical Consultation Cases

Jones

Nazarian

Duncan

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Assessment of accuracy and feasibility of whole slide imaging (WSI) for interinstitutional consultation in surgical pathology.Objectives.-To train technical and pathologist staff in WSI technology, establish and evaluate a WSI workflow using training cases and second-opinion consultations, and assess diagnostic accuracy.Design.-First, WSI training and evaluation using selected subspecialty service cases were performed and compared with the clinical glass slide (GS) diagnosis. Second, WSI and GS diagnoses of consecutive, secondopinion consultation cases were compared. Discrepancies underwent adjudication to determine a reference diagnosis. Participant observations on WSI initiation to practice were gathered.Results.-There were 130 cases evaluated, with 123 correlations (94.6%) and 6 minor (4.6%) and 1 major (0.8%) discrepancies. The 74 consultation cases interpreted had 52 correlations (70.3%), and 18 minor (24.3%) and 4 major (5.4%) discrepancies. The WSI and GS adjusted major discrepancy rates in second-opinion consultations were 2.7% (2 of 74) and 4.1% (3 of 74), respectively. Statistical analysis showed that WSI was not inferior to GS interpretation. Pathologists agreed the software was easy to use and the images were adequate, but more time was spent rendering WSI interpretations.Conclusions.-A significant learning curve was observed in the transition from the training set to clinical consultation cases associated both with WSI interpretation and adjustments to the digital analogs of routine GS workflow. Results from second-opinion consultations indicated that WSI interpretation was as accurate as GS interpretation among properly trained and experienced users. Overall, WSI-based practice appears feasible for second-opinion consultations.(Arch Pathol Lab Med. 2015;139:627-635; doi: 10.5858/ arpa.2014-0133-OA) T he use of whole slide imaging (WSI) technology for surgical pathology diagnosis is being investigated in many laboratories around the world. Improvements in the technology during the past several years, coupled with better understanding of pitfalls and caveats of the digital pathology environment and reduced costs for instrumentation, networking, and memory, have allowed for a greater understanding of the promise and the remaining challenges. Many studies have shown potential alternatives or improvements to traditional pathology practice through use of WSI technology in intraoperative frozen section interpretations, 1-3 image analysis applications with hematoxylin-eosin stains 4 and immunohistochemical and special stains, 5 in archiving and quality assurance programs, 6,7 for primary diagnosis, 8,9 for potential laboratory workflow improvements and pathologist ergonomics, 10 with laser-capture microdissection 11 (and thus burgeoning molecular testing methods), and for consultation purposes. 12Teleconsultation with WSI could improve consultation services by dramatically decreasing the turnaround time, compared with shipping glass slides; decrease the amount of pathologist labor required in inte...

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Section: Commentsupporting

confidence: 90%

Section: Commentmentioning

confidence: 99%

Interinstitutional Whole Slide Imaging Teleconsultation Service Development: Assessment Using Internal Training and Clinical Consultation Cases

Jones

Nazarian

Duncan

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

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“…10 Several studies in recent years have demonstrated that primary histopathologic diagnoses can be rendered digitally using WSI. [11][12][13][14][15][16][17][18] Discrepancies in diagnoses between digital and glass slides in publications were attributed to image quality, rarely missed tissue on the digital image, inadequate clinical metadata, and pathologists' lack of experience using the WSI system. Specific microscopic details (eg, organisms, nuclear atypia, apoptosis, mitotic figures, eosinophil granules) were sometimes noted to be difficult to identify because of poor image resolution on high magnification or went undetected (eg, minute focus of prostate adenocarcinoma) in the digital image.…”

mentioning

confidence: 99%

Validating Whole Slide Imaging for Diagnostic Purposes in Pathology: Guideline from the College of American Pathologists Pathology and Laboratory Quality Center

Pantanowitz

Sinard

Henricks

et al. 2013

Archives of Pathology & Laboratory Medicine

520

495

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Context.-There is increasing interest in using whole slide imaging (WSI) for diagnostic purposes (primary and/ or consultation). An important consideration is whether WSI can safely replace conventional light microscopy as the method by which pathologists review histologic sections, cytology slides, and/or hematology slides to render diagnoses. Validation of WSI is crucial to ensure that diagnostic performance based on digitized slides is at least equivalent to that of glass slides and light microscopy. Currently, there are no standard guidelines regarding validation of WSI for diagnostic use.Objective.-To recommend validation requirements for WSI systems to be used for diagnostic purposes.Design.-The College of American Pathologists Pathology and Laboratory Quality Center convened a nonvendor panel from North America with expertise in digital pathology to develop these validation recommendations. A literature review was performed in which 767 international publications that met search term requirements were identified. Studies outside the scope of this effort and those related solely to technical elements, education, and image analysis were excluded. A total of 27 publications were graded and underwent data extraction for evidence evaluation. Recommendations were derived from the strength of evidence determined from 23 of these published studies, open comment feedback, and expert panel consensus.Results.-Twelve guideline statements were established to help pathology laboratories validate their own WSI systems intended for clinical use. Validation of the entire WSI system, involving pathologists trained to use the system, should be performed in a manner that emulates the laboratory's actual clinical environment. It is recommended that such a validation study include at least 60 routine cases per application, comparing intraobserver diagnostic concordance between digitized and glass slides viewed at least 2 weeks apart. It is important that the validation process confirm that all material present on a glass slide to be scanned is included in the digital image.Conclusions.-Validation should demonstrate that the WSI system under review produces acceptable digital slides for diagnostic interpretation. The intention of validating WSI systems is to permit the clinical use of this technology in a manner that does not compromise patient care.

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“…A number of studies have evaluated a variety of different specimens from the routine practice in the department of pathology, including between 25 and 607 samples [22,39,40,41,80,81]. Inter- and intraobserver agreement between WSI and CLM varied from 75 to 97.7% depending on the study.…”

Section: Surgical Pathologymentioning

confidence: 99%

Validation of Whole-Slide Imaging for Histolopathogical Diagnosis: Current State

et al. 2016

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Rapid advances in informatics and technological improvements have led to the development of high-throughput whole-slide imaging (WSI) scanners able to produce high-quality digital images, which allow achieving a correct diagnosis of the biopsies using virtual viewers. This technology is currently prepared to be introduced in the departments of pathology for routine diagnosis. The aim of this review is to analyze the current evidence regarding the use of WSI in primary or routine diagnosis in the different subspecialties of pathology. An increasing number of studies have shown almost perfect inter- and intraobserver agreement between the diagnoses obtained with WSI and the classical diagnoses based on conventional light microscopy. The only exception seems to be cytology, which still requires some technological development. Although validation studies are needed in some areas of pathology, growing evidence indicates that WSI is a reliable tool for routine diagnosis. Pathologists have a positive perception of the ergonomics of the workstations, the low magnification of WSI and the possibility of making annotations and measurements. WSI can be used from any device and anywhere, thereby providing great opportunities for teleconsultation. New technologies such as the recognition of histopathology patterns using image analysis may facilitate diagnosis and improve the reproducibility among pathologists in the future.

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Concordance between whole-slide imaging and light microscopy for routine surgical pathology

Cited by 82 publications

References 26 publications

Interinstitutional Whole Slide Imaging Teleconsultation Service Development: Assessment Using Internal Training and Clinical Consultation Cases

Interinstitutional Whole Slide Imaging Teleconsultation Service Development: Assessment Using Internal Training and Clinical Consultation Cases

Validating Whole Slide Imaging for Diagnostic Purposes in Pathology: Guideline from the College of American Pathologists Pathology and Laboratory Quality Center

Validation of Whole-Slide Imaging for Histolopathogical Diagnosis: Current State

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