Digital pathology imaging as a novel platform for standardization and globalization of quantitative nephropathology

Abstract

The introduction of digital pathology to nephrology provides a platform for the development of new methodologies and protocols for visual, morphometric and computer-aided assessment of renal biopsies. Application of digital imaging to pathology made substantial progress over the past decade; it is now in use for education, clinical trials and translational research. Digital pathology evolved as a valuable tool to generate comprehensive structural information in digital form, a key prerequisite for achieving precision pathology for computational biology. The application of this new technology on an international scale is driving novel methods for collaborations, providing unique opportunities but also challenges. Standardization of methods needs to be rigorously evaluated and applied at each step, from specimen processing to scanning, uploading into digital repositories, morphologic, morphometric and computer-aided assessment, data collection and analysis. In this review, we discuss the status and opportunities created by the application of digital imaging to precision nephropathology, and present a vision for the near future.

Digital pathology in nephrology clinical trials, research, and pathology practice

“…While glass slides may fade, break, be lost, and need to be warehoused, high-quality WSI are permanent and occupy ‘virtual’ space. Web-hosted image libraries can be accessed by multiple users, in underresourced locations, and for multiple purposes (e.g., to test different scoring systems simultaneously or consecutively), with abatement of costs with time and improved workflow [2 ▪▪ ,3,4 ▪ ]. …”

“…Standardization of preanalytic and analytic phases is particularly critical in the setting of international large consortia and/or computational imaging applications, and assures that an adequate product (tissue properly handled, fixed, processed, cut, and stained) is generated by the histology laboratory, prior to scanning into WSI [2 ▪▪ ]. The standardization of these steps on large scale is often underestimated or not addressed because it is perceived as insurmountable.…”

“…The availability of webinar-based meetings and WSIs accessible remotely by multiple investigators provides the opportunity for harmonization of repositories and quantitative assessment across institutions, regions, states, and continents [2 ▪▪ ]. Recently, several investigators focused on standardization and reproducibility of the postanalytic phase (disease analysis), recognizing that, while diagnostic scoring protocols and classification systems are continuously created, reproducibility of morphologic analysis remains problematic [2 ▪▪ ,3,9].…”

“…Recently, several investigators focused on standardization and reproducibility of the postanalytic phase (disease analysis), recognizing that, while diagnostic scoring protocols and classification systems are continuously created, reproducibility of morphologic analysis remains problematic [2 ▪▪ ,3,9]. This led the NEPhrotic syndrome sTUdy NEtwork (NEPTUNE) investigators to exploit a DPR of renal biopsies to test different metrics and statistical approaches, with the goal of increasing accuracy [10 ▪ ] and reproducibility of data collection [11 ▪ ].…”

“…Virtual microscopy, encompassing telepathology and whole slide imaging (WSI), and digital pathology, a dynamic, image-based environment for the acquisition, management, and interpretation of disease information generated from WSI or other digitized images, are becoming the new standard of practice in the setting of clinical trials [1] and research [2 ▪▪ ,3,4 ▪ ]. Simultaneously, telepathology and WSI are consciously, but progressively, introduced to patient care [5–8].…”