Display Characteristics and Their Impact on Digital Pathology: A Current Review of Pathologists’ Future “Microscope”

Abstract

Digital displays (monitors) are an indispensable component of a pathologists’ daily workflow, from writing reports, viewing whole-slide images, or browsing the Internet. Due to a paucity of literature and experience surrounding display use and standardization in pathology, the Food and Drug Administration's (FDA) has currently restricted FDA-cleared whole-slide imaging systems to a specific model of display for each system, which at this time consists of only medical-grade (MG) displays. Further, given that a pathologists’ display will essentially become their new surrogate “microscope,” it becomes exceedingly important that all pathologists have a basic understanding of fundamental display properties and their functional consequences. This review seeks to: (a) define and summarize the current and emerging display technology, terminology, features, and regulation as they pertain to pathologists and review the current literature on the impact of different display types (e.g. MG vs. consumer off the shelf vs. professional grade) on pathologists’ diagnostic performance and (b) discuss the impact of the recent digital pathology device componentization and the coronavirus disease 2019 public emergency on the pixel pathway and display use for remote digital pathology. Display technology has changed dramatically over the past 20 years and continues to change at a rapid rate. There is a paucity of published studies to date that investigate how display type affects pathologist performance, with more research necessary in order to develop standards and minimum specifications for displays in digital pathology. Given the complexity of modern displays, pathologists must become better informed regarding display technology if they wish to have more choice over their future “microscopes.”

Programmed Cell Death Ligand 1 Pathologist Training in the Time of COVID-19: Our Experience using a Digital Solution

“…A number of studies have investigated the effect that different monitors can have when reviewing WSIs. [ 14 ] Some studies indicate that medical-grade displays perform better in WSIs evaluation,[ 15 ] where others saw little difference between medical-grade displays and “consumer-grade” monitors. [ 16 ] While we did stipulate that monitors should have at least minimally-acceptable characteristics (1920 × 1080px resolution, 24bit color, 17” diagonal viewing area, LED backlighting), we did not tightly control for this aspect of the training events.…”

Best Practice Recommendations for the Implementation of a Digital Pathology Workflow in the Anatomic Pathology Laboratory by the European Society of Digital and Integrative Pathology (ESDIP)

“…The other monitor is dedicated to the visualization of the WSIs or other images. Several documents have already described all of the features needed to implement the visualization instruments in DP, namely, monitor quality, brightness and contrast, color depth, fidelity and profiles [32,41]. Many pathology departments already operate with workstations equipped with high-contrast (e.g., minimum contrast ratio of 1000:1), high-resolution (e.g., 16:10, 27 diagonal matrix, 2560 × 1600), and bright displays (e.g., a maximum brightness of 300 cd/m 2 ).…”

“…External sources of variability further complicate this matter, such as the distance from the monitor and the illumination conditions of the room, which makes unbiased comparisons among the different devices available more difficult. This heterogeneity, and the large variety of supply in the digital market, has been recently reviewed [41], stressing the need for appropriate information of pathologists on this topic due to the complexity of the available technologies, which are changing at a fast pace. Alternatively, an easy-to-access and point-of-use quality assessment tool has been proposed, which tests color accuracy and may be a valuable indicator of the suitability of a particular screen for digital pathology diagnostics.…”

Scientific and Regulatory Policy Committee Points to Consider: Primary Digital Histopathology Evaluation and Peer Review for Good Laboratory Practice (GLP) Nonclinical Toxicology Studies

“…25 While their initial use mainly focused on research, their use in veterinary and medical diagnostic pathology was quickly adopted. 26,27 Since 2014, many large veterinary diagnostic companies have used WSIs for their histopathological assessments. 28 The US Food and Drug Administration (FDA) Center for Devices and Radiological Health cleared the first digital pathology system (Philips IntelliSite) for primary diagnostic use of human histopathology samples in 2017 via the 510(k) or premarket approval process, 10,29 and approved a second system in 2019.…”