The Diagnostic Concordance of Whole Slide Imaging and Light Microscopy: A Systematic Review

Goacher, Edward; Randell, Rebecca; Williams, Bethany; Treanor, Darren

doi:10.5858/arpa.2016-0025-ra

Cited by 147 publications

(124 citation statements)

References 57 publications

(43 reference statements)

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“…Goacher et al 12 found a mean diagnostic concordance of WSI and light microscopy, weighted by the number of cases per study, of 92.4%. In this study, we aimed to complement this work with a systematic analysis of the discordant diagnoses reported in the validation literature, in the hope that this analysis would allow a more precise evaluation of primary digital diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…In light of this, guidance is needed regarding potential safety implications for patients. A number of validation studies have been reported in the literature, but as we discovered in our systematic review, 12 these vary greatly in terms of the number and types of participants and cases, the methodology, and the technologies examined. In the absence of a multicenter clinical trial, a systematic review remains the highest level of digital pathology concordance evidence available for those engaged in regulatory efforts.…”

Section: Discussionmentioning

confidence: 99%

“…12,14 A search of clinicaltrials.gov (Bethesda, Maryland) was performed to identify any ongoing studies. Included studies underwent manual reference searching and citation tracking through PubMed and Google Scholar.…”

Section: Search Strategymentioning

confidence: 99%

“…In 2016, Goacher et al 12 undertook a systematic review of these studies in which study quality was assessed. They identified 38 studies, and reported a mean diagnostic concordance of WSI and light microscopy, weighted by the number of cases per study, of 92.4%.…”

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confidence: 99%

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A Systematic Analysis of Discordant Diagnoses in Digital Pathology Compared With Light Microscopy

Williams¹,

DaCosta²,

Goacher³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Relatively little is known about the significance and potential impact of glass-digital discordances, and this is likely to be of importance when considering digital pathology adoption.Objective.-To apply evidence-based medicine to collect and analyze reported instances of glass-digital discordance from the whole slide imaging validation literature.Design.-We used our prior systematic review protocol to identify studies assessing the concordance of light microscopy and whole slide imaging between 1999 and 2015. Data were extracted and analyzed by a team of histopathologists to classify the type, significance, and potential root cause of discordances.Results.-Twenty-three studies were included, yielding 8069 instances of a glass diagnosis being compared with a digital diagnosis. From these 8069 comparisons, 335 instances of discordance (4%) were reported, in which glass was the preferred diagnostic medium in 286 (85%), and digital in 44 (13%), with no consensus in 5 (2%). Twenty-eight discordances had the potential to cause moderate/severe patient harm. Of these, glass was the preferred diagnostic medium for 26 (93%). Of the 335 discordances, 109 (32%) involved the diagnosis or grading of dysplasia. For these cases, glass was the preferred diagnostic medium in 101 cases (93%), suggesting that diagnosis and grading of dysplasia may be a potential pitfall of digital diagnosis. In 32 of 335 cases (10%), discordance on digital was attributed to the inability to find a small diagnostic/prognostic object.Conclusions.-Systematic analysis of concordance studies reveals specific areas that may be problematic on whole slide imaging. It is important that pathologists are aware of these areas to ensure patient safety.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Search Strategymentioning

confidence: 99%

mentioning

confidence: 99%

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A Systematic Analysis of Discordant Diagnoses in Digital Pathology Compared With Light Microscopy

Williams¹,

DaCosta²,

Goacher³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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“…A recent systematic review of the diagnostic accuracy of digital pathology versus conventional light microscopy identified 38 quality validation studies of digital pathology, and found good rates of concordance between digital and light microscopy diagnosis 3. Various proof-of-concept studies both within and outside of the UK have concluded that digital images are of sufficient quality for primary diagnosis of histological specimens 4 5…”

Section: Writing the Introductionmentioning

confidence: 99%

Future-proofing pathology part 2: building a business case for digital pathology

Williams

Bottoms²,

Clark

et al. 2018

J Clin Pathol

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Diagnostic histopathology departments are experiencing unprecedented economic and service pressures, and many institutions are now considering digital pathology as part of the solution. In this document, a follow on to our case for adoption report, we provide information and advice to help departments create their own clear, succinct, individualised business case for the clinical deployment of digital pathology.

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Diagnostic Accuracy of Virtual Pathology vs Traditional Microscopy in a Large Dermatopathology Study

et al. 2017

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represents a transformative technology that impacts dermatologists and dermatopathologists from residency to academic and private practice. Two concerns are accuracy of interpretation from whole-slide images (WSI) and effect on workflow. Studies of considerably large series involving single-organ systems are lacking.OBJECTIVE To evaluate whether diagnosis from WSI on a digital microscope is inferior to diagnosis of glass slides from traditional microscopy (TM) in a large cohort of dermatopathology cases with attention on image resolution, specifically eosinophils in inflammatory cases and mitotic figures in melanomas, and to measure the workflow efficiency of WSI compared with TM. DESIGN, SETTING, AND PARTICIPANTS Three dermatopathologists established interobserver ground truth consensus (GTC) diagnosis for 499 previously diagnosed cases proportionally representing the spectrum of diagnoses seen in the laboratory. Cases were distributed to 3 different dermatopathologists who diagnosed by WSI and TM with a minimum 30-day washout between methodologies. Intraobserver WSI/TM diagnoses were compared, followed by interobserver comparison with GTC. Concordance, major discrepancies, and minor discrepancies were calculated and analyzed by paired noninferiority testing. We also measured pathologists' read rates to evaluate workflow efficiency between WSI and TM. This retrospective study was caried out in an independent, national, university-affiliated dermatopathology laboratory. MAIN OUTCOMES AND MEASURESIntraobserver concordance of diagnoses between WSI and TM methods and interobserver variance from GTC, following College of American Pathology guidelines.RESULTS Mean intraobserver concordance between WSI and TM was 94%. Mean interobserver concordance was 94% for WSI and GTC and 94% for TM and GTC. Mean interobserver concordance between WSI, TM, and GTC was 91%. Diagnoses from WSI were noninferior to those from TM. Whole-slide image read rates were commensurate with WSI experience, achieving parity with TM by the most experienced user.CONCLUSIONS AND RELEVANCE Diagnosis from WSI was found equivalent to diagnosis from glass slides using TM in this statistically powerful study of 499 dermatopathology cases. This study supports the viability of WSI for primary diagnosis in the clinical setting.

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The Diagnostic Concordance of Whole Slide Imaging and Light Microscopy: A Systematic Review

Cited by 147 publications

References 57 publications

A Systematic Analysis of Discordant Diagnoses in Digital Pathology Compared With Light Microscopy

A Systematic Analysis of Discordant Diagnoses in Digital Pathology Compared With Light Microscopy

Future-proofing pathology part 2: building a business case for digital pathology

Diagnostic Accuracy of Virtual Pathology vs Traditional Microscopy in a Large Dermatopathology Study

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