Whole-slide imaging digital pathology as a platform for teleconsultation: a pilot study using paired subspecialist correlations.
BACKGROUND
-Whole-slide imaging technology offers promise for rapid, Internet-based telepathology consultations between institutions. Before implementation, technical issues, pathologist adaptability, and morphologic pitfalls must be well characterized.


OBJECTIVE
-To determine whether interpretation of whole-slide images differed from glass-slide interpretation in difficult surgical pathology cases.


METHODS
-Diagnostically challenging pathology slides from a variety of anatomic sites from an outside laboratory were scanned into whole digital format. Digital and glass slides were independently diagnosed by 2 subspecialty pathologists. Reference, digital, and glass-slide interpretations were compared. Operator comments on technical issues were gathered.


RESULTS
-Fifty-three case pairs were analyzed. There was agreement among digital, glass, and reference diagnoses in 45 cases (85%) and between digital and glass diagnoses in 48 (91%) cases. There were 5 digital cases (9%) discordant with both reference and glass diagnoses. Further review of each of these cases indicated an incorrect digital whole-slide interpretation. Neoplastic cases showed better correlation (93%) than did cases of nonneoplastic disease (88%). Comments on discordant cases related to digital whole technology focused on issues such as fine resolution and navigating ability at high magnification.


CONCLUSIONS
-Overall concordance between digital whole-slide and standard glass-slide interpretations was good at 91%. Adjustments in technology, case selection, and technology familiarization should improve performance, making digital whole-slide review feasible for broader telepathology subspecialty consultation applications.
Wilbur
David C
DC
Department of Pathology, James Homer Wright Pathology Laboratories, Massachusetts General Hospital, and the Department of Pathology, Harvard Medical School, Boston, MA 02114, USA. dwilbur@partners.org
Madi
Kalil
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Colvin
Robert B
RB
Duncan
Lyn M
LM
Faquin
William C
WC
Ferry
Judith A
JA
Frosch
Matthew P
MP
Houser
Stuart L
SL
Kradin
Richard L
RL
Lauwers
Gregory Y
GY
Louis
David N
DN
Mark
Eugene J
EJ
Mino-Kenudson
Mari
M
Misdraji
Joseph
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Nielsen
Gunnlauger P
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Pitman
Martha B
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Rosenberg
Andrew E
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Smith
R Neal
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Sohani
Aliyah R
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Stone
James R
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Tambouret
Rosemary H
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Wu
Chin-Lee
CL
Young
Robert H
RH
Zembowicz
Artur
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Klietmann
Wolfgang
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D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D010338:Pathology, Clinical / Q000379:methods*; D010340:Pathology, Surgical / Q000379:methods; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results; D019113:Telepathology / Q000379:methods*