title: Concordance between whole-slide imaging and light microscopy for routine surgical pathology.
abstract: The use of high-resolution digital images of histopathology slides as a routine diagnostic tool for surgical pathology was investigated. The study purpose was to determine the diagnostic concordance between pathologic interpretations using whole-slide imaging and standard light microscopy. Two hundred fifty-one consecutive surgical pathology cases (312 parts, 1085 slides) from a single pathology service were included in the study after cases had been signed out and reports generated. A broad array of diagnostic challenges and tissue sources were represented, including 52 neoplastic cases. All cases were digitized at ×20 and presented to 2 pathologists for diagnosis using whole-slide imaging as the sole diagnostic tool. Diagnoses rendered by the whole-slide imaging pathologists were compared with the original light microscopy diagnoses. Overall concordance between whole-slide imaging and light microscopy as determined by a third pathologist and jury panel was 96.5% (95% confidence interval, 94.8%-98.3%). Concordance between whole-slide imaging pathologists was 97.7% (95% confidence interval, 94.7%-99.2%). Five cases were discordant between the whole-slide imaging diagnosis and the original light microscopy diagnosis, of which 2 were clinically significant. Discordance resulted from interpretive criteria or diagnostic error. The whole-slide imaging modality did not contribute to diagnostic differences. Problems encountered by the whole-slide imaging pathologists primarily involved the inability to clearly visualize nuclear detail or microscopic organisms. Technical difficulties associated with image scanning required at least 1 slide be rescanned in 13% of the cases. Technical and operational issues associated with whole-slide imaging scanning devices used in this study were found to be the most significant obstacle to the use of whole-slide imaging in general surgical pathology.
authors.affiliation: Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198-5900, USA.
authors.forename: W Scott
authors.initials: WS
authors.lastname: Campbell
authors.forename: Subodh M
authors.initials: SM
authors.lastname: Lele
authors.forename: William W
authors.initials: WW
authors.lastname: West
authors.forename: Audrey J
authors.initials: AJ
authors.lastname: Lazenby
authors.forename: Lynette M
authors.initials: LM
authors.lastname: Smith
authors.forename: Steven H
authors.initials: SH
authors.lastname: Hinrichs
mesh_terms: D003952:Diagnostic Imaging / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D008853:Microscopy / Q000295:instrumentation / Q000379:methods*; D010340:Pathology, Surgical / Q000295:instrumentation / Q000379:methods*; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*; D014584:User-Computer Interface