title: Validation of diagnostic accuracy with whole-slide imaging compared with glass slide review in dermatopathology.
abstract: BACKGROUND
  Teledermatopathology has evolved from static images to whole slide imaging (WSI), which allows for remote viewing and manipulation of tissue sections. Previous studies of WSI in teledermatopathology predated College of American Pathologists (CAP) telepathology validation guidelines.
  
  
  OBJECTIVE
  We conducted a comprehensive retrospective WSI validation study of routine dermatopathology cases, adhering to CAP guidelines.
  
  
  METHODS
  In all, 181 consecutive cases arranged into 3 categories (inflammatory, melanocytic, nonmelanocytic proliferations) were reviewed by 3 board-certified dermatopathologists via traditional microscopy (TM) and WSI. Intraobserver (TM vs WSI), TM intraobserver and interobserver (TM vs TM), and WSI interobserver (WSI vs WSI) concordance was interpreted using a 3-tier system.
  
  
  RESULTS
  TM versus WSI intraobserver concordance (86.9%; 95% confidence interval [CI] 83.7-89.6) did not differ from TM versus TM intraobserver concordance (90.3%; 95% CI 86.7-93.1) or interobserver concordance (WSI: 89.9%; 95% CI 87.0-92.2, and TM: 89.5%; 95% CI 86.5-91.9). Melanocytic proliferations had the lowest TM versus WSI intraobserver concordance (75.6%; 95% CI 68.5-81.5), whereas inflammatory lesions had the highest TM versus WSI intraobserver concordance (96.1%; 95% CI 91.8-98.3). Nonmelanocytic proliferations had an intraobserver concordance of 89.1% (95% CI 83.4-93.0).
  
  
  CONCLUSIONS
  Efficiency and other logistical WSI parameters were not evaluated.
  
  
  CONCLUSIONS
  Intraobserver and interobserver diagnostic concordance between WSI and TM was equivalent. Therefore, WSI appears to be a reliable diagnostic modality for dermatopathology.
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kabeer K
authors.initials: KK
authors.lastname: Shah
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Lehman
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Gibson
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Nneka I
authors.initials: NI
authors.lastname: Comfere
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota. Electronic address: Wieland.Carilyn@mayo.edu.
authors.forename: Carilyn N
authors.initials: CN
authors.lastname: Wieland
mesh_terms: D002280:Basal Cell Carcinoma / Q000175:diagnosis* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D003872:Dermatitis / Q000175:diagnosis* / Q000473:pathology; D003880:Dermatology / Q000379:methods*; D006801:Humans; D017492:Keratosis, Seborrheic / Q000175:diagnosis / Q000473:pathology; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008853:Microscopy; D009508:Nevus, Pigmented / Q000175:diagnosis* / Q000473:pathology; D015588:Observer Variation; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D017216:Telemedicine / Q000379:methods
keywords: concordance; dermatopathology; inflammatory; interobserver; intraobserver variability; melanocytic; nonmelanocytic; validation; variability; whole slide imaging