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. 2009 Dec;133(12):1949-53.
doi: 10.5858/133.12.1949.

Whole-slide imaging digital pathology as a platform for teleconsultation: a pilot study using paired subspecialist correlations

David C Wilbur  1 , Kalil Madi, Robert B Colvin, Lyn M Duncan, William C Faquin, Judith A Ferry, Matthew P Frosch, Stuart L Houser, Richard L Kradin, Gregory Y Lauwers, David N Louis, Eugene J Mark, Mari Mino-Kenudson, Joseph Misdraji, Gunnlauger P Nielsen, Martha B Pitman, Andrew E Rosenberg, R Neal Smith, Aliyah R Sohani, James R Stone, Rosemary H Tambouret, Chin-Lee Wu, Robert H Young, Artur Zembowicz, Wolfgang Klietmann
Affiliations

Whole-slide imaging digital pathology as a platform for teleconsultation: a pilot study using paired subspecialist correlations

David C Wilbur et al. Arch Pathol Lab Med. 2009 Dec.

Abstract

Context: -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.

Design: -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.

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Figures

Figure 1
Figure 1
The Zeiss Mirax Desk Imaging device is shown. This device scans single slides into whole-slide digital images, which are viewed on the Mirax viewer.
Figure 2
Figure 2
The image shown in the Mirax viewer screen is a trichrome stain of one of the discrepant cases interpreted as biliary adenofibroma by the whole-slide reviewer and mesenchymal hamartoma by the glass-slide and reference reviewers. The main image can be magnified and moved about the screen by the use of a mouse and/or function buttons above the image.
See this image and copyright information in PMC

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