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. 2011:2:36.
doi: 10.4103/2153-3539.83746. Epub 2011 Aug 13.

Review of the current state of whole slide imaging in pathology

Affiliations

Review of the current state of whole slide imaging in pathology

Liron Pantanowitz et al. J Pathol Inform. 2011.

Abstract

Whole slide imaging (WSI), or "virtual" microscopy, involves the scanning (digitization) of glass slides to produce "digital slides". WSI has been advocated for diagnostic, educational and research purposes. When used for remote frozen section diagnosis, WSI requires a thorough implementation period coupled with trained support personnel. Adoption of WSI for rendering pathologic diagnoses on a routine basis has been shown to be successful in only a few "niche" applications. Wider adoption will most likely require full integration with the laboratory information system, continuous automated scanning, high-bandwidth connectivity, massive storage capacity, and more intuitive user interfaces. Nevertheless, WSI has been reported to enhance specific pathology practices, such as scanning slides received in consultation or of legal cases, of slides to be used for patient care conferences, for quality assurance purposes, to retain records of slides to be sent out or destroyed by ancillary testing, and for performing digital image analysis. In addition to technical issues, regulatory and validation requirements related to WSI have yet to be adequately addressed. Although limited validation studies have been published using WSI there are currently no standard guidelines for validating WSI for diagnostic use in the clinical laboratory. This review addresses the current status of WSI in pathology related to regulation and validation, the provision of remote and routine pathologic diagnoses, educational uses, implementation issues, and the cost-benefit analysis of adopting WSI in routine clinical practice.

Keywords: Consultation; diagnosis; digital; education; frozen section; imaging; informatics; telepathology; validation; virtual microscopy; whole slide imaging.

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Figures

Figure 1
Figure 1
Qualities of a digital display device. WSI systems can be regulated as a whole, or individual components such as displays can be regulated separately
Figure 2
Figure 2
This figure shows two examples to illustrate the impact of suboptimal frozen section slides on image quality generated by WSI devices. (a) A diffuse astrocytoma with a tissue fold in the center of the field is shown that has caused the edge of the section (right edge) to be out of focus, (b) A high-grade astrocytoma with a large air bubble under the coverslip
Figure 3
Figure 3
Search maps of WSI of inflammatory skin biopsies. Using a “light” version of SlideTutor a user's interaction with the digital image is recorded. The green highlighted areas represent the areas of the image that were viewed (search map). The search maps of three different residents are shown at different magnifications. Images courtesy of Dr. Claudia Mello-Thoms, Department of Biomedical Informatics and Department of Radiology, University of Pittsburgh, USA

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