Validation Study for Use of Digital Microscopy for Primary Diagnosis in General Pathology.
Lynn Schoenfield, Renee Slaw, Scott Mackie, Sol Crisostomo, Pamela Suydam, Thomas Bauer. Cleveland Clinic, OH
Background: Telepathology is a rapidly developing field offering pathologists the ability to remotely review and share diagnostic images.
Design: The aim of the study was to examine real time digital pathology for primary diagnosis. 150 cases from a general pathology practice were examined by one pathologist (LS) using the Aperio whole slide imaging system. Slides were scanned and collated with electronic demographics, working draft and anatomic pathology history. A diagnosis was dictated at the time of digital review but sign-out was delayed until review of derivative glass slides. The glass slides were subsequently reviewed (less than 12 hours following review of the digital images) and time spent, diagnosis, discrepancies if any, and comments recorded.
Results: 150 cases were examined (39 GYN, 37 GI, 33 ocular, 11 GU, 14 soft tissue, 9 ENT, 3 bone, 3 IHC, 1 skin). There were 139 benign lesions, 18 of which were inflammatory, 4 dysplasias, and 7 malignancies. Additional time spent for digital review was: 112 cases 0-1 minute, 24 cases 2-3 min. and 8 cases 4-12 min. In 6 cases digital analysis time was less by 2-5 min. Confidence in diagnosis from the digital image was high (score of 1) in 146 of the 150 cases. The 4 problematic cases were due to inability to focus on a thick fragment (but same on the glass slide), inability to refract gout crystals, and difficulty in seeing possible/few microorganisms. Discrepancies were considered minor and occurred in 5 cases: change in diagnosis from hyperplastic polyp to sessile serrated polyp in 2 cases, addition of focal active inflammation in 2 cases (tonsils and gastric mucosa) and finding of a focus suspicious (but not diagnostic) of cervical dysplasia in an ECC (digitally called negative).
Conclusions: Digital pathology offers advantages over conventional optical microscopy including expedient remote analysis, retrieval of data, and consultations without transporting slides. This reviewer also found that the digital images were subjectively better for diagnostic analysis. Concordance was excellent, and the minor discrepancies noted can be eliminated with practice and experience. Unresolved issues include time spent scanning the images, image storage, ability to focus through thick or folded tissue, refraction, and also licensing and legal issues.
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 209, Wednesday Morning