Journal Article
. 2011 Sep; 2:36.
doi: 10.4103/2153-3539.83746.

Review of the current state of whole slide imaging in pathology

Liron Pantanowitz 1 Paul N Valenstein  Andrew J Evans  Keith J Kaplan  John D Pfeifer  David C Wilbur  Laura C Collins  Terence J Colgan  
  • PMID: 21886892
  •     42 References
  •     110 citations


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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Oncotarget, 2018 Feb 01; 8(70). PMID: 29383131    Free PMC article.
Histopathology: ditch the slides, because digital and 3D are on show.
Ilaria Jansen, Marit Lucas, +4 authors, Patricia J Zondervan.
World J Urol, 2018 Feb 06; 36(4). PMID: 29396786    Free PMC article.
A modular, open-source, slide-scanning microscope for diagnostic applications in resource-constrained settings.
Qiang Lu, Guanghui Liu, +6 authors, Zachary J Smith.
PLoS One, 2018 Mar 16; 13(3). PMID: 29543835    Free PMC article.
Validation of digital microscopy in the histopathological diagnoses of oral diseases.
Anna Luíza Damaceno Araújo, Gleyson Kleber Amaral-Silva, +6 authors, Alan Roger Santos-Silva.
Virchows Arch, 2018 Jun 03; 473(3). PMID: 29858684
Diagnostic Performance of Deep Learning Algorithms Applied to Three Common Diagnoses in Dermatopathology.
Thomas George Olsen, B Hunter Jackson, +5 authors, Rajath E Soans.
J Pathol Inform, 2018 Oct 09; 9. PMID: 30294501    Free PMC article.
Innovation in Transplantation: The Digital Era.
Albino Eccher, Matteo Brunelli, +3 authors, Aldo Scarpa.
J Pathol Inform, 2018 Oct 09; 9. PMID: 30294502    Free PMC article.
Convolutional neural networks for whole slide image superresolution.
Lopamudra Mukherjee, Adib Keikhosravi, Dat Bui, Kevin W Eliceiri.
Biomed Opt Express, 2018 Nov 22; 9(11). PMID: 30460134    Free PMC article.
3D image analysis reveals differences of CD30 positive cells and network formation in reactive and malignant human lymphoid tissue (classical Hodgkin Lymphoma).
Julia Liebers, Patrick Wurzel, Kerstin Bianca Reisinger, Martin-Leo Hansmann.
PLoS One, 2019 Oct 28; 14(10). PMID: 31648255    Free PMC article.
Digital Assessment of Stained Breast Tissue Images for Comprehensive Tumor and Microenvironment Analysis.
Shachi Mittal, Catalin Stoean, Andre Kajdacsy-Balla, Rohit Bhargava.
Front Bioeng Biotechnol, 2019 Nov 05; 7. PMID: 31681737    Free PMC article.
Automated detection and quantification of breast cancer brain metastases in an animal model using democratized machine learning tools.
Dina Sikpa, Jérémie P Fouquet, +3 authors, Martin Lepage.
Sci Rep, 2019 Nov 24; 9(1). PMID: 31758004    Free PMC article.
Recent advances in tissue imaging for cancer research.
Oscar Maiques, Mirella Georgouli, Victoria Sanz-Moreno.
F1000Res, 2019 Dec 12; 8. PMID: 31824652    Free PMC article.
A novel histological index for evaluation of environmental enteric dysfunction identifies geographic-specific features of enteropathy among children with suboptimal growth.
Ta-Chiang Liu, Kelley VanBuskirk, +16 authors, Christopher A Moskaluk.
PLoS Negl Trop Dis, 2020 Jan 14; 14(1). PMID: 31929525    Free PMC article.
Orbit Image Analysis: An open-source whole slide image analysis tool.
Manuel Stritt, Anna K Stalder, Enrico Vezzali.
PLoS Comput Biol, 2020 Feb 06; 16(2). PMID: 32023239    Free PMC article.
Evaluating cellularity and structural connectivity on whole brain slides using a custom-made digital pathology pipeline.
Thomas Roetzer, Konrad Leskovar, +8 authors, Adelheid Woehrer.
J Neurosci Methods, 2018 Oct 27; 311. PMID: 30365968    Free PMC article.
Precise Identification of Cell and Tissue Features Important for Histopathologic Diagnosis by a Whole Slide Imaging System.
Thomas W Bauer, Cynthia Behling, +6 authors, Jinsong Qiu.
J Pathol Inform, 2020 Mar 11; 11. PMID: 32154040    Free PMC article.
Semi-Supervised Nests of Melanocytes Segmentation Method Using Convolutional Autoencoders.
Dariusz Kucharski, Pawel Kleczek, +2 authors, Marek Gorgon.
Sensors (Basel), 2020 Mar 15; 20(6). PMID: 32168748    Free PMC article.
Artificial intelligence driven next-generation renal histomorphometry.
Briana A Santo, Avi Z Rosenberg, Pinaki Sarder.
Curr Opin Nephrol Hypertens, 2020 Mar 25; 29(3). PMID: 32205581    Free PMC article.
Enhancing the Value of Histopathological Assessment of Allograft Biopsy Monitoring.
Michelle A Wood-Trageser, Andrew J Lesniak, Anthony J Demetris.
Transplantation, 2019 Feb 16; 103(7). PMID: 30768568    Free PMC article.
Classifying non-small cell lung cancer types and transcriptomic subtypes using convolutional neural networks.
Kun-Hsing Yu, Feiran Wang, +4 authors, Isaac S Kohane.
J Am Med Inform Assoc, 2020 May 05; 27(5). PMID: 32364237    Free PMC article.
Evaluation and comparison between smartphone and photomicrography based whole slide imaging.
Shruthi K Patil, Mukund R Nair, A B Manjunath, B R Ahmed Mujib.
J Family Med Prim Care, 2020 Aug 06; 9(5). PMID: 32754495    Free PMC article.
Implementation of Digital Pathology Offers Clinical and Operational Increase in Efficiency and Cost Savings.
Matthew G Hanna, Victor E Reuter, +9 authors, S Joseph Sirintrapun.
Arch Pathol Lab Med, 2019 Jun 08; 143(12). PMID: 31173528    Free PMC article.
Artificial Intelligence and Digital Pathology: Challenges and Opportunities.
Hamid Reza Tizhoosh, Liron Pantanowitz.
J Pathol Inform, 2019 Jan 05; 9. PMID: 30607305    Free PMC article.
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Interactive Digital Microscopy at the Center for a Cross-Continent Undergraduate Pathology Course in Mozambique.
Leonor David, Isabel Martins, +5 authors, Carla Carrilho.
J Pathol Inform, 2019 Jan 05; 9. PMID: 30607309    Free PMC article.
Sparse Autoencoder for Unsupervised Nucleus Detection and Representation in Histopathology Images.
Le Hou, Vu Nguyen, +8 authors, Joel H Saltz.
Pattern Recognit, 2019 Jan 12; 86. PMID: 30631215    Free PMC article.
Invention and Early History of Telepathology (1985-2000).
Ronald S Weinstein, Michael J Holcomb, Elizabeth A Krupinski.
J Pathol Inform, 2019 Feb 21; 10. PMID: 30783545    Free PMC article.
Annotations, Ontologies, and Whole Slide Images - Development of an Annotated Ontology-Driven Whole Slide Image Library of Normal and Abnormal Human Tissue.
Karin Lindman, Jerómino F Rose, +2 authors, Darren Treanor.
J Pathol Inform, 2019 Sep 17; 10. PMID: 31523480    Free PMC article.
Whole Slide Imaging (WSI) in Pathology: Current Perspectives and Future Directions.
Neeta Kumar, Ruchika Gupta, Sanjay Gupta.
J Digit Imaging, 2020 May 30; 33(4). PMID: 32468487    Free PMC article.
Immune contexture analysis in immuno-oncology: applications and challenges of multiplex fluorescent immunohistochemistry.
Reshma Shakya, Tam Hong Nguyen, Nigel Waterhouse, Rajiv Khanna.
Clin Transl Immunology, 2020 Oct 20; 9(10). PMID: 33072322    Free PMC article.
Pathology Trainees' Experience and Attitudes on Use of Digital Whole Slide Images.
Joann G Elmore, Hannah Shucard, +6 authors, Donald L Weaver.
Acad Pathol, 2020 Oct 23; 7. PMID: 33088907    Free PMC article.
Whole-Organism Cellular Pathology: A Systems Approach to Phenomics.
K C Cheng, S R Katz, +2 authors, Y Ding.
Adv Genet, 2016 Aug 10; 95. PMID: 27503355    Free PMC article.
The performance of digital microscopy for primary diagnosis in human pathology: a systematic review.
Anna Luíza Damaceno Araújo, Lady Paola Aristizábal Arboleda, +13 authors, Alan Roger Santos-Silva.
Virchows Arch, 2019 Jan 28; 474(3). PMID: 30685784
Systematic Review.
Comparison of the whole slide imaging and conventional light microscopy in the grading of oral epithelial dysplasia: a multi-institutional study.
P-B Diniz, M Sena-Filho, +4 authors, J Jorge.
Med Oral Patol Oral Cir Bucal, 2020 Nov 29; 26(1). PMID: 33247580    Free PMC article.
Harnessing non-destructive 3D pathology.
Jonathan T C Liu, Adam K Glaser, +4 authors, Anant Madabhushi.
Nat Biomed Eng, 2021 Feb 17; 5(3). PMID: 33589781    Free PMC article.
Automated gleason grading on prostate biopsy slides by statistical representations of homology profile.
Chaoyang Yan, Kazuaki Nakane, +6 authors, Jun Xu.
Comput Methods Programs Biomed, 2020 May 30; 194. PMID: 32470903    Free PMC article.
A Review of Computer-Aided Expert Systems for Breast Cancer Diagnosis.
Xin Yu Liew, Nazia Hameed, Jeremie Clos.
Cancers (Basel), 2021 Jul 03; 13(11). PMID: 34199444    Free PMC article.
Automatic Pancreatic Ductal Adenocarcinoma Detection in Whole Slide Images Using Deep Convolutional Neural Networks.
Hao Fu, Weiming Mi, +9 authors, Hao Zou.
Front Oncol, 2021 Jul 13; 11. PMID: 34249702    Free PMC article.
Transfer Learning Approach for Classification of Histopathology Whole Slide Images.
Shakil Ahmed, Asadullah Shaikh, +4 authors, Maheen Bakhtyar.
Sensors (Basel), 2021 Aug 29; 21(16). PMID: 34450802    Free PMC article.