Journal Article
. 2012 Apr; 7:35.
doi: 10.1186/1746-1596-7-35.

Validation of diagnostic accuracy using digital slides in routine histopathology

László Fónyad 1 Tibor Krenács  Péter Nagy  Attila Zalatnai  Judit Csomor  Zoltán Sápi  Judit Pápay  Júlia Schönléber  Csaba Diczházi  Béla Molnár  
  • PMID: 22463804
  •     22 References
  •     15 citations


Background: Robust hardware and software tools have been developed in digital microscopy during the past years for pathologists. Reports have been advocated the reliability of digital slides in routine diagnostics. We have designed a retrospective, comparative study to evaluate the scanning properties and digital slide based diagnostic accuracy.

Methods: 8 pathologists reevaluated 306 randomly selected cases from our archives. The slides were scanned with a 20× Plan-Apochromat objective, using a 3-chip Hitachi camera, resulting 0.465 μm/pixel resolution. Slide management was supported with dedicated Data Base and Viewer software tools. Pathologists used their office PCs for evaluation and reached the digital slides via intranet connection. The diagnostic coherency and uncertainty related to digital slides and scanning quality were analyzed.

Results: Good to excellent image quality of slides was recorded in 96%. In half of the critical 61 digital slides, poor image quality was related to section folds or floatings. In 88.2% of the studied cases the digital diagnoses were in full agreement with the consensus. Out of the overall 36 incoherent cases, 7 (2.3%) were graded relevant without any recorded uncertainty by the pathologist. Excluding the non-field specific cases from each pathologist's record this ratio was 1.76% of all cases.

Conclusions: Our results revealed that: 1) digital slide based histopathological diagnoses can be highly coherent with those using optical microscopy; 2) the competency of pathologists is a factor more important than the quality of digital slide; 3) poor digital slide quality do not endanger patient safety as these errors are recognizable by the pathologist and further actions for correction could be taken.

Virtual Slides: The virtual slide(s) for this article can be found here:

Telepathology diagnosis by means of digital still images: an international validation study.
D S Weinberg, F A Allaert, +7 authors, M Doolittle.
Hum Pathol, 1996 Feb 01; 27(2). PMID: 8617451
Use of robotic telepathology for frozen-section diagnosis: a retrospective trial of a telepathology system for intraoperative consultation.
Keith J Kaplan, Jeanette R Burgess, +3 authors, Renata B Greenspan.
Mod Pathol, 2002 Nov 14; 15(11). PMID: 12429799
Image standards in tissue-based diagnosis (diagnostic surgical pathology).
Klaus Kayser, Jürgen Görtler, +3 authors, Gian Kayser.
Diagn Pathol, 2008 Apr 22; 3. PMID: 18423031    Free PMC article.
Virtual slide telepathology for an academic teaching hospital surgical pathology quality assurance program.
Anna R Graham, Achyut K Bhattacharyya, +9 authors, Ronald S Weinstein.
Hum Pathol, 2009 Jun 23; 40(8). PMID: 19540562
Prospects for telepathology.
R S Weinstein.
Hum Pathol, 1986 May 01; 17(5). PMID: 3516858
Virtual slide telepathology enables an innovative telehealth rapid breast care clinic.
Ana Maria López, Anna R Graham, +9 authors, Ronald S Weinstein.
Hum Pathol, 2009 Jun 26; 40(8). PMID: 19552938
Telepathology for intraoperative neuropathologic consultations at an academic medical center: a 5-year report.
Craig Horbinski, Jeffrey L Fine, +2 authors, Clayton A Wiley.
J Neuropathol Exp Neurol, 2007 Sep 21; 66(8). PMID: 17882019
Shifting gears higher--digital slides in graduate education--4 years experience at Semmelweis University.
László Fónyad, László Gerely, +2 authors, András Matolcsy.
Diagn Pathol, 2010 Nov 26; 5. PMID: 21092205    Free PMC article.
Comparison of immunohistochemistry by automated cellular imaging system (ACIS) versus fluorescence in-situ hybridization in the evaluation of HER-2/neu expression in primary breast carcinoma.
O W Tawfik, B F Kimler, +8 authors, C J Fabian.
Histopathology, 2006 Jan 25; 48(3). PMID: 16430472
Informatics for practicing anatomical pathologists: marking a new era in pathology practice.
Manal Y Gabril, George M Yousef.
Mod Pathol, 2010 Jan 19; 23(3). PMID: 20081805
Measuring errors in surgical pathology in real-life practice: defining what does and does not matter.
Andrew A Renshaw, Edwin W Gould.
Am J Clin Pathol, 2006 Dec 06; 127(1). PMID: 17145620
Evaluation of whole slide image immunohistochemistry interpretation in challenging prostate needle biopsies.
Jeffrey L Fine, Dana M Grzybicki, +8 authors, Drazen M Jukic.
Hum Pathol, 2008 Feb 01; 39(4). PMID: 18234276
Telepathology: a diagnostic tool for the millennium?
C A Wells, C Sowter.
J Pathol, 2000 Apr 18; 191(1). PMID: 10767711
Study of parameters in focus simulation functions of virtual slide.
Ichiro Mori, Takashi Ozaki, Emiko Taniguchi, Kennichi Kakudo.
Diagn Pathol, 2011 Apr 22; 6 Suppl 1. PMID: 21489195    Free PMC article.
Automated quantitative analysis of estrogen receptor expression in breast carcinoma does not differ from expert pathologist scoring: a tissue microarray study of 3,484 cases.
Dmitry A Turbin, Samuel Leung, +12 authors, David G Huntsman.
Breast Cancer Res Treat, 2007 Oct 04; 110(3). PMID: 17912629
Immunophenotypic profiling of nonsmall cell lung cancer progression using the tissue microarray approach.
Judit Papay, Tibor Krenacs, +4 authors, Laszlo Kopper.
Appl Immunohistochem Mol Morphol, 2007 Jun 01; 15(1). PMID: 17536303
The importance of optical optimization in whole slide imaging (WSI) and digital pathology imaging.
Yukako Yagi, John R Gilbertson.
Diagn Pathol, 2008 Aug 05; 3 Suppl 1. PMID: 18673497    Free PMC article.
Use of whole slide imaging in surgical pathology quality assurance: design and pilot validation studies.
Jonhan Ho, Anil V Parwani, +3 authors, John R Gilbertson.
Hum Pathol, 2006 Apr 15; 37(3). PMID: 16613327
Automated complete slide digitization: a medium for simultaneous viewing by multiple pathologists.
F J Leong, J O McGee.
J Pathol, 2001 Dec 18; 195(4). PMID: 11745684
User attitudes in analyzing digital slides in a quality control test bed: a preliminary study.
Vincenzo Della Mea, Francesca Demichelis, +2 authors, Carlo Alberto Beltrami.
Comput Methods Programs Biomed, 2006 Apr 25; 82(2). PMID: 16632072
Teleconsultation in diagnostic pathology: experience from Iran and Germany with the use of two European telepathology servers.
Masoud Mireskandari, Gian Kayser, +2 authors, Klaus Kayser.
J Telemed Telecare, 2004 Apr 08; 10(2). PMID: 15068646
Digital slide and virtual microscopy based routine and telepathology evaluation of routine gastrointestinal biopsy specimens.
B Molnar, L Berczi, +4 authors, Z Tulassay.
J Clin Pathol, 2003 Jun 05; 56(6). PMID: 12783970    Free PMC article.
Development of a teledermatopathology consultation system using virtual slides.
Ikunori Nakayama, Tsubasa Matsumura, +5 authors, Takashi Sawai.
Diagn Pathol, 2012 Dec 15; 7. PMID: 23237667    Free PMC article.
What is a virtual multidisciplinary team (vMDT)?
A J Munro, S Swartzman.
Br J Cancer, 2013 Jun 13; 108(12). PMID: 23756866    Free PMC article.
A novel approach for quantitative assessment of mucosal damage in inflammatory bowel disease.
Ismail I Matalka, Faruq A Al-Omari, Rola M Salama, Alia H Mohtaseb.
Diagn Pathol, 2013 Sep 24; 8. PMID: 24053788    Free PMC article.
Rationale for Quality Assurance in Fecal Egg Monitoring of Soil-Transmitted Helminthiasis.
David J L Hoekendijk, Philip C Hill, Stephen J Sowerby.
Am J Trop Med Hyg, 2016 Jun 30; 95(3). PMID: 27352875    Free PMC article.
A novel quantitative immunohistochemistry method for precise protein measurements directly in formalin-fixed, paraffin-embedded specimens: analytical performance measuring HER2.
Kristian Jensen, Rikke Krusenstjerna-Hafstrøm, +2 authors, Helene Derand.
Mod Pathol, 2016 Oct 22; 30(2). PMID: 27767098
The Empirical Foundations of Telepathology: Evidence of Feasibility and Intermediate Effects.
Rashid L Bashshur, Elizabeth A Krupinski, +2 authors, Noura Bashshur.
Telemed J E Health, 2017 Feb 09; 23(3). PMID: 28170313    Free PMC article.
Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study).
Sanjay Mukhopadhyay, Michael D Feldman, +31 authors, Clive R Taylor.
Am J Surg Pathol, 2017 Sep 30; 42(1). PMID: 28961557    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
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.
Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center.
Liron Pantanowitz, John H Sinard, +8 authors, College of American Pathologists Pathology and Laboratory Quality Center.
Arch Pathol Lab Med, 2013 May 03; 137(12). PMID: 23634907    Free PMC article.
Highly Cited. Review.
Validation of a digital pathology system including remote review during the COVID-19 pandemic.
Matthew G Hanna, Victor E Reuter, +21 authors, Meera Hameed.
Mod Pathol, 2020 Jun 24; 33(11). PMID: 32572154    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.
Remote Reporting from Home for Primary Diagnosis in Surgical Pathology: A Tertiary Oncology Center Experience during the COVID-19 Pandemic.
Vidya Rao, Rajiv Kumar, +17 authors, Sangeeta Desai.
J Pathol Inform, 2021 May 21; 12. PMID: 34012707    Free PMC article.
Poor Endometrial Proliferation After Clomiphene is Associated With Altered Estrogen Action.
Leah Hawkins Bressler, Marc A Fritz, +5 authors, Steven L Young.
J Clin Endocrinol Metab, 2021 Jun 01; 106(9). PMID: 34058008    Free PMC article.
Integrating digital pathology into clinical practice.
Matthew G Hanna, Orly Ardon, +4 authors, Meera R Hameed.
Mod Pathol, 2021 Oct 03;. PMID: 34599281