Systematic Review
. 2016 Jul; 141(1):151-161.
doi: 10.5858/arpa.2016-0025-RA.

The Diagnostic Concordance of Whole Slide Imaging and Light Microscopy: A Systematic Review

Edward Goacher  Rebecca Randell  Bethany Williams  Darren Treanor 1 
Affiliations
  • PMID: 27399211
  •     44 citations

Abstract

Context: -Light microscopy (LM) is considered the reference standard for diagnosis in pathology. Whole slide imaging (WSI) generates digital images of cellular and tissue samples and offers multiple advantages compared with LM. Currently, WSI is not widely used for primary diagnosis. The lack of evidence regarding concordance between diagnoses rendered by WSI and LM is a significant barrier to both regulatory approval and uptake.

Objective: -To examine the published literature on the concordance of pathologic diagnoses rendered by WSI compared with those rendered by LM.

Data Sources: -We conducted a systematic review of studies assessing the concordance of pathologic diagnoses rendered by WSI and LM. Studies were identified following a systematic search of Medline (Medline Industries, Mundelein, Illinois), Medline in progress (Medline Industries), EMBASE (Elsevier, Amsterdam, the Netherlands), and the Cochrane Library (Wiley, London, England), between 1999 and March 2015.

Conclusions: -Thirty-eight studies were included in the review. The mean diagnostic concordance of WSI and LM, weighted by the number of cases per study, was 92.4%. The weighted mean κ coefficient between WSI and LM was 0.75, signifying substantial agreement. Of the 30 studies quoting percentage concordance, 18 (60%) showed a concordance of 90% or greater, of which 10 (33%) showed a concordance of 95% or greater. This review found evidence to support a high level of diagnostic concordance. However, there were few studies, many were small, and they varied in quality, suggesting that further validation studies are still needed.

Enterprise Implementation of Digital Pathology: Feasibility, Challenges, and Opportunities.
D J Hartman, L Pantanowitz, +3 authors, G R Lauro.
J Digit Imaging, 2017 Jan 25; 30(5). PMID: 28116576    Free PMC article.
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.
Review.
Relevance of deep learning to facilitate the diagnosis of HER2 status in breast cancer.
Michel E Vandenberghe, Marietta L J Scott, +3 authors, Craig Barker.
Sci Rep, 2017 Apr 06; 7. PMID: 28378829    Free PMC article.
RecutClub.com: An Open Source, Whole Slide Image-based Pathology Education System.
Paul A Christensen, Nathan E Lee, +3 authors, S Wesley Long.
J Pathol Inform, 2017 Apr 07; 8. PMID: 28382224    Free PMC article.
Nuclear features of infiltrating urothelial carcinoma are distinguished from low-grade noninvasive papillary urothelial carcinoma by image analysis.
Noritake Kosuge, Masanao Saio, +3 authors, Naoki Yoshimi.
Oncol Lett, 2017 Sep 21; 14(3). PMID: 28928814    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.
Diagnostic Accuracy of Virtual Pathology vs Traditional Microscopy in a Large Dermatopathology Study.
Michael N Kent, Thomas G Olsen, +10 authors, Michael A Bottomley.
JAMA Dermatol, 2017 Oct 20; 153(12). PMID: 29049424    Free PMC article.
Digital pathology access and usage in the UK: results from a national survey on behalf of the National Cancer Research Institute's CM-Path initiative.
Bethany Jill Williams, Jessica Lee, Karin A Oien, Darren Treanor.
J Clin Pathol, 2018 Jan 11; 71(5). PMID: 29317516    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.
Routine Digital Pathology Workflow: The Catania Experience.
Filippo Fraggetta, Salvatore Garozzo, +2 authors, Esther Diana Rossi.
J Pathol Inform, 2018 Feb 09; 8. PMID: 29416914    Free PMC article.
Digital versus light microscopy assessment of surgical margin status after radical prostatectomy.
Metka Volavšek, Ana Blanca, +6 authors, Antonio Lopez-Beltran.
Virchows Arch, 2018 Feb 18; 472(3). PMID: 29453523
Conventional Microscopical versus Digital Whole-Slide Imaging-Based Diagnosis of Thin-Layer Cervical Specimens: A Validation Study.
Odille Bongaerts, Carla Clevers, +7 authors, Marius Nap.
J Pathol Inform, 2018 Sep 11; 9. PMID: 30197818    Free PMC article.
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.
Validation of Remote Digital Frozen Sections for Cancer and Transplant Intraoperative Services.
Luca Cima, Matteo Brunelli, +14 authors, Albino Eccher.
J Pathol Inform, 2018 Nov 20; 9. PMID: 30450263    Free PMC article.
Digital versus light microscopy assessment of extraprostatic extension in radical prostatectomy samples.
Metka Volavšek, Vanessa Henriques, +7 authors, Antonio Lopez-Beltran.
Virchows Arch, 2019 Oct 08; 475(6). PMID: 31588959
The California Telepathology Service: UCLA's Experience in Deploying a Regional Digital Pathology Subspecialty Consultation Network.
Thomas Chong, M Fernando Palma-Diaz, +10 authors, W Dean Wallace.
J Pathol Inform, 2019 Oct 18; 10. PMID: 31620310    Free PMC article.
["Digital Pathology in Diagnostics-reporting on digital images" guideline of the Professional Association of German Pathologists].
G Haroske, R Zwönitzer, P Hufnagl, Kommission Digitale Pathologie.
Pathologe, 2018 Nov 07; 39(Suppl 2). PMID: 30397786
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.
Systematic Review of the Use of Telepathology During Intraoperative Consultation.
Robin L Dietz, Douglas J Hartman, Liron Pantanowitz.
Am J Clin Pathol, 2019 Oct 17; 153(2). PMID: 31618416    Free PMC article.
Systematic Review.
Summary of third Nordic symposium on digital pathology.
Claes Lundström, Marie Waltersson, Anders Persson, Darren Treanor.
J Pathol Inform, 2016 May 04; 7. PMID: 27141318    Free PMC article.
Artificial Intelligence in Clinical Health Care Applications: Viewpoint.
Michael van Hartskamp, Sergio Consoli, +2 authors, Anja van de Stolpe.
Interact J Med Res, 2019 Apr 06; 8(2). PMID: 30950806    Free PMC article.
Validation of Whole-slide Digitally Imaged Melanocytic Lesions: Does Z-Stack Scanning Improve Diagnostic Accuracy?
Bart Sturm, David Creytens, +9 authors, Jeroen A W M van der Laak.
J Pathol Inform, 2019 Apr 12; 10. PMID: 30972225    Free PMC article.
Agreement in Histological Assessment of Mitotic Activity Between Microscopy and Digital Whole Slide Images Informs Conversion for Clinical Diagnosis.
Bih-Rong Wei, Charles H Halsey, +21 authors, R Mark Simpson.
Acad Pathol, 2019 Jul 20; 6. PMID: 31321298    Free PMC article.
The Landscape of Digital Pathology in Transplantation: From the Beginning to the Virtual E-Slide.
Ilaria Girolami, Anil Parwani, +8 authors, Albino Eccher.
J Pathol Inform, 2019 Aug 02; 10. PMID: 31367473    Free PMC article.
Review.
Digital pathology in the time of corona.
Nikolas Stathonikos, Nadege C van Varsseveld, +7 authors, Paul J van Diest.
J Clin Pathol, 2020 Jul 24; 73(11). PMID: 32699117    Free PMC article.
Review.
Digital Pathology: Advantages, Limitations and Emerging Perspectives.
Stephan W Jahn, Markus Plass, Farid Moinfar.
J Clin Med, 2020 Nov 22; 9(11). PMID: 33217963    Free PMC article.
Review.
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.
(Re) Defining the High-Power Field for Digital Pathology.
David Kim, Liron Pantanowitz, +6 authors, Matthew G Hanna.
J Pathol Inform, 2020 Dec 22; 11. PMID: 33343994    Free PMC article.
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.
Interchangeability of light and virtual microscopy for histopathological evaluation of prostate cancer.
Renata Zelic, Francesca Giunchi, +12 authors, Andreas Pettersson.
Sci Rep, 2021 Feb 07; 11(1). PMID: 33547336    Free PMC article.
Digital Pathology During the COVID-19 Outbreak in Italy: Survey Study.
Simone Giaretto, Salvatore Lorenzo Renne, +19 authors, Luca Di Tommaso.
J Med Internet Res, 2021 Jan 28; 23(2). PMID: 33503002    Free PMC article.
Fully digital pathology laboratory routine and remote reporting of oral and maxillofacial diagnosis during the COVID-19 pandemic: a validation study.
Anna Luíza Damaceno Araújo, Gleyson Kleber do Amaral-Silva, +15 authors, Pablo Agustin Vargas.
Virchows Arch, 2021 Mar 14; 479(3). PMID: 33713188    Free PMC article.
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.
Verification and Validation of Digital Pathology (Whole Slide Imaging) for Primary Histopathological Diagnosis: All Wales Experience.
M Babawale, A Gunavardhan, +24 authors, Muhammad Aslam.
J Pathol Inform, 2021 May 21; 12. PMID: 34012708    Free PMC article.
Selection of Representative Histologic Slides in Interobserver Reproducibility Studies: Insights from Expert Review for Ovarian Carcinoma Subtype Classification.
Marios A Gavrielides, Brigitte M Ronnett, +2 authors, Jeffrey D Seidman.
J Pathol Inform, 2021 May 21; 12. PMID: 34012719    Free PMC article.
Diagnostic concordance and discordance in digital pathology: a systematic review and meta-analysis.
Ayesha S Azam, Islam M Miligy, +4 authors, David R J Snead.
J Clin Pathol, 2020 Sep 17; 74(7). PMID: 32934103    Free PMC article.
Systematic Review.
Integrated digital pathology at scale: A solution for clinical diagnostics and cancer research at a large academic medical center.
Peter J Schüffler, Luke Geneslaw, +29 authors, Thomas J Fuchs.
J Am Med Inform Assoc, 2021 Jul 15; 28(9). PMID: 34260720    Free PMC article.
WHO/ISUP grading of clear cell renal cell carcinoma and papillary renal cell carcinoma; validation of grading on the digital pathology platform and perspectives on reproducibility of grade.
Lisa Browning, Richard Colling, Clare Verrill.
Diagn Pathol, 2021 Aug 23; 16(1). PMID: 34419085    Free PMC article.
Comparative Assessment of Digital Pathology Systems for Primary Diagnosis.
Sathyanarayanan Rajaganesan, Rajiv Kumar, +5 authors, Sangeeta Desai.
J Pathol Inform, 2021 Aug 28; 12. PMID: 34447605    Free PMC article.
Analysis of Image Feature Characteristics for Automated Scoring of HER2 in Histology Slides.
Ramakrishnan Mukundan.
J Imaging, 2019 Mar 10; 5(3). PMID: 34460463    Free PMC article.
Validation of grading of non-invasive urothelial carcinoma by digital pathology for routine diagnosis.
Richard Colling, Hayleigh Colling, Lisa Browning, Clare Verrill.
BMC Cancer, 2021 Sep 08; 21(1). PMID: 34488682    Free PMC article.
Virtual Microscopy in Undergraduate Pathology Education: An early transformative experience in clinical reasoning.
Ritu Lakhtakia.
Sultan Qaboos Univ Med J, 2021 Sep 16; 21(3). PMID: 34522409    Free PMC article.
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Wangpan Shi, Petros Georgiou, +6 authors, Safeera Khan.
Cureus, 2021 Sep 23; 13(8). PMID: 34548958    Free PMC article.
Review.
Integrating digital pathology into clinical practice.
Matthew G Hanna, Orly Ardon, +3 authors, Meera R Hameed.
Mod Pathol, 2021 Oct 03;. PMID: 34599281
Review.