Review
. 2016 Dec; 70(1):134-145.
doi: 10.1111/his.12993.

Digital pathology in clinical use: where are we now and what is holding us back?

Jon Griffin 1 Darren Treanor 2 
Affiliations
  • PMID: 27960232
  •     50 citations

Abstract

Whole slide imaging is being used increasingly in research applications and in frozen section, consultation and external quality assurance practice. Digital pathology, when integrated with other digital tools such as barcoding, specimen tracking and digital dictation, can be integrated into the histopathology workflow, from specimen accession to report sign-out. These elements can bring about improvements in the safety, quality and efficiency of a histopathology department. The present paper reviews the evidence for these benefits. We then discuss the challenges of implementing a fully digital pathology workflow, including the regulatory environment, validation of whole slide imaging and the evidence for the design of a digital pathology workstation.

Keywords: digital pathology; whole slide imaging.

Development of a Whole Slide Imaging System on Smartphones and Evaluation With Frozen Section Samples.
Hong Yu, Feng Gao, Liren Jiang, Shuoxin Ma.
JMIR Mhealth Uhealth, 2017 Sep 17; 5(9). PMID: 28916508    Free PMC article.
Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer.
Babak Ehteshami Bejnordi, Mitko Veta, +67 authors, Rui Venâncio.
JAMA, 2017 Dec 14; 318(22). PMID: 29234806    Free PMC article.
Highly Cited.
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.
Comparative analysis of tissue reconstruction algorithms for 3D histology.
Kimmo Kartasalo, Leena Latonen, +3 authors, Pekka Ruusuvuori.
Bioinformatics, 2018 Apr 24; 34(17). PMID: 29684099    Free PMC article.
Constant Quest for Quality: Digital Cytopathology.
Simone L Van Es, Janelle Greaves, +3 authors, Tony Badrick.
J Pathol Inform, 2018 May 04; 9. PMID: 29721361    Free PMC article.
Accuracy of Digital Pathologic Analysis vs Traditional Microscopy in the Interpretation of Melanocytic Lesions.
Tracy Onega, Raymond L Barnhill, +9 authors, Joann G Elmore.
JAMA Dermatol, 2018 Aug 25; 154(10). PMID: 30140929    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 Microscopy, Image Analysis, and Virtual Slide Repository.
Famke Aeffner, Hibret A Adissu, +8 authors, Kristin Wilson.
ILAR J, 2018 Dec 12; 59(1). PMID: 30535284    Free PMC article.
On the Edge of a Digital Pathology Transformation: Views from a Cellular Pathology Laboratory Focus Group.
Casmir Turnquist, Sharon Roberts-Gant, +5 authors, Clare Verrill.
J Pathol Inform, 2020 Jan 04; 10. PMID: 31897354    Free PMC article.
Clinical-grade Computational Pathology: Alea Iacta Est.
Filippo Fraggetta.
J Pathol Inform, 2020 Jan 11; 10. PMID: 31921486    Free PMC article.
Deep Learning in Image Cytometry: A Review.
Anindya Gupta, Philip J Harrison, +9 authors, Carolina Wählby.
Cytometry A, 2018 Dec 20; 95(4). PMID: 30565841    Free PMC article.
Review.
Combining Diagnostic Imaging and Pathology for Improving Diagnosis and Prognosis of Cancer.
Orazio Schillaci, Manuel Scimeca, +3 authors, Elena Bonanno.
Contrast Media Mol Imaging, 2019 Jul 30; 2019. PMID: 31354394    Free PMC article.
Review.
Segmentation and Classification in Digital Pathology for Glioma Research: Challenges and Deep Learning Approaches.
Tahsin Kurc, Spyridon Bakas, +21 authors, Keyvan Farahani.
Front Neurosci, 2020 Mar 11; 14. PMID: 32153349    Free PMC article.
The leading role of pathology in assessing the somatic molecular alterations of cancer: Position Paper of the European Society of Pathology.
Xavier Matias-Guiu, Giorgio Stanta, +4 authors, European Society of Pathology (ESP).
Virchows Arch, 2020 Mar 04; 476(4). PMID: 32124002    Free PMC article.
Review.
Intraoperative frozen section consultation by remote whole-slide imaging analysis -validation and comparison to robotic remote microscopy.
Thomas Menter, Stefan Nicolet, +2 authors, Alexandar Tzankov.
J Clin Pathol, 2019 Nov 14; 73(6). PMID: 31719106    Free PMC article.
Systems Biology and Kidney Disease.
Jennifer A Schaub, Habib Hamidi, Lalita Subramanian, Matthias Kretzler.
Clin J Am Soc Nephrol, 2020 Jan 30; 15(5). PMID: 31992571    Free PMC article.
Review.
Digital Pathology and PD-L1 Testing in Non Small Cell Lung Cancer: A Workshop Record.
Fabio Pagni, Umberto Malapelle, +12 authors, Giancarlo Troncone.
Cancers (Basel), 2020 Jul 09; 12(7). PMID: 32635634    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.
Immunohistochemical Study of Ezrin Expression in Colorectal Carcinoma: A Comparative Study between Objective Method and Digital Quantitative Assessment.
Essam E Ayad, Yousra O Kamal Eldin, +2 authors, Hesham A Elmeligy.
Asian Pac J Cancer Prev, 2020 Apr 27; 21(4). PMID: 32334457    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.
Introduction to Digital Image Analysis in Whole-slide Imaging: A White Paper from the Digital Pathology Association.
Famke Aeffner, Mark D Zarella, +11 authors, Douglas Bowman.
J Pathol Inform, 2019 Apr 16; 10. PMID: 30984469    Free PMC article.
Highly Cited. Review.
Physician perspectives on integration of artificial intelligence into diagnostic pathology.
Shihab Sarwar, Anglin Dent, +4 authors, Phedias Diamandis.
NPJ Digit Med, 2019 Jul 16; 2. PMID: 31304375    Free PMC article.
Empiric Methods to Account for Pre-analytical Variability in Digital Histopathology in Frontotemporal Lobar Degeneration.
Lucia A A Giannini, Sharon X Xie, +7 authors, David J Irwin.
Front Neurosci, 2019 Jul 25; 13. PMID: 31333403    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.
Integrative Data Augmentation with U-Net Segmentation Masks Improves Detection of Lymph Node Metastases in Breast Cancer Patients.
Yong Won Jin, Shuo Jia, Ahmed Bilal Ashraf, Pingzhao Hu.
Cancers (Basel), 2020 Oct 16; 12(10). PMID: 33053723    Free PMC article.
A narrative review of digital pathology and artificial intelligence: focusing on lung cancer.
Taro Sakamoto, Tomoi Furukawa, +8 authors, Junya Fukuoka.
Transl Lung Cancer Res, 2020 Nov 20; 9(5). PMID: 33209648    Free PMC article.
Review.
The Role of Telehealth During the COVID-19 Pandemic Across the Interdisciplinary Cancer Team: Implications for Practice.
Catherine Paterson, Rachel Bacon, +10 authors, Sandra C Hayes.
Semin Oncol Nurs, 2020 Nov 22; 36(6). PMID: 33218886    Free PMC article.
Review.
Experimental Assessment of Color Deconvolution and Color Normalization for Automated Classification of Histology Images Stained with Hematoxylin and Eosin.
Francesco Bianconi, Jakob N Kather, Constantino Carlos Reyes-Aldasoro.
Cancers (Basel), 2020 Nov 15; 12(11). PMID: 33187299    Free PMC article.
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.
WHO/ISUP classification, grading and pathological staging of renal cell carcinoma: standards and controversies.
Anne Y Warren, David Harrison.
World J Urol, 2018 Aug 21; 36(12). PMID: 30123932    Free PMC article.
Review.
Role of digital pathology in diagnostic histopathology in the response to COVID-19: results from a survey of experience in a UK tertiary referral hospital.
Lisa Browning, Eve Fryer, +4 authors, Clare Verrill.
J Clin Pathol, 2020 Jul 04; 74(2). PMID: 32616541    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.
The Role of the Pathologist in the Next-Generation Era of Tumor Molecular Characterization.
Valentina Angerilli, Francesca Galuppini, +3 authors, Matteo Fassan.
Diagnostics (Basel), 2021 Mar 07; 11(2). PMID: 33670699    Free PMC article.
Review.
A literature review of quality, costs, process-associated with digital pathology.
Yoo Jung Kim, Eul Hee Roh, Sangchan Park.
J Exerc Rehabil, 2021 Mar 18; 17(1). PMID: 33728283    Free PMC article.
Review.
Artificial Intelligence & Tissue Biomarkers: Advantages, Risks and Perspectives for Pathology.
Cesare Lancellotti, Pierandrea Cancian, +4 authors, Luca Di Tommaso.
Cells, 2021 May 01; 10(4). PMID: 33918173    Free PMC article.
Review.
Developing image analysis pipelines of whole-slide images: Pre- and post-processing.
Byron Smith, Meyke Hermsen, +2 authors, Walter Kremers.
J Clin Transl Sci, 2021 May 06; 5(1). PMID: 33948260    Free PMC article.
Review.
Impact of Preanalytical Factors During Histology Processing on Section Suitability for Digital Image Analysis.
Elizabeth A Chlipala, Mark Butters, +4 authors, Brad Bolon.
Toxicol Pathol, 2020 Dec 01; 49(4). PMID: 33251977    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.
Europe Unites for the Digital Transformation of Pathology: The Role of the New ESDIP.
Catarina Eloy, Norman Zerbe, Filippo Fraggetta.
J Pathol Inform, 2021 May 21; 12. PMID: 34012714    Free PMC article.
Digital pathology for the routine diagnosis of renal diseases: a standard model.
Vincenzo L'Imperio, Virginia Brambilla, +3 authors, Fabio Pagni.
J Nephrol, 2020 Jul 20; 34(3). PMID: 32683656    Free PMC article.
Systematic Review.
Non-Alcoholic Fatty Liver Disease: Implementing Complete Automated Diagnosis and Staging. A Systematic Review.
Stefan L Popa, Abdulrahman Ismaiel, +4 authors, Dan L Dumitrascu.
Diagnostics (Basel), 2021 Jul 03; 11(6). PMID: 34204822    Free PMC article.
Review.
Integrating the Health-care Enterprise Pathology and Laboratory Medicine Guideline for Digital Pathology Interoperability.
Rajesh C Dash, Nicholas Jones, +7 authors, François Macary.
J Pathol Inform, 2021 Jul 06; 12. PMID: 34221632    Free PMC article.
Dissecting the Business Case for Adoption and Implementation of Digital Pathology: A White Paper from the Digital Pathology Association.
Giovanni Lujan, Jennifer C Quigley, +16 authors, Doug Bowman.
J Pathol Inform, 2021 Jul 06; 12. PMID: 34221633    Free PMC article.
Artificial Intelligence in Pathology.
Sebastian Försch, Frederick Klauschen, Peter Hufnagl, Wilfried Roth.
Dtsch Arztebl Int, 2021 May 25; 118(12). PMID: 34024323    Free PMC article.
Review.
Development of a Deep-Learning Pipeline to Recognize and Characterize Macrophages in Colo-Rectal Liver Metastasis.
Pierandrea Cancian, Nina Cortese, +12 authors, Luca Di Tommaso.
Cancers (Basel), 2021 Jul 21; 13(13). PMID: 34282750    Free PMC article.
Collagen fiber orientation disorder from H&E images is prognostic for early stage breast cancer: clinical trial validation.
Haojia Li, Kaustav Bera, +11 authors, Anant Madabhushi.
NPJ Breast Cancer, 2021 Aug 08; 7(1). PMID: 34362928    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.
HistoClean: Open-source software for histological image pre-processing and augmentation to improve development of robust convolutional neural networks.
Kris D McCombe, Stephanie G Craig, +8 authors, Jacqueline A James.
Comput Struct Biotechnol J, 2021 Sep 16; 19. PMID: 34522291    Free PMC article.
A cross-platform informatics system for the Gut Cell Atlas: integrating clinical, anatomical and histological data.
Shunxing Bao, Sophie Chiron, +13 authors, Bennett A Landman.
Proc SPIE Int Soc Opt Eng, 2021 Sep 21; 11601. PMID: 34539029    Free PMC article.
A Survival Guide for the Rapid Transition to a Fully Digital Workflow: The "Caltagirone Example".
Filippo Fraggetta, Alessandro Caputo, +3 authors, Vincenzo L'Imperio.
Diagnostics (Basel), 2021 Oct 24; 11(10). PMID: 34679614    Free PMC article.