. 2020 May; 33(4):1034-1040.
doi: 10.1007/s10278-020-00351-z.

Whole Slide Imaging (WSI) in Pathology: Current Perspectives and Future Directions

Neeta Kumar 1 Ruchika Gupta 2 Sanjay Gupta 3 
  • PMID: 32468487
  •     39 References
  •     4 citations


Whole slide imaging (WSI), ever since its first introduction about two decades ago, has been validated for a number of applications in the field of pathology. The recent approval of US FDA to a WSI system for use in primary surgical pathology diagnosis has opened avenues for wider acceptance and application of this technology in routine practice. The ongoing technological advances in digital scanners, image visualization methods, and the integration of artificial intelligence-derived algorithms with these systems provide opportunities of its newer applications. Its benefits are innumerable such as ease of access through internet, avoidance of physical storage space, and no risk of deterioration of staining quality or breakage of slides to name a few. Various barriers such as the high cost, technical glitches, and professional hesitation to adopt a new technology have hindered its use in pathology. This review article summarizes the technical aspects of WSI, its applications in diagnostic pathology, training, and research along with future perspectives. It highlights the benefits, limitations, and challenges delaying the use of this technology in routine practice. The review is targeted at students, residents, and budding pathologists to better acquaint them with the key aspects of state-of-the-art technology and enable them to implement WSI judiciously.

Keywords: Automated image analysis; Cytopathology; Diagnosis; Education; Regulation; Telepathology; Validation; Whole slide imaging.

"Slide less pathology": Fairy tale or reality?
M Indu, R Rathy, M P Binu.
J Oral Maxillofac Pathol, 2016 Sep 08; 20(2). PMID: 27601824    Free PMC article.
Virtual electron microscopy: a simple implementation creating a new paradigm in ultrastructural examination.
King-Chung Lee, Lap-Sam Mak.
Int J Surg Pathol, 2011 Sep 10; 19(5). PMID: 21903681
Telepathology at the Armed Forces Institute of Pathology: A Retrospective Review of Consultations From 1996 to 1997.
Arunima Ghosh, G Thomas Brown, Paul Fontelo.
Arch Pathol Lab Med, 2017 Oct 03; 142(2). PMID: 28967805
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
Video compression to support the expansion of whole-slide imaging into cytology.
Mark D Zarella, Jennifer Jakubowski.
J Med Imaging (Bellingham), 2020 Jan 01; 6(4). PMID: 31890747    Free PMC article.
Whole slide images add value to journal article figures.
Philip T Cagle, Eric F Glassy.
Arch Pathol Lab Med, 2014 May 03; 138(5). PMID: 24786116
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.
Creation of a fully digital pathology slide archive by high-volume tissue slide scanning.
André Huisman, Arnoud Looijen, Steven M van den Brink, Paul J van Diest.
Hum Pathol, 2010 Feb 05; 41(5). PMID: 20129646
Ovarian frozen section diagnosis: use of whole-slide imaging shows excellent correlation between virtual slide and original interpretations in a large series of cases.
Margaret A Fallon, David C Wilbur, Manju Prasad.
Arch Pathol Lab Med, 2010 Jul 01; 134(7). PMID: 20586631
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.
Telecytology in East Africa: a feasibility study of forty cases using a static imaging system.
Neeta Kumar, Satya Vara Prasad Busarla, +5 authors, Aliyah R Sohani.
J Telemed Telecare, 2011 Nov 05; 18(1). PMID: 22052967
Whole-slide imaging digital pathology as a platform for teleconsultation: a pilot study using paired subspecialist correlations.
David C Wilbur, Kalil Madi, +22 authors, Wolfgang Klietmann.
Arch Pathol Lab Med, 2009 Dec 08; 133(12). PMID: 19961250    Free PMC article.
Digital cytology: current state of the art and prospects for the future.
David C Wilbur.
Acta Cytol, 2011 Apr 29; 55(3). PMID: 21525733
Comparison of glass slides and various digital-slide modalities for cytopathology screening and interpretation.
Matthew G Hanna, Sara E Monaco, +3 authors, Liron Pantanowitz.
Cancer Cytopathol, 2017 May 31; 125(9). PMID: 28558124
Twenty Years of Digital Pathology: An Overview of the Road Travelled, What is on the Horizon, and the Emergence of Vendor-Neutral Archives.
Liron Pantanowitz, Ashish Sharma, +3 authors, Joel Saltz.
J Pathol Inform, 2019 Jan 05; 9. PMID: 30607307    Free PMC article.
Digital slides: present status of a tool for consultation, teaching, and quality control in pathology.
Rafael Rocha, José Vassallo, +2 authors, Helenice Gobbi.
Pathol Res Pract, 2009 Jun 09; 205(11). PMID: 19501988
Web-based oil immersion whole slide imaging increases efficiency and clinical team satisfaction in hematopathology tumor board.
Zhongchuan Will Chen, Jessica Kohan, +2 authors, Mohamed E Salama.
J Pathol Inform, 2014 Nov 08; 5(1). PMID: 25379347    Free PMC article.
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.
Telepathology consultation for frozen section diagnosis in China.
Yingxin Huang, Yan Lei, +11 authors, Yongjian Deng.
Diagn Pathol, 2018 May 16; 13(1). PMID: 29759085    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.
A Practical Guide to Whole Slide Imaging: A White Paper From the Digital Pathology Association.
Mark D Zarella, Douglas Bowman, +6 authors, Douglas J Hartman.
Arch Pathol Lab Med, 2018 Oct 12; 143(2). PMID: 30307746
Highly Cited. Review.
Review of the current state of whole slide imaging in pathology.
Liron Pantanowitz, Paul N Valenstein, +5 authors, Terence J Colgan.
J Pathol Inform, 2011 Sep 03; 2. PMID: 21886892    Free PMC article.
Highly Cited.
US Food and Drug Administration Approval of Whole Slide Imaging for Primary Diagnosis: A Key Milestone Is Reached and New Questions Are Raised.
Andrew J Evans, Thomas W Bauer, +12 authors, Liron Pantanowitz.
Arch Pathol Lab Med, 2018 May 01; 142(11). PMID: 29708429
Virtual microscopy in pathology education.
Fred R Dee.
Hum Pathol, 2009 Jun 23; 40(8). PMID: 19540551
Rebooting the pathology journal: learning in the age of digital pathology.
Eric F Glassy.
Arch Pathol Lab Med, 2014 Jun 01; 138(6). PMID: 24878011
The state of telepathology in Japan.
Takashi Sawai, Miwa Uzuki, Akihisa Kamataki, Ikuo Tofukuji.
J Pathol Inform, 2010 Oct 06; 1. PMID: 20922030    Free PMC article.
Digital slide imaging in cervicovaginal cytology: a pilot study.
Angela M Wright, Debora Smith, +6 authors, Donna M Coffey.
Arch Pathol Lab Med, 2012 Sep 14; 137(5). PMID: 22970841
2014 American Telemedicine Association clinical guidelines for telepathology: Another important step in support of increased adoption of telepathology for patient care.
Andrew J Evans, Elizabeth A Krupinski, Ronald S Weinstein, Liron Pantanowitz.
J Pathol Inform, 2015 Apr 04; 6. PMID: 25838965    Free PMC article.
Quality control and automation in cervical cytology.
Neeta Kumar, Shyama Jain.
J Indian Med Assoc, 2005 Feb 19; 102(7). PMID: 15717583
Are we throwing histology out with the microscope? A look at histology from the physician's perspective.
Rebecca L Pratt.
Anat Sci Educ, 2009 Aug 19; 2(5). PMID: 19688840
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
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.
Digital imaging in pathology: whole-slide imaging and beyond.
Farzad Ghaznavi, Andrew Evans, Anant Madabhushi, Michael Feldman.
Annu Rev Pathol, 2012 Nov 20; 8. PMID: 23157334
Interobserver and intraobserver reproducibility in digital and routine microscopic assessment of prostate needle biopsies.
Paula A Rodriguez-Urrego, Angel M Cronin, +4 authors, Samson W Fine.
Hum Pathol, 2010 Oct 26; 42(1). PMID: 20970164
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.
An automated system for whole microscopic image acquisition and analysis.
Gloria Bueno, Oscar Déniz, +2 authors, Jesús Salido.
Microsc Res Tech, 2014 Jun 12; 77(9). PMID: 24916187
Applications of pathology-assisted image analysis of immunohistochemistry-based biomarkers in oncology.
V Shinde, K E Burke, +7 authors, D Bowman.
Vet Pathol, 2013 Nov 16; 51(1). PMID: 24232190
From Detection of Individual Metastases to Classification of Lymph Node Status at the Patient Level: The CAMELYON17 Challenge.
Peter Bandi, Oscar Geessink, +33 authors, Geert Litjens.
IEEE Trans Med Imaging, 2019 Feb 05; 38(2). PMID: 30716025
SurfaceSlide: a multitouch digital pathology platform.
Yinhai Wang, Kate E Williamson, +2 authors, Peter W Hamilton.
PLoS One, 2012 Feb 01; 7(1). PMID: 22292040    Free PMC article.
Digital pathology and computational image analysis in nephropathology.
Laura Barisoni, Kyle J Lafata, +2 authors, Ulysses G J Balis.
Nat Rev Nephrol, 2020 Aug 28; 16(11). PMID: 32848206    Free PMC article.
REDECA: A Novel Framework to Review Artificial Intelligence and Its Applications in Occupational Safety and Health.
Maryam Pishgar, Salah Fuad Issa, +2 authors, Houshang Darabi.
Int J Environ Res Public Health, 2021 Jul 03; 18(13). PMID: 34206378    Free PMC article.
Multispecialty Enterprise Imaging Workgroup Consensus on Interactive Multimedia Reporting Current State and Road to the Future: HIMSS-SIIM Collaborative White Paper.
Christopher J Roth, David A Clunie, +22 authors, Les R Folio.
J Digit Imaging, 2021 Jun 17; 34(3). PMID: 34131793    Free PMC article.
Morphological Estimation of Cellularity on Neo-Adjuvant Treated Breast Cancer Histological Images.
Mauricio Alberto Ortega-Ruiz, Cefa Karabağ, Victor García Garduño, Constantino Carlos Reyes-Aldasoro.
J Imaging, 2021 Aug 31; 6(10). PMID: 34460542    Free PMC article.