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Rizzo PC, Girolami I, Marletta S, Pantanowitz L, Antonini P, Brunelli M, Santonicco N, Vacca P, Tumino N, Moretta L, Parwani A, Satturwar S, Eccher A, Munari E. Technical and Diagnostic Issues in Whole Slide Imaging Published Validation Studies. Front Oncol 2022; 12:918580. [PMID: 35785212 PMCID: PMC9246412 DOI: 10.3389/fonc.2022.918580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/24/2022] [Indexed: 01/07/2023] Open
Abstract
ObjectiveDigital pathology with whole-slide imaging (WSI) has many potential clinical and non-clinical applications. In the past two decades, despite significant advances in WSI technology adoption remains slow for primary diagnosis. The aim of this study was to identify common pitfalls of WSI reported in validation studies and offer measures to overcome these challenges.MethodsA systematic search was conducted in the electronic databases Pubmed-MEDLINE and Embase. Inclusion criteria were all validation studies designed to evaluate the feasibility of WSI for diagnostic clinical use in pathology. Technical and diagnostic problems encountered with WSI in these studies were recorded.ResultsA total of 45 studies were identified in which technical issues were reported in 15 (33%), diagnostic issues in 8 (18%), and 22 (49%) reported both. Key technical problems encompassed slide scan failure, prolonged time for pathologists to review cases, and a need for higher image resolution. Diagnostic challenges encountered were concerned with grading dysplasia, reliable assessment of mitoses, identification of microorganisms, and clearly defining the invasive front of tumors.ConclusionDespite technical advances with WSI technology, some critical concerns remain that need to be addressed to ensure trustworthy clinical diagnostic use. More focus on the quality of the pre-scanning phase and training of pathologists could help reduce the negative impact of WSI technical difficulties. WSI also seems to exacerbate specific diagnostic tasks that are already challenging among pathologists even when examining glass slides with conventional light microscopy.
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Affiliation(s)
- Paola Chiara Rizzo
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | | | - Stefano Marletta
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Liron Pantanowitz
- Department of Pathology & Clinical Labs, University of Michigan, Ann Arbor, MI, United States
| | - Pietro Antonini
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Nicola Santonicco
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Paola Vacca
- Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Nicola Tumino
- Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Lorenzo Moretta
- Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Anil Parwani
- Department of Pathology, Ohio State University Medical Center, Columbus, OH, United States
| | - Swati Satturwar
- Department of Pathology, Ohio State University Medical Center, Columbus, OH, United States
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
- *Correspondence: Albino Eccher,
| | - Enrico Munari
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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Bertram CA, Stathonikos N, Donovan TA, Bartel A, Fuchs-Baumgartinger A, Lipnik K, van Diest PJ, Bonsembiante F, Klopfleisch R. Validation of digital microscopy: Review of validation methods and sources of bias. Vet Pathol 2022; 59:26-38. [PMID: 34433345 PMCID: PMC8761960 DOI: 10.1177/03009858211040476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Digital microscopy (DM) is increasingly replacing traditional light microscopy (LM) for performing routine diagnostic and research work in human and veterinary pathology. The DM workflow encompasses specimen preparation, whole-slide image acquisition, slide retrieval, and the workstation, each of which has the potential (depending on the technical parameters) to introduce limitations and artifacts into microscopic examination by pathologists. Performing validation studies according to guidelines established in human pathology ensures that the best-practice approaches for patient care are not deteriorated by implementing DM. Whereas current publications on validation studies suggest an overall high reliability of DM, each laboratory is encouraged to perform an individual validation study to ensure that the DM workflow performs as expected in the respective clinical or research environment. With the exception of validation guidelines developed by the College of American Pathologists in 2013 and its update in 2021, there is no current review of the application of methods fundamental to validation. We highlight that there is high methodological variation between published validation studies, each having advantages and limitations. The diagnostic concordance rate between DM and LM is the most relevant outcome measure, which is influenced (regardless of the viewing modality used) by different sources of bias including complexity of the cases examined, diagnostic experience of the study pathologists, and case recall. Here, we review 3 general study designs used for previous publications on DM validation as well as different approaches for avoiding bias.
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Affiliation(s)
- Christof A. Bertram
- University of Veterinary Medicine, Vienna, Austria
- Freie Universität Berlin, Berlin, Germany
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