Discrepancies in digital hematopathology diagnoses for consultation and expert panel analysis

Michiel Van Den Brand,Kimberly D Van Der Laan,Jos W Meijer,Jan Willem Leeuwis,Irene Otte-Höller,Peet T G A Nooijen,A M Van Leeuwen,Konnie M Hebeda,Peter C De Bruin

doi:10.1007/s00428-020-02907-4

Abstract

Digital pathology with whole-slide imaging (WSI) has a large potential to make the process of expert consultation and expert panel diagnosis more rapid and more efficient. However, comparison with the current methods is necessary for validation of the technique. In this study, we determined if digital assessment of whole-slide images of hematopathology specimens with a focus on the assessment of lymphoma can be used for consultation and panel diagnostics. Ninety-three histological specimens with a suspicion for lymphoma were assessed both with conventional microscopy and digital microscopy with a wash out period between assessments. A consensus diagnosis was based on full concordance between the pathologists or, in case of discordances, was reached at a joint session at a multi-headed microscope. In 81% of the cases, there was a full concordance between digital and light microscopical assessment for all three pathologists. Discordances between conventional microscopy and digital pathology were present in 3% of assessments. In comparison with the consensus diagnosis, discordant diagnoses were made in 5 cases with digital microscopy and in 3 cases with light microscopy. The reported level of confidence and need for additional investigations were similar between assessment by conventional and by digital microscopy. In conclusion, the performance of assessment by digital pathology is in general comparable with that of conventional light microscopy and pathologists feel confident using digital pathology for this subspecialty.

Highlights

A correct histological diagnosis of malignant lymphoma is essential for adequate treatment and accurate prognostication
Images were first assessed by three hematopathologists (KH, PN, MB) with the Philips Image Management System on a regular desktop computer screen, resulting in the digital microscopy diagnosis (DMD)
There was no standard setup used for digital pathology; the pathologist assessed the cases on their regular computer equipment

Summary

Introduction

A correct histological diagnosis of malignant lymphoma is essential for adequate treatment and accurate prognostication. Hematopathological diagnosis of lymphoma is known for significant inter- and intra-observer variability. The percentage of discordance between pathologists in the World Health Organization classification from 2008 ranges. The Netherlands 4 Pathology-DNA, St. Antonius Hospital, Nieuwegein, The Netherlands from 6 to 27% between studies, depending on the case mix [1,2,3]. Expert panels can help to decrease inter-observer variation. The introduction of a panel of expert hematopathologist in the East Netherlands in 2000 resulted in a decrease in discordance from 14 to 9% in a period of 5 years [2]

Methods

Results

Conclusion