Abstract
BackgroundValidation of digital whole slide images is crucial to ensure that diagnostic performance is at least equivalent to that of glass slides and light microscopy. The College of American Pathologists Pathology and Laboratory Quality Center recently developed recommendations for internal digital pathology system validation. Following these guidelines we sought to validate the performance of a digital approach for routine diagnosis by using an iPad and digital control widescreen-assisted workstation through a pilot study.MethodsFrom January 2014, 61 histopathological slides were scanned by ScanScope Digital Slides Scanner (Aperio, Vista, CA). Two independent pathologists performed diagnosis on virtual slides in front of a widescreen by using two computer devices (ImageScope viewing software) located to different Health Institutions (AOUI Verona) connected by local network and a remote image server using an iPad tablet (Aperio, Vista, CA), after uploading the Citrix receiver for iPad. Quality indicators related to image characters and work-flow of the e-health cockpit enterprise system were scored based on subjective (high vs poor) perception. The images were re-evaluated two weeks apart.ResultsThe whole glass slides encountered 10 liver: hepatocarcinoma, 10 renal carcinoma, 10 gastric carcinoma and 10 prostate biopsies: adenocarcinoma, 5 excisional skin biopsies: melanoma, 5 lymph-nodes: lymphoma. 6 immuno- and 5 special stains were available for intra- and internet remote viewing. Scan times averaged two minutes and 54 seconds per slide (standard deviation 2 minutes 34 seconds). Megabytes ranged from 256 to 680 (mean 390) per slide storage. Reliance on glass slide, image quality (resolution and color fidelity), slide navigation time, simultaneous viewers in geographically remote locations were considered of high performance score. Side by side comparisons between diagnosis performed on tissue glass slides versus widescreen were excellent showing an almost perfect concordance (0.81, kappa index).ConclusionsWe validated our institutional digital pathology system for routine diagnostic facing with whole slide images in a cockpit enterprise digital system or iPad tablet. Computer widescreens are better for diagnosing scanned glass slide that iPad. For urgent requests, iPad may be used. Legal aspects have to be soon faced with to permit the clinical use of this technology in a manner that does not compromise patient care.
Highlights
Validation of digital whole slide images is crucial to ensure that diagnostic performance is at least equivalent to that of glass slides and light microscopy
For this purpose an expert non vendor panel convened by the College of American Pathologists Pathology and Laboratory Quality Center recently developed practice guidelines for internal digital pathology system validation, recommending a study of intra-observer diagnostic concordance between digitized and glass slides in at least 60 routine cases for each application, viewed at least 2 weeks apart [4]
Since these guidelines are applicable to any whole slide imaging system, we sought to validate the performance of a digital approach for routine diagnosis with images available for intra- and internet remote viewing by using an iPad tablet compared to a widescreen-assisted digital workstation through a pilot study
Summary
Validation of digital whole slide images is crucial to ensure that diagnostic performance is at least equivalent to that of glass slides and light microscopy. Validation of applications for digital whole slide images for routine diagnostic use is a critical step to ensure that accuracy is at least equivalent to the one obtained viewing glass slide through a light microscopy For this purpose an expert non vendor panel convened by the College of American Pathologists Pathology and Laboratory Quality Center recently developed practice guidelines for internal digital pathology system validation, recommending a study of intra-observer diagnostic concordance between digitized and glass slides in at least 60 routine cases for each application, viewed at least 2 weeks apart [4]. Since these guidelines are applicable to any whole slide imaging system, we sought to validate the performance of a digital approach for routine diagnosis with images available for intra- and internet remote viewing by using an iPad tablet compared to a widescreen-assisted digital workstation through a pilot study
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