Whole slide imaging in pathology: what is holding us back?

Abstract

Pathology and Laboratory Medicine International Dovepresssubmit your manuscript | www.dovepress.com 4 Why, despite all the advances described in the accompanying article, has WSI not taken pathology by storm like digital radiology and picture archiving and communication system (PACS) took radiology by storm years ago. Where have we fallen short and why has there been slow adoption of WSI beyond the research and education venues, where it has been much more broadly adopted. Perhaps because the use cases in research and education have such a strong return on investment (ROI), they have been much better targets for early adoption of WSI. Dovepress 35 E d I t o r I a LIt has been more than 10 years since the first rapid high speed scanners for WSI came onto the market. While these high speed scanners have improved and new approaches to WSI have evolved, today's scanners provide high spatial and color fidelity in the X-Y plane but they still cannot recapitulate all the functions of a standard clinical microscope. Today's scanners cannot perform a Z-axis across an entire slide rapidly. While some scanners are capable of a Z-stack scan, these scanners acquire the Z-stack by making multiple individual scans at different focal planes, a very time consuming process that makes them impractical for widespread use of a Z-stack in today's high volume clinical labs. How important are multiple focal planes? Without a side by side study it is impossible to say, but consider the types of uses and frequency that we use the Z-axis on our microscopes. Without multiple focal planes, accurately assessing mitotic figures are only accurate to 80%-85% as described in the accompanying article and this point was further demonstrated in a software competition where image scientists were asked to create algorithms that could detect mitoses and the best the advanced image processing software were able to achieve was a similar 80%-85% accuracy compared to manually annotated slides using an analog microscope. 54.202.233.140 on 12-May-2018 For personal use only.

Digital pathology in the diagnostic setting: beyond technology into best practice and service management

“…To date, this traditional method remains the ‘gold standard’ of the specialty. WSI technology, which has seen substantial growth and progress since the introduction of automated high-speed WSI in 1999 by Wetzel and Gilbertson,4 is steadily transforming histopathology, most noticeably in education and research,5 6 though at a slower pace in diagnostics. There is increasing evidence that WSI is comparable to glass slide examination in the delivery of histopathology diagnoses, both in routine preparations from paraffin-embedded tissues as well as frozen sections 7–9.…”

Future perspectives of digital pathology

“…Within diagnostics itself, only teleconsultation and automated intraoperative examination have become adopted. At present, routine pathomorphological digital diagnostics is neither so widely accepted nor widespread as compared to digital diagnostic radiology [23].…”

“…Laboratory work involved in using this technology line to prepare WSIs takes more time than the traditional organisation of workloads, because of the additional procedure required for creating digital images. Despite the many advantages of digital diagnostics, most pathologists feel more confident when using light microscopes for making diagnoses, especially if they had previously received their education in conventional methods [23]. Furthermore, in spite of all the facilities available for automated image analysis, making diagnoses is more rapid and simple when using light microscopes than using computers.…”

“…Upon introducing routine digital diagnostics, a large investment in IT infrastructure is required including setting up the hardware and software as well as additional staff training [19]. It should also be noted that even the most modern scanners still do not fully cover all the functions of modern optical microscopes [23].…”

Digital dynamo, delayed: Despite progress, whole slide imaging faces more hurdles on the path to broader acceptance in primary diagnostics

“…The same cannot be said for primary diagnosis. So why hasn't WSI, one of the most hotly anticipated, if controversial, advances in the field, “taken pathology by storm,” as a recent editorial put it?…”