Review of the current state of whole slide imaging in pathology

Liron Pantanowitz¹, Paul N Valenstein², Andrew J Evans³, Keith J Kaplan⁴, John D Pfeifer⁵, David C Wilbur⁶, Laura C Collins⁷, Terence J Colgan^8
1 Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
² Department of Pathology, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
³ Department of Pathology, (UHN) Toronto General Hospital, Toronto, ON, Canada
⁴ Carolinas Pathology Group, Charlotte, NC, USA
⁵ Department of Pathology, Washington University School of Medicine, Saint Louis, MO, USA
⁶ Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
⁷ Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
⁸ Department of Laboratory Medicine and Pathology, Mt. Sinai Hospital, Toronto, ON, Canada

Correspondence Address:
Liron Pantanowitz
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 
USA

© 2011 Pantanowitz et al; This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.4103/2153-3539.83746

Abstract

Whole slide imaging (WSI), or "virtual" microscopy, involves the scanning (digitization) of glass slides to produce "digital slides". WSI has been advocated for diagnostic, educational and research purposes. When used for remote frozen section diagnosis, WSI requires a thorough implementation period coupled with trained support personnel. Adoption of WSI for rendering pathologic diagnoses on a routine basis has been shown to be successful in only a few "niche" applications. Wider adoption will most likely require full integration with the laboratory information system, continuous automated scanning, high-bandwidth connectivity, massive storage capacity, and more intuitive user interfaces. Nevertheless, WSI has been reported to enhance specific pathology practices, such as scanning slides received in consultation or of legal cases, of slides to be used for patient care conferences, for quality assurance purposes, to retain records of slides to be sent out or destroyed by ancillary testing, and for performing digital image analysis. In addition to technical issues, regulatory and validation requirements related to WSI have yet to be adequately addressed. Although limited validation studies have been published using WSI there are currently no standard guidelines for validating WSI for diagnostic use in the clinical laboratory. This review addresses the current status of WSI in pathology related to regulation and validation, the provision of remote and routine pathologic diagnoses, educational uses, implementation issues, and the cost-benefit analysis of adopting WSI in routine clinical practice.

Keywords: Consultation, diagnosis, digital, education, frozen section, imaging, informatics, telepathology, validation, virtual microscopy, whole slide imaging