Multi-institutional comparison of whole slide digital imaging and optical microscopy for interpretation of hematoxylin-eosin-stained breast tissue sections

Arch Pathol Lab Med. 2013 Dec;137(12):1733-9. doi: 10.5858/arpa.2012-0437-OA. Epub 2013 Aug 15.


Context: Whole slide imaging (WSI) is now used for educational purposes, for consultation, and for archiving and quantitation of immunostains. However, it is not routinely used for the primary diagnosis of hematoxylin-eosin-stained tissue sections.

Objective: To compare WSI using the Aperio digital pathology system (Aperio Technologies, Inc, Vista, California) with optical microscopy (OM) for the interpretation of hematoxylin-eosin-stained tissue sections of breast lesions.

Design: The study was conducted at 3 clinical sites; 3 breast pathologists interpreted 150 hematoxylin-eosin-stained slides at each site, 3 times each by WSI and 3 times each by OM. For WSI, slides were scanned using an Aperio ScanScope and interpreted on a computer monitor using Aperio ImageScope software and Aperio Spectrum data management software. Pathologic interpretations were recorded using the College of American Pathologists breast checklist. WSI diagnoses were compared with OM diagnoses for accuracy, precision (interpathologist variation), and reproducibility (intrapathologist variation). Results were considered accurate only if the interpretation matched exactly between WSI and OM. The proportion of accurate results reported by each pathologist was expressed as a percentage for the comparison of the 2 platforms.

Results: The accuracy of WSI for classifying lesions as not carcinoma or as noninvasive (ductal or lobular) or invasive (ductal, lobular, or other) carcinoma was 90.5%. The accuracy of OM was 92.1%. The precision and reproducibility of WSI and OM were determined on the basis of pairwise comparisons (3 comparisons for each slide, resulting in 36 possible comparisons). The overall precision of WSI was 90.5% in comparison with 92.1% for OM; reproducibility of WSI was 91.6% in comparison with 94.5% for OM, respectively.

Conclusions: In this study, we demonstrated that WSI and OM have similar accuracy, precision, and reproducibility for interpreting hematoxylin-eosin-stained breast tissue sections. Further clinical studies using routine surgical pathology specimens would be useful to confirm these findings and facilitate the incorporation of WSI into diagnostic practice.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / pathology
  • Carcinoma, Ductal, Breast / diagnosis
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Lobular / diagnosis
  • Carcinoma, Lobular / pathology
  • Diagnosis, Differential
  • Diagnostic Imaging / methods
  • Diagnostic Imaging / standards
  • Eosine Yellowish-(YS)*
  • Female
  • Hematoxylin*
  • Histocytochemistry / methods*
  • Humans
  • Image Interpretation, Computer-Assisted / methods
  • Image Interpretation, Computer-Assisted / standards*
  • Microscopy / methods
  • Microscopy / standards*
  • Optical Imaging / methods
  • Optical Imaging / standards*
  • Reproducibility of Results


  • Eosine Yellowish-(YS)
  • Hematoxylin