Fully digital pathology laboratory routine and remote reporting of oral and maxillofacial diagnosis during the COVID-19 pandemic: a validation study

Virchows Arch. 2021 Sep;479(3):585-595. doi: 10.1007/s00428-021-03075-9. Epub 2021 Mar 13.


The role of digital pathology in remote reporting has seen an increase during the COVID-19 pandemic. Recently, recommendations had been made regarding the urgent need of reorganizing head and neck cancer diagnostic services to provide a safe work environment for the staff. A total of 162 glass slides from 109 patients over a period of 5 weeks were included in this validation and were assessed by all pathologists in both analyses (digital and conventional) to allow intraobserver comparison. The intraobserver agreement between the digital method (DM) and conventional method (CM) was considered almost perfect (κ ranged from 0.85 to 0.98, with 95% CI, ranging from 0.81 to 1). The most significant and frequent disagreements within trainees encompassed epithelial dysplasia grading and differentiation among severe dysplasia (carcinoma in situ) and oral squamous cell carcinoma. The most frequent pitfall from DM was lag in screen mirroring. The lack of details of inflammatory cells and the need for a higher magnification to assess dysplasia were pointed in one case each. The COVID-19 crisis has accelerated and consolidated the use of online meeting tools, which would be a valuable resource even in the post-pandemic scenario. Adaptation in laboratory workflow, the advent of digital pathology and remote reporting can mitigate the impact of similar future disruptions to the oral and maxillofacial pathology laboratory workflow avoiding delays in diagnosis and report, to facilitate timely management of head and neck cancer patients. Graphical abstract.

Keywords: COVID-19; Digital microscopy; Digital pathology; Laboratory workflow; Oral and maxillofacial pathology; Remote reporting.

Publication types

  • Validation Study

MeSH terms

  • Biopsy
  • COVID-19*
  • Carcinoma in Situ / pathology*
  • Diagnosis, Differential
  • Digital Technology*
  • Humans
  • Image Interpretation, Computer-Assisted*
  • Maxillary Neoplasms / pathology*
  • Microscopy*
  • Mouth Neoplasms / pathology*
  • Observer Variation
  • Predictive Value of Tests
  • Reproducibility of Results
  • Squamous Cell Carcinoma of Head and Neck / pathology*
  • Telepathology*
  • Workflow