Implementation of Digital Pathology Workflow for Routine Primary Diagnosis in a Large Private Hospital Network

Abstract

Digital pathology provides better access to high-quality diagnostic services and requires validation before moving into routine practice. This study aimed to evaluate and share our experiences in the validation process of digital pathology. A total of 6128 histopathological slides from 846 patients were digitized using two scanners and shared with fifteen pathologists. Digital slides were assessed, and a preliminary report was prepared, and then slides were reviewed by light microscopy before the final report was signed. Data were collected regarding organ systems, diagnostic outcomes, discrepancies between digital and microscopic evaluations, causes of discordance, the need for rescanning or reexamination with a microscope, and perceived advantages and disadvantages of digital diagnostics. Minor diagnostic discordances were detected in 5.7% of cases (48/837), whereas no major discordances affecting treatment decisions were observed in 98% of cases (821/837). Rescanning was required in 3% of cases, and reevaluation by light microscope in 7%. The most frequent discordances involved the detection of microorganisms and the assessment of mitotic figures. Although certain limitations, microscopic diagnoses were not considered to be superior to the diagnoses using whole slide imaging.

Keywords: digital pathology validation; discordance; routine diagnosis; scanned slides.