Corporación Universitaria Rafael Nuñez (CURN), Dentistry Progr...

Validation studies of whole slide imaging WSI systems produce evidence regarding digital microscopy DM This systematic review aimed to provide information about the performance of WSI devices by evaluating intraobserver agreement reported in previously published studies as the best evidence to elucidate whether DM is reliable for primary diagnostic purposes In addition this review delineates the reasons for the occurrence of discordant diagnoses Scopus MEDLINE PubMed and Embase were searched electronically A total of 13 articles were included The total sample of 2145 had a majority of 695 32 4 cases from dermatopathology followed by 200 9 3 cases from gastrointestinal pathology Intraobserver agreements showed an excellent concordance with values ranging from 87 to 98 3 coefficient range 0 8 0 98 Ten studies 77 reported a total of 128 disagreements The remaining three studies 23 did not report the exact number and nature of disagreements Borderline challenging cases were the most frequently reported reason for disagreements 53 8 Six authors reported limitations of the equipment and or limited image resolution as reasons for the discordant diagnoses Within these articles the reported pitfalls were as follows difficulties in the identification of eosinophilic granular bodies in brain biopsies eosinophils and nucleated red blood cells and mitotic figures nuclear details and chromatin patterns in neuropathology specimens The lack of image clarity was reported to be associated with difficulties in the identification of microorganisms e g Candida albicans Helicobacter pylori and Giardia lamblia However authors stated that the intraobserver variances do not derive from technical limitations of WSI A lack of clinical information was reported by four authors as a source for disagreements Two studies 15 4 reported poor quality of the biopsies specifically small size of the biopsy material or inadequate routine laboratory processes as reasons for disagreements One author 7 7 indicated the lack of immunohistochemistry and special stains as a source for discordance Furthermore nine studies 69 2 did not consider the performance of the digital method limitations of the equipment insufficient magnification limited image resolution as reasons for disagreements To summarize the pitfalls of digital pathology practice and better address the root cause of the diagnostic discordance we suggest a Categorization for Digital Pathology Discrepancies to be used in further validations studies Among 99 discordances only 37 37 3 had preferred diagnosis rendered by means of WSI The risk of bias and applicability concerns were judged with the QUADAS-2 Two studies 15 4 presented an unclear risk of bias in the sample selection domain and 2 15 4 presented a high risk of bias in the index test domain Regarding applicability all studies included were classified as a low concern in all domains The included studies were optimally designed to validate WSI for general clinical use providing evidence with confidence In general this systematic review showed a high concordance between diagnoses achieved by using WSI and conventional light microscope CLM summarizes difficulties related to specific findings of certain areas of pathology including dermatopathology pediatric pathology neuropathology and gastrointestinal pathology and demonstrated that WSI can be used to render primary diagnoses in several subspecialties of human pathology

Corporación Universitaria Rafael Nuñez (CURN), Dentistry Program, Health of Science Faculty, Cartagena de Índias, Colombia

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The performance of digital microscopy for primary diagnosis in human pathology: a systematic review