Evaluation of 2 whole-slide imaging applications in dermatopathology

Digitization of glass slides holds great promise for increasing workflow efficiency, but current applications have not gained widespread acceptance. Applications to date have not taken into consideration pathologists' workflow patterns, and as a result many find navigation cumbersome and interpretation more challenging when compared to glass slides. We observed 3 dermatopathologists evaluate a set of cases using 2 digital applications, one of which used a novel navigation method developed in-house. We then compared their approach to the digital slides with the gold standard traditional microscopy with glass slides. Common diagnoses were identified in 3 categories: inflammatory, nonmelanocytic, and melanocytic lesions. Forty-five cases were selected representing these diagnoses. Digital slides were captured on a commercially available scanner. Sign-out was performed with a commercial viewer as well as with the in-house application. Sessions were captured on video and reviewed. Time to examine each slide, time spent at each magnification, and diagnostic concordance were measured. Average time spent per slide was least with the microscope (23 seconds) as compared with the in-house (34 seconds) or the vendor application (38 seconds). This difference was most significant in the least complex cases. Pathologists reported difficulty interpreting mitotic figures, neutrophil lobules, and eosinophil granules by digital slides. These results suggest that current applications for viewing digital slides do not yet provide a more efficient means of evaluating dermatopathology cases and reinforce the need for improvement in both the capture process and the presentation of digital slides, with particular attention paid to the interface and navigation.