Whole slide imaging equivalency and efficiency study: experience at a large academic center

Area of Science:

• Digital Pathology
• Pathology Informatics
• Medical Imaging

Background:

• Whole slide imaging (WSI) is FDA-approved for primary diagnosis in the US, but enterprise-wide implementation is limited.
• Published studies show diagnostic equivalence between digital and conventional systems, yet efficiency data for clinical workloads is lacking.

Purpose of the Study:

• To compare the diagnostic equivalency and efficiency of digital pathology signout using WSI versus conventional microscopy in a real-world clinical setting.
• To evaluate the impact of digital pathology on pathology practice workflows and workloads across multiple subspecialties.

Main Methods:

• A randomized, equivalency, and efficiency study comparing glass slide signout to WSI signout for routine clinical workloads.
• Six anatomic pathology subspecialties at Memorial Sloan Kettering Cancer Center participated, reporting on 204 glass slide cases and 199 WSI cases.
• Intraobserver metrics included diagnosis, margin status, and ancillary testing needs; efficiency was measured by turnaround time.

Main Results:

• Overall diagnostic equivalency between digital and glass slide signout was high at 99.3% for top-line diagnoses.
• Signout using WSI demonstrated a median 19% decrease in efficiency per case compared to glass slides.
• No significant differences in equivalency or efficiency were found based on reader, subspecialty, or specimen type.

Conclusions:

• This study confirms high intraobserver diagnostic equivalence between WSI and glass slides in reporting clinical workloads.
• Efficiency remains a significant challenge for widespread digital pathology adoption, requiring further workflow optimization.
• Digital pathology has the potential to transform practice, but improvements in efficiency are crucial for broader implementation.