Impact of Stain Normalization on Pathologist Assessment of Prostate Cancer: A Comparative Study

In clinical routine, the quality of whole-slide images plays a key role in the pathologist's diagnosis, and suboptimal staining may be a limiting factor. The stain normalization process helps to solve this problem through the standardization of color appearance of a source image with respect to a target image with optimal chromatic features. The analysis is focused on the evaluation of the following parameters assessed by two experts on original and normalized slides: (i) perceived color quality, (ii) diagnosis for the patient, (iii) diagnostic confidence and (iv) time required for diagnosis. Results show a statistically significant increase in color quality in the normalized images for both experts (p < 0.0001). Regarding prostate cancer assessment, the average times for diagnosis are significantly lower for normalized images than original ones (first expert: 69.9 s vs. 77.9 s with p < 0.0001; second expert: 37.4 s vs. 52.7 s with p < 0.0001), and at the same time, a statistically significant increase in diagnostic confidence is proven. The improvement of poor-quality images and greater clarity of diagnostically important details in normalized slides demonstrate the potential of stain normalization in the routine practice of prostate cancer assessment.