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Digital pathology in forensic science: a systematic review of the literature
Laura Ambrosi1, Federica Amirante2, Simona Nicolì3
1Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, Bari, Italy.
Background:
Digital pathology (DP) and whole-slide imaging (WSI) are increasingly utilized in clinical pathology; however, their role in forensic medicine remains less defined, as evidentiary standards demand robust validation, auditability, and a chain of custody.
Methods:
We conducted a systematic review of PubMed, Scopus, and Web of Science for studies that applied DP and WSI to forensic, autopsy, or postmortem contexts, with eligibility requiring peer-reviewed human studies that reported methods and outcomes. Data were charted for study design, tissue, devices/software, and outcomes (diagnostic agreement, quantitative metrics, validation/quality assurance (QA)).
Results:
The search retrieved 361 records; after screening and full-text assessment, 21 studies were selected for inclusion. Fifteen studies primarily advanced diagnostic knowledge using postmortem material (e.g., quantitative neuropathology and organ-specific morphometry), while five had direct forensic aims (casework validation or core forensic tests).
Conclusions:
The review highlights that DP is technically ready for medico-legal workflows; however, its use remains low compared to other clinical settings. Adoption in forensics should centre on CAP-style, use-case-specific validation, traceable/auditable pipelines (including hashing, logs, and tile-linked overlays), stain/colour governance, and external robustness testing. Under these conditions, DP can deliver reproducible, transparent, and court-defensible evidence across forensic practice.
