Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Clin Pathol. 2013 Mar;66(3):218-23. doi: 10.1136/jclinpath-2012-201104. Epub 2012 Nov 30.
Whole slide images (WSI) have been used in many pathology applications such as teleconsultation, teaching and research, but not in primary diagnostics. The aim of this study was to test the feasibility of using WSI in primary diagnostics of paediatric pathology specimens and placental tissue.
Eighty consecutive tissues biopsies and resections from patients under 18 years old were selected, as well as 20 placentas. These cases had been diagnosed in the year 2009 by a single pathologist. The same pathologist who had performed the original diagnosis based on light microscopy was asked to rediagnose these 100 cases on WSI scanned at 20× magnification as well as by light microscopy having the original clinical information available, but blinded to the original light microscopic diagnoses. The original diagnoses were compared with WSI based diagnoses and rediagnoses by light microscopy and classified as concordant, mildly discordant (without clinical consequences) and discordant (with clinical consequences).
The original diagnoses were concordant with WSI and light microscopic diagnoses in 90% and 93% of cases respectively, which was not significantly different. Digital reassessment yielded eight mild discrepancies and two discrepant cases (2%) where the difference in diagnoses could have clinical implications for the patient. Light microscopic reassessment showed seven mild discrepancies. It turned out to be difficult to identify nucleated red blood cells on WSI, even when scanned at 40×.
Primary diagnostics of paediatric tissue biopsies and resections can generally well be done on WSI. However, some difficulties were encountered in examining placenta tissue where the identification of nucleated red blood cells may need higher resolution or even scanning at multiple focus depths, which is well possible on most current slide scanners.
全切片图像（WSI）已在许多病理学应用中得到应用，如远程会诊、教学和研究，但不能用于初级诊断。本研究旨在测试在儿科病理标本和胎盘组织的初级诊断中使用 WSI 的可行性。
选择了 80 例连续的 18 岁以下患者的组织活检和切除标本，以及 20 例胎盘。这些病例是在 2009 年由一位病理学家单独诊断的。要求同一位根据光学显微镜进行原始诊断的病理学家根据 20×放大倍数扫描的 WSI 以及具有原始临床信息的光学显微镜重新诊断这 100 例病例，但对原始光镜诊断结果不知情。将原始诊断与 WSI 基于诊断和光镜重新诊断进行比较，并分为一致、轻度不一致（无临床后果）和不一致（有临床后果）。
原始诊断与 WSI 和光镜诊断的一致性分别为 90%和 93%，差异无统计学意义。数字重新评估产生了 8 个轻度差异和 2 个不一致的病例（2%），其中诊断差异可能对患者有临床影响。光镜重新评估显示有 7 个轻度差异。结果发现，即使在 40×下扫描，也很难在 WSI 上识别有核红细胞。
儿科组织活检和切除标本的初级诊断通常可以在 WSI 上完成。然而，在检查胎盘组织时遇到了一些困难，在这种情况下，可能需要更高的分辨率或甚至在多个焦点深度进行扫描才能识别有核红细胞，这在大多数当前的切片扫描仪上都是可行的。
