Vyas Nikki S, Markow Michael, Prieto-Granada Carlos, Gaudi Sudeep, Turner Leslie, Rodriguez-Waitkus Paul, Messina Jane L, Jukic Drazen M
Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Pathology and Cell Biology, University of South Florida, Tampa, USA.
J Pathol Inform. 2016 Jul 26;7:30. doi: 10.4103/2153-3539.186909. eCollection 2016.
The quality and limitations of digital slides are not fully known. We aimed to estimate intrapathologist discrepancy in detecting specific microscopic features on glass slides and digital slides created by scanning at ×20.
Hematoxylin and eosin and periodic acid-Schiff glass slides were digitized using the Mirax Scan (Carl Zeiss Inc., Germany). Six pathologists assessed 50-71 digital slides. We recorded objective magnification, total time, and detection of the following: Mast cells; eosinophils; plasma cells; pigmented macrophages; melanin in the epidermis; fungal bodies; neutrophils; civatte bodies; parakeratosis; and sebocytes. This process was repeated using the corresponding glass slides after 3 weeks. The diagnosis was not required.
The mean time to assess digital slides was 176.77 s and 137.61 s for glass slides (P < 0.001, 99% confidence interval [CI]). The mean objective magnification used to detect features using digital slides was 18.28 and 14.07 for glass slides (P < 0.001, 99.99% CI). Parakeratosis, civatte bodies, pigmented macrophages, melanin in the epidermis, mast cells, eosinophils, plasma cells, and neutrophils, were identified at lower objectives on glass slides (P = 0.023-0.001, 95% CI). Average intraobserver concordance ranged from κ = 0.30 to κ = 0.78. Features with poor to fair average concordance were: Melanin in the epidermis (κ = 0.15-0.58); plasma cells (κ = 0.15-0.49); and neutrophils (κ = 0.12-0.48). Features with moderate average intrapathologist concordance were: parakeratosis (κ = 0.21-0.61); civatte bodies (κ = 0.21-0.71); pigment-laden macrophages (κ = 0.34-0.66); mast cells (κ = 0.29-0.78); and eosinophils (κ = 0.31-0.79). The average intrapathologist concordance was good for sebocytes (κ = 0.51-1.00) and fungal bodies (κ = 0.47-0.76).
Telepathology using digital slides scanned at ×20 is sufficient for detection of histopathologic features routinely encountered in dermatitis cases, though less efficient than glass slides.
数字切片的质量和局限性尚未完全明确。我们旨在评估病理医生在检测玻璃切片以及通过×20扫描创建的数字切片上的特定微观特征时的内部差异。
使用Mirax Scan（德国卡尔蔡司公司）将苏木精和伊红染色切片以及过碘酸-希夫染色切片数字化。六位病理医生评估了50 - 71张数字切片。我们记录了物镜放大倍数、总时间以及以下各项的检测情况：肥大细胞；嗜酸性粒细胞；浆细胞；色素沉着巨噬细胞；表皮中的黑色素；真菌体；中性粒细胞；基底层液化变性小体；角化不全；以及皮脂腺细胞。3周后，使用相应的玻璃切片重复此过程。不需要做出诊断。
评估数字切片的平均时间为176.77秒，评估玻璃切片的平均时间为137.61秒（P < 0.001，99%置信区间[CI]）。使用数字切片检测特征时的平均物镜放大倍数为18.28，使用玻璃切片时为14.07（P < 0.001，99.99% CI）。在玻璃切片上，角化不全、基底层液化变性小体、色素沉着巨噬细胞、表皮中的黑色素、肥大细胞、嗜酸性粒细胞和浆细胞、中性粒细胞在较低物镜下被识别（P = 0.023 - 0.001，95% CI）。观察者内部平均一致性范围为κ = 0.30至κ = 0.78。平均一致性较差至中等的特征有：表皮中的黑色素（κ = 0.15 - 0.58）；浆细胞（κ = 0.15 - 0.49）；中性粒细胞（κ = 0.12 - 0.48）。病理医生内部平均一致性中等的特征有：角化不全（κ = 0.21 - 0.61）；基底层液化变性小体（κ = 0.21 - 0.71）；含色素巨噬细胞（κ = 0.34 - 0.66）；肥大细胞（κ = 0.29 - 0.78）；嗜酸性粒细胞（κ = 0.31 - 0.79）。病理医生内部对皮脂腺细胞（κ = 0.51 - 1.00）和真菌体（κ = 0.47 - 0.76）的平均一致性良好。
使用×20扫描的数字切片进行远程病理学检查足以检测皮炎病例中常规遇到的组织病理学特征，尽管效率低于玻璃切片。
