Lee Jonathan J, Jedrych Jaroslaw, Pantanowitz Liron, Ho Jonhan
Departments of Dermatology and.
Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Am J Dermatopathol. 2018 Jan;40(1):17-23. doi: 10.1097/DAD.0000000000000888.
Digital pathology (DP) systems have been validated for routine, histopathological diagnosis by several investigators. The diagnostic matter in previous studies is composed mostly of neoplasms. However, in dermatopathology, inflammatory diseases constitute a greater proportion of cases and have been under-represented in this literature. Herein, we report the results of a prospective, DP side-by-side validation study comparing the histologic assessment of routine, clinical inflammatory dermatopathology cases by whole slide imaging (WSI) and traditional light microscopy (LM).
Glass slides were digitized at ×40 magnification. Two dermatopathologists rendered diagnoses digitally and immediately thereafter by light microscopy. Additional recuts, special, and immunohistochemical stains obtained during workup were scanned and evaluated similarly. Morphological features used to make diagnoses and appreciable differences in histology were recorded.
A total of 332 slides representing 93 cases were examined, including 157 hematoxylin & eosin sections, 132 special stains, and 43 immunohistochemical slides. In total, 333 microscopic features important for rendering inflammatory diagnoses were identified. Two discrepant instances were noted wherein Gram-positive cocci were identified using traditional microscopy but not by DP (×40 scan). Eosinophils, melanin granules, and mucin were identified on both modalities but were noted to have different appearances.
Our findings indicate that DP is sufficient for primary diagnosis in inflammatory dermatopathology. Higher magnification scanning may be required to identify submicron features, such as microorganisms. Subtle differences in image quality between these 2 modalities may contribute to varied histologic interpretations of which pathologists should be aware when validating clinical DP systems.
数位病理学（DP）系统已被多位研究者验证可用于常规组织病理学诊断。以往研究中的诊断病例大多为肿瘤。然而，在皮肤病理学中，炎症性疾病占病例的比例更大，而该文献对此的描述较少。在此，我们报告一项前瞻性DP并行验证研究的结果，该研究比较了通过全切片成像（WSI）和传统光学显微镜（LM）对常规临床炎症性皮肤病理学病例进行的组织学评估。
将载玻片在×40倍放大倍数下数字化。两位皮肤病理学家先通过数字方式做出诊断，随后立即通过光学显微镜进行诊断。对检查过程中获得的额外重切切片、特殊染色和免疫组织化学染色切片进行类似的扫描和评估。记录用于做出诊断的形态学特征以及组织学上的明显差异。
共检查了代表93个病例的332张载玻片，包括157张苏木精和伊红切片、132张特殊染色切片和43张免疫组织化学切片。总共识别出333个对做出炎症性诊断很重要的微观特征。注意到两例差异情况，其中使用传统显微镜鉴定出革兰氏阳性球菌，但通过DP（×40扫描）未鉴定出。在两种模式下均识别出嗜酸性粒细胞、黑色素颗粒和黏液，但注意到它们的外观不同。
我们的研究结果表明，DP足以用于炎症性皮肤病理学的初步诊断。可能需要更高放大倍数的扫描来识别亚微米特征，如微生物。这两种模式之间图像质量的细微差异可能导致组织学解释的不同，病理学家在验证临床DP系统时应予以注意。
