Mills Anne M, Gradecki Sarah E, Horton Bethany J, Blackwell Rebecca, Moskaluk Christopher A, Mandell James W, Mills Stacey E, Cathro Helen P
Department of Pathology.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA.
Am J Surg Pathol. 2018 Jan;42(1):53-59. doi: 10.1097/PAS.0000000000000930.
Prior work has shown that digital images and microscopic slides can be interpreted with comparable diagnostic accuracy. Although accuracy has been well-validated, the interpretative time for digital images has scarcely been studied and concerns about efficiency remain a major barrier to adoption. We investigated the efficiency of digital pathology when compared with glass slide interpretation in the diagnosis of surgical pathology biopsy and resection specimens. Slides were pulled from 510 surgical pathology cases from 5 organ systems (gastrointestinal, gynecologic, liver, bladder, and brain). Original diagnoses were independently confirmed by 2 validating pathologists. Diagnostic slides were scanned using the Philips IntelliSite Pathology Solution. Each case was assessed independently on digital and optical by 3 reading pathologists, with a ≥6 week washout period between modalities. Reading pathologists recorded assessment times for each modality; digital times included time to load the case. Diagnostic accuracy was determined based on whether a rendered diagnosis differed significantly from the original diagnosis. Statistical analysis was performed to assess for differences in interpretative times across modalities. All 3 reading pathologists showed comparable diagnostic accuracy across optical and digital modalities (mean major discordance rates with original diagnosis: 4.8% vs. 4.4%, respectively). Mean assessment times ranged from 1.2 to 9.1 seconds slower on digital versus optical. The slowest reader showed a significant learning effect during the course of the study so that digital assessment times decreased over time and were comparable with optical times by the end of the series. Organ site and specimen type did not significantly influence differences in interpretative times. In summary, digital image reading times compare favorably relative to glass slides across a variety of organ systems and specimen types. Mean increase in assessment time is 4 seconds/case. This time can be minimized with experience and may be further balanced by the improved ease of electronic chart access allowed by digital slide viewing, as well as quantitative assessments which can be expedited on digital images.
先前的研究表明，数字图像和显微镜载玻片在诊断准确性方面具有可比性。尽管准确性已得到充分验证，但数字图像的解读时间却鲜有研究，而对效率的担忧仍然是采用数字图像的主要障碍。我们研究了在手术病理活检和切除标本诊断中，数字病理学与玻璃载玻片解读相比的效率。从5个器官系统（胃肠道、妇科、肝脏、膀胱和脑）的510例手术病理病例中抽取载玻片。原始诊断由2名经验丰富的病理学家独立确认。使用飞利浦IntelliSite病理解决方案对诊断载玻片进行扫描。由3名阅片病理学家分别在数字和光学模式下独立评估每个病例，两种模式之间有≥6周的洗脱期。阅片病理学家记录每种模式的评估时间；数字模式下的时间包括加载病例的时间。根据给出的诊断与原始诊断是否存在显著差异来确定诊断准确性。进行统计分析以评估不同模式下解读时间的差异。所有3名阅片病理学家在光学和数字模式下均表现出可比的诊断准确性（与原始诊断的平均主要不一致率分别为4.8%和4.4%）。数字模式下的平均评估时间比光学模式慢1.2至9.1秒。在研究过程中，最慢的阅片者显示出显著的学习效应，因此数字评估时间随时间减少，到系列结束时与光学模式下的时间相当。器官部位和标本类型对解读时间的差异没有显著影响。总之，在各种器官系统和标本类型中，数字图像的阅读时间相对于玻璃载玻片具有优势。平均评估时间增加为4秒/病例。随着经验的积累，这个时间可以最小化，并且通过数字载玻片查看所带来的电子病历访问便利性的提高以及数字图像上可以加快的定量评估，时间可能会进一步得到平衡。
