Cima Luca, Brunelli Matteo, Parwani Anil, Girolami Ilaria, Ciangherotti Andrea, Riva Giulio, Novelli Luca, Vanzo Francesca, Sorio Alessandro, Cirielli Vito, Barbareschi Mattia, D'Errico Antonietta, Scarpa Aldo, Bovo Chiara, Fraggetta Filippo, Pantanowitz Liron, Eccher Albino
Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy.
Department of Pathology, Ohio State University, Columbus, OH, USA.
J Pathol Inform. 2018 Oct 9;9:34. doi: 10.4103/jpi.jpi_52_18. eCollection 2018.
Whole-slide imaging (WSI) technology can be used for primary diagnosis and consultation, including intraoperative (IO) frozen section (FS). We aimed to implement and validate a digital system for the FS evaluation of cancer and transplant specimens following recommendations of the College of American Pathologists.
FS cases were routinely scanned at ×20 employing the "Navigo" scanner system. IO diagnoses using glass versus digital slides after a 3-week washout period were recorded. Intraobserver concordance was evaluated using accuracy rate and kappa statistics. Feasibility of WSI diagnoses was assessed by the way of sensitivity, specificity, as well as positive and negative predictive values. Participants also completed a survey denoting scan time, time spent viewing cases, preference for glass versus WSI, image quality, interface experience, and any problems encountered.
Of the 125 cases submitted, 121 (436 slides) were successfully scanned including 93 oncological and 28 donor-organ FS biopsies. Four cases were excluded because of failed digitalization due to scanning problems or sample preparation artifacts. Full agreement between glass and digital-slide diagnosis was obtained in 90 of 93 (97%, κ = 0.96) oncology and in 24 of 28 (86%, κ = 0.91) transplant cases. There were two major and one minor discrepancy for cancer cases (sensitivity 100%, specificity 96%) and two major and two minor disagreements for transplant cases (sensitivity 96%, specificity 75%). Average scan and viewing/reporting time were 12 and 3 min for cancer cases, compared to 18 and 5 min for transplant cases. A high diagnostic comfort level among pathologists emerged from the survey.
These data demonstrate that the "Navigo" digital WSI system can reliably support an IO FS service involving complicated cancer and transplant cases.
全切片成像（WSI）技术可用于初步诊断和会诊，包括术中（IO）冰冻切片（FS）。我们旨在根据美国病理学家学会的建议，实施并验证一种用于癌症和移植标本FS评估的数字系统。
使用“Navigo”扫描仪系统对FS病例进行常规20倍扫描。记录在3周洗脱期后使用玻璃切片与数字切片的IO诊断结果。使用准确率和kappa统计量评估观察者内部一致性。通过敏感性、特异性以及阳性和阴性预测值来评估WSI诊断的可行性。参与者还完成了一项调查，记录扫描时间、查看病例所花费的时间、对玻璃切片与WSI的偏好、图像质量、界面体验以及遇到的任何问题。
在提交的125例病例中，121例（436张切片）成功扫描，包括93例肿瘤学和28例供体器官FS活检。4例因扫描问题或样本制备伪像导致数字化失败而被排除。在93例肿瘤学病例中的90例（97%，κ = 0.96）以及28例移植病例中的24例（86%，κ = 0.91）中，玻璃切片和数字切片诊断完全一致。癌症病例有2例主要差异和1例次要差异（敏感性100%，特异性96%），移植病例有2例主要差异和2例次要差异（敏感性96%，特异性75%）。癌症病例的平均扫描时间和查看/报告时间分别为12分钟和3分钟，移植病例分别为18分钟和5分钟。调查显示病理学家的诊断舒适度较高。
这些数据表明，“Navigo”数字WSI系统能够可靠地支持涉及复杂癌症和移植病例的IO FS服务。
