Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.
Lab Invest. 2024 Jan;104(1):100262. doi: 10.1016/j.labinv.2023.100262. Epub 2023 Oct 13.
With advancements in the field of digital pathology, there has been a growing need to compare the diagnostic abilities of pathologists using digitized whole slide images against those when using traditional hematoxylin and eosin (H&E)-stained glass slides for primary diagnosis. One of the most common specimens received in pathology practices is an endoscopic gastric biopsy with a request to rule out Helicobacter pylori (H. pylori) infection. The current standard of care is the identification of the organisms on H&E-stained slides. Immunohistochemical or histochemical stains are used selectively. However, due to their small size (2-4 μm in length by 0.5-1 μm in width), visualization of the organisms can present a diagnostic challenge. The goal of the study was to compare the ability of pathologists to identify H. pylori on H&E slides using a digital platform against the gold standard of H&E glass slides using routine light microscopy. Diagnostic accuracy rates using glass slides vs digital slides were 81% vs 72% (P = .0142) based on H&E slides alone. When H. pylori immunohistochemical slides were provided, the diagnostic accuracy was significantly improved to comparable rates (96% glass vs 99% digital, P = 0.2199). Furthermore, differences in practice settings (academic/subspecialized vs community/general) and the duration of sign-out experience did not significantly impact the accuracy of detecting H. pylori on digital slides. We concluded that digital whole slide images, although amenable in different practice settings and teaching environments, does present some shortcomings in accuracy and precision, especially in certain circumstances and thus is not yet fully capable of completely replacing glass slide review for identification of H. pylori. We specifically recommend reviewing glass slides and/or performing ancillary stains, especially when there is a discrepancy between the degree of inflammation and the presence of microorganisms on digital images.
随着数字病理学领域的进步，人们越来越需要比较病理学家使用数字化全玻片图像进行诊断的能力与使用传统苏木精和伊红（H&E）染色玻璃片进行初步诊断的能力。在病理实践中最常见的标本之一是要求排除幽门螺杆菌（H. pylori）感染的内镜胃活检。目前的标准护理是在 H&E 染色载玻片上识别这些生物体。免疫组织化学或组织化学染色则选择性使用。然而，由于它们的体积小（长度 2-4μm，宽度 0.5-1μm），因此可视化这些生物体可能具有诊断挑战性。该研究的目的是比较病理学家在数字平台上使用 H&E 幻灯片识别 H. pylori 的能力与使用常规显微镜的 H&E 玻璃幻灯片的金标准相比。单独使用 H&E 幻灯片时，玻璃幻灯片与数字幻灯片的诊断准确率分别为 81%和 72%（P=0.0142）。当提供 H. pylori 免疫组织化学幻灯片时，诊断准确率显著提高到可比水平（玻璃 96% vs 数字 99%，P=0.2199）。此外，实践环境（学术/专科与社区/普通）和阅片经验持续时间的差异并没有显著影响数字幻灯片上检测 H. pylori 的准确性。我们得出结论，数字全玻片图像虽然在不同的实践环境和教学环境中可行，但在准确性和精密度方面确实存在一些不足，特别是在某些情况下，因此还不能完全替代玻璃幻灯片检查来识别 H. pylori。我们特别建议复查玻璃幻灯片和/或进行辅助染色，尤其是在数字图像上的炎症程度与微生物存在存在差异时。
