Evaluation of whole-slide imaging for diagnosing frozen sections

Abstract

A promising application of digital pathology is the use of Whole slide imaging (WSI) for rapid and remote intraoperative consultations. Based on recommendations from the College of American Pathologists, we compared diagnostic accuracy and technical analysis of WSI with optical microscopy (OM) for reporting frozen sections (FS). A series of 105 consecutive FS cases were included in our study and were categorized as primary diagnosis, assessment of margin status, and lymph node status. A surgical pathologist reviewed all WSI digital slides of FS cases online and their corresponding glass slides using OM after a 2-week washout period. Technical and diagnostic parameters for remote reporting of frozen sections using WSI were compared to routine OM. Diagnostic agreement between WSI and OM in the FS cases was 100 %. In comparison with the reference standard (original sign-out diagnosis), the overall diagnostic accuracy of WSI and OM was 99.04 %. Scan time per slide averaged 103.89 s. Mean diagnostic assessment time for OM was 17.48 s, while it was 26.62 s for WSI, with a mean difference of 9.14 s (P < .001). The overall mean turnaround time was 3.8 min for reporting a single slide using WSI based digital pathology system. The diagnostic accuracy of WSI is comparable to that of conventional OM. Therefore, we conclude that WSI based digital pathology systems can be safely implemented and integrated into a laboratory workflow as an alternative to conventional OM.