Diagnostic challenges of faded hematoxylin and eosin slides: limitations of re-staining and re-sectioning and possible reason to go digital.

Background: Archiving hematoxylin and eosin (H&E)-stained slides on glass slides is problematic because the slides fade over time. This study evaluated the diagnostic accuracy of faded slides and their restoration methods to assess the impact and limitations on diagnoses.

Methods: The study was conducted in two parts. In the first study, gastric and lung biopsy cases diagnosed between 2011 and 2012 were analyzed. Diagnostic accuracy of the faded slides was compared to the original diagnoses. In the second study, gastric biopsy cases diagnosed in 2011 and 2015 were used to obtain faded slides, create re-stained slides, and re-sectioned slides from the same cases. Diagnostic accuracy was assessed using whole slide images (WSI) and compared to the original diagnoses to evaluate the effectiveness and limitations of the restoration methods.

Results: In the first study, diagnostic accuracy for faded slides were 77.5% for gastric biopsies and 73.3% for lung biopsies, both showing significant decreases compared to the original diagnoses. The decrease in accuracy was particularly evident in the diagnosis of malignant lesions. In the second study, diagnostic accuracy was 92.4% for faded slides, slightly improving to 93.9% for re-stained slides. However, challenges such as staining inconsistencies and tissue damage were observed with re-staining. Re-sectioned slides demonstrated higher diagnostic accuracy at 95.5%, but achieving perfect reproducibility was not feasible.

Conclusion: Diagnostic accuracy significantly decreased when using faded slides. Our findings suggest the utility of digital archiving rather than glass slide archiving.