TY - JOUR
T1 - Evaluation of whole slide image immunohistochemistry interpretation in challenging prostate needle biopsies
AU - Fine, Jeffrey L.
AU - Grzybicki, Dana M.
AU - Silowash, Russell
AU - Ho, Jonhan
AU - Gilbertson, John R.
AU - Anthony, Leslie
AU - Wilson, Robb
AU - Parwani, Anil V.
AU - Bastacky, Sheldon I.
AU - Epstein, Jonathan I.
AU - Jukic, Drazen M.
N1 - Funding Information:
This work was supported by funding from the US Air Force (contract no. DAMD17-03-2-0017) administered by the US Army Medical Research Acquisition Activity, Ft Detrick, MD. The content of the information does not necessarily reflect the position or policy of the US government and no official endorsement should be inferred.
PY - 2008/4
Y1 - 2008/4
N2 - Whole slide images (WSIs), also known as virtual slides, can support electronic distribution of immunohistochemistry (IHC) stains to pathologists that rely on remote sites for these services. This may lead to improvement in turnaround times, reduction of courier costs, fewer errors in slide distribution, and automated image analyses. Although this approach is practiced de facto today in some large laboratories, there are no clinical validation studies on this approach. Our retrospective study evaluated the interpretation of IHC stains performed in difficult prostate biopsies using WSIs. The study included 30 foci with IHC stains identified by the original pathologist as both difficult and pivotal to the final diagnosis. WSIs were created from the glass slides using a scanning robot (T2, Aperio Technologies, Vista, CA). An evaluation form was designed to capture data in 2 phases: (1) interpretation of WSIs and (2) interpretation of glass slides. Data included stain interpretations, diagnoses, and other parameters such as time required to diagnose and image/slide quality. Data were also collected from an expert prostate pathologist, consensus meetings, and a poststudy focus group. WSI diagnostic validity (intraobserver pairwise κ statistics) was "almost perfect" for 1 pathologist, "substantial" for 3 pathologists, and "moderate" for 1 pathologist. Diagnostic agreement between the final/consensus diagnoses of the group and those of the domain expert was "almost perfect" (κ = 0.817). Except for one instance, WSI technology was not felt to be the cause of disagreements. These results are encouraging and compare favorably with other efforts to quantify diagnostic variability in surgical pathology. With thorough training, careful validation of specific applications, and regular postsignout review of glass IHC slides (eg, quality assurance review), WSI technology can be used for IHC stain interpretation.
AB - Whole slide images (WSIs), also known as virtual slides, can support electronic distribution of immunohistochemistry (IHC) stains to pathologists that rely on remote sites for these services. This may lead to improvement in turnaround times, reduction of courier costs, fewer errors in slide distribution, and automated image analyses. Although this approach is practiced de facto today in some large laboratories, there are no clinical validation studies on this approach. Our retrospective study evaluated the interpretation of IHC stains performed in difficult prostate biopsies using WSIs. The study included 30 foci with IHC stains identified by the original pathologist as both difficult and pivotal to the final diagnosis. WSIs were created from the glass slides using a scanning robot (T2, Aperio Technologies, Vista, CA). An evaluation form was designed to capture data in 2 phases: (1) interpretation of WSIs and (2) interpretation of glass slides. Data included stain interpretations, diagnoses, and other parameters such as time required to diagnose and image/slide quality. Data were also collected from an expert prostate pathologist, consensus meetings, and a poststudy focus group. WSI diagnostic validity (intraobserver pairwise κ statistics) was "almost perfect" for 1 pathologist, "substantial" for 3 pathologists, and "moderate" for 1 pathologist. Diagnostic agreement between the final/consensus diagnoses of the group and those of the domain expert was "almost perfect" (κ = 0.817). Except for one instance, WSI technology was not felt to be the cause of disagreements. These results are encouraging and compare favorably with other efforts to quantify diagnostic variability in surgical pathology. With thorough training, careful validation of specific applications, and regular postsignout review of glass IHC slides (eg, quality assurance review), WSI technology can be used for IHC stain interpretation.
KW - Digital pathology
KW - Immunohistochemistry
KW - Prostate biopsy
KW - Prostate carcinoma
KW - Telepathology
KW - Virtual microscopy
KW - Virtual slides
KW - Whole slide images
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U2 - 10.1016/j.humpath.2007.08.007
DO - 10.1016/j.humpath.2007.08.007
M3 - Article
C2 - 18234276
AN - SCOPUS:40649091346
SN - 0046-8177
VL - 39
SP - 564
EP - 572
JO - Human pathology
JF - Human pathology
IS - 4
ER -