Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study)

Sanjay Mukhopadhyay, Michael D. Feldman, Esther Abels, Raheela Ashfaq, Senda Beltaifa, Nicolas G. Cacciabeve, Helen P. Cathro, Liang Cheng, Kumarasen Cooper, Glenn E. Dickey, Ryan M. Gill, Robert P. Heaton, René Kerstens, Guy M. Lindberg, Reenu K. Malhotra, James W. Mandell, Ellen D. Manlucu, Anne M. Mills, Stacey E. Mills, Christopher A. MoskalukMischa Nelis, Deepa T. Patil, Christopher G. Przybycin, Jordan P. Reynolds, Brian P. Rubin, Mohammad H. Saboorian, Mauricio Salicru, Mark A. Samols, Charles D. Sturgis, Kevin O. Turner, Mark R. Wick, Ji Y. Yoon, Po Zhao, Clive R. Taylor

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard. Cases were scanned, converted to WSI and randomized. Sixteen pathologists interpreted cases by microscopy or WSI, followed by a wash-out period of ≥4 weeks, after which cases were read by the same observers using the other modality. Major discordances were identified by an adjudication panel, and the differences between major discordance rates for both microscopy (against the reference standard) and WSI (against the reference standard) were calculated. A total of 1992 cases were included, resulting in 15,925 reads. The major discordance rate with the reference standard diagnosis was 4.9% for WSI and 4.6% for microscopy. The difference between major discordance rates for microscopy and WSI was 0.4% (95% confidence interval, -0.30% to 1.01%). The difference in major discordance rates for WSI and microscopy was highest in endocrine pathology (1.8%), neoplastic kidney pathology (1.5%), urinary bladder pathology (1.3%), and gynecologic pathology (1.2%). Detailed analysis of these cases revealed no instances where interpretation by WSI was consistently inaccurate compared with microscopy for multiple observers. We conclude that WSI is noninferior to microscopy for primary diagnosis in surgical pathology, including biopsies and resections stained with hematoxylin and eosin, immunohistochemistry and special stains. This conclusion is valid across a wide variety of organ systems and specimen types.

Original languageEnglish (US)
Pages (from-to)39-52
Number of pages14
JournalAmerican Journal of Surgical Pathology
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Surgical Pathology
Microscopy
Pathology
Hematoxylin
Eosine Yellowish-(YS)
Coloring Agents
Immunohistochemistry
Biopsy
Urinary Bladder
Confidence Intervals
Kidney

Keywords

  • digital imaging
  • microscopy
  • noninferiority trial
  • pathology
  • primary diagnosis
  • surgical pathology
  • whole slide imaging

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology : A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study). / Mukhopadhyay, Sanjay; Feldman, Michael D.; Abels, Esther; Ashfaq, Raheela; Beltaifa, Senda; Cacciabeve, Nicolas G.; Cathro, Helen P.; Cheng, Liang; Cooper, Kumarasen; Dickey, Glenn E.; Gill, Ryan M.; Heaton, Robert P.; Kerstens, René; Lindberg, Guy M.; Malhotra, Reenu K.; Mandell, James W.; Manlucu, Ellen D.; Mills, Anne M.; Mills, Stacey E.; Moskaluk, Christopher A.; Nelis, Mischa; Patil, Deepa T.; Przybycin, Christopher G.; Reynolds, Jordan P.; Rubin, Brian P.; Saboorian, Mohammad H.; Salicru, Mauricio; Samols, Mark A.; Sturgis, Charles D.; Turner, Kevin O.; Wick, Mark R.; Yoon, Ji Y.; Zhao, Po; Taylor, Clive R.

In: American Journal of Surgical Pathology, Vol. 42, No. 1, 01.01.2018, p. 39-52.

Research output: Contribution to journalArticle

Mukhopadhyay, S, Feldman, MD, Abels, E, Ashfaq, R, Beltaifa, S, Cacciabeve, NG, Cathro, HP, Cheng, L, Cooper, K, Dickey, GE, Gill, RM, Heaton, RP, Kerstens, R, Lindberg, GM, Malhotra, RK, Mandell, JW, Manlucu, ED, Mills, AM, Mills, SE, Moskaluk, CA, Nelis, M, Patil, DT, Przybycin, CG, Reynolds, JP, Rubin, BP, Saboorian, MH, Salicru, M, Samols, MA, Sturgis, CD, Turner, KO, Wick, MR, Yoon, JY, Zhao, P & Taylor, CR 2018, 'Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study)', American Journal of Surgical Pathology, vol. 42, no. 1, pp. 39-52. https://doi.org/10.1097/PAS.0000000000000948
Mukhopadhyay, Sanjay ; Feldman, Michael D. ; Abels, Esther ; Ashfaq, Raheela ; Beltaifa, Senda ; Cacciabeve, Nicolas G. ; Cathro, Helen P. ; Cheng, Liang ; Cooper, Kumarasen ; Dickey, Glenn E. ; Gill, Ryan M. ; Heaton, Robert P. ; Kerstens, René ; Lindberg, Guy M. ; Malhotra, Reenu K. ; Mandell, James W. ; Manlucu, Ellen D. ; Mills, Anne M. ; Mills, Stacey E. ; Moskaluk, Christopher A. ; Nelis, Mischa ; Patil, Deepa T. ; Przybycin, Christopher G. ; Reynolds, Jordan P. ; Rubin, Brian P. ; Saboorian, Mohammad H. ; Salicru, Mauricio ; Samols, Mark A. ; Sturgis, Charles D. ; Turner, Kevin O. ; Wick, Mark R. ; Yoon, Ji Y. ; Zhao, Po ; Taylor, Clive R. / Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology : A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study). In: American Journal of Surgical Pathology. 2018 ; Vol. 42, No. 1. pp. 39-52.
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abstract = "Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard. Cases were scanned, converted to WSI and randomized. Sixteen pathologists interpreted cases by microscopy or WSI, followed by a wash-out period of ≥4 weeks, after which cases were read by the same observers using the other modality. Major discordances were identified by an adjudication panel, and the differences between major discordance rates for both microscopy (against the reference standard) and WSI (against the reference standard) were calculated. A total of 1992 cases were included, resulting in 15,925 reads. The major discordance rate with the reference standard diagnosis was 4.9{\%} for WSI and 4.6{\%} for microscopy. The difference between major discordance rates for microscopy and WSI was 0.4{\%} (95{\%} confidence interval, -0.30{\%} to 1.01{\%}). The difference in major discordance rates for WSI and microscopy was highest in endocrine pathology (1.8{\%}), neoplastic kidney pathology (1.5{\%}), urinary bladder pathology (1.3{\%}), and gynecologic pathology (1.2{\%}). Detailed analysis of these cases revealed no instances where interpretation by WSI was consistently inaccurate compared with microscopy for multiple observers. We conclude that WSI is noninferior to microscopy for primary diagnosis in surgical pathology, including biopsies and resections stained with hematoxylin and eosin, immunohistochemistry and special stains. This conclusion is valid across a wide variety of organ systems and specimen types.",
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AU - Przybycin, Christopher G.

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AU - Rubin, Brian P.

AU - Saboorian, Mohammad H.

AU - Salicru, Mauricio

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AU - Sturgis, Charles D.

AU - Turner, Kevin O.

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