Lets dive into applications of Digital pathology in part-III of this blog series.
APPLICATIONS OF WHOLE SLIDE IMAGING
Health care facilities are witnessing extensive digitization with inclusion of digital imaging connected to hospital information systems, LIS, picture archiving, and communication systems. Pathology laboratories equipped with WSI facility would fall into place well in such a setting with varied applications in diagnosis, education, and research (11, 34,37, 42,43).
WSI IN EDUCATION, TUMOR BOARDS, PRESENTATIONS, QUALITY ASSURANCE, AND RESEARCH
WSI has gained wide acceptance for education, at the tumor boards, and for presentations, research, and quality assurance (QA) (4,43-46). Digitized slides are more interactive compared to glass slides, can be easily shared anywhere at any time, and can help standardize training and research material. Many authors have highlighted its use in undergraduate medical education, pathology residents and fellow training (45-48). Unlike glass slide teaching sets, digital slides do not fade, break, or disappear. Digital slides also offer the ability to standardize images, permit annotation, and can provide a wide case range for trainees (48,49). Digital teaching sets can be accessed on a server over a network, are available to multiple users, and can be developed to contain test modules for trainees. WSI can also facilitate preparation and conduct of tumor boards through obviating the need of a multi-headed microscope or microscope with projection attachment or acquisition of multiple static images of a case (50,51). This is because WSI offers higher quality images with annotation, greater educational value for clinicians, involves less preparation time than photographing cases, and permits real-time flexibility (e.g. easy to add on cases, perform side-by-side viewing, and gives access to the entire slide which allows one to answer “on-the-spot” questions) (52). It is also useful in E-education, virtual workshops, and for proficiency testing (53). The use of this technology in Quality Assurance (QA) programs in Surgical pathology and Cytopathology can help in cost cutting and overcoming transportation difficulties, as also minimizing the potential second-reviewer bias by hiding the initial diagnosis (10, 30, 54). Online WSI resources such as College of American Pathologists (CAP) Virtual Slide Box, Digital Pathology Association hosted repository, and the Cancer Digital Slide Archive offer virtual slide sets for training and learning purposes. Virtual slides are also being used in pathology conferences and meetings to promote interactive learning and provide ease of visualization of multiple images of different stains in conjunction with relevant clinical material (30). Electronic publication of text books and articles in scientific journals has also opened new panoramas of scientific communication (55). Utilization of WSI-generated high-quality virtual images has proven to be the single most upgrade for pathology journals, thus empowering the readers to be involved in a scientifically based diagnostic approach to the lesion described (56).
WSI IN PRIMARY FROZEN SECTION/INTRAOPERATIVE CONSULTATION/DIAGNOSIS
Over the last few years, WSI has been utilized in primary frozen section diagnosis and secondary/tertiary teleconsultation (43,51, 57-59). The advantages include access to an entire digitized slide or even an entire case (set of slides), automated scanning, the high resolution of images available for review, rapid interpretation time, and the ability of teleconferencing.
A high concordance rate between WSI-based frozen section and permanent section diagnosis or on-site interpretation has been demonstrated in several studies (11,37, 60). However, further studies on a range of different pathologies are required to validate the utility and limitations of WSI. Successful implementation requires: effective planning and communication, a willingness to adjust old routines without compromising quality, and histo-technologists who are able to provide consistently high-quality frozen section slides (41,61,62).
WSI IN ROUTINE PATHOLOGICAL DIAGNOSIS
WSI is increasingly being used in the daily practice of surgical pathology, particularly for teleconsultation and certain quality assurance practices, such as obtaining second opinions (31,63,64). However, it raises a question whether WSI will be utilized for making routine pathologic diagnoses, ushering in the era of the “slideless” laboratory, especially after the COVID-19 pandemic (60,65,66). The adoption of digital pathology has been slower than in radiology partly due to the fact that in pathology, digital data is acquired in a slightly different manner from that in radiology (31,67,68). Although both fields require an imaging modality to collect primary data, in radiology, images begin as digital data whereas pathology images have to be converted from an analog substrate into a digital format (67-69).
Rendering routine pathologic diagnoses using WSI is feasible if the images truly represent an accurate digital reproduction of the scanned glass slide which can be saved, archived, reviewed, and later retrieved without any degradation (70). Moreover, apart from integration with the LIS, the routine use of WSI requires seamless connectivity over broadband networks, efficient workstations, cost-effective storage solutions, and standards-based informatics transactions for integrating information (63,71). Discrepancies between digital and glass slide diagnoses may be attributed to inadequate clinical data, missed tissue on the digital slide, and the pathologists’ lack of experience using a WSI system (72). One study demonstrated that using a virtual slide system, correct diagnosis was made in 66% of cases without clinical data provided compared to a correct diagnosis of 76% when clinical data was provided (72). Therefore, in order for WSI to become an accepted diagnostic modality, the provision of adequate medical information (e.g. gross pathology description, prior pathology reports, clinical history, imaging and other relevant laboratory parameters etc.) will need to be weaved into the imaging system (63,73,74).
Digital slides offer several advantages in terms of fidelity of the diagnostic material, portability, ease of sharing, retrieval of archival images, and ability to make use of computer-aided diagnostic tools (e.g. image algorithms) (37, 62, 75, 76). WSI has also permitted new business models of care in pathology (78). For example, virtual IHC service provided by large national laboratories. After the remote reference laboratory performs staining and slide scanning services, the referring pathologist is provided with full access to these IHC slides for interpretation or referral to a teleconsultant (43). In the near future, the adoption of standards, validation guidelines, automation of workflow, creation of new revenue streams, and nuances of clinical digital practice will likely dictate a new standard of care for primary pathologic interpretations (11, 77-80).
WSI AND IMMUNOHISTOCHEMISTRY AND ELECTRON MICROSCOPY
WSI offers advantages in enhancing objectivity in the interpretation of IHC used in tumor diagnosis, prognosis, and evaluation of biomarkers for targeted therapy (1,81,82). A study reported a concordance of 90% between WSI and glass slides of HER2/neu expression in breast cancer (81). Application of automated image analysis with algorithm-based scoring for the prognostic markers can assist in improving the scoring protocols and thereby enhance the efficacy of targeted therapies (82). Also in electron microscopy, a virtual ultrathin slide allows the pathologists to navigate the slide in their office while noting the exact location of the specific features. Apart from this, WSI technology can be valuable for obtaining consultation on ultrathin sections from experts located in higher centres (83).
WSI and CYTOPATHOLOGY
The role of WSI in Cytopathology has been increasing but there are certain obstacles such as the inherent complexity of scanning, higher scanning time, and storage costs (10,84-87). The scanning of cytology smear is difficult as well as complex because of its three dimensional character (85). Consequently, it is essential to integrate z-stacking or multiplane scanning feature into the systems intended for use in cytopathology (87). Alternative approach includes the conversion of z-stacks of images into video frames and storing the stack as a high-efficiency video coding file(s). Subsequent video compression has demonstrated to exceed the JPEG compression with comparable image quality (88). A comparison of conventional glass slides and WSI in 10 cervical and 20 non-gynecologic cytology cases showed similar diagnostic concordance between the two modalities among the reviewing cytopathologists (89). Another recent study comparing WSI with glass slides of thin-layer cervical specimens demonstrated 95.3% concordance rates, paving the way for WSI use in routine cytologic diagnosis (86). A study by Wright et al evaluated the efficiency of WSI in cervico-vaginal cytology highlighting issues such as a lack of familiarity with the technology, difficulty in detecting few abnormal cells in the smears, problems with hyperchromatic nuclei, dark and crowded groups of cells, and massive image file size leading to increased duration of scanning (90). Certain problems encountered while using WSI in cytology smears compared to the histology sections, include (a) presence of dense overlapping tissue fragments making it difficult for scanners to focus on the cells, (b) red cell contamination of the smear and/or background acellular material(s) leading the scanner to focus on red cells and/or the background material rather than the cells of interest, (c) smears with scant cellularity making z-stacking difficult, and (d) need to remove the screening marks/dots before scanning (for which keeping a photographic record of the diagnostic screening marks is recommended) (91). Papanicolaou- and H&E-stained smears often have cells in multiple planes due to wet fixation, and thus require z-scanning to obtain a crisp, high quality image. On the other hand, air-dried Romanowsky-stained smears can be scanned with only x and y-axes, as air drying flattens the cells thus minimizing the requirement of z-stacking (91,92).
Given the ongoing need for a cytologic diagnosis, the trend of using WSI in Cytopathology may possibly increase in future as minimally invasive procedures to obtain material for genetic/ molecular analysis are used. The possibility to scan whole slides and to organize them in structured databases accessible via the Internet would represent a powerful educational resource. The examples of rare cases can be shared without the risk of stain fading or loss or breakage of slide(s).
In next part of this series we will explore WSI in Artificial intelligence.
1. Aeffner F, Zarella MD, Buchbinder N, Bui MM, Goodman MR, Hartman DJ, et al. Introduction to digital image analysis in whole-slide imaging: a white paper from the digital pathology association. Journal of pathology informatics. 2019;10.
2. Hamilton PW, Wang Y, McCullough SJ. Virtual microscopy and digital pathology in training and education. Apmis. 2012 Apr;120(4):305-15.
3. Ferreira R, Moon J, Humphries J, Sussman A, Saltz J, Miller R, et al. "The virtual microscope". Romanian Journal of Morphology and Embryology. 1997;45: 449–453.
4. Ho J, Parwani AV, Jukic DM, Yagi Y, Anthony L, Gilbertson JR. Use of whole slide imaging in surgical pathology quality assurance: design and pilot validation studies. Human pathology. 2006 Mar 1;37(3):322-31.
5. Pantanowitz L. Digital images and the future of digital pathology. Journal of pathology informatics. 2010;1.
6. Pantanowitz L, Sharma A, Carter AB, Kurc T, Sussman A, Saltz J. Twenty years of digital pathology: an overview of the road travelled, what is on the horizon, and the emergence of vendor-neutral archives. Journal of pathology informatics. 2018;9.
7. Saco A, Bombi JA, Garcia A, Ramírez J, Ordi J. Current status of whole-slide imaging in education. Pathobiology. 2016;83(2-3):79-88.
8. Abels E, Pantanowitz L. Current state of the regulatory trajectory for whole slide imaging devices in the USA. Journal of pathology informatics. 2017;8.
9. Wilbur DC. Digital cytology: current state of the art and prospects for the future. Acta cytologica. 2011;55(3):227-38.
10. Cucoranu IC, Parwani AV, Pantanowitz L. Digital whole slide imaging in cytology. Archives of Pathology and Laboratory Medicine. 2014 Mar;138(3):300.
11. Farris AB, Cohen C, Rogers TE, Smith GH. Whole slide imaging for analytical anatomic pathology and telepathology: practical applications today, promises, and perils. Archives of pathology & laboratory medicine. 2017 Apr;141(4):542-50.
12. Gilbertson JR, Ho J, Anthony L, Jukic DM, Yagi Y, Parwani AV. Primary histologic diagnosis using automated whole slide imaging: a validation study. BMC clinical pathology. 2006 Dec;6(1):1-9.
13. Farahani N, Parwani AV, Pantanowitz L. Whole slide imaging in pathology: advantages, limitations, and emerging perspectives. Pathol Lab Med Int. 2015 Jun 11;7(23-33):4321.
14. Pantanowitz L, Sinard JH, Henricks WH, Fatheree LA, Carter AB, Contis L, et al. Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Archives of Pathology and Laboratory Medicine. 2013 Dec;137(12):1710-22.
15. Bueno G, Déniz O, Fernández‐Carrobles MD, Vállez N, Salido J. An automated system for whole microscopic image acquisition and analysis. Microscopy research and technique. 2014 Sep;77(9):697-713.
16. Montironi R, Cimadamore A, Massari F, Montironi MA, Lopez-Beltran A, Cheng L, et al. Whole slide imaging of large format histology in prostate pathology: potential for information fusion. Archives of Pathology & Laboratory Medicine. 2017 Nov;141(11):1460-1.
17. Indu M, Rathy R, Binu MP. “Slide less pathology”: Fairy tale or reality? Journal of oral and maxillofacial pathology: JOMFP. 2016 May;20(2):284.
18. Hamilton PW, Bankhead P, Wang Y, Hutchinson R, Kieran D, McArt DG, et al. Digital pathology and image analysis in tissue biomarker research. Methods. 2014 Nov 1;70(1):59-73.
19. Higgins C. Applications and challenges of digital pathology and whole slide imaging.
Biotech Histochem. 2015 Jul;90(5):341-7.
20. Feng Z, Puri S, Moudgil T, Wood W, Hoyt CC, Wang C, et al. Multispectral imaging of formalin-fixed tissue predicts ability to generate tumor-infiltrating lymphocytes from melanoma. Journal for immunotherapy of cancer. 2015 Dec;3(1):1-1.
21. Montalto MC, McKay RR, Filkins RJ. Autofocus methods of whole slide imaging systems and the introduction of a second-generation independent dual sensor scanning method. Journal of pathology informatics. 2011;2.
22. Boyce BF. Whole slide imaging: uses and limitations for surgical pathology and teaching. Biotechnic&Histochemistry. 2015 Jul 4;90(5):321-30.
23. Al‐Janabi S, Huisman A, Van Diest PJ. Digital pathology: current status and future perspectives. Histopathology. 2012 Jul;61(1):1-9.
24. Laurent C, Guérin M, Frenois FX, Thuries V, Jalabert L, Brousset P, et al. Whole-slide imaging is a robust alternative to traditional fluorescent microscopy for fluorescence in situ hybridization imaging using break-apart DNA probes. Human Pathology. 2013 Aug 1;44(8):1544-55.
25. Bertram CA, Klopfleisch R. The pathologist 2.0: an update on digital pathology in veterinary medicine. Veterinary pathology. 2017 Sep;54(5):756-66.
26. Neil DA, Demetris AJ. Digital pathology services in acute surgical situations. Journal of British Surgery. 2014 Sep;101(10):1185-6.
27. Sellaro TL, Filkins R, Hoffman C, Fine JL, Ho J, Parwani AV, et al. Relationship between magnification and resolution in digital pathology systems. Journal of pathology informatics. 2013;4.
28. Johnson JP, Krupinski EA, Nafziger JS, Yan M, Roehrig H. Visually lossless compression of breast biopsy virtual slides for telepathology. InMedical Imaging 2009: Image Perception, Observer Performance, and Technology Assessment 2009 Mar 12 (Vol. 7263, pp. 206-213). SPIE.
29. Pantanowitz L, Szymas J, Yagi Y, Wilbur D. Whole slide imaging for educational purposes. Journal of pathology informatics. 2012;3.
30. Pantanowitz L, Wiley CA, Demetris A, Lesniak A, Ahmed I, Cable W, et al. Experience with multimodality telepathology at the University of Pittsburgh Medical Center. Journal of pathology informatics. 2012;3.
31. Isaacs M, Lennerz JK, Yates S, Clermont W, Rossi J, Pfeifer JD. Implementation of whole slide imaging in surgical pathology: A value added approach. Journal of Pathology Informatics. 2011;2.
32. Saco A, Diaz A, Hernandez M, Martinez D, Montironi C, Castillo P, et al. Validation of whole-slide imaging in the primary diagnosis of liver biopsies in a university hospital. Digestive and Liver Disease. 2017 Nov 1;49(11):1240-6.
33. Krupinski EA, Johnson JP, Jaw S, Graham AR, Weinstein RS. Compressing pathology whole-slide images using a human and model observer evaluation. Journal of pathology informatics. 2012;3.
34. Avanaki AR, Espig KS, Sawhney S, Pantanowitzc L, Parwani AV, Xthona A, et al. Aging display's effect on interpretation of digital pathology slide. InMedical Imaging 2015: Digital Pathology 2015 Mar 19 (Vol. 9420, p. 942006). International Society for Optics and Photonics.
35. Yagi Y. Color standardization and optimization in whole slide imaging. In: Diagnostic pathology 2011 Dec (Vol. 6, No. 1, pp. 1-12). BioMed Central.
36. Hanna MG, Parwani A, Sirintrapun SJ. Whole slide imaging: technology and applications. Advances in Anatomic Pathology. 2020 Jul 12;27(4):251-9.
37. Parwani AV, Hassell L, Glassy E, Pantanowitz L. Regulatory barriers surrounding the use of whole slide imaging in the United States of America. Journal of pathology informatics. 2014;5.
38. Ho J, Aridor O, Glinski DW, Saylor CD, Pelletier JP, Selby DM, et al. Needs and workflow assessment prior to implementation of a digital pathology infrastructure for the US Air Force Medical Service. Journal of Pathology Informatics. 2013;4.
39. Evans AJ, Bauer TW, Bui MM, Cornish TC, Duncan H, Glassy EF, et al. US Food and Drug Administration approval of whole slide imaging for primary diagnosis: a key milestone is reached and new questions are raised. Archives of pathology & laboratory medicine. 2018 Nov;142(11):1383-7.
40. Evans AJ, Kiehl TR, Croul S. Frequently asked questions concerning the use of whole-slide imaging telepathology for neuropathology frozen sections. In Seminars in diagnostic pathology 2010 Aug 1 (Vol. 27, No. 3, pp. 160-166). WB Saunders.
41. Ordi J, Castillo P, Saco A, Pino MD, Ordi O, Rodriguez-Carunchio Let al. Validation of whole slide imaging in the primary diagnosis of gynaecological pathology in a University Hospital. J ClinPathol2015;68:33-39.
42. Hanna MG, Reuter VE, Samboy J, England C, Corsale L, Fine SW, et al. Implementation of digital pathology offers clinical and operational increase in efficiency and cost savings. Archives of pathology & laboratory medicine. 2019 Dec;143(12):1545-55.
43. Zarella MD, Bowman D, Aeffner F, Farahani N, Xthona A, Absar SF, et al. A practical guide to whole slide imaging: a white paper from the digital pathology association. Archives of pathology & laboratory medicine. 2019 Feb;143(2):222-34.
44. Park S, Pantanowitz L, Parwani AV. Digital imaging in pathology. Clinics in laboratory medicine. 2012 Dec 1;32(4):557-84.
45. Chen YK, Hsue SS, Lin DC, Wang WC, Chen JY, Lin CC, et al. An application of virtual microscopy in the teaching of an oral and maxillofacial pathology laboratory course. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2008 Mar 1;105(3):342-7.
46. Rohde GK, Ozolek JA, Parwani AV, Pantanowitz L. Carnegie Mellon University bioimaging day 2014: Challenges and opportunities in digital pathology. Journal of pathology informatics. 2014;5.
47. Lee BC, Hsieh ST, Chang YL, Tseng FY, Lin YJ, Chen YL, et al. A web‐based virtual microscopy platform for improving academic performance in histology and pathology laboratory courses: A pilot study. Anatomical sciences education. 2020 Nov;13(6):743-58.
48. Fraggetta F, Yagi Y, Garcia-Rojo M, Evans AJ, Tuthill JM, Baidoshvili A, et al. The importance of eSlide macro images for primary diagnosis with whole slide imaging. Journal of Pathology Informatics. 2018;9.
49. Guo H, Birsa J, Farahani N, Hartman DJ, Piccoli A, O’Leary M, et al. Digital pathology and anatomic pathology laboratory information system integration to support digital pathology sign-out. Journal of pathology informatics. 2016;7.
50. Li L, Dangott BJ, Parwani AV. Development and use of a genitourinary pathology digital teaching set for trainee education. Journal of pathology informatics. 2010;1.
51. Volynskaya Z, Evans AJ, Asa SL. Clinical applications of whole-slide imaging in anatomic pathology. Advances in Anatomic Pathology. 2017 Jul 1;24(4):215-21.
52. Ho J, Ahlers SM, Stratman C, Aridor O, Pantanowitz L, Fine JL, et al. Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization. Journal of pathology informatics. 2014;5.
53. Girolami I, Pantanowitz L, Marletta S, Brunelli M, Mescoli C, Parisi A, et al. Diagnostic concordance between whole slide imaging and conventional light microscopy in cytopathology: a systematic review. Cancer cytopathology. 2020 Jan;128(1):17-28.
54. Eccher A, Brunelli M, Pantanowitz L, Parwani A, Girolami I, Scarpa A. Innovation in transplantation: The digital era. Journal of Pathology Informatics. 2018;9.
55. Kayser K, Ogilvie R, Borkenfeld S, Kayser G. E-education in pathology including certification of e-institutions. InDiagnostic Pathology 2011 Dec (Vol. 6, No. 1, pp. 1-4). BioMed Central.
56. Glassy EF. Rebooting the pathology journal: learning in the age of digital pathology. Archives of Pathology and Laboratory Medicine. 2014 Jun;138(6):728-9.
57. Girolami I, Parwani A, Barresi V, Marletta S, Ammendola S, Stefanizzi L, et al. The landscape of digital pathology in transplantation: From the beginning to the virtual E-slide. Journal of Pathology Informatics. 2019;10.
58. Ghaznavi F, Evans A, Madabhushi A, Feldman M. Digital imaging in pathology: whole-slide imaging and beyond. Annual Review of Pathology: Mechanisms of Disease. 2013 Jan 24;8:331-59.
59. Wilbur DC, Madi K, Colvin RB, Duncan LM, Faquin WC, Ferry JA, et al. Whole-slide imaging digital pathology as a platform for teleconsultation: a pilot study using paired subspecialist correlations. Archives of pathology & laboratory medicine. 2009 Dec;133(12):1949-53.
60. Williams BJ, Fraggetta F, Hanna MG, Huang R, Lennerz J, Salgado R, et al The future of pathology: What can we learn from the COVID-19 pandemic?. Journal of Pathology Informatics. 2020;11.
61. Zhao C, Wu T, Ding X, Parwani AV, Chen H, McHugh J, et al. International telepathology consultation: three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China. Journal of Pathology Informatics. 2015;6.
62. Pantanowitz L, McHugh J, Cable W, Zhao C, Parwani AV. Imaging file management to support international telepathology. Journal of pathology informatics. 2015;6.
63. Weinstein RS, Graham AR, Richter LC, Barker GP, Krupinski EA, Lopez AM, et al. Overview of telepathology, virtual microscopy, and whole slide imaging: prospects for the future. Human pathology. 2009 Aug 1;40(8):1057-69.
64. Feldman MD. Beyond morphology: whole slide imaging, computer-aided detection, and other techniques. Archives of pathology & laboratory medicine. 2008 May;132(5):758-63.
65. Hanna MG, Reuter VE, Ardon O, Kim D, Sirintrapun SJ, Schüffler PJ, et al. Validation of a digital pathology system including remote review during the COVID-19 pandemic. Modern Pathology. 2020 Nov;33(11):2115-27.
66. Scarl RT, Parwani A, Yearsley M. From glass-time to screen-time: a pathology resident's experience with digital sign-out during the coronavirus 2019 pandemic. Archives of Pathology & Laboratory Medicine. 2021 Jun;145(6):644-5.
67. Hipp JD, Fernandez A, Compton CC, Balis UJ. Why a pathology image should not be considered as a radiology image. Journal of pathology informatics. 2011;2.
68. Patterson ES, Rayo M, Gill C, Gurcan MN. Barriers and facilitators to adoption of soft copy interpretation from the user perspective: Lessons learned from filmless radiology for slideless pathology. Journal of pathology informatics. 2011;2.
69. Montalto MC. Pathology RE-imagined: the history of digital radiology and the future of anatomic pathology. Archives of pathology & laboratory medicine. 2008 May;132(5):764-5.
70. Mukhopadhyay S, Feldman MD, Abels E, Ashfaq R, Beltaifa S, Cacciabeve NG, et al. Whole slide imaging versus microscopy for primary diagnosis in surgical pathology: a multicenter blinded randomized noninferiority study of 1992 cases (pivotal study). The American journal of surgical pathology. 2018 Jan;42(1):39.
71. Graham AR, Bhattacharyya AK, Scott KM, Lian F, Grasso LL, Richter LC, et al. Virtual slide telepathology for an academic teaching hospital surgical pathology quality assurance program. Human pathology. 2009 Aug 1;40(8):1129-36.
72. Daniel C, Rojo MG, Klossa J, Della Mea V, Boet-0[poker D, Beckwith BA, et al. Standardizing the use of whole slide images in digital pathology. Computerized Medical Imaging and Graphics. 2011 Oct 1;35(7-8):496-505.
73. Chordia TD, Vikey A, Choudhary AB, Samdariya Y, Chordia DS. Current status and future trends in telepathology and digital pathology. Journal of oral and maxillofacial pathology: JOMFP. 2016 May;20(2):178.
74. Farahani N, Pantanowitz L. Overview of telepathology. Surgical Pathology Clinics. 2015 Jun 1;8(2):223-31.
75. Parwani AV, Amin MB. Convergence of Digital Pathology and Artifiial intelligence tools in anatomic pathology practice: Current landscape and future directions. Adv Anat Pathol 2020;27:221-226.
76. Abels E, Pantanowitz L, Aeffner F, Zarella MD, van der Laak J, Bui MM, et al. Computational pathology definitions, best practices, and recommendations for regulatory guidance: a white paper from the Digital Pathology Association. The Journal of pathology. 2019 Nov;249(3):286-94.
77. Parwani A. Overcoming barriers to digital pathology. MLO Med Lab Obs2016;48:38.
78. Evans AJ, Vajpeyi R, Henry M, Chetty R. Establishment of a remote diagnostic histopathology service using whole slide imaging (digital pathology). Journal of Clinical Pathology. 2021 Jul 1;74(7):421-4.
79. Romero Lauro G, Cable W, Lesniak A, Tseytlin E, McHugh J, Parwani A, et al. Digital pathology consultations—a new era in digital imaging, challenges and practical applications. Journal of digital imaging. 2013 Aug;26(4):668-77.
80. McClintock DS, Lee RE, Gilbertson JR. Using computerized workflow simulations to assess the feasibility of whole slide imaging full adoption in a high-volume histology laboratory. Analytical Cellular Pathology. 2012 Jan 1;35(1):57-64.
81. Lara H, Li Z, Abels E, Aeffner F, Bui MM, ElGabry EA, et al. Quantitative image analysis for tissue biomarker use: a white paper from the digital pathology association. Applied Immunohistochemistry & Molecular Morphology. 2021 Aug;29(7):479.
82. Fine JL, Grzybicki DM, Silowash R, Ho J, Gilbertson JR, Anthony L, et al. Evaluation of whole slide image immunohistochemistry interpretation in challenging prostate needle biopsies. Human pathology. 2008 Apr 1;39(4):564-72.
83. Lee KC, Mak LS. Virtual electron microscopy: a simple implementation creating a new paradigm in ultrastructural examination. International Journal of Surgical Pathology. 2011 Oct;19(5):570-5.
84. Lee RE, McClintock DS, Laver NM, Yagi Y. Evaluation and optimization for liquid-based preparation cytology in whole slide imaging. Journal of pathology Informatics. 2011;2.
85. Khalbuss WE, Pantanowitz L, Parwani AV. Digital imaging in cytopathology. Pathology research international. 2011;2011.
86. Hanna MG, Pantanowitz L. Why is digital pathology in cytopathology lagging behind surgical pathology? Cancer Cytopathology. 2017 Jul;125(7):519-20.
87. Bongaerts O, Clevers C, Debets M, Paffen D, Senden L, Rijks K, et al. Conventional microscopical versus digital whole-slide imaging-based diagnosis of thin-layer cervical specimens: a validation study. Journal of Pathology Informatics. 2018;9.Zarella MD, Jakubowski J: Video compression to support the expansion of whole-slide imaging into cytology. J Med Imaging (Bellingham). 6:047502, 2019.
88. Hanna MG, Monaco SE, Cuda J, Xing J, Ahmed I, Pantanowitz L. Comparison of glass slides and various digital‐slide modalities for cytopathology screening and interpretation. Cancer Cytopathology. 2017 Sep;125(9):701-9.
89. Wright AM, Smith D, Dhurandhar B, Fairley T, Scheiber-Pacht M, Chakraborty S, et al. Digital slide imaging in cervicovaginal cytology: a pilot study. Archives of pathology and laboratory medicine. 2013 May;137(5):618-24.
Sambit K Mohanty, MD