Primary digital reporting in gastrointestinal pathology

The technology for producing digital scans of whole glass slides at high resolution has matured to a point where the user experience is at a level that could be compatible with using digital images as the primary reporting medium in histopathology. The quality of the scans is excellent, the user interface is getting better and the speed of transmission is good with virtually no lag on most systems. However there are two areas which need a lot more investigation before there is a wholesale transition to digital pathology – validation of the digital diagnoses against glass slide diagnosis and ‘time and motion’ studies to investigate how digital reporting affects workflow. A new study by Loughrey et al. in Virchovs Archiv provides some validation of digital reporting for gastrointestinal specimens. They took a sample of 100 consecutive gastrointestinal specimens in routine practice and three pathologists reported them as digital images and later reviewed them on glass slides. They found a concordance rate of 95.3% which is comparable with inter- and intra-observer agreement on pure glass slide studies. All the discordant cases were judged to be of minor clinical significance. In 10 of the discordant cases the glass slide diagnosis was favoured, in the other 4 the digital diagnosis was favoured. This study is a good start to producing enough validation of digital images to enable this to be the primary reporting medium but it should be recognised that 100 consecutive gastrointestinal specimens are unlikely to have many subtle diagnoses in them, they could be nearly all normal duodenal and colonic biopsies, so a high level of concordance would be expected using digital or glass slides.