Validation of digital pathology imaging for primary histopathological diagnosis

David R.J. Snead, Yee Wah Tsang, Aisha Meskiri, Peter K. Kimani, Richard Crossman, Nasir M. Rajpoot, Elaine Blessing, Klaus Chen, Kishore Gopalakrishnan, Paul Matthews, Navid Momtahan, Sarah Read-Jones, Shatrughan Sah, Emma Simmons, Bidisa Sinha, Sari Suortamo, Yen Yeo, Hesham El Daly, Ian A. Cree

Research output: Contribution to journalArticlepeer-review

179 Citations (Scopus)


Aims: Digital pathology (DP) offers advantages over glass slide microscopy (GS), but data demonstrating a statistically valid equivalent (i.e. non-inferior) performance of DP against GS are required to permit its use in diagnosis. The aim of this study is to provide evidence of non-inferiority. Methods and results: Seventeen pathologists re-reported 3017 cases by DP. Of these, 1009 were re-reported by the same pathologist, and 2008 by a different pathologist. Re-examination of 10 138 scanned slides (2.22 terabytes) produced 72 variances between GS and DP reports, including 21 clinically significant variances. Ground truth lay with GS in 12 cases and with DP in nine cases. These results are within the 95% confidence interval for existing intraobserver and interobserver variability, proving that DP is non-inferior to GS. In three cases, the digital platform was deemed to be responsible for the variance, including a gastric biopsy, where Helicobacter pylori only became visible on slides scanned at the ×60 setting, and a bronchial biopsy and penile biopsy, where dysplasia was reported on DP but was not present on GS. Conclusions: This is one of the largest studies proving that DP is equivalent to GS for the diagnosis of histopathology specimens. Error rates are similar in both platforms, although some problems e.g. detection of bacteria, are predictable.

Original languageEnglish
Pages (from-to)1063-1072
Number of pages10
Issue number7
Publication statusPublished - 1 Jun 2016
Externally publishedYes


  • Diagnosis
  • Digital pathology
  • Histopathology
  • Validation
  • Whole slide imaging


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