• David C Wilbur, Kalil Madi, Robert B Colvin, Lyn M Duncan, William C Faquin, Judith A Ferry, Matthew P Frosch, Stuart L Houser, Richard L Kradin, Gregory Y Lauwers, David N Louis, Eugene J Mark, Mari Mino-Kenudson, Joseph Misdraji, Gunnlauger P Nielsen, Martha B Pitman, Andrew E Rosenberg, R Neal Smith, Aliyah R Sohani, James R Stone, Rosemary H Tambouret, Chin-Lee Wu, Robert H Young, Artur Zembowicz, and Wolfgang Klietmann.
• Department of Pathology, James Homer Wright Pathology Laboratories, Massachusetts General Hospital, and the Department of Pathology, Harvard Medical School, Boston, MA 02114, USA. dwilbur@partners.org
• Arch. Pathol. Lab. Med. 2009 Dec 1; 133 (12): 1949-53.

Context-Whole-slide imaging technology offers promise for rapid, Internet-based telepathology consultations between institutions. Before implementation, technical issues, pathologist adaptability, and morphologic pitfalls must be well characterized.Objective-To determine whether interpretation of whole-slide images differed from glass-slide interpretation in difficult surgical pathology cases.Design-Diagnostically challenging pathology slides from a variety of anatomic sites from an outside laboratory were scanned into whole digital format. Digital and glass slides were independently diagnosed by 2 subspecialty pathologists. Reference, digital, and glass-slide interpretations were compared. Operator comments on technical issues were gathered.Results-Fifty-three case pairs were analyzed. There was agreement among digital, glass, and reference diagnoses in 45 cases (85%) and between digital and glass diagnoses in 48 (91%) cases. There were 5 digital cases (9%) discordant with both reference and glass diagnoses. Further review of each of these cases indicated an incorrect digital whole-slide interpretation. Neoplastic cases showed better correlation (93%) than did cases of nonneoplastic disease (88%). Comments on discordant cases related to digital whole technology focused on issues such as fine resolution and navigating ability at high magnification.Conclusions-Overall concordance between digital whole-slide and standard glass-slide interpretations was good at 91%. Adjustments in technology, case selection, and technology familiarization should improve performance, making digital whole-slide review feasible for broader telepathology subspecialty consultation applications.

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