Original ArticlesDiagnostic Efficiency in Digital Pathology A Comparison of Optical Versus Digital Assessment in 510 Surgical Pathology CasesMills, Anne M. MD*; Gradecki, Sarah E. BS*; Horton, Bethany J. PhD†; Blackwell, Rebecca BS*; Moskaluk, Christopher A. MD*; Mandell, James W. MD, PhD*; Mills, Stacey E. MD*; Cathro, Helen P. MBChB*Author Information *Department of Pathology †Department of Public Health Sciences, University of Virginia, Charlottesville, VA Conflicts of Interest and Source of Funding: A.M.M., R.B., C.A.M., J.W.M., S.E.M., and H.P.C. received compensation in the form of salary support from Philips Digital Pathology Solutions for their work in the Multi-Center Clinical Validation Study by Philips. They did not receive compensation for their efforts in this side study. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Anne M. Mills, MD, Department of Pathology, University of Virginia, 3rd Floor HEP, Room 3001,1215 Lee Street Charlottesville, VA 22908 (e-mail: email@example.com). The American Journal of Surgical Pathology: January 2018 - Volume 42 - Issue 1 - p 53-59 doi: 10.1097/PAS.0000000000000930 Buy Metrics Abstract Prior work has shown that digital images and microscopic slides can be interpreted with comparable diagnostic accuracy. Although accuracy has been well-validated, the interpretative time for digital images has scarcely been studied and concerns about efficiency remain a major barrier to adoption. We investigated the efficiency of digital pathology when compared with glass slide interpretation in the diagnosis of surgical pathology biopsy and resection specimens. Slides were pulled from 510 surgical pathology cases from 5 organ systems (gastrointestinal, gynecologic, liver, bladder, and brain). Original diagnoses were independently confirmed by 2 validating pathologists. Diagnostic slides were scanned using the Philips IntelliSite Pathology Solution. Each case was assessed independently on digital and optical by 3 reading pathologists, with a ≥6 week washout period between modalities. Reading pathologists recorded assessment times for each modality; digital times included time to load the case. Diagnostic accuracy was determined based on whether a rendered diagnosis differed significantly from the original diagnosis. Statistical analysis was performed to assess for differences in interpretative times across modalities. All 3 reading pathologists showed comparable diagnostic accuracy across optical and digital modalities (mean major discordance rates with original diagnosis: 4.8% vs. 4.4%, respectively). Mean assessment times ranged from 1.2 to 9.1 seconds slower on digital versus optical. The slowest reader showed a significant learning effect during the course of the study so that digital assessment times decreased over time and were comparable with optical times by the end of the series. Organ site and specimen type did not significantly influence differences in interpretative times. In summary, digital image reading times compare favorably relative to glass slides across a variety of organ systems and specimen types. Mean increase in assessment time is 4 seconds/case. This time can be minimized with experience and may be further balanced by the improved ease of electronic chart access allowed by digital slide viewing, as well as quantitative assessments which can be expedited on digital images. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.