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Whole Slide Image Based Interpretation of Immunohistochemistry Stains in Challenging Prostate Needle Biopsies
Jeffrey L Fine MD1 (finejl@upmc.edu) ; Jonhan Ho MD1; Yukako Yagi1; Drazen Jukic MD PhD1,2; John R Gilbertson MD3; Sheldon I. Bastacky MD2; Dana M. Grzybicki MD PhD1; Leslie Anthony1; Robb Wilson1; Anil V. Parwani MD PhD1,2; 1Centers for Pathology and Oncology Informatics, University of Pittsburgh; 2 Department of Pathology, University of Pittsburgh Medical Center; 3 Department of Pathology, Case Western Reserve University School of Medicine
Context: Several hospitals in our academic network are supported by a centralized immunohistochemistry (IHC) laboratory, necessitating physical transportation of IHC stained slides. Electronic distribution of these slides, using whole slide image (WSI) technology, could decrease turnaround time and courier-associated costs. This study is a validation study of IHC stains in challenging prostate needle biopsies, retrospectively comparing glass microscope slides to WSI.
Technology: WSI, also called “virtual slides”, were created using a high-throughput robotic scanner utilizing 20x objective magnification at a spatial sampling period of 0.47 microns per pixel (T2, Aperio Technologies, Vista, California, USA). A server provided storage and access to WSI (Windows Server 2000, Microsoft, Redmond, Washington, USA). Images were viewed using standard desktop computers using either a web browser plug-in or stand-alone software, both provided by the imaging robot vendor.
Design: One hundred consecutive prostate needle biopsy cases were screened by a non-participant who selected 30 cases with dotted foci which had been evaluated by IHC. The IHC slides were scanned using a T2 scanner (Aperio Technologies, Vista, California, USA) and viewed using ordinary desktop computers. Data was collected from 5 pathologists in 3 phases: 1) review of glass H&E slides; 2) review of IHC stains using WSI; 3) review of all original glass slides and 4) comparison of study findings with original diagnoses.
Results: Preliminary analysis of phase 1 and 2 data showed high inter-observer variability for both phase 1 (agreement in 7 foci) and phase 2 (agreement in 15 foci). For phase 1 (H&E only) this is expected. However for phase 2 this high variability is not expected and could represent a true difference between WSI and glass slides. Analysis of phase 3 data will be required to explore this further. Approximately 79% of foci required fewer than 15 minutes to interpret. Average confidence, rated from 1 (low) to 3 (high), was similar for phase 2 (2.6) and for phase 1 (2.4).
Discussion: WSI validation studies serve to: highlight deficiencies in existing image quality and virtual microscopy systems; spur d07/18/2006sts with exposure to and knowledge of these emerging technologies. Electronic IHC stain distribution, if feasible, would decrease temporal and financial costs associated with obtaining IHC from a central laboratory.