Lost in digitization – A systematic review about the diagnostic test accuracy of digital pathology solutions

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Introduction: Digital pathology solutions are increasingly implemented for primary diagnostics in departments of pathology around the world. This has sparked a growing engagement on validation studies to evaluate the diagnostic performance of whole slide imaging (WSI) regarding safety, reliability, and accuracy. The aim of this review was to evaluate the performance of digital pathology for diagnostic purposes compared to light microscopy (LM) in human pathology, based on validation studies designed to assess such technologies. Methods: In this systematic review based on PRISMA guidelines, we analyzed validation studies of WSI compared with LM. We included studies of diagnostic performance of WSI regarding diagnostic test accuracy (DTA) indicators, degree of overdiagnosis, diagnostic concordance, and observer variability as a secondary outcome. Overdiagnosis is (for example) detecting a pathological condition that will either not progress or progress very slowly. Thus, the patient will never get symptoms from this condition and the pathological condition will never be the cause of death. From a search comprising four databases: PubMed, EMBASE, Cochrane Library, and Web of Science, encompassing the period 2010–2021, we selected and screened 12 peer-reviewed articles that fulfilled our selection criteria. Risk of bias was conducted through QUADAS-2 tool, and data analysis and synthesis were performed in a qualitative format. Results: We found that diagnostic performance of WSI was not inferior to LM for DTA indicators, concordance, and observer variability. The degree of overdiagnosis was not explicitly reported in any of the studies, while the term itself was used in one study and could be implicitly calculated in another. Conclusion: WSI had an overall high diagnostic accuracy based on traditional accuracy measurements; however, the degree of overdiagnosis is unknown.

OriginalsprogEngelsk
Artikelnummer100136
TidsskriftJournal of Pathology Informatics
Vol/bind13
Antal sider11
ISSN2229-5089
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
We are grateful to Susie Rimborg for her help on how to conduct advanced search in the medical databases. We thank also Klaus Høyer, Margaret Bearman, and Radhika Gorur for their help and support during the process of conducting this review. Finally, we would like to thank all those that helped with their comments to improve this review.

Publisher Copyright:
© 2022 The Authors

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