Introduction of virtual microscopy in routine surgical pathology - a hypothesis and personal view from Europe

Klaus Kayser

The technology of whole image acquisition from histological glass slides (Virtual slides, (VS)) and its associated software such as image storage, viewers, and virtual microscopy (VM), has matured in the recent years. There is an ongoing discussion whether to introduce VM into routine diagnostic surgical pathology (tissue-based diagnosis) or not, and if these are to be introduced how best to do this. The discussion also centres around how to substantially define the mandatory standards and working conditions related to introducing VM. This article briefly describes some hypotheses alongside our perspective and that of several of our European colleagues who have experienced VS and VM either in research or routine praxis. After consideration of the different opinions and published data the following statements can be derived: 1. Experiences from static and remote telepathology as well as from daily routine diagnoses, confirm that VM is a diagnostic tool that can be handled with the same diagnostic accuracy as conventional microscopy; at least no statistically significant differences (p > 0.05) exist. 2. VM possesses several practical advantages in comparison to conventional microscopy; such as digital image storage and retrieval and contemporary display of multiple images (acquired from different stains, and/or different cases). 3. VM enables fast and efficient feedback between the pathologist and the laboratory in terms of ordered additional stains, automated access to the latest research for references, and fast consultation with outstanding telepathology experts. 4. Industry has already invested "big money" into this technology which certainly will be of influence in its future development. The main constraints against VM include the questionable reimbursement of the initial investment, the missing direct and short term financial benefit, and the loss of potential biological identity between the patient and the examined tissue. This article tries to analyze and evaluate the factors that influence the implementation of VM into routine tissue-based diagnosis, for example in combination with predictive diagnosis. It focuses on describing the advantages of modern and innovative electronically based communication technology.