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Christina Mastromonaco, Patrick T Logan, Pablo Zoroquiain, Sarah Alghamdi, Matthew Balazsi, Miguel N Burnier; Diagnosing pathological prognostic factors in retinoblastoma: correlation between traditional microscopy and digital slides. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):78.
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© ARVO (1962-2015); The Authors (2016-present)
Digital pathology is a tool that converts a microscope slide into a digital image using a scanner that can be viewed on a computer screen rather than on a microscope. Whole slide imaging (WSI) possess the unique feature of having a global view of the entire eye in order to visualize the relationships between the tumor and ocular structures. The aim of the present study was to determine the diagnostic accuracy, using WSI generated by a scanner, of high-risk prognostic factors and morphological characteristics of retinoblastomas.
Forty-seven enucleated eyes with retinoblastoma from the Henry C. Witelson Ocular Pathology Laboratory, Montreal, Quebec, were stained with hematoxylin and eosin. Whole slide images at 40× magnification were reviewed by a pathologist using the Virtuoso image analyzer, and the following prognostic factors were evaluated: muticentricity, type of growth, choroidal, anterior chamber, and optic nerve invasion, rosette formation, necrosis, and Azzopardi effect. These results were compared with results obtained from the same pathologist after reviewing the slides in a random order using a regular microscope as the gold standard. McNemar’s test (MT), percentage of agreement (POA), and sensibility (S) and specificity (Sp) were evaluated between WSI and conventional microscopy.
There were no differences with respect to the determination of multicentricity, type of growth, rosette formation (Homer Wright, Flexner-Wintersteiner, and fleurettes), choroidal invasion, invasion of anterior chamber structures, extraocular extension, extension to the sclera (including vortex vessels), optic nerve invasion (head or prelaminar, laminar, or postlamellar invasion), necrosis, or Azzopardi effect between WSI analysis and light microscopy (MT, P = 1.0; POA = 100%; S = 100%; and Sp = 100%).
To the best of our knowledge, this is the first report using digital pathology (WSI) to evaluate prognostic factors in eyes containing retinoblastomas. Using WSI, the pathologist was able to detect high-risk morphological features in retinoblastoma. WSI is an important tool now in particular for ophthalmic pathologists examining enucleation and exenteration specimens. WSI should be considered as a viable alternative to traditional microscopy in ocular pathology.
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