This article summarizes key observations from the poster "Evaluation of Whole Slide Imaging for Frozen Intraoperative Consultations at a Large Academic Institution", presented at USCAP 2024.
Authors: Patrick Morse MD, Kaleigh Roberts MD PhD, Jon Ritter MD, Joseph Gaut MD PhD, Mena Mansour MD
Institution: Washington University in St. Louis and Barnes Jewish Hospital, Saint Louis, MO
Whole slide imaging and digital pathology are increasingly used in frozen section consultation workflows, particularly in institutions with geographically distributed infrastructure. Telepathology services support this process by enabling remote interpretation of tissue slides without direct access to traditional glass slides, with implications for workflow efficiency and pathology turnaround time.
Common telepathology modalities include static image transmission, dynamic microscopy, and whole slide imaging, each with different strengths and limitations. While whole slide imaging is considered a reliable and efficient tool based on prior studies, its use in large academic institutions and fully digital frozen consultation workflows has not been widely evaluated. This study addresses this gap by evaluating whole slide imaging for frozen section consultation and comparing pathology turnaround time with traditional glass slide microscopy in a large academic setting.
This study presents a retrospective comparison of traditional glass slide microscopy and whole slide imaging–based frozen section consultation within a large academic institution. Turnaround time data were retrieved from a digital frozen module over a one-year period from September 2022 to September 2023.
The analysis focused on pathology turnaround time as a key performance metric, comparing how slide imaging and digital workflow integration influence the time required to generate intraoperative diagnostic reports. Cases were categorized based on complexity, including one-part cases involving a single specimen and multi-part cases requiring evaluation of multiple tissue slides. This structured approach enabled quantitative analysis of workflow performance across both traditional and digital pathology systems without introducing assumptions beyond recorded timing data.
The digital pathology workflow incorporated whole slide imaging technology within an integrated digital module designed for frozen section consultation. Tissue slides prepared during intraoperative procedures were scanned to create digital images that could be reviewed remotely by pathologists. The workflow incorporated whole slide imaging systems within a digital frozen module, including platforms such as 3DHISTECH and Grundium Ocus®40, as part of the slide imaging process for selected cases.
This system supported the acquisition, storage, and management of digital slides, enabling remote viewing, data tracking, and coordination across pathology informatics infrastructure. Compared with traditional microscopy, where pathologists review physical glass slides directly, digital pathology requires additional steps including slide scanning, image processing, and data transmission.
The implementation highlights the importance of integration between laboratory processes, software systems, and network infrastructure to support efficient telepathology services. These components collectively influence turnaround time, workflow efficiency, and the overall feasibility of digital pathology adoption in institutions with widespread infrastructure.
The study demonstrates that traditional frozen section consultation using a microscope achieved lower turnaround time compared with whole slide imaging (p<0.0001). However, the observed differences were not considered clinically significant within the context of intraoperative decision-making.
For one-part cases, mean turnaround time was 14.6 minutes using traditional glass slides compared to 22.5 minutes using whole slide imaging. For multi-part cases, the difference was smaller, with 19.2 minutes for traditional microscopy and 20.9 minutes for digital pathology workflows.
These findings indicate that while slide imaging introduces measurable delays, particularly in simpler cases, the impact on overall clinical workflow may be limited. The results support the concept that digital pathology systems can be integrated into frozen section consultation without clinically significant differences in turnaround time.
Differences in pathology turnaround time reflect the additional steps required in digital pathology workflows. Slide scanning, image generation, and data transfer contribute to increased processing time compared to direct microscope-based review of traditional glass slides.
At the same time, workflow complexity influences the relative impact of these delays. In multi-part cases, where specimen preparation and interpretation are inherently more time-consuming, the proportional effect of scanning is reduced.
Key workflow considerations identified in this evaluation include:
Slide imaging and scanning time within digital pathology systems
Integration of digital modules with pathology information systems
Coordination between laboratory staff and pathologists
Data management, storage, and remote viewing capabilities
These factors highlight the need for optimized workflow design and infrastructure to support efficient telepathology services.
Telepathology services based on whole slide imaging offer several advantages for institutions with widespread infrastructure. Remote viewing allows expert pathologists to provide consultation across multiple sites, supporting collaboration and improving access to subspecialty expertise.
Digital pathology systems also enable improved data storage, case tracking, and education through access to archived digital images. These capabilities contribute to improved data management and case tracking, and opportunities for future development in pathology practice and life science research.
This study represents a single-institution retrospective analysis and focuses primarily on turnaround time rather than diagnostic outcomes. As such, conclusions are limited to workflow performance and do not extend to accuracy comparisons between modalities.
In addition, digital pathology workflows depend on reliable technology, including slide imaging systems, software integration, and network infrastructure. Variability in these components may influence performance across different institutions. The findings also reflect a specific implementation using an integrated digital module, which may not be directly generalizable to all pathology environments or telepathology systems.
This evaluation demonstrates that whole slide imaging can be effectively implemented in frozen section consultation workflows within a large academic institution. Although traditional microscopy showed lower pathology turnaround time, the difference between modalities was not clinically significant, particularly in more complex multi-part cases. These findings support the feasibility of integrating digital pathology into time-sensitive intraoperative consultation workflows while maintaining clinically acceptable turnaround time.
Digital pathology and telepathology services provide a viable framework for remote viewing, workflow integration, and expanded access to expert interpretation across distributed healthcare systems. As slide imaging technology, system integration, and infrastructure continue to develop, further improvements in efficiency are expected, supporting broader adoption of whole slide imaging in frozen section consultation while maintaining realistic expectations regarding pathology turnaround time performance.
A curated collection of digital pathology studies and references is available on Grundium’s website.
