Despite advances in technology, do WSI scanners really deliver a “perfect ‘Xerox’” of the specimen? If so, then why aren’t the images identical between scanners? For all of the published articles demonstrating the “equivalence” of digital images to “brass and glass” observation, there are plenty of examples illustrating that the microscope continues to be the benchmark. Journals tend to publish articles describing scientific advancements, not the shortcomings. Yes, significant progress has been made, we’re getting closer to the reality of digital pathology and, I believe, the pending FDA guidance on technical performance assessment in slide scanning will only strengthen the argument for digital pathology in the US.

A second observation is that digital images must be displayed to the pathologist’s retina. For the moment, monitor quality, performance, calibration and even color profile remain topics for debate. A visit to a consumer electronics store illustrates the wide range of inconsistency in monitor performance, and how do we know which display is accurate? Until standards are identified and adopted, pathologists will continue to view images on displays that vary in color and tonal reproduction.

Third, in regard to the patient mentioned in the WSJ article who sought a second opinion, it is wonderful that digital images enable consultation, but doesn’t this become a slippery slope? Patients may not “like” or accept a first opinion and may continue to seek alternatives until they obtain an opinion that is satisfactory to them. The same could apply to insurers who would prefer a diagnosis with a lower cost for treatment, thus assuming the risk that the first treatment may be unsuccessful and follow up intervention may be required. And who pays for the pathologists’ time? Where digital pathology should contribute to a virtuous circle for patient care, it could quickly spiral out of control.