Article Text

Download PDFPDF
Observer agreement comparing the use of virtual slides with glass slides in the pathology review component of the POSH breast cancer cohort study
  1. Emily Clare Shaw1,
  2. Andrew M Hanby2,
  3. Kevin Wheeler3,
  4. Abeer M Shaaban2,
  5. David Poller4,
  6. Sheila Barton5,
  7. Darren Treanor2,
  8. Laura Fulford6,
  9. Rosemary A Walker7,
  10. Deirdre Ryan8,
  11. Sunil R Lakhani9,10,
  12. Clive A Wells11,
  13. Heather Roche12,
  14. Jeffrey M Theaker12,
  15. Ian O Ellis13,
  16. J Louise Jones14,
  17. Diana M Eccles15
  1. 1Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
  2. 2Department of Histopathology, St James's University Hospital, Leeds, UK
  3. 3Division of Cancer Sciences, University of Southampton, Southampton, UK
  4. 4Department of Cellular Pathology, Queen Alexandra Hospital, Portsmouth, UK
  5. 5MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  6. 6Department of Cellular Pathology, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, UK
  7. 7Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
  8. 8Department of Cellular Pathology, St Bartholomew's Hospital, London, UK
  9. 9School of Medicine and Centre for Clinical Research, Molecular and Cellular Pathology, University of Queensland, Queensland, Australia
  10. 10Department of Anatomical Pathology, Pathology, Queensland, Australia
  11. 11Department of Histopathology, St Bartholomew's Hospital, London, UK
  12. 12Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
  13. 13Department of Histopathology, University of Nottingham, Nottingham, UK
  14. 14Tumour Biology Laboratory, Cancer Research UK Clinical Cancer Centre, Institute of Cancer Studies, Queen Mary's School of Medicine and Dentistry, London, UK
  15. 15Division of Cancer Sciences, University of Southampton, Southampton, UK
  1. Correspondence to Dr Emily Clare Shaw, Department of Cellular Pathology, Mail point 2, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; ecshaw{at}


Aims (1) To compare the use of scanned virtual slide images (virtual microscopy) with glass slides (conventional microscopy) in the assessment of morphological characteristics of breast cancers within the setting of the Prospective study of Outcomes in Sporadic versus Hereditary breast cancer (POSH), involving a cohort of women under 40 years of age, presenting with breast cancer. (2) To assess the acceptability to histopathologists of the use of virtual slide images.

Methods 13 histopathologists from the UK and Australia participated in the POSH pathology review. The observers were asked to assess multiple morphological features such as tumour grade and type. Comparisons were made for a single observer using both virtual images and glass slides. Intra- and inter-observer variability was calculated using the κ statistic and a comparison was made between the use of each image modality.

Results Diagnostic performance with virtual slides was comparable to conventional microscopic assessment, with the measurement of agreement best for vascular invasion, necrosis and the presence of a central scar (κ=0.37–0.78), and poor for more subjective parameters such as pleomorphism, stroma, the nature of the tumour border and the degree of lymphocytic infiltrate (κ=0.1).

Conclusion Virtual slides represent an acceptable methodology for central review of breast cancer histopathology and can circumvent the need for either travel to view material, or the potential problems of sending it by post.

  • Virtual slides
  • breast cancer
  • digital pathology
  • breast pathology
  • cancer research
  • computer assisted
  • digital pathology
  • breast
  • pagets disease
  • CERB 2
  • cancer genetics
  • collagenous colitis
  • crohns disease
  • thyroid
  • gastric pathology
  • apoptosis
  • immunohistochemistry
  • steroid receptors
  • molecular oncology
  • oncology
  • molecular biology
  • molecular genetics
  • molecular pathology
  • cancer
  • histopathology
  • diagnosis
  • cytology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was supported by Cancer Research UK and the Breast Cancer Campaign.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the South and West Multi-Centre Research Ethics Committee (reference MREC/00/6/69).

  • Provenance and peer review Not commissioned; externally peer reviewed.