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Real-world digital pathology: considerations and ruminations of four young pathologists
  1. Alessandro Caputo1,
  2. Fabio Gibilisco2,
  3. Beatrice Belmonte3,4,
  4. Andrea Mondello3,
  5. Vincenzo L'Imperio5,6,
  6. Filippo Fraggetta3
  1. 1 Department of Medicine and Surgery, University of Salerno, Salerno, Italy
  2. 2 Department of Medical and Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, University of Catania, Catania, Italy
  3. 3 Department of Pathology, Gravina Hospital, Caltagirone, Italy
  4. 4 Tumor Immunology Unit, Department of Science and Promotion of Health and Maternal Infancy "G. D'Alessandro", University of Palermo, Palermo, Italy
  5. 5 Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardia, Italy
  6. 6 Department of Pathology, ASST Monza, Monza, Lombardia, Italy
  1. Correspondence to Dr Filippo Fraggetta, Department of Pathology, Gravina Hospital, 95126 Caltagirone, Sicilia, Italy; filippofra{at}

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Digital pathology offers the opportunity to improve all aspects of pathology by introducing recent technical advancements in daily diagnostic practice.1 Its introduction in routine work, especially as part of a fully digitised workflow, allows for the creation of a smoother, traceable and interconnected environment where primary diagnoses can be rendered directly on digital slides.2 Besides its main use as a diagnostic tool, however, digital pathology has a role in enhancing education of trainees and in research activities.3

In this letter, we present the impressions of two pathology residents and two young pathologists after exposing them to a fully digital workflow.

AM: routine practice

When I started working in Caltagirone, primary diagnosis on whole slide images was already the standard for routine histology and most cytology cases. I had doubts about the feasibility of this and I thought that image quality could not be compared to traditional optical microscopy.

These doubts were dispelled in a few days of actual experience in my new workplace. At first it was almost like getting lost inside the digital slide: everything looked bigger and thus more suspicious of malignancy to me. After a few days of practice, however, I realised that I really did not need to cross-check glass slides anymore. The ease of glancing at the whole mount and then progressively looking at the finer details was also something that became second nature very quickly (figure 1).

Figure 1

The workspace of the digital pathologist comprises at least two computer monitors, so that one can show the laboratory information system (left, for clinical data and report writing), while another is free to display the whole-slide image at full-screen resolution (right). Comparing multiple slides (eg, immunohistochemistry to standard H&E) is also feasible, either splitting a monitor in half or using multiple monitors.

In time I noticed …

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  • Handling editor Runjan Chetty.

  • Twitter @ACaputoMD, @VLimperioMD

  • AC and FG contributed equally.

  • Contributors VL and FF conceived the study. AC, FG, BB and AM drafted the manuscript. All authors took part in critical revision of the manuscript for important intellectual content, have given final approval of the submitted manuscript and agree to be held accountable for all aspects of the present work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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