Lost in digitization – A systematic review about the diagnostic test accuracy of digital pathology solutions
Methods In this systematic review based on PRISMA guidelines, we analyzed validation studies of WSI compared with LM. We included studies of diagnostic performance of WSI regarding diagnostic test accuracy (DTA) indicators, degree of overdiagnosis, diagnostic concordance, and observer variability as a secondary outcome. Overdiagnosis is (for example) detecting a pathological condition that will either not progress or progress very slowly. Thus, the patient will never get symptoms from this condition and the pathological condition will never be the cause of death. From a search comprising four databases: PubMed, EMBASE, Cochrane Library, and Web of Science, encompassing the period 2010–2021, we selected and screened 12 peer-reviewed articles that fulfilled our selection criteria. Risk of bias was conducted through QUADAS-2 tool, and data analysis and synthesis were performed in a qualitative format.
Results We found that diagnostic performance of WSI was not inferior to LM for DTA indicators, concordance, and observer variability. The degree of overdiagnosis was not explicitly reported in any of the studies, while the term itself was used in one study and could be implicitly calculated in another.
Conclusion WSI had an overall high diagnostic accuracy based on traditional accuracy measurements; however, the degree of overdiagnosis is unknown.