The Role of Digital Pathology in Cancer Diagnosis: A Comparative Study of Traditional vs. Digital Techniques in a Pathology

Background:Cancer diagnosis in Nigeria faces significant challenges, including delays, limited access to advanced technologies, and a shortage of skilled pathologists. While traditional light microscopy remains the gold standard, digital pathology technologies such as whole slide imaging (WSI) have the potential to improve diagnostic accuracy, efficiency, and reproducibility. This study aimed to compare the effectiveness of digital pathology against traditional microscopy in diagnosing cancer at a Nigerian teaching hospital.Objective:This study compared the diagnostic accuracy, turnaround time, and cost-effectiveness of traditional microscopy and digital pathology in diagnosing breast, cervical, and colorectal cancers at Olabisi Onabanjo University Teaching Hospital (OOUTH) in Sagamu, Nigeria. The goal was to assess whether digital pathology could enhance diagnostic processes and improve outcomes in a resource-limited setting.Methods:A prospective, comparative study was conducted at OOUTH, including 266 formalin-fixed, paraffin-embedded (FFPE) tissue samples from cancer patients. The cancers studied included breast, cervical, and colorectal cancers, chosen for their prevalence and diagnostic significance in the Nigerian population. Traditional slides were reviewed using conventional light microscopy, while digital slides were analyzed using whole slide imaging (WSI) scanners. Diagnostic accuracy, time to diagnosis, inter-observer variability, and cost-effectiveness were evaluated. Diagnostic accuracy was measured through inter-observer agreement (Cohen’s Kappa), while turnaround time was compared between both methods. A cost-effectiveness analysis considered savings from reduced slide handling and transportation.Results:Digital pathology demonstrated significantly higher diagnostic accuracy, with Cohen’s Kappa of 0.85 for digital pathology vs. 0.68 for traditional microscopy. Digital pathology also reduced diagnostic turnaround time by 35% (13 minutes for digital slides vs. 20 minutes for traditional slides). Additionally, the study found digital pathology to be more cost-effective. Savings were primarily due to the reduced need for slide transportation and handling, leading to a 30% reduction in overall diagnostic costs.Conclusion:Digital pathology provided superior diagnostic accuracy, faster turnaround times, and greater consistency compared to traditional microscopy. These improvements not only optimize the efficiency of cancer diagnosis but also offer a more cost-effective solution in a resource-limited setting like Nigeria. This study supports the integration of digital pathology into Nigerian healthcare infrastructure and suggests that digital pathology could significantly enhance cancer diagnosis, potentially transforming diagnostic practices in other low-resource regions globally.

Learning Objectives: 

1. Understand the benefits and limitations of digital pathology compared to traditional microscopy in terms of diagnostic accuracy, turnaround time, and inter-observer variability.
2. Evaluate the potential cost-effectiveness of integrating digital pathology technologies into resource-limited healthcare settings, considering savings in logistics and slide handling.
3. Identify the feasibility and practical considerations for adopting digital pathology in low-resource environments, particularly in cancer diagnosis at teaching hospitals like those in Nigeria.