Iranian Journal of Pathology

Whole Slide Imaging (WSI) in Pathology: Emerging Trends and Future Applications in Clinical Diagnostics, Medical Education, and Pathology

Document Type : Review Article

Authors

Sadegh Masjoodi 1
Mohammad Hossein Anbardar 2
Mansoureh Shokripour 2
Navid Omidifar 2

1 Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

https://doi.org/10.30699/ijp.2025.2044210.3367
Abstract
Background & Objective: Whole Slide Imaging (WSI) has emerged as a transformative technology in the fields of clinical diagnostics, medical education, and pathology research. By digitizing entire glass slides into high-resolution images, WSI enables advanced remote collaboration, the integration of artificial intelligence (AI) into diagnostic workflows, and facilitates large-scale data sharing for multi-center research.
Methods: This paper explores the growing applications of WSI, focusing on its impact on diagnostics through telepathology, AI-powered diagnoses and precision medicine, and educational advancements. In this report, we will highlight the profound impact of WSI and address the challenges that must be overcome to enable its broader adoption.
Results & Conclusion: Despite its many advantages, challenges such as infrastructure limitations and regulatory issues need to be addressed for broader adoption. The future of WSI lies in its ability to integrate with cloud-based platforms and big data analytics, continuing to drive the digital transformation of pathology.

Keywords

Telepathology
Clinical Pathology
Artificial Intelligence
Deep Learning
Computing Methodologies

Subjects

Copyright © 2025. This is an open-access article distributed under the terms of the Creative Commons Attribution- 4.0 International License which permits Share, copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, even commercially.

  1. Jain E, Patel A, Parwani AV, Shafi S, Brar Z, Sharma S, et al. Whole slide imaging technology and its applications: Current and emerging perspectives. Int J Surg Pathol. 2023:10668969231185089. [DOI:10.1177/10668969231185089] [PMID]
  2. Caputo A, L'Imperio V, Merolla F, Girolami I, Leoni E, Della Mea V, et al. The slow-paced digital evolution of pathology: lights and shadows from a multifaceted board. Pathologica. 2023;115(3):127. [DOI:10.32074/1591-951X-868] [PMID] [PMCID]
  3. Fraggetta F, Yagi Y, Garcia-Rojo M, Evans AJ, Tuthill JM, Baidoshvili A, et al. The importance of eSlide macro images for primary diagnosis with whole slide imaging. J Pathol Inform. 2018;9(1):46. [DOI:10.4103/jpi.jpi_70_18] [PMID] [PMCID]
  4. Fraggetta F, Garozzo S, Zannoni GF, Pantanowitz L, Rossi ED. Routine digital pathology workflow: the Catania experience. J Pathol Inform. 2017;8(1):51. [DOI:10.4103/jpi.jpi_58_17] [PMID] [PMCID]
  5. Weinstein RS, Graham AR, Lian F, Braunhut BL, Barker GR, Krupinski EA, et al. Reconciliation of diverse telepathology system designs. Historic issues and implications for emerging markets and new applications. Apmis. 2012;120(4):256-75. [DOI:10.1111/j.1600-0463.2011.02866.x] [PMID]
  6. Madabhushi A, Lee G. Image analysis and machine learning in digital pathology: Challenges and opportunities. Medical image analysis. 2016;33:170-5. [PMID] [PMCID] [DOI:10.1016/j.media.2016.06.037]
  7. Weaker FJ, Herbert DC. Transition of a dental histology course from light to virtual microscopy. J Dent Educ. 2009;73(10):1213-21. [DOI:10.1002/j.0022-0337.2009.73.10.tb04813.x]
  8. Chang S, Sadimin E, Yao K, Hamilton S, Aoun P, Pillai R, et al. Establishment of a whole slide imaging-based frozen section service at a cancer center. J Pathol Inform. 2022;13:100106. [DOI:10.1016/j.jpi.2022.100106] [PMID] [PMCID]
  9. Feldman MD. Beyond morphology: whole slide imaging, computer-aided detection, and other techniques. Arch Pathol Lab Med. 2008; 132(5):758-63. [DOI:10.5858/2008-132-758-BMWSIC] [PMID]
  10. Chargari C, Comperat E, Magné N, Védrine L, Houlgatte A, Egevad L, et al. Prostate needle biopsy examination by means of virtual microscopy. Pathology-Research and Practice. 2011;207(6):366-9. [DOI:10.1016/j.prp.2011.03.005] [PMID]
  11. Farahani N, Parwani AV, Pantanowitz L. Whole slide imaging in pathology: advantages, limitations, and emerging perspectives. Pathol Lab Med Int. 2015:23-33. [DOI:10.2147/PLMI.S59826]
  12. Lu MY, Williamson DF, Chen TY, Chen RJ, Barbieri M, Mahmood F. Data-efficient and weakly supervised computational pathology on whole-slide images. Nat Biomed Eng. 2021;5(6):555-70. [DOI:10.1038/s41551-020-00682-w] [PMID] [PMCID]
  13. Katare P, Gorthi SS. Recent technical advances in whole slide imaging instrumentation. Journal of Microscopy. 2021;284(2):103-17. [DOI:10.1111/jmi.13049] [PMID]
  14. Yazdanfar S, Kenny KB, Tasimi K, Corwin AD, Dixon EL, Filkins RJ. Simple and robust image-based autofocusing for digital microscopy. Optics express. 2008;16(12):8670-7. [DOI:10.1364/OE.16.008670] [PMID]
  15. Dunn BE, Almagro UA, Choi H, Sheth NK, Arnold JS, Recla DL, et al. Dynamic-robotic telepathology: Department of Veterans Affairs feasibility study. Human pathology. 1997;28(1):8-12. [DOI:10.1016/S0046-8177(97)90271-9] [PMID]
  16. Ferreira R, Moon B, Humphries J, Sussman A, Saltz J, Miller R, et al., editors. The virtual microscope. Proc AMIA Annu Fall Symp; 1997: American Medical Informatics Association.
  17. Weinstein RS, Descour MR, Liang C, Barker G, Scott KM, Richter L, et al. An array microscope for ultrarapid virtual slide processing and telepathology. Design, fabrication, and validation study. Human pathology. 2004;35(11):1303-14. [DOI:10.1016/j.humpath.2004.09.002] [PMID]
  18. Evans AJ, Depeiza N, Allen S-G, Fraser K, Shirley S, Chetty R. Use of whole slide imaging (WSI) for distance teaching. Journal of Clinical Pathology. 2020. [DOI:10.1136/jclinpath-2020-206763] [PMID]
  19. Patel A, Balis UG, Cheng J, Li Z, Lujan G, McClintock DS, et al. Contemporary whole slide imaging devices and their applications within the modern pathology department: A selected hardware review. J Pathol Inform. 2021;12(1):50. [DOI:10.4103/jpi.jpi_66_21] [PMID] [PMCID]
  20. Fraggetta F, L'imperio V, Ameisen D, Carvalho R, Leh S, Kiehl T-R, et al. Best practice recommendations for the implementation of a digital pathology workflow in the anatomic pathology laboratory by the European Society of Digital and Integrative Pathology (ESDIP). Diagnostics. 2021;11(11):2167. [DOI:10.3390/diagnostics11112167] [PMID] [PMCID]

 

  1. Amin W, Srintrapun SJ, Parwani AV. Automated whole slide imaging. Expert Opin Med Diagn. 2008;2(10):1173-81. [DOI:10.1517/17530059.2.10.1173] [PMID]
  2. Pantanowitz L, Valenstein PN, Evans AJ, Kaplan KJ, Pfeifer JD, Wilbur DC, et al. Review of the current state of whole slide imaging in pathology. J Pathol Inform. 2011;2(1):36. [PMCID] [DOI:10.4103/2153-3539.83746] [PMID]
  3. Wang X, Chen H, Gan C, Lin H, Dou Q, Tsougenis E, et al. Weakly supervised deep learning for whole slide lung cancer image analysis. IEEE transactions on cybernetics. 2019;50(9):3950-62. [DOI:10.1109/TCYB.2019.2935141] [PMID]
  4. Pantanowitz L, Sinard JH, Henricks WH, Fatheree LA, Carter AB, Contis L, et al. Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med. 2013;137(12):1710-22. [DOI:10.5858/arpa.2013-0093-CP] [PMID] [PMCID]
  5. Rodriguez JPM, Rodriguez R, Silva VWK, Kitamura FC, Corradi GCA, de Marchi ACB, et al. Artificial intelligence as a tool for diagnosis in digital pathology whole slide images: A systematic review. J Pathol Inform. 2022;13:100138. [DOI:10.1016/j.jpi.2022.100138] [PMID] [PMCID]
  6. Zuraw A, Aeffner F. Whole-slide imaging, tissue image analysis, and artificial intelligence in veterinary pathology: An updated introduction and review. Veterinary Pathol. 2022;59(1):6-25. [DOI:10.1177/03009858211040484] [PMID]
  7. Malik S, Zaheer S. ChatGPT as an aid for pathological diagnosis of cancer. Pathology-Research and Practice. 2023:154989. [DOI:10.1016/j.prp.2023.154989] [PMID]
  8. Kanwal N, Pérez-Bueno F, Schmidt A, Engan K, Molina R. The devil is in the details: Whole slide image acquisition and processing for artifacts detection, color variation, and data augmentation: A review. IEEE Access. 2022;10:58821-44. [DOI:10.1109/ACCESS.2022.3176091]
  9. Kumar N, Gupta R, Gupta S. Whole slide imaging (WSI) in pathology: current perspectives and future directions. Journal of digital imaging. 2020;33(4):1034-40. [DOI:10.1007/s10278-020-00351-z] [PMID] [PMCID]
  10. Hanna MG, Parwani A, Sirintrapun SJ. Whole slide imaging: technology and applications. Adv Anat Pathol. 2020;27(4):251-9. [DOI:10.1097/PAP.0000000000000273] [PMID]
  11. Shaker N, Sardana R, Hamasaki S, Nohle DG, Ayers LW, Parwani AV. Accuracy of whole slide image based image analysis is adversely affected by preanalytical factors such as stained tissue slide and paraffin block age. J Pathol Inform. 2022;13:100121. [PMID] [PMCID] [DOI:10.1016/j.jpi.2022.100121]
  12. Pantanowitz L, Szymas J, Yagi Y, Wilbur D. Whole slide imaging for educational purposes. J Pathol Inform. 2012;3(1):46. [DOI:10.4103/2153-3539.104908] [PMID] [PMCID]
  13. Catalyurek U, Beynon MD, Chang C, Kurc T, Sussman A, Saltz J. The virtual microscope. IEEE Transactions on Information Technology in Biomedicine. 2003;7(4):230-48. [DOI:10.1109/TITB.2004.823952] [PMID]
  14. Glatz-Krieger K, Spornitz U, Spatz A, Mihatsch MJ, Glatz D. Factors to keep in mind when introducing virtual microscopy. Virchows Archiv. 2006;448:248-55. [DOI:10.1007/s00428-005-0112-2] [PMID]
  15. Weinstein RS, Graham AR, Richter LC, Barker GP, Krupinski EA, Lopez AM, et al. Overview of telepathology, virtual microscopy, and whole slide imaging: prospects for the future. Hum Pathol. 2009;40(8):1057-69. [DOI:10.1016/j.humpath.2009.04.006] [PMID]
  16. Evans AJ, Salama ME, Henricks WH, Pantanowitz L. Implementation of whole slide imaging for clinical purposes: issues to consider from the perspective of early adopters. Arch Pathol Lab Med. 2017;141(7):944-59. [DOI:10.5858/arpa.2016-0074-OA] [PMID]
  17. Pantanowitz L, Wiley CA, Demetris A, Lesniak A, Ahmed I, Cable W, et al. Experience with multimodality telepathology at the University of Pittsburgh Medical Center. J Pathol Inform. 2012;3(1):45. [DOI:10.4103/2153-3539.104907] [PMID] [PMCID]
  18. Pantanowitz L, Sharma A, Carter AB, Kurc T, Sussman A, Saltz J. Twenty years of digital pathology: an overview of the road travelled, what is on the horizon, and the emergence of vendor-neutral archives. J Pathol Inform. 2018;9(1):40. [DOI:10.4103/jpi.jpi_69_18] [PMID] [PMCID]
  19. Pantanowitz L, Sinard JH, Henricks WH, Fatheree LA, Carter AB, Contis L, et al. Validating whole slide imaging for diagnostic purposes in pathology. 2013.
  20. Cheng WC, Saleheen F, Badano A. Assessing color performance of whole‐slide imaging scanners for digital pathology. Color Res Appl. 2019;44(3):322-34. [DOI:10.1002/col.22365]
  21. Bashshur RL, Krupinski EA, Weinstein RS, Dunn MR, Bashshur N. The empirical foundations of telepathology: evidence of feasibility and intermediate effects. Telemedicine and e-Health. 2017;23(3):155-91. [DOI:10.1089/tmj.2016.0278] [PMID] [PMCID]
  22. Ryan J, Gerhold AR, Boudreau V, Smith L, Maddox PS. Introduction to modern methods in light microscopy. Light Microscopy: Methods and Protocols. 2017:1-15. [DOI:10.1007/978-1-4939-6810-7_1] [PMID]
  23. Jiang S, Guo C, Song P, Wang T, Wang R, Zhang T, et al. High-throughput digital pathology via a handheld, multiplexed, and AI-powered ptychographic whole slide scanner. Lab on a Chip. 2022;22(14):2657-70. [DOI:10.1039/D2LC00084A] [PMID]
  24. Swiderska-Chadaj Z, de Bel T, Blanchet L, Baidoshvili A, Vossen D, van der Laak J, et al. Impact of rescanning and normalization on convolutional neural network performance in multi-center, whole-slide classification of prostate cancer. Sci Rep. 2020;10(1):14398. [PMCID] [DOI:10.1038/s41598-020-71420-0] [PMID]
  25. Hassell LA, Absar SF, Chauhan C, Dintzis S, Farver CF, Fathima S, et al. Pathology education powered by virtual and digital transformation: now and the future. Arch Pathol Lab Med. 2023;147(4):474-91. [DOI:10.5858/arpa.2021-0473-RA] [PMID]
  26. Ho J, Parwani AV, Jukic DM, Yagi Y, Anthony L, Gilbertson JR. Use of whole slide imaging in surgical pathology quality assurance: design and pilot validation studies. Human pathology. 2006;37(3):322-31. [DOI:10.1016/j.humpath.2005.11.005] [PMID]
  27. Randell R, Ambepitiya T, Mello-Thoms C, Ruddle RA, Brettle D, Thomas RG, et al. Effect of display resolution on time to diagnosis with virtual pathology slides in a systematic search task. J Digit Imaging. 2015;28:68-76. [PMCID] [DOI:10.1007/s10278-014-9726-8] [PMID]
  28. Mercan E, Shapiro LG, Brunyé TT, Weaver DL, Elmore JG. Characterizing diagnostic search patterns in digital breast pathology: scanners and drillers. J Digit Imaging. 2018;31:32-41. [DOI:10.1007/s10278-017-9990-5] [PMID] [PMCID]
  29. Webster J, Dunstan R. Whole-slide imaging and automated image analysis: considerations and opportunities in the practice of pathology. Vet Pathol 2014;51(1):211-23. [DOI:10.1177/0300985813503570] [PMID]
  30. Hamilton PW, Wang Y, McCullough SJ. Virtual microscopy and digital pathology in training and education. Apmis. 2012;120(4):305-15. [DOI:10.1111/j.1600-0463.2011.02869.x] [PMID]
  31. Crowley R, Medvedeva O, Jukic D, editors. SlideTutor: A model-tracing Intelligent Tutoring System for teaching microscopic diagnosis. Proceedings of the 11th international conference on artificial intelligence in education; 2003: Citeseer.
  32. Chukwuyem E, Santosh K, Ramya T, Ekokobe F, Jai G. The emergence of virtual tumor boards in neuro-oncology: opportunities and challenges. Cureus. 2022;14(6).
  33. Davis CH, Ho J, Stephenson R, August DA, Gee H, Weiner J, et al. Virtual tumor board increases provider attendance and case presentations. JCO Oncology Practice. 2022;18(10):e1603-e10. [DOI:10.1200/OP.22.00158] [PMID]
  34. Hopkins SE, Vidri RJ, Hill MV, Vijayvergia N, Farma JM. A virtual tumor board platform: a way to enhance decision-making for complex malignancies. Journal of Surgical Research. 2022;278:233-9. [DOI:10.1016/j.jss.2022.04.070] [PMID]
  35. Kalia V, Ortiz DA, Patel AK, Moriarity AK, Canon CL, Duszak Jr R. Leveraging Twitter to maximize the radiology meeting experience. Journal of the American College of Radiology. 2018;15(1):177-83. [DOI:10.1016/j.jacr.2017.10.022] [PMID]
  36. Tecotzky R. Digital pathology enhances hospital's tumor board meetings. Medical Laboratory Observer (MLO). 2009;41(11).
  37. Baidoshvili A, Bucur A, van Leeuwen J, van der Laak J, Kluin P, van Diest PJ. Evaluating the benefits of digital pathology implementation: time savings in laboratory logistics. Histopathology. 2018;73(5):784-94. [DOI:10.1111/his.13691] [PMID]
  38. Hamilton P, O'Reilly P, Bankhead P, Abels E, Salto-Tellez M. Digital and computational pathology for biomarker discovery. Predictive Biomarkers in Oncology: Applications in Precision Medicine. 2019:87-105. [DOI:10.1007/978-3-319-95228-4_7]
  39. Szymas J, Lundin M, editors. Five years of experience teaching pathology to dental students using the WebMicroscope. Diagn Pathol; 2011: Springer. [DOI:10.1186/1746-1596-6-S1-S13] [PMID] [PMCID]
  40. Hanna MG, Reuter VE, Samboy J, England C, Corsale L, Fine SW, et al. Implementation of digital pathology offers clinical and operational increase in efficiency and cost savings. Arch Pathol Lab Med. 2019;143(12):1545-55. [DOI:10.5858/arpa.2018-0514-OA] [PMID] [PMCID]
  41. Lutnick B, Manthey D, Becker JU, Ginley B, Moos K, Zuckerman JE, et al. A user-friendly tool for cloud-based whole slide image segmentation with examples from renal histopathology. Communications medicine. 2022;2(1):105. [DOI:10.1038/s43856-022-00138-z] [PMID] [PMCID]
  42. Bisson T, Franz M, Dogan O I, Romberg D, Jansen C, Hufnagl P, et al. Anonymization of whole slide images in histopathology for research and education. Digital Health. 2023;9: 20552076231171475. [PMID] [PMCID] [DOI:10.1177/20552076231171475]
  43. Holub P, Müller H, Bíl T, Pireddu L, Plass M, Prasser F, et al. Privacy risks of whole-slide image sharing in digital pathology. Nature Communications. 2023; 14(1):2577. [PMCID] [DOI:10.1038/s41467-023-37991-y] [PMID]
  44. Evans AJ, Bauer TW, Bui MM, Cornish TC, Duncan H, Glassy EF, et al. US Food and Drug Administration approval of whole slide imaging for primary diagnosis: a key milestone is reached and new questions are raised. Arch Pathol Lab Med. 2018;142(11):1383-7. [DOI:10.5858/arpa.2017-0496-CP] [PMID]
  45. Boyce B. An update on the validation of whole slide imaging systems following FDA approval of a system for a routine pathology diagnostic service in the United States. Biotechnic & Histochemistry. 2017;92(6):381-9. [DOI:10.1080/10520295.2017.1355476] [PMID]
  46. Henricks WH. Laboratory information systems. Surgical pathology clinics. 2015;8(2):101-8. [DOI:10.1016/j.path.2015.02.016] [PMID]
  47. Auguste L, Palsana D. Mobile Whole Slide Imaging (mWSI): a low resource acquisition and transport technique for microscopic pathological specimens. BMJ Innov. 2015;1(3):137-43. [DOI:10.1136/bmjinnov-2015-000040]
Iranian Journal of Pathology
Volume 20, Issue 3
Summer 2025
Pages 257-265

  • Receive Date 24 October 2024
  • Revise Date 20 May 2025
  • Accept Date 13 April 2025

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