Digitalization in diagnostic histopathology refers to digitized images of microscopic glass slides (i.e., virtual slides, VS) and to the diagnostic work with such slides (i.e., virtual slide microscopy), including derived clinical applications
It forms the basis for communication and represents a major component in medical research and treatment There are several advantages associated with digitalization of glass slides One key advantage is “image sharing for teaching, consultation, remote interpretation, quality assurance, and tumor boards” Additional features are “interactive publication” (similar to on-line scientific chat), image analysis (readers might use measurement systems freely available in the web)and direct integration with information derived from other imaging techniques, such as multiparametric magnetic Resonance imaging (mpMRI).
A figure in an article shows just one selected area of a glass slide at a certain magnification . Digital technology offers the reader the opportunity to review the diagnostic slide from which a figure was taken in its entirety and at multiple magnifications, duplicating what the reader would encounter if the slide was an actual case under his or her microscope . European Urology and European Urology Focus offer a demonstration of digital diagnostic histopathology applied to a urology journal article figure.
In this issue of European Urology, please see the Letter to the Editor: “Re: Karim A. Touijer, James A. Eastham. The Sentinel Lymph Node Concept and Novel Approaches in Detecting Lymph Node Metastasis in Prostate Cancer. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.02.047” by Rodolfo Montironi, Silvia Gasparrini, Roberta Mazzucchelli, Francesco Massari, Liang Cheng, Antonio Lopez-Beltran, Francesco Montorsi, and Marina Scarpelli . The reader can access the scanned whole slide image from which the selected figure was taken and examine the entire VS at various magnifications as if the reader were examining the original glass slide .
European Urology is not the first journal to provide access to a VS. The International Journal of Surgical Pathology, Diagnostic Pathology and Archives of Pathology & Laboratory Medicine have already offered such possibility . It is also offered by Elsevier, the publishing company of European Urology and European Urology Focus, for other journals of the group. Elsevier has developed a Virtual Microscope Viewer in collaboration with Kitware SAS . This integrated, browser based viewer provides access to high resolution microscopic images, such as histological slides. Authors can now complement conventional (low resolution) microscopic images with digital, high resolution equivalents, viewable directly from ScienceDirect using the Virtual Microscope . It is easy to use, fully interactive, and enables authors to navigate and zoom within the microscopic image alongside the article. Viewing a whole-slide image is also feasible on a mobile device . There is no need for special software or plugins
The whole point of a journal article is education, that is, the transfer of knowledge, experience, and guidance. Yin et al  have conducted a study on the “Educational Value of Digital Whole Slides Accompanying Published Online Pathology Journal Articles”. Participants read a sequence of journal articles on a range of topics. A randomized subgroup also reviewed the VSs published with the articles. Most VS group participants gave positive comments on their experience. Favored features supporting the use of VS included the ability to fully evaluate a specimen by choosing different fields and by switching among different magnifications, which allowed the reader to decide if the presented figures were truly representative; VS also helped readers have a better understanding of the journal articles because it gave a broader visual representation of the words in the articles. The participants agreed that viewing VSs when reading the articles enhanced the overall educational experience.
In conclusion, we agree with Kaplan on that “There is no doubt this is an excellent use of digital pathology technologies illustrating a journal article, beyond the traditional use of static imaging alone, showcasing a simple yet effective way to further educate and inform pathologists”. All these advantages will greatly boost the value of VS-enabled journal-based education in the future.