The College of American Pathologists guidelines for whole slide imaging validation are feasible for pediatric pathology: a pediatric pathology practice experience.

Whole slide imaging (WSI) is rapidly transforming educational and diagnostic pathology services. Recently, the College of American Pathologists Pathology and Laboratory Quality Center (CAP-PLQC) published recommended guidelines for validating diagnostic WSI. We prospectively evaluated the guidelines to determine their utility in validating pediatric surgical pathology and cytopathology specimens. Our validation included varied pediatric specimen types, including complex or less common diagnoses, in accordance with the guidelines. We completed WSI review of 60 surgical pathology cases and attempted WSI review of 21 cytopathology cases. For surgical pathology cases, WSI diagnoses were highly concordant with glass slide diagnoses; a discordant diagnosis was observed in 1 of 60 cases (98.3% concordance). We found that nucleated red blood cells and eosinophilic granular bodies represented specific challenges to WSI review of pediatric specimens. Cytology specimens were more frequently discordant or failed for technical reasons, with overall concordance of 66.7%. Review of pediatric cytopathology specimens will likely require image capture in multiple focal planes. This study is the first to specifically evaluate WSI review for pediatric specimens and demonstrates that specimens representing the spectrum of pediatric surgical pathology practice can be reviewed using WSI. Our application of the proposed CAP-PLQC guidelines to pediatric surgical pathology specimens is, to our knowledge, the first prospective implementation of the CAP-PLQC guidelines.

Respiratory virus infection in infants and children.

The recent availability of diagnostic polymerase chain reaction-based assays for the detection of viral pathogens has allowed us to identify the infectious agents present in a large percentage of culture-negative specimens. The information gained by these studies has led to a reassessment of the prevalence of individual viruses in lower respiratory tract infections in both normal and immunocompromised children. Pathologic examination of less severe cases identified by more sensitive methodologies in immunocompetent children is now possible and has prompted the realization that many of the classic features of particular viral infections in the lung are in fact hallmarks of fulminant disease. In this article we review the body of literature discussing these anatomic findings, the approaches taken by those investigators, and the types of reagents that are commercially available.