Abstract
Whole slide images (WSI) have revolutionized dermatopathology, allowing dermatopathologists to provide diagnoses remotely and permitting incorporation of AI tools that can improve diagnosis and minimize time to treatment. Yet, many dermatopathologists find using a computer mouse to navigate WSI cumbersome compared to using a conventional microscope (“microscope”). We hypothesized that a new user interface may impact diagnostic time of WSI. We developed a prototype, the SmartScope, which mimics a microscope and allows dermatopathologists to manipulate WSI by maneuvering a mock slide. We compared the diagnostic times of two dermatopathologists on 18 routine skin biopsies using WSI viewed on a computer (“mouse-based navigation”), SmartScope, and microscope. The mean diagnostic time (MDT) in seconds using mouse-based navigation was 117 (range: 34-402); SmartScope, 56 (range: 17-131); and microscope, 24 (range: 6-57). A linear mixed-effects model (LME), controlling for case and dermatopathologist as random effects, showed that time using the SmartScope was 61 seconds shorter than that of mouse-based navigation (95% CI: -84, -38; p-value: 2.73e-06). Another LME failed to support the equivalence of MDTs between SmartScope and microscope. Cohen’s kappa analysis revealed almost perfect diagnostic agreement between the two dermatopathologists on all three modalities. Diagnosis using SmartScope was significantly faster than mouse-based navigation, though not as fast as on a microscope. These results indicate that user interface can significantly impact diagnostic time. Future work could examine changes to the interface to improve user experience and further shorten diagnostic time in digital pathology.