Towards an automated virtual slide screening: theoretical considerations and practical experiences of automated tissue-based virtual diagnosis to be implemented in the Internet

Aims: To develop and implement an automated virtual slide screening system that distinguishes normal histological findings and several tissue - based crude (texture - based) diagnoses. Theoretical considerations: Virtual slide technology has to handle and transfer images of GB Bytes in size. The performance of tissue based diagnosis can be separated into a) a sampling procedure to allocate the slide area containing the most significant diagnostic information, and b) the evaluation of the diagnosis obtained from the information present in the selected area. Nyquist's theorem that is broadly applied in acoustics, can also serve for quality assurance in image information analysis, especially to preset the accuracy of sampling. Texture - based diagnosis can be performed with recursive formulas that do not require a detailed segmentation procedure. The obtained results will then be transferred into a self-learning discrimination system that adjusts itself to changes of image parameters such as brightness, shading, or contrast. Methods: Non-overlapping compartments of the original virtual slide (image) will be chosen at random and according to Nyquist's theorem (predefined error-rate). The compartments will be standardized by local filter operations, and are subject for texture analysis. The texture analysis is performed on the basis of a recursive formula that computes the median gray value and the local noise distribution. The computations will be performed at different magnifications that are adjusted to the most frequently used objectives (*2, *4.5, *10, *20, *40). The obtained data are statistically analyzed in a hierarchical sequence, and in relation to the clinical significance of the diagnosis. Results: The system has been tested with a total of 896 lung cancer cases that include the diagnoses groups: cohort (1) normal lung - cancer; cancer subdivided: cohort (2) small cell lung cancer - non small cell lung cancer; non small cell lung cancer subdivided: cohort (3) squamous cell carcinoma - adenocarcinoma - large cell carcinoma. The system can classify all diagnoses of the cohorts (1) and (2) correctly in 100%, those of cohort (3) in more than 95%. The percentage of the selected area can be limited to only 10% of the original image without any increased error rate. Conclusion: The developed system is a fast and reliable procedure to fulfill all requirements for an automated pre-screening of virtual slides in lung pathology.