More scanning, but not zooming, is associated with diagnostic accuracy in evaluating digital breast pathology slides

Diagnoses of medical images can invite strikingly diverse strategies for image navigation and visual search. In computed tomography screening for lung nodules, distinct strategies, termed scanning and drilling, relate to both radiologists' clinical experience and accuracy in lesion detection. Here, we examined associations between search patterns and accuracy for pathologists (N = 92) interpreting a diverse set of breast biopsy images. While changes in depth in volumetric images reveal new structures through movement in the z-plane, in digital pathology changes in depth are associated with increased magnification. Thus, drilling in radiology may be more appropriately termed zooming in pathology. We monitored eye-movements and navigation through digital pathology slides to derive metrics of how quickly the pathologists moved through XY (scanning) and Z (zooming) space. Prior research on eye-movements in depth has categorized clinicians as either scanners or drillers. In contrast, we found that there was no reliable association between a clinician's tendency to scan or zoom while examining digital pathology slides. Thus, in the current work we treated scanning and zooming as continuous predictors rather than categorizing as either a scanner or zoomer. In contrast to prior work in volumetric chest images, we found significant associations between accuracy and scanning rate but not zooming rate. These findings suggest fundamental differences in the relative value of information types and review behaviors across two image formats. Our data suggest that pathologists gather critical information by scanning on a given plane of depth, whereas radiologists drill through depth to interrogate critical features.

Automated summary

The study found differences in image navigation and visual search strategies between radiology and pathology in medical image diagnoses. Pathologists associate changes in image depth with magnification, while drilling in radiology is more similar to zooming in pathology. Unlike previous classifications of clinicians as either scanners or drillers, there was no reliable association between a clinician's tendency to scan or zoom while examining digital pathology slides in the current study.