Limited studies on whole slide imaging (WSI) in surgical neuropathology reported a perceived limitation in the recognition of mitoses. This study analyzed and compared the inter- and intra-observer concordance for atypical meningioma, using glass slides and WSI. Two neuropathologists and two residents assessed the histopathological features of 35 meningiomas—originally diagnosed as atypical—in a representative glass slide and corresponding WSI. For each histological parameter and final diagnosis, we calculated the inter- and intra-observer concordance in the two viewing modes and the predictive accuracy on recurrence. The concordance rates for atypical meningioma on glass slides and on WSI were 54% and 60% among four observers and 63% and 74% between two neuropathologists. The inter-observer agreement was higher using WSI than with glass slides for all parameters, with the exception of high mitotic index. For all histological features, we found median intra-observer concordance of ≥ 79% and similar predictive accuracy for recurrence between the two viewing modes. The higher concordance for atypical meningioma using WSI than with glass slides and the similar predictive accuracy for recurrence in the two modalities suggest that atypical meningioma may be safely diagnosed using WSI.

在外科神经病理学中对全玻片成像（WSI）的有限研究报告了对有丝分裂识别的感知限制。这项研究使用载玻片和WSI分析并比较了非典型脑膜瘤观察者之间和观察者内部的一致性。两名神经病理学家和两名住院医师在代表性的载玻片和相应的WSI中评估了35种脑膜瘤的组织病理学特征（最初诊断为非典型性）。对于每个组织学参数和最终诊断，我们计算了两种观察模式下观察者间和观察者内的一致性以及复发的预测准确性。载玻片和WSI上的非典型脑膜瘤的一致率在四个观察者中分别为54％和60％，在两个神经病理学家之间分别为63％和74％。对于所有参数，使用WSI的观察者间协议要比使用载玻片的观察者更高，除了有丝分裂指数高。对于所有组织学特征，我们发现观察者中位数一致度≥79％，并且两种观察模式之间复发的预测准确性相似。与使用载玻片相比，使用WSI对非典型脑膜瘤的一致性更高，并且在两种方式下复发率的预测准确性相似，这表明使用WSI可以安全地诊断非典型脑膜瘤。