Diagnostic concordance in forensic pathology between Digital Pathology Systems and optical microscopy

Abstract

This study evaluated the diagnostic agreement between a Digital Pathology System (DPS) and conventional optical microscopy in forensic pathology. A total of 1,220 slides from 90 forensic cases were digitized and reviewed using both methods by a forensic pathologist, with a washout period between readings. Agreement was analyzed using Cohen’s Kappa coefficient under two scenarios: complete agreement and complete agreement plus minor discrepancies. High concordance was observed, with agreement rates of 93.03% (κ = 0.909) and 96.80% (κ = 0.957). Major organs such as the brain, heart, liver, and kidney showed agreement rates above 95% (κ = 0.949 – 1.000), while slightly lower agreement was found in lung and spleen due to histological complexity and postmortem changes. These findings suggest that DPS is a reliable alternative to conventional microscopy in forensic histopathology, though further validation is recommended for specific tissues.