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Learn more: PMC Disclaimer | PMC Copyright Notice J Pathol Inform . 2026 Mar 12;21:100652. doi: 10.1016/j.jpi.2026.100652 Search in PMC Search in PubMed View in NLM Catalog Add to search Perceptions of digital pathology among healthcare workers in pathology Aditi Tayal Aditi Tayal 1 University Hospitals Cleveland Medical Center, Case Western Reserve University, School of Medicine, Cleveland, OH, USA Find articles by Aditi Tayal 1, ⁎ , Meghan E Kapp Meghan E Kapp 1 University Hospitals Cleveland Medical Center, Case Western Reserve University, School of Medicine, Cleveland, OH, USA Find articles by Meghan E Kapp 1 , Sylvia L Asa Sylvia L Asa 1 University Hospitals Cleveland Medical Center, Case Western Reserve University, School of Medicine, Cleveland, OH, USA Find articles by Sylvia L Asa 1 Author information Article notes Copyright and License information 1 University Hospitals Cleveland Medical Center, Case Western Reserve University, School of Medicine, Cleveland, OH, USA ⁎ Corresponding author. [email protected] Received 2026 Jan 4; Revised 2026 Mar 9; Accepted 2026 Mar 10; Collection date 2026 Apr. © 2026 The Authors This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). PMC Copyright notice PMCID: PMC13068662 PMID: 41971910 Abstract The integration of informatics into pathology is rapidly transforming the field, with the potential to enhance diagnostic accuracy, streamline workflows, and improve patient outcomes. Digital pathology, artificial intelligence (AI), and machine learning are among the innovations revolutionizing traditional practices by enabling the digitization of tissue samples, the automation of data analysis, and the incorporation of large datasets into diagnostic processes. While these advancements hold great promise, they have also generated mixed reactions among healthcare professionals, particularly in pathology, where the balance between human expertise and technology is critical. To better understand the perceptions of informatics in pathology, a cross-sectional survey was conducted among healthcare workers within the field. The survey aimed to assess attitudes toward the adoption of informatics, with specific focus on its perceived benefits and challenges. This study seeks to provide insights into how these new technologies are being received by those at the forefront of pathology, exploring both the enthusiasm and apprehension surrounding the growing role of informatics in the discipline. Keywords: Digital pathology, Glass slide, Artificial intelligence, Pathologist Introduction The integration of informatics into pathology is rapidly transforming the field, with the potential to enhance diagnostic accuracy, streamline workflows, and improve patient outcomes. Digital pathology (DP), artificial intelligence (AI), and machine learning are among the innovations revolutionizing traditional practices by enabling the digitization of tissue samples, the automation of data analysis, and the incorporation of large datasets into diagnostic processes. Whereas these advancements hold great promise, they have also generated mixed reactions among healthcare professionals, particularly in pathology, where the balance between human expertise and technology is critical. To better understand the perceptions of informatics in pathology, a cross-sectional survey was conducted among healthcare workers within the field. The survey aimed to assess attitudes toward the adoption of informatics, with specific focus on its perceived benefits and challenges. This study seeks to provide insights into how these new technologies are being received by those at the forefront of pathology, exploring both the enthusiasm and apprehension surrounding the growing role of informatics in the discipline. Methodology A cross-sectional survey was conducted to evaluate perceptions of DP among healthcare professionals within the Division of Anatomic Pathology at an university hospital that has implemented DP for multidisciplinary tumor boards and educational activities, as well as full digital sign-out for selected subspecialty services. The survey instrument was developed through a structured review of the published literature on DP adoption and workforce perceptions, supplemented by expert consultation. Survey items were derived from previously published instruments and recurring thematic constructs identified in the DP literature, with iterative refinement to enhance clarity and domain coverage. Items were mapped to predefined domains, including awareness, attitudes toward DP, perceived benefits, implementation barriers, educational impact, and workforce implications. Formal pilot testing and psychometric validation were not performed before survey deployment, representing a methodological limitation. Question design was formed by structured stakeholder input from individuals directly involved in DP implementation and daily operational workflows. These stakeholders included attending pathologists representing subspecialty services utilizing full digital sign-out, pathology residents involved in learning, studying, and slide scanning processes. Stakeholders reviewed draft survey items to assess domain completeness, clarity, workflow relevance, and feasibility. Feedback resulted in refinement of item wording to reduce ambiguity, consolidation of redundant questions, and incorporation of additional items addressing practical implementation considerations such as infrastructure limitations, turnaround time impact, and adequacy of training. Once the survey was approved by all stake holder representatives, the study goals and objectives were submitted for review by Institutional Review Board. The study was approved by the Institutional Review Board. The survey was administered electronically using REDCap (Research Electronic Data Capture), a secure, web-based platform for survey design and data management. The instrument was distributed via institutional email to all members of the pathology department. Three reminder emails were sent at 1-week intervals to maximize participation. Responses were anonymized at the time of collection. Participation was voluntary, and electronic informed consent was obtained before survey initiation. Quantitative data were analyzed using descriptive statistics, and open-ended responses were evaluated using thematic analysis. Results Baseline demographic data A total of 273 healthcare workers were eligible to participate in the survey, with 99 consenting, yielding a response rate of 36.26%. Among the respondents, 30% were male and 64% were female. Participants were fairly and evenly distributed across the age groups of 25–34, 35–44, and 45–54, with a smaller number ages 55–64 and over 65. Regarding educational background, the majority of respondents held either a master's or doctoral degree. Of the 99 respondents, 41 were physicians, including 22 attending physicians and 19 residents, whereas the remaining 58 were histology and lab technicians and administrative staff. In terms of experience, 40% of the respondents reported having 11–15 years of experience, whereas 20% had 1–2 years of experience, with the rest in between. Assessing respondents' familiarity and adaptability to digital pathology When asked about their familiarity with DP, 96% of respondents identified key components such as “slide scanning,” “image viewing and analysis,” “computer-aided analysis,” and “image storage and management.” Additionally, 92% reported having used DP in some capacity and noted that they had developed new skills to adapt to these advancements, emphasizing that DP represents a lasting innovation in the field, rather than a temporary trend. Moreover, 60% expressed a willingness to pursue further training to enhance their proficiency in DP. However, 92% of respondents acknowledged that cost, infrastructure requirements, regulatory and compliance issues, workflow integration, interoperability, and workforce training remain significant barriers to the widespread adoption of DP in healthcare institutions. Assessing future impact of digital pathology on job market One of the survey questions addressed the potential for job displacement among pathologists due to the introduction of DP. Respondents were given five options: “Very likely,” “Likely,” “Neutral,” “Unlikely,” and “Very unlikely,” and were asked to explain their selections. The results are summarized in Fig. 1 . Fig. 1. Open in a new tab Assessing future impact of digital pathology on job market. Comments associated with these responses are summarized in Fig. 2 . Fig. 2. Open in a new tab Comments regarding future impact of digital pathology on job market. The age of the respondent impacted their response to this question as shown in Fig. 3 . Fig. 3. Open in a new tab Age distribution of respondents to “Will digital pathology replace jobs?” Key observations: • The Neutral category has the highest number of responses across most age groups, especially among the 45–54 age group. • The Unlikely response is most prevalent among the 25–34 and 35–44 age groups, indicating skepticism about job displacement. • The Very likely and Very unlikely categories received minimal responses across all age groups, suggesting that extreme opinions on the matter are uncommon. • The Likely category is most pronounced in the 45–54 age group, indicating some concern about potential job displacement among middle-aged professionals. Assessing future impact of digital pathology on accuracy When asked about their views on whether DP can improve diagnostic accuracy compared to traditional microscopy, 74% of respondents agreed that it would enhance accuracy to some extent, whereas 22% believed there would be no change, and 4% were unsure. Additionally, 72% of respondents expressed the belief that DP would foster collaboration among experts, improve efficiency and accuracy, enhance patient care, facilitate resident training, and serve as a valuable tool for pathologists ( Fig. 4 ). Fig. 4. Open in a new tab Comments about “Will digital pathology improve accuracy?” Assessing preferences for glass slides vs digital slides Respondents were asked to indicate their preferences between glass slides and digital slides for various purposes, including frozen sections, previewing, sign-out with attending physicians, independent case reviews, unknown teaching sessions, exam preparation, personal slide collections, research projects, and tumor board discussions. The responses differed between Residents and Attending Pathologists/Fellows. Key observations on responses from Residents: Slide modality was significantly associated with activity domain (χ 2 (8) = 51.24, p < 0.001). The effect size was large (Cramér's V = 0.55), indicating substantial differences in utilization patterns between glass and digital slides. Glass slides were more frequently used for frozen section interpretation and traditional sign-out activities, whereas digital slides were more commonly used for educational activities, including teaching sessions, examination preparation, personal slide collection, and research-related functions. These findings suggest that, within resident workflows, DP is preferentially integrated into educational and academic contexts, whereas glass slides remain more prominent in direct clinical applications. Key observations in responses from Attendings/Fellows: Slide modality was significantly associated with activity domain (χ 2 (8) = 66.55, p < 0.001). The magnitude of this association was large (Cramér's V = 0.58), indicating substantial differences in utilization patterns between glass and digital slides. Glass slides were more frequently used across traditional clinical and academic activities, including frozen section interpretation, sign-out, independent case review, and research-related functions. In contrast, digital slides demonstrated a distinct distribution pattern, with comparatively higher representation in selected educational and conference-based contexts. When attendings and residents were analyzed together, significant differences in modality-specific activity distribution were observed (χ 2 (24) = 117.80, p < 0.001). The magnitude of association was moderate (Cramér's V = 0.33), indicating that workflow integration of digital and glass slides varies by professional role. Whereas both groups demonstrated modality-dependent usage patterns, residents showed greater integration of digital slides within educational and academic activities, whereas attendings demonstrated stronger reliance on glass slides for clinical tasks. These findings suggest that DP adoption is role-sensitive and differentially embedded within trainee and faculty workflows. Discussion Our study findings These survey results highlight important insights regarding the implementation and impact of DP in healthcare settings. Of the 273 healthcare workers eligible to participate, 99 consented, yielding a response rate of 36.26%. The respondents demonstrated a high level of familiarity with DP, with 96% identifying key components such as slide scanning, image viewing, computer-aided analysis, and image storage. Furthermore, 92% reported using DP tools and emphasized the development of new skills to adapt to these advancements, suggesting that DP is viewed as a lasting innovation rather than a fleeting trend. However, despite the enthusiasm, 92% acknowledged significant barriers to widespread adoption, including cost, infrastructure needs, and regulatory challenges. In terms of the impact on jobs, the responses varied by age group. Whereas some concern was noted about job displacement, particularly among middle-aged professionals (45–54 years old), most respondents maintained a neutral stance, indicating that DP might create new opportunities while potentially displacing certain tasks. For example, in traditional workflows, histotechnologists spend time physically retrieving slides, organizing trays for sign-out, and transporting materials between labs and pathologists. In a fully digital environment, these tasks may decrease as cases are scanned and made instantly accessible. However, new responsibilities emerge, including slide scanning operations, image quality control, troubleshooting scanner artifacts, managing large image datasets, and coordinating digital case routing. This shifts technical work from manual handling toward informatics-integrated lab operations. A notable 74% of respondents agreed that DP would improve diagnostic accuracy, and 72% believed it would foster collaboration and enhance patient care. Interestingly, preferences for digital slides were strongest in certain contexts such as tumor boards and research projects, though traditional glass slides remain dominant in frozen section use. These findings suggest that whereas DP is expected to augment efficiency and collaboration in healthcare, it is unlikely to fully replace the role of pathologists. Instead, it may lead to a shift in job functions, with pathologists still essential for complex case interpretation and oversight. Literature search: Pros The adoption of whole-slide imaging (WSI) in pathology has sparked both excitement and hesitation. Supporters view WSI as the next logical step in digital transformation, highlighting its strong agreement with traditional light microscopy (LM) and its many advantages for workflow efficiency, education, and remote consultation. 1 , 17 Pathology has long relied on LM for diagnosis, teaching, and research, but over the past two decades, DP has become a major innovation. WSI allows entire glass slides to be scanned into high-resolution digital images that can be viewed, shared, and analyzed on a computer. As this technology becomes more common, it is important to understand both the strengths and limitations of WSI compared with LM, especially in terms of diagnostic accuracy, workflow integration, subspecialty use, and practical challenges. Several systematic reviews and validation studies have shown high diagnostic concordance between WSI and LM. A 2015 systematic review of 38 studies reported an average concordance rate of about 92% showing substantial agreement. 1 Another review of 13 studies (over 2000 cases) found excellent intraobserver agreement with WSI (87–98%), noting that most discrepancies involved borderline or inherently difficult cases rather than true WSI errors. 2 Subspecialty studies also support these findings. In breast pathology, WSI demonstrated strong agreement with LM in needle biopsy diagnoses. 3 Similar reliability has been reported in gastrointestinal, genitourinary, and cervical pathology. 4 , 5 In dermatopathology, a large study of 499 cases found WSI to be non-inferior to LM, with about 94% concordance, although complex lesions occasionally showed disagreement. 6 Pathologist consistency matters as much as slide quality. A better approach would be to validate that the WSI exactly matches the original glass slide. Cytopathology poses unique challenges. A systematic review of 19 studies reported an overall concordance of ∼84% between WSI and LM, with high intraobserver agreement (92.5%). However, diagnostic times were longer and confidence levels slightly lower when using WSI. 7 A 2025 AJCP study of a WSI system reported non-inferiority to manual microscopy for primary diagnosis with similar mean read times (2.33 vs 2.34 min) and no modality-specific causes for major disagreements in several organ system. 20 The same AJCP study found higher disagreements were linked to contextual factors (e.g., adjudicating long reference diagnoses vs shorter reader diagnoses; pandemic-related constraints) and that direct DR/MR adjudication reduced disagreement estimates. This enforces that belief that “discordance” is often about borderline entities and comparison method, not inherent WSI failure. Beyond diagnostic accuracy, studies have highlighted the broader benefits of DP. Digital systems can enhance collaboration, transparency, and knowledge sharing among colleagues, with the validation process itself encouraging richer discussions and collective learning. 14 In medical education, digital archives provide access to rare and delicate specimens, including small biopsies not typically used in traditional teaching sets. These online modules increase student engagement and expand case exposure. 14 , 18 Cost savings are another advantage, with reduced dependence on glass slides, fewer microscope purchases, and lower maintenance costs, as well as improved turnaround times and fewer error-related investigations. 14 , 18 From a research standpoint, digital systems reduce the need to rebuild old cohorts and minimize risks of slide loss or damage, while also creating essential infrastructure for AI development. 14 Many also believe that DP can attract new trainees, especially those interested in technology and algorithm design—fostering innovation and teamwork within the field. 14 Clinically, digital systems can improve multidisciplinary team meetings by allowing slides to be displayed more efficiently, enhancing communication, and supporting discussion of complex findings such as surgical margins. 14 Giving patients access to their own images may promote patient-centered care and strengthen communication between patients and pathologists. 14 Many also believe that sample distribution became faster and less error-prone, whereas digital archives allowed quick, frequent slide access without physical retrieval—benefiting both consultants and administrative staff. 16 , 19 Using WSI in multidisciplinary case conferences enhances communication among patient care team members. Quality control was strengthened through standardized slide preparation and scanning, setting new benchmarks for assurance. 16 Image sharing enabled seamless collaboration across institutions and during absences, whereas education and supervision improved as multiple users could review cases together and discuss features in real time. 16 , 19 For pathologists, digital workflows supported simultaneous sample review, offered calibrated measurement tools, and reduced the risk of overlooking key tissue regions. Remote access enhanced flexibility, allowing continued case review from home and better work–life balance. Finally, ergonomics improved, with less physical strain and greater comfort compared to traditional microscopy. 16 , 19 Literature search: Cons Critics have pointed out several ongoing challenges with DP, such as slower turnaround times, reduced diagnostic confidence, and the lack of large, high-quality validation studies. 1 , 21 WSI allows the creation of high-resolution digital images of pathology slides, offering excellent detail and color accuracy in the X–Y plane. This makes it highly valuable for education, research, and drug development. However, unlike conventional microscopy, WSI struggles with focusing through different tissue layers—which is essential for assessing mitotic figures, microorganisms, nuclear chromatin, and three-dimensional cellular structures, especially in cytology. Without this feature, the accuracy of detecting mitotic figures drops to about 80–85% compared to standard microscopy. 21 Interestingly, other studies show that having the ability to focus through different tissue layer does not always improve diagnostic accuracy. For example, in melanocytic lesions, it offers no significant benefit for identifying dermal mitoses or refining lesion classification. 8 Similarly, in cytology, focusing through different tissue layer adds little diagnostic value in urine ThinPrep WSI, and the longer scan times and higher storage demands outweigh its limited advantages. 9 Current evidence suggests that WSI can be around 60% slower than traditional LM for some diagnostic individuals and some task. 1 Although automated biomarker scoring (for ER, PR, HER2, Ki-67, etc.) has shown clear benefits, these represent only a small portion of everyday pathology practice. 1 Moving to a fully digital workflow also requires major investment in scanners, data storage systems, IT support, and long-term maintenance and cybersecurity. 1 These costs remain major barriers to widespread adoption. Still, multiple studies have shown that WSI achieves diagnostic performance comparable to LM, while also improving workflow efficiency, education and training opportunities, remote collaboration, and expanding use across subspecialties. 10 , 19 With careful attention to infrastructure and planning, these advantages can help balance the financial and technical challenges of digital implementation. 11 , 19 In addition, qualitative studies have identified several barriers that could limit successful adoption. Standardization issues—such as differences in staining protocols, reporting practices, and equipment—create concerns about consistency across institutions. 14 The question of validation also divides opinions: some pathologists favor self-validation for its flexibility, whereas others prefer external assessment for transparency, though this can be stressful. Many participants emphasized the need for a supportive, system-wide culture that avoids individual blame. Another concern is fragmented adoption, as many programs remain pilot-based with little national oversight, prompting calls for coordinated strategies to ensure cost-effectiveness and uniformity. 14 Practical worries about storage and backup persist, especially the continued need for glass slides in case of digital archive failure. Many expect hybrid models—using both digital and glass slides—for difficult cases. Training inequality is another challenge, as uneven implementation can limit trainee exposure, underscoring the need for a standardized digital curriculum. Technical and logistical uncertainties—such as platform selection, storage duration, archive management, and funding—remain ongoing challenges. Participants also stressed the importance of formal cost-effectiveness assessments and structured project management. 14 There are major concerns about privacy, patient consent, and data sharing, with broad agreement that national guidance is urgently needed, whereas local institutions conduct interim risk assessments. 14 Our vision Institutional context plays a considerable role in determining the impact of the transition on an organization. The role of training, the clarity of the implementation plan, and the level of involvement of organizational leaders all influence the impact of organizational change. The impact can be constructive for an organization that designs a training module, allocates time for training, and includes operational staff in the redesign of workflows. Conversely, sudden disruptions without support structures may result in increased frustration, particularly for those whose professional training and experience are rooted in systems that do not include the use of digital technologies. From this perspective, DP should not be understood in a binary context of replacement vs retention. It is more constructive to view DP as an opportunity to redistribute work and to create hybrid roles that combine diagnostic work and DP. In such roles, practitioners may be expected to integrate their morphological analyses with a range of different data, including explanatory digital metadata and structural and performance outcomes. The sector will use its digital systems not simply for the sake of using technology but in a sophisticated manner that is far more efficient and effective, even if the headcount remains unchanged. The impact on the workforce from longitudinal studies remains to be seen. Existing research indicates that the evolution of tasks rather than eliminating roles is a more likely outcome. Professional roles and attitudes toward digital pathology Practicing pathologists A review of multiple surveys and qualitative studies shows that practicing pathologists generally hold a positive outlook toward DP and AI. In a survey of UK liver pathologists, most respondents supported the use of DP for primary diagnosis (83%), second opinions (90%), research (85%), and education (95%), 12 reflecting strong confidence in the clinical value of digital workflows. Subspecialists also identified key areas where AI could be most beneficial, particularly in fatty liver disease (80%) and neoplastic liver disease (59%). 12 Despite this optimism, notable concerns persist. Pathologists frequently cite medicolegal uncertainty and the potential for algorithmic error as major barriers to trust. 13 About a quarter (26%) worry that dependence on AI could diminish clinical expertise, whereas a smaller portion (21%) believe it may instead enhance diagnostic skills. 13 A significant majority (73%) express unease with AI development occurring without meaningful pathologist involvement. 12 Qualitative findings echo these sentiments: pathologists appreciate DP for facilitating rapid consultations, subspecialty reviews, and remote collaboration, yet emphasize the ongoing need for rigorous validation, standardization, and training to ensure diagnostic performance equivalent to traditional microscopy. 12 Practical barriers also remain—63% of respondents in the UK National Health System 12 noted challenges integrating AI with existing digital infrastructure. Importantly, fears of job displacement appear minimal, as 63% explicitly disagreed with the idea that AI would render pathologists obsolete. 12 Pathology trainees Trainees represent the future pathology workforce and will inherit a predominantly digital practice environment. Their exposure to and attitudes toward DP are therefore highly consequential. A multicenter US study of residents and fellows demonstrated increasing exposure to WSI during medical school—75% of those entering residency in 2017–2018 reported prior training, compared with 54% of earlier cohorts. 15 Trainees expressed strong confidence in WSI, with 92% agreeing that accurate diagnoses can be achieved digitally and 93% recognizing its value for obtaining second opinions. 15 Notably, those with previous WSI experience reported greater comfort using digital tools (29% vs 12%), emphasizing the importance of integrating DP into training curricula. Furthermore, 64% of respondents anticipated that WSI would become a routine tool for primary diagnosis within the next 5 years. 15 Administrative staff In a qualitative Danish study, biomedical laboratory scientists (BLS) reported that DP implementation substantially increased their workload and stress, particularly in managing scanners, performing digital quality control, and adapting to new distribution processes. 16 Many felt underprepared for these changes and emphasized the need for clearer communication, more structured training, and additional resources during the rollout phase. 16 Despite these difficulties, BLS acknowledged that digital workflows enhanced collaboration and communication across departments, reflecting a mixed yet pragmatic outlook on DP adoption. 16 In the UK, focus group participants similarly identified key barriers such as lack of standardization, challenges in validation, limited storage capacity, financial constraints, and data privacy concerns—issues underscoring the essential technical role of lab scientists in maintaining digital infrastructure. 14 From a managerial perspective, DP was largely viewed as a forwardlooking innovation that could modernize pathology departments. Leaders highlighted early gains in collaboration and efficiency as vital for encouraging staff engagement and acceptance. 16 However, they also stressed the importance of transparent communication about potential obstacles, sufficient resource allocation, and tailored system-specific training before implementation. 16 Although administrative staff were less frequently represented in the literature, they reported temporary workflow disruptions during the transition but acknowledged the modernization of departmental practices as a meaningful long-term benefit. 16 Limitations of our study First, this study was conducted at a single academic institution that has already implemented DP in tumor boards, teaching, and selected services for full digital sign-out. Institutions that invest in DP often have strong leadership support, adequate infrastructure, and a culture receptive to innovation. This environment may not reflect the realities of smaller hospitals or centers that lack comparable resources. Therefore, the findings may represent perceptions in a relatively supportive setting or may act as a roadmap for institutions that strive to implement DP rather than the broader pathology community. Second, selection bias is a meaningful concern. Although all eligible department members were invited to participate, the response rate was approximately 36%. Whereas common for physician surveys, this response rate leaves uncertainty about the views of the remaining two-thirds of eligible participants if non-respondents systematically differ. In survey research, particularly in studies examining new technologies, those who choose to respond are often individuals who are more engaged, more familiar with the system, or who hold stronger opinions. It is plausible that early adopters of DP were overrepresented among respondents. Early adopters typically have higher comfort with technology, greater exposure to digital workflows, and more positive experiences. As a result, reported levels of familiarity, enthusiasm, and perceived benefit may be inflated compared to the full departmental population. This may be true particularly because one of the investigators has a long history of interest in DP and has had industry ties in the field; we attempted to reduce this bias by positioning the study as the work of a Resident with no commercial ties, but there may still have been some influence from these factors. Conversely, individuals who are less comfortable with digital systems or who experience workflow challenges may have been less likely to participate, potentially leading to underrepresentation of critical perspectives. Third, the survey instrument itself presents limitations. Because formal psychometric validation and pilot testing were not performed, there may be variability in how respondents interpreted certain questions. Broad statements such as “DP improves diagnostic accuracy” may be understood differently by different respondents; some may interpret this as improved visualization, others as easier consultation, and others as reduced error rates. Without formal validation, measurement error and construct ambiguity remain possible. Fourth, the term “Digital pathology” was intentionally defined broadly to reflect how the term is operationalized within the institution, where WSI, digital case management, and emerging AI applications are discussed within a unified strategic framework. Combining these elements into a single construct may obscure meaningful distinctions. For example, staff may express high confidence in WSI for routine sign-out while holding greater reservations about AI-assisted quantification or algorithmic decision support. Perceived risks related to job displacement, diagnostic autonomy, or validation rigor may also differ depending on whether respondents are considering slide digitization versus autonomous analytical tools. Taken together, these limitations suggest that the findings should be interpreted as context-specific and hypothesis-generating. Whereas the study provides valuable insight into perceptions within a digitally progressive academic environment, caution is warranted in extrapolating results to pathology workforce as a whole. Perceptions and attitudes toward DP are also likely to evolve over time as exposure and experience increase; therefore, a follow-up or repeated survey would be valuable to assess how these views change with ongoing implementation and technological advancement. Conclusion DP represents a major transformation in diagnostic practice, offering significant opportunities for improved accuracy, workflow efficiency, and collaboration. However, its adoption remains shaped by diverse perspectives across professional roles, reflecting both enthusiasm and caution. Whereas many view WSI as a promising tool poised to enhance routine diagnostics, others emphasize the need for continued validation, standardization, and technological refinement before full-scale implementation. Recognizing and addressing these varied viewpoints will be essential for developing effective implementation strategies, targeted training programs, and supportive policy frameworks that ensure the sustainable and equitable integration of DP into everyday practice. Declaration of competing interest Sylvia L. Asa, M.D., Ph.D. serves on the Medical Advisory Boards of Leica Biosystems and Boehringer-Ingelheim. The remaining authors declare that there are no conflicts of interest to disclose regarding the publication of this article. References 1. Goacher E., Randell R., Williams B., Treanor D. 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