Digital pathology in forensic science: a systematic review of the literature

Abstract

Background: Digital pathology (DP) and whole-slide imaging (WSI) are increasingly utilized in clinical pathology; however, their role in forensic medicine remains less defined, as evidentiary standards demand robust validation, auditability, and a chain of custody. Methods: We conducted a systematic review of PubMed, Scopus, and Web of Science for studies that applied DP and WSI to forensic, autopsy, or postmortem contexts, with eligibility requiring peer-reviewed human studies that reported methods and outcomes. Data were charted for study design, tissue, devices/software, and outcomes (diagnostic agreement, quantitative metrics, validation/quality assurance (QA)). Results: The search retrieved 361 records; after screening and full-text assessment, 21 studies were selected for inclusion. Fifteen studies primarily advanced diagnostic knowledge using postmortem material (e.g., quantitative neuropathology and organ-specific morphometry), while five had direct forensic aims (casework validation or core forensic tests). Conclusions: The review highlights that DP is technically ready for medico-legal workflows; however, its use remains low compared to other clinical settings. Adoption in forensics should centre on CAP-style, use–case–specific validation, traceable/auditable pipelines (including hashing, logs, and tile-linked overlays), stain/colour governance, and external robustness testing. Under these conditions, DP can deliver reproducible, transparent, and court-defensible evidence across forensic practice.