Purpose: The introduction of whole slide imaging and digital pathology has enabled greater scrutiny of visual search behaviors among pathologists. We aim to investigate zooming and panning behaviors, external markers of visual processing capabilities, and the changes with experience.

Approaches: Twenty digitized breast core needle biopsy histopathology slides were obtained from the circulating slides from the main digital pathology trial (IRAS number: 258799). These were presented to five pathologists with varying experience (1.5 to 40 years) whose examinations were recorded. Data of visual fixations were collected using eye-tracking cameras, and the magnification data and zooming behaviors were extracted in an objective fashion by an automated algorithm. The relationship between experience and metrics was analyzed using mixed-effects regression analyses.

Results: There was a significant association between experience and both reading times (p  <  0.001) and a number of fixations (p  <  0.001), with these relationships being inversely proportional. The greater experience was also associated with greater diagnostic accuracy (p  =  0.033). We found that experience was significantly associated with greater use of magnification changes (p  <  0.001). Conversely, less experience showed a near significant association with the increased proportion of time spent panning (p  =  0.070).

Conclusions: Fewer fixations needed to reach a diagnosis and quicker reading times are indicative of greater cognitive and visual processing capabilities with greater experience. These cognitive capabilities may be a prerequisite for the more frequent zooming changes that are more prevalent with increasing experience.