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Amin S, Mori T, Itoh T. A validation study of whole slide imaging for primary diagnosis of lymphoma. Pathol Int 2019; 69:341-349. [PMID: 31295382 DOI: 10.1111/pin.12808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/21/2019] [Indexed: 11/30/2022]
Abstract
Whole slide imaging (WSI) is being increasingly used worldwide. Although previous studies have asserted the validity of WSI diagnosis, they have primarily targeted only small specimens and excluded cases requiring immunohistochemistry or special staining, such as lymphoma. The purpose of this study was to evaluate the accuracy of WSI diagnosis of lymphoma, for which 240 biopsies and resections of lymphoma cases were selected from the study set of lymphomas. All slides including H&E, immunohistochemical and special staining were digitized using a WSI image scanner. An experienced pathologist performed the WSI diagnoses, which were compared with original diagnoses based on light microscopic examinations. Discrepancy between the two interpretations were classified into three categories: concordance, minor discrepancy (no clinical significance), and major discrepancy (with clinical significance). Overall concordance between the light microscopic and WSI diagnosis was found in 223 cases (92.92%; 95%CI = 88.90-95.82), minor discrepancy in fifteen (6.25%; 95%CI = 3.54-10.10), and major discrepancy in two (0.83%; 95%CI = 0.10-2.98). Diagnosis of lymphoma using WSI appeared to be mostly accurate, suggesting that WSI may be a reliable technology for the diagnosis of lymphoma.
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Affiliation(s)
- Saiful Amin
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
| | - Taro Mori
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
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52
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Schaer R, Otálora S, Jimenez-Del-Toro O, Atzori M, Müller H. Deep Learning-Based Retrieval System for Gigapixel Histopathology Cases and the Open Access Literature. J Pathol Inform 2019; 10:19. [PMID: 31367471 PMCID: PMC6639847 DOI: 10.4103/jpi.jpi_88_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/17/2019] [Indexed: 11/08/2022] Open
Abstract
Background: The introduction of digital pathology into clinical practice has led to the development of clinical workflows with digital images, in connection with pathology reports. Still, most of the current work is time-consuming manual analysis of image areas at different scales. Links with data in the biomedical literature are rare, and a need for search based on visual similarity within whole slide images (WSIs) exists. Objectives: The main objective of the work presented is to integrate content-based visual retrieval with a WSI viewer in a prototype. Another objective is to connect cases analyzed in the viewer with cases or images from the biomedical literature, including the search through visual similarity and text. Methods: An innovative retrieval system for digital pathology is integrated with a WSI viewer, allowing to define regions of interest (ROIs) in images as queries for finding visually similar areas in the same or other images and to zoom in/out to find structures at varying magnification levels. The algorithms are based on a multimodal approach, exploiting both text information and content-based image features. Results: The retrieval system allows viewing WSIs and searching for regions that are visually similar to manually defined ROIs in various data sources (proprietary and public datasets, e.g., scientific literature). The system was tested by pathologists, highlighting its capabilities and suggesting ways to improve it and make it more usable in clinical practice. Conclusions: The developed system can enhance the practice of pathologists by enabling them to use their experience and knowledge to control artificial intelligence tools for navigating repositories of images for clinical decision support and teaching, where the comparison with visually similar cases can help to avoid misinterpretations. The system is available as open source, allowing the scientific community to test, ideate and develop similar systems for research and clinical practice.
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Affiliation(s)
- Roger Schaer
- Institute of Information Systems, HES-SO (University of Applied Sciences of Western Switzerland), Sierre, Switzerland
| | - Sebastian Otálora
- Institute of Information Systems, HES-SO (University of Applied Sciences of Western Switzerland), Sierre, Switzerland.,Department of Computer Science, University of Geneva (UNIGE), Geneva, Switzerland
| | - Oscar Jimenez-Del-Toro
- Institute of Information Systems, HES-SO (University of Applied Sciences of Western Switzerland), Sierre, Switzerland.,Department of Computer Science, University of Geneva (UNIGE), Geneva, Switzerland
| | - Manfredo Atzori
- Institute of Information Systems, HES-SO (University of Applied Sciences of Western Switzerland), Sierre, Switzerland
| | - Henning Müller
- Institute of Information Systems, HES-SO (University of Applied Sciences of Western Switzerland), Sierre, Switzerland.,Department of Computer Science, University of Geneva (UNIGE), Geneva, Switzerland
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53
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Allan EL, Livermore L, Price BW, Shchedrina O, Smith VS. A Novel Automated Mass Digitisation Workflow for Natural History Microscope Slides. Biodivers Data J 2019; 7:e32342. [PMID: 30863197 PMCID: PMC6408422 DOI: 10.3897/bdj.7.e32342] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/25/2019] [Indexed: 11/12/2022] Open
Abstract
The Natural History Museum, London (NHM) has embarked on an ambitious programme to digitise its collections. One aim of the programme has been to improve the workflows and infrastructure needed to support high-throughput digitisation and create comprehensive digital inventories of large scientific collections. This paper presents the workflow developed to digitise the entire Phthiraptera (parasitic lice) microscope slide collection (70,663 slides). Here we describe a novel process of semi-automated mass digitisation using both temporary and permanent barcode labels applied before and during slide imaging. By using a series of barcodes encoding information associated with each slide (i.e. unique identifier, location in the collection and taxonomic name), we can run a series of automated processes, including file renaming, image processing and bulk import into the NHM's collection management system. We provide data on the comparative efficiency of these processes, illustrating how simple activities, like automated file renaming, reduces image post-processing time, minimises human error and can be applied across multiple collection types.
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Affiliation(s)
- E Louise Allan
- Natural History Museum, London, United KingdomNatural History MuseumLondonUnited Kingdom
| | - Laurence Livermore
- Natural History Museum, London, United KingdomNatural History MuseumLondonUnited Kingdom
| | - Benjamin W Price
- Natural History Museum, London, United KingdomNatural History MuseumLondonUnited Kingdom
| | - Olha Shchedrina
- Natural History Museum, London, United KingdomNatural History MuseumLondonUnited Kingdom
| | - Vincent S Smith
- Natural History Museum, London, United KingdomNatural History MuseumLondonUnited Kingdom
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54
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Weinstein RS, Holcomb MJ, Krupinski EA. Invention and Early History of Telepathology (1985-2000). J Pathol Inform 2019; 10:1. [PMID: 30783545 PMCID: PMC6369631 DOI: 10.4103/jpi.jpi_71_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/19/2018] [Indexed: 11/11/2022] Open
Abstract
This narrative-based paper provides a first-person account of the early history of telepathology (1985–2000) by the field's inventor, Ronald S. Weinstein, M. D. During the 1980s, Dr. Weinstein, a Massachusetts General Hospital-trained pathologist, was director of the Central Pathology Laboratory (CPL) for the National Cancer Institute-funded National Bladder Cancer Project, located at Rush Medical College in Chicago, IL. The CPL did post therapy revalidations of surgical pathology and cytopathology diagnoses before outcomes of the completed clinical trials were published. The CPL reported that interobserver variability was invalidating inclusion of dozens of treated bladder cancer patients in published reports on treatment outcomes. This problem seemed ripe for a technology-assisted solution. In an effort to solve the interobserver variability problem, Dr. Weinstein devised a novel solution, dynamic-robotic telepathology, that would potentially enable CPL uropathologists to consult on distant uropathology cases in real-time before their assignment to urinary bladder cancer, tumor stage, and grade-specific clinical trials. During the same period, universities were ramping up their support for faculty entrepreneurism and creating in-house technology transfer organizations. Dr. Weinstein recognized telepathology as a potential growth industry. He and his sister, Beth Newburger, were a successful brother–sister entrepreneur team. Their PC-based education software business, OWLCAT™, had just been acquired by Digital Research Inc., a leading software company, located in California. With funding from the COMSAT Corporation, a publically traded satellite communications company, the Weinstein-Newburger team brought the earliest dynamic-robotic telepathology systems to market. Dynamic-robotic telepathology became a dominant telepathology technology in the late 1990s. Dr. Weinstein, a serial entrepreneur, continued to innovate and, with a team of optical scientists at The University of Arizona's College of Optical Sciences, developed the first sub-1-min whole-slide imaging system, the DMetrix DX-40 scanner, in the early 2000s.
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Affiliation(s)
- Ronald S Weinstein
- Department of Pathology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Michael J Holcomb
- Department of Pathology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
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55
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Hon JD, Chen W, Minerowicz C, Thomas S, Barnard N, Gilbert N, Fyfe B. Analysis and Comparison of Tissue-Marking Dye Detection via Light Microscopy, Telemicroscopy, and Virtual Microscopy. Am J Clin Pathol 2019; 151:95-99. [PMID: 30239594 DOI: 10.1093/ajcp/aqy117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To examine the fidelity of ink color identification using light microscopy (LM), telemicroscopy (TM), and virtual microscopy (VM). Methods Twenty H&E-stained frozen section slides, prepared after tissue inking with five stain combinations, were assessed by three pathologists using LM, TM, and VM. TM was performed using Mikroscan D2 slide scanner/LiveQ software with various objectives. VM was performed using Mikroscan D2 scanner/Qumulus software, specimens digitized at20×. Results Sensitivity/specificity by LM was 100%/100% for all colors. TM showed high overall specificity but poor sensitivity, particularly red (54%). VM showed high specificity for all colors except black (69%) and, consequently, poor sensitivity for all colors except black (96%). Conclusions TMD identification via telepathology showed loss of sensitivity/specificity vs LM and highlighted the need for caution when interpreting TMDs with digital technologies and the need for validation protocols.
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Affiliation(s)
- Jane Date Hon
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Wenjin Chen
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | | | - Sumi Thomas
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nicola Barnard
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Billie Fyfe
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Abstract
Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient's electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.
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Affiliation(s)
- S Joseph Sirintrapun
- From Memorial Sloan Kettering Cancer Center, New York, NY; University of Utah, Salt Lake City, UT
| | - Ana Maria Lopez
- From Memorial Sloan Kettering Cancer Center, New York, NY; University of Utah, Salt Lake City, UT
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57
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Herrmann MD, Clunie DA, Fedorov A, Doyle SW, Pieper S, Klepeis V, Le LP, Mutter GL, Milstone DS, Schultz TJ, Kikinis R, Kotecha GK, Hwang DH, Andriole KP, Iafrate AJ, Brink JA, Boland GW, Dreyer KJ, Michalski M, Golden JA, Louis DN, Lennerz JK. Implementing the DICOM Standard for Digital Pathology. J Pathol Inform 2018; 9:37. [PMID: 30533276 PMCID: PMC6236926 DOI: 10.4103/jpi.jpi_42_18] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Digital Imaging and Communications in Medicine (DICOM®) is the standard for the representation, storage, and communication of medical images and related information. A DICOM file format and communication protocol for pathology have been defined; however, adoption by vendors and in the field is pending. Here, we implemented the essential aspects of the standard and assessed its capabilities and limitations in a multisite, multivendor healthcare network. Methods: We selected relevant DICOM attributes, developed a program that extracts pixel data and pixel-related metadata, integrated patient and specimen-related metadata, populated and encoded DICOM attributes, and stored DICOM files. We generated the files using image data from four vendor-specific image file formats and clinical metadata from two departments with different laboratory information systems. We validated the generated DICOM files using recognized DICOM validation tools and measured encoding, storage, and access efficiency for three image compression methods. Finally, we evaluated storing, querying, and retrieving data over the web using existing DICOM archive software. Results: Whole slide image data can be encoded together with relevant patient and specimen-related metadata as DICOM objects. These objects can be accessed efficiently from files or through RESTful web services using existing software implementations. Performance measurements show that the choice of image compression method has a major impact on data access efficiency. For lossy compression, JPEG achieves the fastest compression/decompression rates. For lossless compression, JPEG-LS significantly outperforms JPEG 2000 with respect to data encoding and decoding speed. Conclusion: Implementation of DICOM allows efficient access to image data as well as associated metadata. By leveraging a wealth of existing infrastructure solutions, the use of DICOM facilitates enterprise integration and data exchange for digital pathology.
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Affiliation(s)
| | | | - Andriy Fedorov
- Department of Radiology, Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sean W Doyle
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA
| | | | - Veronica Klepeis
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Long P Le
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - George L Mutter
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - David S Milstone
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Thomas J Schultz
- Enterprise Medical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Ron Kikinis
- Department of Radiology, Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Gopal K Kotecha
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA
| | - David H Hwang
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine P Andriole
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - A John Iafrate
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - James A Brink
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Giles W Boland
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Keith J Dreyer
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mark Michalski
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey A Golden
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - David N Louis
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jochen K Lennerz
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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58
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Cima L, Brunelli M, Parwani A, Girolami I, Ciangherotti A, Riva G, Novelli L, Vanzo F, Sorio A, Cirielli V, Barbareschi M, D'Errico A, Scarpa A, Bovo C, Fraggetta F, Pantanowitz L, Eccher A. Validation of Remote Digital Frozen Sections for Cancer and Transplant Intraoperative Services. J Pathol Inform 2018; 9:34. [PMID: 30450263 PMCID: PMC6187937 DOI: 10.4103/jpi.jpi_52_18] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/31/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction Whole-slide imaging (WSI) technology can be used for primary diagnosis and consultation, including intraoperative (IO) frozen section (FS). We aimed to implement and validate a digital system for the FS evaluation of cancer and transplant specimens following recommendations of the College of American Pathologists. Materials and Methods FS cases were routinely scanned at ×20 employing the "Navigo" scanner system. IO diagnoses using glass versus digital slides after a 3-week washout period were recorded. Intraobserver concordance was evaluated using accuracy rate and kappa statistics. Feasibility of WSI diagnoses was assessed by the way of sensitivity, specificity, as well as positive and negative predictive values. Participants also completed a survey denoting scan time, time spent viewing cases, preference for glass versus WSI, image quality, interface experience, and any problems encountered. Results Of the 125 cases submitted, 121 (436 slides) were successfully scanned including 93 oncological and 28 donor-organ FS biopsies. Four cases were excluded because of failed digitalization due to scanning problems or sample preparation artifacts. Full agreement between glass and digital-slide diagnosis was obtained in 90 of 93 (97%, κ = 0.96) oncology and in 24 of 28 (86%, κ = 0.91) transplant cases. There were two major and one minor discrepancy for cancer cases (sensitivity 100%, specificity 96%) and two major and two minor disagreements for transplant cases (sensitivity 96%, specificity 75%). Average scan and viewing/reporting time were 12 and 3 min for cancer cases, compared to 18 and 5 min for transplant cases. A high diagnostic comfort level among pathologists emerged from the survey. Conclusions These data demonstrate that the "Navigo" digital WSI system can reliably support an IO FS service involving complicated cancer and transplant cases.
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Affiliation(s)
- Luca Cima
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Anil Parwani
- Department of Pathology, Ohio State University, Columbus, OH, USA
| | - Ilaria Girolami
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Andrea Ciangherotti
- Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy
| | - Giulio Riva
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Novelli
- Department of Pathology, Anatomic Pathology Unit, Careggi University Hospital, Firenze, Italy
| | - Francesca Vanzo
- Veneto's Research Center for eHealth Innovation, Veneto, Italy
| | - Alessandro Sorio
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Vito Cirielli
- Department of Diagnostics and Public Health, Forensic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Mattia Barbareschi
- Department of Laboratory Medicine, Anatomic Pathology Unit, S. Chiara Hospital, Trento, Italy
| | - Antonietta D'Errico
- Department of Specialised, Experimental and Diagnostic Medicine, Anatomic Pathology Unit, S. Orsola-Malpighi University Hospital of Bologna, Bologna, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Chiara Bovo
- Medical Direction, University and Hospital Trust of Verona, Verona, Italy
| | - Filippo Fraggetta
- Department of Pathology, Anatomic Pathology Unit, Cannizzaro Hospital, Catania, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, PA, Pennsylvania, USA
| | - Albino Eccher
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
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59
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Weinstein RS. On being a pathologist: a pathway to pathology practice; the added value of supplemental vocational training and mentoring in college and medical school. Hum Pathol 2018; 82:10-19. [PMID: 30267777 DOI: 10.1016/j.humpath.2018.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/17/2018] [Accepted: 08/26/2018] [Indexed: 11/25/2022]
Abstract
Traditionally, vocational training and liberal arts (and premedical) curricula have been separate education tracks. This personal profile describes a program that evolved from the partial fusion of vocational training and a premedical education track. My personal health issue, visual impairment, which presumably resulted as a complication of congenital toxoplasmosis, hampered my ability to read in grammar school and necessitated my placement in remedial reading classes until eighth grade. My father created an independent home-based vocational training program that ran in parallel to my traditional school education all the way through college. In this case study, I provide an overview of this hybrid education program, which we refer to as the Vocational Training/Medical College Curriculum of the Future (VTMC). This term implies that the education of a student from K-12 school through medical college is a continuum. I find it useful to conceptualize a single education continuum beginning with vocational training and ending with medical education, with a large overlap area in the middle. In this paper, I describe a set of my work experiences that leveraged and reinforced my didactic education experiences. Mentors who supported aspects of the VTMC program have included a college president, a US Congressman, a Nobel Laureate, and a Massachusetts General Hospital leader in academic pathology. Elements of this innovative VTMC program have been used in K-12 public schools and in nonmedical graduate school programs.
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Affiliation(s)
- Ronald S Weinstein
- Department of Pathology College of Medicine, The University of Arizona, Tucson, AZ 85724.
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60
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Ayad E, Soliman A, Anis SE, Salem AB, Hu P, Dong Y. Ki 67 assessment in breast cancer in an Egyptian population: a comparative study between manual assessment on optical microscopy and digital quantitative assessment. Diagn Pathol 2018; 13:63. [PMID: 30153851 PMCID: PMC6114705 DOI: 10.1186/s13000-018-0735-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 08/12/2018] [Indexed: 12/18/2022] Open
Abstract
Background Breast cancer is by far the most frequent cancer among women. The proliferative index, Ki-67, is more and more taken into consideration for treatment decisions. However, the reliability of the established Ki-67 scoring is limited. Digital pathology is currently suggested to be a potential solution to Ki 67 assessment problems. Methods This is a retrospective and prospective study including 100 patients diagnosed with invasive breast cancer. Three senior pathologists have been asked to estimate the Ki-67 proliferative index for each of the 100 cases by examining the whole glass slides on optical microscope and providing a continuous score then a categorical score (‘high’ and ‘low’ Ki 67 index) using once 14%, once 20% as threshold indicative of high Ki67 status. Finally, a digital quantitative assessment of Ki67 was performed. Results A high inter-observer agreement was found when using optical microscopy for Ki 67 assessment, with correlation coefficient (CC) estimated at 0.878 (p value < 0.01). The overall agreement between manual and automated evaluation of Ki 67 was only substantial (CC estimated at 0.745 (p value < 0.01)). When using categorical scores, the inter-observers concordance was substantial using both cutoff points with kappa value estimated at 0.796 ([0.696–0.925] while using 14% as a cut off point and at 0.766 ([0.672–0.938] while using 20% as a cutoff point (p value < 0). The inter-observers agreement was better while using 14% as cutoff point. Agreement between manual and automated assessment of Ki 67 indices using both cutoff points was only substantial (Kappa estimated at 0.623, p value < 0.01). In comparison to automated assessment of Ki 67 index, while using 14% as a cutoff point, the overall tendency of all observers was to overestimate the Ki 67 values but to underestimate the proliferation index while using 20% as a cutoff point. Conclusion Automated assessment of Ki 67 value would appear to be comparable to visual Ki 67 assessment on optical microscopy. Such study would help define the role of digital pathology as a potential easy-to use tool for a robust and standardized fully automated Ki 67 scoring.
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Affiliation(s)
- Essam Ayad
- Department of Pathology, Cairo University, Cairo, Egypt.
| | - Ahmed Soliman
- Department of Pathology, Cairo University, Cairo, Egypt
| | | | | | - Pengchao Hu
- Department of Oncology, XiangYang No.1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
| | - Youhong Dong
- Department of Oncology, XiangYang No.1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
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61
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Williams V, Kovarik C. Long-Range Diagnosis of and Support for Skin Conditions in Field Settings. Trop Med Infect Dis 2018; 3:E84. [PMID: 30274480 PMCID: PMC6160944 DOI: 10.3390/tropicalmed3030084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022] Open
Abstract
Skin diseases are a significant cause of morbidity and mortality worldwide; however, access to dermatology services are critically limited, particularly in low- to middle-income countries (LMIC), where there is an overall shortage of physicians. Implementation of long-range technological support tools has been growing in an effort to provide quality dermatology care to even the most remote settings globally. eHealth strategies can provide realistic healthcare solutions if implemented in a feasible and sensitive way, customizing tools to address the unique needs and resource limitations of the local setting. This article summarizes the various types of telemedicine and mobile health (mHealth) tools and their practical applications and benefits for patient care. The challenges and barriers of teledermatology are discussed, as well as steps to consider when implementing a new teledermatology initiative. eHealth arguably offers one of the most flexible and realistic tools for providing critically needed access to dermatology skills in underserved LMICs.
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Affiliation(s)
- Victoria Williams
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Carrie Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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62
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Abstract
Histopathology plays a central role in diagnosis of many diseases including solid cancers. Efforts are underway to transform this subjective art to an objective and quantitative science. Coherent Raman imaging (CRI), a label-free imaging modality with sub-cellular spatial resolution and molecule-specific contrast possesses characteristics which could support the qualitative-to-quantitative transition of histopathology. In this work we briefly survey major themes related to modernization of histopathology, review applications of CRI to histopathology and, finally, discuss potential roles for CRI in the transformation of histopathology that is already underway.
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63
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Gopalan V, Kasem K, Pillai S, Olveda D, Ariana A, Leung M, Lam AKY. Evaluation of multidisciplinary strategies and traditional approaches in teaching pathology in medical students. Pathol Int 2018; 68:459-466. [PMID: 30043440 DOI: 10.1111/pin.12706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/22/2018] [Indexed: 11/28/2022]
Abstract
This study aims to evaluate the impact on the implementation of multiple strategies to improve medical student's pathology learning experience. In two consecutive years, medical students after a whole year of enrolling in pathology teaching, were invited to complete questionnaires rating and commenting on the personal learning experience of multiple teaching resources delivered in pathology. In both years, the overall score was high (mean score = 4.57 ± 0.63 /5) for the newly introduced sessions, namely histology lectures, clinical integrations and virtual microscopy pre-practical sessions. However, this was only marginally different from that of traditional practical (mean = 4.37 ± 0.68/5) and pathology lecture sessions (mean = 4.42 ± 0.61 /5). In addition, 53% positive correlation was noted for the overall responses between virtual microscopy guided pathology modules and practical sessions indicating the benefit of virtual microscopy in better preparing students for these sessions (P < 0.001). Qualitative comments suggested that the virtual microscopy sessions along with clinical scenario based learning were extremely useful for students' learning in pathology. To conclude, a multidisciplinary approach by clinical integration and flexibility in the mode of delivery by the use of virtual microscopy has the potential to better engage students to the learning of pathology.
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Affiliation(s)
- Vinod Gopalan
- Pathology, School of Medicine, Griffith University, Gold Coast
| | - Kais Kasem
- Pathology, School of Medicine, Griffith University, Gold Coast
- Faculty of Medicine, School of Biomedical Science, University of Queensland, Queensland
| | - Suja Pillai
- Pathology, School of Medicine, Griffith University, Gold Coast
- Faculty of Medicine, School of Biomedical Science, University of Queensland, Queensland
| | - David Olveda
- Pathology, School of Medicine, Griffith University, Gold Coast
| | - Armin Ariana
- Pathology, School of Medicine, Griffith University, Gold Coast
| | - Melissa Leung
- Pathology, School of Medicine, Griffith University, Gold Coast
| | - Alfred K Y Lam
- Pathology, School of Medicine, Griffith University, Gold Coast
- Pathology Queensland, Gold Coast University Hospital, Gold Coast, Australia
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64
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Pichat J, Iglesias JE, Yousry T, Ourselin S, Modat M. A Survey of Methods for 3D Histology Reconstruction. Med Image Anal 2018; 46:73-105. [DOI: 10.1016/j.media.2018.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/02/2018] [Accepted: 02/14/2018] [Indexed: 02/08/2023]
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65
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Decker P, Christian A, Xylander WER. VIRMISCO - The Virtual Microscope Slide Collection. Zookeys 2018:271-282. [PMID: 29706780 PMCID: PMC5904399 DOI: 10.3897/zookeys.741.22284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/08/2018] [Indexed: 11/22/2022] Open
Abstract
Digitisation allows scientists rapid access to research objects. For transparent to semi-transparent three-dimensional microscopic objects, such as microinvertebrates or small body parts of organisms, available databases are scarce. Most mounting media used for permanent microscope slides deteriorate after some years or decades, eventually leading to total damage and loss of the object. However, restoration is labour-intensive, and often the composition of the mounting media is not known. A digital preservation of important material, especially types, is important and an urgent need. The Virtual Microscope Slide Collection – VIRMISCO project has developed recommendations for taking microscopic image stacks of three-dimensional objects, depositing and presenting such series of digital image files or z-stacks as an online platform. The core of VIRMISCO is an online viewer, which enables the user to virtually focus through an object online as if using a real microscope. Additionally, VIRMISCO offers features such as search, rotating, zooming, measuring, changing brightness or contrast, taking snapshots, leaving feedback as well as downloading complete z-stacks as jpeg files or video file. The open source system can be installed by any institution and can be linked to common database or images can be sent to the Senckenberg Museum of Natural History Görlitz. The benefits of VIRMISCO are the preservation of important or fragile material, to avoid loan, to act as a digital archive for image files and to allow determination by experts from the distance, as well as providing reference libraries for taxonomic research or education and providing image series as online supplementary material for publications or digital vouchers of specimens of molecular investigations are relevant applications for VIRMISCO.
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Affiliation(s)
- Peter Decker
- Senckenberg Museum of Natural History Görlitz, Görlitz, Germany
| | - Axel Christian
- Senckenberg Museum of Natural History Görlitz, Görlitz, Germany
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66
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Koury H, Leonard CJ, Carry PM, Lee LM. Monkey‐see, Monkey‐do: An Eye‐tracking Study Assessing the Efficacy of Feed‐forward Training in Histology Visual Literacy Development. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.635.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hannah Koury
- Modern Human AnatomyUniversity of Colorado Anschutz Medical CampusAuroraCO
| | | | | | - Lisa M.J. Lee
- Cell and Developmental BiologyUniversity of Colorado Anschutz Medical CampusAuroraCO
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67
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Gibson B, Bracamonte E, Krupinski EA, Briehl MM, Barker GP, Weinstein JB, Weinstein RS. A "Pathology Explanation Clinic (PEC)" for Patient-Centered Laboratory Medicine Test Results. Acad Pathol 2018; 5:2374289518756306. [PMID: 29582001 PMCID: PMC5862367 DOI: 10.1177/2374289518756306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/15/2017] [Accepted: 01/04/2018] [Indexed: 11/15/2022] Open
Abstract
This concept paper addresses communication issues arising between physicians and their patients. To facilitate the communication of essential diagnostic pathology information to patients, and address their questions and concerns, we propose that "Pathology Explanation Clinics" be created. The Pathology Explanation Clinics would provide a channel for direct communications between pathologists and patients. Pathologists would receive special training as "Certified Pathologist Navigators" in preparation for this role. The goal of Pathology Explanation Clinics would be to help fill gaps in communication of information contained in laboratory reports to patients, further explain its relevance, and improve patient understanding of the meaning of such information and its impact on their health and health-care choices. Effort would be made to ensure that Certified Pathologist Navigators work within the overall coordination of care by the health-care team.
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Affiliation(s)
- Blake Gibson
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Erika Bracamonte
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Elizabeth A Krupinski
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Margaret M Briehl
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Gail P Barker
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA.,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Ronald S Weinstein
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA.,Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA.,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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68
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A modular, open-source, slide-scanning microscope for diagnostic applications in resource-constrained settings. PLoS One 2018; 13:e0194063. [PMID: 29543835 PMCID: PMC5854341 DOI: 10.1371/journal.pone.0194063] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/24/2018] [Indexed: 12/20/2022] Open
Abstract
In this paper we report the development of a cost-effective, modular, open source, and fully automated slide-scanning microscope, composed entirely of easily available off-the-shelf parts, and capable of bright field and fluorescence modes. The automated X-Y stage is composed of two low-cost micrometer stages coupled to stepper motors operated in open-loop mode. The microscope is composed of a low-cost CMOS sensor and low-cost board lenses placed in a 4f configuration. The system has approximately 1 micron resolution, limited by the f/# of available board lenses. The microscope is compact, measuring just 25×25×30 cm, and has an absolute positioning accuracy of ±1 μm in the X and Y directions. A Z-stage enables autofocusing and imaging over large fields of view even on non-planar samples, and custom software enables automatic determination of sample boundaries and image mosaicking. We demonstrate the utility of our device through imaging of fluorescent- and transmission-dye stained blood and fecal smears containing human and animal parasites, as well as several prepared tissue samples. These results demonstrate image quality comparable to high-end commercial microscopes at a cost of less than US$400 for a bright-field system, with an extra US$100 needed for the fluorescence module.
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69
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Saliani A, Perraud B, Duval T, Stikov N, Rossignol S, Cohen-Adad J. Axon and Myelin Morphology in Animal and Human Spinal Cord. Front Neuroanat 2017; 11:129. [PMID: 29311857 PMCID: PMC5743665 DOI: 10.3389/fnana.2017.00129] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/13/2017] [Indexed: 12/11/2022] Open
Abstract
Characterizing precisely the microstructure of axons, their density, size and myelination is of interest for the neuroscientific community, for example to help maximize the outcome of studies on white matter (WM) pathologies of the spinal cord (SC). The existence of a comprehensive and structured database of axonal measurements in healthy and disease models could help the validation of results obtained by different researchers. The purpose of this article is to provide such a database of healthy SC WM, to discuss the potential sources of variability and to suggest avenues for robust and accurate quantification of axon morphometry based on novel acquisition and processing techniques. The article is organized in three sections. The first section reviews morphometric results across species according to range of densities and counts of myelinated axons, axon diameter and myelin thickness, and characteristics of unmyelinated axons in different regions. The second section discusses the sources of variability across studies, such as age, sex, spinal pathways, spinal levels, statistical power and terminology in regard to tracts and protocols. The third section presents new techniques and perspectives that could benefit histology studies. For example, coherent anti-stokes Raman spectroscopy (CARS) imaging can provide sub-micrometric resolution without the need for fixation and staining, while slide scanners and stitching algorithms can provide full cross-sectional area of SC. In combination with these acquisition techniques, automatic segmentation algorithms for delineating axons and myelin sheath can help provide large-scale statistics on axon morphometry.
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Affiliation(s)
- Ariane Saliani
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Blanche Perraud
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Tanguy Duval
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Nikola Stikov
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Montreal Heart Institute, Montreal, QC, Canada
| | - Serge Rossignol
- Groupe de Recherche sur le Système Nerveux Central, Department of Neuroscience, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functionnal Neuroimaging Unit, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, QC, Canada
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70
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Palomino J, Hånell A. Computer graphics for the microscopist. J Clin Pathol 2017; 71:e1-e2. [PMID: 29146884 DOI: 10.1136/jclinpath-2017-204861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/06/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Jhonel Palomino
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hånell
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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71
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Affiliation(s)
- Oscar Lin
- Memorial Sloan Kettering Cancer Center, Department of Pathology, 1275 York Avenue, New York, NY 10065
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72
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Momenzadeh M, Vard A, Talebi A, Mehri Dehnavi A, Rabbani H. Computer-aided diagnosis software for vulvovaginal candidiasis detection from Pap smear images. Microsc Res Tech 2017; 81:13-21. [DOI: 10.1002/jemt.22951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/14/2017] [Accepted: 09/26/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Mohammadreza Momenzadeh
- Department of Biomedical Engineering, School of Advanced Technologies in Medicine; Isfahan University of Medical Sciences; Isfahan Iran
- Student Research Committee, School of Advanced Technologies in Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Alireza Vard
- Department of Biomedical Engineering, School of Advanced Technologies in Medicine; Isfahan University of Medical Sciences; Isfahan Iran
- Medical Image and Signal Processing Research Center; Isfahan University of Medical Sciences; Isfahan Iran
| | - Ardeshir Talebi
- Department of Pathology, School of Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Alireza Mehri Dehnavi
- Department of Biomedical Engineering, School of Advanced Technologies in Medicine; Isfahan University of Medical Sciences; Isfahan Iran
- Medical Image and Signal Processing Research Center; Isfahan University of Medical Sciences; Isfahan Iran
| | - Hossein Rabbani
- Department of Biomedical Engineering, School of Advanced Technologies in Medicine; Isfahan University of Medical Sciences; Isfahan Iran
- Medical Image and Signal Processing Research Center; Isfahan University of Medical Sciences; Isfahan Iran
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73
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Platiša L, Brantegem LV, Kumcu A, Ducatelle R, Philips W. Influence of study design on digital pathology image quality evaluation: the need to define a clinical task. J Med Imaging (Bellingham) 2017; 4:021108. [PMID: 28653011 PMCID: PMC5478946 DOI: 10.1117/1.jmi.4.2.021108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/22/2017] [Indexed: 11/14/2022] Open
Abstract
Despite the current rapid advance in technologies for whole slide imaging, there is still no scientific consensus on the recommended methodology for image quality assessment of digital pathology slides. For medical images in general, it has been recommended to assess image quality in terms of doctors' success rates in performing a specific clinical task while using the images (clinical image quality, cIQ). However, digital pathology is a new modality, and already identifying the appropriate task is difficult. In an alternative common approach, humans are asked to do a simpler task such as rating overall image quality (perceived image quality, pIQ), but that involves the risk of nonclinically relevant findings due to an unknown relationship between the pIQ and cIQ. In this study, we explored three different experimental protocols: (1) conducting a clinical task (detecting inclusion bodies), (2) rating image similarity and preference, and (3) rating the overall image quality. Additionally, within protocol 1, overall quality ratings were also collected (task-aware pIQ). The experiments were done by diagnostic veterinary pathologists in the context of evaluating the quality of hematoxylin and eosin-stained digital pathology slides of animal tissue samples under several common image alterations: additive noise, blurring, change in gamma, change in color saturation, and JPG compression. While the size of our experiments was small and prevents drawing strong conclusions, the results suggest the need to define a clinical task. Importantly, the pIQ data collected under protocols 2 and 3 did not always rank the image alterations the same as their cIQ from protocol 1, warning against using conventional pIQ to predict cIQ. At the same time, there was a correlation between the cIQ and task-aware pIQ ratings from protocol 1, suggesting that the clinical experiment context (set by specifying the clinical task) may affect human visual attention and bring focus to their criteria of image quality. Further research is needed to assess whether and for which purposes (e.g., preclinical testing) task-aware pIQ ratings could substitute cIQ for a given clinical task.
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Affiliation(s)
- Ljiljana Platiša
- Ghent University, Faculty of Engineering and Architecture, Department of Telecommunications and Information Processing, imec-IPI-UGent, Ghent, Belgium
| | - Leen Van Brantegem
- Ghent University, Faculty of Veterinary Medicine, Department of Pathology, Bacteriology and Poultry Diseases, Merelbeke, Belgium
| | - Asli Kumcu
- Ghent University, Faculty of Engineering and Architecture, Department of Telecommunications and Information Processing, imec-IPI-UGent, Ghent, Belgium
| | - Richard Ducatelle
- Ghent University, Faculty of Veterinary Medicine, Department of Pathology, Bacteriology and Poultry Diseases, Merelbeke, Belgium
| | - Wilfried Philips
- Ghent University, Faculty of Engineering and Architecture, Department of Telecommunications and Information Processing, imec-IPI-UGent, Ghent, Belgium
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74
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Meléndez-Álvarez B, Robayo O, Gil-Guillén V, Carratalá-Munuera M. Design and Validation of a Low-Cost Telepathology System. Telemed J E Health 2017; 23:976-982. [PMID: 28537789 DOI: 10.1089/tmj.2017.0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This work sought to evaluate the precision and repeatability of a telepathology prototype based on open software and hardware. MATERIALS AND METHODS A prototype was designed with application in telepathology and telemicroscopy. Accuracy and prototype precision were evaluated by calculating the mean absolute error and the intraclass and repeatability correlation coefficients for a series of 190 displacements at 10, 25, 50, 75, and 100 μm. RESULTS AND CONCLUSIONS This work developed a low-cost prototype that is accessible, easily reproducible, implementable, and scalable; based on the use of technology created under principles of open software and hardware. A pathologist reviewed the obtained images and found them to be of diagnostic quality. Its excellent repeatability, coupled with its good accuracy, allows for its application in telemicroscopy and static, dynamic, and whole-slide imaging pathology systems.
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Affiliation(s)
| | - Omar Robayo
- 1 Medical School, Pedagogical and Technological University of Colombia, Tunja, Colombia
| | - Vicente Gil-Guillén
- 2 Clinical Medicine Department, University of Miguel Hernández, Elche, Spain
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75
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Barisoni L, Gimpel C, Kain R, Laurinavicius A, Bueno G, Zeng C, Liu Z, Schaefer F, Kretzler M, Holzman LB, Hewitt SM. Digital pathology imaging as a novel platform for standardization and globalization of quantitative nephropathology. Clin Kidney J 2017; 10:176-187. [PMID: 28584625 PMCID: PMC5455257 DOI: 10.1093/ckj/sfw129] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/01/2016] [Indexed: 12/16/2022] Open
Abstract
The introduction of digital pathology to nephrology provides a platform for the development of new methodologies and protocols for visual, morphometric and computer-aided assessment of renal biopsies. Application of digital imaging to pathology made substantial progress over the past decade; it is now in use for education, clinical trials and translational research. Digital pathology evolved as a valuable tool to generate comprehensive structural information in digital form, a key prerequisite for achieving precision pathology for computational biology. The application of this new technology on an international scale is driving novel methods for collaborations, providing unique opportunities but also challenges. Standardization of methods needs to be rigorously evaluated and applied at each step, from specimen processing to scanning, uploading into digital repositories, morphologic, morphometric and computer-aided assessment, data collection and analysis. In this review, we discuss the status and opportunities created by the application of digital imaging to precision nephropathology, and present a vision for the near future.
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Affiliation(s)
- Laura Barisoni
- Department of Pathology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Charlotte Gimpel
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center – University of Freiburg, Germany
| | - Renate Kain
- Clinical Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Arvydas Laurinavicius
- Faculty of Medicine and National Center of Pathology, Vilnius University, Vilnius, Lithuania
| | - Gloria Bueno
- VISILAB – E.T.S.I.I., University of Castilla-La Mancha, Ciudad Real, Spain
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Franz Schaefer
- University Children Hospital, Pediatric Nephrology, Heidelberg, Germany
| | - Matthias Kretzler
- Department of Internal Medicine and Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Lawrence B. Holzman
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
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76
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Wilbur DC. Digital pathology and its role in cytology education. Cytopathology 2017; 27:325-30. [PMID: 27650601 DOI: 10.1111/cyt.12377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 01/13/2023]
Abstract
Digital methods have the potential to greatly expand content availability, accessibility, and quality for pathology education. Use of this technology allows for anywhere/anytime interactions and delivery in a variety of methods to accommodate any learning style. This review introduces basic digital technology, its uses for education, and prospects for the future.
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Affiliation(s)
- D C Wilbur
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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77
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Bashshur RL, Krupinski EA, Weinstein RS, Dunn MR, Bashshur N. The Empirical Foundations of Telepathology: Evidence of Feasibility and Intermediate Effects. Telemed J E Health 2017; 23:155-191. [PMID: 28170313 DOI: 10.1089/tmj.2016.0278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Telepathology evolved from video microscopy (i.e., "television microscopy") research in the early 1950s to video microscopy used in basic research in the biological sciences to a basic diagnostic tool in telemedicine clinical applications. Its genesis can be traced to pioneering feasibility studies regarding the importance of color and other image-based parameters for rendering diagnoses and a series of studies assessing concordance of virtual slide and light microscopy diagnoses. This article documents the empirical foundations of telepathology. METHODS A selective review of the research literature during the past decade (2005-2016) was conducted using robust research design and adequate sample size as criteria for inclusion. CONCLUSIONS The evidence regarding feasibility/acceptance of telepathology and related information technology applications has been well documented for several decades. The majority of evidentiary studies focused on intermediate outcomes, as indicated by comparability between telepathology and conventional light microscopy. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include use of telepathology and whole slide imaging for teaching, research, and outreach to resource-limited countries. Challenges still exist, however, in terms of use of telepathology as an effective diagnostic modality in clinical practice.
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Affiliation(s)
- Rashid L Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | | | | | - Matthew R Dunn
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
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78
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Vallangeon BD, Hawley JS, Sloane R, Bean SM. An Assessment of Pathology Resident Access to and Use of Technology: A Nationwide Survey. Arch Pathol Lab Med 2017; 141:431-436. [DOI: 10.5858/arpa.2016-0228-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Current technologies including digital slide scanners and handheld devices can revolutionize clinical practice and pathology graduate medical education (GME). The extent to which these technologies are used in pathology GME is unknown.
Objectives.—
To determine the types of technologies used, usage amount, and how they are integrated into pathology residency/fellowship programs nationwide.
Design.—
A 40-question online survey for residents/fellows was developed and administered via the Research Electronic Data Capture System after institutional review board approval.
Results.—
Fifty-two program directors (37%) gave permission for participation. One-hundred seventy-one responses were received (18% response rate). Most respondents have access to personal technology (laptop = 78% [134 of 171]), smartphone = 81% [139 of 171], tablet = 49% [84 of 171]), and Web-based digital slide collections (82%, 141 of 171). Few residents are provided electronic devices by their programs (laptop = 22% [38 of 171], smartphone = 0.5% [1 of 171], and tablet = 12% [21 of 171]). Fifty-nine percent have access to digital slide scanners, 33% have access to a program-created database of digitized slides, and 52% use telepathology. Fifteen percent have access to asynchronous learning. Of those with access to video-recorded conferences, 89% review them. Program size was significantly positively correlated with resident access to program-provided laptops (P = .02) and tablets (P < .001), digital slide scanners (P = .01), and telepathology (P = .001). Of all devices, program-provided laptops are used most for professional work (60.5% use this device for more than 5 hours per day).
Conclusions.—
Most residents report access to multiple types of innovative technology, but incorporation of these tools within pathology training programs is highly variable. Opportunities for incorporating innovative technologies exist and could be further explored.
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Affiliation(s)
| | | | | | - Sarah M. Bean
- From the Department of Pathology (Dr Vallangeon) and Duke Office of Clinical Research (Messrs Hawley and Sloane), Duke University Hospital, Durham, North Carolina; and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Bean). Dr Vallangeon is now with the Department of Pathology, East Carolina University, Greenville, North Carolina
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79
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Ohta M, Ohira Y, Uehara T, Keira K, Noda K, Hirukawa M, Shikino K, Kajiwara H, Shimada F, Hirota Y, Ikegami A, Ikusaka M. How Accurate Are First Visit Diagnoses Using Synchronous Video Visits with Physicians? Telemed J E Health 2017; 23:119-129. [DOI: 10.1089/tmj.2015.0245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mitsuyasu Ohta
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Division of Rotated Collaboration Systems for Local Healthcare, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Division of Rotated Collaboration Systems for Local Healthcare, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazunori Keira
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Division of Rotated Collaboration Systems for Local Healthcare, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Misa Hirukawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Division of Rotated Collaboration Systems for Local Healthcare, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Hideki Kajiwara
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Fumio Shimada
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yusuke Hirota
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Akiko Ikegami
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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80
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Kawano Y, Namiki K, Miyawaki A, Ishikawa T. Extending Whole Slide Imaging: Color Darkfield Internal Reflection Illumination (DIRI) for Biological Applications. PLoS One 2017; 12:e0167774. [PMID: 28085892 PMCID: PMC5235376 DOI: 10.1371/journal.pone.0167774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/21/2016] [Indexed: 11/19/2022] Open
Abstract
Whole slide imaging (WSI) is a useful tool for multi-modal imaging, and in our work, we have often combined WSI with darkfield microscopy. However, traditional darkfield microscopy cannot use a single condenser to support high- and low-numerical-aperture objectives, which limits the modality of WSI. To overcome this limitation, we previously developed a darkfield internal reflection illumination (DIRI) microscope using white light-emitting diodes (LEDs). Although the developed DIRI is useful for biological applications, substantial problems remain to be resolved. In this study, we propose a novel illumination technique called color DIRI. The use of three-color LEDs dramatically improves the capability of the system, such that color DIRI (1) enables optimization of the illumination color; (2) can be combined with an oil objective lens; (3) can produce fluorescence excitation illumination; (4) can adjust the wavelength of light to avoid cell damage or reactions; and (5) can be used as a photostimulator. These results clearly illustrate that the proposed color DIRI can significantly extend WSI modalities for biological applications.
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Affiliation(s)
- Yoshihiro Kawano
- The Department of Biomedical Engineering, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
- Olympus Corporation, Shinjuku-Ku, Tokyo, Japan
- * E-mail:
| | - Kana Namiki
- Cell Function & Dynamics, Brain Science Institute, RIKEN, Wako, Saitama, Japan
| | - Atsushi Miyawaki
- Cell Function & Dynamics, Brain Science Institute, RIKEN, Wako, Saitama, Japan
| | - Takuji Ishikawa
- The Department of Biomedical Engineering, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
- Department of Finemechanics, Tohoku University, Sendai, Miyagi, Japan
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81
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Pantanowitz L, Dickinson K, Evans AJ, Hassell LA, Henricks WH, Lennerz JK, Lowe A, Parwani AV, Riben M, Smith CD, Tuthill JM, Weinstein RS, Wilbur DC, Krupinski EA, Bernard J. ATA clinical guidelines for telepathology. Telemed J E Health 2016; 20:1049-56. [PMID: 25384254 DOI: 10.1089/tmj.2014.9976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liron Pantanowitz
- 1 Department of Pathology, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
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82
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Paramanandam M, O’Byrne M, Ghosh B, Mammen JJ, Manipadam MT, Thamburaj R, Pakrashi V. Automated Segmentation of Nuclei in Breast Cancer Histopathology Images. PLoS One 2016; 11:e0162053. [PMID: 27649496 PMCID: PMC5029866 DOI: 10.1371/journal.pone.0162053] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023] Open
Abstract
The process of Nuclei detection in high-grade breast cancer images is quite challenging in the case of image processing techniques due to certain heterogeneous characteristics of cancer nuclei such as enlarged and irregularly shaped nuclei, highly coarse chromatin marginalized to the nuclei periphery and visible nucleoli. Recent reviews state that existing techniques show appreciable segmentation accuracy on breast histopathology images whose nuclei are dispersed and regular in texture and shape; however, typical cancer nuclei are often clustered and have irregular texture and shape properties. This paper proposes a novel segmentation algorithm for detecting individual nuclei from Hematoxylin and Eosin (H&E) stained breast histopathology images. This detection framework estimates a nuclei saliency map using tensor voting followed by boundary extraction of the nuclei on the saliency map using a Loopy Back Propagation (LBP) algorithm on a Markov Random Field (MRF). The method was tested on both whole-slide images and frames of breast cancer histopathology images. Experimental results demonstrate high segmentation performance with efficient precision, recall and dice-coefficient rates, upon testing high-grade breast cancer images containing several thousand nuclei. In addition to the optimal performance on the highly complex images presented in this paper, this method also gave appreciable results in comparison with two recently published methods-Wienert et al. (2012) and Veta et al. (2013), which were tested using their own datasets.
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Affiliation(s)
| | - Michael O’Byrne
- School of Mechanical and Materials Engineering, University College Dublin, Ireland
| | - Bidisha Ghosh
- Department of Civil, Structural and Environmental Engineering, Trinity College Dublin, Ireland
| | - Joy John Mammen
- Department of Transfusion Medicine & Immunohematology, Christian Medical College, Vellore, India
| | | | | | - Vikram Pakrashi
- School of Mechanical and Materials Engineering, University College Dublin, Ireland
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83
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Vyas NS, Markow M, Prieto-Granada C, Gaudi S, Turner L, Rodriguez-Waitkus P, Messina JL, Jukic DM. Comparing whole slide digital images versus traditional glass slides in the detection of common microscopic features seen in dermatitis. J Pathol Inform 2016; 7:30. [PMID: 27563489 PMCID: PMC4977977 DOI: 10.4103/2153-3539.186909] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/30/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The quality and limitations of digital slides are not fully known. We aimed to estimate intrapathologist discrepancy in detecting specific microscopic features on glass slides and digital slides created by scanning at ×20. METHODS Hematoxylin and eosin and periodic acid-Schiff glass slides were digitized using the Mirax Scan (Carl Zeiss Inc., Germany). Six pathologists assessed 50-71 digital slides. We recorded objective magnification, total time, and detection of the following: Mast cells; eosinophils; plasma cells; pigmented macrophages; melanin in the epidermis; fungal bodies; neutrophils; civatte bodies; parakeratosis; and sebocytes. This process was repeated using the corresponding glass slides after 3 weeks. The diagnosis was not required. RESULTS The mean time to assess digital slides was 176.77 s and 137.61 s for glass slides (P < 0.001, 99% confidence interval [CI]). The mean objective magnification used to detect features using digital slides was 18.28 and 14.07 for glass slides (P < 0.001, 99.99% CI). Parakeratosis, civatte bodies, pigmented macrophages, melanin in the epidermis, mast cells, eosinophils, plasma cells, and neutrophils, were identified at lower objectives on glass slides (P = 0.023-0.001, 95% CI). Average intraobserver concordance ranged from κ = 0.30 to κ = 0.78. Features with poor to fair average concordance were: Melanin in the epidermis (κ = 0.15-0.58); plasma cells (κ = 0.15-0.49); and neutrophils (κ = 0.12-0.48). Features with moderate average intrapathologist concordance were: parakeratosis (κ = 0.21-0.61); civatte bodies (κ = 0.21-0.71); pigment-laden macrophages (κ = 0.34-0.66); mast cells (κ = 0.29-0.78); and eosinophils (κ = 0.31-0.79). The average intrapathologist concordance was good for sebocytes (κ = 0.51-1.00) and fungal bodies (κ = 0.47-0.76). CONCLUSIONS Telepathology using digital slides scanned at ×20 is sufficient for detection of histopathologic features routinely encountered in dermatitis cases, though less efficient than glass slides.
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Affiliation(s)
- Nikki S Vyas
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Markow
- Department of Pathology and Cell Biology, University of South Florida, Tampa, USA
| | - Carlos Prieto-Granada
- Department of Pathology and Cell Biology, University of South Florida, Tampa, USA; Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, USA; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Sudeep Gaudi
- Department of Pathology and Laboratory Medicine Service, James A Haley VA Hospital, Tampa, USA
| | - Leslie Turner
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, USA; Department of Pathology and Laboratory Medicine Service, James A Haley VA Hospital, Tampa, USA
| | - Paul Rodriguez-Waitkus
- Department of Pathology and Cell Biology, University of South Florida, Tampa, USA; Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, USA
| | - Jane L Messina
- Department of Pathology and Cell Biology, University of South Florida, Tampa, USA; Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, USA; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA; Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Drazen M Jukic
- Department of Pathology and Cell Biology, University of South Florida, Tampa, USA; Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, USA; Department of Pathology and Laboratory Medicine Service, James A Haley VA Hospital, Tampa, USA; Georgia Dermatopathology, Savannah, GA, USA; Department of Dermatology, University of Florida, Gainesville, FL, USA
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84
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Yin F, Han G, Bui MM, Gibbs J, Martin I, Sundharkrishnan L, King L, Jabcuga C, Stuart LN, Hassell LA. Educational Value of Digital Whole Slides Accompanying Published Online Pathology Journal Articles: A Multi-Institutional Study. Arch Pathol Lab Med 2016; 140:694-697. [PMID: 27116087 DOI: 10.5858/arpa.2015-0366-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
CONTEXT -Despite great interest in using whole slide imaging (WSI) in pathology practice and education, few pathology journals have published WSI pertinent to articles within their pages or as supplemental materials. OBJECTIVE -To evaluate whether there is measurable added educational value of including WSI in publications. DESIGN -Thirty-seven participants, 16 (43.3%), 15 (40.5%), and 6 (16.2%) junior pathology residents (postgraduate year 1-2), senior pathology residents (postgraduate year 3-4), and board-certified pathologists, respectively, read a sequence of 10 journal articles on a wide range of pathology topics. A randomized subgroup also reviewed the WSI published with the articles. Both groups completed a survey tool assessing recall of text-based content and of image-based material pertinent to the diseases but not present in the fixed published images. RESULTS -The group examining WSI had higher performance scores in 72% of image-based questions (36 of 50 questions) as compared with the non-WSI group. As an internal study control, the WSI group had higher performance scores in only 40% of text-based questions (6 of 15 questions). The WSI group had significantly better performance than the non-WSI group for image-based questions compared with text-based questions (P < .05, Fisher exact test). CONCLUSION -Our study provides supporting evidence that WSI offers enhanced value to the learner beyond the text and fixed images selected by the author. We strongly encourage more journals to incorporate WSI into their publications.
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Affiliation(s)
- Feng Yin
- From the Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City (Drs Yin and Hassell); the Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut (Dr Han); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Bui); the Department of Pathology and Cell Biology, Morsani College of Medicine at University of South Florida, Tampa (Drs Bui, Gibbs, and Martin); the Department of Pathology, Orlando Health, Orlando, Florida (Dr Sundharkrishnan); Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas (Dr King); the Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota (Dr Jabcuga); and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Stuart)
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85
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Dennis E, Banks P, Murata LB, Sanchez SA, Pennington C, Hockersmith L, Miller R, Lambe J, Feng J, Kapadia M, Clements J, Loftin I, Singh S, Das-Gupta A, Lloyd W, Bloom K. Validation of an electronic program for pathologist training in the interpretation of a complex companion diagnostic immunohistochemical assay. Hum Pathol 2016; 56:194-203. [PMID: 27349303 DOI: 10.1016/j.humpath.2016.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/11/2016] [Accepted: 06/11/2016] [Indexed: 01/03/2023]
Abstract
Companion diagnostics assay interpretation can select patients with the greatest targeted therapy benefits. We present the results from a prospective study demonstrating that pathologists can effectively learn immunohistochemical assay-interpretation skills from digital image-based electronic training (e-training). In this study, e-training was used to train board-certified pathologists to evaluate non-small cell lung carcinoma for eligibility for treatment with onartuzumab, a MET-inhibiting agent. The training program mimicked the live training that was previously validated in clinical trials for onartuzumab. A digital interface was developed for pathologists to review high-resolution, static images of stained slides. Sixty-four pathologists practicing in the United States enrolled while blinded to the type of training. After training, both groups completed a mandatory final test using glass slides. The results indicated both training modalities to be effective. Overall, 80.6% of e-trainees and 72.7% of live trainees achieved passing scores (at least 85%) on the final test. All study participants reported that their training experience was "good" and that they had received sufficient information to determine the adequacy of case slide staining to score each case. This study established that an e-training program conducted under highly controlled conditions can provide pathologists with the skills necessary to interpret a complex assay and that these skills can be equivalent to those achieved with face-to-face training using conventional microscopy. Programs of this type are scalable for global distribution and offer pathologists the potential for readily accessible and robust training in new companion diagnostic assays linked to novel, targeted, adjuvant therapies for cancer patients.
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Affiliation(s)
- Eslie Dennis
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755.
| | - Peter Banks
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | - Lauren B Murata
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | | | | | - Linda Hockersmith
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | - Rachel Miller
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | - Jess Lambe
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | - Janine Feng
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | - Monesh Kapadia
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | - June Clements
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | - Isabell Loftin
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | - Shalini Singh
- Ventana Medical Systems, Inc, a member of the Roche Group, Tucson, AZ 85755
| | | | | | - Kenneth Bloom
- Clarient Diagnostic Services, Inc, Aliso Viejo, CA 92656
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86
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Ishikawa M, Murakami Y, Ahi ST, Yamaguchi M, Kobayashi N, Kiyuna T, Yamashita Y, Saito A, Abe T, Hashiguchi A, Sakamoto M. Automatic quantification of morphological features for hepatic trabeculae analysis in stained liver specimens. J Med Imaging (Bellingham) 2016; 3:027502. [PMID: 27335894 DOI: 10.1117/1.jmi.3.2.027502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/12/2016] [Indexed: 11/14/2022] Open
Abstract
This paper proposes a digital image analysis method to support quantitative pathology by automatically segmenting the hepatocyte structure and quantifying its morphological features. To structurally analyze histopathological hepatic images, we isolate the trabeculae by extracting the sinusoids, fat droplets, and stromata. We then measure the morphological features of the extracted trabeculae, divide the image into cords, and calculate the feature values of the local cords. We propose a method of calculating the nuclear-cytoplasmic ratio, nuclear density, and number of layers using the local cords. Furthermore, we evaluate the effectiveness of the proposed method using surgical specimens. The proposed method was found to be an effective method for the quantification of the Edmondson grade.
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Affiliation(s)
- Masahiro Ishikawa
- Tokyo Institute of Technology, Interdisciplinary Graduate School of Science and Engineering, 4259, Nagatsuta, Midori-ku 226-8503, Japan; Saitama Medical University, Faculty of Health and Medical Care, 1397-1 Yamane, Hidaka-shi Saitama 350-1241, Japan
| | - Yuri Murakami
- Tokyo Institute of Technology , Interdisciplinary Graduate School of Science and Engineering, 4259, Nagatsuta, Midori-ku 226-8503, Japan
| | - Sercan Taha Ahi
- Tokyo Institute of Technology , Interdisciplinary Graduate School of Science and Engineering, 4259, Nagatsuta, Midori-ku 226-8503, Japan
| | - Masahiro Yamaguchi
- Tokyo Institute of Technology , Interdisciplinary Graduate School of Science and Engineering, 4259, Nagatsuta, Midori-ku 226-8503, Japan
| | - Naoki Kobayashi
- Saitama Medical University , Faculty of Health and Medical Care, 1397-1 Yamane, Hidaka-shi Saitama 350-1241, Japan
| | - Tomoharu Kiyuna
- NEC Corporation , Medical Solutions Division, 5-7-1 Shiba Minato-ku, Tokyo 108-8001, Japan
| | - Yoshiko Yamashita
- NEC Corporation , Medical Solutions Division, 5-7-1 Shiba Minato-ku, Tokyo 108-8001, Japan
| | - Akira Saito
- Tokyo Medical University, Quantitative Pathology and Immunology Division, 6-1-1- Shinjuku, Sinjyuku-ku Tokyo 160-8402, Japan; Tokyo Medical University, Molecular Pathology Division, 6-1-1- Shinjuku, Sinjyuku-ku, Tokyo 160-8402, Japan
| | - Tokiya Abe
- Keio University School of Medicine , Department of Pathology, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Akinori Hashiguchi
- Keio University School of Medicine , Department of Pathology, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Michiie Sakamoto
- Keio University School of Medicine , Department of Pathology, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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87
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Laurinavicius A, Plancoulaine B, Herlin P, Laurinaviciene A. Comprehensive Immunohistochemistry: Digital, Analytical and Integrated. Pathobiology 2016; 83:156-63. [PMID: 27101138 DOI: 10.1159/000442389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Immunohistochemistry (IHC) is widely used in contemporary pathology as a diagnostic and, increasingly, as a prognostic and predictive tool. The main value of the method today comes from a sensitive and specific detection of a protein of interest in the context of tissue architecture and cell populations. One of the major limitations of conventional IHC is related to the fact that the results are usually obtained by visual qualitative or semiquantitative evaluation. While this is sufficient for diagnostic purposes, measurement of prognostic and predictive biomarkers requires better accuracy and reproducibility. Also, objective evaluation of the spatial heterogeneity of biomarker expression as well as the development of combined/integrated biomarkers are in great demand. On the other end of the scale, the rapid development of tissue proteomics accounting for 2D spatial aspects has led to a disruptive concept of next-generation IHC, promising high multiplexing and broad dynamic range quantitative/spatial data on tissue protein expression. This 'evolutionary gap' between conventional and next-generation IHC can be filled by comprehensive IHC based on digital technologies (empowered by quantification and spatial and multiparametric analytics) and integrated into the pathology workflow and information systems. In this paper, we share our perspectives on a comprehensive IHC road map as a multistep development process.
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88
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Hashimoto N, Bautista PA, Haneishi H, Snuderl M, Yagi Y. Development of a 2D Image Reconstruction and Viewing System for Histological Images from Multiple Tissue Blocks: Towards High-Resolution Whole-Organ 3D Histological Images. Pathobiology 2016; 83:127-39. [PMID: 27100217 DOI: 10.1159/000443278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
High-resolution 3D histology image reconstruction of the whole brain organ starts from reconstructing the high-resolution 2D histology images of a brain slice. In this paper, we introduced a method to automatically align the histology images of thin tissue sections cut from the multiple paraffin-embedded tissue blocks of a brain slice. For this method, we employed template matching and incorporated an optimization technique to further improve the accuracy of the 2D reconstructed image. In the template matching, we used the gross image of the brain slice as a reference to the reconstructed 2D histology image of the slice, while in the optimization procedure, we utilized the Jaccard index as the metric of the reconstruction accuracy. The results of our experiment on the initial 3 different whole-brain tissue slices showed that while the method works, it is also constrained by tissue deformations introduced during the tissue processing and slicing. The size of the reconstructed high-resolution 2D histology image of a brain slice is huge, and designing an image viewer that makes particularly efficient use of the computing power of a standard computer used in our laboratories is of interest. We also present the initial implementation of our 2D image viewer system in this paper.
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89
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Farahani N, Riben M, Evans AJ, Pantanowitz L. International Telepathology: Promises and Pitfalls. Pathobiology 2016; 83:121-6. [PMID: 27101287 DOI: 10.1159/000442390] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Innovative technologies for digital imaging and telecommunications are changing the way we deliver health care. Telepathology collaborations are one example of how delivering remote pathology services to patients can benefit from leveraging this change. Over the years, several academic and commercial teleconsultation networks have been established. Herein, we review the landscape of these international telepathology efforts and highlight key supportive factors and potential barriers to successful cross-border collaborations. Important features of successful international telepathology programs include efficient workflows, dedicated information technology staff, continuous maintenance, financial incentives, ensuring that all involved stakeholders are satisfied, and value-added clinical benefit to patient care. Factors that plague such telepathology operations include legal/regulatory issues, sustainability, and cultural and environmental issues. Pathologists, vendors and laboratory accreditation agencies will need to embrace and capitalize on this new paradigm of international telepathology accordingly.
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90
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91
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Singer DB. Pediatric Pathology In The Year 2050. Pediatr Dev Pathol 2015. [PMID: 26214731 DOI: 10.2350/15-06-1664-oa.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The study of pathology in fetuses, infants, and children had its beginnings in the mid-19th century. Now, 165 years later, hundreds of pediatric pathologists are in up-to-date practices throughout the world. They, and all medical practitioners, are just beginning to delve into the nanotechnical wave. Nanotechnology refers to the structure and activity of minute particles, molecules, compounds, and atoms. By 2050, as nanotechnical studies develop further, new diseases and variations of old diseases will be discovered. Aggregation of medical data from billions of people, a process known as crowd sourcing, will be digitally interconnected to the new findings with computers. Pediatric pathologists will contribute to this expanding science with new laboratory instruments, including ultramodern microscopes known as Omniscopes. Robots will be programmed to perform autopsies and process surgical specimens. Analyzers in chemistry, microbiology, hematology, and genetics will, in 2050, produce dozens or even hundreds of results within minutes. These advances will lead to better treatments and overall better health for everyone.
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Affiliation(s)
- Don B Singer
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Street, Madison, WI 53705, USA
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92
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Vitkovski T, Bhuiya T, Esposito M. Utility of telepathology as a consultation tool between an off-site surgical pathology suite and affiliated hospitals in the frozen section diagnosis of lung neoplasms. J Pathol Inform 2015; 6:55. [PMID: 26605120 PMCID: PMC4639948 DOI: 10.4103/2153-3539.168515] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/21/2015] [Indexed: 11/13/2022] Open
Abstract
Background: Increasingly, as in our institution, operating rooms are located in hospitals and the pathology suite is located at a distant location because of off-site consolidation of pathology services. Telepathology is a technology which bridges the gap between pathologists and offers a means to obtain a consultation remotely. We aimed to evaluate the utility of telepathology as a means to assist the pathologist at the time of intraoperative consultation of lung nodules when a subspecialty pathologist is not available to directly review the slide. Methods: Cases of lung nodules suspicious for a neoplasm were included. Frozen sections were prepared in the usual manner. The pathologists on the intraoperative consultation service at two of our system hospitals notified the thoracic pathologist of each case after rendering a preliminary diagnosis. The consultation was performed utilizing a Nikon™ Digital Sight camera and web-based Remote Medical Technologies™ software with live video streaming directed by the host pathologist. The thoracic pathologist rendered a diagnosis without knowledge of the preliminary interpretation then discussed the interpretation with the frozen section pathologist. The interpretations were compared with the final diagnosis rendered after sign-out. Results: One hundred and three consecutive cases were included. The frozen section pathologist and a thoracic pathologist had concordant diagnoses in 93 cases (90.2%), discordant diagnoses in nine cases (8.7%), and one case in which both deferred. There was an agreement between the thoracic pathologist's diagnosis and the final diagnosis in 98% of total cases including 8/9 (88.9%) of the total discordant cases. In two cases, if the thoracic pathologist had not been consulted, the patient would have been undertreated. Conclusions: We have shown that telepathology is an excellent consultation tool in the frozen section diagnosis of lung nodules.
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Affiliation(s)
- Taisia Vitkovski
- Department of Pathology, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York, USA
| | - Tawfiqul Bhuiya
- Department of Pathology, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York, USA
| | - Michael Esposito
- Department of Pathology, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York, USA
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93
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [PMID: 26343551 DOI: 10.1002/14651858.cd002098.pub2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Headington, Oxford, Oxfordshire, UK, OX3 7LF
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2015; 2015:CD002098. [PMID: 26343551 PMCID: PMC6473731 DOI: 10.1002/14651858.cd002098.pub2] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthThe Norwegian Knowledge Centre for the Health ServicesPilestredet Park 7OsloNorway0176
| | - Antoine Rachas
- European Hospital Georges Pompidou and Paris Descartes UniversityDepartment of IT and Public Health20‐40 Rue leBlancParisFrance75908
| | - Andrew J Farmer
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory Quarter, Walton StreetOxfordUKOX2 6GG
| | - Marco Inzitari
- Parc Sanitari Pere Virgili and Universitat Autònoma de BarcelonaDepartment of Healthcare/Medicinec Esteve Terrades 30BarcelonaSpain08023
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordOxfordshireUKOX3 7LF
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Schuh F, Biazús JV, Resetkova E, Benfica CZ, Ventura ADF, Uchoa D, Graudenz M, Edelweiss MIA. Histopathological grading of breast ductal carcinoma in situ: validation of a web-based survey through intra-observer reproducibility analysis. Diagn Pathol 2015; 10:93. [PMID: 26159429 PMCID: PMC4702358 DOI: 10.1186/s13000-015-0320-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 06/10/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Histopathological grading diagnosis of ductal carcinoma in situ (DCIS) of the breast may be very difficult even for experts, and it is important for therapeutic decisions. The challenge may be due to the inaccurate and/or subjective application of the diagnosis criteria. The aim of this study was to investigate the intra-observer agreement between a traditional method and a developed web-based questionnaire for scoring breast DCIS. METHODS A cross-sectional study was carried out to evaluate the diagnostic agreement of an electronic questionnaire and its point scoring system with the subjective reading of digital images for 3 different DCIS grading systems: Holland, Van Nuys and modified Black nuclear grade system. Three pathologists analyzed the same set of digitized images from 43 DCIS cases using two different web-based programs. In the first phase, they accessed a website with a newly created questionnaire and scoring system developed to allow the determination of the histological grade of the cases. After at least 6 months, the pathologists read again the same images, but without the help of the questionnaire, indicating subjectively the diagnoses. The intra-observer agreement analysis was employed to validate this innovative web-based survey. RESULTS Overall, diagnostic reproducibility was similar for all histologic grading classification systems, with kappa values of 0.57 ± 0.10, 0.67 ± 0.09 and 0.67 ± 0.09 for Holland, Van Nuys classification and modified Black nuclear grade system respectively. Only two 2-step diagnostic disagreements were found, one for Holland and another for Van Nuys. Both cases were superestimated by the web-based survey. CONCLUSION The diagnostic agreement between the web-based questionnaire and a traditional method, both using digital images, is moderate to good for Holland, Van Nuys and modified Black nuclear grade system. The use of a scoring point system does not appear to pose a major risk of presenting large (2-step) diagnostic disagreements. These findings indicate that the use of this point scoring system in this web-based survey to grade objectively DCIS lesions is a useful diagnostic tool.
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Affiliation(s)
- Fernando Schuh
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Breast surgeon, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | | | - Erika Resetkova
- Department of Pathology, MD Anderson Cancer Center, Houston, Texas, USA.
| | | | | | - Diego Uchoa
- Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Márcia Graudenz
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Maria Isabel Albano Edelweiss
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
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96
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Gomez-Gelvez JC, Kryvenko ON, Chabot-Richards DS, Foucar K, Inamdar KV, Karner KH. Comparative Analysis Reveals Potential Utility of Digital Microscopy in the Evaluation of Peripheral Blood Smears With Some Barriers to Implementation. Am J Clin Pathol 2015; 144:68-77. [PMID: 26071463 DOI: 10.1309/ajcp25almxqfjcqa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Evaluation of the peripheral blood smear (PBS) is an essential diagnostic test in current medical practice. We aimed to evaluate the use of digital microscopy for the examination of PBS as an option to provide expert interpretation to remote sites and in "on-call" situations. METHODS We collected 100 Wright-Giemsa-stained PBS slides representing normal and abnormal findings seen at a community-based hospital. Four hematopathologists independently evaluated the cases using conventional light and digital microscopy. RESULTS When comparing digital vs light microscopy, most of the cellular features evaluated showed at least a moderate degree of agreement in at least three of the reviewers. Discrepancies in final diagnosis were identified in a minority of the cases, most of which were attributed to the poorer resolution of digital microscopy at high magnification (×400). CONCLUSIONS These results support the limited use of digital microscopy for evaluation and triage of peripheral blood smears as a practical option to obtain expert opinion in locations where experienced staff is not available on site. Our results indicate that while digital microscopy is well suited for basic triage of these blood smears, limitations in quality of imaging at higher magnification as well as large file size may limit its utility in certain settings and situations.
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97
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Wilbur DC, Brachtel EF, Gilbertson JR, Jones NC, Vallone JG, Krishnamurthy S. Whole slide imaging for human epidermal growth factor receptor 2 immunohistochemistry interpretation: Accuracy, Precision, and reproducibility studies for digital manual and paired glass slide manual interpretation. J Pathol Inform 2015; 6:22. [PMID: 26110090 PMCID: PMC4466789 DOI: 10.4103/2153-3539.157788] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/03/2015] [Indexed: 11/23/2022] Open
Abstract
Background: The use of digital whole slide imaging for human epidermal growth factor receptor 2 (HER2) immunohistochemistry (IHC) could create improvements in workflow and performance, allowing for central archiving of specimens, distributed and remote interpretation, and the potential for additional computerized automation. Procedures: The accuracy, precision, and reproducibility of manual digital interpretation for HER2 IHC were determined by comparison to manual glass slide interpretation. Inter- and intra-pathologist reproducibility and precision between the glass slide and digital interpretations of HER2 IHC were determined in 5 studies using DAKO HercepTest-stained breast cancer slides with the Philips Digital Pathology System. In 2 inter-method studies, 3 pathologists interpreted glass and digital slides in sequence or in random order with a minimum of 7 days as a washout period. These studies also measured inter-observer reproducibility and precision. Another two studies measured intra-pathologist reproducibility on cases read 10 times by glass and digital methods. One additional study evaluated the effects of adding IHC control slides with each run, using 1 pathologist interpreting glass and digital slides randomized from the sets above along with appropriate controls for each slide in the set. Results: The overall results show that there is no statistical difference between the variance of performance when comparing glass and digital HER2 interpretations; and there were no effects noted when control tissues were evaluated in conjunction with the test slides. Conclusions: The results show that there is an equivalence of result when interpreting HER2 IHC slides in breast cancer by either glass slides or digital images. Digital interpretation can therefore be safely and effectively used for this purpose.
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Affiliation(s)
- David C Wilbur
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Elena F Brachtel
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - John R Gilbertson
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Nicholas C Jones
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - John G Vallone
- Department of Pathology, University of Southern California, Los Angeles, California, USA
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Van Es SL, Kumar RK, Pryor WM, Salisbury EL, Velan GM. Cytopathology whole slide images and adaptive tutorials for postgraduate pathology trainees: a randomized crossover trial. Hum Pathol 2015; 46:1297-305. [PMID: 26093936 DOI: 10.1016/j.humpath.2015.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/29/2015] [Accepted: 05/07/2015] [Indexed: 11/28/2022]
Abstract
To determine whether cytopathology whole slide images and virtual microscopy adaptive tutorials aid learning by postgraduate trainees, we designed a randomized crossover trial to evaluate the quantitative and qualitative impact of whole slide images and virtual microscopy adaptive tutorials compared with traditional glass slide and textbook methods of learning cytopathology. Forty-three anatomical pathology registrars were recruited from Australia, New Zealand, and Malaysia. Online assessments were used to determine efficacy, whereas user experience and perceptions of efficiency were evaluated using online Likert scales and open-ended questions. Outcomes of online assessments indicated that, with respect to performance, learning with whole slide images and virtual microscopy adaptive tutorials was equivalent to using traditional methods. High-impact learning, efficiency, and equity of learning from virtual microscopy adaptive tutorials were strong themes identified in open-ended responses. Participants raised concern about the lack of z-axis capability in the cytopathology whole slide images, suggesting that delivery of z-stacked whole slide images online may be important for future educational development. In this trial, learning cytopathology with whole slide images and virtual microscopy adaptive tutorials was found to be as effective as and perceived as more efficient than learning from glass slides and textbooks. The use of whole slide images and virtual microscopy adaptive tutorials has the potential to provide equitable access to effective learning from teaching material of consistently high quality. It also has broader implications for continuing professional development and maintenance of competence and quality assurance in specialist practice.
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Affiliation(s)
- Simone L Van Es
- Department of Pathology, School of Medical Sciences, The University of New South Wales, Sydney NSW 2052, Australia.
| | - Rakesh K Kumar
- Department of Pathology, School of Medical Sciences, The University of New South Wales, Sydney NSW 2052, Australia.
| | - Wendy M Pryor
- Royal College of Pathologists of Australasia, Surry Hills 2010, Australia.
| | - Elizabeth L Salisbury
- Department of Anatomical Pathology, Prince of Wales Hospital, Randwick 2031, Australia.
| | - Gary M Velan
- Department of Pathology, School of Medical Sciences, The University of New South Wales, Sydney NSW 2052, Australia.
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Abstract
Virtual microscopy is a method for digitizing images of tissue on glass slides and using a computer to view, navigate, change magnification, focus and mark areas of interest. Virtual microscope systems (also called digital pathology or whole slide imaging systems) offer several advantages for biological scientists who use slides as part of their general, pharmaceutical, biotechnology or clinical research. The systems usually are based on one of two methodologies: area scanning or line scanning. Virtual microscope systems enable automatic sample detection, virtual-Z acquisition and creation of focal maps. Virtual slides are layered with multiple resolutions at each location, including the highest resolution needed to allow more detailed review of specific regions of interest. Scans may be acquired at 2, 10, 20, 40, 60 and 100 × or a combination of magnifications to highlight important detail. Digital microscopy starts when a slide collection is put into an automated or manual scanning system. The original slides are archived, then a server allows users to review multilayer digital images of the captured slides either by a closed network or by the internet. One challenge for adopting the technology is the lack of a universally accepted file format for virtual slides. Additional challenges include maintaining focus in an uneven sample, detecting specimens accurately, maximizing color fidelity with optimal brightness and contrast, optimizing resolution and keeping the images artifact-free. There are several manufacturers in the field and each has not only its own approach to these issues, but also its own image analysis software, which provides many options for users to enhance the speed, quality and accuracy of their process through virtual microscopy. Virtual microscope systems are widely used and are trusted to provide high quality solutions for teleconsultation, education, quality control, archiving, veterinary medicine, research and other fields.
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Affiliation(s)
- C Higgins
- Olympus Corporation of the Americas , Center Valley, Pennsylvania
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100
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Nast CC, Lemley KV, Hodgin JB, Bagnasco S, Avila-Casado C, Hewitt SM, Barisoni L. Morphology in the Digital Age: Integrating High-Resolution Description of Structural Alterations With Phenotypes and Genotypes. Semin Nephrol 2015; 35:266-78. [PMID: 26215864 PMCID: PMC4764351 DOI: 10.1016/j.semnephrol.2015.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Conventional light microscopy has been used to characterize and classify renal diseases, evaluate histopathology in studies and trials, and educate renal pathologists and nephrologists. The advent of digital pathology, in which a glass slide can be scanned to create whole slide images (WSIs) for viewing and manipulating on a computer monitor, provides real and potential advantages compared with conventional light microscopy. Software tools such as annotation, morphometry, and image analysis can be applied to WSIs for studies or educational purposes, and the digital images are available globally to clinicians, pathologists, and investigators. New ways of assessing renal pathology with observational data collection may allow better morphologic correlations and integration with molecular and genetic signatures, refinements of classification schema, and understanding of disease pathogenesis. In multicenter studies, WSIs, which require additional quality assurance steps, provide efficiency by reducing slide shipping and consensus conference costs, and they allow slide viewing anytime and anywhere. Although validation studies for the routine diagnostic use of digital pathology still are needed, this is a powerful tool currently available for translational research, clinical trials, and education in renal pathology.
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Affiliation(s)
- Cynthia C. Nast
- Dept of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kevin V. Lemley
- Division of Nephrology, Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Serena Bagnasco
- Department of Pathology, Johns Hopkins University Medical Center, Baltimore, MD
| | | | - Stephen M Hewitt
- Experimental Pathology Laboratory, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda MD
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