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Eloy C, Bychkov A, Fraggetta F, Temprana-Salvador J, Pantanowitz L, Vielh P. How many more slides to go until we fully adopt digital cytology? Cytopathology 2024; 35:442-443. [PMID: 38736173 DOI: 10.1111/cyt.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/27/2024] [Indexed: 05/14/2024]
Abstract
Two‐liner/synopsis: The digital cytology hub (DCH) has been established under the umbrella of the Cytopathology journal. DCH will help bring about the crucial changes needed to make digital cytology the way of practicing cytology in our laboratories.
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Affiliation(s)
- Catarina Eloy
- Pathology Department, Medical Faculty of University of Porto & Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP), Porto, Portugal
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Chiba, Japan
| | | | | | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Philippe Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
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Tresserra F, Fabra G, Luque O, Castélla M, Gómez C, Fernández-Cid C, Rodríguez I. Validation of digital image slides for diagnosis in cervico-vaginal cytology. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2024; 57:182-189. [PMID: 38971618 DOI: 10.1016/j.patol.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE To test the diagnostic concordance between microscopic (MI) and digital (DG) observation of cervico-vaginal (CV) cytology in a validation study of the technique. METHODS Five cytotechnologists (CT) reviewed 888 routine CV cytology cases from the Cervical Pathology Unit of our center over a 2-week period of time. The cases were first observed by MI and at the end of the day the cases were observed by DG. STATISTICAL ANALYSIS USED Agreement calculated using the Kappa index. RESULTS Most of the diagnoses corresponded to benign (64%) or inflammatory conditions (14%) and 24% corresponded to the intraepithelial lesion or malignancy (ILM) category. The overall kappa coefficient of concordance was strong (0.87). Among the different CTs it was almost perfect in two, strong in two and moderate in one. In 18 cases (10%) there were discrepancies between techniques in the category of ILM. In 10 (56%) cases there was an overdiagnosis in DG and in 8 (44%) an overdiagnosis in MI. Only in two cases, the diagnostic discrepancy exceeded one degree of difference between lesions, and they were ASCUS or AGUS for DG and CIN 2 for MI. CONCLUSIONS In this validation test in which routine cases during a two-week period have been used, observing the cases with both techniques on the same day, we have obtained a strong degree of concordance. The discordances obtained have not been considered relevant.
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Affiliation(s)
- Francisco Tresserra
- Cytology Laboratory, Gynecology Service, Dexeus Women's Health, Dexeus University Hospital, Barcelona, Spain.
| | - Gemma Fabra
- Cytology Laboratory, Gynecology Service, Dexeus Women's Health, Dexeus University Hospital, Barcelona, Spain
| | - Olga Luque
- Cytology Laboratory, Gynecology Service, Dexeus Women's Health, Dexeus University Hospital, Barcelona, Spain
| | - Miriam Castélla
- Cytology Laboratory, Gynecology Service, Dexeus Women's Health, Dexeus University Hospital, Barcelona, Spain
| | - Carla Gómez
- Cytology Laboratory, Gynecology Service, Dexeus Women's Health, Dexeus University Hospital, Barcelona, Spain
| | - Carmen Fernández-Cid
- Cytology Laboratory, Gynecology Service, Dexeus Women's Health, Dexeus University Hospital, Barcelona, Spain
| | - Ignacio Rodríguez
- Epidemiology Unit, Gynecology Service, Dexeus Women's Health, Dexeus University Hospital, Barcelona, Spain
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Jain E, Patel A, Parwani AV, Shafi S, Brar Z, Sharma S, Mohanty SK. Whole Slide Imaging Technology and Its Applications: Current and Emerging Perspectives. Int J Surg Pathol 2024; 32:433-448. [PMID: 37437093 DOI: 10.1177/10668969231185089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Background. Whole slide imaging (WSI) represents a paradigm shift in pathology, serving as a necessary first step for a wide array of digital tools to enter the field. It utilizes virtual microscopy wherein glass slides are converted into digital slides and are viewed by pathologists by automated image analysis. Its impact on pathology workflow, reproducibility, dissemination of educational material, expansion of service to underprivileged areas, and institutional collaboration exemplifies a significant innovative movement. The recent US Food and Drug Administration approval to WSI for its use in primary surgical pathology diagnosis has opened opportunities for wider application of this technology in routine practice. Main Text. The ongoing technological advances in digital scanners, image visualization methods, and the integration of artificial intelligence-derived algorithms with these systems provide avenues to exploit its applications. Its benefits are innumerable such as ease of access through the internet, avoidance of physical storage space, and no risk of deterioration of staining quality or breakage of slides to name a few. Although the benefits of WSI to pathology practices are many, the complexities of implementation remain an obstacle to widespread adoption. Some barriers including the high cost, technical glitches, and most importantly professional hesitation to adopt a new technology have hindered its use in routine pathology. Conclusions. In this review, we summarize the technical aspects of WSI, its applications in diagnostic pathology, training, and research along with future perspectives. It also highlights improved understanding of the current challenges to implementation, as well as the benefits and successes of the technology. WSI provides a golden opportunity for pathologists to guide its evolution, standardization, and implementation to better acquaint them with the key aspects of this technology and its judicial use. Also, implementation of routine digital pathology is an extra step requiring resources which (currently) does not usually result increased efficiency or payment.
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Affiliation(s)
- Ekta Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Ankush Patel
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Anil V Parwani
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Saba Shafi
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Zoya Brar
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
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Chen-Yost HI, Bammert C, Hao W, Heymann JJ, Lin DM, Marotti J, Waraksa-Deutsch T, Huang M, Krishnamurti U, Lin O, Ly A, Moatamed N, Pantanowitz L, Roy-Chowdhuri S. Changing digital and telecytology practices post COVID-19 comparing ASC survey results from 2016 to 2023. J Am Soc Cytopathol 2024; 13:194-204. [PMID: 38582697 DOI: 10.1016/j.jasc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION During the COVID-19 pandemic, the need for digital pathology tools became more urgent. However, there needs to be more knowledge of the use in cytology. We aimed to evaluate current digital cytology practices and attitudes and compare the results with a pre-COVID-19 American Society of Cytopathology (ASC) survey. MATERIALS AND METHODS Fourteen survey questions assessing current attitudes toward digital cytology were developed from a 2016 ASC Digital Pathology Survey. Ten new survey questions were also created to evaluate telecytology use. The survey was e-mailed to ASC members over 6 weeks in 2023. RESULTS A total of 123 individuals responded (116 in 2016). Attitudes toward digital cytology were unchanged; most participants stated digital cytology is beneficial (87% 2023 versus 90% 2016). The percentage of individuals using digital cytology was unchanged (56% in 2016 and 2023). However, telecytology for rapid onsite assessment (ROSE) is now considered the best application (55% 2023 versus 31% 2016). Forty-three institutions reported using digital and telecytology tools; 40% made implementations after 2020; most did not feel that COVID-19 affected digital cytology (56%). Telecytology for ROSE is the most common application now (78%) compared with education (30%) in 2016. Limitations for implementing digital imaging in cytology included inability to focus (38%) and expense (33%). CONCLUSIONS General attitudes toward digital tools by the cytology community have essentially remained the same between 2016 and now. However, telecytology for ROSE is increasingly being used, which supports a need for validation and competency guidelines.
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Affiliation(s)
| | - Catherine Bammert
- School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei Hao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Diana Murro Lin
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jonathan Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Min Huang
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Uma Krishnamurti
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Neda Moatamed
- Department of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, California
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sinchita Roy-Chowdhuri
- Department of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas
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Yamamoto FM, Liano LC, Camilo-Júnior DJ, Xavier-Junior JCC. Digital analyses of nuclear features can help discriminate among non-invasive follicular thyroid neoplasm with papillary-like nuclear features, papillary thyroid carcinoma follicular subtype, and follicular carcinoma in cytological specimens. Cytopathology 2024; 35:98-104. [PMID: 37688777 DOI: 10.1111/cyt.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND As it stands, the diagnosis of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is primarily based on histological analysis. We hypothesised that computerised analysis of nuclear images of cytological specimens could be used to differentiate NIFTP from papillary thyroid carcinoma follicular subtype (PTCFS) and follicular carcinoma (FC), influencing patient management. METHODS We employed a retrospective analytical observational study based on nuclear morphometric variables of cytological material from thyroid nodules classified as PTCFS, NIFTP, or FC. Five cases of each entity were analysed. Cytological slides were photographed, and 1170 cells for each entity were analysed digitally. The captured images were evaluated (blindly) using the ImageJ software package. The morphometric evaluation included area, perimeter, width, height, and circularity. Numerical variables were expressed as mean, median, minimum, and maximum (min; max) values. Kruskal-Wallis and Dunn's tests were used with a 5% significance level. RESULTS Regarding nuclear analysis, all variables differed among the three groups (p < 0.001). Given the interdependence among the variables, these data indicated that nuclear size was greatest in the NIFTP group, followed by FC and PTCFS. DISCUSSION/CONCLUSION Our analysis of the digital images, with a focus on nuclear parameters, found significantly difference among cytological specimens from cases of NIFTP, PTCFS and FC. Thus, this tool has the potential to provide additional information that may help in the diagnosis of NIFTP, even during the preoperative period. Additional studies are needed to create protocols, evaluate the applicability of nuclear morphological and morphometric parameters-focusing on digital pathology-and create algorithms and tools to assist cytopathologists with their diagnostic routines.
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Affiliation(s)
| | - Leonardo Carnevalli Liano
- School of Medicine, Centro Universitário Católico Salesiano Auxilium (Unisalesiano), Araçatuba, Brazil
| | | | - José Cândido Caldeira Xavier-Junior
- School of Medicine, São Paulo State University, Botucatu, Brazil
- School of Medicine, Centro Universitário Católico Salesiano Auxilium (Unisalesiano), Araçatuba, Brazil
- Pathology Institute of Araçatuba, Araçatuba, Brazil
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Bychkov A, Yoshikawa A, Munkhdelger J, Hori T, Fukuoka J. Integrating cytology into routine digital pathology workflow: a 5-year journey. Virchows Arch 2023; 483:555-559. [PMID: 37119336 DOI: 10.1007/s00428-023-03547-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/13/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023]
Abstract
Despite recent advances in digital imaging, the adoption of digital cytology is challenging due to technical limitations. This study describes our 5-year institutional experience with the implementation of digital cytology. The routine cytology workflow included conventional two-step screening by cytotechnologists, followed by sign out by pathologists. We introduced sign out of cytologic cases using a microscopic digital imaging platform operated by cytotechnologists, which allowed for remote review of slides by cytopathologists via video streaming. We also provided cytologic correlation to support the virtual slide-based sign out of histopathological specimens and for a weekly pathology-radiology conference. In addition, positive cytology cases were archived for integration into the laboratory information system and for prospective computational pathology studies. We also summarized lessons learned over the years and outlined our vision for future developments. This unique experience may serve as a role model for other institutions.
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Affiliation(s)
- Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan.
| | - Akira Yoshikawa
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan
| | - Jijgee Munkhdelger
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan
| | - Takashi Hori
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan
| | - Junya Fukuoka
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Caputo A, Macrì L, Gibilisco F, Vatrano S, Taranto C, Occhipinti E, Santamaria F, Arcoria A, Scillieri R, Fraggetta F. Validation of full-remote reporting for cervicovaginal cytology: the Caltagirone-Acireale distributed lab. J Am Soc Cytopathol 2023; 12:378-385. [PMID: 37482510 DOI: 10.1016/j.jasc.2023.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Cervical cancer is the fourth most common cancer in women, and its prevention is based on vaccination and screening. Screening consists of molecular human papillomavirus (HPV) testing and cytologic analysis of cervical smears, which require expensive equipment and the interaction of numerous professionals such as biologists, cytologists, laboratory technicians, and pathologists. MATERIALS AND METHODS We centralize the cervical samples from more than 51 clinics in 1 main laboratory, where automated HPV testing is performed. HPV-positive cases are collected and used to prepare a liquid-based cytology slide, which is stained and immediately scanned. The resulting whole-slide images (WSIs) are immediately available in a remote laboratory where they are examined by experienced cytologists using virtual microscopy. This setup was validated by making each of the 3 readers independently diagnose 506 specimens in random order, using both conventional light microscopy (CLM) and WSIs, with a minimum wash-out period of 3 weeks and with a final discussion for all cases. RESULTS Intraobserver agreement among CLM and WSI ranged from 0.71 to 0.79, and interobserver agreement for the 3 readers compared with the consensus diagnosis was similar for the 2 modes of assessment. Readers subjectively felt confident in their WSI diagnosis for inadequate and negative cases, but less so in other cases. The perceived difficulty was slightly higher in WSI readings. CONCLUSIONS Interobserver agreement in cervicovaginal cytology is moderate and does not vary if the slides are examined conventionally or digitally. Despite higher reported subjective difficulty and lower confidence in the WSI diagnosis, we did not observe a deterioration in diagnostic performance using WSI compared with CLM.
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Affiliation(s)
- Alessandro Caputo
- Department of Pathology, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy; Department of Pathology, Hospital "Gravina e Santo Pietro", Caltagirone, Italy
| | - Luigia Macrì
- Central Cervicovaginal Screening Unit and Center for Cancer Epidemiology and Prevention, Turin, Italy
| | - Fabio Gibilisco
- Department of Pathology, Hospital "Gravina e Santo Pietro", Caltagirone, Italy; Department of Medical and Surgical Sciences and Advanced Technologies, "G. F. Ingrassia", University of Catania, Catania, Italy
| | - Simona Vatrano
- Department of Pathology, Hospital "Gravina e Santo Pietro", Caltagirone, Italy
| | - Chiara Taranto
- Department of Pathology, Hospital "Gravina e Santo Pietro", Caltagirone, Italy
| | | | | | - Angela Arcoria
- Department of Pathology, Hospital "Gravina e Santo Pietro", Caltagirone, Italy
| | | | - Filippo Fraggetta
- Department of Pathology, Hospital "Gravina e Santo Pietro", Caltagirone, Italy.
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Caputo A, L’Imperio V, Merolla F, Girolami I, Leoni E, Mea VD, Pagni F, Fraggetta F. The slow-paced digital evolution of pathology: lights and shadows from a multifaceted board. Pathologica 2023; 115:127-136. [PMID: 37387439 PMCID: PMC10462988 DOI: 10.32074/1591-951x-868] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 07/01/2023] Open
Abstract
Objective The digital revolution in pathology represents an invaluable resource fto optimise costs, reduce the risk of error and improve patient care, even though it is still adopted in a minority of laboratories. Barriers include concerns about initial costs, lack of confidence in using whole slide images for primary diagnosis, and lack of guidance on transition. To address these challenges and develop a programme to facilitate the introduction of digital pathology (DP) in Italian pathology departments, a panel discussion was set up to identify the key points to be considered. Methods On 21 July 2022, an initial conference call was held on Zoom to identify the main issues to be discussed during the face-to-face meeting. The final summit was divided into four different sessions: (I) the definition of DP, (II) practical applications of DP, (III) the use of AI in DP, (IV) DP and education. Results Essential requirements for the implementation of DP are a fully tracked and automated workflow, selection of the appropriate scanner based on the specific needs of each department, and a strong commitment combined with coordinated teamwork (pathologists, technicians, biologists, IT service and industries). This could reduce human error, leading to the application of AI tools for diagnosis, prognosis and prediction. Open challenges are the lack of specific regulations for virtual slide storage and the optimal storage solution for large volumes of slides. Conclusion Teamwork is key to DP transition, including close collaboration with industry. This will ease the transition and help bridge the gap that currently exists between many labs and full digitisation. The ultimate goal is to improve patient care.
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Affiliation(s)
- Alessandro Caputo
- Department of Pathology, Ruggi University Hospital, Salerno, Italy
- Pathology Unit, Gravina Hospital Caltagirone ASP, Catania, Italy
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, University of Milan-Bicocca, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Francesco Merolla
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität
| | - Eleonora Leoni
- Pathology Unit, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Vincenzo Della Mea
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milan-Bicocca, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy
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Rizzo PC, Caputo A, Maddalena E, Caldonazzi N, Girolami I, Dei Tos AP, Scarpa A, Sbaraglia M, Brunelli M, Gobbo S, Marletta S, Pantanowitz L, Della Mea V, Eccher A. Digital pathology world tour. Digit Health 2023; 9:20552076231194551. [PMID: 37654717 PMCID: PMC10467307 DOI: 10.1177/20552076231194551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Objective Digital pathology (DP) is currently in the spotlight and is rapidly gaining ground, even though the history of this field spans decades. Despite great technological progress, the adoption of DP for routine clinical diagnostic use remains limited. Methods A systematic search was conducted in the electronic databases Pubmed-MEDLINE and Embase. Inclusion criteria were all published studies that encompassed any application of DP. Results Of 4888 articles retrieved, 4041 were included. Relevant articles were categorized as "diagnostic" (147/4041, 4%) where DP was utilized for routine diagnostic workflow and "non-diagnostic" (3894/4041, 96%) for all other applications. The "non-diagnostic" articles were further categorized according to DP application including "artificial intelligence" (33%), "education" (5%), "narrative" (17%) for reviews and editorials, and "technical" (45%) for pure research publications. Conclusion This manuscript provided temporal and geographical insight into the global adoption of DP by analyzing the published scientific literature.
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Affiliation(s)
- Paola Chiara Rizzo
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Alessandro Caputo
- Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - Eddy Maddalena
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Nicolò Caldonazzi
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Aldo Scarpa
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Stefano Gobbo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Stefano Marletta
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | | | - Vincenzo Della Mea
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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Caputo A, Pepe L, Fraggetta F. Current State of Cytologic-Histologic Correlation Implementation for North American and International Laboratories. Arch Pathol Lab Med 2023; 147:15-16. [PMID: 36577092 DOI: 10.5858/arpa.2022-0262-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 12/29/2022]
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Sura GH, Doan JV, Thrall MJ. Assessing the quality of cytopathology whole slide imaging for education from archived cases. J Am Soc Cytopathol 2022; 11:313-319. [PMID: 35780060 DOI: 10.1016/j.jasc.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Many institutions have cytopathology case archives for education. Unfortunately, these slides deteriorate over time and have limited accessibility. Whole slide imaging (WSI) can overcome these limitations. However, suboptimal image quality and scanning effort are barriers. MATERIALS AND METHODS We selected 123 slides from cytopathology study sets for WSI scanning at 400x magnification without z-stacking. The Ventana DP 200 scanner and Virtuoso software were used. Slides were scanned in 2 rounds: the first round of slides was prepared for scanning with light cleaning, and the second round was performed only on slides that had unacceptable WSI quality after thorough cleaning. Slides were assessed with a 4-tier grading system created by the authors. Time to scan each slide was recorded. RESULTS Within the first round, 96 of 123 (78%) slides scanned were determined to be of acceptable quality. After the second round of scanning, in total, 118 of 123 (95.9%) slides were determined to be of acceptable quality. The average time needed to scan each slide was 213 seconds. CONCLUSIONS The majority of slides scanned were of acceptable quality in the first round of scanning. After cleaning and rescanning, nearly every slide investigated was of acceptable quality. The primary objective is to provide other institutions that may be considering a similar project a benchmark so that they know what to expect in terms of slide scan success rate and the amount of time needed to digitize slides for educational archiving. This pilot study demonstrates the feasibility of using WSI for cytology education cases.
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Affiliation(s)
- Gloria H Sura
- Department of Pathology and Genomic Medicine, Houston Methodist, Houston, Texas.
| | - James V Doan
- Department of Pathology and Genomic Medicine, Houston Methodist, Houston, Texas
| | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist, Houston, Texas
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Kim D, Burkhardt R, Alperstein SA, Gokozan HN, Goyal A, Heymann JJ, Patel A, Siddiqui MT. Evaluating the role of Z-stack to improve the morphologic evaluation of urine cytology whole slide images for high-grade urothelial carcinoma: Results and review of a pilot study. Cancer Cytopathol 2022; 130:630-639. [PMID: 35584402 DOI: 10.1002/cncy.22595] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Whole slide imaging (WSI) adoption has been slower in cytopathology due, in part, to challenges in multifocal plane scanning on 3-dimensional cell clusters. ThinPrep and other liquid-based preparations may alleviate the issue by reducing clusters in a concentrated area. This study investigates the use of Z-stacked images for diagnostic assessment and the experience of evaluating urine ThinPrep WSI. METHODS Thirty ThinPrep urine cases of high-grade urothelial carcinoma (n = 22) and cases of negative for high-grade urothelial carcinoma (n = 8) were included. Slides were scanned at 40× magnification without Z-stack and with Z-stack at 3 layers, 1 μm each. Six cytopathologists and 1 cytotechnologist evaluated the cases in 2 rounds with a 2-week wash-out period in a blinded manner. A Cohen's Kappa (CK) calculated concordance rates. A survey after each round evaluated participant experience. RESULTS CK with the original report ranged from 0.606 to 1.0 (P < .05) without Z-stack and 0.533 to 1.0 (P < .05) with Z-stack both indicating substantial-to-perfect concordance. For both rounds, interobserver CK was moderate-to-perfect (0.417-1.0, P < .05). Intraobserver CK was 0.697-1.0 (P < 0.05), indicating substantial to perfect concordance. The average scan time and file size for slides without Z-stack and with Z-stack are 6.27 minute/0.827 GB and 14.06 minute/2.650 GB, respectively. Surveys demonstrated a range in comfort and use with slightly more favorable opinions for Z-stacked cases. CONCLUSIONS Z-stack images provide minimal diagnostic benefit for urine ThinPrep WSI. In addition, Z-stacked urine WSI does not justify the prolonged scan times and larger storage needs compared to those without Z-stack.
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Affiliation(s)
- David Kim
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Robert Burkhardt
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Susan A Alperstein
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Hamza N Gokozan
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Abha Goyal
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Jonas J Heymann
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Ami Patel
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Momin T Siddiqui
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
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13
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Salama AM, Hanna MG, Giri D, Kezlarian B, Jean MH, Lin O, Vallejo C, Brogi E, Edelweiss M. Digital validation of breast biomarkers (ER, PR, AR, and HER2) in cytology specimens using three different scanners. Mod Pathol 2022; 35:52-59. [PMID: 34518629 PMCID: PMC8702445 DOI: 10.1038/s41379-021-00908-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
Progression in digital pathology has yielded new opportunities for a remote work environment. We evaluated the utility of digital review of breast cancer immunohistochemical prognostic markers (IHC) using whole slide images (WSI) from formalin fixed paraffin embedded (FFPE) cytology cell block specimens (CB) using three different scanners.CB from 20 patients with breast cancer diagnosis and available IHC were included. Glass slides including 20 Hematoxylin and eosin (H&E), 20 Estrogen Receptor (ER), 20 Progesterone Receptor (PR), 16 Androgen Receptor (AR), and 20 Human Epidermal Growth Factor Receptor 2 (HER2) were scanned on 3 different scanners. Four breast pathologists reviewed the WSI and recorded their semi-quantitative scoring for each marker. Kappa concordance was defined as complete agreement between glass/digital pairs. Discordances between microscopic and digital reads were classified as a major when a clinically relevant change was seen. Minor discordances were defined as differences in scoring percentages/staining pattern that would not have resulted in a clinical implication. Scanner precision was tabulated according to the success rate of each scan on all three scanners.In total, we had 228 paired glass/digital IHC reads on all 3 scanners. There was strong concordance kappa ≥0.85 for all pathologists when comparing paired microscopic/digital reads. Strong concordance (kappa ≥0.86) was also seen when comparing reads between scanners.Twenty-three percent of the WSI required rescanning due to barcode detection failures, 14% due to tissue detection failures, and 2% due to focus issues. Scanner 1 had the best average precision of 92%. HER2 IHC had the lowest intra-scanner precision (64%) among all stains.This study is the first to address the utility of WSI in breast cancer IHC in CB and to validate its reporting using 3 different scanners. Digital images are reliable for breast IHC assessment in CB and offer similar reproducibility to microscope reads.
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Affiliation(s)
- Abeer M Salama
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Dilip Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Brie Kezlarian
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Marc-Henri Jean
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Christina Vallejo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Marcia Edelweiss
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
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Eloy C, Vale J, Curado M, Polónia A, Campelos S, Caramelo A, Sousa R, Sobrinho-Simões M. Digital Pathology Workflow Implementation at IPATIMUP. Diagnostics (Basel) 2021; 11:diagnostics11112111. [PMID: 34829458 PMCID: PMC8620597 DOI: 10.3390/diagnostics11112111] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/29/2022] Open
Abstract
The advantages of the digital methodology are well known. In this paper, we provide a detailed description of the process for the digital transformation of the pathology laboratory at IPATIMUP, the major modifications that operate throughout the processing pipeline, and the advantages of its implementation. The model of digital workflow implementation at IPATIMUP demonstrates that careful planning and adoption of simple measures related to time, space, and sample management can be adopted by any pathology laboratory to achieve higher quality and easy digital transformation.
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Affiliation(s)
- Catarina Eloy
- Pathology Laboratory, Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.V.); (M.C.); (A.P.); (S.C.); (A.C.); (R.S.); (M.S.-S.)
- i3S—Instituto de Investigação e Inovação em Saúde & Pathology Department of Medical Faculty, University of Porto, 4200-135 Porto, Portugal
- Correspondence:
| | - João Vale
- Pathology Laboratory, Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.V.); (M.C.); (A.P.); (S.C.); (A.C.); (R.S.); (M.S.-S.)
| | - Mónica Curado
- Pathology Laboratory, Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.V.); (M.C.); (A.P.); (S.C.); (A.C.); (R.S.); (M.S.-S.)
| | - António Polónia
- Pathology Laboratory, Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.V.); (M.C.); (A.P.); (S.C.); (A.C.); (R.S.); (M.S.-S.)
- i3S—Instituto de Investigação e Inovação em Saúde & Pathology Department of Medical Faculty, University of Porto, 4200-135 Porto, Portugal
| | - Sofia Campelos
- Pathology Laboratory, Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.V.); (M.C.); (A.P.); (S.C.); (A.C.); (R.S.); (M.S.-S.)
| | - Ana Caramelo
- Pathology Laboratory, Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.V.); (M.C.); (A.P.); (S.C.); (A.C.); (R.S.); (M.S.-S.)
| | - Rui Sousa
- Pathology Laboratory, Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.V.); (M.C.); (A.P.); (S.C.); (A.C.); (R.S.); (M.S.-S.)
| | - Manuel Sobrinho-Simões
- Pathology Laboratory, Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.V.); (M.C.); (A.P.); (S.C.); (A.C.); (R.S.); (M.S.-S.)
- i3S—Instituto de Investigação e Inovação em Saúde & Pathology Department of Medical Faculty, University of Porto, 4200-135 Porto, Portugal
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Li N, Lv T, Sun Y, Liu X, Zeng S, Lv X. High throughput slanted scanning whole slide imaging system for digital pathology. JOURNAL OF BIOPHOTONICS 2021; 14:e202000499. [PMID: 33638313 DOI: 10.1002/jbio.202000499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
In whole slide imaging (WSI), normally only a one layer imaging of the slide is performed. Autofocus at multiple positions is usually required. But defocus blur still exists due to tissue folding or specimen thickness. Repeated Z-stack scan be applied here, which, however, is too time consuming. Here, a high throughput slanted scanning WSI system is reported. In this system, the slide surface was slanted 1° relative to the focal plane. Thus, the focal plane spanned multiple layers of the sample. By moving the slide, multi-layer image data of the sample can be acquired simultaneously at a time frame comparable to conventional 1-layer imaging. With image fusion, defocus blur can be avoided. High quality and fast imaging of both cytological and histological slide specimens was demonstrated without applying aberration correction. The system can be a highly efficient way for the application of WSI in digital pathology.
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Affiliation(s)
- Ning Li
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Science, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Lv
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Science, Huazhong University of Science and Technology, Wuhan, China
| | - Yulin Sun
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Science, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuli Liu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Science, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoqun Zeng
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Science, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohua Lv
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Science, Huazhong University of Science and Technology, Wuhan, China
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16
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Su F, Sun Y, Hu Y, Yuan P, Wang X, Wang Q, Li J, Ji JF. Development and validation of a deep learning system for ascites cytopathology interpretation. Gastric Cancer 2020; 23:1041-1050. [PMID: 32500456 DOI: 10.1007/s10120-020-01093-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early diagnosis of Peritoneal metastasis (PM) is clinically significant regarding optimal treatment selection and avoidance of unnecessary surgical procedures. Cytopathology plays an important role in early screening of PM. We aimed to develop a deep learning (DL) system to achieve intelligent cytopathology interpretation, especially in ascites cytopathology. METHODS The original ascites cytopathology image dataset consists of 139 patients' original hematoxylin-eosin (HE) and Papanicolaou (PAP) Staining images. DL system was developed using transfer learning (TL) to achieve cell detection and classification. Pre-trained alexnet, vgg16, goolenet, resnet18 and resnet50 models were studied. Cell detection dataset consists of 176 cropped images with 6573 annotated cell bounding boxes. Cell classification data set consists of 487 cropped images with 18,558 and 6089 annotated malignant and benign cells in total, respectively. RESULTS We established a novel ascites cytopathology image dataset and achieved automatically cell detection and classification. DetectionNet based on Faster R-CNN using pre-trained resnet18 achieved cell detection with 87.22% of cells' Intersection of Union (IoU) bigger than the threshold of 0.5. The mean average precision (mAP) was 0.8316. The ClassificationNet based on resnet50 achieved the greatest performance in cell classification with AUC = 0.8851, Precision = 96.80%, FNR = 4.73%. The DL system integrating the separately trained DetectionNet and Classificationnet showed great performance in the cytopathology image interpretation. CONCLUSIONS We demonstrate that the integration of DL can improve the efficiency of healthcare. The DL system we developed using TL techniques achieved accurate cytopathology interpretation, and had great potential to be integrated into clinician workflow.
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Affiliation(s)
- Feng Su
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Yu Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yajie Hu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Peijiang Yuan
- School of Mechanical Engineering and Automation, Beihang University, Beijing, 100191, China
| | - Xinyu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Qian Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianmin Li
- Institute for Artificial Intelligence, the State Key Laboratory of Intelligence Technology and Systems, Beijing National Research Center for Information Science and Technology, Department of Computer Science and Technology, Tsinghua University, Hai Dian District, Beijing, 100084, China.
| | - Jia-Fu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University, Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
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Jiang XS, Madrigal E. Innovations: Innovating together while social distancing. Cancer Cytopathol 2020; 129:99-101. [PMID: 33058521 PMCID: PMC7675745 DOI: 10.1002/cncy.22325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/07/2022]
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18
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Chiou PZ. Learning cytology in times of pandemic: an educational institutional experience with remote teaching. J Am Soc Cytopathol 2020; 9:579-585. [PMID: 32622857 PMCID: PMC7283062 DOI: 10.1016/j.jasc.2020.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 01/24/2023]
Abstract
Introduction As the coronavirus pandemic swept across national and state borders, institutions of higher learning, including cytology, began closing campuses and moving instruction online. We have described a method of remotely teaching cytology in our institution, including using the telecytology concept used with rapid onsite evaluation and remote conferencing and educational tools to conduct eCytology learning. This is a cost-effective method to transition a traditional in-classroom program into online teaching for cytology. It can also be implemented quickly. Materials and methods In March 2020, our cytology program developed a method for teaching cytology remotely. The distance-learning teaching method included the use of remote conferencing (Zoom platform) and learning management platforms (Canvas) to present lectures and administer tests. Remote multihead sessions were conducted by adapting the telecytology rapid onsite evaluation concept, which attaches a mobile device to the microscope to transmit live video to remote learners. Results When asked about their experience with online learning, the students had responded positively. All the students indicated a willingness to attend classes remotely in the future, even when the traditional in-classroom learning option is available. Conclusions We have presented a method for educating students remotely using existing technology that is affordable and can be implemented quickly by nearly all cytology education programs. Our experience with teaching eCytology in times of pandemic can serve as a cost-effective way to transition a traditionally in-classroom program, into an online teaching in cytology. It can also be implemented quickly. Remote multi-head sessions, conducted by adapting the tele-cytology ROSE concept with an attached mobile device to the microscope, is an effective approach to distance learning in times of social distancing and is a promising tool for the future cytology education. The students, when asked about their experiences with online learning, responded positively.
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Affiliation(s)
- Paul Z Chiou
- Clinical Laboratory and Medical Imaging, Rutgers Biomedical and Health Sciences, Newark, New Jersey.
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19
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Eccher A, Girolami I. Current state of whole slide imaging use in cytopathology: Pros and pitfalls. Cytopathology 2020; 31:372-378. [PMID: 32020667 DOI: 10.1111/cyt.12806] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/17/2023]
Abstract
Whole slide imaging (WSI) allows generation of large whole slide images and their navigation with zoom in and out like a true virtual microscope. It has become widely used in surgical pathology for many purposes, such as education and training, research activity, teleconsultation, and primary diagnosis. However, in cytopathology, the use of WSI has been lagging behind histology, mainly due to the cytological specimen's characteristics, as groups of cells of different thickness are distributed throughout the slide. To allow the same focusing capability of light microscope, slides have to be scanned at multiple focal planes, at the cost of longer scan times and larger file size. These are the main technical pitfalls of WSI for cytopathology, partly overcome by solutions like liquid-based preparations. Validation studies for the use in primary diagnosis are less numerous and more heterogeneous than in surgical pathology. WSI has been proved effective for training students and successfully used in proficiency testing, allowing the creation of digital cytology atlases. Longer scan times are also a barrier for use in rapid on-site evaluation, but WSI retains its advantages of easy sharing of images for consultation, multiple simultaneous viewing in different locations, the possibility of unlimited annotations and easy integration with medical records. Moreover, digital slides set the laboratory free from reliance on a physical glass slide, with no more concern of fading of stain or slide breakage. Costs are still a problem for small institutions, but WSI can also represent the beginning of a more efficient way of working.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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20
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A small-scale experimental study of breast FNA consultation on the internet using Panoptiq. J Am Soc Cytopathol 2019; 8:175-181. [PMID: 31235440 DOI: 10.1016/j.jasc.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To test the potential for cytopathology consultation using Panoptiq (ViewsIQ, Richmond, BC, Canada; this is a new type of whole-slide image that is made manually and incorporates video content), we investigated its application in the cytopathological diagnosis of cases that were difficult to diagnose by breast fine-needle aspiration (FNA). MATERIALS AND METHODS Panoptiq files were created from liquid-based cytology slides prepared by the BD CytoRich Red (BD, Franklin Lakes, NJ) method. The slides were prepared from 23 consecutive samples of breast FNA that had been diagnosed as atypical or suspicious by the Hokkaido Cancer Center, Hokkaido, Japan. Nine volunteer reviewers, who were provided with the URL of the Panoptiq file, the original cytopathological diagnosis, and the clinical information, were asked to classify the cytopathological diagnosis of each case into 4 diagnostic categories (benign, atypical, suspicious, or malignant). We examined the consultation benefit (CB)-how much closer the reviewer's cytopathology diagnosis came to the final histopathological diagnosis than the original cytodiagnosis. The CB scoring system was decided in advance. RESULTS All 9 reviewers showed a positive total CB score and 2 reviewers showed a significantly higher CB score (Wilcoxon's signed rank test). The representative diagnosis (ie, the most frequently rendered diagnosis in each case) also showed a significant CB. CONCLUSIONS Our small-scale experimental study, in which Panoptiq was used in the diagnosis of cases that were difficult to diagnose definitively by breast FNA, revealed a positive CB score by every reviewer and the representative diagnosis showed a significant CB. The study suggests that Panoptiq could be used for cytopathology consultation.
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21
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Van Es SL. Digital pathology: semper ad meliora. Pathology 2018; 51:1-10. [PMID: 30522785 DOI: 10.1016/j.pathol.2018.10.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 02/07/2023]
Abstract
This review is an evidence-based summary of digital pathology: past, present and future. It discusses digital surgical pathology and the cytopathology digitisation challenge as well as the performance of digital histopathology and cytopathology as a diagnostic tool, particularly in contrast to user perceptions. Time and cost efficiency of digital pathology, learning curves, education and quality assurance, with the importance of validation of systems, is emphasised. The review concludes with a discussion of digital pathology as a source of 'big data' and where this might lead pathologists in the digital pathology future.
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Affiliation(s)
- Simone L Van Es
- Department of Pathology, School of Medical Sciences, UNSW, Sydney, NSW, Australia.
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22
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Van Es SL, Greaves J, Gay S, Ross J, Holzhauser D, Badrick T. Constant Quest for Quality: Digital Cytopathology. J Pathol Inform 2018; 9:13. [PMID: 29721361 PMCID: PMC5907455 DOI: 10.4103/jpi.jpi_6_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 01/20/2023] Open
Abstract
Background: Special consideration should be given when creating and selecting cytopathology specimens for digitization to maximize quality. Advances in scanning and viewing technology can also improve whole-slide imaging (WSI) output quality. Methods: Accumulated laboratory experience with digitization of glass cytopathology slides was collected. Results: This paper describes characteristics of a cytopathology glass slide that can reduce quality on resulting WSI. Important points in the glass cytopathology slide selection process, preparation, scanning, and WSI-editing process that will maximize the quality of the resulting acquired digital image are covered. The paper outlines scanning solutions which have potential to predict issues with a glass cytopathology slide before image acquisition, allowing for adjustment of the scanning approach. WSI viewing solutions that better simulate the traditional microscope experience are also discussed. Conclusion: In addition to taking advantage of technical advances, practical steps can taken to maximize quality of cytopathology WSI.
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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.,The Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd, St Leonards, NSW 2065, Australia.,The Royal College of Pathologists of Australasia, Surry Hills, NSW 2010, Australia
| | - Janelle Greaves
- The Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd, St Leonards, NSW 2065, Australia
| | - Stephanie Gay
- The Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd, St Leonards, NSW 2065, Australia
| | - Jennifer Ross
- The Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd, St Leonards, NSW 2065, Australia
| | - Derek Holzhauser
- The Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd, St Leonards, NSW 2065, Australia
| | - Tony Badrick
- The Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd, St Leonards, NSW 2065, Australia
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23
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Van Es SL. Why is digital pathology in cytopathology lagging behind surgical pathology? Cancer Cytopathol 2017; 125:731. [PMID: 28657657 DOI: 10.1002/cncy.21889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Simone L Van Es
- Department of Pathology School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
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24
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Hanna MG, Pantanowitz L. Reply to Why is digital pathology in cytopathology lagging behind surgical pathology? Cancer Cytopathol 2017; 125:732. [PMID: 28657675 DOI: 10.1002/cncy.21890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Matthew G Hanna
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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