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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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Kim D, Sundling KE, Virk R, Thrall MJ, Alperstein S, Bui MM, Chen-Yost H, Donnelly AD, Lin O, Liu X, Madrigal E, Michelow P, Schmitt FC, Vielh PR, Zakowski MF, Parwani AV, Jenkins E, Siddiqui MT, Pantanowitz L, Li Z. Digital cytology part 1: digital cytology implementation for practice: a concept paper with review and recommendations from the American Society of Cytopathology Digital Cytology Task Force. J Am Soc Cytopathol 2024; 13:86-96. [PMID: 38158316 DOI: 10.1016/j.jasc.2023.11.006] [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: 11/06/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
Digital cytology and artificial intelligence (AI) are gaining greater adoption in the cytopathology laboratory. However, peer-reviewed real-world data and literature are lacking regarding the current clinical landscape. The American Society of Cytopathology in conjunction with the International Academy of Cytology and the Digital Pathology Association established a special task force comprising 20 members with expertise and/or interest in digital cytology. The aim of the group was to investigate the feasibility of incorporating digital cytology, specifically cytology whole slide scanning and AI applications, into the workflow of the laboratory. In turn, the impact on cytopathologists, cytologists (cytotechnologists), and cytology departments were also assessed. The task force reviewed existing literature on digital cytology, conducted a worldwide survey, and held a virtual roundtable discussion on digital cytology and AI with multiple industry corporate representatives. This white paper, presented in 2 parts, summarizes the current state of digital cytology and AI practice in global cytology practice. Part 1 of the white paper presented herein is a review and offers best practice recommendations for incorporating digital cytology into practice. Part 2 of the white paper provides a comprehensive review of AI in cytology practice along with best practice recommendations and legal considerations. Additionally, the results of a global survey regarding digital cytology are highlighted.
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Affiliation(s)
- David Kim
- Department of Pathology & Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kaitlin E Sundling
- The Wisconsin State Laboratory of Hygiene and Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Renu Virk
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Susan Alperstein
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Marilyn M Bui
- The Department of Pathology, Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Amber D Donnelly
- Diagnostic Cytology Education, University of Nebraska Medical Center, College of Allied Health Professions, Omaha, Nebraska
| | - Oscar Lin
- Department of Pathology & Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Xiaoying Liu
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Emilio Madrigal
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Pamela Michelow
- Division of Anatomical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Pathology, National Health Laboratory Services, Johannesburg, South Africa
| | - Fernando C Schmitt
- Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
| | - Philippe R Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
| | | | - Anil V Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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de Velozo G, Cordeiro J, Sousa J, Holanda AC, Pessoa G, Porfírio M, Távora F. Comparison of glass and digital slides for cervical cytopathology screening and interpretation. Diagn Cytopathol 2023; 51:735-743. [PMID: 37587842 DOI: 10.1002/dc.25209] [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: 05/22/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
Cervical cancer is the second most common form of cancer and a leading cause of premature death among women aged 15 to 44 worldwide. In Brazil, there is a high prevalence of infection by the human papillomavirus - HPV. Digital pathology optimizes time and space for reading cervicovaginal cytology slides. We evaluated the feasibility of using whole slide images (WSI) for the routine interpretation of cytology exams. A total of 99 cases of vaginal cytology were selected from a reference laboratory in Northeastern Brazil. Three cytotechnicians participated in the study. Cellular atypia was the one that most presented concordance values. Two observers almost perfectly agreed (k = 0.86 and k = 0.84, respectively) on the negative diagnoses. The performance of the evaluators for NILM (negative for intraepithelial lesion and malignancy) showed high reproducibility and sensitivity in the digital slides, mainly between evaluators A and C. In contrast, the microbiology group showed disagreement between the diagnoses by digital slides and the standard- gold. The concordance between the digital diagnoses and the gold standard for ASCUS was 89%. In the inflammatory category, Spearman's test showed similar results between raters A, B, and C (rs = 0.47, rs = 0.41, and rs = 0.47, respectively). This study reports the diagnostic validation using digital slides in view of the need to optimize the cytology visualization process. Our experience shows good diagnostic agreement between digital and optical microscopy in several analyzed categories, but mainly in relation to cellular atypia and inflammatory processes.
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Affiliation(s)
| | - Juliana Cordeiro
- Federal University of Ceará, Argos Patologia Laboratory, Fortaleza, Brazil
| | | | | | | | - Mônica Porfírio
- Federal University of Ceará, Argos Patologia Laboratory, Fortaleza, Brazil
| | - Fábio Távora
- Federal University of Ceará, Argos Patologia Laboratory, Fortaleza, Brazil
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Chong Y, Hong SA, Oh HK, Jung SJ, Kim BS, Jeong JY, Lee HC, Gong G. Diagnostic proficiency test using digital cytopathology and comparative assessment of whole slide images of cytologic samples for quality assurance program in Korea. J Pathol Transl Med 2023; 57:251-264. [PMID: 37608552 PMCID: PMC10518242 DOI: 10.4132/jptm.2023.07.17] [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: 05/24/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The Korean Society for Cytopathology introduced a digital proficiency test (PT) in 2021. However, many doubtful opinions remain on whether digitally scanned images can satisfactorily present subtle differences in the nuclear features and chromatin patterns of cytological samples. METHODS We prepared 30 whole-slide images (WSIs) from the conventional PT archive by a selection process for digital PT. Digital and conventional PT were performed in parallel for volunteer institutes, and the results were compared using feedback. To assess the quality of cytological assessment WSIs, 12 slides were collected and scanned using five different scanners, with four cytopathologists evaluating image quality through a questionnaire. RESULTS Among the 215 institutes, 108 and 107 participated in glass and digital PT, respectively. No significant difference was noted in category C (major discordance), although the number of discordant cases was slightly higher in the digital PT group. Leica, 3DHistech Pannoramic 250 Flash, and Hamamatsu NanoZoomer 360 systems showed comparable results in terms of image quality, feature presentation, and error rates for most cytological samples. Overall satisfaction was observed with the general convenience and image quality of digital PT. CONCLUSIONS As three-dimensional clusters are common and nuclear/chromatin features are critical for cytological interpretation, careful selection of scanners and optimal conditions are mandatory for the successful establishment of digital quality assurance programs in cytology.
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Affiliation(s)
- Yosep Chong
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soon Auck Hong
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hoon Kyu Oh
- Department of Pathology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Soo Jin Jung
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea
| | - Bo-Sung Kim
- Department of Pathology, Green Cross Laboratories, Yongin, Korea
| | - Ji Yun Jeong
- Department of Pathology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho-Chang Lee
- Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - The Committee of Quality Improvement of Korean Society for Cytopathology
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Pathology, Daegu Catholic University School of Medicine, Daegu, Korea
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea
- Department of Pathology, Green Cross Laboratories, Yongin, Korea
- Department of Pathology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Jiang P, Liu J, Luo Q, Pang B, Xiao D, Cao D. Development of Automatic Portable Pathology Scanner and Its Evaluation for Clinical Practice. J Digit Imaging 2023; 36:1110-1122. [PMID: 36604365 PMCID: PMC10287606 DOI: 10.1007/s10278-022-00761-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/01/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
Digital pathological scanners transform traditional glass slides into whole slide images (WSIs), which significantly improve the efficiency of pathological diagnosis and promote the development of digital pathology. However, the huge economic burden limits the spread and application of general WSI scanners in relatively remote and backward regions. In this paper, we develop an automatic portable cytopathology scanner based on mobile internet, Landing-Smart, to avert the above problems. Landing-Smart is a tiny device with a size of 208 mm × 107 mm × 104 mm and a weight of 1.8 kg, which integrates four main components including a smartphone, a glass slide carrier, an electric controller, and an optical imaging unit. By leveraging a simple optical imaging unit to substitute the sophisticated but complex conventional light microscope, the cost of Landing-Smart is less than $3000, much cheaper than general WSI scanners. On the one hand, Landing-Smart utilizes the built-in camera of the smartphone to acquire field of views (FoVs) in the section one by one. On the other hand, it uploads the images to the cloud server in real time via mobile internet, where the image processing and stitching method is implemented to generate the WSI of the cytological sample. The practical assessment of 209 cervical cytological specimens has demonstrated that Landing-Smart is comparable to general digital scanners in cytopathology diagnosis. Landing-Smart provides an effective tool for preliminary cytological screening in underdeveloped areas.
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Affiliation(s)
- Peng Jiang
- Institute of Artificial Intelligence, National Engineering Research Center for Multimedia Software, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Juan Liu
- Institute of Artificial Intelligence, National Engineering Research Center for Multimedia Software, School of Computer Science, Wuhan University, Wuhan, 430072, China.
| | - Qiang Luo
- Landing Artificial Intelligence Center for Pathological Diagnosis, Wuhan, China
| | - Baochuan Pang
- Landing Artificial Intelligence Center for Pathological Diagnosis, Wuhan, China
| | - Di Xiao
- Landing Artificial Intelligence Center for Pathological Diagnosis, Wuhan, China
| | - Dehua Cao
- Landing Artificial Intelligence Center for Pathological Diagnosis, Wuhan, China
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Vassilakos P, Clarke H, Murtas M, Stegmüller T, Wisniak A, Akhoundova F, Sando Z, Orock GE, Sormani J, Thiran JP, Petignat P. Telecytologic diagnosis of cervical smears for triage of self-sampled human papillomavirus-positive women in a resource-limited setting: concept development before implementation. J Am Soc Cytopathol 2023; 12:170-180. [PMID: 36922319 DOI: 10.1016/j.jasc.2023.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/12/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Cytology is an option for triaging human papillomavirus (HPV)-positive women. The interpretation of cytologic slides requires expertise and financial resources that are not always available in resource-limited settings. A solution could be offered by manual preparation and digitization of slides on site for real-time remote cytologic diagnosis by specialists. In the present study, we evaluated the operational feasibility and cost of manual preparation and digitization of thin-layer slides and the diagnostic accuracy of screening with virtual microscopy. MATERIALS AND METHODS Operational feasibility was evaluated on 30 cervical samples obtained during colposcopy. The simplicity of the process and cellularity and quality of digitized thin-layer slides were evaluated. The diagnostic accuracy of digital versus glass slides to detect cervical intraepithelial neoplasia grade 2 or worse was assessed using a cohort of 264 HPV-positive Cameroonian women aged 30 to 49 years. The histologic results served as the reference standard. RESULTS Manual preparation was found to be feasible and economically viable. The quality characteristics of the digital slides were satisfactory, and the mean cellularity was 6078 squamous cells per slide. When using the atypical squamous cells of undetermined significance or worse threshold for positivity, the diagnostic performance of screening digital slides was not significantly different statistically compared with the same set of slides screened using a light microscope (P = 0.26). CONCLUSIONS We have developed an innovative triage concept for HPV-positive women. A quality-ensured telecytologic diagnosis could be an effective solution in areas with a shortage of specialists, applying a same day "test-triage-treat" approach. Our results warrant further on-site clinical validation in a large prospective screening trial.
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Affiliation(s)
- Pierre Vassilakos
- Gynecology Division, Geneva University Hospital, Geneva, Switzerland; Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Holly Clarke
- Gynecology Division, Geneva University Hospital, Geneva, Switzerland.
| | - Micol Murtas
- Gynecology Division, Geneva University Hospital, Geneva, Switzerland
| | - Thomas Stegmüller
- Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland
| | - Ania Wisniak
- Gynecology Division, Geneva University Hospital, Geneva, Switzerland
| | - Farida Akhoundova
- Gynecology Division, Geneva University Hospital, Geneva, Switzerland
| | - Zacharie Sando
- Gyneco-Obstetrics and Paediatric Hospital, Yaoundé, Cameroon
| | | | - Jessica Sormani
- Gynecology Division, Geneva University Hospital, Geneva, Switzerland
| | | | - Patrick Petignat
- Gynecology Division, Geneva University Hospital, Geneva, Switzerland
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Antonini P, Santonicco N, Pantanowitz L, Girolami I, Rizzo PC, Brunelli M, Bellevicine C, Vigliar E, Negri G, Troncone G, Fadda G, Parwani A, Marletta S, Eccher A. Relevance of the College of American Pathologists guideline for validating whole slide imaging for diagnostic purposes to cytopathology. Cytopathology 2023; 34:5-14. [PMID: 36082410 PMCID: PMC10087327 DOI: 10.1111/cyt.13178] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022]
Abstract
Whole slide imaging (WSI) allows pathologists to view virtual versions of slides on computer monitors. With increasing adoption of digital pathology, laboratories have begun to validate their WSI systems for diagnostic purposes according to reference guidelines. Among these the College of American Pathologists (CAP) guideline includes three strong recommendations (SRs) and nine good practice statements (GPSs). To date, the application of WSI to cytopathology has been beyond the scope of the CAP guideline due to limited evidence. Herein we systematically reviewed the published literature on WSI validation studies in cytology. A systematic search was carried out in PubMed-MEDLINE and Embase databases up to November 2021 to identify all publications regarding validation of WSI in cytology. Each article was reviewed to determine if SRs and/or GPSs recommended by the CAP guideline were adequately satisfied. Of 3963 retrieved articles, 25 were included. Only 4/25 studies (16%) satisfied all three SRs, with only one publication (1/25, 4%) fulfilling all three SRs and nine GPSs. Lack of a suitable validation dataset was the main missing SR (16/25, 64%) and less than a third of the studies reported intra-observer variability data (7/25, 28%). Whilst the CAP guideline for WSI validation in clinical practice helped the widespread adoption of digital pathology, more evidence is required to routinely employ WSI for diagnostic purposes in cytopathology practice. More dedicated validation studies satisfying all SRs and/or GPSs recommended by the CAP are needed to help expedite the use of WSI for primary diagnosis in cytopathology.
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Affiliation(s)
- Pietro Antonini
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Nicola Santonicco
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Paola Chiara Rizzo
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | | | - Elena Vigliar
- Public Health, University of Naples Federico II, Naples, Italy
| | - Giovanni Negri
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | | | - Guido Fadda
- Section of Pathological Anatomy, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Anil Parwani
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Stefano Marletta
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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Hortsch M, Koney NKK, Oommen AM, Yohannan DG, Li Y, de Melo Leite ACR, Girão-Carmona VCC. Virtual Microscopy Goes Global: The Images Are Virtual and the Problems Are Real. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1421:79-124. [PMID: 37524985 DOI: 10.1007/978-3-031-30379-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
For the last two centuries, the scholarly education of histology and pathology has been based on technology, initially on the availability of low-cost, high-quality light microscopes, and more recently on the introduction of computers and e-learning approaches to biomedical education. Consequently, virtual microscopy (VM) is replacing glass slides and the traditional light microscope as the main instruments of instruction in histology and pathology laboratories. However, as with most educational changes, there are advantages and disadvantages associated with a new technology. The use of VM for the teaching of histology and pathology requires an extensive infrastructure and the availability of computing devices to all learners, both posing a considerable financial strain on schools and students. Furthermore, there may be valid reasons for practicing healthcare professionals to maintain competency in using light microscopes. In addition, some educators may be reluctant to embrace new technologies. These are some of the reasons why the introduction of VM as an integral part of histology and pathology instruction has been globally uneven. This paper compares the teaching of histology and pathology using traditional or VM in five different countries and their adjacent regions, representing developed, as well as developing areas of the globe. We identify general and local roadblocks to the introduction of this still-emerging didactic technology and outline solutions for overcoming these barriers.
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Affiliation(s)
- Michael Hortsch
- Departments of Cell and Developmental Biology and of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Nii Koney-Kwaku Koney
- Department of Anatomy, University of Ghana Medical School, University of Ghana, Korle Bu, Accra, Ghana
| | - Aswathy Maria Oommen
- Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Doris George Yohannan
- Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Yan Li
- Department of Anatomy, Histology and Embryology, Fudan University, Shanghai, China
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Bouyssoux A, Jarnouen K, Lallement L, Fezzani R, Olivo-Marin JC. Automated staining analysis in digital cytopathology and applications. Cytometry A 2022; 101:1068-1083. [PMID: 35614552 DOI: 10.1002/cyto.a.24659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/25/2022] [Accepted: 05/16/2022] [Indexed: 01/27/2023]
Abstract
The progress of digital pathology in recent years has been an opportunity for the development of automated image analysis algorithms for quantitative measurements and computer aided diagnosis. With those new methods comes the need for high staining quality and reproducibility, as image analysis tools are typically more sensible to slight stain variations than trained pathologists. This article presents a method for the automated analysis of cytology slides stains specifically adapted to the challenges encountered in digital cytopathology. In particular, the variety of cell types in cytology slides, the 3D distribution of the cellular material, the presence of superposed cells and the need for independent analysis of sub-cellular compartments are addressed. The proposed method is applied to the quantification of staining variations for quality control, resulting from changes in the staining protocol such as reagent immersion time or a reagent change. Another demonstrated application is the selection of staining protocol parameters that maximize the visible details in nucleus. Finally the analysis pipeline is also used to compare different stain normalization algorithms on digital cytology slides. Code available at: https://gitlab.com/vitadx/articles/automated_staining_analysis.
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Affiliation(s)
- Alexandre Bouyssoux
- BioImage Analysis Unit, CNRS UMR 3691, Institut Pasteur, Université de Paris, Paris, France.,VitaDX International, Paris, France
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Giannoutsos I, Black D, Fuller SJ. Web‐based versus face‐to‐face blood cell morphology teaching: A pilot randomised controlled trial. Aust J Rural Health 2022; 31:336-338. [PMID: 36321645 DOI: 10.1111/ajr.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ioannis Giannoutsos
- New South Wales Health Pathology Nepean Hospital Kingswood New South Wales Australia
| | - Deborah Black
- Faculty of Medicine and Health Quadrangle, The University of Sydney Sydney New South Wales Australia
| | - Stephen J. Fuller
- Department of Medicine, Faculty of Medicine and Health Nepean Clinical School, The University of Sydney Kingswood New South Wales Australia
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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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12
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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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Chantziantoniou N. BestCyte® Cell Sorter Imaging System: Primary and Adjudicative Whole Slide Image Rescreening Review Times of 500 ThinPrep Pap Test Thin-layers - An Intra-observer, Time-Surrogate Analysis of Diagnostic Confidence Potentialities. J Pathol Inform 2022; 13:100095. [PMID: 36268084 PMCID: PMC9576977 DOI: 10.1016/j.jpi.2022.100095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background The novel Artificial Intelligence-driven BestCyte® Cell Sorter Imaging System (BestCyte) enables hybrid digital screening through classification and sorting of tiles depicting cells in 8 galleries or whole slide image (WSI) reviews. Objectives (1) Analyze expenditures of time (minutes) for primary BestCyte cell sorter screening and adjudicative WSI rescreening of 500 blinded, randomized ThinPrep thin-layers to determine review times per Bethesda nomenclature; (2) Analyze review times for NILM qualifier diagnoses reflecting increasing interpretive complexity (i.e., Inflammation, Reactive/Repair, Bacterial cytolysis, Bacterial vaginosis, Atrophy, and Atrophic vaginitis); (3) Challenge accuracy of primary diagnoses (Downgraded, Upheld, and Upgraded) following adjudicative WSI rescreening to assess correlated review times as surrogate indicators of diagnostic confidence in BestCyte functionality (i.e., learning curve); and (4) Correlate primary and adjudicative diagnoses to calculate intra-observer reproducibility Kappa coefficients per Bethesda nomenclature. Results Of 500 thin-layers, the mean [primary/adjudicative rescreening review times (minutes)] were: Overall study [1.38/3.94], NILM [1.23/3.02], ASCUS [1.18/2.53], ASC-H [1.73/4.86], AGUS [1.84/6.34], LSIL [1.49/4.16], HSIL [1.52/4.10], CA [0.65/2.57]. Of 500 primary Bethesda diagnoses: 2 (0.40%) downgraded; 483 (96.6%) upheld; 15 (3.00%) upgraded after adjudicative WSI rescreening. Of 354 NILM diagnoses: 0 downgraded; 344 (97.2%) upheld; 10 (2.82%) upgraded. Of 34 ASCUS diagnoses: 2 (5.88%) downgraded; 28 (82.4%) upheld; 4 (11.8%) upgraded. Of 17 ASC-H diagnoses: 0 downgraded; 16 (94.1%) upheld; 1 (5.88%) upgraded. Of AGUS (n=1), LSIL (n=24), HSIL (n=52), CA (n=1), UNSAT (n=17): 100% upheld. Kappa coefficients with 95% (Confidence Intervals): Overall study 0.9305 (0.8983–0.9627), NILM 0.9429 (0.9110–0.9748), ASCUS 0.8378 (0.7393–0.9363), ASC-H 0.9112 (0.8113–0.9999), AGUS 1.0 (1.0–1.0), LSIL 0.9189 (0.8400–0.9978), HSIL 0.9894 (0.9685–0.9999), CA 1.0 (1.0–1.0), UNSAT 1.0 (1.0–1.0). Primary BestCyte cell image review time trends for NILM, ASCUS, LSIL, and HSIL, revealed plateaus relative to decreasing respective adjudicative WSI rescreening times. Conclusions Given innovative robustness, BestCyte accommodates interpretive fundamentals, enabling shorter ThinPrep thin-layer review times with optimal intra-observer concordance per Bethesda nomenclature through classifying, ranking, sorting, and displaying clinically relevant cells efficiently in galleries. BestCyte fosters continuously optimizing diagnostic confidence learning curves; may supplant manual microscopy for primary screening.
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14
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Zhang Q, Wang Y, Li Q, Tao X, Zhou X, Zhang Y, Liu G. An autofocus algorithm considering wavelength changes for large scale microscopic hyperspectral pathological imaging system. JOURNAL OF BIOPHOTONICS 2022; 15:e202100366. [PMID: 35020264 DOI: 10.1002/jbio.202100366] [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: 11/25/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Microscopic hyperspectral imaging technology has been widely used to acquire pathological information of tissue sections. Autofocus is one of the most important steps in microscopic hyperspectral imaging systems to capture large scale or even whole slide images of pathological slides with high quality and high speed. However, there are quite few autofocus algorithm put forward for the microscopic hyperspectral imaging system. Therefore, this article proposes a Laplace operator based autofocus algorithm for microscopic hyperspectral imaging system which takes the influence of wavelength changes into consideration. Through the proposed algorithm, the focal length for each wavelength can be adjusted automatically to ensure that each single band image can be autofocused precisely with adaptive image sharpness evaluation method. In addition, to increase the capture speed, the relationship of wavelength and focal length is derived and the focal offsets among different single band images are calculated for pre-focusing. We have employed the proposed method on our own datasets and the experimental results show that it can capture large-scale microscopic hyperspectral pathology images with high precise.
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Affiliation(s)
- Qing Zhang
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
| | - Yan Wang
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
- Center of SHMEC for Space Information and GNSS, East China Normal University, Shanghai, China
| | - Qingli Li
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
- Engineering Research Center of Nanophotonics & Advanced Instrument, Ministry of Education, East China Normal University, Shanghai, China
- Center of SHMEC for Space Information and GNSS, East China Normal University, Shanghai, China
| | - Xiang Tao
- Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | | | - Yonghe Zhang
- Jiangsu Huachuang High-tech Medical Technology Co., Ltd., Suzhou, China
| | - Gang Liu
- Panovue Biological Technology (Beijing) Co., Ltd, Beijing, China
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15
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Hanna MG, Ardon O, Reuter VE, Sirintrapun SJ, England C, Klimstra DS, Hameed MR. Integrating digital pathology into clinical practice. Mod Pathol 2022; 35:152-164. [PMID: 34599281 DOI: 10.1038/s41379-021-00929-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 11/09/2022]
Abstract
The field of anatomic pathology has been evolving in the last few decades and the advancements have been largely fostered by innovative technology. Immunohistochemistry enabled a paradigm shift in discovery and diagnostic evaluation, followed by booming genomic advancements which allowed for submicroscopic pathologic characterization, and now the field of digital pathology coupled with machine learning and big data acquisition is paving the way to revolutionize the pathology medical domain. Whole slide imaging (WSI) is a disruptive technology where glass slides are digitized to produce on-screen whole slide images. Specifically, in the past decade, there have been significant advances in digital pathology systems that have allowed this technology to promote integration into clinical practice. Whole slide images (WSI), or digital slides, can be viewed and navigated comparable to glass slides on a microscope, as digital files. Whole slide imaging has increased in adoption among pathologists, pathology departments, and scientists for clinical, educational, and research initiatives. Integration of digital pathology systems requires a coordinated effort with numerous stakeholders, not only within the pathology department, but across the entire enterprise. Each pathology department has distinct needs, use cases and blueprints, however the framework components and variables for successful clinical integration can be generalized across any organization seeking to undergo a digital transformation at any scale. This article will review those components and considerations for integrating digital pathology systems into clinical practice.
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Affiliation(s)
- Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Christine England
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David S Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meera R Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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16
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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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17
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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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18
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Dov D, Kovalsky SZ, Feng Q, Assaad S, Cohen J, Bell J, Henao R, Carin L, Range DE. Use of Machine Learning-Based Software for the Screening of Thyroid Cytopathology Whole Slide Images. Arch Pathol Lab Med 2021; 146:872-878. [PMID: 34669924 DOI: 10.5858/arpa.2020-0712-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The use of whole slide images (WSIs) in diagnostic pathology presents special challenges for the cytopathologist. Informative areas on a direct smear from a thyroid fine-needle aspiration biopsy (FNAB) smear may be spread across a large area comprising blood and dead space. Manually navigating through these areas makes screening and evaluation of FNA smears on a digital platform time-consuming and laborious. We designed a machine learning algorithm that can identify regions of interest (ROIs) on thyroid fine-needle aspiration biopsy WSIs. OBJECTIVE.— To evaluate the ability of the machine learning algorithm and screening software to identify and screen for a subset of informative ROIs on a thyroid FNA WSI that can be used for final diagnosis. DESIGN.— A representative slide from each of 109 consecutive thyroid fine-needle aspiration biopsies was scanned. A cytopathologist reviewed each WSI and recorded a diagnosis. The machine learning algorithm screened and selected a subset of 100 ROIs from each WSI to present as an image gallery to the same cytopathologist after a washout period of 117 days. RESULTS.— Concordance between the diagnoses using WSIs and those using the machine learning algorithm-generated ROI image gallery was evaluated using pairwise weighted κ statistics. Almost perfect concordance was seen between the 2 methods with a κ score of 0.924. CONCLUSIONS.— Our results show the potential of the screening software as an effective screening tool with the potential to reduce cytopathologist workloads.
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Affiliation(s)
- David Dov
- From the Department of Electrical and Computer Engineering (Dov, Assaad, Carin), Duke University, Durham, North Carolina
| | - Shahar Z Kovalsky
- The Department of Mathematics, University of North Carolina at Chapel Hill (Kovalsky)
| | - Qizhang Feng
- The Department of Computer Science & Engineering, Texas A&M University, College Station (Feng)
| | - Serge Assaad
- From the Department of Electrical and Computer Engineering (Dov, Assaad, Carin), Duke University, Durham, North Carolina
| | - Jonathan Cohen
- The Department of Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel (Cohen)
| | - Jonathan Bell
- The Department of Pathology (Bell, Range), Duke University Medical Center, Durham, North Carolina
| | - Ricardo Henao
- Department of Biostatistics and Bioinformatics (Henao), Duke University, Durham, North Carolina
| | - Lawrence Carin
- From the Department of Electrical and Computer Engineering (Dov, Assaad, Carin), Duke University, Durham, North Carolina.,Carin is currently located in the Office of the Provost at King Abdullah University of Science and Technology, Thuwal, Kingdom of Saudi Arabia
| | - Danielle Elliott Range
- The Department of Pathology (Bell, Range), Duke University Medical Center, Durham, North Carolina
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19
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Fraggetta F, Caputo A, Guglielmino R, Pellegrino MG, Runza G, L'Imperio V. A Survival Guide for the Rapid Transition to a Fully Digital Workflow: The "Caltagirone Example". Diagnostics (Basel) 2021; 11:1916. [PMID: 34679614 PMCID: PMC8534326 DOI: 10.3390/diagnostics11101916] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 12/28/2022] Open
Abstract
Digital pathology for the routine assessment of cases for primary diagnosis has been implemented by few laboratories worldwide. The Gravina Hospital in Caltagirone (Sicily, Italy), which collects cases from 7 different hospitals distributed in the Catania area, converted the entire workflow to digital starting from 2019. Before the transition, the Caltagirone pathology laboratory was characterized by a non-tracked workflow, based on paper requests, hand-written blocks and slides, as well as manual assembling and delivering of the cases and glass slides to the pathologists. Moreover, the arrangement of the spaces and offices in the department was illogical and under-productive for the linearity of the workflow. For these reasons, an adequate 2D barcode system for tracking purposes, the redistribution of the spaces inside the laboratory and the implementation of the whole-slide imaging (WSI) technology based on a laboratory information system (LIS)-centric approach were adopted as a needed prerequisite to switch to a digital workflow. The adoption of a dedicated connection for transfer of clinical and administrative data between different software and interfaces using an internationally recognised standard (Health Level 7, HL7) in the pathology department further facilitated the transition, helping in the integration of the LIS with WSI scanners. As per previous reports, the components and devices chosen for the pathologists' workstations did not significantly impact on the WSI-based reporting phase in primary histological diagnosis. An analysis of all the steps of this transition has been made retrospectively to provide a useful "handy" guide to lead the digital transition of "analog", non-tracked pathology laboratories following the experience of the Caltagirone pathology department. Following the step-by-step instructions, the implementation of a paperless routine with more standardized and safe processes, the possibility to manage the priority of the cases and to implement artificial intelligence (AI) tools are no more an utopia for every "analog" pathology department.
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Affiliation(s)
- Filippo Fraggetta
- Pathology Unit, ASP Catania, “Gravina” Hospital, 95041 Caltagirone, Italy;
| | - Alessandro Caputo
- Department of Medicine and Surgery, University of Salerno, 84121 Salerno, Italy;
| | - Rosa Guglielmino
- Pathology Unit, ASP Catania, “Gravina” Hospital, 95041 Caltagirone, Italy;
| | | | - Giampaolo Runza
- Superintendency Unit, ASP Catania, “Gravina” Hospital, 95041 Caltagirone, Italy;
| | - Vincenzo L'Imperio
- Pathology, Department of Medicine and Surgery, ASST Monza, University of Milano-Bicocca, 20900 Monza, Italy;
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20
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Bertram CA, Stathonikos N, Donovan TA, Bartel A, Fuchs-Baumgartinger A, Lipnik K, van Diest PJ, Bonsembiante F, Klopfleisch R. Validation of digital microscopy: Review of validation methods and sources of bias. Vet Pathol 2021; 59:26-38. [PMID: 34433345 PMCID: PMC8761960 DOI: 10.1177/03009858211040476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Digital microscopy (DM) is increasingly replacing traditional light microscopy (LM) for performing routine diagnostic and research work in human and veterinary pathology. The DM workflow encompasses specimen preparation, whole-slide image acquisition, slide retrieval, and the workstation, each of which has the potential (depending on the technical parameters) to introduce limitations and artifacts into microscopic examination by pathologists. Performing validation studies according to guidelines established in human pathology ensures that the best-practice approaches for patient care are not deteriorated by implementing DM. Whereas current publications on validation studies suggest an overall high reliability of DM, each laboratory is encouraged to perform an individual validation study to ensure that the DM workflow performs as expected in the respective clinical or research environment. With the exception of validation guidelines developed by the College of American Pathologists in 2013 and its update in 2021, there is no current review of the application of methods fundamental to validation. We highlight that there is high methodological variation between published validation studies, each having advantages and limitations. The diagnostic concordance rate between DM and LM is the most relevant outcome measure, which is influenced (regardless of the viewing modality used) by different sources of bias including complexity of the cases examined, diagnostic experience of the study pathologists, and case recall. Here, we review 3 general study designs used for previous publications on DM validation as well as different approaches for avoiding bias.
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Affiliation(s)
- Christof A Bertram
- University of Veterinary Medicine, Vienna, Austria.,Freie Universität Berlin, Berlin, Germany
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21
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Abstract
Whole slide imaging (WSI), ever since its first introduction about two decades ago, has been validated for a number of applications in the field of pathology. The recent approval of US FDA to a WSI system for use in primary surgical pathology diagnosis has opened avenues for wider acceptance and application of this technology in routine practice. The ongoing technological advances in digital scanners, image visualization methods, and the integration of artificial intelligence-derived algorithms with these systems provide opportunities of its newer applications. Its benefits are innumerable such as ease of access through internet, avoidance of physical storage space, and no risk of deterioration of staining quality or breakage of slides to name a few. Various barriers such as the high cost, technical glitches, and professional hesitation to adopt a new technology have hindered its use in pathology. This review article summarizes the technical aspects of WSI, its applications in diagnostic pathology, training, and research along with future perspectives. It highlights the benefits, limitations, and challenges delaying the use of this technology in routine practice. The review is targeted at students, residents, and budding pathologists to better acquaint them with the key aspects of state-of-the-art technology and enable them to implement WSI judiciously.
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22
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Katare P, Gorthi SS. Recent technical advances in whole slide imaging instrumentation. J Microsc 2021; 284:103-117. [PMID: 34254690 DOI: 10.1111/jmi.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
Microscopic observation of biological specimen smears is the mainstay of diagnostic pathology, as defined by the Digital Pathology Association. Though automated systems for this are commercially available, their bulky size and high cost renders them unusable for remote areas. The research community is investing much effort towards building equivalent but portable, low-cost systems. An overview of such research is presented here, including a comparative analysis of recent reports. This paper also reviews recently reported systems for automated staining and smear formation, including microfluidic devices; and optical and computational automated microscopy systems including smartphone-based devices. Image pre-processing and analysis methods for automated diagnosis are also briefly discussed. It concludes with a set of foreseeable research directions that could lead to affordable, integrated and accurate whole slide imaging systems.
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Affiliation(s)
- Prateek Katare
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore, India
| | - Sai Siva Gorthi
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore, India
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Abstract
We present CytoBrowser, an open-source (GPLv3) JavaScript and Node.js driven environment for fast and accessible collaborative online visualization, assessment, and annotation of very large microscopy images, including, but not limited to, z-stacks (focus stacks) of cytology or histology whole slide images. CytoBrowser provides a web-based viewer for high-resolution zoomable images and facilitates easy remote collaboration, with options for joint-view visualization and simultaneous collaborative annotation of very large datasets. It delivers a unique combination of functionalities not found in other software solutions, making it a preferred tool for large scale annotation of whole slide image data. The web browser interface is directly accessible on any modern computer or even on a mobile phone, without need for additional software. By sharing a "session", several remote users can interactively explore and jointly annotate whole slide image data, thereby reaching improved data understanding and annotation quality, effortless project scaling and distribution of resources to/from remote locations, efficient creation of "ground truth" annotations for methods' evaluation and training of machine learning-based approaches, a user-friendly learning environment for medical students, to just name a few. Rectangle and polygon region annotations complement point-based annotations, each with a selectable annotation-class as well as free-form text fields. The default setting of CytoBrowser presents an interface for the Bethesda cancer grading system, while other annotation schemes can easily be incorporated. Automatic server side storage of annotations is complemented by JSON-based import/export options facilitating easy interoperability with other tools. CytoBrowser is available here: https://mida-group.github.io/CytoBrowser/.
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Remote cytological diagnosis of salivary gland lesions by means of precaptured videos. J Am Soc Cytopathol 2021; 10:435-443. [PMID: 33707150 DOI: 10.1016/j.jasc.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/24/2021] [Accepted: 02/15/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of implementing videos captured by static telecytological applications for remote cytological diagnosis of fine needle aspiration (FNA) specimens from salivary gland lesions. METHODS The current study was performed on 102 specimens from patients referred to the Alpha Prolipsis Cytopathology Department for preoperative evaluation of salivary gland lesions. In all cases, surgical excision followed the initial cytological diagnosis. (benign lesions, 11; benign neoplasms, 68; malignant neoplasms, 23). Videos were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. RESULTS Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of precaptured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect with κ values of 0.71-0.89. CONCLUSIONS Videos production by static telecytology applications can be used as an alternative method for telecytological diagnosis of salivary glands FNAs. Videos of salivary glands FNAs can be used for accurate diagnosis, educational and second opinion purposes,. They can also be used for archiving, teleconsultation and educational purposes, improving the performance of the already existing static telecytology stations and small cytology departments' quality indices.
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Satturwar S, Pantanowitz L. Architectural aspects of cell-blocks as small biopsies. Cytojournal 2021; 18:5. [PMID: 33880128 PMCID: PMC8053489 DOI: 10.25259/cytojournal_4_2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/01/2023] Open
Abstract
Cell-block preparations have become an essential part of integrated cytology diagnosis. They are essentially microbiopsies that are formalin fixed and embedded in paraffin. This has become more prevalent with greater sample procurement due to the advent of newer biopsy techniques and needles. Cell-blocks allow retrieval of small tissue fragments from cytology specimens that sometimes cannot be processed by alternate cytologic techniques. They represent concentrated, cell-enriched preparations that provide cytologists with the opportunity to evaluate cellular architecture, as well as to perform ancillary testing. A cell-block compatible sample may thus obviate the need for a more invasive procedure such as a tissue biopsy. Microscopic examination of cell-blocks is quick, avoids obscuring material, permits cells to be evaluated in one focal plane, and allows the histologic architecture such as glandular differentiation, papillary formations, and sometimes invasion to be easily identified. This new era of “cytohistology” accordingly requires practicing cytologists to become more familiar with histopathology. This review article discusses the benefit of various architectural patterns identifiable in cell-blocks employed as an adjunct to Pap tests, exfoliative fluid specimens, and fine-needle aspirations.
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Affiliation(s)
- Swati Satturwar
- Department of Pathology, University of Pittsburgh Medical Center, Pennsylvania, United States
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Michigan, United States
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26
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Archondakis S, Roma M, Evropi K. Implementation of pre-captured videos for remote cytological evaluation of salivary gland lesions. J Telemed Telecare 2021:1357633X21995061. [PMID: 33596713 DOI: 10.1177/1357633x21995061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to examine the feasibility of implementing videos captured by static telecytological applications for remote cytological evaluation of fine needle aspiration specimens from salivary gland lesions. METHODS The current study was carried out on 102 fine needle aspiration specimens from salivary gland lesions with histological confirmation (benign lesions, 11; benign neoplasms, 68; malignant neoplasms, 23), retrospectively selected from the department's registry. Videos were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. RESULTS Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of pre-captured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect with κ values of 0.71-0.89. CONCLUSIONS Video production by static telecytology applications can be used as an alternative method for telecytological diagnosis of salivary gland fine needle aspirations. Videos of salivary gland fine needle aspirations can be used for rapid and accurate diagnosis, by diminishing turn-around times and improving the quality indices of small cytology departments. They can also be used for archiving, teleconsultation, educational and second opinion purposes, improving the performance of the already existing static telecytology stations.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Kaladelfou Evropi
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
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Archondakis S, Roma M, Kaladelfou E. Implementation of pre-captured videos for remote diagnosis of cervical cytology specimens. Cytopathology 2020; 32:338-343. [PMID: 33368677 DOI: 10.1111/cyt.12948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/08/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of implementing short videos captured by static telecytological applications for remote evaluation of cervical smears prepared by means of liquid-based cytology. METHODS The study was performed on representative short videos captured from a total of 404 cervical smears (benign, 135; atypical squamous cells of undetermined significance, 92; low-grade squamous intraepithelial lesion, 62; high-grade squamous intraepithelial lesion, 87; squamous cell carcinoma, 26; adenocarcinoma, 2) that were sent via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on the overall digital video quality. Contributors' and reviewers' diagnoses were collected, recorded, and statistically evaluated. RESULTS Statistical evaluation detected no significant difference in diagnostic accuracy between cytological diagnoses based on short videos versus conventional slides. The overall interobserver agreement ranged from substantial to almost perfect with κ values of 0.74-0.91. CONCLUSIONS Short videos produced by static telecytology applications can be used as an alternative method for telecytological diagnosis of cervical smears, particularly for quality control purposes. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into the daily workflow. Short pre-captured videos of cervical smears can be used for rapid and accurate diagnosis, diminishing turnaround times and improving small cytology departments' quality indices. They can also be used for archiving, teleconsultation, and second opinion purposes, improving the performance of already existing static telecytology stations.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Evropi Kaladelfou
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
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Sholl LM, Hwang DH. Expanding the utility of cytology preparations in cancer biomarker testing. Cancer Cytopathol 2020; 129:337-340. [PMID: 33119210 DOI: 10.1002/cncy.22380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David H Hwang
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Negri G, Macciocu E, Cepurnaite R, Kasal A, Troncone G, Steinkasserer M, Vittadello F. Non-human papilloma virus associated adenocarcinomas of the cervix uteri. Cytologic features and diagnostic agreement using whole slide digital cytology imaging. Diagn Cytopathol 2020; 49:316-321. [PMID: 33118707 DOI: 10.1002/dc.24652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-Human Papilloma Virus associated adenocarcinomas (NHPVAs) are uncommon tumors of the cervix uteri which often show a deceptive morphology. Therefore, their diagnostic assessment may be challenging. Slide digital cytology imaging may be an useful tool to improve cytological diagnostic accuracy. However, this novel technology has not been applied to NHPVAs associated cytologies yet. METHODS The study included 31 whole slide digital cytology cases from 10 women with a proven histological diagnosis of NHPVA. As a control group, three further digital slides, from two women with a histological diagnosis of squamous intraepithelial lesion (SIL), were included. The digitally scanned cytological slides were revised to assess the concordance rate among three observers and to find out the most relevant NHPVA cytological criteria. RESULTS Overall diagnostic agreement between observers was 67.60% (K = 0.50; P < 0.0001). At the consensus diagnosis 34 cases were re-classified as at least suspicious for glandular lesion (n = 24), SIL (n = 2) and negative (n = 8). The most relevant cytologic features for atypical glandular cells or adenocarcinoma at consensus were evident nucleoli, nuclear overlapping and atypical enlarged nuclei. CONCLUSIONS The diagnosis of NHPVA in digital cytology is feasible using criteria which are also used in conventional microscopy. Our study shows a moderate agreement for the cytological diagnosis of NHPVAs using whole slide digital cytology approach. These results are discussed taking into account the most relevant differential diagnostic issues.
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Affiliation(s)
- Giovanni Negri
- Pathology Unit, Central Hospital Bolzano, Bolzano, Italy
| | - Elena Macciocu
- Pathology Unit, Central Hospital Bolzano, Bolzano, Italy
| | - Rima Cepurnaite
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Armin Kasal
- Pathology Unit, Central Hospital Bolzano, Bolzano, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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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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31
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Girolami I, Pantanowitz L, Marletta S, Brunelli M, Mescoli C, Parisi A, Barresi V, Parwani A, Neil D, Scarpa A, Rossi ED, Eccher A. Diagnostic concordance between whole slide imaging and conventional light microscopy in cytopathology: A systematic review. Cancer Cytopathol 2020; 128:17-28. [DOI: 10.1002/cncy.22195] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/23/2019] [Indexed: 08/29/2023]
Affiliation(s)
- Ilaria Girolami
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Liron Pantanowitz
- Department of Pathology UPMC Shadyside Hospital University of Pittsburgh Pittsburgh Pennsylvania
| | - Stefano Marletta
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Claudia Mescoli
- Surgical Pathology and Cytopathology Unit Department of Medicine University and Hospital Trust of Padua Padua Italy
| | - Alice Parisi
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Valeria Barresi
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Anil Parwani
- Department of Pathology Ohio State University Columbus Ohio
| | - Desley Neil
- Department of Histopathology University Hospital Birmingham National Health Service Foundation Trust Birmingham United Kingdom
| | - Aldo Scarpa
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart Agostino Gemelli School of Medicine Rome Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
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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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Blanchet CJK, Fish EJ, Miller AG, Snyder LA, Labadie JD, Avery PR. Evaluation of Region of Interest Digital Cytology Compared to Light Microscopy for Veterinary Medicine. Vet Pathol 2019; 56:725-731. [PMID: 31113293 DOI: 10.1177/0300985819846874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Digital microscopy (DM) has been employed for primary diagnosis in human medicine and for research and teaching applications in veterinary medicine, but there are few veterinary DM validation studies. Region of interest (ROI) digital cytology is a subset of DM that uses image-stitching software to create a low-magnification image of a slide, then selected ROI at higher magnification, and stitches the images into a relatively small file of the embedded magnifications. This study evaluated the concordance of ROI-DM compared to traditional light microscopy (LM) between 2 blinded clinical pathologists. Sixty canine and feline cytology samples from a variety of anatomic sites, including 31 cases of malignant neoplasia, 15 cases of hyperplastic or benign neoplastic lesions, and 14 infectious/inflammatory lesions, were evaluated. Two separate nonblinded adjudicating clinical pathologists evaluated the reports and diagnoses and scored each paired case as fully concordant, partially concordant, or discordant. The average overall concordance (full and partial concordance) for both pathologists was 92%. Full concordance was significantly higher for malignant lesions than benign. For the 40 neoplastic lesions, ROI-DM and LM agreed on general category of tumor type in 78 of 80 cases (98%). ROI-DM cytology showed robust concordance with the current gold standard of LM cytology and is potentially a viable alternative to current LM cytology techniques.
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Affiliation(s)
- Conor J K Blanchet
- 1 Lacuna Diagnostics, Inc, Fort Collins, CO, USA.,2 Colorado State University College of Veterinary Medicine, Fort Collins, CO, USA
| | - Eric J Fish
- 1 Lacuna Diagnostics, Inc, Fort Collins, CO, USA.,3 Auburn University College of Veterinary Medicine, Auburn, AL, USA
| | | | - Laura A Snyder
- 1 Lacuna Diagnostics, Inc, Fort Collins, CO, USA.,5 Marshfield Labs, Marshfield, WI, USA
| | - Julia D Labadie
- 2 Colorado State University College of Veterinary Medicine, Fort Collins, CO, USA
| | - Paul R Avery
- 2 Colorado State University College of Veterinary Medicine, Fort Collins, CO, USA
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Gupta A, Harrison PJ, Wieslander H, Pielawski N, Kartasalo K, Partel G, Solorzano L, Suveer A, Klemm AH, Spjuth O, Sintorn I, Wählby C. Deep Learning in Image Cytometry: A Review. Cytometry A 2019; 95:366-380. [PMID: 30565841 PMCID: PMC6590257 DOI: 10.1002/cyto.a.23701] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/07/2018] [Accepted: 11/29/2018] [Indexed: 12/18/2022]
Abstract
Artificial intelligence, deep convolutional neural networks, and deep learning are all niche terms that are increasingly appearing in scientific presentations as well as in the general media. In this review, we focus on deep learning and how it is applied to microscopy image data of cells and tissue samples. Starting with an analogy to neuroscience, we aim to give the reader an overview of the key concepts of neural networks, and an understanding of how deep learning differs from more classical approaches for extracting information from image data. We aim to increase the understanding of these methods, while highlighting considerations regarding input data requirements, computational resources, challenges, and limitations. We do not provide a full manual for applying these methods to your own data, but rather review previously published articles on deep learning in image cytometry, and guide the readers toward further reading on specific networks and methods, including new methods not yet applied to cytometry data. © 2018 The Authors. Cytometry Part A published by Wiley Periodicals, Inc. on behalf of International Society for Advancement of Cytometry.
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Affiliation(s)
- Anindya Gupta
- Centre for Image AnalysisUppsala UniversityUppsala75124Sweden
| | - Philip J. Harrison
- Department of Pharmaceutical BiosciencesUppsala UniversityUppsala75124Sweden
| | | | | | - Kimmo Kartasalo
- Faculty of Medicine and Life SciencesUniversity of TampereTampere33014Finland
- Faculty of Biomedical Sciences and EngineeringTampere University of TechnologyTampere33720Finland
| | - Gabriele Partel
- Centre for Image AnalysisUppsala UniversityUppsala75124Sweden
| | | | - Amit Suveer
- Centre for Image AnalysisUppsala UniversityUppsala75124Sweden
| | - Anna H. Klemm
- Centre for Image AnalysisUppsala UniversityUppsala75124Sweden
- BioImage Informatics Facility of SciLifeLabUppsala75124Sweden
| | - Ola Spjuth
- Department of Pharmaceutical BiosciencesUppsala UniversityUppsala75124Sweden
| | | | - Carolina Wählby
- Centre for Image AnalysisUppsala UniversityUppsala75124Sweden
- BioImage Informatics Facility of SciLifeLabUppsala75124Sweden
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Sturm B, Creytens D, Cook MG, Smits J, van Dijk MCRF, Eijken E, Kurpershoek E, Küsters-Vandevelde HVN, Ooms AHAG, Wauters C, Blokx WAM, van der Laak JAWM. Validation of Whole-slide Digitally Imaged Melanocytic Lesions: Does Z-Stack Scanning Improve Diagnostic Accuracy? J Pathol Inform 2019; 10:6. [PMID: 30972225 PMCID: PMC6415522 DOI: 10.4103/jpi.jpi_46_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/17/2018] [Indexed: 01/21/2023] Open
Abstract
Background Accurate diagnosis of melanocytic lesions is challenging, even for expert pathologists. Nowadays, whole-slide imaging (WSI) is used for routine clinical pathology diagnosis in several laboratories. One of the limitations of WSI, as it is most often used, is the lack of a multiplanar focusing option. In this study, we aim to establish the diagnostic accuracy of WSI for melanocytic lesions and investigate the potential accuracy increase of z-stack scanning. Z-stack enables pathologists to use a software focus adjustment, comparable to the fine-focus knob of a conventional light microscope. Materials and Methods Melanocytic lesions (n = 102) were selected from our pathology archives: 35 nevi, 5 spitzoid tumors of unknown malignant potential, and 62 malignant melanomas, including 10 nevoid melanomas. All slides were scanned at a magnification comparable to use of a ×40 objective, in z-stack mode. A ground truth diagnosis was established on the glass slides by four academic dermatopathologists with a special interest in the diagnosis of melanoma. Six nonacademic surgical pathologists subspecialized in dermatopathology examined the cases by WSI. Results An expert consensus diagnosis was achieved in 99 (97%) of cases. Concordance rates between surgical pathologists and the ground truth varied between 75% and 90%, excluding nevoid melanoma cases. Concordance rates of nevoid melanoma varied between 10% and 80%. Pathologists used the software focusing option in 7%-28% of cases, which in 1 case of nevoid melanoma resulted in correcting a misdiagnosis after finding a dermal mitosis. Conclusion Diagnostic accuracy of melanocytic lesions based on glass slides and WSI is comparable with previous publications. A large variability in diagnostic accuracy of nevoid melanoma does exist. Our results show that z-stack scanning, in general, does not increase the diagnostic accuracy of melanocytic.
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Affiliation(s)
- Bart Sturm
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Martin G Cook
- Department of Histopathology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Jan Smits
- Pathan B.V., Rotterdam, The Netherlands
| | | | - Erik Eijken
- Laboratory for Pathology East Netherlands (LabPON), Hengelo, The Netherlands
| | | | | | | | - Carla Wauters
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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Singh A, Ohgami RS. Super-Resolution Digital Pathology Image Processing of Bone Marrow Aspirate and Cytology Smears and Tissue Sections. J Pathol Inform 2018; 9:48. [PMID: 30662794 PMCID: PMC6319039 DOI: 10.4103/jpi.jpi_56_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/13/2018] [Indexed: 11/05/2022] Open
Abstract
Background: Accurate digital pathology image analysis depends on high-quality images. As such, it is imperative to obtain digital images with high resolution for downstream data analysis. While hematoxylin and eosin (H&E)-stained tissue section slides from solid tumors contain three-dimensional information, these data have been ignored in digital pathology. In addition, in cytology and bone marrow aspirate smears, the three-dimensional nature of the specimen has precluded efficient analysis of such morphologic data. An individual image snapshot at a single focal distance is often not sufficient for accurate diagnoses and multiple whole-slide images at different focal distances are necessary for diagnostics. Materials and Methods: We describe a novel computational pipeline and processing program for obtaining a super-resolved image from multiple static images at different z-planes in overlapping but separate frames. This program, MULTI-Z, performs image alignment, Gaussian smoothing, and Laplacian filtering to construct a final super-resolution image from multiple images. Results: We applied this algorithm and program to images of cytology and H&E-stained sections and demonstrated significant improvements in both resolution and image quality by objective data analyses (24% increase in sharpness and focus). Conclusions: With the use of our program, super-resolved images of cytology and H&E-stained tissue sections can be obtained to potentially allow for more optimal downstream computational analysis. This method is applicable to whole-slide scanned images.
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Affiliation(s)
- Amol Singh
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
| | - Robert S Ohgami
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
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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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Mosquera-Zamudio A, Hanna MG, Parra-Medina R, Piedrahita AC, Rodriguez-Urrego PA, Pantanowitz L. Advantage of Z-stacking for teleconsultation between the USA and Colombia. Diagn Cytopathol 2018; 47:35-40. [DOI: 10.1002/dc.23992] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/01/2018] [Accepted: 05/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Andres Mosquera-Zamudio
- Department of Pathology; Fundación Universitaria Ciencias de la Salud. Hospital de San José; Bogotá Colombia
| | - Matthew G. Hanna
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Rafael Parra-Medina
- Research Institute, Fundación Universitaria Ciencias de la Salud; Bogotá Colombia
| | - Ana C. Piedrahita
- Department of Pathology; Fundación Universitaria Ciencias de la Salud. Hospital de San José; Bogotá Colombia
| | - Paula A. Rodriguez-Urrego
- Research Institute, Fundación Universitaria Ciencias de la Salud; Bogotá Colombia
- Hospital Universitario Fundación Santa Fe de Bogotá; Bogotá Colombia
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Ross J, Greaves J, Earls P, Shulruf B, Van Es SL. Digital vs traditional: Are diagnostic accuracy rates similar for glass slides vs whole slide images in a non-gynaecological external quality assurance setting? Cytopathology 2018; 29:326-334. [DOI: 10.1111/cyt.12552] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J. Ross
- Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd; St Leonards NSW Australia
| | - J. Greaves
- Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd; St Leonards NSW Australia
| | - P. Earls
- Department of Anatomical Pathology; St Vincents Hospital; Darlinghurst NSW Australia
| | - B. Shulruf
- Office of Medical Education; Faculty of Medicine; UNSW; Sydney NSW Australia
| | - S. L. Van Es
- Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd; St Leonards NSW Australia
- Department of Pathology; School of Medical Sciences; UNSW; Sydney NSW Australia
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Digital pathology in nephrology clinical trials, research, and pathology practice. Curr Opin Nephrol Hypertens 2018; 26:450-459. [PMID: 28858910 DOI: 10.1097/mnh.0000000000000360] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW In this review, we will discuss (i) how the recent advancements in digital technology and computational engineering are currently applied to nephropathology in the setting of clinical research, trials, and practice; (ii) the benefits of the new digital environment; (iii) how recognizing its challenges provides opportunities for transformation; and (iv) nephropathology in the upcoming era of kidney precision and predictive medicine. RECENT FINDINGS Recent studies highlighted how new standardized protocols facilitate the harmonization of digital pathology database infrastructure and morphologic, morphometric, and computer-aided quantitative analyses. Digital pathology enables robust protocols for clinical trials and research, with the potential to identify previously underused or unrecognized clinically useful parameters. The integration of digital pathology with molecular signatures is leading the way to establishing clinically relevant morpho-omic taxonomies of renal diseases. SUMMARY The introduction of digital pathology in clinical research and trials, and the progressive implementation of the modern software ecosystem, opens opportunities for the development of new predictive diagnostic paradigms and computer-aided algorithms, transforming the practice of renal disease into a modern computational science.
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Evans AJ, Bauer TW, Bui MM, Cornish TC, Duncan H, Glassy EF, Hipp J, McGee RS, Murphy D, Myers C, O'Neill DG, Parwani AV, Rampy BA, Salama ME, Pantanowitz L. US Food and Drug Administration Approval of Whole Slide Imaging for Primary Diagnosis: A Key Milestone Is Reached and New Questions Are Raised. Arch Pathol Lab Med 2018; 142:1383-1387. [PMID: 29708429 DOI: 10.5858/arpa.2017-0496-cp] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
April 12, 2017 marked a significant day in the evolution of digital pathology in the United States, when the US Food and Drug Administration announced its approval of the Philips IntelliSite Pathology Solution for primary diagnosis in surgical pathology. Although this event is expected to facilitate more widespread adoption of whole slide imaging for clinical applications in the United States, it also raises a number of questions as to the means by which pathologists might choose to incorporate this technology into their clinical practice. This article from the College of American Pathologists Digital Pathology Committee reviews frequently asked questions on this topic and provides answers based on currently available information.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Liron Pantanowitz
- From the Laboratory Medicine Program, Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Evans); the Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York (Dr Bauer); the Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida (Dr Bui); the Department of Pathology, University of Colorado Denver, Aurora (Dr Cornish); Economic and Regulatory Affairs, College of American Pathologists, Washington, DC (Ms Duncan); Affiliated Pathologists Medical Group, Rancho Dominguez, California (Dr Glassy); the Medical Brain Team, Google, San Francisco, California (Dr Hipp); Covance, Indianapolis, Indiana (Dr McGee); the Surveys Department, College of American Pathologists, Northfield, Illinois (Mr Murphy); the Department of Pathology, Emory University Hospital, Atlanta, Georgia (Dr Myers); the Department of Pathology, Manchester Memorial Hospital, Manchester, Connecticut (Dr O'Neill); the Department of Pathology, Ohio State University Wexner Medical Center, Columbus (Dr Parwani); the Department of Pathology, Dell Medical School, University of Texas at Austin (Dr Rampy); ARUP Laboratories Incorporated, Salt Lake City, Utah (Dr Salama); and the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Pantanowitz)
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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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43
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Huang YN, Peng XC, Ma S, Yu H, Jin YB, Zheng J, Fu GH. Development of Whole Slide Imaging on Smartphones and Evaluation With ThinPrep Cytology Test Samples: Follow-Up Study. JMIR Mhealth Uhealth 2018; 6:e82. [PMID: 29618454 PMCID: PMC5906711 DOI: 10.2196/mhealth.9518] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 12/24/2022] Open
Abstract
Background The smartphone-based whole slide imaging (WSI) system represents a low-cost and effective alternative to automatic scanners for telepathology. In a previous study, the development of one such solution, named scalable whole slide imaging (sWSI), was presented and analyzed. A clinical evaluation of its iOS version with 100 frozen section samples verified the diagnosis-readiness of the produced virtual slides. Objective The first aim of this study was to delve into the quantifying issues encountered in the development of an Android version. It should also provide insights into future high-resolution real-time feedback medical imaging apps on Android and invoke the awareness of smartphone manufacturers for collaboration. The second aim of this study was to further verify the clinical value of sWSI with cytology samples. This type is different from the frozen section samples in that they require finer detail on the cellular level. Methods During sWSI development on Android, it was discovered that many models do not support uncompressed camera pixel data with sufficient resolution and full field of view. The proportion of models supporting the optimal format was estimated in a test on 200 mainstream Android models. Other factors, including slower processing speed and camera preview freezing, also led to inferior performance of sWSI on Android compared with the iOS version. The processing speed was mostly determined by the central processing unit frequency in theory, and the relationship was investigated in the 200-model simulation experiment with physical devices. The camera preview freezing was caused by the lag between triggering photo capture and resuming preview. In the clinical evaluation, 100 ThinPrep cytology test samples covering 6 diseases were scanned with sWSI and compared against the ground truth of optical microscopy. Results Among the tested Android models, only 3.0% (6/200) provided an optimal data format, meeting all criteria of quality and efficiency. The image-processing speed demonstrated a positive relationship with the central processing unit frequency but to a smaller degree than expected and was highly model-dependent. The virtual slides produced by sWSI on Android and iOS of ThinPrep cytology test samples achieved similar high quality. Using optical microscopy as the ground truth, pathologists made a correct diagnosis on 87.5% (175/200) of the cases with sWSI virtual slides. Depending on the sWSI version and the pathologist in charge, the kappa value varied between .70 and .82. All participating pathologists considered the quality of the sWSI virtual slides in the experiment to be adequate for routine usage. Conclusions Limited by hardware and operating system support, the performance of sWSI on mainstream Android smartphones did not fully match the iOS version. However, in practice, this difference was not significant, and both were adequate for digitizing most of the sample types for telepathology consultation.
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Affiliation(s)
- Yu-Ning Huang
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Faculty of Basic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing-Chun Peng
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Faculty of Basic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuoxin Ma
- TerryDr Info Technology Co, Ltd, Nanjing, China
| | - Hong Yu
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Biao Jin
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zheng
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Hui Fu
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Faculty of Basic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Fraggetta F, Garozzo S, Zannoni GF, Pantanowitz L, Rossi ED. Routine Digital Pathology Workflow: The Catania Experience. J Pathol Inform 2017; 8:51. [PMID: 29416914 PMCID: PMC5760840 DOI: 10.4103/jpi.jpi_58_17] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/10/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction: Successful implementation of whole slide imaging (WSI) for routine clinical practice has been accomplished in only a few pathology laboratories worldwide. We report the transition to an effective and complete digital surgical pathology workflow in the pathology laboratory at Cannizzaro Hospital in Catania, Italy. Methods: All (100%) permanent histopathology glass slides were digitized at ×20 using Aperio AT2 scanners. Compatible stain and scanning slide racks were employed to streamline operations. eSlide Manager software was bidirectionally interfaced with the anatomic pathology laboratory information system. Virtual slide trays connected to the two-dimensional (2D) barcode tracking system allowed pathologists to confirm that they were correctly assigned slides and that all tissues on these glass slides were scanned. Results: Over 115,000 glass slides were digitized with a scan fail rate of around 1%. Drying glass slides before scanning minimized them sticking to scanner racks. Implementation required introduction of a 2D barcode tracking system and modification of histology workflow processes. Conclusion: Our experience indicates that effective adoption of WSI for primary diagnostic use was more dependent on optimizing preimaging variables and integration with the laboratory information system than on information technology infrastructure and ensuring pathologist buy-in. Implementation of digital pathology for routine practice not only leveraged the benefits of digital imaging but also creates an opportunity for establishing standardization of workflow processes in the pathology laboratory.
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Affiliation(s)
| | | | - Gian Franco Zannoni
- Division of Anatomic Pathology and Histology, School of Medicine, "Agostino Gemelli", Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, School of Medicine, "Agostino Gemelli", Rome, Italy
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Groen R, Abe K, Yoon HS, Li Z, Shen R, Yoshikawa A, Nitanda T, Shimizu Y, Otsuka I, Fukuoka J. Application of microscope-based scanning software (Panoptiq) for the interpretation of cervicovaginal cytology specimens. Cancer Cytopathol 2017; 125:918-925. [DOI: 10.1002/cncy.21921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/08/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Ruben Groen
- Nagasaki Educational and Diagnostic Center of Pathology; Nagasaki University Hospital; Nagasaki Japan
- Department of Pathology; Kameda Medical Center; Kamogawa Chiba Japan
| | - Kuniko Abe
- Nagasaki Educational and Diagnostic Center of Pathology; Nagasaki University Hospital; Nagasaki Japan
| | - Han-Seung Yoon
- Nagasaki Educational and Diagnostic Center of Pathology; Nagasaki University Hospital; Nagasaki Japan
| | - Zaibo Li
- The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Rulong Shen
- The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Akira Yoshikawa
- Nagasaki Educational and Diagnostic Center of Pathology; Nagasaki University Hospital; Nagasaki Japan
| | - Takao Nitanda
- Nagasaki Educational and Diagnostic Center of Pathology; Nagasaki University Hospital; Nagasaki Japan
| | - Yukiko Shimizu
- Department of Obstetrics and Gynecology; Kameda Medical Center; Kamogawa Chiba Japan
| | - Isao Otsuka
- Department of Pathology; Kameda Medical Center; Kamogawa Chiba Japan
| | - Junya Fukuoka
- Nagasaki Educational and Diagnostic Center of Pathology; Nagasaki University Hospital; Nagasaki Japan
- Department of Pathology; Kameda Medical Center; Kamogawa Chiba Japan
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