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Birtolo MF, Jouinot A, Vasiljevic A, Boulagnon-Rombi C, Asioli S, Bousdira G, Tetka LMM, Perbet R, Maurage CA, Appay R, Figarella-Branger D, Gauchotte G, Sturm N, Baussart B, Roncaroli F, Bertherat J, Brue T, Villa C. PIT-EASY survey: validation of the European Pituitary Pathology Group proposal for reporting pituitary neuroendocrine tumors. Virchows Arch 2024; 485:407-415. [PMID: 38907774 DOI: 10.1007/s00428-024-03849-x] [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: 04/10/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024]
Abstract
The aim of this multicenter prospective survey called PIT-EASY was to assess the relevance of the European Pituitary Pathology Group (EPPG) diagnostic tools for pituitary neuroendocrine tumors (PitNETs) to improve the quality of their histological diagnosis. Each center performed at least 30 histological cases of PitNETs using the EPPG tools and assessed their value using a scorecard with 10 questions. For each center, the histological cases were carried out by pathologists with varying levels of expertise in pituitary pathology defined as junior, intermediate, and expert. Two hundred and ninety histological cases were collected from six French and Italian centers. The three EPPG tools were validated and regarded as helpful for a more accurate and time-efficient diagnosis. The usefulness of level 2 and level 3 of the "EPPG's multi-step approach for immunohistochemistry" including pituitary transcription factors (PIT1, TPIT, and SF1) and chromogranin, SSTRs, and P53 respectively was higher in "other non-functioning" (silent plurihormonal PIT1, silent corticotroph, and null cell): 88% vs 32%, p < 10-6 and 42% vs 14%, p = 0.002, respectively. The diagnostic algorithm proved more useful for junior pathologists (p = 0.0001) and those with intermediate experience. PIT-EASY survey confirmed the importance of a standardized approach to PitNETs for an accurate and reproducible diagnosis and served as validation of the EPPG proposal. The tool appeared to be of practical value to junior participants and staff with intermediate experience for safe routine diagnostic reporting.
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Affiliation(s)
- Maria Francesca Birtolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
| | - Anne Jouinot
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
- Service d'Endocrinologie, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, 75014, Paris, France
| | - Alexandre Vasiljevic
- Inserm U1052, CNRS UMR5286, Cancer Research Center of Lyon, 69373, Lyon, France
- Pathology Department, Center for Rare Pituitary Diseases (CRMR HYPO), "Groupement Hospitalier Est" Hospices Civils de Lyon, 69677, Bron, France
| | - Camille Boulagnon-Rombi
- Service de Pathologie, CHU de Reims, 51092, Reims, France
- CNRS, MEDyC UMR 7369, Université de Reims Champagne Ardenne, 51097, Reims, France
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Pituitary Unit, Referent Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ghizelaine Bousdira
- Service de Pathologie, CHU de Reims, 51092, Reims, France
- CNRS, MEDyC UMR 7369, Université de Reims Champagne Ardenne, 51097, Reims, France
| | - Louise Marie Mboua Tetka
- Service de Pathologie, CHU de Reims, 51092, Reims, France
- CNRS, MEDyC UMR 7369, Université de Reims Champagne Ardenne, 51097, Reims, France
| | - Romain Perbet
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, France
| | - Claude-Alain Maurage
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, France
| | - Romain Appay
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Guillaume Gauchotte
- Department of Biopathology, CHRU-ICL, INSERM U1256 NGERE, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Nathalie Sturm
- Department of Anatomo-Cytopathology, Grenoble University Hospital, 38700, La Tronche, France
| | - Bertrand Baussart
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
- Department of Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Federico Roncaroli
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jérôme Bertherat
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
- Service d'Endocrinologie, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, 75014, Paris, France
| | - Thierry Brue
- Aix Marseille Univ, AP-HM, Inserm, MMG, MarMaRa, Marseille, France
- Department of Endocrinology, Reference Center for Rare Pituitary Diseases (CRMR HYPO), La Conception University Hospital, AP-HM, Marseille, France
| | - Chiara Villa
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France.
- Department of Neuropathology, Hôpital Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France.
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Guaraldi F, Ambrosi F, Ricci C, Di Sciascio L, Asioli S. Histopathology of growth hormone-secreting pituitary tumors: State of the art and new perspectives. Best Pract Res Clin Endocrinol Metab 2024; 38:101894. [PMID: 38614953 DOI: 10.1016/j.beem.2024.101894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
Somatotroph (GH) adenomas/PitNETs typically arise from adenohypophysis and are biochemically active, leading to acromegaly and gigantism. More rarely, they present with ectopic origin and do not present overt biochemical or clinical features (silent variants). Histopathological examination should consider the clinical and radiological background, and include multiple steps assessing tumor morphology, pituitary transcription factors (PTFs), hormone secretion, proliferation markers, granulation, and somatostatin receptors (STRs), aimed at depicting as better as possible tumor origin (in case of non-functioning and/or metastatic tumor), and clinical behavior, including response to treatment. GH-secreting tumors are part of the Pit-1 family tumors and can secrete GH only (pure somatotrophs) or co-secrete prolactin (mixed tumors; in this case, various histological subtypes have been identified). Each subtype presents unique radiological, biochemical, and clinical characteristic. Therefore, the integration of biochemical, clinical, radiological, and histopathological elements is fundamental for proper diagnosis and management of pituitary adenomas/PitNETs, to be performed in referral Centers. In more recent times, the importance of genetic and epigenetic evaluation in the characterization of pituitary tumors (i.e., early identification of aggressive variants) has been outlined by some large studies, with the intention of improving targeted treatments.
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Affiliation(s)
- Federica Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Francesca Ambrosi
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
| | - Costantino Ricci
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
| | - Luisa Di Sciascio
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Sofia Asioli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
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Munari E, Scarpa A, Cima L, Pozzi M, Pagni F, Vasuri F, Marletta S, Dei Tos AP, Eccher A. Cutting-edge technology and automation in the pathology laboratory. Virchows Arch 2024; 484:555-566. [PMID: 37930477 PMCID: PMC11062949 DOI: 10.1007/s00428-023-03637-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 11/07/2023]
Abstract
One of the goals of pathology is to standardize laboratory practices to increase the precision and effectiveness of diagnostic testing, which will ultimately enhance patient care and results. Standardization is crucial in the domains of tissue processing, analysis, and reporting. To enhance diagnostic testing, innovative technologies are also being created and put into use. Furthermore, although problems like algorithm training and data privacy issues still need to be resolved, digital pathology and artificial intelligence are emerging in a structured manner. Overall, for the field of pathology to advance and for patient care to be improved, standard laboratory practices and innovative technologies must be adopted. In this paper, we describe the state-of-the-art of automation in pathology laboratories in order to lead technological progress and evolution. By anticipating laboratory needs and demands, the aim is to inspire innovation tools and processes as positively transformative support for operators, organizations, and patients.
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Affiliation(s)
- Enrico Munari
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Piazza Del Mercato, 15, 25121, Brescia, BS, Italy.
| | - Aldo Scarpa
- Pathology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Luca Cima
- Pathology Unit, Department of Laboratory Medicine, Santa Chiara Hospital, APSS, Trento, Italy
| | - Matteo Pozzi
- Bruno Kessler Foundation, Trento, Italy
- University of Trento, CIBIO Department, Trento, Italy
| | - Fabio Pagni
- Pathology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, IRCCS Fondazione San Gerardo Dei Tintori, Monza, Italy
| | - Francesco Vasuri
- Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stefano Marletta
- Pathology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Albino Eccher
- Section of Pathology, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
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Schaad N, Berezowska S, Perren A, Hewer E. Impact of template-based synoptic reporting on completeness of surgical pathology reports. Virchows Arch 2024; 484:31-36. [PMID: 37017774 PMCID: PMC10791929 DOI: 10.1007/s00428-023-03533-6] [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: 01/10/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023]
Abstract
Synoptic reporting increases completeness and standardization of surgical pathology reports and thereby contributes to an increased quality of clinical cancer care. Nevertheless, its widespread practical implementation remains a challenge, which is in part related to the effort required for setup and maintenance of database structures. This prompted us to assess the effect of a simple template-based, database-free system for synoptic reporting on completeness of surgical pathology reports. For this purpose, we analyzed 200 synoptic reports (100 colon and 100 lung cancer resections each) for completeness as required by the pertinent College of American Pathologists (CAP) protocols and compared these to a control dataset of 200 narrative reports. Introduction of template-based synoptic reporting resulted in improved completeness (98% of mandatory data elements) as compared to narrative reports (77%). Narrative reports showed a high degree of completeness for data elements covered by previously existing dictation templates. In conclusion, template-based synoptic reporting without underlying database structure can be a useful transitory phase in the implementation of synoptic reporting. It can result in a similar degree of completeness as reported in the literature for database solutions and provides other benefits of synoptic reporting while facilitating its implementation.
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Affiliation(s)
- Nicole Schaad
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Sabina Berezowska
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 25, 1011 Lausanne, Switzerland
| | - Aurel Perren
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Ekkehard Hewer
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland.
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 25, 1011 Lausanne, Switzerland.
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Cazzaniga G, Eccher A, Munari E, Marletta S, Bonoldi E, Della Mea V, Cadei M, Sbaraglia M, Guerriero A, Dei Tos AP, Pagni F, L’Imperio V. Natural Language Processing to extract SNOMED-CT codes from pathological reports. Pathologica 2023; 115:318-324. [PMID: 38180139 PMCID: PMC10767798 DOI: 10.32074/1591-951x-952] [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: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024] Open
Abstract
Objective The use of standardized structured reports (SSR) and suitable terminologies like SNOMED-CT can enhance data retrieval and analysis, fostering large-scale studies and collaboration. However, the still large prevalence of narrative reports in our laboratories warrants alternative and automated labeling approaches. In this project, natural language processing (NLP) methods were used to associate SNOMED-CT codes to structured and unstructured reports from an Italian Digital Pathology Department. Methods Two NLP-based automatic coding systems (support vector machine, SVM, and long-short term memory, LSTM) were trained and applied to a series of narrative reports. Results The 1163 cases were tested with both algorithms, showing good performances in terms of accuracy, precision, recall, and F1 score, with SVM showing slightly better performances as compared to LSTM (0.84, 0.87, 0.83, 0.82 vs 0.83, 0.85, 0.83, 0.82, respectively). The integration of an explainability allowed identification of terms and groups of words of importance, enabling fine-tuning, balancing semantic meaning and model performance. Conclusions AI tools allow the automatic SNOMED-CT labeling of the pathology archives, providing a retrospective fix to the large lack of organization of narrative reports.
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Affiliation(s)
- Giorgio Cazzaniga
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Italy
| | - Albino Eccher
- Section of Pathology, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Enrico Munari
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Stefano Marletta
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Emanuela Bonoldi
- Unit of Surgical Pathology and Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Vincenzo Della Mea
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Moris Cadei
- Pathology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Angela Guerriero
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Italy
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Italy
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Gupta R, Selinger CI, Ashford B, Chua MST, Clark JR, Damian DL, Jackett LA, James C, Johnson S, Ladwa R, Lambie D, McKenzie C, Tan ST, Scolyer RA. Implementing structured pathology reporting protocol for non-melanocytic skin cancers: practical considerations. Pathology 2023; 55:743-759. [PMID: 37573165 DOI: 10.1016/j.pathol.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
Non-melanocytic skin cancers (NMSCs) account for five times the incidence of all other cancers combined and cost US $6 billion annually. These are the most frequent specimens encountered in community pathology practice in many Western countries. Lack of standardised structured pathology reporting protocols (SPRPs) can result in omission of critical information or miscommunication leading to suboptimal patient management. The lack of standardised data has significant downstream public health implications, including insufficient data for reliable development of prognostic tools and health-economy planning. The Royal College of Pathologists of Australasia has developed an NMSC SPRP. A multidisciplinary expert committee including pathologists, surgeons, dermatologists, and radiation and medical oncologists from high volume cancer centres was convened. A systematic literature review was performed to identify evidence for including elements as mandatory standards or best practice guidelines. The SPRP and accompanying commentary of evidence, definitions and criteria was peer reviewed by external stakeholders. Finally, the protocol was revised following feedback and trialled in multiple centres prior to implementation. Some parameters utilised clinically for determining management and prognosis including tumour depth, lymphovascular invasion or distance to the margins lack high level evidence in NMSC. Dermatologists, surgeons, and radiation oncologists welcomed the SPRP. Pathologists indicated that the variety of NMSC specimens ranging from curettes to radical resections as well as significant differences in the biological behaviour of different tumours covered by the NMSC umbrella made use of a single protocol difficult. The feedback included that using a SPRP for low risk NMSC was neither clinically justified nor compensated adequately by the Australian Medicare Reimbursement Schedule. Following stakeholder feedback, the SPRP implementation was restricted to excision specimens of head and neck NMSC; and low-risk NMSC, such as superficial basal cell carcinoma, were excluded. Implementing NMSC SPRP fulfils an unmet clinical need. Unlike other cancers, NMSCs generate a range of specimen types and are reported in a wide range of pathology practices. Limiting use of SPRP to NMSC at higher risk of progression and providing formatted templates for easy incorporation into laboratory information systems were essential to successful deployment. In the future, further consideration should be given to implementing the SPRP to include all relevant specimens, including non-head and neck and low-risk NMSC specimens.
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Affiliation(s)
- Ruta Gupta
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia.
| | | | - Bruce Ashford
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Margaret S T Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Vic, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Diona L Damian
- Discipline of Dermatology, Bosch Institute, University of Sydney, and Royal Prince Alfred Hospital Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Louise A Jackett
- Department of Pathology, Austin Health, Melbourne, Vic, Australia
| | | | | | - Rahul Ladwa
- Department of Cancer Care Services, Princess Alexandra Hospital, Woolloongabba, Qld, Australia; Faculty of Medicine, University of Queensland, Herston, Qld, Australia
| | - Duncan Lambie
- Princess Alexandra Hospital, Pathology Queensland, Brisbane, Qld, Australia; Frazer Institute, University of Queensland, Brisbane, Qld, Australia
| | - Catriona McKenzie
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand; Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
| | - Richard A Scolyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Guerrero-Aranda A, Friman-Guillen H, González-Garrido AA. Acceptability by End-users of a Standardized Structured Format for Reporting EEG. Clin EEG Neurosci 2023; 54:483-488. [PMID: 35369781 DOI: 10.1177/15500594221091527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The report of the electroencephalogram (EEG) results has traditionally been made using free-text formats with a huge variation in descriptions due to several factors. Recently, the International Federation of Clinical Neurophysiology (IFCN) endorsed the use of the Standardized Computer-based Organized Reporting of EEG (SCORE). This system has many advantages, but only some concerns have been investigated so far. This study aimed to assess the end-users acceptability of this proposed EEG report format. A 16-item electronic survey was sent to physicians who use EEG services of a medical diagnosis clinic. Physicians had been receiving the EEG reports in free-text formats from the same three board-certified electroencephalographers for the past three years. In January 2019, the report changed to the SCORE format. The survey assessed five main topics: physician information and historical use of EEG; personal preferences; comparative aspects of the formats; impact of the new format on clinical decision-making; and satisfaction. Thirty-two of 52 have responded to the survey (61%). On average, 81% of the responders have received enough reports with the new format to reliably complete the survey. Every responder prefers the standardized compared to the free-text format. Twenty-five responders like the inclusion of the head model, and interestingly, five suggest including another legend to differentiate "slow activity" from "other abnormal activity". Virtually all responders would recommend the new format, but one-third read only the conclusion. Our findings suggest high acceptability of this standardized report format. Despite the limitations of this study, we hope these findings contribute to the improvement and expansion of standardized EEG reporting systems.
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Affiliation(s)
- Alioth Guerrero-Aranda
- Department of Clinical Neurophysiology, Grupo RIO, Guadalajara, Jalisco, México
- Department of Clinical Neurophysiology, SYNAPTIKA, Guadalajara, Jalisco, México
| | - Henry Friman-Guillen
- Department of Clinical Neurophysiology, Grupo RIO, Guadalajara, Jalisco, México
- Department of Clinical Neurophysiology, SYNAPTIKA, Guadalajara, Jalisco, México
| | - Andrés Antonio González-Garrido
- Department of Clinical Neurophysiology, Grupo RIO, Guadalajara, Jalisco, México
- Institute of Neurosciences, University of Guadalajara, Guadalajara, Jalisco, México
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Menotti L, Silvello G, Atzori M, Boytcheva S, Ciompi F, Di Nunzio GM, Fraggetta F, Giachelle F, Irrera O, Marchesin S, Marini N, Müller H, Primov T. Modelling digital health data: The ExaMode ontology for computational pathology. J Pathol Inform 2023; 14:100332. [PMID: 37705689 PMCID: PMC10495665 DOI: 10.1016/j.jpi.2023.100332] [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: 05/09/2023] [Revised: 07/14/2023] [Accepted: 08/16/2023] [Indexed: 09/15/2023] Open
Abstract
Computational pathology can significantly benefit from ontologies to standardize the employed nomenclature and help with knowledge extraction processes for high-quality annotated image datasets. The end goal is to reach a shared model for digital pathology to overcome data variability and integration problems. Indeed, data annotation in such a specific domain is still an unsolved challenge and datasets cannot be steadily reused in diverse contexts due to heterogeneity issues of the adopted labels, multilingualism, and different clinical practices. Material and methods This paper presents the ExaMode ontology, modeling the histopathology process by considering 3 key cancer diseases (colon, cervical, and lung tumors) and celiac disease. The ExaMode ontology has been designed bottom-up in an iterative fashion with continuous feedback and validation from pathologists and clinicians. The ontology is organized into 5 semantic areas that defines an ontological template to model any disease of interest in histopathology. Results The ExaMode ontology is currently being used as a common semantic layer in: (i) an entity linking tool for the automatic annotation of medical records; (ii) a web-based collaborative annotation tool for histopathology text reports; and (iii) a software platform for building holistic solutions integrating multimodal histopathology data. Discussion The ontology ExaMode is a key means to store data in a graph database according to the RDF data model. The creation of an RDF dataset can help develop more accurate algorithms for image analysis, especially in the field of digital pathology. This approach allows for seamless data integration and a unified query access point, from which we can extract relevant clinical insights about the considered diseases using SPARQL queries.
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Affiliation(s)
- Laura Menotti
- Department of Information Engineering, University of Padua, Padova, Italy
| | - Gianmaria Silvello
- Department of Information Engineering, University of Padua, Padova, Italy
| | - Manfredo Atzori
- Information Systems Institute, University of Applied Sciences Western Switzerland, Delémont, Switzerland
- Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Francesco Ciompi
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Fabio Giachelle
- Department of Information Engineering, University of Padua, Padova, Italy
| | - Ornella Irrera
- Department of Information Engineering, University of Padua, Padova, Italy
| | - Stefano Marchesin
- Department of Information Engineering, University of Padua, Padova, Italy
| | - Niccolò Marini
- Information Systems Institute, University of Applied Sciences Western Switzerland, Delémont, Switzerland
| | - Henning Müller
- Information Systems Institute, University of Applied Sciences Western Switzerland, Delémont, Switzerland
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Iscoe MS, Loza AJ, Turbiville D, Campbell SM, Peaper DR, Balbuena-Merle RI, Hauser RG. PROSER: A Web-Based Peripheral Blood Smear Interpretation Support Tool Utilizing Electronic Health Record Data. Am J Clin Pathol 2023; 160:98-105. [PMID: 37026746 DOI: 10.1093/ajcp/aqad024] [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: 11/17/2022] [Accepted: 02/10/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVES Peripheral blood smear (PBS) interpretation represents a cornerstone of pathology practice and resident training but has remained largely static for decades. Here, we describe a novel PBS interpretation support tool. METHODS In a mixed-methods quality improvement study, a web-based clinical decision support (CDS) tool to assist pathologists in PBS interpretation, PROSER, was deployed in an academic hospital over a 2-month period in 2022. PROSER interfaced with the hospital system's electronic health record and data warehouse to obtain and display relevant demographic, laboratory, and medication information for patients with pending PBS consults. PROSER used these data along with morphologic findings entered by the pathologist to draft a PBS interpretation using rule-based logic. We evaluated users' perceptions of PROSER with a Likert-type survey. RESULTS PROSER displayed 46 laboratory values with corresponding reference ranges and abnormal flags, allowed for entry of 14 microscopy findings, and computed 2 calculations based on laboratory values; it composed automated PBS reports using a library of 92 prewritten phrases. Overall, PROSER was well received by residents. CONCLUSIONS In this quality improvement study, we successfully deployed a web-based CDS tool for PBS interpretation. Future work is needed to quantitatively evaluate this intervention's effects on clinical outcomes and resident training.
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Affiliation(s)
- Mark S Iscoe
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Andrew J Loza
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Donald Turbiville
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Sheldon M Campbell
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - David R Peaper
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Raisa I Balbuena-Merle
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Ronald G Hauser
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
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10
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Dancey SR, Benton SJ, Lafreniere AJ, Leckie M, McLeod B, Sim J, El-Demellawy D, Grynspan D, Bainbridge SA. Synoptic Reporting in Clinical Placental Pathology: A Preliminary Investigation Into Report Findings and Interobserver Agreement. Pediatr Dev Pathol 2023; 26:333-344. [PMID: 37082923 PMCID: PMC10559645 DOI: 10.1177/10935266231164446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Placental pathology is key for investigating adverse pregnancy outcomes, however, lack of standardization in reporting has limited clinical utility. We evaluated a novel placental pathology synoptic report, comparing its robustness to narrative reports, and assessed interobserver agreement. METHODS 100 singleton placentas were included. Histology slides were examined by 2 senior perinatal pathologists and 2 pathology residents using a synoptic report (32 lesions). Historical narrative reports were compared to synoptic reports. Kappa scores were calculated for interobserver agreement between senior, resident, and senior vs resident pathologists. RESULTS Synoptic reporting detected 169 (51.4%) lesion instances initially not included in historical reports. Amongst senior pathologists, 64% of all lesions examined demonstrated fair-to-excellent agreement (Kappa ≥0.41), with only 26% of Kappas ≥0.41 amongst those examined by resident pathologists. Well-characterized lesions (e.g., chorioamnionitis) demonstrated higher agreement, with lower agreement for uncommon lesions and those previously shown to have poor consensus. DISCUSSION Synoptic reporting is one proposed method to address issues in placenta pathology reporting. The synoptic report generally identifies more lesions compared to the narrative report, however clinical significance remains unclear. Interobserver agreement is likely related to differential in experience. Further efforts to improve overall standardization of placenta pathology reporting are needed.
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Affiliation(s)
- Sonia R. Dancey
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Samantha J. Benton
- Department of Health Sciences, Faculty of Science, Carleton University, Ottawa, ON, Canada
| | | | - Michal Leckie
- Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Benjamin McLeod
- Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jordan Sim
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Dina El-Demellawy
- Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - David Grynspan
- Department of Pathology and Laboratory Medicine, Vernon Jubilee Hospital, Vernon, BC, Canada
| | - Shannon A. Bainbridge
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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11
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Pung L, Moorin R, Trevithick R, Taylor K, Chai K, Garcia Gewerc C, Ha N, Smith S. Determining cancer stage at diagnosis in population-based cancer registries: A rapid scoping review. FRONTIERS IN HEALTH SERVICES 2023; 3:1039266. [PMID: 36926511 PMCID: PMC10012750 DOI: 10.3389/frhs.2023.1039266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/03/2023] [Indexed: 03/18/2023]
Abstract
Introduction Population-based cancer registries are the main source of data for population-level analysis of cancer stage at diagnosis. This data enables analysis of cancer burden by stage, evaluation of screening programs and provides insight into differences in cancer outcomes. The lack of standardised collection of cancer staging in Australia is well recognised and is not routinely collected within the Western Australia Cancer Registry. This review aimed to explore how cancer stage at diagnosis is determined in population-based cancer registries. Methods This review was guided by the Joanna-Briggs Institute methodology. A systematic search of peer-reviewed research studies and grey literature from 2000 to 2021 was conducted in December 2021. Literature was included if peer-reviewed articles or grey literature sources used population-based cancer stage at diagnosis, and were published in English between 2000 and 2021. Literature was excluded if they were reviews or only the abstract was available. Database results were screened by title and abstract using Research Screener. Full-texts were screened using Rayyan. Included literature were analysed using thematic analysis and managed through NVivo. Results The findings of the 23 included articles published between 2002 and 2021 consisted of two themes. (1) "Data sources and collection processes" outlines the data sources used, as well as the processes and timing of data collection utilised by population-based cancer registries. (2) "Staging classification systems" reveals the staging classification systems employed or developed for population-based cancer staging, including the American Joint Committee on Cancer's Tumour Node Metastasis and related systems; simplified systems classified into localised, regional, and distant categories; and miscellaneous systems. Conclusions Differences in approaches used to determine population-based cancer stage at diagnosis challenge attempts to make interjurisdictional and international comparisons. Barriers to collecting population-based stage at diagnosis include resource availability, infrastructure differences, methodological complexity, interest variations, and differences in population-based roles and emphases. Even within countries, disparate funding sources and funder interests can challenge the uniformity of population-based cancer registry staging practices. International guidelines to guide cancer registries in collecting population-based cancer stage is needed. A tiered framework of standardising collection is recommended. The results will inform integrating population-based cancer staging into the Western Australian Cancer Registry.
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Affiliation(s)
- Li Pung
- School of Population Health, Curtin University, Perth, WA, Australia.,Public Health, North Metropolitan Health Service, Perth, WA, Australia
| | - Rachael Moorin
- School of Population Health, Curtin University, Perth, WA, Australia.,School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Richard Trevithick
- Department of Health, Western Australia Cancer Registry, Clinical Excellence Division, Perth, WA, Australia
| | - Karen Taylor
- Cancer Network WA, North Metropolitan Health Service, Perth, WA, Australia
| | - Kevin Chai
- School of Population Health, Curtin University, Perth, WA, Australia
| | | | - Ninh Ha
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Stephanie Smith
- School of Population Health, Curtin University, Perth, WA, Australia
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12
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Snoek JAA, Nagtegaal ID, Siesling S, van den Broek E, van Slooten HJ, Hugen N. The impact of standardized structured reporting of pathology reports for breast cancer care. Breast 2022; 66:178-182. [PMID: 36308925 PMCID: PMC9619179 DOI: 10.1016/j.breast.2022.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/21/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE With the increasing complexity of modern oncological patient management and the growing amount of information needed from the pathologist, traditional narrative pathology reports (NR) do not suffice. Standardized synoptic reporting (SR) increases both completeness and readability. In the Netherlands SR for breast cancer was introduced in 2009. We explore the impact of synoptic reporting on breast cancer care. METHODS Using data from the Netherlands Cancer Registry and Dutch Nationwide Pathology Databank, a retrospective population-based cohort study was performed. Data of breast cancer resections from 2007 to 2014 were collected to compare NR and SR for all outcome measures. Kaplan-Meier analyses and log-rank testing were used to estimate overall survival. RESULTS Over time there was an increase from 12% to 78.9% in the use of SR. SR resulted in higher completeness of pathology reports, particularly for hormone and HER2/neu receptor status. Although there was no difference in the administration of antihormonal therapy, anti-HER2 treatment was more frequently administered to eligible patients in the SR group. An effect on overall survival could not yet be confirmed on multivariate analysis. CONCLUSIONS We demonstrate that SR has led to more complete pathology reports, which meets the needs for precision of information in breast cancer care. This is expected to improve communication and discussions between specialists regarding parameters important for adjuvant breast cancer treatment decisions. SR thereby improves breast cancer care and leads to improved allocation of treatment based on pathologic parameters and more personalized treatment regimens.
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Affiliation(s)
- J A A Snoek
- Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands
| | - I D Nagtegaal
- Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands.
| | - S Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | | | | | - N Hugen
- Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands; Rijnstate Hospital, Department of Surgery, Arnhem, the Netherlands
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13
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Lam H, Nguyen F, Wang X, Stock A, Lenskaya V, Kooshesh M, Li P, Qazi M, Wang S, Dehghan M, Qian X, Si Q, Polydorides AD. An accessible, efficient, and accurate natural language processing method for extracting diagnostic data from pathology reports. J Pathol Inform 2022; 13:100154. [PMID: 36605108 PMCID: PMC9808011 DOI: 10.1016/j.jpi.2022.100154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/09/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Context Analysis of diagnostic information in pathology reports for the purposes of clinical or translational research and quality assessment/control often requires manual data extraction, which can be laborious, time-consuming, and subject to mistakes. Objective We sought to develop, employ, and evaluate a simple, dictionary- and rule-based natural language processing (NLP) algorithm for generating searchable information on various types of parameters from diverse surgical pathology reports. Design Data were exported from the pathology laboratory information system (LIS) into extensible markup language (XML) documents, which were parsed by NLP-based Python code into desired data points and delivered to Excel spreadsheets. Accuracy and efficiency were compared to a manual data extraction method with concordance measured by Cohen's κ coefficient and corresponding P values. Results The automated method was highly concordant (90%-100%, P<.001) with excellent inter-observer reliability (Cohen's κ: 0.86-1.0) compared to the manual method in 3 clinicopathological research scenarios, including squamous dysplasia presence and grade in anal biopsies, epithelial dysplasia grade and location in colonoscopic surveillance biopsies, and adenocarcinoma grade and amount in prostate core biopsies. Significantly, the automated method was 24-39 times faster and inherently contained links for each diagnosis to additional variables such as patient age, location, etc., which would require additional manual processing time. Conclusions A simple, flexible, and scaleable NLP-based platform can be used to correctly, safely, and quickly extract and deliver linked data from pathology reports into searchable spreadsheets for clinical and research purposes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Alexandros D. Polydorides
- Corresponding author at: Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1194, New York, NY 10029, USA.
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14
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Richter C, Mezger E, Schüffler PJ, Sommer W, Fusco F, Hauner K, Schmid SC, Gschwend JE, Weichert W, Schwamborn K, Pförringer D, Schlitter AM. Pathological Reporting of Radical Prostatectomy Specimens Following ICCR Recommendation: Impact of Electronic Reporting Tool Implementation on Quality and Interdisciplinary Communication in a Large University Hospital. Curr Oncol 2022; 29:7245-7256. [PMID: 36290848 PMCID: PMC9600383 DOI: 10.3390/curroncol29100571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 01/13/2023] Open
Abstract
Prostate cancer represents one of the most common malignant tumors in male patients in Germany. The pathological reporting of radical prostatectomy specimens following a structured process constitutes an excellent prototype for the introduction of software-based standardized structured reporting in pathology. This can lead to reports of higher quality and could create a fundamental improvement for future AI applications. A software-based reporting template was used to generate standardized structured pathological reports of radical prostatectomy specimens of patients treated at the University Hospital Klinikum rechts der Isar of Technische Universität München, Germany. Narrative reports (NR) and standardized structured reports (SSR) were analyzed with regard to completeness, and clinicians' satisfaction with each report type was evaluated. SSR show considerably higher completeness than NR. A total of 10 categories out of 32 were significantly more complete in SSR than in NR (p < 0.05). Clinicians awarded overall high scores in NR and SSR reports. One rater acknowledged a significantly higher level of clarity and time saving when comparing SSR to NR. Our findings highlight that the standardized structured reporting of radical prostatectomy specimens, qualifying as level 5 reports, significantly increases objectively measured content quality and the level of completeness. The implementation of nationwide SSR in Germany, particularly in oncologic pathology, can serve pathologists, clinicians, and patients.
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Affiliation(s)
- Caroline Richter
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Eva Mezger
- Smart Reporting GmbH, 80538 Munich, Germany
| | - Peter J. Schüffler
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Wieland Sommer
- Smart Reporting GmbH, 80538 Munich, Germany
- Department of Radiology, LMU University Hospital, 81377 Munich, Germany
| | - Federico Fusco
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Katharina Hauner
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Sebastian C. Schmid
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Jürgen E. Gschwend
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Wilko Weichert
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Kristina Schwamborn
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Dominik Pförringer
- Clinic and Policlinic for Trauma Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Anna Melissa Schlitter
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
- Correspondence:
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15
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Marchesin S, Giachelle F, Marini N, Atzori M, Boytcheva S, Buttafuoco G, Ciompi F, Di Nunzio GM, Fraggetta F, Irrera O, Müller H, Primov T, Vatrano S, Silvello G. Empowering digital pathology applications through explainable knowledge extraction tools. J Pathol Inform 2022; 13:100139. [PMID: 36268087 PMCID: PMC9577130 DOI: 10.1016/j.jpi.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022] Open
Abstract
Exa-scale volumes of medical data have been produced for decades. In most cases, the diagnosis is reported in free text, encoding medical knowledge that is still largely unexploited. In order to allow decoding medical knowledge included in reports, we propose an unsupervised knowledge extraction system combining a rule-based expert system with pre-trained Machine Learning (ML) models, namely the Semantic Knowledge Extractor Tool (SKET). Combining rule-based techniques and pre-trained ML models provides high accuracy results for knowledge extraction. This work demonstrates the viability of unsupervised Natural Language Processing (NLP) techniques to extract critical information from cancer reports, opening opportunities such as data mining for knowledge extraction purposes, precision medicine applications, structured report creation, and multimodal learning. SKET is a practical and unsupervised approach to extracting knowledge from pathology reports, which opens up unprecedented opportunities to exploit textual and multimodal medical information in clinical practice. We also propose SKET eXplained (SKET X), a web-based system providing visual explanations about the algorithmic decisions taken by SKET. SKET X is designed/developed to support pathologists and domain experts in understanding SKET predictions, possibly driving further improvements to the system.
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Affiliation(s)
- Stefano Marchesin
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Fabio Giachelle
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Niccolò Marini
- Information Systems Institute, University of Applied Sciences Western Switzerland, Delémont, Switzerland
| | - Manfredo Atzori
- Information Systems Institute, University of Applied Sciences Western Switzerland, Delémont, Switzerland
- Department of Neuroscience, University of Padua, Padua, Italy
| | | | | | - Francesco Ciompi
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Ornella Irrera
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Henning Müller
- Information Systems Institute, University of Applied Sciences Western Switzerland, Delémont, Switzerland
| | | | - Simona Vatrano
- Pathology Unit Gravina Hospital Caltagirone ASP Catania, Italy
| | - Gianmaria Silvello
- Department of Information Engineering, University of Padua, Padua, Italy
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16
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Fox SB, Webster F, Chen CJ, Chua B, Collins LC, Foschini MP, Mann GB, Millar EKA, Pinder SE, Rakha E, Shaaban AM, Tan BY, Tse GM, Watson PH, Tan PH. Dataset for pathology reporting of ductal carcinoma in situ, variants of lobular carcinoma in situ and low grade lesions: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2022; 81:467-476. [DOI: 10.1111/his.14725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- SB Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Level 4 Victorian Comprehensive Cancer Centre Melbourne VIC 3000 Australia
| | - F Webster
- International Collaboration on Cancer Reporting, Albion St, Surry Hills NSW 2010 Australia
| | - CJ Chen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4 Taichung 40705 Taiwan
| | - B Chua
- Prince of Wales Clinical School, UNSW Sydney The University of New South Wales Randwick NSW 2031 Australia
| | - LC Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave and Harvard Medical School Boston MA 02215 USA
| | - MP Foschini
- Department Anatomic Pathology University of Bologna Department of Biomedical and Neuromotor Sciences Unit of Anatomic Pathology at Bellaria Hospital, Via Altura 3 40139 Bologna Italy
| | - GB Mann
- The Breast Service, The Royal Melbourne Hospital, Grattan St Parkville VIC 3050 Australia
| | - EKA Millar
- Department of Anatomical Pathology Heath Pathology St George Hospital, Kogarah NSW 2217 & St George & Sutherland Clinical School, UNSW NSW Sydney Australia
| | - SE Pinder
- School of Cancer & Pharmaceutical Sciences King's College London, 9th Floor, Innovation Hub, Comprehensive Cancer Centre at Guy's Hospital, Great Maze Pond. London SE1 9RT United Kingdom
| | - E Rakha
- Department of Histopathology The University of Nottingham Nottingham City Hospital, Hucknall Road Nottingham NG5 1PB United Kingdom
| | - AM Shaaban
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham and Cancer and Genomic Sciences University of Birmingham, Mindelsohn Way Birmingham B15 2GW United Kingdom
| | - BY Tan
- Department of Anatomical Pathology, Singapore General Hospital College Rd Singapore 169856
| | - GM Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital The Chinese University of Hong Kong, Ngan Shing Street Shatin Hong Kong
| | - PH Watson
- Department of Pathology, Biobanking and Biospecimen Research Services, Deeley Research Centre, BC Cancer Agency, 2410 Lee Ave Victoria BC V8R 6V5 Canada Victoria British Columbia Canada
| | - PH Tan
- Division of Pathology Singapore General Hospital Singapore
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17
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van Velthuysen MF, Couvelard A, Rindi G, Fazio N, Hörsch D, Nieveen van Dijkum EJ, Klöppel G, Perren A. ENETS standardized (synoptic) reporting for neuroendocrine tumour pathology. J Neuroendocrinol 2022; 34:e13100. [PMID: 35165954 PMCID: PMC9285411 DOI: 10.1111/jne.13100] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 12/03/2022]
Abstract
In recent years the WHO classification of neuroendocrine neoplasms (NEN) has evolved. Nomenclature as well as thresholds for grading have changed leading to potential confusion and lack of comparability of tumour reports. Therefore, the European Neuroendocrine Tumour Society (ENETS) has set-up an interdisciplinary working group to develop templates for a pathology data set for standardised reporting of NEN. Experts of various disciplines, members of the ENETS Advisory Board, formed a taskforce that discussed and decided on the structure, content and the number of templates needed for reporting the most common NEN. The selection of the required items was based on the WHO classification of digestive system tumours, the WHO classification of tumours of the lung and mediastinum and on "ENETS standard of care" reports. The final proposal of the working group was approved by the ENETS Advisory Board. Templates for synoptic reporting were created for the seven most common NEN primary sites, that is, stomach, duodenum, jejunum-ileum, appendix, colon-rectum, pancreas, lung and mediastinum. In addition, a general template for reporting biopsies was designed. The templates allow the recording of the essential items on differentiation, proliferation (Ki-67 and mitosis), neuroendocrine features (positivity for chromogranin A and synaptophysin) and stage as well as several optional markers especially helpful for the distinction of neuroendocrine tumours (NET) from neuroendocrine carcinomas (NEC). In summary, this paper presents the content and development of synoptic reports for most sites of NEN by a multidisciplinary team of international experts in the field, which could help to improve unambiguous reporting of NEN.
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Affiliation(s)
| | - Anne Couvelard
- Service de PathologieHôpital Bichat AP‐HP et Université de ParisParisFrance
| | - Guido Rindi
- Section of Anatomic PathologyDepartment of Life Sciences and Public HealthUniversità Cattolica del Sacro CuoreRomaItalia
- Unit of Anatomic PathologyDepartment of Woman and Child Health and Public HealthFondazione Policlinico Universitario A. Gemelli IRCCSRomaItalia
- Roma European Neuroendocrine Tumor Society (ENETS) Center of ExcellenceRomaItalia
| | - Nicola Fazio
- Division of gastrointestinal medical oncology and neuroendocrine tumorsEuropean Institute of Oncology (IEO)IRCCSMilanItaly
| | - Dieter Hörsch
- CA GastroenterologieZentralklinik Bad Berka GmbHBad BerkaGermany
| | - Els J. Nieveen van Dijkum
- Department of SurgeryCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Günter Klöppel
- Department of PathologyConsultation Center for Pancreatic and Endocrine Tumors, TU MunichMunichGermany
| | - Aurel Perren
- Institute of PathologyUniversity of BernBernSwitzerland
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18
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de Herder WW, Fazio N, O'Toole D. ENETS standardized (synoptic) reporting in neuroendocrine tumours. J Neuroendocrinol 2022; 34:e13054. [PMID: 34739148 DOI: 10.1111/jne.13054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/25/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Wouter W de Herder
- Erasmus MC and Erasmus MC Cancer Center, ENETS Center of Excellence, Rotterdam, The Netherlands
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Dermot O'Toole
- National Centre for Neuroendocrine Tumours, St Vincent's University Hospital and St James's Hospital and Trinity College Dublin, Dublin, Ireland
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19
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Using Explainable Machine Learning to Explore the Impact of Synoptic Reporting on Prostate Cancer. ALGORITHMS 2022. [DOI: 10.3390/a15020049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Machine learning (ML) models have proven to be an attractive alternative to traditional statistical methods in oncology. However, they are often regarded as black boxes, hindering their adoption for answering real-life clinical questions. In this paper, we show a practical application of explainable machine learning (XML). Specifically, we explored the effect that synoptic reporting (SR; i.e., reports where data elements are presented as discrete data items) in Pathology has on the survival of a population of 14,878 Dutch prostate cancer patients. We compared the performance of a Cox Proportional Hazards model (CPH) against that of an eXtreme Gradient Boosting model (XGB) in predicting patient ranked survival. We found that the XGB model (c-index = 0.67) performed significantly better than the CPH (c-index = 0.58). Moreover, we used Shapley Additive Explanations (SHAP) values to generate a quantitative mathematical representation of how features—including usage of SR—contributed to the models’ output. The XGB model in combination with SHAP visualizations revealed interesting interaction effects between SR and the rest of the most important features. These results hint that SR has a moderate positive impact on predicted patient survival. Moreover, adding an explainability layer to predictive ML models can open their black box, making them more accessible and easier to understand by the user. This can make XML-based techniques appealing alternatives to the classical methods used in oncological research and in health care in general.
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Kriplani D, Olivar AA, Tchrakian N, Butcher D, Casey L, Crook JA, Deo N, Dilley J, Griffiths R, Hogg M, Jeyarajah AR, Khan SJ, Lawrence A, Lee A, Leen SL, Leitch-Devlin L, Manchanda R, Masood M, Nyarko E, Okaro E, Phadnis S, Trevisan G, Tsang J, Vimplis S, Wilmott F, Brockbank E, Singh N. Concise Reporting of Benign Endometrial Biopsies is an Acceptable Alternative to Descriptive Reporting. Int J Gynecol Pathol 2022; 41:20-27. [PMID: 33664191 DOI: 10.1097/pgp.0000000000000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the United Kingdom, endometrial biopsy reports traditionally consist of a morphologic description followed by a conclusion. Recently published consensus guidelines for reporting benign endometrial biopsies advocate the use of standardized terminology. In this project we aimed to assess the acceptability and benefits of this simplified "diagnosis only" format for reporting non-neoplastic endometrial biopsies. Two consultants reported consecutive endometrial biopsies using 1 of 3 possible formats: (i) diagnosis only, (ii) diagnosis plus an accompanying comment, and (iii) the traditional descriptive format. Service users were asked to provide feedback on this approach via an anonymized online survey. The reproducibility of this system was assessed on a set of 53 endometrial biopsies among consultants and senior histopathology trainees. Of 370 consecutive benign endometrial biopsies, 245 (66%) were reported as diagnosis only, 101 (27%) as diagnosis plus a brief comment, and 24 (7%) as diagnosis following a morphologic description. Of the 43 survey respondents (28 gynecologists, 11 pathologists, and 4 clinical nurse specialists), 40 (93%) preferred a diagnosis only, with 3 (7%) being against/uncertain about a diagnosis only report. Among 3 histopathology consultants and 4 senior trainees there was majority agreement on the reporting format in 53/53 (100%) and 52/53 (98%) biopsies. In summary, we found that reporting benign specimens within standardized, well-understood diagnostic categories is an acceptable alternative to traditional descriptive reporting, with the latter reserved for the minority of cases that do not fit into specific categories. This revised approach has the potential to improve reporting uniformity and reproducibility.
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Abstract
The medical kidney biopsy has an important added value in patient care in nephrology. In order to facilitate communication between the pathologist and the nephrologist and optimize patient care, both the content and form of the medical kidney biopsy report matter. With some exceptions, current guidelines in nephropathology focus on content rather than form and, not surprisingly, medical kidney biopsy reports mostly consist of unformatted and often lengthy free text. In contrast, in oncology, a more systematic reporting called synoptic reporting has become the dominant method. Synoptic formats enable complete, concise and clear reports that comply with agreed upon standards. In this review we discuss the possibilities of systematic reporting in nephropathology (including synoptic reporting). Furthermore, we explore applications of electronic formats with structured data and usage of international terminologies or coding systems. The benefits include the timely collection of high-quality data for benchmarking between centres as well as for epidemiologic and other research studies. Based on these developments, a scenario for future medical kidney biopsy reporting is drafted.
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Affiliation(s)
- Sabine Leh
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Amélie Dendooven
- Department of Pathology, University Hospital Ghent, Ghent, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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22
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Alvfeldt G, Aspelin P, Blomqvist L, Sellberg N. Radiology reporting in rectal cancer using MRI: adherence to national template for structured reporting. Acta Radiol 2021; 63:1603-1612. [PMID: 34866405 DOI: 10.1177/02841851211057276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In 2014, a national workshop program was initiated and a reporting template and manual for rectal cancer primary staging using magnetic resonance imaging (MRI) was introduced and made available by the national Swedish Colorectal Cancer Registry. PURPOSE To evaluate the effect of the national template program by identify if there was a gap between the content in Swedish MRI reports from 2016 and the national reporting template from 2014. The aim was to explore and compare differences in content in reporting practice in different hospitals in relation to the national reporting template, with focus on: (i) identifying any implementational differences in reporting styles; and (ii) evaluating if reporting completeness vary based on such implementational differences. MATERIAL AND METHODS A total of 250 MRI reports from 10 hospitals in four healthcare regions in Sweden were collected. Reports were analyzed using qualitative content analysis with a deductive thematic coding scheme based on the national reporting template. RESULTS Three different implemented reporting styles were identified with variations of content coverage in relation to the template: (i) standardized and structured protocol (reporting style A); (ii) standardized semi-structured free-text (reporting style B); and (iii) regular free-text (reporting style C). The relative completeness of reporting practice of rectal cancer staging in relation to the national reporting template were 92.9% for reporting style A, 77.5% for reporting style B, and 63.9% for reporting style C. CONCLUSION The implementation of template-based reporting according to reporting style A is a key factor to conform to evidence-based practice for rectal cancer reporting using MRI.
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Affiliation(s)
- Gustav Alvfeldt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nina Sellberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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23
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Olkhov-Mitsel E, Lu FI, Gagliardi A, Plotkin A. Gynecologic pathology services in low- and middle-income countries. Int J Gynecol Cancer 2021; 32:918-923. [PMID: 34815269 DOI: 10.1136/ijgc-2021-003103] [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: 11/04/2022] Open
Abstract
OBJECTIVE The International Gynecologic Cancer Society (IGCS) offers multidisciplinary conferences to underserved communities. Mentor pathologists have become an integral part of these tumor boards, as pathology services in low-to-middle-income countries are often inadequate and disjointed. The IGCS Pathology Working Group conducted a survey to assess barriers to quality pathology services in low-to-middle-income countries and identified potential solutions. METHODS A 69-question cross-sectional survey assessing different aspects of pathology services was sent to 15 IGCS Extension for Community Healthcare Outcomes (ECHO) training sites in Africa, Asia, Central America, and the Caribbean. Local gynecologic oncologists distributed the survey to their pathology departments for review. The responses were tabulated in Microsoft Excel. RESULTS Responses were received from nine training sites: five sites in Africa, two in Asia, one in Central America, and one in the Caribbean. There were no pathologists with subspecialty training in gynecologic pathology. Most (7/9, 78%) surveyed sites indicated that they have limited access to online education and knowledge transfer resources. Of the eight sites that responded to the questions, 50% had an electronic medical system and 75% had a cancer registry. Synoptic reporting was used in 75% of the sites and paper-based reporting was predominant (75%). Most (6/7, 86%) laboratories performed limited immunohistochemical stains on site. None of the sites had access to molecular testing. CONCLUSIONS Initial goals for collaboration with local pathologists to improve diagnostic pathology in low- and middle-income countries could be defining minimal gross, microscopic, and reporting pathology requirements, as well as wisely designed educational programs intended to mentor local leaders in pathology. Larger studies are warranted to confirm these observations.
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Affiliation(s)
- Ekaternia Olkhov-Mitsel
- Division of Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Fang-I Lu
- Division of Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anna Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anna Plotkin
- Division of Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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24
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Srigley JR, Judge M, Helliwell T, Birdsong GG, Ellis DW. The International Collaboration on Cancer Reporting (ICCR): a decade of progress towards global pathology standardisation and data interoperability. Histopathology 2021; 79:897-901. [PMID: 34783048 DOI: 10.1111/his.14431] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/13/2021] [Indexed: 12/01/2022]
Affiliation(s)
- John R Srigley
- Trillium Health Partners and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Meagan Judge
- International Collaboration on Cancer Reporting, Sydney, Australia
| | - Tim Helliwell
- Department of Cellular Pathology, University of Liverpool, Liverpool, UK
| | - George G Birdsong
- Emory University School of Medicine at Grady Hospital, Atlanta, GA, USA
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25
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A Text Mining Approach in the Classification of Free-Text Cancer Pathology Reports from the South African National Health Laboratory Services. INFORMATION 2021. [DOI: 10.3390/info12110451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A cancer pathology report is a valuable medical document that provides information for clinical management of the patient and evaluation of health care. However, there are variations in the quality of reporting in free-text style formats, ranging from comprehensive to incomplete reporting. Moreover, the increasing incidence of cancer has generated a high throughput of pathology reports. Hence, manual extraction and classification of information from these reports can be intrinsically complex and resource-intensive. This study aimed to (i) evaluate the quality of over 80,000 breast, colorectal, and prostate cancer free-text pathology reports and (ii) assess the effectiveness of random forest (RF) and variants of support vector machine (SVM) in the classification of reports into benign and malignant classes. The study approach comprises data preprocessing, visualisation, feature selections, text classification, and evaluation of performance metrics. The performance of the classifiers was evaluated across various feature sizes, which were jointly selected by four filter feature selection methods. The feature selection methods identified established clinical terms, which are synonymous with each of the three cancers. Uni-gram tokenisation using the classifiers showed that the predictive power of RF model was consistent across various feature sizes, with overall F-scores of 95.2%, 94.0%, and 95.3% for breast, colorectal, and prostate cancer classification, respectively. The radial SVM achieved better classification performance compared with its linear variant for most of the feature sizes. The classifiers also achieved high precision, recall, and accuracy. This study supports a nationally agreed standard in pathology reporting and the use of text mining for encoding, classifying, and production of high-quality information abstractions for cancer prognosis and research.
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26
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Hewer E, Rump A, Langer R. [Standardized structured reports for gastrointestinal tumors]. DER PATHOLOGE 2021; 43:57-62. [PMID: 34609569 PMCID: PMC8789623 DOI: 10.1007/s00292-021-00986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/24/2022]
Abstract
Synoptic reporting in pathology as opposed to traditional narrative reporting is defined by a laboratory value-like format and use of standardized checklists. It contributes to completeness and comprehensibility of pathology reports and ultimately patient care. As of today, two major institutions publish synoptic reporting templates, the College of American Pathologists (CAP) and the International Collaboration for Cancer Reporting (ICCR). Synoptic protocols are available for all major cancer types and provide not only a standardized terminology and a checklist for completeness of reports, but also facilitate uniform utilization of diagnostic criteria. Additionally, both CAP and ICCR protocols are accompanied by detailed and up-to-date reference lists and thereby represent a valuable source of information even when synoptic reporting is not used. The benefits and challenges of implementation of synoptic reporting are discussed, in particular with regard to reporting in German.
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Affiliation(s)
- Ekkehard Hewer
- Institut universitaire de pathologie, Centre hospitalier universitaire vaudois (CHUV) et Université de Lausanne, Rue du Bugnon 25, 1011, Lausanne, Schweiz.
| | - Anna Rump
- Institut für Pathologie und Molekularpathologie, Kepler Universitätsklinikum und Johannes-Kepler-Universität, Linz, Österreich
| | - Rupert Langer
- Institut für Pathologie und Molekularpathologie, Kepler Universitätsklinikum und Johannes-Kepler-Universität, Linz, Österreich
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27
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Noh KW, Buettner R, Klein S. Shifting Gears in Precision Oncology-Challenges and Opportunities of Integrative Data Analysis. Biomolecules 2021; 11:biom11091310. [PMID: 34572523 PMCID: PMC8465238 DOI: 10.3390/biom11091310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023] Open
Abstract
For decades, research relating to modification of host immunity towards antitumor response activation has been ongoing, with the breakthrough discovery of immune-checkpoint blockers. Several biomarkers with potential predictive value have been reported in recent studies for these novel therapies. However, with the plethora of therapeutic options existing for a given cancer entity, modern oncology is now being confronted with multifactorial interpretation to devise “the best therapy” for the individual patient. Into the bargain come the multiverse guidelines for established and emerging diagnostic biomarkers, as well as the complex interplay between cancer cells and tumor microenvironment, provoking immense challenges in the therapy decision-making process. Through this review, we present various molecular diagnostic modalities and techniques, such as genomics, immunohistochemistry and quantitative image analysis, which have the potential of becoming powerful tools in the development of an optimal treatment regime when analogized with patient characteristics. We will summarize the underlying complexities of these methods and shed light upon the necessary considerations and requirements for data integration. It is our hope to provide compelling evidence to emphasize on the need for inclusion of integrative data analysis in modern cancer therapy, and thereupon paving a path towards precision medicine and better patient outcomes.
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Affiliation(s)
- Ka-Won Noh
- Institute for Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (K.-W.N.); (R.B.)
| | - Reinhard Buettner
- Institute for Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (K.-W.N.); (R.B.)
| | - Sebastian Klein
- Gerhard-Domagk-Institute of Pathology, University Hospital Münster, 48149 Münster, Germany
- Correspondence: ; Tel.: +49-251-83-57670
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28
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[Standardized diagnosis of pancreatic head carcinoma]. DER PATHOLOGE 2021; 42:453-463. [PMID: 34357472 DOI: 10.1007/s00292-021-00971-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
Most pancreatic ductal adenocarcinomas are localized in the pancreatic head. Due to the complex anatomic relationships with the surrounding organs and vascular structures in the retroperitoneal space and to the presence of numerous transection margins and dissection planes, pancreatic head resections belong to the most complex specimens concerning grossing and sampling for histopathologic analysis.Here we discuss current guidelines for standardized grossing and reporting of pancreatic cancer, with special reference to the assessment of the resection margin status. The importance of standardized reporting for the sake of completeness, comprehensibility, comparability, and quality control as well as for the integration of pathology reports in interdisciplinary digital workflows and artificial intelligence applications will be emphasized.
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29
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Lynch C, Reguilon I, Langer DL, Lane D, De P, Wong WL, Mckiddie F, Ross A, Shack L, Win T, Marshall C, Revheim ME, Danckert B, Butler J, Dizdarevic S, Louzado C, Mcgivern C, Hazlett A, Chew C, O'connell M, Harrison S. A comparative analysis: international variation in PET-CT service provision in oncology-an International Cancer Benchmarking Partnership study. Int J Qual Health Care 2021; 33:6030987. [PMID: 33306102 PMCID: PMC7896108 DOI: 10.1093/intqhc/mzaa166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services. Design Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions. Setting PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK). Participants None. Intervention(s) None. Main Outcome Measure(s) None. Results PET-CT service provision has grown over the period 2006–2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied. Conclusions Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services.
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Affiliation(s)
- Charlotte Lynch
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK
| | - Irene Reguilon
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK.,Brand & Strategy, eConsult Health Ltd, 46-48 East Street, Surrey, KT17 1HQ, UK
| | - Deanna L Langer
- Cancer Imaging, Ontario Health (Cancer Care Ontario), 620 University Avenue, Toronto, ON M5G 2L7, Canada
| | - Damon Lane
- Radiology, Pacific Radiology, 123 Victoria Street, Christchurch Central, Christchurch 8013, New Zealand
| | - Prithwish De
- Surveillance and Cancer Registry, Ontario Health (Cancer Care Ontario), 620 University Avenue, Toronto, ON M5G 2L7, Canada
| | - Wai-Lup Wong
- Nuclear Medicine, Mount Vernon Hospital, East and North Hertfordshire NHS Trust, Rickmansworth Road, Northwood, HA6 2RN, UK
| | - Fergus Mckiddie
- Nuclear Medicine and PET Department, NHS Grampian, 2 Eday Road, Aberdeen AB15 6RE, UK
| | - Andrew Ross
- Dalhousie Medical School, Dalhousie University, 6299 South Street, Halifax, Nova Scotia, NS B3H 4R2, Canada
| | - Lorraine Shack
- Surveillance and Reporting, Alberta Health Services (Cancer Control Alberta), 10030-107 Street NW, Edmonton, Alberta, T5J 3E4, Canada
| | - Thida Win
- General and Respiratory Medicine, Lister Hospital, East and North Hertfordshire NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK
| | - Christopher Marshall
- Wales Research and Diagnostic PET Imaging Centre, Cardiff University, Cardiff University School of Medicine Health Park, Cardiff, CF14, 4XN, UK
| | - Mona-Eliszabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Pb 4950 Nydalen, Oslo, 0424, Norway
| | - Bolette Danckert
- Research Centre, Danish Cancer Society, Strandboulevarden 49, 2100 Kobenhavn, Denmark
| | - John Butler
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK.,Gynaecology Department, Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK
| | - Sabina Dizdarevic
- Imaging and Nuclear Medicine, Brighton and Sussex University Hospital Trust, Kemptown, Brighton, BN2 1ES, United Kingdom and Brighton and Sussex Medical School, University of Sussex and Brighton, London Road, Brighton, BN1 4GE, UK
| | - Cheryl Louzado
- Strategy Implementation Planning & Partner Relations, Canadian Partnership Against Cancer, 145 King St, Toronto, ON M5H 1J8, Canada
| | - Canice Mcgivern
- Department of Regional Medical Physics, Belfast Health and Social Care Trust, 83 Shankill Road, Belfast, BT13 1FD, UK
| | - Anne Hazlett
- Department of Regional Medical Physics, Belfast Health and Social Care Trust, 83 Shankill Road, Belfast, BT13 1FD, UK
| | - Cindy Chew
- School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin O'connell
- Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, DO7 R2WY, Ireland
| | - Samantha Harrison
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK
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30
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Meuten DJ, Moore FM, Donovan TA, Bertram CA, Klopfleisch R, Foster RA, Smedley RC, Dark MJ, Milovancev M, Stromberg P, Williams BH, Aubreville M, Avallone G, Bolfa P, Cullen J, Dennis MM, Goldschmidt M, Luong R, Miller AD, Miller MA, Munday JS, Roccabianca P, Salas EN, Schulman FY, Laufer-Amorim R, Asakawa MG, Craig L, Dervisis N, Esplin DG, George JW, Hauck M, Kagawa Y, Kiupel M, Linder K, Meichner K, Marconato L, Oblak ML, Santos RL, Simpson RM, Tvedten H, Whitley D. International Guidelines for Veterinary Tumor Pathology: A Call to Action. Vet Pathol 2021; 58:766-794. [PMID: 34282984 DOI: 10.1177/03009858211013712] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Standardization of tumor assessment lays the foundation for validation of grading systems, permits reproducibility of oncologic studies among investigators, and increases confidence in the significance of study results. Currently, there is minimal methodological standardization for assessing tumors in veterinary medicine, with few attempts to validate published protocols and grading schemes. The current article attempts to address these shortcomings by providing standard guidelines for tumor assessment parameters and protocols for evaluating specific tumor types. More detailed information is available in the Supplemental Files, the intention of which is 2-fold: publication as part of this commentary, but more importantly, these will be available as "living documents" on a website (www.vetcancerprotocols.org), which will be updated as new information is presented in the peer-reviewed literature. Our hope is that veterinary pathologists will agree that this initiative is needed, and will contribute to and utilize this information for routine diagnostic work and oncologic studies. Journal editors and reviewers can utilize checklists to ensure publications include sufficient detail and standardized methods of tumor assessment. To maintain the relevance of the guidelines and protocols, it is critical that the information is periodically updated and revised as new studies are published and validated with the intent of providing a repository of this information. Our hope is that this initiative (a continuation of efforts published in this journal in 2011) will facilitate collaboration and reproducibility between pathologists and institutions, increase case numbers, and strengthen clinical research findings, thus ensuring continued progress in veterinary oncologic pathology and improving patient care.
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Affiliation(s)
| | | | | | - Christof A Bertram
- Freie Universität Berlin, Berlin, Germany.,University of Veterinary Medicine, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | - Pompei Bolfa
- Ross University, Basseterre, Saint Kitts and Nevis
| | - John Cullen
- North Carolina State University, Raleigh, NC, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nick Dervisis
- VA-MD College of Veterinary Medicine, Blacksburg, VA, USA
| | | | | | | | | | | | - Keith Linder
- North Carolina State University, Raleigh, NC, USA
| | | | | | | | - Renato L Santos
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - R Mark Simpson
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Harold Tvedten
- Swedish University of Agricultural Sciences, Uppsala, Sweden
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Prospective evaluation of interrater agreement between EEG technologists and neurophysiologists. Sci Rep 2021; 11:13406. [PMID: 34183718 PMCID: PMC8238944 DOI: 10.1038/s41598-021-92827-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/16/2021] [Indexed: 11/22/2022] Open
Abstract
We aim to prospectively investigate, in a large and heterogeneous population, the electroencephalogram (EEG)-reading performances of EEG technologists. A total of 8 EEG technologists and 5 certified neurophysiologists independently analyzed 20-min EEG recordings. Interrater agreement (IRA) for predefined EEG pattern identification between EEG technologists and neurophysiologits was assessed using percentage of agreement (PA) and Gwet-AC1. Among 1528 EEG recordings, the PA [95% confidence interval] and interrater agreement (IRA, AC1) values were as follows: status epilepticus (SE) and seizures, 97% [96–98%], AC1 kappa = 0.97; interictal epileptiform discharges, 78% [76–80%], AC1 = 0.63; and conclusion dichotomized as “normal” versus “pathological”, 83.6% [82–86%], AC1 = 0.71. EEG technologists identified SE and seizures with 99% [98–99%] negative predictive value, whereas the positive predictive values (PPVs) were 48% [34–62%] and 35% [20–53%], respectively. The PPV for normal EEGs was 72% [68–76%]. SE and seizure detection were impaired in poorly cooperating patients (SE and seizures; p < 0.001), intubated and older patients (SE; p < 0.001), and confirmed epilepsy patients (seizures; p = 0.004). EEG technologists identified ictal features with few false negatives but high false positives, and identified normal EEGs with good PPV. The absence of ictal features reported by EEG technologists can be reassuring; however, EEG traces should be reviewed by neurophysiologists before taking action.
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32
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Roth CJ, Clunie DA, Vining DJ, Berkowitz SJ, Berlin A, Bissonnette JP, Clark SD, Cornish TC, Eid M, Gaskin CM, Goel AK, Jacobs GC, Kwan D, Luviano DM, McBee MP, Miller K, Hafiz AM, Obcemea C, Parwani AV, Rotemberg V, Silver EL, Storm ES, Tcheng JE, Thullner KS, Folio LR. Multispecialty Enterprise Imaging Workgroup Consensus on Interactive Multimedia Reporting Current State and Road to the Future: HIMSS-SIIM Collaborative White Paper. J Digit Imaging 2021; 34:495-522. [PMID: 34131793 PMCID: PMC8329131 DOI: 10.1007/s10278-021-00450-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Abstract
Diagnostic and evidential static image, video clip, and sound multimedia are captured during routine clinical care in cardiology, dermatology, ophthalmology, pathology, physiatry, radiation oncology, radiology, endoscopic procedural specialties, and other medical disciplines. Providers typically describe the multimedia findings in contemporaneous electronic health record clinical notes or associate a textual interpretative report. Visual communication aids commonly used to connect, synthesize, and supplement multimedia and descriptive text outside medicine remain technically challenging to integrate into patient care. Such beneficial interactive elements may include hyperlinks between text, multimedia elements, alphanumeric and geometric annotations, tables, graphs, timelines, diagrams, anatomic maps, and hyperlinks to external educational references that patients or provider consumers may find valuable. This HIMSS-SIIM Enterprise Imaging Community workgroup white paper outlines the current and desired clinical future state of interactive multimedia reporting (IMR). The workgroup adopted a consensus definition of IMR as “interactive medical documentation that combines clinical images, videos, sound, imaging metadata, and/or image annotations with text, typographic emphases, tables, graphs, event timelines, anatomic maps, hyperlinks, and/or educational resources to optimize communication between medical professionals, and between medical professionals and their patients.” This white paper also serves as a precursor for future efforts toward solving technical issues impeding routine interactive multimedia report creation and ingestion into electronic health records.
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Affiliation(s)
| | | | - David J Vining
- Department of Abdominal Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Seth J Berkowitz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre - University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jean-Pierre Bissonnette
- Departments of Radiation Oncology and Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Shawn D Clark
- University of Miami Hospitals and Clinics, Miami, FL, USA
| | - Toby C Cornish
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Monief Eid
- eHealth & Digital Transformation Agency, Ministry of Health, Riyadh, Saudi Arabia
| | - Cree M Gaskin
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | | | | | - David Kwan
- Health Technology and Information Management, Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Damien M Luviano
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Morgan P McBee
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | | | - Abdul Moiz Hafiz
- Division of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ceferino Obcemea
- Radiation Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Anil V Parwani
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Veronica Rotemberg
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Erik S Storm
- Department of Radiology and Medical Education, Salem VA Medical Center, Salem, VA, USA
| | - James E Tcheng
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA
| | | | - Les R Folio
- Lead CT Radiologist, NIH Clinical Center, Bethesda, MD, USA
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Naso JR, Yang HM, Schaeffer DF. Variability in Synoptic Reporting of Colorectal Cancer pT4a Category and Lymphovascular Invasion. Arch Pathol Lab Med 2021; 145:343-351. [PMID: 32886771 DOI: 10.5858/arpa.2020-0124-oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Serosal involvement (pT4a category) and lymphovascular invasion have prognostic significance in colorectal carcinoma, but are subject to interobserver variation in assessment. OBJECTIVES.— To provide the first large-scale assessment of interobserver variability in pT4a category and lymphovascular invasion reporting in real-world practice and to explore the impact of information from guidelines on variability in reporting these features. DESIGN.— Analysis of 1555 consecutive synoptic reports of colorectal carcinoma was performed using multivariate logistic regression. Interobserver variability before and after the presentation of guideline information was assessed using an image-based survey. RESULTS.— Significant differences in the odds of reporting pT4a versus pT3 category, detecting lymphovascular invasion of any type, and detecting large vessel invasion were identified among hospital sites and for individual pathologists compared with the median pathologist at the same site. Consistent with these results, interobserver agreement was only moderate in the image-based survey regarding T4a staging and lymphovascular invasion (all κ ≤ 0.57). The provision of information from guidelines did not tend to increase interobserver agreement in the survey, though responses in favor of using an elastic stain increased following recommendations for their use. However, when observers were provided with elastic-stained images, interobserver agreement remained only moderate (κ = 0.55). CONCLUSIONS.— Real-world reporting of pT4a category and lymphovascular invasion shows substantial variability at both local and regional levels. Our study underscores the need to address these features in quality initiatives, and provides a novel method through which existing synoptic data can be harnessed to monitor reporting patterns and provide individualized feedback.
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Affiliation(s)
- Julia R Naso
- From the Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,The Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Hui-Min Yang
- From the Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,The Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - David F Schaeffer
- From the Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,The Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
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Papathomas TG, Suurd DPD, Pacak K, Tischler AS, Vriens MR, Lam AK, de Krijger RR. What Have We Learned from Molecular Biology of Paragangliomas and Pheochromocytomas? Endocr Pathol 2021; 32:134-153. [PMID: 33433885 DOI: 10.1007/s12022-020-09658-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
Recent advances in molecular genetics and genomics have led to increased understanding of the aetiopathogenesis of pheochromocytomas and paragangliomas (PPGLs). Thus, pan-genomic studies now provide a comprehensive integrated genomic analysis of PPGLs into distinct molecularly defined subtypes concordant with tumour genotypes. In addition, new embryological discoveries have refined the concept of how normal paraganglia develop, potentially establishing a developmental basis for genotype-phenotype correlations for PPGLs. The challenge for modern pathology is to translate these scientific discoveries into routine practice, which will be based largely on histopathology for the foreseeable future. Here, we review recent progress concerning the cell of origin and molecular pathogenesis of PPGLs, including pathogenetic mechanisms, genetic susceptibility and molecular classification. The current roles and tools of pathologists are considered from a histopathological perspective, including differential diagnoses, genotype-phenotype correlations and the use of immunohistochemistry in identifying hereditary predisposition and validating genetic variants of unknown significance. Current and potential molecular prognosticators are also presented with the hope that predictive molecular biomarkers will be integrated into risk stratification scoring systems to assess the metastatic potential of these intriguing neoplasms and identify potential drug targets.
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Affiliation(s)
- Thomas G Papathomas
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Diederik P D Suurd
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Arthur S Tischler
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston Massachusetts, USA
| | - Menno R Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alfred K Lam
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.
- Pathology Queensland, Gold Coast University Hospital, Gold Coast, QLD, Australia.
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Ronald R de Krijger
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
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35
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Desai SB. Breast cancer pathology reporting in the Indian context: Need for introspection. INDIAN J PATHOL MICR 2020; 63:S3-S4. [PMID: 32108618 DOI: 10.4103/ijpm.ijpm_824_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sangeeta B Desai
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr. E. Borges Rd, Parel, Mumbai, Maharashtra, India
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Parra-Herran C, Romero Y, Milner D. Pathology and Laboratory Medicine in cancer care: A global analysis of national cancer control plans. Int J Cancer 2020; 148:1938-1947. [PMID: 33152147 DOI: 10.1002/ijc.33384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/29/2020] [Indexed: 11/11/2022]
Abstract
In order to understand the structure and effectiveness of national cancer control systems, the International Cancer Control Partnership, the World Health Organization, the National Cancer Institute and the Union for International Cancer Control underwent a review of available national cancer health plans (NCCPs) and noncommunicable diseases plans (NCDPs) worldwide. Pathology and Laboratory Medicine (PALM) plays a major role in cancer management, from prevention and screening to patient care (diagnosis and treatment) and population-level cancer surveillance. This review concentrates on the analysis of elements in national cancer care plans pertaining to PALM. Of 157 countries surveyed, 90 (57%) had a NCCP and 123 (78%) had a NCDP. While 54% of plans included guidelines on cancer diagnosis or plans to develop standards protocols for diagnosis, only 14% included PALM as a component of the plan. PALM-related variables such as synoptic pathology reporting, cancer staging guidelines and cancer genetics programs were similarly underrepresented (being mentioned in only 6%, 17% and 16% of plans, respectively). Absence of PALM-related variables tended to be more frequent in lower-income countries. Our analysis highlights an important gap in national cancer control initiatives worldwide represented by the overall lack of inclusion of PALM resources. Cancer control will only be effective if laboratory sciences are placed as a priority. Based on the data presented herein, there is a need to increase awareness about the importance of PALM in cancer care, and to incorporate this discipline in the design and implementation of multilevel cancer control strategies.
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Affiliation(s)
- Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yannick Romero
- Union for International Cancer Control, Geneva, Switzerland
| | - Danny Milner
- American Society for Clinical Pathology, Chicago, Illinois, USA
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Embaye KS, Raja SM, Gebreyesus MH, Ghebrehiwet MA. Distribution of breast lesions diagnosed by cytology examination in symptomatic patients at Eritrean National Health Laboratory, Asmara, Eritrea: a retrospective study. BMC WOMENS HEALTH 2020; 20:250. [PMID: 33172446 PMCID: PMC7654611 DOI: 10.1186/s12905-020-01116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/03/2020] [Indexed: 11/10/2022]
Abstract
Background Fine needle aspiration cytology is a simple, relatively accurate, non-invasive, and cost-effective method of diagnosing most breast pathologies. To date, there is no sufficient data depicting the distribution of breast lesions detected by fine needle aspiration cytology in our healthcare setting. The aim of this study was to elucidate the general distribution of breast lesions diagnosed by cytology test at Eritrean National Health Laboratory.
Methods This retrospective study was carried out on 905 symptomatic patients between the years 2013 and 2017 at Eritrean National Health Laboratory. Diagnosis was made by fine needle aspiration cytology in patients with palpable breast lump and in some patients direct smear was prepared from a nipple discharge. Statistical analysis was carried out using Statistical Package for the Social Sciences version 23. Results A total of 905 patients were included in the study, of whom 871 (96.24%) were females. The age range of patients was from 13 to 93 years with mean and standard deviation of 33 ± 14.9 years. Breast lump, occurring in 892 (98.56%), was the most frequent presenting symptom. Fibroadenoma and fibrocystic breast lesions were the most prevalent lesions accounting for approximately 40% and 15%, respectively. Malignant breast lesions were seen predominantly in females above the age of 40 years with the highest frequency observed in the age range between 51 and 60 years. Pearson Chi-squared test showed significant association between patients’ age above 40 years and the risk of having a malignant breast lesion (p < 0.001). The highest number of benign and malignant breast lesions was documented in 2014 with little fluctuation elsewhere in the study period. Conclusion Fine needle aspiration cytology is a procedure of choice for preoperative diagnosis in breast lesions mainly in a resource-limited settings. Our study identified the occurrence of malignant breast lesions in young women, which is of a paramount public health concern. Of note, significant proportion of patients were late to seek medical attention. Therefore, enhancement of community awareness regarding breast disease and implementation of screening programs are necessary to ameliorate the morbidity and mortality associated with the disease.
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Affiliation(s)
- Kidane Siele Embaye
- Department of Basic Medicine, Orotta School of Medicine and Dentistry, Asmara, Eritrea.
| | - Saud Mohammed Raja
- Department of Internal Medicine, Orotta School of Medicine and Dentistry, Asmara, Eritrea
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Tresserra F, Temprana J, Vasquez C, Lloveras B, Català I, Tarroch X, Combalia N, Alameda F, Bosch R, Gallardo J, Mancebo E, Fabra G, Dinares MC, Santacana M, Gonzalez C, Pérez-Ochoa F. Developing indicators for quality assurance in cytopathology. Catalan Society of Cytopathology. Diagn Cytopathol 2020; 49:273-286. [PMID: 33074593 DOI: 10.1002/dc.24639] [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: 06/26/2020] [Revised: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Quality control in cytology must be established through reliable and easily measurable indicators. METHODS From the Catalan Society of Cytopathology a group of experts has been established to write a document with 13 indicators that cover the entire cytological process, based on its Cytopathology Quality Guide. It has been elaborated through guides and documents with scientific evidence and DELPHI methodology in order to reach a structured consensus on the opinions of a group of experts. RESULTS Thirteen indicators, covering all the cytologic process are expressed in worksheets specifying all their characteristics. CONCLUSION This document allows the control of all stages of the cytological process.
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Affiliation(s)
| | - Jordi Temprana
- Hospital Universitario Valle de Hebron, Barcelona, Spain
| | - Carem Vasquez
- Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | | | - Isabel Català
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | | | | | - Ramon Bosch
- Hospital de Tortosa Verge de la Cinta, Tarragona, Spain
| | | | - Eva Mancebo
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Gemma Fabra
- Hospital Universitario Dexeus, Barcelona, Spain
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Thompson LDR, Gill AJ, Asa SL, Clifton-Bligh RJ, de Krijger RR, Kimura N, Komminoth P, Lack EE, Lenders JWM, Lloyd RV, Papathomas TG, Sadow PM, Tischler AS. Data set for the reporting of pheochromocytoma and paraganglioma: explanations and recommendations of the guidelines from the International Collaboration on Cancer Reporting. Hum Pathol 2020; 110:83-97. [PMID: 32407815 DOI: 10.1016/j.humpath.2020.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES The International Collaboration on Cancer Reporting (ICCR) is a not-for-profit to develop evidence-based, internationally agreed-upon standardized data sets for each anatomic site, to be used throughout the world. Providing global standardization of pathology tumor classification, staging, and other reporting elements will lead to improved patient management and enhanced epidemiological research. METHODS Pheochromocytoma and paraganglioma are uncommon and are frequently overlooked in registry data sets. Malignant criteria have previously been defined only when there was metastatic disease. RESULTS With recent recognition of a significant inheritance association and the development of risk stratification tools, this data set was created in order to obtain more meaningful outcomes and management data, using similar criteria across the global pathology community. Issues related to key core and non-core elements, especially clinical hormonal status, familial history, tumor focality, proliferative fraction, adverse or risk stratification features, and ancillary techniques, are discussed in the context of daily application to these types of specimens. CONCLUSIONS The ICCR data set, developed by an international panel of endocrine organ specialists, establishes a pathology-standardized reporting guide for pheochromocytoma and paraganglioma.
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Affiliation(s)
- Lester D R Thompson
- Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA, USA.
| | - Anthony J Gill
- University of Sydney, Sydney, New South Wales, Australia; Cancer Diagnosis and Pathology Group Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Pathology, Case Western Reserve University, Cleveland, OH, USA; University Health Network, Toronto, Canada.
| | - Roderick J Clifton-Bligh
- University of Sydney, Sydney, New South Wales, Australia; Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
| | - Ronald R de Krijger
- Department of Pathology, University Medical Centre and Princess Maxima Centre, Utrecht, the Netherlands.
| | - Noriko Kimura
- Department of Diagnostic Pathology, Department of Clinical Research, Pathology Division, National Hospital Organization Hakodate Hospital, Japan.
| | - Paul Komminoth
- University of Zürich, Institute of Pathology, City Hospital Triemli, Zürich, Switzerland.
| | - Ernest E Lack
- Department of Endocrine Pathology, The Joint Pathology Center, Silver Spring, MD, USA.
| | - Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Medicine III, University Hospital Carl Gustav Carus and Medical Faculty, Technical University Dresden, Dresden, Germany.
| | - Ricardo V Lloyd
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA.
| | - Thomas G Papathomas
- Institute of Metabolism and Systems Research, University of Birmingham, United Kingdom.
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Arthur S Tischler
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, USA.
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40
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Haroske G, Mörz M, Oemig F. [Document standards for pathology reports in digital medicine]. DER PATHOLOGE 2020; 41:52-59. [PMID: 31960116 DOI: 10.1007/s00292-019-00742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pathology reports are important clinical documents for the diagnosis, treatment, and follow-up of often severe diseases. They are subject to a series of formal and substantive requirements that are anchored in several jurisdictions, which also apply to the digital form of these records. Only a few of the currently used digital document formats meet these requirements and are at the same time interoperable, regardless of the computer platforms used. Practically, they are only partially used in pathology laboratories, practice management, and hospital information systems. The consistent use of these standard formats for pathological findings reports provided a clear digital added value for both pathologists and clinicians as well as their patients.
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Affiliation(s)
- G Haroske
- Kommission Digitale Pathologie, Bundesverband Deutscher Pathologen e. V., Robert-Koch-Platz 9, 10115, Berlin, Deutschland. .,HL7 Deutschland e. V., Berlin, Deutschland.
| | - M Mörz
- Kommission Digitale Pathologie, Bundesverband Deutscher Pathologen e. V., Robert-Koch-Platz 9, 10115, Berlin, Deutschland
| | - F Oemig
- HL7 Deutschland e. V., Berlin, Deutschland.,Deutsche Telekom Healthcare and Security Solutions GmbH, Essen, Deutschland
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41
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Cancer staging at diagnosis data comparisons in South Australia. Sci Rep 2020; 10:1008. [PMID: 31974401 PMCID: PMC6978520 DOI: 10.1038/s41598-020-57704-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/04/2019] [Indexed: 11/08/2022] Open
Abstract
Cancer stage at diagnosis is an important gap for Australian population based cancer registries. The study aims to understand the quality and completeness of three different collections of cancer staging data. The South Australian Cancer Registry data collection for breast and colorectal cancer (CRC) cases diagnosed in 2011, was linked to Registry Derived Stage (RDS) data, pathology plus hospital metastasis codes (pathology stage), and the South Australian Clinical Cancer Registry Stage (SACCR stage). The agreement between staging systems was examined using kappa statistics. Kaplan-Meier curves and Cox regression were used to examine the difference in survival by staging methods. Among 2,530 breast and CRC cases 98.8% were stageable (n = 2,500) according to histology. Among stageable cases, 84.6% had RDS, 51.2% had pathology stage and 29.5% had SACCR stage. The kappa statistic for RDS and pathology stage was 0.930 for breast cancer and 0.973 for CRC, and 0.574 for RDS and SACCR stage for breast cancer and 0.632 for CRC. The agreement between pathology stage and SACCR stage was 0.430 for breast cancer and 0.528 for CRC. The distribution of stage was similar across staging methods, although more stage four cancers by pathology stage, and survival patterns were similar but not the same. The agreement was high between different staging systems. Pathology stage had a higher than expected stage 4 proportion. This study highlights an opportunity to collect stage information in a cost-effective manner, while collecting data that usefully represent stage at diagnosis across the population, for population based epidemiological analyses.
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42
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Sluijter CE, van Workum F, Wiggers T, van de Water C, Visser O, van Slooten HJ, Overbeek LI, Nagtegaal ID. Improvement of Care in Patients With Colorectal Cancer: Influence of the Introduction of Standardized Structured Reporting for Pathology. JCO Clin Cancer Inform 2019; 3:1-12. [DOI: 10.1200/cci.18.00104] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The use of standardized structured reporting (SSR) can improve communication between cancer specialists, which might improve clinical care; however, there are no reliable data on whether the introduction of SSR is associated with improvements in clinical outcome. PATIENTS AND METHODS We performed a retrospective cohort study in the Netherlands, including all patients with colorectal cancer (CRC) from 2009 to 2014. As a reference, cohorts of 2007 and 2008 were included. Data from the Netherlands Cancer Registry were used and combined with data from the Dutch Pathology Registry (PALGA) and the Dutch ColoRectal Audit. We tested the preformulated hypothesis that use of SSR improves the care of patients with CRC by improving the completeness of the pathology reports, the quality of the pathology evaluation, and patient outcomes with respect to treatment and survival. RESULTS We included 72,859 patients with CRC (23.8% reference, 32.9% SSR, and 43.3% narrative reports). Use of SSR increased over time, which resulted in more complete pathology reports (95.8% v 89.8%; P < .001). Risk assessment in stage II colon cancer was more adequate and resulted in an increased delivery of adjuvant therapy in patients with SSR (19.6% v 15.1%; P = .001). Risk of death for patients in the SSR group was significantly lowered (corrected hazard ratio, 0.94; 95% CI 0.90 to 0.97). CONCLUSION We demonstrate that use of SSR improved patient care in those with CRC by providing more complete reports of higher quality, which had significant effects on the delivery of adjuvant therapy and patient outcomes.
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Affiliation(s)
- Caro E. Sluijter
- Radboudumc, Nijmegen, the Netherlands
- PALGA Foundation, Houten, the Netherlands
| | | | - Theo Wiggers
- Dutch ColoRectal Surgical Audit, Leiden, the Netherlands
| | | | - Otto Visser
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Henk-Jan van Slooten
- PALGA Foundation, Houten, the Netherlands
- Symbiant Pathology Expert Centre, Alkmaar, the Netherlands
| | | | - Iris D. Nagtegaal
- Radboudumc, Nijmegen, the Netherlands
- PALGA Foundation, Houten, the Netherlands
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43
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Yesufe AA, Assefa M, Bekele A, Ergete W, Aynalem A, Wondemagegnehu T, Tausjø J, Assefa Tessema G, Kantelhardt EJ, Gansler T, Jemal A. Adequacy of Pathologic Reports of Invasive Breast Cancer From Mastectomy Specimens at Tikur Anbessa Specialized Hospital Oncology Center in Ethiopia. J Glob Oncol 2019; 4:1-12. [PMID: 30084708 PMCID: PMC6223529 DOI: 10.1200/jgo.17.00198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose Although information from pathology reports is essential to the care of individuals with cancer and to population-level cancer control, no systematic evidence exists regarding the adequacy of breast pathology reporting in Ethiopia. This study audited pathology reports of mastectomy specimens from patients evaluated at the Tikur Anbessa Specialized Hospital Oncology Center in Addis Ababa, Ethiopia. Methods Mastectomy pathology reports from February 2014 through January 2016 were assessed for gross and microscopic information considered by the Breast Cancer Initiative 2.5 (BCI 2.5; formerly the Breast Health Global Initiative) guideline to be necessary for care of patients with breast cancer stratified according to basic, limited, and enhanced resource settings. Results Fewer than two thirds (61.6%) of the 417 reports we reviewed included all four of the BCI 2.5 basic pathology data elements we could evaluate with available data (tumor category, lymph node category, histologic type, and histologic grade). Only 1.0% of reports included all three pathology data elements recommended for limited resource settings (estrogen receptor status, margin status, and lymphovascular invasion). Several elements were significantly more likely to be noted in reports from nonpublic hospitals than from public hospitals. Although only three of 417 reports included checklists or templates, all three of these reports included all of the basic pathology information, and they all included at least two of the three limited pathology elements not already on the basic list. Conclusion More than one third (38.4%) of mastectomy pathology reports did not meet BCI 2.5 standards for basic resource settings. Quality measurement and improvement programs and capacity-building interventions by national pathology and oncology organizations, collaboration with medical and public health organizations in neighboring countries, adoption of synoptic reporting templates, use of electronic pathology reporting, and histotechnology and histopathology training collaborations with laboratories in high-resource regions are recommended.
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Affiliation(s)
- Abdu A Yesufe
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mathewos Assefa
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Abebe Bekele
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Wondwossen Ergete
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Abreha Aynalem
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Tigeneh Wondemagegnehu
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Johan Tausjø
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Gizachew Assefa Tessema
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Eva Johanna Kantelhardt
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
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Eckstein M, Cimadamore A, Hartmann A, Lopez-Beltran A, Cheng L, Scarpelli M, Montironi R, Gevaert T. PD-L1 assessment in urothelial carcinoma: a practical approach. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:690. [PMID: 31930091 PMCID: PMC6944605 DOI: 10.21037/atm.2019.10.24] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 01/24/2023]
Abstract
Five programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors are currently approved for treatment of locally advanced or metastatic urothelial carcinoma of the bladder and the upper urinary tract. Due to restrictions by the FDA and EMA first-line treatment with Atezolizumab and Pembrolizumab in platinum-ineligible patients requires immunohistochemical PD-L1 testing. In the second-line setting all drugs are approved without PD-L1 testing. Used PD-L1 assays in clinical trials include the 28-8 pharmDx (Nivolumab), the 22C3 pharmDx (Pembrolizumab), Ventana SP142 (Atezolizumab), and the Ventana PD-L1 SP263 assays (Durvalumab). Differences in antibodies, needed platforms and testing algorithms have raised questions about interchangeability and comparability among these assays and their diagnostic use. We provide a practical review about the current recommendations, used assays and algorithms of PD-L1 testing in urothelial carcinoma to help oncologists, urologists and pathologists to understand analytical features, differences in antibody assays, differences in scoring algorithms and comparability of various PD-L1 assays. We reviewed and summarized published studies from the last four years (2016-2019) on PD-L1 testing in bladder cancer and present a condensed practical guideline including pre-analytical, analytical and test-specific issues.
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Affiliation(s)
- Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91052, Germany
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91052, Germany
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, and Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Scarpelli
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy
| | - Thomas Gevaert
- Department of Urology, UZ Leuven, Leuven, Belgium
- Organ Systems, KU Leuven, Leuven, Belgium
- Department of Pathology, AZ Klina, Brasschaat, Belgium
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45
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Swillens JEM, Sluijter CE, Overbeek LIH, Nagtegaal ID, Hermens RPMG. Identification of barriers and facilitators in nationwide implementation of standardized structured reporting in pathology: a mixed method study. Virchows Arch 2019; 475:551-561. [PMID: 31270615 PMCID: PMC6861434 DOI: 10.1007/s00428-019-02609-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/05/2019] [Accepted: 06/16/2019] [Indexed: 12/24/2022]
Abstract
Standardized structured reporting (SSR) enables high-quality pathology reporting, but implementing SSR is slow. The objective of this study is to identify both barriers and facilitators that pathologists encounter in SSR, in order to develop tailored implementation tools to increase SSR usage. We used a mixed method design: a focus group interview helped to identify barriers and facilitators in SSR. The findings were classified into the following domains: innovation, individual professional, social setting, organization, and economic and political context. We used a web-based survey among Dutch pathologists to quantify the findings. Ten pathologists participated in the focus group interview, and 97 pathologists completed the survey. The results of both showed that pathologists perceive barriers related to SSR itself. Particularly its incompatibility caused lack of nuance (73%, n = 97) in the standardized structured pathology report. Regarding the individual professional, knowledge about available SSR-templates was lacking (28%, n = 97), and only 44% (n = 94) of the respondents agreed that using SSR facilitates the most accurate diagnosis. Related to social setting, support from the multidisciplinary team members was lacking (45%, n = 94). At organization level, SSR leads to extra work (52%, n = 94) because of its incompatibility with other information systems (38%, n = 93). Main facilitators of SSR were incorporation of speech recognition (54%, n = 94) and improvement in communication during multidisciplinary team meetings (69%, n = 94). Both barriers and facilitators existed in various domains. These factors can be used to develop implementation tools to encourage SSR usage.
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Affiliation(s)
- J E M Swillens
- Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein 21, POB 9101, 6500, HB, Nijmegen, The Netherlands.
| | - C E Sluijter
- PALGA Foundation, Randhoeve 225A, 3995, GA, Houten, The Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Department of Pathology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, POB 9101, 6500, HB, Nijmegen, The Netherlands
| | - L I H Overbeek
- PALGA Foundation, Randhoeve 225A, 3995, GA, Houten, The Netherlands
| | - I D Nagtegaal
- PALGA Foundation, Randhoeve 225A, 3995, GA, Houten, The Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Department of Pathology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, POB 9101, 6500, HB, Nijmegen, The Netherlands
| | - R P M G Hermens
- Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein 21, POB 9101, 6500, HB, Nijmegen, The Netherlands
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Hewer E. The Oncologist's Guide to Synoptic Reporting: A Primer. Oncology 2019; 98:396-402. [PMID: 31177262 DOI: 10.1159/000500884] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/10/2019] [Indexed: 11/19/2022]
Abstract
Synoptic reporting in tumour pathology is defined by (1) completeness in terms of data elements as well as (2) a specific, laboratory value-like format. Adoption of synoptic reporting leads to more complete reporting of essential parameters, improved standardisation of diagnostic criteria and terminology, as well as easier retrieval of information. It is therefore associated with a high degree of satisfaction among end users including surgeons and oncologists and contributes to improvement of clinical care. Furthermore, synoptic reporting is an important step towards higher levels of data capture, which facilitate data exchange and analysis for quality assurance, cancer epidemiology and clinical and basic research. Increased interest in and adoption of synoptic reporting on a global level is stimulated by the International Collaboration on Cancer Reporting (ICCR) which publishes freely available, evidence-based datasets for reporting an increasing number of different cancer types. These developments pave the path for increased future application of synoptic reporting across the entire field of oncologic medicine, where it will likely deploy similar benefits to those in pathology. Given that synoptic reporting can be considered the most precise means available for reporting of medical findings, it may be predicted to be critical for the promise of precision medicine to become real.
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Affiliation(s)
- Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland,
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47
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Canadian Consensus-based and Evidence-based Guidelines for Benign Endometrial Pathology Reporting in Biopsy Material. Int J Gynecol Pathol 2019; 38:119-127. [PMID: 29369922 DOI: 10.1097/pgp.0000000000000481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Standardized terminology has proven benefits in cancer reporting; in contrast, reporting of benign diagnoses in endometrial biopsy currently lacks such standardization. Unification and update on the lexicon can provide the structure and consistency needed for optimal patient care and quality assurance purposes. The Special Interest Group in Gynecologic Pathology of the Canadian Association of Pathologists-Association Canadienne des Pathologistes (CAP-ACP) embarked in an initiative to address the current need for consensus terminology in benign endometrial biopsy pathology reporting. Nine members of the Special Interest Group developed a guideline for structured diagnosis of benign endometrial pathology through critical appraisal of the available peer-reviewed literature and joint discussions. The first version of the document was circulated for feedback to a group of professionals in akin fields, the CAP-ACP Executive Committee and the CAP-ACP general membership. The final 1-page document included 17 diagnostic terms comprising the most common benign endometrial entities, as well as explanatory notes for pathologists. The proposed terminology was implemented in the practice of 5 pathologists from the group, who applied the guideline to all benign endometrial biopsies over a 2-wk period. A total of 212 benign endometrial biopsies were evaluated in this implementation step; the recommended terminology adequately covered the diagnosis in 203 cases (95.8%). A list of terminology for benign endometrial biopsy reporting, based on expert consensus and critical appraisal of the available literature, is presented. On the basis of our results of implementation at multiple centers, the proposed guideline can successfully cover the large majority of diagnostic scenarios. The document has the potential to positively impact patient care, promote quality assurance, and facilitate research initiatives aimed at improving histopathologic assessment of benign endometrium.
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Benson J, Burgstahler M, Zhang L, Rischall M. The value of structured radiology reports to categorize intracranial metastases following radiation therapy. Neuroradiol J 2019; 32:267-272. [PMID: 31017073 DOI: 10.1177/1971400919845365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Radiology descriptions of intracranial metastases following radiotherapy are often imprecise. This study sought to improve such reports by creating and disseminating a structured template that encourages discrete categorization of intracranial lesions. METHODS Following initiation of the structured template, a retrospective review assessed patients with intracranial metastases that underwent radiotherapy, comparing 'pre-template' with 'post-template' reports. A total of 139 patients were included; 94 patients (67.6%) were imaged pre-template, 45 (32.4%) post-template. Reports were assessed for discrete versus non-specific descriptions of lesions: '(presumed) new metastases', 'treated metastases', and 'indeterminate lesions'. Non-specific language was subdivided based on the type of lesion(s) described: e.g. 'stable enhancing foci' was deemed a non-specific description of 'treated metastases'. RESULTS Non-specific descriptions of lesions were used in 25/94 reports (26.6%) pre-template, and eight reports (17.8%) post-template. No significant difference was found in the frequency of inappropriate/ambiguous descriptions of intracranial lesions following template initiation (P = 0.52). However, only 27/45 (60.0%) of the reports in the post-template time period used the structured report; the other reports were written as free prose. Of the reports that did use the structured template, the authors used significantly less ambiguous language structured template (P = 0.02). CONCLUSION When utilized, a structured report template resulted in decreased non-specific descriptions and improved discrete characterization of intracranial metastases in patients treated with radiation. However, the frequency of non-specific language usage before and after template initiation was unchanged, probably due to poor compliance with template utilization.
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Affiliation(s)
| | | | - Lei Zhang
- 3 Clinical and Translational Science Institute, University of Minnesota, USA
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Renshaw AA, Gould EW. Improving Discrete Data Capture in Synoptic Reports With Optional Free-Text Modifiers. JCO Clin Cancer Inform 2019; 2:1-6. [PMID: 30652544 DOI: 10.1200/cci.17.00127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Upfront, discrete data capture in synoptic reporting fails when pathologists choose a response not associated with discrete data. We sought to determine the factors associated with this event. METHODS The results of all "Other" entries in four common tumor sites in synoptic reports were reviewed. RESULTS "Other" entries occurred in 329 of 13,421 questions (2.5%). In 306 of these 329 questions (93.0%), the pathologist appeared to choose this response because they wished to add additional information to an already existing response that was associated with discrete data capture. As a result, the addition of a free-text modifiers to existing responses would allow pathologist to add this additional information while still selecting a response associated with discrete data capture, significantly improving the total discrete data capture (13,092 of 13,421 questions [97.5%] v 13,398 of 13,421 questions [99.8%]; P < .001). CONCLUSION The addition of free-text modifiers to structured responses in synoptic reports could significantly improve the discrete data capture rate.
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Affiliation(s)
- Andrew A Renshaw
- Andrew A. Renshaw and Edwin W. Gould, Miami Cancer Institute and Baptist Hospital, Miami, FL
| | - Edwin W Gould
- Andrew A. Renshaw and Edwin W. Gould, Miami Cancer Institute and Baptist Hospital, Miami, FL
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Renshaw AA, Mena-Allauca M, Gould EW, Sirintrapun SJ. Synoptic Reporting: Evidence-Based Review and Future Directions. JCO Clin Cancer Inform 2018; 2:1-9. [PMID: 30652566 PMCID: PMC6873952 DOI: 10.1200/cci.17.00088] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Andrew A. Renshaw
- Andrew A. Renshaw, Mercy Mena-Allauca, and Edwin W. Gould, Baptist Health South Florida, Miami, FL; and S. Joseph Sirintrapun, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mercy Mena-Allauca
- Andrew A. Renshaw, Mercy Mena-Allauca, and Edwin W. Gould, Baptist Health South Florida, Miami, FL; and S. Joseph Sirintrapun, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edwin W. Gould
- Andrew A. Renshaw, Mercy Mena-Allauca, and Edwin W. Gould, Baptist Health South Florida, Miami, FL; and S. Joseph Sirintrapun, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S. Joseph Sirintrapun
- Andrew A. Renshaw, Mercy Mena-Allauca, and Edwin W. Gould, Baptist Health South Florida, Miami, FL; and S. Joseph Sirintrapun, Memorial Sloan Kettering Cancer Center, New York, NY
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