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Lo Y, Lester SC, Ellis IO, Lanjewar S, Laurini J, Patel A, Bhattarai A, Ustun B, Harmon B, Kleer CG, Ross D, Amin A, Wang Y, Bradley R, Turashvili G, Zeng J, Baum J, Singh K, Hakima L, Harigopal M, Komforti M, Shin SJ, Abbott SE, Jaffer S, Badve SS, Khoury T, D'Alfonso TM, Ginter PS, Collins V, Towne W, Gan Y, Nassar A, Sahin AA, Flieder A, Aldrees R, Ngo MH, Edema U, Sapna F, Schnitt SJ, Fineberg SA. Identification of Glandular (Acinar)/Tubule Formation in Invasive Carcinoma of the Breast: A Study to Determine Concordance Using the World Health Organization Definition. Arch Pathol Lab Med 2024; 148:1119-1125. [PMID: 38244086 DOI: 10.5858/arpa.2023-0163-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 01/22/2024]
Abstract
CONTEXT.— The Nottingham Grading System (NGS) developed by Elston and Ellis is used to grade invasive breast cancer (IBC). Glandular (acinar)/tubule formation is a component of NGS. OBJECTIVE.— To investigate the ability of pathologists to identify individual structures that should be classified as glandular (acinar)/tubule formation. DESIGN.— A total of 58 hematoxylin-eosin photographic images of IBC with 1 structure circled were classified as tubules (41 cases) or nontubules (17 cases) by Professor Ellis. Images were sent as a PowerPoint (Microsoft) file to breast pathologists, who were provided with the World Health Organization definition of a tubule and asked to determine if a circled structure represented a tubule. RESULTS.— Among 35 pathologists, the κ statistic for assessing agreement in evaluating the 58 images was 0.324 (95% CI, 0.314-0.335). The median concordance rate between a participating pathologist and Professor Ellis was 94.1% for evaluating 17 nontubule cases and 53.7% for 41 tubule cases. A total of 41% of the tubule cases were classified correctly by less than 50% of pathologists. Structures classified as tubules by Professor Ellis but often not recognized as tubules by pathologists included glands with complex architecture, mucinous carcinoma, and the "inverted tubule" pattern of micropapillary carcinoma. A total of 80% of participants reported that they did not have clarity on what represented a tubule. CONCLUSIONS.— We identified structures that should be included as tubules but that were not readily identified by pathologists. Greater concordance for identification of tubules might be obtained by providing more detailed images and descriptions of the types of structures included as tubules.
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Affiliation(s)
- Yungtai Lo
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Susan C Lester
- the Department of Pathology, Brigham and Women's Hospital and the Dana-Farber/Harvard Cancer Center, Boston, Massachusetts (Lester, Aldrees, Ngo, Schnitt)
| | - Ian O Ellis
- the Department of Histopathology, University of Nottingham/Nottingham City Hospital, Nottingham, United Kingdom (Ellis)
| | - Sonali Lanjewar
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Javier Laurini
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ami Patel
- the Department of Pathology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York (Patel)
| | - Ava Bhattarai
- the Department of Pathology, Methodist University Hospital, Memphis, Tennessee (Bhattarai, Bradley)
| | - Berrin Ustun
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Bryan Harmon
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Celina G Kleer
- the Department of Pathology, University of Michigan, Ann Arbor (Kleer, Abbott)
| | - Dara Ross
- the Department of Pathology Memorial Sloan Kettering Cancer Center, New York, New York (Ross, D'Alfonso)
| | - Ali Amin
- the Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Amin, Wang, Singh)
| | - Yihong Wang
- the Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Amin, Wang, Singh)
| | - Robert Bradley
- the Department of Pathology, Methodist University Hospital, Memphis, Tennessee (Bhattarai, Bradley)
| | - Gulisa Turashvili
- the Department of Pathology, Emory University Hospital, Atlanta, Georgia (Turashvili, Badve)
| | - Jennifer Zeng
- the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Zeng, Collins)
| | - Jordan Baum
- the Department of Pathology, NYU Langone Hospital, Mineola, New York (Baum, Ginter, Flieder)
| | - Kamaljeet Singh
- the Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Amin, Wang, Singh)
| | - Laleh Hakima
- the Department of Pathology, University of North Carolina Hospitals, Chapel Hill (Hakima)
| | - Malini Harigopal
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Harigopal)
| | - Miglena Komforti
- the Department of Pathology, Mayo Clinic, Jacksonville, Florida (Komforti, Nassar)
| | - Sandra J Shin
- the Department of Pathology, Albany Medical College, Albany, New York (Shin)
| | - Sara E Abbott
- the Department of Pathology, University of Michigan, Ann Arbor (Kleer, Abbott)
| | - Shabnam Jaffer
- the Department of Pathology, Lenox Hill Hospital/Northwell Health, New York, New York (Jaffer)
| | - Sunil Shankar Badve
- the Department of Pathology, Emory University Hospital, Atlanta, Georgia (Turashvili, Badve)
| | - Thaer Khoury
- the Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York (Khoury)
| | - Timothy M D'Alfonso
- the Department of Pathology Memorial Sloan Kettering Cancer Center, New York, New York (Ross, D'Alfonso)
| | - Paula S Ginter
- the Department of Pathology, NYU Langone Hospital, Mineola, New York (Baum, Ginter, Flieder)
| | - Victoria Collins
- the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Zeng, Collins)
| | - William Towne
- the Department of Pathology, Columbia University/New York Presbyterian Hospital, New York, New York (Towne)
| | - Yujun Gan
- the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Gan)
| | - Aziza Nassar
- the Department of Pathology, Mayo Clinic, Jacksonville, Florida (Komforti, Nassar)
| | - Aysegul A Sahin
- the Department of Pathology, MD Anderson Cancer Center, Houston, Texas (Sahin)
| | - Andrea Flieder
- the Department of Pathology, NYU Langone Hospital, Mineola, New York (Baum, Ginter, Flieder)
| | - Rana Aldrees
- the Department of Pathology, Brigham and Women's Hospital and the Dana-Farber/Harvard Cancer Center, Boston, Massachusetts (Lester, Aldrees, Ngo, Schnitt)
| | - Marie-Helene Ngo
- the Department of Pathology, Brigham and Women's Hospital and the Dana-Farber/Harvard Cancer Center, Boston, Massachusetts (Lester, Aldrees, Ngo, Schnitt)
| | - Ukuemi Edema
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Fnu Sapna
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Stuart J Schnitt
- the Department of Pathology, Brigham and Women's Hospital and the Dana-Farber/Harvard Cancer Center, Boston, Massachusetts (Lester, Aldrees, Ngo, Schnitt)
| | - Susan A Fineberg
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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van Diest PJ, Flach RN, van Dooijeweert C, Makineli S, Breimer GE, Stathonikos N, Pham P, Nguyen TQ, Veta M. Pros and cons of artificial intelligence implementation in diagnostic pathology. Histopathology 2024; 84:924-934. [PMID: 38433288 DOI: 10.1111/his.15153] [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: 11/15/2023] [Revised: 12/29/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024]
Abstract
The rapid introduction of digital pathology has greatly facilitated development of artificial intelligence (AI) models in pathology that have shown great promise in assisting morphological diagnostics and quantitation of therapeutic targets. We are now at a tipping point where companies have started to bring algorithms to the market, and questions arise whether the pathology community is ready to implement AI in routine workflow. However, concerns also arise about the use of AI in pathology. This article reviews the pros and cons of introducing AI in diagnostic pathology.
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Affiliation(s)
- Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rachel N Flach
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Seher Makineli
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerben E Breimer
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nikolas Stathonikos
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul Pham
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tri Q Nguyen
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mitko Veta
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Flach RN, Fransen NL, Sonnen AFP, Nguyen TQ, Breimer GE, Veta M, Stathonikos N, van Dooijeweert C, van Diest PJ. Implementation of Artificial Intelligence in Diagnostic Practice as a Next Step after Going Digital: The UMC Utrecht Perspective. Diagnostics (Basel) 2022; 12:diagnostics12051042. [PMID: 35626198 PMCID: PMC9140005 DOI: 10.3390/diagnostics12051042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 01/31/2023] Open
Abstract
Building on a growing number of pathology labs having a full digital infrastructure for pathology diagnostics, there is a growing interest in implementing artificial intelligence (AI) algorithms for diagnostic purposes. This article provides an overview of the current status of the digital pathology infrastructure at the University Medical Center Utrecht and our roadmap for implementing AI algorithms in the next few years.
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Affiliation(s)
- Rachel N. Flach
- Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (R.N.F.); (N.L.F.); (A.F.P.S.); (T.Q.N.); (G.E.B.); (M.V.); (N.S.); (C.v.D.)
| | - Nina L. Fransen
- Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (R.N.F.); (N.L.F.); (A.F.P.S.); (T.Q.N.); (G.E.B.); (M.V.); (N.S.); (C.v.D.)
| | - Andreas F. P. Sonnen
- Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (R.N.F.); (N.L.F.); (A.F.P.S.); (T.Q.N.); (G.E.B.); (M.V.); (N.S.); (C.v.D.)
| | - Tri Q. Nguyen
- Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (R.N.F.); (N.L.F.); (A.F.P.S.); (T.Q.N.); (G.E.B.); (M.V.); (N.S.); (C.v.D.)
| | - Gerben E. Breimer
- Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (R.N.F.); (N.L.F.); (A.F.P.S.); (T.Q.N.); (G.E.B.); (M.V.); (N.S.); (C.v.D.)
| | - Mitko Veta
- Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (R.N.F.); (N.L.F.); (A.F.P.S.); (T.Q.N.); (G.E.B.); (M.V.); (N.S.); (C.v.D.)
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
| | - Nikolas Stathonikos
- Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (R.N.F.); (N.L.F.); (A.F.P.S.); (T.Q.N.); (G.E.B.); (M.V.); (N.S.); (C.v.D.)
| | - Carmen van Dooijeweert
- Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (R.N.F.); (N.L.F.); (A.F.P.S.); (T.Q.N.); (G.E.B.); (M.V.); (N.S.); (C.v.D.)
| | - Paul J. van Diest
- Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (R.N.F.); (N.L.F.); (A.F.P.S.); (T.Q.N.); (G.E.B.); (M.V.); (N.S.); (C.v.D.)
- Correspondence:
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