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Jain E, Patel A, Parwani AV, Shafi S, Brar Z, Sharma S, Mohanty SK. Whole Slide Imaging Technology and Its Applications: Current and Emerging Perspectives. Int J Surg Pathol 2024; 32:433-448. [PMID: 37437093 DOI: 10.1177/10668969231185089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Background. Whole slide imaging (WSI) represents a paradigm shift in pathology, serving as a necessary first step for a wide array of digital tools to enter the field. It utilizes virtual microscopy wherein glass slides are converted into digital slides and are viewed by pathologists by automated image analysis. Its impact on pathology workflow, reproducibility, dissemination of educational material, expansion of service to underprivileged areas, and institutional collaboration exemplifies a significant innovative movement. The recent US Food and Drug Administration approval to WSI for its use in primary surgical pathology diagnosis has opened opportunities for wider application of this technology in routine practice. Main Text. The ongoing technological advances in digital scanners, image visualization methods, and the integration of artificial intelligence-derived algorithms with these systems provide avenues to exploit its applications. Its benefits are innumerable such as ease of access through the internet, avoidance of physical storage space, and no risk of deterioration of staining quality or breakage of slides to name a few. Although the benefits of WSI to pathology practices are many, the complexities of implementation remain an obstacle to widespread adoption. Some barriers including the high cost, technical glitches, and most importantly professional hesitation to adopt a new technology have hindered its use in routine pathology. Conclusions. In this review, we summarize the technical aspects of WSI, its applications in diagnostic pathology, training, and research along with future perspectives. It also highlights improved understanding of the current challenges to implementation, as well as the benefits and successes of the technology. WSI provides a golden opportunity for pathologists to guide its evolution, standardization, and implementation to better acquaint them with the key aspects of this technology and its judicial use. Also, implementation of routine digital pathology is an extra step requiring resources which (currently) does not usually result increased efficiency or payment.
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Affiliation(s)
- Ekta Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Ankush Patel
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Anil V Parwani
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Saba Shafi
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Zoya Brar
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
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2
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Karperien AL, Jelinek HF. ImageJ in Computational Fractal-Based Neuroscience: Pattern Extraction and Translational Research. ADVANCES IN NEUROBIOLOGY 2024; 36:795-814. [PMID: 38468064 DOI: 10.1007/978-3-031-47606-8_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
To explore questions asked in neuroscience, neuroscientists rely heavily on the tools available. One such toolset is ImageJ, open-source, free, biological digital image analysis software. Open-source software has matured alongside of fractal analysis in neuroscience, and today ImageJ is not a niche but a foundation relied on by a substantial number of neuroscientists for work in diverse fields including fractal analysis. This is largely owing to two features of open-source software leveraged in ImageJ and vital to vigorous neuroscience: customizability and collaboration. With those notions in mind, this chapter's aim is threefold: (1) it introduces ImageJ, (2) it outlines ways this software tool has influenced fractal analysis in neuroscience and shaped the questions researchers devote time to, and (3) it reviews a few examples of ways investigators have developed and used ImageJ for pattern extraction in fractal analysis. Throughout this chapter, the focus is on fostering a collaborative and creative mindset for translating knowledge of the fractal geometry of the brain into clinical reality.
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Affiliation(s)
| | - Herbert F Jelinek
- Department of Medical Sciences and Biotechnology Center, Khalifa University, Abu Dhabi, UAE
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3
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Kurita Y, Meguro S, Tsuyama N, Kosugi I, Enomoto Y, Kawasaki H, Uemura T, Kimura M, Iwashita T. Accurate deep learning model using semi-supervised learning and Noisy Student for cervical cancer screening in low magnification images. PLoS One 2023; 18:e0285996. [PMID: 37200281 DOI: 10.1371/journal.pone.0285996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
Deep learning technology has been used in the medical field to produce devices for clinical practice. Deep learning methods in cytology offer the potential to enhance cancer screening while also providing quantitative, objective, and highly reproducible testing. However, constructing high-accuracy deep learning models necessitates a significant amount of manually labeled data, which takes time. To address this issue, we used the Noisy Student Training technique to create a binary classification deep learning model for cervical cytology screening, which reduces the quantity of labeled data necessary. We used 140 whole-slide images from liquid-based cytology specimens, 50 of which were low-grade squamous intraepithelial lesions, 50 were high-grade squamous intraepithelial lesions, and 40 were negative samples. We extracted 56,996 images from the slides and then used them to train and test the model. We trained the EfficientNet using 2,600 manually labeled images to generate additional pseudo labels for the unlabeled data and then self-trained it within a student-teacher framework. Based on the presence or absence of abnormal cells, the created model was used to classify the images as normal or abnormal. The Grad-CAM approach was used to visualize the image components that contributed to the classification. The model achieved an area under the curve of 0.908, accuracy of 0.873, and F1-score of 0.833 with our test data. We also explored the optimal confidence threshold score and optimal augmentation approaches for low-magnification images. Our model efficiently classified normal and abnormal images at low magnification with high reliability, making it a promising screening tool for cervical cytology.
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Affiliation(s)
- Yuki Kurita
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shiori Meguro
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naoko Tsuyama
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Isao Kosugi
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yasunori Enomoto
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hideya Kawasaki
- Institute for NanoSuit Research, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takashi Uemura
- Department of Pathology, JA Shizuoka Kohseiren Enshu Hospital, Hamamatsu, Shizuoka, Japan
| | - Michio Kimura
- Department of Medical Informatics, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Toshihide Iwashita
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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4
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Antonini P, Santonicco N, Pantanowitz L, Girolami I, Rizzo PC, Brunelli M, Bellevicine C, Vigliar E, Negri G, Troncone G, Fadda G, Parwani A, Marletta S, Eccher A. Relevance of the College of American Pathologists guideline for validating whole slide imaging for diagnostic purposes to cytopathology. Cytopathology 2023; 34:5-14. [PMID: 36082410 PMCID: PMC10087327 DOI: 10.1111/cyt.13178] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022]
Abstract
Whole slide imaging (WSI) allows pathologists to view virtual versions of slides on computer monitors. With increasing adoption of digital pathology, laboratories have begun to validate their WSI systems for diagnostic purposes according to reference guidelines. Among these the College of American Pathologists (CAP) guideline includes three strong recommendations (SRs) and nine good practice statements (GPSs). To date, the application of WSI to cytopathology has been beyond the scope of the CAP guideline due to limited evidence. Herein we systematically reviewed the published literature on WSI validation studies in cytology. A systematic search was carried out in PubMed-MEDLINE and Embase databases up to November 2021 to identify all publications regarding validation of WSI in cytology. Each article was reviewed to determine if SRs and/or GPSs recommended by the CAP guideline were adequately satisfied. Of 3963 retrieved articles, 25 were included. Only 4/25 studies (16%) satisfied all three SRs, with only one publication (1/25, 4%) fulfilling all three SRs and nine GPSs. Lack of a suitable validation dataset was the main missing SR (16/25, 64%) and less than a third of the studies reported intra-observer variability data (7/25, 28%). Whilst the CAP guideline for WSI validation in clinical practice helped the widespread adoption of digital pathology, more evidence is required to routinely employ WSI for diagnostic purposes in cytopathology practice. More dedicated validation studies satisfying all SRs and/or GPSs recommended by the CAP are needed to help expedite the use of WSI for primary diagnosis in cytopathology.
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Affiliation(s)
- Pietro Antonini
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Nicola Santonicco
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Paola Chiara Rizzo
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | | | - Elena Vigliar
- Public Health, University of Naples Federico II, Naples, Italy
| | - Giovanni Negri
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | | | - Guido Fadda
- Section of Pathological Anatomy, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Anil Parwani
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Stefano Marletta
- Section of Pathology, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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5
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Escobar Díaz Guerrero R, Carvalho L, Bocklitz T, Popp J, Oliveira JL. Software tools and platforms in Digital Pathology: a review for clinicians and computer scientists. J Pathol Inform 2022; 13:100103. [PMID: 36268075 PMCID: PMC9576980 DOI: 10.1016/j.jpi.2022.100103] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
Abstract
At the end of the twentieth century, a new technology was developed that allowed an entire tissue section to be scanned on an objective slide. Originally called virtual microscopy, this technology is now known as Whole Slide Imaging (WSI). WSI presents new challenges for reading, visualization, storage, and analysis. For this reason, several technologies have been developed to facilitate the handling of these images. In this paper, we analyze the most widely used technologies in the field of digital pathology, ranging from specialized libraries for the reading of these images to complete platforms that allow reading, visualization, and analysis. Our aim is to provide the reader, whether a pathologist or a computational scientist, with the knowledge to choose the technologies to use for new studies, development, or research.
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Affiliation(s)
- Rodrigo Escobar Díaz Guerrero
- BMD Software, PCI - Creative Science Park, 3830-352 Ilhavo, Portugal
- DETI/IEETA, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Lina Carvalho
- Institute of Anatomical and Molecular Pathology, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Thomas Bocklitz
- Leibniz Institute of Photonic Technology Jena, Member of Leibniz research alliance ‘Health technologies’, Albert-Einstein-Straße 9, 07745 Jena, Germany
- Institute of Physical Chemistry and Abbe Center of Photonics (IPC), Friedrich-Schiller-University, Jena, Germany
| | - Juergen Popp
- Leibniz Institute of Photonic Technology Jena, Member of Leibniz research alliance ‘Health technologies’, Albert-Einstein-Straße 9, 07745 Jena, Germany
- Institute of Physical Chemistry and Abbe Center of Photonics (IPC), Friedrich-Schiller-University, Jena, Germany
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6
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Hu D, Wang C, Zheng S, Cui X. Investigating the genealogy of the literature on digital pathology: a two-dimensional bibliometric approach. Scientometrics 2022. [DOI: 10.1007/s11192-021-04224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Herrmann MD, Lennerz JK. [Technical, operational, and regulatory considerations for the adoption of digital and computational pathology]. DER PATHOLOGE 2021; 41:103-110. [PMID: 33263808 DOI: 10.1007/s00292-020-00871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Innovative information technologies open new possibilities for diagnostics and promise to improve patient care. However, the integration of data- and computing-intensive procedures into diagnostic workflows also poses risks and considerable challenges for pathologists. OBJECTIVES Considering technical, operational, and regulatory aspects, we present a holistic and systematic approach for the adoption of digital and computational pathology. MATERIAL AND METHODS We discuss challenges for the implementation of computational diagnostic procedures and analyze regulatory frameworks for risk-based assessment and monitoring of software as an in vitro diagnostic device. Applying regulatory science, we develop an approach to streamline adoption of digital workflows in pathology. RESULTS Data- and computing-intensive workflows in digital pathology are complex and underscore the need for computational and regulatory science as a central part of pathological diagnostics. To promote the adoption of computational diagnostics, we have founded an interdisciplinary initiative (the Alliance) that focuses on regulatory research in the field of digital pathology and works closely with a number of expert and interest groups on the precompetitive development of standards for computational workflows. DISCUSSION The inclusion of different stakeholder groups and the coordination of technical, operational, and regulatory aspects is necessary to maintain the balance between progress and safety in diagnostics and to make innovations quickly and safely available for patient care.
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Affiliation(s)
- Markus D Herrmann
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. .,Pathology Service, Massachusetts General Hospital, 55 Fruit Street, 02114, Boston, MA, USA.
| | - Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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8
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Srivastava A, Hanig JP. Quantitative neurotoxicology: Potential role of artificial intelligence/deep learning approach. J Appl Toxicol 2020; 41:996-1006. [PMID: 33140470 DOI: 10.1002/jat.4098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022]
Abstract
Neurotoxicity studies are important in the preclinical stages of drug development process, because exposure to certain compounds that may enter the brain across a permeable blood brain barrier damages neurons and other supporting cells such as astrocytes. This could, in turn, lead to various neurological disorders such as Parkinson's or Huntington's disease as well as various dementias. Toxicity assessment is often done by pathologists after these exposures by qualitatively or semiquantitatively grading the severity of neurotoxicity in histopathology slides. Quantification of the extent of neurotoxicity supports qualitative histopathological analysis and provides a better understanding of the global extent of brain damage. Stereological techniques such as the utilization of an optical fractionator provide an unbiased quantification of the neuronal damage; however, the process is time-consuming. Advent of whole slide imaging (WSI) introduced digital image analysis which made quantification of neurotoxicity automated, faster and with reduced bias, making statistical comparisons possible. Although automated to a certain level, simple digital image analysis requires manual efforts of experts which is time-consuming and limits analysis of large datasets. Digital image analysis coupled with a deep learning artificial intelligence model provides a good alternative solution to time-consuming stereological and simple digital analysis. Deep learning models could be trained to identify damaged or dead neurons in an automated fashion. This review has focused on and discusses studies demonstrating the role of deep learning in segmentation of brain regions, toxicity detection and quantification of degenerated neurons as well as the estimation of area/volume of degeneration.
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Affiliation(s)
- Anshul Srivastava
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Joseph P Hanig
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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9
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Girolami I, Pantanowitz L, Marletta S, Brunelli M, Mescoli C, Parisi A, Barresi V, Parwani A, Neil D, Scarpa A, Rossi ED, Eccher A. Diagnostic concordance between whole slide imaging and conventional light microscopy in cytopathology: A systematic review. Cancer Cytopathol 2020; 128:17-28. [DOI: 10.1002/cncy.22195] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/23/2019] [Indexed: 08/29/2023]
Affiliation(s)
- Ilaria Girolami
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Liron Pantanowitz
- Department of Pathology UPMC Shadyside Hospital University of Pittsburgh Pittsburgh Pennsylvania
| | - Stefano Marletta
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Claudia Mescoli
- Surgical Pathology and Cytopathology Unit Department of Medicine University and Hospital Trust of Padua Padua Italy
| | - Alice Parisi
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Valeria Barresi
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Anil Parwani
- Department of Pathology Ohio State University Columbus Ohio
| | - Desley Neil
- Department of Histopathology University Hospital Birmingham National Health Service Foundation Trust Birmingham United Kingdom
| | - Aldo Scarpa
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart Agostino Gemelli School of Medicine Rome Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics University and Hospital Trust of Verona Verona Italy
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10
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Girolami I, Parwani A, Barresi V, Marletta S, Ammendola S, Stefanizzi L, Novelli L, Capitanio A, Brunelli M, Pantanowitz L, Eccher A. The Landscape of Digital Pathology in Transplantation: From the Beginning to the Virtual E-Slide. J Pathol Inform 2019; 10:21. [PMID: 31367473 PMCID: PMC6639852 DOI: 10.4103/jpi.jpi_27_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background Digital pathology has progressed over the last two decades, with many clinical and nonclinical applications. Transplantation pathology is a highly specialized field in which the majority of practicing pathologists do not have sufficient expertise to handle critical needs. In this context, digital pathology has proven to be useful as it allows for timely access to expert second-opinion teleconsultation. The aim of this study was to review the experience of the application of digital pathology to the field of transplantation. Methods Papers on this topic were retrieved using PubMed as a search engine. Inclusion criteria were the presence of transplantation setting and the use of any type of digital image with or without the use of image analysis tools; the search was restricted to English language papers published in the 25 years until December 31, 2018. Results Literature regarding digital transplant pathology is mostly about the digital interpretation of posttransplant biopsies (75 vs. 19), with 15/75 (20%) articles focusing on agreement/reproducibility. Several papers concentrated on the correlation between biopsy features assessed by digital image analysis (DIA) and clinical outcome (45/75, 60%). Whole-slide imaging (WSI) only appeared in recent publications, starting from 2011 (13/75, 17.3%). Papers dealing with preimplantation biopsy are less numerous, the majority (13/19, 68.4%) of which focus on diagnostic agreement between digital microscopy and light microscopy (LM), with WSI technology being used in only a small quota of papers (4/19, 21.1%). Conclusions Overall, published studies show good concordance between digital microscopy and LM modalities for diagnosis. DIA has the potential to increase diagnostic reproducibility and facilitate the identification and quantification of histological parameters. Thus, with advancing technology such as faster scanning times, better image resolution, and novel image algorithms, it is likely that WSI will eventually replace LM.
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Affiliation(s)
- Ilaria Girolami
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Anil Parwani
- Department of Pathology, Ohio State University, Columbus, Ohio, USA
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Marletta
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Serena Ammendola
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Lavinia Stefanizzi
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Novelli
- Department of Translational Medicine and Surgery, Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Arrigo Capitanio
- Department of Clinical Pathology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Liron Pantanowitz
- Department of Pathology, UPMC Shadyside Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albino Eccher
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
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11
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A mobile-based telepathology system for a low resource setting in Ethiopia. APPLIED COMPUTING AND INFORMATICS 2018. [DOI: 10.1016/j.aci.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Somanchi S, Neill DB, Parwani AV. Discovering anomalous patterns in large digital pathology images. Stat Med 2018; 37:3599-3615. [PMID: 29900578 DOI: 10.1002/sim.7828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/04/2018] [Accepted: 04/27/2018] [Indexed: 11/06/2022]
Abstract
Advances in medical imaging technology have created opportunities for computer-aided diagnostic tools to assist human practitioners in identifying relevant patterns in massive, multiscale digital pathology slides. This work presents Hierarchical Linear Time Subset Scanning, a novel statistical method for pattern detection. Hierarchical Linear Time Subset Scanning exploits the hierarchical structure inherent in data produced through virtual microscopy in order to accurately and quickly identify regions of interest for pathologists to review. We take a digital image at various resolution levels, identify the most anomalous regions at a coarse level, and continue to analyze the data at increasingly granular resolutions until we accurately identify its most anomalous subregions. We demonstrate the performance of our novel method in identifying cancerous locations on digital slides of prostate biopsy samples and show that our methods detect regions of cancer in minutes with high accuracy, both as measured by the ROC curve (measuring ability to distinguish between benign and cancerous slides) and by the spatial precision-recall curve (measuring ability to pick out the malignant areas on a slide which contains cancer). Existing methods need small scale images (small areas of a slide preselected by the pathologist for analysis, eg, 32 × 32 pixels) and may not work effectively on large, raw digitized images of size 100K × 100K pixels. In this work, we provide a methodology to fill this significant gap by analyzing large digitized images and identifying regions of interest that may be indicative of cancer.
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Affiliation(s)
- Sriram Somanchi
- IT, Analytics, and Operations, Mendoza College of Business, University of Notre Dame, Notre Dame, IN, 46556, U.S.A
| | - Daniel B Neill
- Event and Pattern Detection Laboratory, H.J. Heinz III College, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, U.S.A
| | - Anil V Parwani
- Department of Pathology, Ohio State University, Columbus, OH 43210, U.S.A
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13
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Development of a reliable and accurate algorithm to quantify the tumor immune stroma (QTiS) across tumor types. Oncotarget 2017; 8:114935-114944. [PMID: 29383131 PMCID: PMC5777743 DOI: 10.18632/oncotarget.22932] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/05/2017] [Indexed: 12/13/2022] Open
Abstract
The tumor microenvironment plays an important role in the tumor biology. Overall survival of tumor patients after resection is influenced by tumor-infiltrating lymphocytes (TILs) as a component of the tumor stroma. However, it is not clear how to assess TILs in the tumor stroma due to heterogeneous methods in different cancer types. Therefore, we present a novel Quantification of the Tumor immune Stroma (QTiS) Algorithm to reliably and accurately quantify cells in the tumor stroma. Immunohistochemical staining of CD3 and CD8 cells in sections of metastatic colorectal cancer (mCRC), ovarian cancer (OvCa), hepatocellular carcinoma (HCC), and pancreatic ductal adenocarcinoma (PDAC), alltogether N = 80, was performed. Hot spots of infiltrating immune cells are reported in the literature. Reliability of the hot spot identification of TILs was examined by two blinded observers. Accuracy was tested in 1 and 3 hot spots using computed counting methods (ZEN 2 software counting (ZC), ImageJ software with subjective threshold (ISC) and ImageJ with color deconvolution (IAC)) and compared to manual counting. All tumor types investigated showed an accumulation of TILs in the tumor stroma (peri- and intratumoral). Reliability between observers indicated a high level consistency. Accuracy for CD8+/CD3+ ratio and absolute cell count required 1 and 3 hot spots, respectively. ISC was found to be the best for paraffin sections, whereas IAC was ideal for frozen sections. ImageJ software is cost-effective and yielded the best results. In conclusion, an algorithm for quantification of tumoral stroma could be established. With this QTiS Algorithm counting of tumor stromal cells is reliable, accurate, and cost-effective.
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14
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Palomino J, Hånell A. Computer graphics for the microscopist. J Clin Pathol 2017; 71:e1-e2. [PMID: 29146884 DOI: 10.1136/jclinpath-2017-204861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/06/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Jhonel Palomino
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hånell
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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15
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Farahani N, Braun A, Jutt D, Huffman T, Reder N, Liu Z, Yagi Y, Pantanowitz L. Three-dimensional Imaging and Scanning: Current and Future Applications for Pathology. J Pathol Inform 2017; 8:36. [PMID: 28966836 PMCID: PMC5609355 DOI: 10.4103/jpi.jpi_32_17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/03/2017] [Indexed: 11/04/2022] Open
Abstract
Imaging is vital for the assessment of physiologic and phenotypic details. In the past, biomedical imaging was heavily reliant on analog, low-throughput methods, which would produce two-dimensional images. However, newer, digital, and high-throughput three-dimensional (3D) imaging methods, which rely on computer vision and computer graphics, are transforming the way biomedical professionals practice. 3D imaging has been useful in diagnostic, prognostic, and therapeutic decision-making for the medical and biomedical professions. Herein, we summarize current imaging methods that enable optimal 3D histopathologic reconstruction: Scanning, 3D scanning, and whole slide imaging. Briefly mentioned are emerging platforms, which combine robotics, sectioning, and imaging in their pursuit to digitize and automate the entire microscopy workflow. Finally, both current and emerging 3D imaging methods are discussed in relation to current and future applications within the context of pathology.
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Affiliation(s)
| | - Alex Braun
- 3Scan, Inc., San Francisco, California, USA
| | - Dylan Jutt
- 3Scan, Inc., San Francisco, California, USA
| | | | - Nick Reder
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Zheng Liu
- Department of Pathology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Yukako Yagi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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An efficient architecture to support digital pathology in standard medical imaging repositories. J Biomed Inform 2017; 71:190-197. [PMID: 28602907 DOI: 10.1016/j.jbi.2017.06.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 11/21/2022]
Abstract
In the past decade, digital pathology and whole-slide imaging (WSI) have been gaining momentum with the proliferation of digital scanners from different manufacturers. The literature reports significant advantages associated with the adoption of digital images in pathology, namely, improvements in diagnostic accuracy and better support for telepathology. Moreover, it also offers new clinical and research applications. However, numerous barriers have been slowing the adoption of WSI, among which the most important are performance issues associated with storage and distribution of huge volumes of data, and lack of interoperability with other hospital information systems, most notably Picture Archive and Communications Systems (PACS) based on the DICOM standard. This article proposes an architecture of a Web Pathology PACS fully compliant with DICOM standard communications and data formats. The solution includes a PACS Archive responsible for storing whole-slide imaging data in DICOM WSI format and offers a communication interface based on the most recent DICOM Web services. The second component is a zero-footprint viewer that runs in any web-browser. It consumes data using the PACS archive standard web services. Moreover, it features a tiling engine especially suited to deal with the WSI image pyramids. These components were designed with special focus on efficiency and usability. The performance of our system was assessed through a comparative analysis of the state-of-the-art solutions. The results demonstrate that it is possible to have a very competitive solution based on standard workflows.
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Utilization Management in a Large Community Hospital. UTILIZATION MANAGEMENT IN THE CLINICAL LABORATORY AND OTHER ANCILLARY SERVICES 2017. [PMCID: PMC7123185 DOI: 10.1007/978-3-319-34199-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The utilization management of laboratory tests in a large community hospital is similar to academic and smaller community hospitals. There are numerous factors that influence laboratory utilization. Outside influences like hospitals buying physician practices, increasing numbers of hospitalists, and hospital consolidation will influence the number and complexity of the test menu that will need to be monitored for over and/or under utilization in the central laboratory and reference laboratory. CLIA’88 outlines the four test categories including point-of-care testing (waived) and provider-performed microscopy that need laboratory test utilization management. Incremental cost analysis is the most efficient method for evaluating utilization reduction cost savings. Economies of scale define reduced unit cost per test as test volume increases. Outreach programs in large community hospitals provide additional laboratory tests from non-patients in physician offices, nursing homes, and other hospitals. Disruptive innovations are changing the present paradigms in clinical diagnostics, like wearable sensors, MALDI-TOF, multiplex infectious disease panels, cell-free DNA, and others. Obsolete tests need to be universally defined and accepted by manufacturers, physicians, laboratories, and hospitals, to eliminate access to their reagents and testing platforms.
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Meyer J, Paré G. Telepathology Impacts and Implementation Challenges: A Scoping Review. Arch Pathol Lab Med 2016; 139:1550-7. [PMID: 26619028 DOI: 10.5858/arpa.2014-0606-ra] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Telepathology is a particular form of telemedicine that fundamentally alters the way pathology services are delivered. Prior reviews in this area have mostly focused on 2 themes, namely technical feasibility issues and diagnosis accuracy. OBJECTIVES To synthesize the literature on telepathology implementation challenges and broader organizational and societal impacts and to propose a research agenda to guide future efforts in this domain. DATA SOURCES Two complementary databases were systematically searched: MEDLINE (PubMed) and ABI/INFORM (ProQuest). Peer-reviewed articles and conference proceedings were considered. The final sample consisted of 159 papers published between 1992 and 2013. CONCLUSIONS This review highlights the diversity of telepathology networks and the importance of considering these distinctions when interpreting research findings. Various network structures are associated with different benefits. Although the dominant rationale in single-site projects is financial, larger centralized and decentralized telepathology networks are targeting a more diverse set of benefits, including extending access to pathology to a whole region, achieving substantial economies of scale in workforce and equipment, and improving quality by standardizing care. Importantly, our synthesis reveals that the nature and scale of encountered implementation challenges also varies depending on the network structure. In smaller telepathology networks, organizational concerns are less prominent, and implementers are more focused on usability issues. As the network scope widens, organizational and legal issues gain prominence.
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Affiliation(s)
- Julien Meyer
- From the Department of Information Technology, HEC Montréal, Montreal, Quebec, Canada
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Guo H, Birsa J, Farahani N, Hartman DJ, Piccoli A, O'Leary M, McHugh J, Nyman M, Stratman C, Kvarnstrom V, Yousem S, Pantanowitz L. Digital pathology and anatomic pathology laboratory information system integration to support digital pathology sign-out. J Pathol Inform 2016; 7:23. [PMID: 27217973 PMCID: PMC4872480 DOI: 10.4103/2153-3539.181767] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/06/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The adoption of digital pathology offers benefits over labor-intensive, time-consuming, and error-prone manual processes. However, because most workflow and laboratory transactions are centered around the anatomical pathology laboratory information system (APLIS), adoption of digital pathology ideally requires integration with the APLIS. A digital pathology system (DPS) integrated with the APLIS was recently implemented at our institution for diagnostic use. We demonstrate how such integration supports digital workflow to sign-out anatomical pathology cases. METHODS Workflow begins when pathology cases get accessioned into the APLIS (CoPathPlus). Glass slides from these cases are then digitized (Omnyx VL120 scanner) and automatically uploaded into the DPS (Omnyx(®) Integrated Digital Pathology (IDP) software v.1.3). The APLIS transmits case data to the DPS via a publishing web service. The DPS associates scanned images with the correct case using barcode labels on slides and information received from the APLIS. When pathologists remotely open a case in the DPS, additional information (e.g. gross pathology details, prior cases) gets retrieved from the APLIS through a query web service. RESULTS Following validation of this integration, pathologists at our institution have signed out more than 1000 surgical pathology cases in a production environment. Integration between the APLIS and DPS enabled pathologists to review digital slides while simultaneously having access to pertinent case metadata. The introduction of a digital workflow eliminated costly manual tasks involving matching of glass slides and avoided delays waiting for glass slides to be delivered. CONCLUSION Integrating the DPS and APLIS were instrumental for successfully implementing a digital solution at our institution for pathology sign-out. The integration streamlined our digital sign-out workflow, diminished the potential for human error related to matching slides, and improved the sign-out experience for pathologists.
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Affiliation(s)
- Huazhang Guo
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joe Birsa
- Omnyx, LLC, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Navid Farahani
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Douglas J Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anthony Piccoli
- Information Services Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew O'Leary
- Information Services Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey McHugh
- Information Services Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark Nyman
- Omnyx, LLC, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Curtis Stratman
- Omnyx, LLC, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vanja Kvarnstrom
- Omnyx, LLC, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Samuel Yousem
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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20
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Montalto MC. An industry perspective: An update on the adoption of whole slide imaging. J Pathol Inform 2016; 7:18. [PMID: 27141323 PMCID: PMC4837789 DOI: 10.4103/2153-3539.180014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/18/2016] [Indexed: 12/29/2022] Open
Abstract
This manuscript is an adaptation of the closing keynote presentation of the Digital Pathology Association Pathology Visions Conference 2015 in Boston, MA, USA. In this presentation, analogies are drawn between the adoption of whole slide imaging (WSI) and other mainstream digital technologies, including digital music and books. In doing so, it is revealed that the adoption of seemingly similar digital technologies does not follow the same adoption profiles and that understanding the unique aspects of value for each customer segment is critical. Finally, a call to action is given to academia and industry to study the value that WSI brings to the global healthcare community.
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Affiliation(s)
- Michael C. Montalto
- Clinical, Medical and Scientific Affairs, Omnyx, LLC, Pittsburgh, PA 15222, USA
- Corresponding author
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Seger S, Stritt M, Doppler K, Frank S, Panaite A, Kuntzer T, Steck A, Pagenstecher A, Sommer C, Stalder AK. A semi-automated method to assess intraepidermal nerve fibre density in human skin biopsies. Histopathology 2015; 68:657-65. [PMID: 26249211 DOI: 10.1111/his.12794] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
Abstract
AIMS Evaluation of intraepidermal nerve fibres (IENFs) in skin biopsies is used in the diagnosis of small-fibre neuropathies. The number of IENFs is assessed manually under a microscope, with an inter-rater variability of ~25%. Unless the images are digitized, there is no documentation. Our aim was to develop a method for standardized semi-automated quantification (SAQ) and documentation of IENF density. METHODS AND RESULTS We analysed samples from four different university centres that were immunostained according to local protocols. Images were acquired through the Z-plane with a whole slide scanner. orbit image analysis software was used to create an analysable image and develop a reliable algorithm for IENF detection. Rebuilt images revealed well-contrasted nerves, allowing detection of IENFs (automated). The software presented the detected nerves for confirmation by the operator (manual). As compared with the conventional microscopy count, the SAQ achieved correlation coefficients of 0.99 and 0.96 and interfacility variabilities of 19% and 23%, respectively. We found better reproducibility with fluorescence-stained specimens than with bright-field images. CONCLUSIONS The new semi-automated method has high experimenter-independent reproducibility when based on nerve detection by fluorescence and is easy to perform, even by untrained users. The IENF counting is electronically well documented.
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Affiliation(s)
- Shanon Seger
- Department of Translational Science, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Manuel Stritt
- Department of Information Management Drug Discovery, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Stephan Frank
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Adrian Panaite
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Andreas Steck
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Axel Pagenstecher
- Department of Neuropathology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Anna K Stalder
- Department of Translational Science, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
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Collins BT, Weimholt RC. Whole slide image with image analysis of atypical bile duct brushing: Quantitative features predictive of malignancy. J Pathol Inform 2015; 6:47. [PMID: 26430535 PMCID: PMC4584443 DOI: 10.4103/2153-3539.163986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/06/2015] [Indexed: 01/28/2023] Open
Abstract
Background: Whole slide images (WSIs) involve digitally capturing glass slides for microscopic computer-based viewing and these are amenable to quantitative image analysis. Bile duct (BD) brushing can show morphologic features that are categorized as indeterminate for malignancy. The study aims to evaluate quantitative morphologic features of atypical categories of BD brushing by WSI analysis for the identification of criteria predictive of malignancy. Materials and Methods: Over a 3-year period, BD brush specimens with indeterminate diagnostic categorization (atypical to suspicious) were subjected to WSI analysis. Ten well-visualized groups with morphologic atypical features were selected per case and had the quantitative analysis performed for group area, individual nuclear area, the number of nuclei per group, N: C ratio and nuclear size differential. Results: There were 28 cases identified with 17 atypical and 11 suspicious. The average nuclear area was 63.7 µm2 for atypical and 80.1 µm2 for suspicious (+difference 16.4 µm2; P = 0.002). The nuclear size differential was 69.7 µm2 for atypical and 88.4 µm2 for suspicious (+difference 18.8 µm2; P = 0.009). An average nuclear area >70 µm2 had a 3.2 risk ratio for suspicious categorization. Conclusion: The quantitative criteria findings as measured by image analysis on WSI showed that cases categorized as suspicious had more nuclear size pleomorphism (+18.8 µm2) and larger nuclei (+16.4 µm2) than those categorized as atypical. WSI with morphologic image analysis can demonstrate quantitative statistically significant differences between atypical and suspicious BD brushings and provide objective criteria that support the diagnosis of carcinoma.
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Affiliation(s)
- Brian T Collins
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - R Cody Weimholt
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Abstract
A major goal of modern medicine is increasing patient specificity so that the right treatment is administered to the right patient at the right time with the right dose. While current cancer studies have largely focused on identification of genetic or epigenetic properties of tumor cells, emerging evidence has clearly demonstrated substantial genetic heterogeneity between tumors in the same patient and within subclones of a single tumor. Thus, molecular analysis from populations of cells (either a whole tumor or small biopsy of that tumor) is, at best, an incomplete representation of the underlying biology. These observations indicate a significant need to define intratumoral evolutionary dynamics that yield the observed spatial variations in cellular properties. It is generally accepted that genetic heterogeneity among cancer cells is a manifestation of intratumoral evolution, and this is typically viewed as a consequence of random mutations generated by genomic instability within the cancer cells. We suggest that this represents an incomplete view of Darwinian dynamics, which typically are governed by phenotypic variations in response to spatial and temporal heterogeneity in environmental selection forces. We propose that pathologic feature analysis can provide precise information regarding regional variations in environmental selection forces and phenotypic adaptations. These observations can be integrated using quantitative, spatially explicit methods developed in landscape ecology to interrogate heterogenous biological processes in tumors within individual patients. The ability to investigate tumor heterogeneity has been shown to inform physicians regarding critical aspects of cancer progression including invasion, metastasis, drug resistance, and disease relapse.
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Gomez-Gelvez JC, Kryvenko ON, Chabot-Richards DS, Foucar K, Inamdar KV, Karner KH. Comparative Analysis Reveals Potential Utility of Digital Microscopy in the Evaluation of Peripheral Blood Smears With Some Barriers to Implementation. Am J Clin Pathol 2015; 144:68-77. [PMID: 26071463 DOI: 10.1309/ajcp25almxqfjcqa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Evaluation of the peripheral blood smear (PBS) is an essential diagnostic test in current medical practice. We aimed to evaluate the use of digital microscopy for the examination of PBS as an option to provide expert interpretation to remote sites and in "on-call" situations. METHODS We collected 100 Wright-Giemsa-stained PBS slides representing normal and abnormal findings seen at a community-based hospital. Four hematopathologists independently evaluated the cases using conventional light and digital microscopy. RESULTS When comparing digital vs light microscopy, most of the cellular features evaluated showed at least a moderate degree of agreement in at least three of the reviewers. Discrepancies in final diagnosis were identified in a minority of the cases, most of which were attributed to the poorer resolution of digital microscopy at high magnification (×400). CONCLUSIONS These results support the limited use of digital microscopy for evaluation and triage of peripheral blood smears as a practical option to obtain expert opinion in locations where experienced staff is not available on site. Our results indicate that while digital microscopy is well suited for basic triage of these blood smears, limitations in quality of imaging at higher magnification as well as large file size may limit its utility in certain settings and situations.
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Brunelli M, Beccari S, Colombari R, Gobbo S, Giobelli L, Pellegrini A, Chilosi M, Lunardi M, Martignoni G, Scarpa A, Eccher A. iPathology cockpit diagnostic station: validation according to College of American Pathologists Pathology and Laboratory Quality Center recommendation at the Hospital Trust and University of Verona. Diagn Pathol 2014; 9 Suppl 1:S12. [PMID: 25565219 PMCID: PMC4305970 DOI: 10.1186/1746-1596-9-s1-s12] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Validation of digital whole slide images is crucial to ensure that diagnostic performance is at least equivalent to that of glass slides and light microscopy. The College of American Pathologists Pathology and Laboratory Quality Center recently developed recommendations for internal digital pathology system validation. Following these guidelines we sought to validate the performance of a digital approach for routine diagnosis by using an iPad and digital control widescreen-assisted workstation through a pilot study. Methods From January 2014, 61 histopathological slides were scanned by ScanScope Digital Slides Scanner (Aperio, Vista, CA). Two independent pathologists performed diagnosis on virtual slides in front of a widescreen by using two computer devices (ImageScope viewing software) located to different Health Institutions (AOUI Verona) connected by local network and a remote image server using an iPad tablet (Aperio, Vista, CA), after uploading the Citrix receiver for iPad. Quality indicators related to image characters and work-flow of the e-health cockpit enterprise system were scored based on subjective (high vs poor) perception. The images were re-evaluated two weeks apart. Results The whole glass slides encountered 10 liver: hepatocarcinoma, 10 renal carcinoma, 10 gastric carcinoma and 10 prostate biopsies: adenocarcinoma, 5 excisional skin biopsies: melanoma, 5 lymph-nodes: lymphoma. 6 immuno- and 5 special stains were available for intra- and internet remote viewing. Scan times averaged two minutes and 54 seconds per slide (standard deviation 2 minutes 34 seconds). Megabytes ranged from 256 to 680 (mean 390) per slide storage. Reliance on glass slide, image quality (resolution and color fidelity), slide navigation time, simultaneous viewers in geographically remote locations were considered of high performance score. Side by side comparisons between diagnosis performed on tissue glass slides versus widescreen were excellent showing an almost perfect concordance (0.81, kappa index). Conclusions We validated our institutional digital pathology system for routine diagnostic facing with whole slide images in a cockpit enterprise digital system or iPad tablet. Computer widescreens are better for diagnosing scanned glass slide that iPad. For urgent requests, iPad may be used. Legal aspects have to be soon faced with to permit the clinical use of this technology in a manner that does not compromise patient care.
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Parwani AV, Hassell L, Glassy E, Pantanowitz L. Regulatory barriers surrounding the use of whole slide imaging in the United States of America. J Pathol Inform 2014; 5:38. [PMID: 25379344 PMCID: PMC4221881 DOI: 10.4103/2153-3539.143325] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/07/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Anil V Parwani
- Department of Pathology, Division of Pathology Informatics, UPMC Shadyside Hospital, Pittsburgh, PA 15232, USA
| | - Lewis Hassell
- Department of Pathology, University of Oklahama, Oklahoma City, OK, USA
| | - Eric Glassy
- Affliated Pathologists Medical Group, Torrance, CA, USA
| | - Liron Pantanowitz
- Department of Pathology, Division of Pathology Informatics, UPMC Shadyside Hospital, Pittsburgh, PA 15232, USA
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Roy S, Pantanowitz L, Amin M, Seethala RR, Ishtiaque A, Yousem SA, Parwani AV, Cucoranu I, Hartman DJ. Smartphone adapters for digital photomicrography. J Pathol Inform 2014; 5:24. [PMID: 25191623 PMCID: PMC4141421 DOI: 10.4103/2153-3539.137728] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/22/2014] [Indexed: 12/04/2022] Open
Abstract
Background: Photomicrographs in Anatomic Pathology provide a means of quickly sharing information from a glass slide for consultation, education, documentation and publication. While static image acquisition historically involved the use of a permanently mounted camera unit on a microscope, such cameras may be expensive, need to be connected to a computer, and often require proprietary software to acquire and process images. Another novel approach for capturing digital microscopic images is to use smartphones coupled with the eyepiece of a microscope. Recently, several smartphone adapters have emerged that allow users to attach mobile phones to the microscope. The aim of this study was to test the utility of these various smartphone adapters. Materials and Methods: We surveyed the market for adapters to attach smartphones to the ocular lens of a conventional light microscope. Three adapters (Magnifi, Skylight and Snapzoom) were tested. We assessed the designs of these adapters and their effectiveness at acquiring static microscopic digital images. Results: All adapters facilitated the acquisition of digital microscopic images with a smartphone. The optimal adapter was dependent on the type of phone used. The Magnifi adapters for iPhone were incompatible when using a protective case. The Snapzoom adapter was easiest to use with iPhones and other smartphones even with protective cases. Conclusions: Smartphone adapters are inexpensive and easy to use for acquiring digital microscopic images. However, they require some adjustment by the user in order to optimize focus and obtain good quality images. Smartphone microscope adapters provide an economically feasible method of acquiring and sharing digital pathology photomicrographs.
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Affiliation(s)
- Somak Roy
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Milon Amin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ahmed Ishtiaque
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Samuel A Yousem
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anil V Parwani
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ioan Cucoranu
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Douglas J Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Nunes C, Rocha R, Buzelin M, Balabram D, Foureaux F, Porto S, Gobbi H. High agreement between whole slide imaging and optical microscopy for assessment of HER2 expression in breast cancer: whole slide imaging for the assessment of HER2 expression. Pathol Res Pract 2014; 210:713-8. [PMID: 25091257 DOI: 10.1016/j.prp.2014.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/03/2013] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Whole slide imaging (WSI) technology has been used for training, teaching, researching, and remote consultation. Few studies compared HER2 expression using optical microscopy (OM) and WSI evaluations in breast carcinomas. However, no consensus has been achieved comparing both assessments. MATERIAL AND METHODS Sections from tissue microarray containing 200 preselected invasive breast carcinomas were submitted to immunohistochemistry applying three anti-HER2 antibodies (HercepTest™, CB11, SP3) and in situ hybridization (DDISH). Slides were evaluated using OM and WSI (Pannoramic MIDI and Viewer, 3DHISTECH). Sensitivity and specificity were calculated comparing the anti-HER2 antibodies and DDISH. RESULTS WSI and OM HER2 evaluations agreement was considered good (SP3, k=0.80) to very good (CB11 and HercepTest™, k=0.81). WSI evaluation led to higher sensitivity (ranging from 100 of SP3 and HercepTest™ to 97 of CB11) and lower specificity (ranging from 86.4 of SP3 to 89.4 of HercepTest™) compared to OM evaluation (sensitivity ranged from 92.1 of CB11 to 98 of SP3 and specificity ranged from 95.2 of SP3 and HercepTest™ to 97.1 of CB11 and SP3). CONCLUSION High agreement was achieved between WSI and OM evaluations. All three antibodies were highly sensitive and specific using both evaluations. WSI can be considered a useful tool for HER2 immunohistochemical assessment.
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Affiliation(s)
- Cristiana Nunes
- Department of Anatomic Pathology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Rafael Rocha
- Department of Anatomic Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Marcelo Buzelin
- Department of Anatomic Pathology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Débora Balabram
- Department of Anatomic Pathology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Fernanda Foureaux
- Department of Anatomic Pathology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Simone Porto
- Department of Anatomic Pathology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Helenice Gobbi
- Department of Anatomic Pathology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Cucoranu IC, Parwani AV, Vepa S, Weinstein RS, Pantanowitz L. Digital pathology: A systematic evaluation of the patent landscape. J Pathol Inform 2014; 5:16. [PMID: 25057430 PMCID: PMC4060404 DOI: 10.4103/2153-3539.133112] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/28/2014] [Indexed: 11/06/2022] Open
Abstract
Introduction: Digital pathology is a relatively new field. Inventors of technology in this field typically file for patents to protect their intellectual property. An understanding of the patent landscape is crucial for companies wishing to secure patent protection and market dominance for their products. To our knowledge, there has been no prior systematic review of patents related to digital pathology. Therefore, the aim of this study was to systematically identify and evaluate United States patents and patent applications related to digital pathology. Materials and Methods: Issued patents and patent applications related to digital pathology published in the United States Patent and Trademark Office (USPTO) database (www.uspto.gov) (through January 2014) were searched using the Google Patents search engine (Google Inc., Mountain View, California, USA). Keywords and phrases related to digital pathology, whole-slide imaging (WSI), image analysis, and telepathology were used to query the USPTO database. Data were downloaded and analyzed using the Papers application (Mekentosj BV, Aalsmeer, Netherlands). Results: A total of 588 United States patents that pertain to digital pathology were identified. In addition, 228 patent applications were identified, including 155 that were pending, 65 abandoned, and eight rejected. Of the 588 patents granted, 348 (59.18%) were specific to pathology, while 240 (40.82%) included more general patents also usable outside of pathology. There were 70 (21.12%) patents specific to pathology and 57 (23.75%) more general patents that had expired. Over 120 unique entities (individual inventors, academic institutions, and private companies) applied for pathology specific patents. Patents dealt largely with telepathology and image analysis. WSI related patents addressed image acquisition (scanning and focus), quality (z-stacks), management (storage, retrieval, and transmission of WSI files), and viewing (graphical user interface (GUI), workflow, slide navigation and remote control). An increasing number of recent patents focused on computer-aided diagnosis (CAD) and digital consultation networks. Conclusion: In the last 2 decades, there have been an increasing number of patents granted and patent applications filed related to digital pathology. The number of these patents quadrupled during the last decade, and this trend is predicted to intensify based on the number of patent applications already published by the USPTO.
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Affiliation(s)
- Ioan C Cucoranu
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anil V Parwani
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Suryanarayana Vepa
- Office of Technology Transfer, National Institutes of Health, Rockville, Maryland, USA
| | - Ronald S Weinstein
- Department of Pathology and Arizona Telemedicine Program, University of Arizona, Tucson, Arizona, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Pantanowitz L, Sinard JH, Henricks WH, Fatheree LA, Carter AB, Contis L, Beckwith BA, Evans AJ, Lal A, Parwani AV. Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med 2013; 137:1710-22. [PMID: 23634907 PMCID: PMC7240346 DOI: 10.5858/arpa.2013-0093-cp] [Citation(s) in RCA: 400] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT There is increasing interest in using whole slide imaging (WSI) for diagnostic purposes (primary and/or consultation). An important consideration is whether WSI can safely replace conventional light microscopy as the method by which pathologists review histologic sections, cytology slides, and/or hematology slides to render diagnoses. Validation of WSI is crucial to ensure that diagnostic performance based on digitized slides is at least equivalent to that of glass slides and light microscopy. Currently, there are no standard guidelines regarding validation of WSI for diagnostic use. OBJECTIVE To recommend validation requirements for WSI systems to be used for diagnostic purposes. DESIGN The College of American Pathologists Pathology and Laboratory Quality Center convened a nonvendor panel from North America with expertise in digital pathology to develop these validation recommendations. A literature review was performed in which 767 international publications that met search term requirements were identified. Studies outside the scope of this effort and those related solely to technical elements, education, and image analysis were excluded. A total of 27 publications were graded and underwent data extraction for evidence evaluation. Recommendations were derived from the strength of evidence determined from 23 of these published studies, open comment feedback, and expert panel consensus. RESULTS Twelve guideline statements were established to help pathology laboratories validate their own WSI systems intended for clinical use. Validation of the entire WSI system, involving pathologists trained to use the system, should be performed in a manner that emulates the laboratory's actual clinical environment. It is recommended that such a validation study include at least 60 routine cases per application, comparing intraobserver diagnostic concordance between digitized and glass slides viewed at least 2 weeks apart. It is important that the validation process confirm that all material present on a glass slide to be scanned is included in the digital image. CONCLUSIONS Validation should demonstrate that the WSI system under review produces acceptable digital slides for diagnostic interpretation. The intention of validating WSI systems is to permit the clinical use of this technology in a manner that does not compromise patient care.
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Affiliation(s)
- Liron Pantanowitz
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Pantanowitz, Contis, and Parwani); the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Dr Sinard); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Dr Henricks); the College of American Pathologists, Northfield, Illinois (Ms Fatheree); the Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (Dr Carter); the Department of Pathology, North Shore Medical Center, Salem, Massachusetts (Dr Beckwith); the Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada (Dr Evans); the Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts (Dr Otis); and University Hospital, London Health Science Center, London, Ontario, Canada (Dr Lal)
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Ho J, Aridor O, Glinski DW, Saylor CD, Pelletier JP, Selby DM, Davis SW, Lancia N, Gerlach CB, Newberry J, Anthony L, Pantanowitz L, Parwani AV. Needs and workflow assessment prior to implementation of a digital pathology infrastructure for the US Air Force Medical Service. J Pathol Inform 2013; 4:32. [PMID: 24392246 PMCID: PMC3869953 DOI: 10.4103/2153-3539.122388] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/23/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Advances in digital pathology are accelerating integration of this technology into anatomic pathology (AP). To optimize implementation and adoption of digital pathology systems within a large healthcare organization, initial assessment of both end user (pathologist) needs and organizational infrastructure are required. Contextual inquiry is a qualitative, user-centered tool for collecting, interpreting, and aggregating such detailed data about work practices that can be employed to help identify specific needs and requirements. AIM Using contextual inquiry, the objective of this study was to identify the unique work practices and requirements in AP for the United States (US) Air Force Medical Service (AFMS) that had to be targeted in order to support their transition to digital pathology. SUBJECTS AND METHODS A pathology-centered observer team conducted 1.5 h interviews with a total of 24 AFMS pathologists and histology lab personnel at three large regional centers and one smaller peripheral AFMS pathology center using contextual inquiry guidelines. Findings were documented as notes and arranged into a hierarchal organization of common themes based on user-provided data, defined as an affinity diagram. These data were also organized into consolidated graphic models that characterized AFMS pathology work practices, structure, and requirements. RESULTS Over 1,200 recorded notes were grouped into an affinity diagram composed of 27 third-level, 10 second-level, and five main-level (workflow and workload distribution, quality, communication, military culture, and technology) categories. When combined with workflow and cultural models, the findings revealed that AFMS pathologists had needs that were unique to their military setting, when compared to civilian pathologists. These unique needs included having to serve a globally distributed patient population, transient staff, but a uniform information technology (IT) structure. CONCLUSIONS The contextual inquiry method helped reveal similarities and key differences with civilian pathologists. Such an analysis helped identify specific instances that would benefit from implementing digital pathology in a military environment. Employing digital pathology to facilitate workload distribution, secondary consultations, and quality assurance (over-reads) could help the AFMS deliver more accurate, efficient, and timely AP services at a global level.
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Affiliation(s)
- Jonhan Ho
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Orly Aridor
- Office of Sponsored Programs and Research Support, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David W Glinski
- Office of Sponsored Programs and Research Support, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christopher D Saylor
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph P Pelletier
- Department of Pathology, San Antonio Military Medical Center, Joint Base San Antonio, San Antonio, Texas, USA
| | - Dale M Selby
- Department of Pathology, San Antonio Military Medical Center, Joint Base San Antonio, San Antonio, Texas, USA
| | - Steven W Davis
- Department of Radiation Medicine, Air Force Institute of Technology, University California, San Diego, La Jolla, California, USA
| | - Nicholas Lancia
- Institute of Gastrointestinal Pathology and Digestive Disease, AmeriPath, Inc., Cleveland, Ohio, USA
| | | | - Jonathan Newberry
- Department of Pathology, 96 Medical Group, Eglin Air Force Base, Fort Walton Beach, Florida, USA
| | - Leslie Anthony
- Office of Sponsored Programs and Research Support, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anil V Parwani
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Sellaro TL, Filkins R, Hoffman C, Fine JL, Ho J, Parwani AV, Pantanowitz L, Montalto M. Relationship between magnification and resolution in digital pathology systems. J Pathol Inform 2013; 4:21. [PMID: 24083056 PMCID: PMC3779393 DOI: 10.4103/2153-3539.116866] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/19/2013] [Indexed: 11/04/2022] Open
Abstract
Many pathology laboratories are implementing digital pathology systems. The image resolution and scanning (digitization) magnification can vary greatly between these digital pathology systems. In addition, when digital images are compared with viewing images using a microscope, the cellular features can vary in size. This article highlights differences in magnification and resolution between the conventional microscopes and the digital pathology systems. As more pathologists adopt digital pathology, it is important that they understand these differences and how they ultimately translate into what the pathologist can see and how this may impact their overall viewing experience.
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Affiliation(s)
- Timothy Craig Allen
- From the Department of Pathology, University of Texas Health Science Center at Tyler. Dr Allen is now located at the University of Texas Medical Branch at Galveston, Texas
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Park S, Parwani AV, Aller RD, Banach L, Becich MJ, Borkenfeld S, Carter AB, Friedman BA, Rojo MG, Georgiou A, Kayser G, Kayser K, Legg M, Naugler C, Sawai T, Weiner H, Winsten D, Pantanowitz L. The history of pathology informatics: A global perspective. J Pathol Inform 2013; 4:7. [PMID: 23869286 PMCID: PMC3714902 DOI: 10.4103/2153-3539.112689] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/09/2013] [Indexed: 02/06/2023] Open
Abstract
Pathology informatics has evolved to varying levels around the world. The history of pathology informatics in different countries is a tale with many dimensions. At first glance, it is the familiar story of individuals solving problems that arise in their clinical practice to enhance efficiency, better manage (e.g., digitize) laboratory information, as well as exploit emerging information technologies. Under the surface, however, lie powerful resource, regulatory, and societal forces that helped shape our discipline into what it is today. In this monograph, for the first time in the history of our discipline, we collectively perform a global review of the field of pathology informatics. In doing so, we illustrate how general far-reaching trends such as the advent of computers, the Internet and digital imaging have affected pathology informatics in the world at large. Major drivers in the field included the need for pathologists to comply with national standards for health information technology and telepathology applications to meet the scarcity of pathology services and trained people in certain countries. Following trials by a multitude of investigators, not all of them successful, it is apparent that innovation alone did not assure the success of many informatics tools and solutions. Common, ongoing barriers to the widespread adoption of informatics devices include poor information technology infrastructure in undeveloped areas, the cost of technology, and regulatory issues. This review offers a deeper understanding of how pathology informatics historically developed and provides insights into what the promising future might hold.
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Affiliation(s)
- Seung Park
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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