1
|
Chen-Yost HI, Bammert C, Hao W, Heymann JJ, Lin DM, Marotti J, Waraksa-Deutsch T, Huang M, Krishnamurti U, Lin O, Ly A, Moatamed N, Pantanowitz L, Roy-Chowdhuri S. Changing digital and telecytology practices post COVID-19 comparing ASC survey results from 2016 to 2023. J Am Soc Cytopathol 2024; 13:194-204. [PMID: 38582697 DOI: 10.1016/j.jasc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION During the COVID-19 pandemic, the need for digital pathology tools became more urgent. However, there needs to be more knowledge of the use in cytology. We aimed to evaluate current digital cytology practices and attitudes and compare the results with a pre-COVID-19 American Society of Cytopathology (ASC) survey. MATERIALS AND METHODS Fourteen survey questions assessing current attitudes toward digital cytology were developed from a 2016 ASC Digital Pathology Survey. Ten new survey questions were also created to evaluate telecytology use. The survey was e-mailed to ASC members over 6 weeks in 2023. RESULTS A total of 123 individuals responded (116 in 2016). Attitudes toward digital cytology were unchanged; most participants stated digital cytology is beneficial (87% 2023 versus 90% 2016). The percentage of individuals using digital cytology was unchanged (56% in 2016 and 2023). However, telecytology for rapid onsite assessment (ROSE) is now considered the best application (55% 2023 versus 31% 2016). Forty-three institutions reported using digital and telecytology tools; 40% made implementations after 2020; most did not feel that COVID-19 affected digital cytology (56%). Telecytology for ROSE is the most common application now (78%) compared with education (30%) in 2016. Limitations for implementing digital imaging in cytology included inability to focus (38%) and expense (33%). CONCLUSIONS General attitudes toward digital tools by the cytology community have essentially remained the same between 2016 and now. However, telecytology for ROSE is increasingly being used, which supports a need for validation and competency guidelines.
Collapse
Affiliation(s)
| | - Catherine Bammert
- School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei Hao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Diana Murro Lin
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jonathan Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Min Huang
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Uma Krishnamurti
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Neda Moatamed
- Department of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, California
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sinchita Roy-Chowdhuri
- Department of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
2
|
Sugiura-Nakazato M, Takase H, Nakazato T. A Functional Platform for Remote use of Electron Microscopes Using Web Conferencing Systems. Microscopy (Oxf) 2022; 71:242-244. [PMID: 35639614 DOI: 10.1093/jmicro/dfac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/27/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
In this study, we propose a useful system for remote sharing of transmission electron microscope (TEM) images by connecting three computers: a computer connected to a TEM, a computer distributing images, and a computer receiving images. Then, we confirmed the performance of three web conferencing systems, Microsoft Teams, Zoom, and Google Meet, to evaluate the usefulness of their remote use based on the clarity of images, smoothness of movement, and time lag in images on each computer in the system. A screen image can be captured using the following two methods: a virtual camera of a video distribution software that provided a good reaction speed to transfer images and the screen sharing by conference system software that could share high-quality images.
Collapse
Affiliation(s)
| | - Hiroshi Takase
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences.,Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences
| | - Takeru Nakazato
- Database Center for Life Science (DBCLS), Joint Support-Center for Data Science Research, Research Organization of Information and Systems
| |
Collapse
|
3
|
Buabbas AJ, Mohammad T, Ayed AK, Mallah H, Al-Shawaf H, Khalfan AM. Evaluating the success of the tele-pathology system in governmental hospitals in Kuwait: an explanatory sequential mixed methods design. BMC Med Inform Decis Mak 2021; 21:229. [PMID: 34340685 PMCID: PMC8326651 DOI: 10.1186/s12911-021-01567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telepathology is the practice of reviewing and exchanging pathological images through telecommunication systems to obtain diagnoses remotely. Studying the factors that make such a system successful and favourable is important to ensure the merits of its implementation in clinical practice. OBJECTIVE This study aims to evaluate the success of a telepathology system from the users' perspectives, using specific evaluation criteria, namely: system quality, information quality, technical service quality, user satisfaction, and benefits. METHODS A sequential explanatory mixed methods design was adopted in this study, which consists of two phases. Initially, a questionnaire was distributed via WhatsApp to all of the pathologists (total: 45) working at governmental hospitals in Kuwait. Followed by, semi-structured interviews with ten senior pathologists. RESULTS Forty pathologists responded to the questionnaire, giving an 89% response rate. There were 42.5% of the respondents aged between 35-44 years old, and 52.5% were male. The quantitative results reveal that most of the respondents were satisfied with the quality of the telepathology system with a mean of 2.6025 (Standard Deviation (SD) = 0.47176), whereas they were dissatisfied with the quality of the information with a mean of 2.4100 (SD = 1.580) and the technical support services with a mean of 2.2750 (SD = 0.99535). In addition, there was disagreement on the benefits of telepathology in clinical practice among the pathologists with a mean of 2.4667 (SD = 0.77552). The qualitative results indicate that the lack of interest in and little experience with using the system were behind the general dissatisfaction of most of the respondents. All of the interviewees were satisfied with the performance of the telepathology system and considered it successful; however, the quality of the technical support services, including training workshops, was deemed deficient. CONCLUSION This study concluded that telepathology system in Kuwait is functioning well and has been successful in its implementation; however, pathologists are dissatisfied with it, mainly due to the deficient quality of the technical support services provided. In addition, the successful implementation of such advanced technologies requires careful steps to be taken on multiple levels: technical, organisational, and managerial. Recommendations were suggested.
Collapse
Affiliation(s)
- Ali Jasem Buabbas
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Safat 13110, P.O. Box 24923, Jabriya, Kuwait.
| | - Tareq Mohammad
- Department of Pathology, Jaber Al Ahmad Al Sabah Hospital, Ministry of Health, South Surra, Kuwait
| | - Adel K Ayed
- Department of Surgery, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Hawraa Mallah
- Department of Internal Medicine, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Kuwait
| | - Hamza Al-Shawaf
- Department of Health Informatics and Information Management, Allied Health Sciences, Kuwait University, Jabriya, Kuwait
| | - Abdulwahed Mohammed Khalfan
- Department of Computing and Information Systems, The Public Authority for Applied Education and Training, Ardhiya, Kuwait
| |
Collapse
|
4
|
He X, Wang L, Wang L, Gao J, Cui F, Ma Q, Zhang W, Wang L, Zhai Y, Zhao J. Effectiveness of a Cloud-Based Telepathology System in China: Large-Sample Observational Study. J Med Internet Res 2021; 23:e23799. [PMID: 34326037 PMCID: PMC8367172 DOI: 10.2196/23799] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/18/2020] [Accepted: 05/24/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Whole-slide imaging allows the entire slide to be viewed in a manner that simulates microscopy; therefore, it is widely used in telepathology. However, managing the large digital files needed for whole-slide imaging is difficult. To solve this problem, we set up the Chinese National Cloud-Based Telepathology System (CNCTPS). CNCTPS has been running for more than 4 years and has accumulated a large amount of data. OBJECTIVE The main purpose of this study was to comprehensively evaluate the effectiveness of the CNCTPS based on a large sample. The evaluation indicators included service volume, turnaround time, diagnosis accuracy, and economic benefits. METHODS Details of 23,167 cases submitted to the CNCTPS from January 2016 to December 2019 were collected to analyze the service volume, turnaround time, and economic benefits. A total of 564 patients who visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of the CNCTPS. RESULTS From 2016 to 2019, the service volume of the CNCTPS increased from 2335 to 9240, and the number of participating hospitals increased from 60 to 74. Consultation requests from county-level hospitals accounted for 86.57% (20,287/23,167). A total of 17,495 of 23,167 cases (75.52%) were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions. Of the cases, 3.85% (893/23,167) failed to be diagnosed for reasons such as poor slice quality and incomplete sampling. The median turnaround time was 16.93 hours and was shortened yearly (between 2018 and 2019: adjusted P=.01; other groups: adjusted P<.001); 82.88% cases were diagnosed in 48 hours. There was a discrepancy between the diagnosis and final diagnosis for 11 cases, including 4 false-positive cases and 7 false-negative cases. The sensitivity and specificity were 97.66% and 98.49%, respectively. The diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in the hospital (P=.55). By using this system, a total of US $300,000 was saved for patients every year. CONCLUSIONS The novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals. It can also simultaneously reduce medical costs for patients in China. It should, therefore, be further promoted to enhance the efficiency, quantity, and quality of telepathology diagnoses.
Collapse
Affiliation(s)
- Xianying He
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Wang
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinghong Gao
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China
| | - Fangfang Cui
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qianqian Ma
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Zhang
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China
| | - Lin Wang
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yunkai Zhai
- School of Management Engineering, Zhengzhou University, Zhengzhou, China
| | - Jie Zhao
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China
| |
Collapse
|
5
|
López C, Gibert-Ramos A, Bosch R, Korzynska A, García-Rojo M, Bueno G, García-Fontgivell JF, Martínez González S, Fontoura L, Gras Navarro A, Sauras Colón E, Casanova Ribes J, Roszkowiak L, Roso A, Berenguer M, Llobera M, Baucells J, Lejeune M. Differences in the Immune Response of the Nonmetastatic Axillary Lymph Nodes between Triple-Negative and Luminal A Breast Cancer Surrogate Subtypes. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 191:545-554. [PMID: 33309504 DOI: 10.1016/j.ajpath.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 01/21/2023]
Abstract
Breast cancer (BC) comprises four immunohistochemical surrogate subtypes of which triple-negative breast cancer (TNBC) has the highest risk of mortality. Axillary lymph nodes (ALNs) are the regions where BC cells first establish before distant metastasis, and the presence of tumor cells in the ALN causes an immune tolerance profile that contrasts with that of the nonmetastatic ALN (ALN-). However, few studies have compared the immune components of the ALNs- in BC subtypes. The present study aimed to determine whether differences between immune populations in the primary tumor and ALNs- were associated with the luminal A or TNBC subtype. We evaluated a retrospective cohort of 144 patients using paraffin-embedded biopsies. The TNBC samples tended to have a higher histologic grade and proliferation index and had higher levels of immune markers compared with luminal A in primary tumors and ALNs-. Two methods for validating the multivariate analysis found that histologic grade, intratumoral S100 dendritic cells, and CD8 T lymphocytes and CD57 natural killer cells in the ALNs- were factors associated with TNBC, whereas CD83 dendritic cells in the ALNs- were associated with the luminal A subtype. In conclusion, we found that intratumoral regions and ALNs- of TNBC contained higher concentrations of markers related to immune tolerance than luminal A. This finding partially explains the worse prognosis of patients with TNBC.
Collapse
Affiliation(s)
- Carlos López
- Oncological Pathology and Bioinformatics Research Group, Department of Pathology, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain; Universitat Rovira i Virgili (URV) - Campus Terres de l'Ebre, Tortosa, Spain.
| | - Albert Gibert-Ramos
- Oncological Pathology and Bioinformatics Research Group, Department of Pathology, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain.
| | - Ramón Bosch
- Oncological Pathology and Bioinformatics Research Group, Department of Pathology, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain
| | - Anna Korzynska
- Laboratory of Processing and Analysis of Microscopic Images, Nalęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences (IBIB PAN), Warsaw, Poland
| | - Marcial García-Rojo
- Department of Pathology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Gloria Bueno
- VISILAB, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | | | | | - Laia Fontoura
- Oncological Pathology and Bioinformatics Research Group, Department of Pathology, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain
| | - Andrea Gras Navarro
- Oncological Pathology and Bioinformatics Research Group, Department of Pathology, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain; Universitat Rovira i Virgili (URV) - Campus Terres de l'Ebre, Tortosa, Spain
| | - Esther Sauras Colón
- Oncological Pathology and Bioinformatics Research Group, Department of Pathology, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain
| | - Júlia Casanova Ribes
- Oncological Pathology and Bioinformatics Research Group, Department of Pathology, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain
| | - Lukasz Roszkowiak
- Laboratory of Processing and Analysis of Microscopic Images, Nalęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences (IBIB PAN), Warsaw, Poland
| | - Albert Roso
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Marta Berenguer
- Knowledge Management Department, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain
| | - Montserrat Llobera
- Department of Oncology, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain
| | - Jordi Baucells
- Informatics Department, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain
| | - Marylène Lejeune
- Oncological Pathology and Bioinformatics Research Group, Department of Pathology, Hospital de Tortosa Verge de la Cinta, ICS, IISPV, Tortosa, Spain; Universitat Rovira i Virgili (URV) - Campus Terres de l'Ebre, Tortosa, Spain
| |
Collapse
|
6
|
Crescenzi A, Trimboli P, Basolo F, Frasoldati A, Orlandi F, Palombini L, Papini E, Pontecorvi A, Vitti P, Zini M, Nardi F, Fadda G. Exploring the Inter-observer Agreement Among the Members of the Italian Consensus for the Classification and Reporting of Thyroid Cytology. Endocr Pathol 2020; 31:301-306. [PMID: 32621106 DOI: 10.1007/s12022-020-09636-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Classification schemes for reporting thyroid cytology of fine needle aspiration (FNA) of thyroid nodules are largely used in clinical practice, but the level of inter-observer agreement among cytopathologists is poorly acknowledged. The present study aimed to explore the inter-observer agreement among the experienced authors of the 2014 Italian Consensus for Classification and Reporting of Thyroid Cytology (ICCRTC). A stratified randomization was performed in order to obtain a sample homogeneously distributed and representative of all ICCRTC classes. Four high-experience raters were randomly selected among the extensors of the Italian consensus. They independently reviewed 60 FNA samples blindly of the initial cytological report and clinical features. Their overall agreement was evaluated according to Fleiss' kappa. The overall inter-observer agreement was moderate (κ 0.46). Specifically, a good agreement was found when the samples were consistent for malignancy (TIR5) or were not adequate for diagnosis (TIR1) (κ 0.67 and κ 0.73, respectively). A moderate agreement was present for suspicious-for-malignant category (TIR4), and a fair agreement was recorded in the two intermediate ones (TIR3A and TIR3B) (κ 0.36 and κ 0.35, respectively). For clinical purposes, the agreement was good (κ 0.74) in differentiating cases with surgical indication (TIR4/TIR5) from those in which surgery is not essential or requires limited extension (TIR3B/TIR3A/TIR2). In conclusion, the present study confirms the reliability of ICCRTC. These data represent a reference for cytopathologists using this system and are useful for the practice of clinicians and surgeons.
Collapse
Affiliation(s)
- Anna Crescenzi
- Pathology Unit, University Hospital Campus Bio-Medico of Rome, Rome, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Andrea Frasoldati
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabio Orlandi
- Department of Oncology, University of Turin, Turin, Italy
| | | | - Enrico Papini
- Endocrinology and Metabolism Unit, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Alfredo Pontecorvi
- Università Cattolica Del Sacro Cuore Agostino Gemelli, University Hospital, Rome, Italy
| | - Paolo Vitti
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Zini
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Nardi
- Former Professor in Pathology, Sapienza University of Rome, Rome, Italy
| | - Guido Fadda
- Department of Pathology and Cytopathology - Catholic University, "Agostino Gemelli" Hospital IRCCS, Rome, Italy
| |
Collapse
|
7
|
Larghi A, Fornelli A, Lega S, Ragazzi M, Carlinfante G, Baccarini P, Fabbri C, Pierotti P, Tallini G, Bondi A, de Biase D. Concordance, intra- and inter-observer agreements between light microscopy and whole slide imaging for samples acquired by EUS in pancreatic solid lesions. Dig Liver Dis 2019; 51:1574-1579. [PMID: 31147212 DOI: 10.1016/j.dld.2019.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND No study has compared the performance of light microscopy (LM) and whole slide imaging (WSI) for endoscopic ultrasound (EUS) histological acquired tissue samples from pancreatic solid lesions (PSLs). We evaluated the concordance between LM and WSI and the inter- and intra-observer agreements among pathologists on PSLs EUS acquired samples. METHODS LM and WSI from 60 patients with PSLs were evaluated by five expert pathologists to define: diagnostic classification, presence of a core, number and percentage of lesional cells. Washout period between evaluations was 3 months. Time of the procedures was also assessed. RESULTS Forty-eight cell-block and 12 biopsy samples were evaluated. A high concordance between LM and WSI was found. Inter- and intra-observer agreements for diagnostic classification were substantial and complete, respectively. For all the other parameters, the inter-observer agreement was usually higher for LM. For the intra-observer, a substantial agreement was reached regarding the presence of tissue core and the number and the percentage of malignant cells. Median time for performing LM was significantly shorter than for WSI (p < 0.0001). CONCLUSIONS LM and WSI of cell-block and biopsy samples acquired by EUS in PSLs were highly concordant, with a substantial inter-observer and a complete intra-observer agreements regarding diagnostic classification.
Collapse
Affiliation(s)
- Alberto Larghi
- Digestive Endoscopy Unit, Foundation University Hospital Policlinico A. Gemelli IRCCS, CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | | | | | - Moira Ragazzi
- Pathology Unit, S. Maria Nuova Hospital, IRCSS-AUSL Reggio Emilia, Italy
| | | | | | - Carlo Fabbri
- Digestive Endoscopy and Gastroenterology, Forlì and Cesena Hospitals, Italy
| | | | - Giovanni Tallini
- Anatomical Pathology, Molecular Diagnostic Unit, University of Bologna School of Medicine, Bologna, Italy
| | - Arrigo Bondi
- Pathology Unit, Maggiore Hospital, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, Bologna, Italy
| |
Collapse
|
8
|
Abstract
This paper reviews the components of Orthanc, a free and open-source, highly versatile ecosystem for medical imaging. At the core of the Orthanc ecosystem, the Orthanc server is a lightweight vendor neutral archive that provides PACS managers with a powerful environment to automate and optimize the imaging flows that are very specific to each hospital. The Orthanc server can be extended with plugins that provide solutions for teleradiology, digital pathology, or enterprise-ready databases. It is shown how software developers and research engineers can easily develop external software or Web portals dealing with medical images, with minimal knowledge of the DICOM standard, thanks to the advanced programming interface of the Orthanc server. The paper concludes by introducing the Stone of Orthanc, an innovative toolkit for the cross-platform rendering of medical images.
Collapse
Affiliation(s)
- Sébastien Jodogne
- Scientific Collaborator, Montefiore Institute, B28, Department of Electrical Engineering and Computer Science, University of Liège, B-4000, Liège, Belgium.
| |
Collapse
|
9
|
Heeke S, Delingette H, Fanjat Y, Long-Mira E, Lassalle S, Hofman V, Benzaquen J, Marquette CH, Hofman P, Ilié M. [The age of artificial intelligence in lung cancer pathology: Between hope, gloom and perspectives]. Ann Pathol 2019; 39:130-136. [PMID: 30772062 DOI: 10.1016/j.annpat.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/16/2019] [Indexed: 12/14/2022]
Abstract
Histopathology is the fundamental tool of pathology used for more than a century to establish the final diagnosis of lung cancer. In addition, the phenotypic data contained in the histological images reflects the overall effect of molecular alterations on the behavior of cancer cells and provides a practical visual reading of the aggressiveness of the disease. However, the human evaluation of the histological images is sometimes subjective and may lack reproducibility. Therefore, computational analysis of histological imaging using so-called "artificial intelligence" (AI) approaches has recently received considerable attention to improve this diagnostic accuracy. Thus, computational analysis of lung cancer images has recently been evaluated for the optimization of histological or cytological classification, prognostic prediction or genomic profile of patients with lung cancer. This rapidly growing field constantly demonstrates great power in the field of computing medical imaging by producing highly accurate detection, segmentation or recognition tasks. However, there are still several challenges or issues to be addressed in order to successfully succeed the actual transfer into clinical routine. The objective of this review is to emphasize recent applications of AI in pulmonary cancer pathology, but also to clarify the advantages and limitations of this approach, as well as the perspectives to be implemented for a potential transfer into clinical routine.
Collapse
Affiliation(s)
- Simon Heeke
- Laboratoire de pathologie clinique et expérimentale/biobanque (BB 0033-00025), Fédération hospitalo-universitaire OncoAge, CHU de Nice, université Côte-d'Azur, 30, voie Romaine, 06000 Nice, France; Équipe 4, CNRS UMR7284, Inserm U1081, faculté de médecine, institut de recherche sur le cancer et le vieillissement de Nice (Ircan), 28, avenue de Valombrose, 06107 Nice, France
| | - Hervé Delingette
- Équipe Asclepios, Inria Sophia-Antipolis, université Côte-d'Azur, 2004, route des Lucioles, 06902 Sophia-Antipolis, France
| | - Youta Fanjat
- Laboratoire de pathologie clinique et expérimentale/biobanque (BB 0033-00025), Fédération hospitalo-universitaire OncoAge, CHU de Nice, université Côte-d'Azur, 30, voie Romaine, 06000 Nice, France
| | - Elodie Long-Mira
- Laboratoire de pathologie clinique et expérimentale/biobanque (BB 0033-00025), Fédération hospitalo-universitaire OncoAge, CHU de Nice, université Côte-d'Azur, 30, voie Romaine, 06000 Nice, France; Équipe 4, CNRS UMR7284, Inserm U1081, faculté de médecine, institut de recherche sur le cancer et le vieillissement de Nice (Ircan), 28, avenue de Valombrose, 06107 Nice, France
| | - Sandra Lassalle
- Laboratoire de pathologie clinique et expérimentale/biobanque (BB 0033-00025), Fédération hospitalo-universitaire OncoAge, CHU de Nice, université Côte-d'Azur, 30, voie Romaine, 06000 Nice, France; Équipe 4, CNRS UMR7284, Inserm U1081, faculté de médecine, institut de recherche sur le cancer et le vieillissement de Nice (Ircan), 28, avenue de Valombrose, 06107 Nice, France
| | - Véronique Hofman
- Laboratoire de pathologie clinique et expérimentale/biobanque (BB 0033-00025), Fédération hospitalo-universitaire OncoAge, CHU de Nice, université Côte-d'Azur, 30, voie Romaine, 06000 Nice, France; Équipe 4, CNRS UMR7284, Inserm U1081, faculté de médecine, institut de recherche sur le cancer et le vieillissement de Nice (Ircan), 28, avenue de Valombrose, 06107 Nice, France
| | - Jonathan Benzaquen
- Équipe 4, CNRS UMR7284, Inserm U1081, faculté de médecine, institut de recherche sur le cancer et le vieillissement de Nice (Ircan), 28, avenue de Valombrose, 06107 Nice, France; Service de pneumologie, Fédération hospitalo-universitaire OncoAge, CHU de Nice, université Côte-d'Azur, 30, voie Romaine, 06000 Nice, France
| | - Charles-Hugo Marquette
- Service de pneumologie, Fédération hospitalo-universitaire OncoAge, CHU de Nice, université Côte-d'Azur, 30, voie Romaine, 06000 Nice, France
| | - Paul Hofman
- Laboratoire de pathologie clinique et expérimentale/biobanque (BB 0033-00025), Fédération hospitalo-universitaire OncoAge, CHU de Nice, université Côte-d'Azur, 30, voie Romaine, 06000 Nice, France; Équipe 4, CNRS UMR7284, Inserm U1081, faculté de médecine, institut de recherche sur le cancer et le vieillissement de Nice (Ircan), 28, avenue de Valombrose, 06107 Nice, France
| | - Marius Ilié
- Laboratoire de pathologie clinique et expérimentale/biobanque (BB 0033-00025), Fédération hospitalo-universitaire OncoAge, CHU de Nice, université Côte-d'Azur, 30, voie Romaine, 06000 Nice, France; Équipe 4, CNRS UMR7284, Inserm U1081, faculté de médecine, institut de recherche sur le cancer et le vieillissement de Nice (Ircan), 28, avenue de Valombrose, 06107 Nice, France.
| |
Collapse
|
10
|
Hon JD, Chen W, Minerowicz C, Thomas S, Barnard N, Gilbert N, Fyfe B. Analysis and Comparison of Tissue-Marking Dye Detection via Light Microscopy, Telemicroscopy, and Virtual Microscopy. Am J Clin Pathol 2019; 151:95-99. [PMID: 30239594 DOI: 10.1093/ajcp/aqy117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To examine the fidelity of ink color identification using light microscopy (LM), telemicroscopy (TM), and virtual microscopy (VM). Methods Twenty H&E-stained frozen section slides, prepared after tissue inking with five stain combinations, were assessed by three pathologists using LM, TM, and VM. TM was performed using Mikroscan D2 slide scanner/LiveQ software with various objectives. VM was performed using Mikroscan D2 scanner/Qumulus software, specimens digitized at20×. Results Sensitivity/specificity by LM was 100%/100% for all colors. TM showed high overall specificity but poor sensitivity, particularly red (54%). VM showed high specificity for all colors except black (69%) and, consequently, poor sensitivity for all colors except black (96%). Conclusions TMD identification via telepathology showed loss of sensitivity/specificity vs LM and highlighted the need for caution when interpreting TMDs with digital technologies and the need for validation protocols.
Collapse
Affiliation(s)
- Jane Date Hon
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Wenjin Chen
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | | | - Sumi Thomas
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nicola Barnard
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Billie Fyfe
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| |
Collapse
|
11
|
Huang YN, Peng XC, Ma S, Yu H, Jin YB, Zheng J, Fu GH. Development of Whole Slide Imaging on Smartphones and Evaluation With ThinPrep Cytology Test Samples: Follow-Up Study. JMIR Mhealth Uhealth 2018; 6:e82. [PMID: 29618454 PMCID: PMC5906711 DOI: 10.2196/mhealth.9518] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 12/24/2022] Open
Abstract
Background The smartphone-based whole slide imaging (WSI) system represents a low-cost and effective alternative to automatic scanners for telepathology. In a previous study, the development of one such solution, named scalable whole slide imaging (sWSI), was presented and analyzed. A clinical evaluation of its iOS version with 100 frozen section samples verified the diagnosis-readiness of the produced virtual slides. Objective The first aim of this study was to delve into the quantifying issues encountered in the development of an Android version. It should also provide insights into future high-resolution real-time feedback medical imaging apps on Android and invoke the awareness of smartphone manufacturers for collaboration. The second aim of this study was to further verify the clinical value of sWSI with cytology samples. This type is different from the frozen section samples in that they require finer detail on the cellular level. Methods During sWSI development on Android, it was discovered that many models do not support uncompressed camera pixel data with sufficient resolution and full field of view. The proportion of models supporting the optimal format was estimated in a test on 200 mainstream Android models. Other factors, including slower processing speed and camera preview freezing, also led to inferior performance of sWSI on Android compared with the iOS version. The processing speed was mostly determined by the central processing unit frequency in theory, and the relationship was investigated in the 200-model simulation experiment with physical devices. The camera preview freezing was caused by the lag between triggering photo capture and resuming preview. In the clinical evaluation, 100 ThinPrep cytology test samples covering 6 diseases were scanned with sWSI and compared against the ground truth of optical microscopy. Results Among the tested Android models, only 3.0% (6/200) provided an optimal data format, meeting all criteria of quality and efficiency. The image-processing speed demonstrated a positive relationship with the central processing unit frequency but to a smaller degree than expected and was highly model-dependent. The virtual slides produced by sWSI on Android and iOS of ThinPrep cytology test samples achieved similar high quality. Using optical microscopy as the ground truth, pathologists made a correct diagnosis on 87.5% (175/200) of the cases with sWSI virtual slides. Depending on the sWSI version and the pathologist in charge, the kappa value varied between .70 and .82. All participating pathologists considered the quality of the sWSI virtual slides in the experiment to be adequate for routine usage. Conclusions Limited by hardware and operating system support, the performance of sWSI on mainstream Android smartphones did not fully match the iOS version. However, in practice, this difference was not significant, and both were adequate for digitizing most of the sample types for telepathology consultation.
Collapse
Affiliation(s)
- Yu-Ning Huang
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Faculty of Basic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing-Chun Peng
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Faculty of Basic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuoxin Ma
- TerryDr Info Technology Co, Ltd, Nanjing, China
| | - Hong Yu
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Biao Jin
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zheng
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Hui Fu
- Department of Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Faculty of Basic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
12
|
Ghosh A, Brown GT, Fontelo P. Telepathology at the Armed Forces Institute of Pathology: A Retrospective Review of Consultations From 1996 to 1997. Arch Pathol Lab Med 2017; 142:248-252. [DOI: 10.5858/arpa.2017-0055-oa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Telepathology is the practice of pathology at a distance, transmitting images using telecommunication methods for second opinion and/or diagnostic assistance, or for educational purposes. It may be the only means of consultation for some pathologists.
Objective.—
To retrospectively review and evaluate a subset of telepathology consultations from June 1996 to March 1997, and to determine the concordance between the telepathology diagnosis of the contributor and pathologists at the Armed Forces Institute of Pathology (AFIP), Washington, District of Columbia, as well as the concordance between the telepathology diagnosis and the glass slide diagnosis, when available.
Design.—
Photocopies of de-identified telepathology reports from the AFIP during a 15-month period between June 1996 and March 1997 were reviewed. Contributor versus telepathology diagnosis was graded as 1 (complete agreement), 2 (partial agreement), 3 (disagreement; usually a diagnosis of benign versus malignant), and deferred. Data were analyzed using descriptive statistical methods.
Results.—
Of the 262 cases, 194 (74%) were in complete agreement with the contributor's diagnosis, 34 of 262 (13%) were in minor disagreement, and 21 of 262 (8%) were in major disagreement. Diagnoses were deferred in 5% (13 of 262) of cases.
Conclusions.—
Using commercial off-the-shelf technology and despite telecommunication challenges during that time, the AFIP demonstrated that telepathology could be conducted reliably.
Collapse
|
13
|
Bertram CA, Klopfleisch R. The Pathologist 2.0: An Update on Digital Pathology in Veterinary Medicine. Vet Pathol 2017; 54:756-766. [DOI: 10.1177/0300985817709888] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Christof A. Bertram
- Institute of Veterinary Pathology, Freie Universitaet Berlin, Berlin, Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universitaet Berlin, Berlin, Germany
| |
Collapse
|
14
|
Vodovnik A, Aghdam MRF, Espedal DG. Remote autopsy services: A feasibility study on nine cases. J Telemed Telecare 2017; 24:460-464. [PMID: 28537510 DOI: 10.1177/1357633x17708947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction We have conducted a feasibility study on remote autopsy services in order to increase the flexibility of the service with benefits for teaching and interdepartmental collaboration. Methods Three senior staff pathologists, one senior autopsy technician and one junior resident participated in the study. Nine autopsies were performed by the autopsy technician or resident, supervised by the primary pathologist, through the secure, double encrypted video link using Jabber Video (Cisco) with a high-speed broadband connection. The primary pathologist and autopsy room each connected to the secure virtual meeting room using 14″ laptops with in-built cameras (Hewlett-Packard). A portable high-definition web camera (Cisco) was used in the autopsy room. Primary and secondary pathologists independently interpreted and later compared gross findings for the purpose of quality assurance. The video was streamed live only during consultations and interpretation. A satisfaction survey on technical and professional aspects of the study was conducted. Results Independent interpretations of gross findings between primary and secondary pathologists yielded full agreement. A definite cause of death in one complex autopsy was determined following discussions between pathologists and reviews of the clinical notes. Our satisfaction level with the technical and professional aspects of the study was 87% and 97%, respectively. Discussion Remote autopsy services are found to be feasible in the hands of experienced staff, with increased flexibility and interest of autopsy technicians in the service as a result.
Collapse
|
15
|
Meléndez-Álvarez B, Robayo O, Gil-Guillén V, Carratalá-Munuera M. Design and Validation of a Low-Cost Telepathology System. Telemed J E Health 2017; 23:976-982. [PMID: 28537789 DOI: 10.1089/tmj.2017.0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This work sought to evaluate the precision and repeatability of a telepathology prototype based on open software and hardware. MATERIALS AND METHODS A prototype was designed with application in telepathology and telemicroscopy. Accuracy and prototype precision were evaluated by calculating the mean absolute error and the intraclass and repeatability correlation coefficients for a series of 190 displacements at 10, 25, 50, 75, and 100 μm. RESULTS AND CONCLUSIONS This work developed a low-cost prototype that is accessible, easily reproducible, implementable, and scalable; based on the use of technology created under principles of open software and hardware. A pathologist reviewed the obtained images and found them to be of diagnostic quality. Its excellent repeatability, coupled with its good accuracy, allows for its application in telemicroscopy and static, dynamic, and whole-slide imaging pathology systems.
Collapse
Affiliation(s)
| | - Omar Robayo
- 1 Medical School, Pedagogical and Technological University of Colombia, Tunja, Colombia
| | - Vicente Gil-Guillén
- 2 Clinical Medicine Department, University of Miguel Hernández, Elche, Spain
| | | |
Collapse
|
16
|
Farris AB, Cohen C, Rogers TE, Smith GH. Whole Slide Imaging for Analytical Anatomic Pathology and Telepathology: Practical Applications Today, Promises, and Perils. Arch Pathol Lab Med 2017; 141:542-550. [PMID: 28157404 DOI: 10.5858/arpa.2016-0265-sa] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Whole slide imaging (WSI) offers a convenient, tractable platform for measuring features of routine and special-stain histology or in immunohistochemistry staining by using digital image analysis (IA). We now routinely use IA for quantitative and qualitative analysis of theranostic markers such as human epidermal growth factor 2 (HER2/neu), estrogen and progesterone receptors, and Ki-67. Quantitative IA requires extensive validation, however, and may not always be the best approach, with pancreatic neuroendocrine tumors being one example in which a semiautomated approach may be preferable for patient care. We find that IA has great utility for objective assessment of gastrointestinal tract dysplasia, microvessel density in hepatocellular carcinoma, hepatic fibrosis and steatosis, renal fibrosis, and general quality analysis/quality control, although the applications of these to daily practice are still in development. Collaborations with bioinformatics specialists have explored novel applications to gliomas, including in silico approaches for mining histologic data and correlating with molecular and radiologic findings. We and many others are using WSI for rapid, remote-access slide reviews (telepathology), though technical factors currently limit its utility for routine, high-volume diagnostics. In our experience, the greatest current practical impact of WSI lies in facilitating long-term storage and retrieval of images while obviating the need to keep slides on site. Once the existing barriers of capital cost, validation, operator training, software design, and storage/back-up concerns are overcome, these technologies appear destined to be a cornerstone of precision medicine and personalized patient care, and to become a routine part of pathology practice.
Collapse
Affiliation(s)
| | | | | | - Geoffrey H Smith
- From the Department of Pathology, Emory University, Atlanta, Georgia
| |
Collapse
|
17
|
Roy S, Pfeifer JD, LaFramboise WA, Pantanowitz L. Molecular digital pathology: progress and potential of exchanging molecular data. Expert Rev Mol Diagn 2016; 16:941-7. [PMID: 27471996 DOI: 10.1080/14737159.2016.1206472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Many of the demands to perform next generation sequencing (NGS) in the clinical laboratory can be resolved using the principles of telepathology. Molecular telepathology can allow facilities to outsource all or a portion of their NGS operation such as cloud computing, bioinformatics pipelines, variant data management, and knowledge curation. Clinical pathology laboratories can electronically share diverse types of molecular data with reference laboratories, technology service providers, and/or regulatory agencies. Exchange of electronic molecular data allows laboratories to perform validation of rare diseases using foreign data, check the accuracy of their test results against benchmarks, and leverage in silico proficiency testing. This review covers the emerging subject of molecular telepathology, describes clinical use cases for the appropriate exchange of molecular data, and highlights key issues such as data integrity, interoperable formats for massive genomic datasets, security, malpractice and emerging regulations involved with this novel practice.
Collapse
Affiliation(s)
- Somak Roy
- a Department of Pathology , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - John D Pfeifer
- b Department of Pathology , Washington University , St Louis , MO , USA
| | - William A LaFramboise
- a Department of Pathology , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Liron Pantanowitz
- a Department of Pathology , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| |
Collapse
|