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Reinhart JP, Proffer SL, Ridgeway JL, Barry B, Kamath C, Gerdes EW, Cervenka D, Peters MS, Comfere NI, Johnson EF, Wieland CN. Trainee perceptions of digital dermatopathology implementation at a multisite academic institution. J Cutan Pathol 2024. [PMID: 38967247 DOI: 10.1111/cup.14681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/28/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Affiliation(s)
- Jacob P Reinhart
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sydney L Proffer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara Barry
- Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Celia Kamath
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin Wissler Gerdes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek Cervenka
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Proffer SL, Reinhart J, Ridgeway JL, Barry B, Kamath C, Gerdes EW, Todd A, Cervenka DJ, DiCaudo DJ, Sokumbi O, Johnson EF, Peters MS, Wieland CN, Comfere NI. Digital dermatopathology implementation: Experience at a multisite academic institution. J Cutan Pathol 2024. [PMID: 38783791 DOI: 10.1111/cup.14629] [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: 01/08/2024] [Revised: 04/01/2024] [Accepted: 04/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Technology has revolutionized not only direct patient care but also diagnostic care processes. This study evaluates the transition from glass-slide microscopy to digital pathology (DP) at a multisite academic institution, using mixed methods to understand user perceptions of digitization and key productivity metrics of practice change. METHODS Participants included dermatopathologists, pathology reporting specialists, and clinicians. Electronic surveys and individual or group interviews included questions related to technology comfort, trust in DP, and rationale for DP adoption. Case volumes and turnaround times were abstracted from the electronic health record from Qtr 4 2020 to Qtr 1 2023 (inclusive). Data were analyzed descriptively, while interviews were analyzed using methods of content analysis. RESULTS Thirty-four staff completed surveys and 22 participated in an interview. Case volumes and diagnostic turnaround time did not differ across the institution during or after implementation timelines (p = 0.084; p = 0.133, respectively). 82.5% (28/34) of staff agreed that DP improved the sign-out experience, with accessibility, ergonomics, and annotation features described as key factors. Clinicians reported positive perspectives of DP impact on patient safety and interdisciplinary collaboration. CONCLUSIONS Our study demonstrates that DP has a high acceptance rate, does not adversely impact productivity, and may improve patient safety and care collaboration.
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Affiliation(s)
- Sydney L Proffer
- Department of Dermatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Jacob Reinhart
- Department of Dermatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Barbara Barry
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Celia Kamath
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Erin Wissler Gerdes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Austin Todd
- Division of Clinical Trials and Biostatistics of the Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek J Cervenka
- Department of Dermatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - David J DiCaudo
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Arizona, USA
| | | | - Emma F Johnson
- Department of Dermatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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McCaffrey C, Jahangir C, Murphy C, Burke C, Gallagher WM, Rahman A. Artificial intelligence in digital histopathology for predicting patient prognosis and treatment efficacy in breast cancer. Expert Rev Mol Diagn 2024; 24:363-377. [PMID: 38655907 DOI: 10.1080/14737159.2024.2346545] [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: 12/07/2023] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Histological images contain phenotypic information predictive of patient outcomes. Due to the heavy workload of pathologists, the time-consuming nature of quantitatively assessing histological features, and human eye limitations to recognize spatial patterns, manually extracting prognostic information in routine pathological workflows remains challenging. Digital pathology has facilitated the mining and quantification of these features utilizing whole-slide image (WSI) scanners and artificial intelligence (AI) algorithms. AI algorithms to identify image-based biomarkers from the tumor microenvironment (TME) have the potential to revolutionize the field of oncology, reducing delays between diagnosis and prognosis determination, allowing for rapid stratification of patients and prescription of optimal treatment regimes, thereby improving patient outcomes. AREAS COVERED In this review, the authors discuss how AI algorithms and digital pathology can predict breast cancer patient prognosis and treatment outcomes using image-based biomarkers, along with the challenges of adopting this technology in clinical settings. EXPERT OPINION The integration of AI and digital pathology presents significant potential for analyzing the TME and its diagnostic, prognostic, and predictive value in breast cancer patients. Widespread clinical adoption of AI faces ethical, regulatory, and technical challenges, although prospective trials may offer reassurance and promote uptake, ultimately improving patient outcomes by reducing diagnosis-to-prognosis delivery delays.
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Affiliation(s)
- Christine McCaffrey
- UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Chowdhury Jahangir
- UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Clodagh Murphy
- UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Caoimbhe Burke
- UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - William M Gallagher
- UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Arman Rahman
- UCD School of Medicine, UCD Conway Institute, University College Dublin, Dublin, Ireland
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de Leng B, Helle L, Jokelainen O, Kainulainen M, Kronqvist P, Mol C, Pawelka F, Pohjanen VM, Vincken K. Joint online distance learning to complement postgraduate pathology training in preparation for national board examinations. J Clin Pathol 2024:jcp-2023-209311. [PMID: 38458748 DOI: 10.1136/jcp-2023-209311] [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: 11/24/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024]
Abstract
AIMS To meet the flexible learning needs of pathology residents preparing for national board examinations, a joint distance learning approach was developed using both asynchronous and synchronous activities with whole slide images, drawing on empirical educational research on online distance learning. METHODS In a case study of an implementation of the designed joint distance learning approach with a geographically dispersed group of pathology residents in Finland, the participants' perceptions were measured with a 12-item questionnaire covering the value of the learning opportunity, the quality of the sociocognitive processes and their emotional engagement and social cohesion. Communication during the online session was also recorded and analysed to provide objectivity to the self-report data. RESULTS The effectiveness of joint online learning for knowledge acquisition and preparation for national board examinations was highly rated. However, despite strong emotional engagement during synchronous activities, participants reported minimal interpersonal interaction, which was also reflected in the recordings of the online session. CONCLUSION Using a technology integration framework and guided by the principles of self-determination theory, joint distance learning is emerging as a beneficial addition to postgraduate pathology programmes in preparation for national examinations. However, to realise the full potential of interpersonal interaction, participants should be prepared for an appropriate mindset.
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Affiliation(s)
- Bas de Leng
- Educational Institute (IfAS), University of Münster Faculty of Medicine, Munster, Germany
| | - Laura Helle
- Centre for Research on Learning and Instruction, University of Turku Faculty of Education, Turku, Finland
| | - Otto Jokelainen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Kainulainen
- Centre for Research on Learning and Instruction, University of Turku Faculty of Education, Turku, Finland
| | | | - Christian Mol
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Friedrich Pawelka
- Educational Institute (IfAS), University of Münster Faculty of Medicine, Munster, Germany
| | | | - Koen Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
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Zheng TL, Sha JC, Deng Q, Geng S, Xiao SY, Yang WJ, Byrne CD, Targher G, Li YY, Wang XX, Wu D, Zheng MH. Object detection: A novel AI technology for the diagnosis of hepatocyte ballooning. Liver Int 2024; 44:330-343. [PMID: 38014574 DOI: 10.1111/liv.15799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD) has reached epidemic proportions worldwide and is the most frequent cause of chronic liver disease in developed countries. Within the spectrum of liver disease in MAFLD, steatohepatitis is a progressive form of liver disease and hepatocyte ballooning (HB) is a cardinal pathological feature of steatohepatitis. The accurate and reproducible diagnosis of HB is therefore critical for the early detection and treatment of steatohepatitis. Currently, a diagnosis of HB relies on pathological examination by expert pathologists, which may be a time-consuming and subjective process. Hence, there has been interest in developing automated methods for diagnosing HB. This narrative review briefly discusses the development of artificial intelligence (AI) technology for diagnosing fatty liver disease pathology over the last 30 years and provides an overview of the current research status of AI algorithms for the identification of HB, including published articles on traditional machine learning algorithms and deep learning algorithms. This narrative review also provides a summary of object detection algorithms, including the principles, historical developments, and applications in the medical image analysis. The potential benefits of object detection algorithms for HB diagnosis (specifically those combined with a transformer architecture) are discussed, along with the future directions of object detection algorithms in HB diagnosis and the potential applications of generative AI on transformer architecture in this field. In conclusion, object detection algorithms have huge potential for the identification of HB and could make the diagnosis of MAFLD more accurate and efficient in the near future.
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Affiliation(s)
- Tian-Lei Zheng
- School of Information and Control Engineering, China University of Mining and Technology, Xuzhou, China
- Artificial Intelligence Unit, Department of Medical Equipment Management, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jun-Cheng Sha
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qian Deng
- Department of Histopathology, Ningbo Clinical Pathology Diagnosis Center, Ningbo, China
| | - Shi Geng
- Artificial Intelligence Unit, Department of Medical Equipment Management, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shu-Yuan Xiao
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Wen-Jun Yang
- Department of Pathology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Christopher D Byrne
- Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, and University of Southampton, Southampton, UK
| | - Giovanni Targher
- Department of Medicine, University of Verona, Verona, Italy
- IRCSS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Yang-Yang Li
- Department of Pathology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang-Xue Wang
- Institute for AI in Medicine, School of Artificial Intelligence, Nanjing University of Information Science and Technology, Nanjing, China
| | - Di Wu
- Department of Pathology, Xuzhou Central Hospital, Xuzhou, China
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Institute of Hepatology, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
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Aref MH, El-Gohary M, Elrewainy A, Mahmoud A, Aboughaleb IH, Hussein AA, El-Ghaffar SA, Mahran A, El-Sharkawy YH. Emerging Technology for Intraoperative Margin and Assisting in Post-Surgery tissue diagnostic for Future Breast-Conserving. Photodiagnosis Photodyn Ther 2023; 42:103507. [PMID: 36940788 DOI: 10.1016/j.pdpdt.2023.103507] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/13/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Tissue-preserving surgery is utilized progressively in cancer therapy, where a clear surgical margin is critical to avoid cancer recurrence, specifically in breast cancer (BC) surgery. The Intraoperative pathologic approaches that rely on tissue segmenting and staining have been recognized as the ground truth for BC diagnosis. Nevertheless, these methods are constrained by its complication and timewasting for tissue preparation. OBJECTIVE We present a non-invasive optical imaging system incorporating a hyperspectral (HS) camera to discriminate between cancerous and non-cancerous tissues in ex-vivo breast specimens, which could be an intraoperative diagnostic technique to aid surgeons during surgery and later a valuable tool to assist pathologists. METHODS We have established a hyperspectral Imaging (HSI) system comprising a push-broom HS camera at wavelength 380∼1050 nm with source light 390∼980 nm. We have measured the investigated samples' diffuse reflectance (Rd), fixed on slides from 30 distinct patients incorporating mutually normal and ductal carcinoma tissue. The samples were divided into two groups, stained tissues during the surgery (control group) and unstained samples (test group), both captured with the HSI system in the visible and near-infrared (VIS-NIR) range. Then, to address the problem of the spectral nonuniformity of the illumination device and the influence of the dark current, the radiance data were normalized to yield the radiance of the specimen and neutralize the intensity effect to focus on the spectral reflectance shift for each tissue. The selection of the threshold window from the measured Rd is carried out by exploiting the statistical analysis by calculating each region's mean and standard deviation. Afterward, we selected the optimum spectral images from the HS data cube to apply a custom K-means algorithm and contour delineation to identify the regular districts from the BC regions. RESULTS We noticed that the measured spectral Rd for the malignant tissues of the investigated case studies versus the reference source light varies regarding the cancer stage, as sometimes the Rd is higher for the tumor or vice versa for the normal tissue. Later, from the analysis of the whole samples, we found that the most appropriate wavelength for the BC tissues was 447 nm, which was highly reflected versus the normal tissue. However, the most convenient one for the normal tissue was at 545 nm with high reflection versus the BC tissue. Finally, we implement a moving average filter for noise reduction and a custom K-means clustering algorithm on the selected two spectral images (447, 551 nm) to identify the various regions and effectively-identified spectral tissue variations with a sensitivity of 98.95%, and specificity of 98.44%. A pathologist later confirmed these outcomes as the ground truth for the tissue sample investigations. CONCLUSIONS The proposed system could help the surgeon and the pathologist identify the cancerous tissue margins from the non-cancerous tissue with a non-invasive, rapid, and minimum time method achieving high sensitivity up to 98.95%.
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Affiliation(s)
| | - Mohamed El-Gohary
- Demonstrator, Communications Department, Faculty of Engineering, Mansoura University, Mansoura, Egypt.
| | - Ahmed Elrewainy
- Avionics Department, Electrical Engineering Branch, Military Technical College, Cairo, Egypt.
| | - Alaaeldin Mahmoud
- Optoelectronics and advanced control systems Department, Military Technical College, Cairo, Egypt.
| | | | | | | | - Ashraf Mahran
- Avionics Department, Military Technical College, Cairo, Egypt.
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Van Es SL, Tan AJ, Vial T, Burnand J, Blizard CM. Harnessing the disruption on medical trainee education due to COVID-19 in New South Wales, Australia. MEDEDPUBLISH 2022; 12:34. [PMID: 37869563 PMCID: PMC10587661 DOI: 10.12688/mep.19122.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has caused disruption and uncertainty for junior medical doctor training and education. This has compounded the existing stress experienced by this cohort. However, by choosing appropriate educational models, as well as using novel educational approaches and advancing our online technology capabilities, we may be able to provide acceptable and even, superior solutions for educational training moving forward, as well as promote trainee wellbeing during these uncertain times.
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Affiliation(s)
- Simone L. Van Es
- NSW Health Education and Training Institute (HETI), Sydney, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, The University of NSW, Sydney, Australia
| | - Aaron J.H. Tan
- NSW Health Education and Training Institute (HETI), Sydney, Australia
| | - Toni Vial
- NSW Health Education and Training Institute (HETI), Sydney, Australia
| | - Jo Burnand
- NSW Health Education and Training Institute (HETI), Sydney, Australia
| | - Claire M. Blizard
- NSW Health Education and Training Institute (HETI), Sydney, Australia
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Van Es SL, Tan AJ, Vial T, Burnand J, Blizard CM. Harnessing the disruption on medical trainee education due to COVID-19 in New South Wales, Australia. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.19122.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has caused disruption and uncertainty for junior medical doctor training and education. This has compounded the existing stress experienced by this cohort. However, by choosing appropriate educational models, as well as using novel educational approaches and advancing our online technology capabilities, we may be able to provide acceptable and even, superior solutions for educational training moving forward, as well as promote trainee wellbeing during these uncertain times.
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Aldeman NLS, de Sá Urtiga Aita KM, Machado VP, da Mata Sousa LCD, Coelho AGB, da Silva AS, da Silva Mendes AP, de Oliveira Neres FJ, do Monte SJH. Smartpath k: a platform for teaching glomerulopathies using machine learning. BMC MEDICAL EDUCATION 2021; 21:248. [PMID: 33926437 PMCID: PMC8084264 DOI: 10.1186/s12909-021-02680-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/20/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND With the emergence of the new coronavirus pandemic (COVID-19), distance learning, especially that mediated by information and digital communication technologies, has been adopted in all areas of knowledge and at all levels, including medical education. Imminently practical areas, such as pathology, have made traditional teaching based on conventional microscopy more flexible through the synergies of computational tools and image digitization, not only to improve teaching-learning but also to offer alternatives to repetitive and exhaustive histopathological analyzes. In this context, machine learning algorithms capable of recognizing histological patterns in kidney biopsy slides have been developed and validated with a view to building computational models capable of accurately identifying renal pathologies. In practice, the use of such algorithms can contribute to the universalization of teaching, allowing quality training even in regions where there is a lack of good nephropathologists. The purpose of this work is to describe and test the functionality of SmartPathk, a tool to support teaching of glomerulopathies using machine learning. The training for knowledge acquisition was performed automatically by machine learning methods using the J48 algorithm to create a computational model of an appropriate decision tree. RESULTS An intelligent system, SmartPathk, was developed as a complementary remote tool in the teaching-learning process for pathology teachers and their students (undergraduate and graduate students), showing 89,47% accuracy using machine learning algorithms based on decision trees. CONCLUSION This artificial intelligence system can assist in teaching renal pathology to increase the training capacity of new medical professionals in this area.
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Affiliation(s)
| | - Keylla Maria de Sá Urtiga Aita
- Open and distance education center and computer scientist of the Immunogenetics and Molecular Biology Laboratory (LIB - UFPI), Federal University of Piauí, Teresina, PI, Brazil
| | - Vinícius Ponte Machado
- Department of Computing and computer scientist of the Immunogenetics and Molecular Biology Laboratory (LIB - UFPI), Federal University of Piauí, Teresina, PI, Brazil
| | - Luiz Claudio Demes da Mata Sousa
- Department of Computing and computer scientist of the Immunogenetics and Molecular Biology Laboratory (LIB - UFPI), Federal University of Piauí, Teresina, PI, Brazil
| | - Antonio Gilberto Borges Coelho
- Systems analyst at the Immunogenetics and Molecular Biology Laboratory, Federal University of Piauí, Teresina, PI, Brazil
| | - Adalberto Socorro da Silva
- Department of Biology and vice coordinator of the Immunogenetics and Molecular Biology Laboratory (LIB - UFPI), Federal University of Piauí, Teresina, PI, Brazil
| | | | | | - Semíramis Jamil Hadad do Monte
- Department of General Clinic and coordinator of the Immunogenetics and Molecular Biology Laboratory (LIB - UFPI), Federal University of Piauí, Teresina, PI, Brazil
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Lidbury BA, Koerbin G, Richardson AM, Badrick T. Gamma-Glutamyl Transferase (GGT) Is the Leading External Quality Assurance Predictor of ISO15189 Compliance for Pathology Laboratories. Diagnostics (Basel) 2021; 11:diagnostics11040692. [PMID: 33924582 PMCID: PMC8069573 DOI: 10.3390/diagnostics11040692] [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: 03/22/2021] [Revised: 04/06/2021] [Accepted: 04/10/2021] [Indexed: 11/16/2022] Open
Abstract
Pathology results are central to modern medical practice, informing diagnosis and patient management. To ensure high standards from pathology laboratories, regulators require compliance with international and local standards. In Australia, the monitoring and regulation of medical laboratories are achieved by conformance to ISO15189-National Pathology Accreditation Advisory Council standards, as assessed by the National Association of Testing Authorities (NATA), and an external quality assurance (EQA) assessment via the Royal College of Pathologists of Australasia Quality Assurance Program (RCPAQAP). While effective individually, integration of data collected by NATA and EQA testing promises advantages for the early detection of technical or management problems in the laboratory, and enhanced ongoing quality assessment. Random forest (RF) machine learning (ML) previously identified gamma-glutamyl transferase (GGT) as a leading predictor of NATA compliance condition reporting. In addition to further RF investigations, this study also deployed single decision trees and support vector machines (SVM) models that included creatinine, electrolytes and liver function test (LFT) EQA results. Across all analyses, GGT was consistently the top-ranked predictor variable, validating previous observations from Australian laboratories. SVM revealed broad patterns of predictive EQA marker interactions with NATA outcomes, and the distribution of GGT relative deviation suggested patterns by which to identify other strong EQA predictors of NATA outcomes. An integrated model of pathology quality assessment was successfully developed, via the prediction of NATA outcomes by EQA results. GGT consistently ranked as the best predictor variable, identified by combining recursive partitioning and SVM ML strategies.
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Affiliation(s)
- Brett A. Lidbury
- The National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT 2601, Australia; (B.A.L.); (A.M.R.)
| | - Gus Koerbin
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia;
| | - Alice M. Richardson
- The National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT 2601, Australia; (B.A.L.); (A.M.R.)
- Statistical Consulting Unit, Australian National University, Canberra, ACT 2601, Australia
| | - Tony Badrick
- The National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT 2601, Australia; (B.A.L.); (A.M.R.)
- Australasia Quality Assurance Programs, Royal College of Pathologists, St. Leonards Sydney, NSW 2065, Australia
- Correspondence: ; Tel.: +61-2-(02)-6125-7875
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Lujan G, Quigley JC, Hartman D, Parwani A, Roehmholdt B, Meter BV, Ardon O, Hanna MG, Kelly D, Sowards C, Montalto M, Bui M, Zarella MD, LaRosa V, Slootweg G, Retamero JA, Lloyd MC, Madory J, Bowman D. Dissecting the Business Case for Adoption and Implementation of Digital Pathology: A White Paper from the Digital Pathology Association. J Pathol Inform 2021; 12:17. [PMID: 34221633 PMCID: PMC8240548 DOI: 10.4103/jpi.jpi_67_20] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/20/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022] Open
Abstract
We believe the switch to a digital pathology (DP) workflow is imminent and it is essential to understand the economic implications of conversion. Many aspects of the adoption of DP will be disruptive and have a direct financial impact, both in short term costs, such as investment in equipment and personnel, and long term revenue potential, such as improved productivity and novel tests. The focus of this whitepaper is to educate pathologists, laboratorians and other stakeholders about the business and monetary considerations of converting to a digital pathology workflow. The components of a DP business plan will be thoroughly summarized, and guidance will be provided on how to build a case for adoption and implementation as well as a roadmap for transitioning from an analog to a digital pathology workflow in various laboratory settings. It is important to clarify that this publication is not intended to list prices although some financials will be mentioned as examples. The authors encourage readers who are evaluating conversion to a DP workflow to use this paper as a foundational guide for conducting a thorough and complete assessment while incorporating in current market pricing. Contributors to this paper analyzed peer-reviewed literature and data collected from various institutions, some of which are mentioned. Digital pathology will change the way we practice through facilitating patient access to expert pathology services and enabling image analysis tools and assays to aid in diagnosis, prognosis, risk stratification and therapeutic selection. Together, they will result in the delivery of valuable information from which to make better decisions and improve the health of patients.
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Affiliation(s)
- Giovanni Lujan
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Douglas Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anil Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian Roehmholdt
- Department of Pathology, Southern California Permanente Medical Group, La Canada Flintridge, CA, USA
| | | | - Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew G. Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Marilyn Bui
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Mark D. Zarella
- Johns Hopkins Medicine Pathology Informatics, Baltimore, MD 21287, USA
| | - Victoria LaRosa
- Education Services Department, Oracle Corp, Austin, Texas, USA
| | | | | | | | - James Madory
- Department of Pathology, Medical University of South Carolina, Charleston, SC, USA
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12
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Barisoni L, Lafata KJ, Hewitt SM, Madabhushi A, Balis UGJ. Digital pathology and computational image analysis in nephropathology. Nat Rev Nephrol 2020; 16:669-685. [PMID: 32848206 PMCID: PMC7447970 DOI: 10.1038/s41581-020-0321-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
The emergence of digital pathology - an image-based environment for the acquisition, management and interpretation of pathology information supported by computational techniques for data extraction and analysis - is changing the pathology ecosystem. In particular, by virtue of our new-found ability to generate and curate digital libraries, the field of machine vision can now be effectively applied to histopathological subject matter by individuals who do not have deep expertise in machine vision techniques. Although these novel approaches have already advanced the detection, classification, and prognostication of diseases in the fields of radiology and oncology, renal pathology is just entering the digital era, with the establishment of consortia and digital pathology repositories for the collection, analysis and integration of pathology data with other domains. The development of machine-learning approaches for the extraction of information from image data, allows for tissue interrogation in a way that was not previously possible. The application of these novel tools are placing pathology centre stage in the process of defining new, integrated, biologically and clinically homogeneous disease categories, to identify patients at risk of progression, and shifting current paradigms for the treatment and prevention of kidney diseases.
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Affiliation(s)
- Laura Barisoni
- Department of Pathology, Duke University, Durham, NC, USA.
- Department of Medicine, Division of Nephrology, Duke University, Durham, NC, USA.
| | - Kyle J Lafata
- Department of Radiology, Duke University, Durham, NC, USA
- Department of Radiation Oncology, Duke University, Durham, NC, USA
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Veterans Administration Medical Center, Cleveland, OH, USA
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13
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Ramani NS, Chen H, Broaddus RR, Lazar AJ, Luthra R, Medeiros LJ, Patel KP, Rashid A, Routbort MJ, Stewart J, Tang Z, Bassett R, Manekia J, Barkoh BA, Dang H, Roy-Chowdhuri S. Utilization of cytology smears improves success rates of RNA-based next-generation sequencing gene fusion assays for clinically relevant predictive biomarkers. Cancer Cytopathol 2020; 129:374-382. [PMID: 33119213 DOI: 10.1002/cncy.22381] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The use of RNA-based next-generation sequencing (NGS) assays to detect gene fusions for targeted therapy has rapidly become an essential component of comprehensive molecular profiling. For cytology specimens, the cell block (CB) is most commonly used for fusion testing; however, insufficient cellularity and/or suboptimal RNA quality are often limiting factors. In the current study, the authors evaluated the factors affecting RNA fusion testing in cytology and the added value of smears in cases with a suboptimal or inadequate CB. METHODS A 12-month retrospective review was performed to identify cytology cases that were evaluated by a targeted RNA-based NGS assay. Samples were sequenced by targeted amplicon-based NGS for 51 clinically relevant genes on a proprietary platform. Preanalytic factors and NGS quality parameters were correlated with the results of RNA fusion testing. RESULTS The overall success rate of RNA fusion testing was 92%. Of the 146 cases successfully sequenced, 14% had a clinically relevant fusion detected. NGS testing success positively correlated with RNA yield (P = .03) but was independent of the tumor fraction, the tumor size, or the number of slides used for extraction. CB preparations were adequate for testing in 45% cases, but the inclusion of direct smears increased the adequacy rate to 92%. There was no significant difference in testing success rates between smears and CB preparations. CONCLUSIONS The success of RNA-based NGS fusion testing depends on the quality and quantity of RNA extracted. The use of direct smears significantly improves the adequacy of cytologic samples for RNA fusion testing for predictive biomarkers.
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Affiliation(s)
- Nisha S Ramani
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hui Chen
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Russell R Broaddus
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander J Lazar
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Asif Rashid
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark J Routbort
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Stewart
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhenya Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roland Bassett
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jawad Manekia
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bedia A Barkoh
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hyvan Dang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sinchita Roy-Chowdhuri
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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14
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Browning L, Fryer E, Roskell D, White K, Colling R, Rittscher J, Verrill C. Role of digital pathology in diagnostic histopathology in the response to COVID-19: results from a survey of experience in a UK tertiary referral hospital. J Clin Pathol 2020; 74:129-132. [PMID: 32616541 PMCID: PMC7841475 DOI: 10.1136/jclinpath-2020-206786] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has challenged our diagnostic services at a time when many histopathology departments already faced a diminishing workforce and increasing workload. Digital pathology (DP) has been hailed as a potential solution to at least some of the challenges faced. We present a survey of pathologists within a UK National Health Service cellular pathology department with access to DP, in which we ascertain the role of DP in clinical services during this current pandemic and explore challenges encountered. This survey indicates an increase in uptake of diagnostic DP during this period, with increased remote access. Half of respondents agreed that DP had facilitated maintenance of diagnostic practice. While challenges have been encountered, these are remediable, and none have impacted on the uptake of DP during this period. We conclude that in our institution, DP has demonstrated current and future potential to increase resilience in diagnostic practice and have highlighted some of the challenges that need to be considered.
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Affiliation(s)
- Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK .,NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Eve Fryer
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Derek Roskell
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Kieron White
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Richard Colling
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jens Rittscher
- NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK.,Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Clare Verrill
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
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15
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Hyperspectral Superpixel-Wise Glioblastoma Tumor Detection in Histological Samples. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10134448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The combination of hyperspectral imaging (HSI) and digital pathology may yield more accurate diagnosis. In this work, we propose the use of superpixels in HS images for combining regions of pixels that can be classified according to their spectral information to classify glioblastoma (GB) brain tumors in histologic slides. The superpixels are generated by a modified simple linear iterative clustering (SLIC) method to accommodate HS images. This work employs a dataset of H&E (Hematoxylin and Eosin) stained histology slides from 13 patients with GB and over 426,000 superpixels. A linear support vector machine (SVM) classifier was performed on independent training, validation, and testing datasets. The results of this investigation show that the proposed method can detect GB brain tumors from non-tumor samples with average sensitivity and specificity of 87% and 81%, respectively. The overall accuracy of this method is 83%. The study demonstrates that hyperspectral digital pathology can be useful for detecting GB brain tumors by exploiting spectral information alone on a superpixel level.
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16
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Ortega S, Halicek M, Fabelo H, Camacho R, Plaza MDLL, Godtliebsen F, M. Callicó G, Fei B. Hyperspectral Imaging for the Detection of Glioblastoma Tumor Cells in H&E Slides Using Convolutional Neural Networks. SENSORS (BASEL, SWITZERLAND) 2020; 20:E1911. [PMID: 32235483 PMCID: PMC7181269 DOI: 10.3390/s20071911] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 12/18/2022]
Abstract
Hyperspectral imaging (HSI) technology has demonstrated potential to provide useful information about the chemical composition of tissue and its morphological features in a single image modality. Deep learning (DL) techniques have demonstrated the ability of automatic feature extraction from data for a successful classification. In this study, we exploit HSI and DL for the automatic differentiation of glioblastoma (GB) and non-tumor tissue on hematoxylin and eosin (H&E) stained histological slides of human brain tissue. GB detection is a challenging application, showing high heterogeneity in the cellular morphology across different patients. We employed an HSI microscope, with a spectral range from 400 to 1000 nm, to collect 517 HS cubes from 13 GB patients using 20× magnification. Using a convolutional neural network (CNN), we were able to automatically detect GB within the pathological slides, achieving average sensitivity and specificity values of 88% and 77%, respectively, representing an improvement of 7% and 8% respectively, as compared to the results obtained using RGB (red, green, and blue) images. This study demonstrates that the combination of hyperspectral microscopic imaging and deep learning is a promising tool for future computational pathologies.
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Affiliation(s)
- Samuel Ortega
- Quantitative Bioimaging Laboratory, Department of Bioengineering, The University of Texas at Dallas, Richardson, TX 75080, USA;
- Institute for Applied Microelectronics (IUMA), University of Las Palmas de Gran Canaria (ULPGC), 35017 Las Palmas de Gran Canaria, Spain; (H.F.); (G.M.C.)
| | - Martin Halicek
- Quantitative Bioimaging Laboratory, Department of Bioengineering, The University of Texas at Dallas, Richardson, TX 75080, USA;
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, 1841 Clifton Road NE, Atlanta, GA 30329, USA
| | - Himar Fabelo
- Institute for Applied Microelectronics (IUMA), University of Las Palmas de Gran Canaria (ULPGC), 35017 Las Palmas de Gran Canaria, Spain; (H.F.); (G.M.C.)
| | - Rafael Camacho
- Department of Pathological Anatomy, University Hospital Doctor Negrin of Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (R.C.); (M.d.l.L.P.)
| | - María de la Luz Plaza
- Department of Pathological Anatomy, University Hospital Doctor Negrin of Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (R.C.); (M.d.l.L.P.)
| | - Fred Godtliebsen
- Department of Mathematics and Statistics, UiT The Artic, University of Norway, Hansine Hansens veg 18, 9019 Tromsø, Norway;
| | - Gustavo M. Callicó
- Institute for Applied Microelectronics (IUMA), University of Las Palmas de Gran Canaria (ULPGC), 35017 Las Palmas de Gran Canaria, Spain; (H.F.); (G.M.C.)
| | - Baowei Fei
- Quantitative Bioimaging Laboratory, Department of Bioengineering, The University of Texas at Dallas, Richardson, TX 75080, USA;
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hine Blvd, Dallas, TX 75390, USA
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hine Blvd, Dallas, TX 75390, USA
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17
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El Achi H, Khoury JD. Artificial Intelligence and Digital Microscopy Applications in Diagnostic Hematopathology. Cancers (Basel) 2020; 12:cancers12040797. [PMID: 32224980 PMCID: PMC7226574 DOI: 10.3390/cancers12040797] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/15/2022] Open
Abstract
Digital Pathology is the process of converting histology glass slides to digital images using sophisticated computerized technology to facilitate acquisition, evaluation, storage, and portability of histologic information. By its nature, digitization of analog histology data renders it amenable to analysis using deep learning/artificial intelligence (DL/AI) techniques. The application of DL/AI to digital pathology data holds promise, even if the scope of use cases and regulatory framework for deploying such applications in the clinical environment remains in the early stages. Recent studies using whole-slide images and DL/AI to detect histologic abnormalities in general and cancer in particular have shown encouraging results. In this review, we focus on these emerging technologies intended for use in diagnostic hematology and the evaluation of lymphoproliferative diseases.
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Affiliation(s)
- Hanadi El Achi
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Joseph D. Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence:
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18
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Eccher A, Girolami I. Current state of whole slide imaging use in cytopathology: Pros and pitfalls. Cytopathology 2020; 31:372-378. [PMID: 32020667 DOI: 10.1111/cyt.12806] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/17/2023]
Abstract
Whole slide imaging (WSI) allows generation of large whole slide images and their navigation with zoom in and out like a true virtual microscope. It has become widely used in surgical pathology for many purposes, such as education and training, research activity, teleconsultation, and primary diagnosis. However, in cytopathology, the use of WSI has been lagging behind histology, mainly due to the cytological specimen's characteristics, as groups of cells of different thickness are distributed throughout the slide. To allow the same focusing capability of light microscope, slides have to be scanned at multiple focal planes, at the cost of longer scan times and larger file size. These are the main technical pitfalls of WSI for cytopathology, partly overcome by solutions like liquid-based preparations. Validation studies for the use in primary diagnosis are less numerous and more heterogeneous than in surgical pathology. WSI has been proved effective for training students and successfully used in proficiency testing, allowing the creation of digital cytology atlases. Longer scan times are also a barrier for use in rapid on-site evaluation, but WSI retains its advantages of easy sharing of images for consultation, multiple simultaneous viewing in different locations, the possibility of unlimited annotations and easy integration with medical records. Moreover, digital slides set the laboratory free from reliance on a physical glass slide, with no more concern of fading of stain or slide breakage. Costs are still a problem for small institutions, but WSI can also represent the beginning of a more efficient way of working.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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19
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Melo RCN, Raas MWD, Palazzi C, Neves VH, Malta KK, Silva TP. Whole Slide Imaging and Its Applications to Histopathological Studies of Liver Disorders. Front Med (Lausanne) 2020; 6:310. [PMID: 31970160 PMCID: PMC6960181 DOI: 10.3389/fmed.2019.00310] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Histological analysis of hepatic tissue specimens is essential for evaluating the pathology of several liver disorders such as chronic liver diseases, hepatocellular carcinomas, liver steatosis, and infectious liver diseases. Manual examination of histological slides on the microscope is a classically used method to study these disorders. However, it is considered time-consuming, limited, and associated with intra- and inter-observer variability. Emerging technologies such as whole slide imaging (WSI), also termed virtual microscopy, have increasingly been used to improve the assessment of histological features with applications in both clinical and research laboratories. WSI enables the acquisition of the tissue morphology/pathology from glass slides and translates it into a digital form comparable to a conventional microscope, but with several advantages such as easy image accessibility and storage, portability, sharing, annotation, qualitative and quantitative image analysis, and use for educational purposes. WSI-generated images simultaneously provide high resolution and a wide field of observation that can cover the entire section, extending any single field of view. In this review, we summarize current knowledge on the application of WSI to histopathological analyses of liver disorders as well as to understand liver biology. We address how WSI may improve the assessment and quantification of multiple histological parameters in the liver, and help diagnose several hepatic conditions with important clinical implications. The WSI technical limitations are also discussed.
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Affiliation(s)
- Rossana C N Melo
- Laboratory of Cellular Biology, Department of Biology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Maximilian W D Raas
- Laboratory of Cellular Biology, Department of Biology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Faculty of Medical Sciences, Radboud University, Nijmegen, Netherlands
| | - Cinthia Palazzi
- Laboratory of Cellular Biology, Department of Biology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Vitor H Neves
- Laboratory of Cellular Biology, Department of Biology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Kássia K Malta
- Laboratory of Cellular Biology, Department of Biology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Thiago P Silva
- Laboratory of Cellular Biology, Department of Biology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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20
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Abstract
Whole-slide imaging (WSI) contributes to medical education, collaboration, quality assurance, examination, and consultation in pathology. The images obtained from WSI are of high quality and could be stored indefinitely. In research involving esophageal squamous cell carcinoma, the combination of WSI and image processing program allows effective interpretations of expressions of various immunomarkers related to pathogenesis, prognosis, and response to therapy in tissue microarray sections. The operation and basic principles of whole-slide imaging of esophageal squamous cell carcinoma are also presented. Common use of WSI will occur with modifications of the whole-slide imaging scanners to adapt to the workflows in diagnostic and research laboratories.
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21
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Browning L, Colling R, Rittscher J, Winter L, McEntyre N, Verrill C. Implementation of digital pathology into diagnostic practice: perceptions and opinions of histopathology trainees and implications for training. J Clin Pathol 2019; 73:223-227. [PMID: 31597682 DOI: 10.1136/jclinpath-2019-206137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 11/04/2022]
Abstract
There is increasing interest in the utility of digital pathology in the diagnostic setting. Successful transition requires guidance and training, but additionally an understanding of opinions and attitudes of histopathologists to ensure that potential barriers are addressed. Histopathology trainees as a group are likely to be at the forefront of this revolution, and have specific and as yet largely neglected training needs in this context. We designed an online survey for trainees within our region to capture their opinions and attitudes to digital pathology in the diagnostic setting, and to assess their perceived training needs. This survey indicates overall that these trainees have similar aspirations with regard to the predicted utility of digital pathology and the challenges faced as have been recognised among consultant histopathologists. While their training needs are also largely similar, there are specific additional considerations based around training in multiple centres with varying exposure to digital pathology.
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Affiliation(s)
- Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Colling
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jens Rittscher
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Big Data Institute, Oxford University, Oxford, UK
| | - Lucinda Winter
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicholas McEntyre
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Clare Verrill
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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22
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Van Es SL, Madabhushi A. The revolving door for AI and pathologists-docendo discimus? ACTA ACUST UNITED AC 2019; 2. [PMID: 31372599 DOI: 10.21037/jmai.2019.05.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Simone L Van Es
- Department of Pathology, School of Medical Sciences, UNSW Medicine, UNSW Sydney, Australia
| | - Anant Madabhushi
- Department of Biomedical Engineering, Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH 44106, USA.,Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH 44106, USA
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23
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Advancing diagnostic hematopathology: pigeons or pixels? J Hematop 2019. [DOI: 10.1007/s12308-019-00358-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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