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Shehabeldin A, Rohra P, Sellen LD, Zhao J, Alqaidy D, Aramin H, Hameed N, Perez YE, Lai Z, Tong YT, Milton DR, Edgerton ME, Fuller G, Hansel D, Prieto VG, Ballester LY, Aung PP. Utility of Whole Slide Imaging for Intraoperative Consultation: Experience of a Large Academic Center. Arch Pathol Lab Med 2024; 148:715-721. [PMID: 37756559 DOI: 10.5858/arpa.2023-0105-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT.— In the United States, review of digital whole slide images (WSIs) using specific systems is approved for primary diagnosis but has not been implemented for intraoperative consultation. OBJECTIVE.— To evaluate the safety of review of WSIs and compare the efficiency of review of WSIs and glass slides (GSs) for intraoperative consultation. DESIGN.— Ninety-one cases previously submitted for frozen section evaluation were randomly selected from 8 different anatomic pathology subspecialties. GSs from these cases were scanned on a Leica Aperio AT2 scanner at ×20 magnification (0.25 μm/pixel). The slides were deidentified, and a short relevant clinical history was provided for each slide. Nine board-certified general pathologists who do not routinely establish primary diagnoses using WSIs reviewed the WSIs using Leica Aperio ImageScope viewing software. After a washout period of 2-3 weeks, the pathologists reviewed the corresponding GSs using a light microscope (Olympus BX43). The pathologists recorded the diagnosis and time to reach the diagnosis. Intraobserver concordance, time to diagnosis, and specificity and sensitivity compared to the original diagnosis were evaluated. RESULTS.— The rate of intraobserver concordance between GS results and WSI results was 93.7%. Mean time to diagnosis was 1.25 minutes for GSs and 1.76 minutes for WSIs (P < .001). Specificity was 91% for GSs and 90% for WSIs; sensitivity was 92% for GSs and 92% for WSIs. CONCLUSIONS.— Time to diagnosis was longer with WSIs than with GSs, and scanning GSs and uploading the data to whole slide imaging systems takes time. However, review of WSIs appears to be a safe alternative to review of GSs. Use of WSIs allows reporting from a remote site during a public health emergency such as the COVID-19 pandemic and facilitates subspecialty histopathology services.
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Affiliation(s)
- Ahmed Shehabeldin
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Prih Rohra
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Linton D Sellen
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Jianping Zhao
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Doaa Alqaidy
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Hermineh Aramin
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Nadia Hameed
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Ydamis Estrella Perez
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Zongshan Lai
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Yi Tat Tong
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Denái R Milton
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Mary E Edgerton
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Gregory Fuller
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Donna Hansel
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Victor G Prieto
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Leomar Y Ballester
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
| | - Phyu P Aung
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston
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Luchini C, Pantanowitz L, Adsay V, Asa SL, Antonini P, Girolami I, Veronese N, Nottegar A, Cingarlini S, Landoni L, Brosens LA, Verschuur AV, Mattiolo P, Pea A, Mafficini A, Milella M, Niazi MK, Gurcan MN, Eccher A, Cree IA, Scarpa A. Ki-67 assessment of pancreatic neuroendocrine neoplasms: Systematic review and meta-analysis of manual vs. digital pathology scoring. Mod Pathol 2022; 35:712-720. [PMID: 35249100 PMCID: PMC9174054 DOI: 10.1038/s41379-022-01055-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 12/18/2022]
Abstract
Ki-67 assessment is a key step in the diagnosis of neuroendocrine neoplasms (NENs) from all anatomic locations. Several challenges exist related to quantifying the Ki-67 proliferation index due to lack of method standardization and inter-reader variability. The application of digital pathology coupled with machine learning has been shown to be highly accurate and reproducible for the evaluation of Ki-67 in NENs. We systematically reviewed all published studies on the subject of Ki-67 assessment in pancreatic NENs (PanNENs) employing digital image analysis (DIA). The most common advantages of DIA were improvement in the standardization and reliability of Ki-67 evaluation, as well as its speed and practicality, compared to the current gold standard approach of manual counts from captured images, which is cumbersome and time consuming. The main limitations were attributed to higher costs, lack of widespread availability (as of yet), operator qualification and training issues (if it is not done by pathologists), and most importantly, the drawback of image algorithms counting contaminating non-neoplastic cells and other signals like hemosiderin. However, solutions are rapidly developing for all of these challenging issues. A comparative meta-analysis for DIA versus manual counting shows very high concordance (global coefficient of concordance: 0.94, 95% CI: 0.83-0.98) between these two modalities. These findings support the widespread adoption of validated DIA methods for Ki-67 assessment in PanNENs, provided that measures are in place to ensure counting of only tumor cells either by software modifications or education of non-pathologist operators, as well as selection of standard regions of interest for analysis. NENs, being cellular and monotonous neoplasms, are naturally more amenable to Ki-67 assessment. However, lessons of this review may be applicable to other neoplasms where proliferation activity has become an integral part of theranostic evaluation including breast, brain, and hematolymphoid neoplasms.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy.
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy.
| | - Liron Pantanowitz
- Department of Pathology & Clinical Labs, University of Michigan, Ann Arbor, MI, USA
| | - Volkan Adsay
- Department of Pathology, Koç University Hospital and Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Sylvia L Asa
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Pietro Antonini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Ilaria Girolami
- Division of Pathology, San Maurizio Central Hospital, Bolzano, Italy
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Alessia Nottegar
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Sara Cingarlini
- Department of Medicine, Section of Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Landoni
- Department of Surgery, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Lodewijk A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anna V Verschuur
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Antonio Pea
- Department of Surgery, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Andrea Mafficini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Michele Milella
- Department of Medicine, Section of Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Muhammad K Niazi
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Metin N Gurcan
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Albino Eccher
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Ian A Cree
- International Agency for Research on Cancer, IARC, Lyon, France
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy.
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy.
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Vesterinen T, Säilä J, Blom S, Pennanen M, Leijon H, Arola J. Automated assessment of Ki-67 proliferation index in neuroendocrine tumors by deep learning. APMIS 2021; 130:11-20. [PMID: 34741788 PMCID: PMC9299468 DOI: 10.1111/apm.13190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Ki‐67 proliferation index (PI) is a prognostic factor in neuroendocrine tumors (NETs) and defines tumor grade. Analysis of Ki‐67 PI requires calculation of Ki‐67‐positive and Ki‐67‐negative tumor cells, which is highly subjective. To overcome this, we developed a deep learning‐based Ki‐67 PI algorithm (KAI) that objectively calculates Ki‐67 PI. Our study material consisted of NETs divided into training (n = 39), testing (n = 124), and validation (n = 60) series. All slides were digitized and processed in the Aiforia® Create (Aiforia Technologies, Helsinki, Finland) platform. The ICC between the pathologists and the KAI was 0.89. In 46% of the tumors, the Ki‐67 PIs calculated by the pathologists and the KAI were the same. In 12% of the tumors, the Ki‐67 PI calculated by the KAI was 1% lower and in 42% of the tumors on average 3% higher. The DL‐based Ki‐67 PI algorithm yields results similar to human observers. While the algorithm cannot replace the pathologist, it can assist in the laborious Ki‐67 PI assessment of NETs. In the future, this approach could be useful in, for example, multi‐center clinical trials where objective estimation of Ki‐67 PI is crucial.
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Affiliation(s)
- Tiina Vesterinen
- Department of Pathology, HUS Diagnostic Center, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Jenni Säilä
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Sami Blom
- Aiforia Technologies Oy, Helsinki, Finland
| | - Mirkka Pennanen
- Department of Pathology, HUS Diagnostic Center, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Helena Leijon
- Department of Pathology, HUS Diagnostic Center, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Arola
- Department of Pathology, HUS Diagnostic Center, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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