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Bontoux C, Hofman V, Chamorey E, Schiappa R, Lassalle S, Long-Mira E, Zahaf K, Lalvée S, Fayada J, Bonnetaud C, Goffinet S, Ilié M, Hofman P. Reproducibility of c-Met Immunohistochemical Scoring (Clone SP44) for Non-Small Cell Lung Cancer Using Conventional Light Microscopy and Whole Slide Imaging. Am J Surg Pathol 2024; 48:1072-1081. [PMID: 38980727 DOI: 10.1097/pas.0000000000002274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Emerging therapies for non-small cell lung cancer targeting c-Met overexpression have recently demonstrated promising results. However, the evaluation of c-Met expression can be challenging. We aimed to study the inter and intraobserver reproducibility of c-Met expression evaluation. One hundred ten cases with non-small cell lung cancer (40 biopsies and 70 surgical specimens) were retrospectively selected in a single laboratory (LPCE) and evaluated for c-Met expression. Six pathologists (4 seniors and 2 juniors) evaluated the H-score and made a 3-tier classification of c-Met expression for all cases, using conventional light microscopy (CLM) and whole slide imaging (WSI). The interobserver reproducibility with CLM gave global Cohen Kappa coefficients (ƙ) ranging from 0.581 (95% CI: 0.364-0.771) to 0.763 (95% CI: 0.58-0.92) using the c-Met 3-tier classification and H-score, respectively. ƙ was higher for senior pathologists and biopsy samples. The interobserver reproducibility with WSI gave a global ƙ ranging from 0.543 (95% CI: 0.33-0.724) to 0.905 (95% CI: 0.618-1) using the c-Met H-score and 2-tier classification (≥25% 3+), respectively. ƙ for intraobserver reproducibility between CLM and WSI ranged from 0.713 to 0.898 for the c-Met H-score and from 0.600 to 0.779 for the c-Met 3-tier classification. We demonstrated a moderate to excellent interobserver agreement for c-Met expression with a substantial to excellent intraobserver agreement between CLM and WSI, thereby supporting the development of digital pathology. However, some factors (scoring method, type of tissue samples, and expertise level) affect reproducibility. Our findings highlight the importance of establishing a consensus definition and providing further training, particularly for inexperienced pathologists, for c-Met immunohistochemistry assessment in clinical practice.
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Affiliation(s)
- Christophe Bontoux
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- Team 4, Institute of Research on Cancer and Aging of Nice Inserm U1081, CNRS UMR7284, Côte d'Azur University
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
| | - Véronique Hofman
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- Team 4, Institute of Research on Cancer and Aging of Nice Inserm U1081, CNRS UMR7284, Côte d'Azur University
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
| | - Emmanuel Chamorey
- Department of Statistics, Antoine Lacassagne Cancer Center, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Cancer Center, Nice, France
| | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- Team 4, Institute of Research on Cancer and Aging of Nice Inserm U1081, CNRS UMR7284, Côte d'Azur University
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
| | - Elodie Long-Mira
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- Team 4, Institute of Research on Cancer and Aging of Nice Inserm U1081, CNRS UMR7284, Côte d'Azur University
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
| | - Katia Zahaf
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
| | - Salomé Lalvée
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
| | - Julien Fayada
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
| | - Christelle Bonnetaud
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
| | | | - Marius Ilié
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- Team 4, Institute of Research on Cancer and Aging of Nice Inserm U1081, CNRS UMR7284, Côte d'Azur University
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology
- Hospital-Integrated Biobank
- Team 4, Institute of Research on Cancer and Aging of Nice Inserm U1081, CNRS UMR7284, Côte d'Azur University
- FHU OncoAge, Côte d'Azur University
- University Hospital Institute RespirERA, Côte d'Azur University, Pasteur Hospital, CHU of Nice
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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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Maity S, Nauhria S, Nayak N, Nauhria S, Coffin T, Wray J, Haerianardakani S, Sah R, Spruce A, Jeong Y, Maj MC, Sharma A, Okpara N, Ike CJ, Nath R, Nelson J, Parwani AV. Virtual Versus Light Microscopy Usage among Students: A Systematic Review and Meta-Analytic Evidence in Medical Education. Diagnostics (Basel) 2023; 13:558. [PMID: 36766660 PMCID: PMC9914930 DOI: 10.3390/diagnostics13030558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The usage of whole-slide images has recently been gaining a foothold in medical education, training, and diagnosis. OBJECTIVES The first objective of the current study was to compare academic performance on virtual microscopy (VM) and light microscopy (LM) for learning pathology, anatomy, and histology in medical and dental students during the COVID-19 period. The second objective was to gather insight into various applications and usage of such technology for medical education. MATERIALS AND METHODS Using the keywords "virtual microscopy" or "light microscopy" or "digital microscopy" and "medical" and "dental" students, databases (PubMed, Embase, Scopus, Cochrane, CINAHL, and Google Scholar) were searched. Hand searching and snowballing were also employed for article searching. After extracting the relevant data based on inclusion and execution criteria, the qualitative data were used for the systematic review and quantitative data were used for meta-analysis. The Newcastle Ottawa Scale (NOS) scale was used to assess the quality of the included studies. Additionally, we registered our systematic review protocol in the prospective register of systematic reviews (PROSPERO) with registration number CRD42020205583. RESULTS A total of 39 studies met the criteria to be included in the systematic review. Overall, results indicated a preference for this technology and better academic scores. Qualitative analyses reported improved academic scores, ease of use, and enhanced collaboration amongst students as the top advantages, whereas technical issues were a disadvantage. The performance comparison of virtual versus light microscopy meta-analysis included 19 studies. Most (10/39) studies were from medical universities in the USA. VM was mainly used for teaching pathology courses (25/39) at medical schools (30/39). Dental schools (10/39) have also reported using VM for teaching microscopy. The COVID-19 pandemic was responsible for the transition to VM use in 17/39 studies. The pooled effect size of 19 studies significantly demonstrated higher exam performance (SMD: 1.36 [95% CI: 0.75, 1.96], p < 0.001) among the students who used VM for their learning. Students in the VM group demonstrated significantly higher exam performance than LM in pathology (SMD: 0.85 [95% CI: 0.26, 1.44], p < 0.01) and histopathology (SMD: 1.25 [95% CI: 0.71, 1.78], p < 0.001). For histology (SMD: 1.67 [95% CI: -0.05, 3.40], p = 0.06), the result was insignificant. The overall analysis of 15 studies assessing exam performance showed significantly higher performance for both medical (SMD: 1.42 [95% CI: 0.59, 2.25], p < 0.001) and dental students (SMD: 0.58 [95% CI: 0.58, 0.79], p < 0.001). CONCLUSIONS The results of qualitative and quantitative analyses show that VM technology and digitization of glass slides enhance the teaching and learning of microscopic aspects of disease. Additionally, the COVID-19 global health crisis has produced many challenges to overcome from a macroscopic to microscopic scale, for which modern virtual technology is the solution. Therefore, medical educators worldwide should incorporate newer teaching technologies in the curriculum for the success of the coming generation of health-care professionals.
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Affiliation(s)
- Sabyasachi Maity
- Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s University School of Medicine, St. George’s, Grenada
| | - Samal Nauhria
- Department of Pathology, St. Matthews University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Narendra Nayak
- Department of Microbiology, St. Matthews University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Shreya Nauhria
- Department of Psychology, University of Leicester, Leicester LE1 7RH, UK
| | - Tamara Coffin
- Medical Student Research Institute, St. George’s University School of Medicine, St. George’s, Grenada
| | - Jadzia Wray
- Medical Student Research Institute, St. George’s University School of Medicine, St. George’s, Grenada
| | - Sepehr Haerianardakani
- Medical Student Research Institute, St. George’s University School of Medicine, St. George’s, Grenada
| | - Ramsagar Sah
- Department of Public Health, Torrens University, Ultimo, Sydney, NSW 2007, Australia
| | - Andrew Spruce
- Department of Pathology, St. Matthews University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Yujin Jeong
- Department of Clinical Medicine, American University of Antigua, St. John’s, Antigua and Barbuda
| | - Mary C. Maj
- Department of Biochemistry, St. George’s University School of Medicine, St. George’s, Grenada
| | - Abhimanyu Sharma
- Department of Pathology, Government Medical College, Jammu 180001, India
| | - Nicole Okpara
- Department of Pathology, St. Matthews University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Chidubem J. Ike
- Department of Clinical Medicine, American University of Antigua, St. John’s, Antigua and Barbuda
| | - Reetuparna Nath
- Department of Education Service, St. George’s University, St. George’s, Grenada
| | - Jack Nelson
- Medical Illustrator, The Centre for Biomedical Visualization, St. George’s University, St. George’s, Grenada
| | - Anil V. Parwani
- Department of Pathology, Wexner Medical Center, The Ohio State University, Cooperative Human Tissue Network (CHTN) Midwestern Division, Columbus, OH 43210, USA
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Smith J, Johnsen S, Zeuthen MC, Thomsen LK, Marcussen N, Hansen S, Jensen CL. On the Road to Digital Pathology in Denmark-National Survey and Interviews. J Digit Imaging 2022; 35:1189-1206. [PMID: 35610395 PMCID: PMC9129899 DOI: 10.1007/s10278-022-00638-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 03/23/2022] [Accepted: 04/10/2022] [Indexed: 11/29/2022] Open
Abstract
Digital pathology (DP) is changing pathology departments dramatically worldwide, yet globally, few departments are presently digitalized for the full diagnostic workflow. Denmark is also on the road to full digitalization countrywide, and this study aim to cover experiences during the implementation process in a national context. Thus, quantitative questionnaires were distributed to all pathology departments in Denmark (n = 13) and distributed to all professions including medical clinical directors, medical doctors (MD) and biomedical laboratory scientists (BLS). For a qualitative perspective, we interviewed four employees representing four professions. Data were collected in 2019–2020. From the questionnaire and interviews, we found strategies differed at the Danish departments with regards to ambitions, technological equipment, workflows, and involvement of type of professions. DP education was requested by personnel. Informants were in general positive toward the digital future but mainly had concerns regarding the political pressure to integrate DP before technological advances are sufficient for maintaining rational budgets, workflows, and for sustaining diagnostic quality. This study is a glance on the Danish implementation process in its early stages from personnel’s point of view. It shows the complexity when large new workflow processes are to be implemented countrywide and with a large diversity of stakeholders like managers, MD, BLS, IT-professionals, and authorities. To ensure best technological and economical solutions and to maintain—or even optimize—diagnostic quality with DP and workflow alignment, we suggest superior inter- and intradepartmental communication. When implementing DP countrywide, a national working group is warranted with the variety of stakeholders represented.
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Affiliation(s)
- Julie Smith
- Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark.
| | - Sys Johnsen
- Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Mette Christa Zeuthen
- Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Lisbeth Koch Thomsen
- Centre for Engineering and Science, University College Absalon, Næstved, Denmark
| | - Niels Marcussen
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark.,Department of Pathology, Department of Regional Health Research, Hospital Sønderjylland, University of Southern Denmark, Aabenraa, Denmark
| | - Stig Hansen
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
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