1
|
Cazzaniga G, Rossi M, Eccher A, Girolami I, L'Imperio V, Van Nguyen H, Becker JU, Bueno García MG, Sbaraglia M, Dei Tos AP, Gambaro G, Pagni F. Time for a full digital approach in nephropathology: a systematic review of current artificial intelligence applications and future directions. J Nephrol 2024; 37:65-76. [PMID: 37768550 PMCID: PMC10920416 DOI: 10.1007/s40620-023-01775-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) integration in nephropathology has been growing rapidly in recent years, facing several challenges including the wide range of histological techniques used, the low occurrence of certain diseases, and the need for data sharing. This narrative review retraces the history of AI in nephropathology and provides insights into potential future developments. METHODS Electronic searches in PubMed-MEDLINE and Embase were made to extract pertinent articles from the literature. Works about automated image analysis or the application of an AI algorithm on non-neoplastic kidney histological samples were included and analyzed to extract information such as publication year, AI task, and learning type. Prepublication servers and reviews were not included. RESULTS Seventy-six (76) original research articles were selected. Most of the studies were conducted in the United States in the last 7 years. To date, research has been mainly conducted on relatively easy tasks, like single-stain glomerular segmentation. However, there is a trend towards developing more complex tasks such as glomerular multi-stain classification. CONCLUSION Deep learning has been used to identify patterns in complex histopathology data and looks promising for the comprehensive assessment of renal biopsy, through the use of multiple stains and virtual staining techniques. Hybrid and collaborative learning approaches have also been explored to utilize large amounts of unlabeled data. A diverse team of experts, including nephropathologists, computer scientists, and clinicians, is crucial for the development of AI systems for nephropathology. Collaborative efforts among multidisciplinary experts result in clinically relevant and effective AI tools.
Collapse
Affiliation(s)
- Giorgio Cazzaniga
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, Università di Milano-Bicocca, Monza, Italy.
| | - Mattia Rossi
- Division of Nephrology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Ilaria Girolami
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy
| | - Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, Università di Milano-Bicocca, Monza, Italy
| | - Hien Van Nguyen
- Department of Electrical and Computer Engineering, University of Houston, Houston, TX, 77004, USA
| | - Jan Ulrich Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - María Gloria Bueno García
- VISILAB Research Group, E.T.S. Ingenieros Industriales, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Giovanni Gambaro
- Division of Nephrology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, Università di Milano-Bicocca, Monza, Italy
| |
Collapse
|
2
|
Maness HT, Hakimjavadi H, Chamala S. Maintaining informatics training learning outcomes with a COVID-19 era shift to a fully online flipped course. J Pathol Inform 2022; 14:100162. [PMCID: PMC9714185 DOI: 10.1016/j.jpi.2022.100162] [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: 06/08/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
The emergence of the coronavirus disease 2019 pandemic forced us to adapt our recently developed informatics training serving a variety of students as well as faculty and staff. The successful flipped classroom course series (a hybrid-format with both asynchronous online learning and in-person synchronous components) was shifted to a fully online format with the synchronous portion now held via web-based video conference. We repeated our participant survey at the end of each of the 3 one-credit courses to compare student satisfaction and learning outcomes achievement to the original offering. The responses were overall very positive again and while there were no differences in satisfaction levels for 2 of the courses, overall satisfaction was higher for the new, fully online Python Programming course. Likewise, students reported similar achievement of the learning outcomes across all courses with 1 of the 12 objectives receiving higher competency agreement in the new, fully online version. Overall, the fully online version of the course series was equally successful, if not more so, than the original version with a physical classroom session each week. Given that participants also had strong agreement with a new question that they would prefer online class meetings instead of in a classroom, even if there wasn’t a global pandemic (citing a variety of logistical reasons such as “convenience of screen sharing,” parking issues, and job-related time constraints), the fully online version of the informatics training will be retained.
Collapse
Affiliation(s)
- Heather T.D. Maness
- UFIT Center for Instructional Technology and Training, University of Florida, Gainesville, FL, USA
| | - Hesamedin Hakimjavadi
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA,Department of Pathology and Laboratory Medicine, Children’s Hospital, Los Angeles, CA, USA
| | - Srikar Chamala
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA,Department of Pathology and Laboratory Medicine, Children’s Hospital, Los Angeles, CA, USA,Corresponding author at: Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| |
Collapse
|
3
|
Katsakhyan L, Jacobson AM, Budina A, Baloch ZW. Practical Scientific Writing and Publishing in Anatomic Pathology. Am J Clin Pathol 2022; 157:451-456. [PMID: 34596207 DOI: 10.1093/ajcp/aqab144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/29/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To develop a structured, introductory curriculum in scientific writing and publishing for residents in anatomic pathology. METHODS We assessed the need for this curriculum by using an online questionnaire sent to anatomic pathology residents in our program and tailored content to address areas of least familiarity. The curriculum consisted of 4 virtual lectures delivered by select experts in the field. Curriculum evaluation was assessed through a postcurriculum questionnaire. RESULTS In total, 27 of 31 (87%) residents responded to the initial questionnaire. The major educational need was identified in the following topics: "responsibilities of a corresponding author"; "selecting a journal for publication"; "editor's approach to evaluating a manuscript"; "correspondence with editors and reviewers"; and "open access, cost and increasing exposure to manuscript." Eight residents participated in at least 3 of 4 lectures and completed the pre- and postcurriculum survey. The postcurriculum survey demonstrated statistically significant interval increases in familiarity with 7 of 18 topics, and the leading increases were noted in topics of most significant educational need. CONCLUSIONS Development of novel curricula is vital to the ever-changing landscape of pathology resident education. This study proposes a generalizable algorithmic approach to assessing new areas of educational need and effectively addressing them through targeted curricula.
Collapse
Affiliation(s)
- Levon Katsakhyan
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Alec M Jacobson
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Anna Budina
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
4
|
Koch LK, Chang OH, Dintzis SM. Medical Education in Pathology: General Concepts and Strategies for Implementation. Arch Pathol Lab Med 2021; 145:1081-1088. [PMID: 34086852 DOI: 10.5858/arpa.2020-0463-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Pathology education must evolve as medical knowledge expands and disruptive technologies emerge. The evolution in pathology teaching practices accelerated as traditional teaching modalities were suspended in March 2020 during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES.— To provide pathologists an overview of established teaching paradigms and practical examples of how these paradigms may be applied to pathology education, emphasizing differences in graduate and undergraduate medical education as well as the challenges and promises of remote learning, as revealed by the COVID-19 pandemic. DATA SOURCES.— Selected peer-reviewed publications representing the field of educational social science. CONCLUSIONS.— Evidence-based methods described in education and social sciences can be effectively deployed in pathology education and especially remote learning, as necessitated by the current COVID-19 pandemic. Understanding established principles, such as cognitive load, competency-based learning, peer-assisted learning, and flipped classrooms may prove useful in developing effective, learner-centric content for pathology education.
Collapse
Affiliation(s)
- Lisa K Koch
- From the Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Oliver H Chang
- From the Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Suzanne M Dintzis
- From the Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| |
Collapse
|
5
|
Black-Schaffer WS, Robboy SJ, Gross DJ, Crawford JM, Johnson K, Austin M, Karcher DS, Johnson RL, Powell SZ, Sanfrancesco J, Cohen MB. Evidence-Based Alignment of Pathology Residency With Practice II: Findings and Implications. Acad Pathol 2021; 8:23742895211002816. [PMID: 33889716 PMCID: PMC8040604 DOI: 10.1177/23742895211002816] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
This article presents findings from a 4-year series of surveys of new-in-practice pathologists, and a survey of physician employers of new pathologists, assessing how pathology graduate medical education prepares its graduates for practice. Using the methodology described in our previous study, we develop evidence for the importance of residency training for various practice areas, comparing findings over different practice settings, sizes, and lengths of time in practice. The principal findings are (1) while new-in-practice pathologists and their employers report residency generally prepared them well for practice, some areas—billing and coding, laboratory management, molecular pathology, and pathology informatics—consistently were identified as being important in practice but inadequately prepared for in residency; (2) other areas—autopsy pathology, and subspecialized apheresis and blood donor center blood banking services—consistently were identified as relatively unimportant in practice and excessively prepared for in residency; (3) the notion of a single comprehensive model for categorical training in residency is challenged by the disparity between broad general practice in some settings and narrower subspecialty practice in others; and (4) the need for preparation in some areas evolves during practice, raising questions about the appropriate mode and circumstance for training in these areas. The implications of these findings range from rebalancing the emphasis among practice areas in residency, to reconsidering the structure of graduate medical education in pathology to meet present and evolving future practice needs.
Collapse
Affiliation(s)
- W Stephen Black-Schaffer
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - David J Gross
- College of American Pathologists, Washington, DC, USA
| | - James M Crawford
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Melissa Austin
- Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Donald S Karcher
- George Washington University Medical Center, Washington, DC, USA
| | | | - Suzanne Z Powell
- Weill Cornell Medical College Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | | | - Michael B Cohen
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
6
|
Chamala S, Maness HTD, Brown L, Adams CB, Lamba JK, Cogle CR. Building a precision oncology workforce by multidisciplinary and case-based learning. BMC MEDICAL EDUCATION 2021; 21:75. [PMID: 33499867 PMCID: PMC7836489 DOI: 10.1186/s12909-021-02500-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Participants in two recent National Academy of Medicine workshops identified a need for more multi-disciplinary professionals on teams to assist oncology clinicians in precision oncology. METHODS We developed a graduate school course to prepare biomedical students and pharmacy students to work within a multidisciplinary team of oncology clinicians, pathologists, radiologists, clinical pharmacists, and genetic counselors. Students learned precision oncology skills via case-based learning, hands-on data analyses, and presentations to peers. After the course, a focus group session was conducted to gain an in-depth student perspective on their interprofessional training experience, achievement of the course learning outcomes, ways to improve the course design in future offerings, and how the course could improve future career outcomes. A convenience sampling strategy was used for recruitment into the focus group session. A thematic content analysis was then conducted using the constant comparative method. RESULTS Major themes arising from student feedback were (1) appreciation of a customized patient case-based teaching approach, (2) more emphasis on using data analysis tools, (3) valuing interdisciplinary inclusion, and (4) request for more student discussion with advanced preparation materials. CONCLUSIONS Feedback was generally positive and supports the continuation and expansion of the precision oncology course to include more hands-on instruction on the use of clinical bioinformatic tools.
Collapse
Affiliation(s)
- Srikar Chamala
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Heather T D Maness
- Center for Instructional Technology and Training, Information Technology, University of Florida, Gainesville, FL, USA
| | - Lisa Brown
- UF Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - C Brooke Adams
- Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, USA
| | - Jatinder K Lamba
- Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Christopher R Cogle
- Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Box 100278, Gainesville, FL, 32610-0278, USA.
| |
Collapse
|
7
|
Seifert RP, Casler V, Al Qaysi N, Gothi SR, Williams L, Christensen PR, Flax S, Chamala S. Informatics driven quality improvement in the modern histology lab. JAMIA Open 2020; 3:530-535. [PMID: 33623889 PMCID: PMC7886543 DOI: 10.1093/jamiaopen/ooaa066] [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] [Received: 04/09/2020] [Revised: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Laboratory Information Systems (LIS) and data visualization techniques have untapped potential in anatomic pathology laboratories. Pre-built functionalities of LIS do not address all the needs of a modern histology laboratory. For instance, “Go live” is not the end of LIS customization, but just the beginning. After closely evaluating various histology lab workflows, we implemented several custom data analytics dashboards and additional LIS functionalities to monitor and address weaknesses. Herein, we present our experience in LIS and data-tracking solutions that improved trainee education, slide logistics, staffing/instrumentation lobbying, and task tracking. The latter was addressed through the creation of a novel “status board” akin to those seen in inpatient wards. These use-cases can benefit other histology laboratories.
Collapse
Affiliation(s)
- Robert P Seifert
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Vektra Casler
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Nada Al Qaysi
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Shaileshbhai Revabhai Gothi
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, Florida, USA
| | - Leah Williams
- UF Health Medical Laboratories, Gainesville, Florida, USA
| | | | - Sherri Flax
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Srikar Chamala
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|