The modern histopathologist: in the changing face of time

Vulvar cancer incidence and net survival in Sweden 1960 to 2019: A population-based national study

INTRODUCTION

Vulvar cancer is a rare gynecological cancer affecting mostly older women. The aim of this population-based study was to investigate the incidence and net survival of vulvar cancer in Swedish women from 1960 to 2019.

MATERIAL AND METHODS

Data were retrieved from the mandatory Swedish Cancer Registry consisting of all women diagnosed with vulvar cancer between 1960 and 2019. Only women with a morphologically verified diagnosis of vulvar cancer were included. The individuals were then further matched with the Swedish Death Registry up until May 31, 2020.

RESULTS

In total, 8499 women were included with the following morphologies: squamous cell carcinoma 7250 (85.8%), malignant melanoma 539 (6.4%), adenocarcinoma 401 (4.8%) and other: 259 (3.1%). More than 50% of vulvar cancer cases occurred in women aged between 65 and 84 years of age. The 5-year age-standardized net survival increased from 53.0% (95% confidence interval [CI] 48.9-57.5) in 1960 to 72.1% (95% CI 68.8-75.5) in 2019. The proportion of adenocarcinoma among all cases increased from 2.0% to 8.7% between the 1960s and 2010s and an increase in age-standardized 5-year net survival was found for adenocarcinoma.

CONCLUSIONS

The age-standardized incidence of vulvar cancer cases in Sweden was stable between 1960 and 2019. During the study period, an increase in adenocarcinoma and a decrease in malignant melanoma cases was found. Five-year net survival increased by 20 percent units during the study period. For squamous cell carcinoma, an increased age-specific 5-year net survival was observed for all age groups, apart for women aged ≥85.

Polarization-based probabilistic discriminative model for quantitative characterization of cancer cells

We propose a polarization-based probabilistic discriminative model for deriving a set of new sigmoid-transformed polarimetry feature parameters, which not only enables accurate and quantitative characterization of cancer cells at pixel level, but also accomplish the task with a simple and stable model. By taking advantages of polarization imaging techniques, these parameters enable a low-magnification and wide-field imaging system to separate the types of cells into more specific categories that previously were distinctive under high magnification. Instead of blindly choosing the model, the L0 regularization method is used to obtain the simplified and stable polarimetry feature parameter. We demonstrate the model viability by using the pathological tissues of breast cancer and liver cancer, in each of which there are two derived parameters that can characterize the cells and cancer cells respectively with satisfactory accuracy and sensitivity. The stability of the final model opens the possibility for physical interpretation and analysis. This technique may bypass the typically labor-intensive and subjective tumor evaluating system, and could be used as a blueprint for an objective and automated procedure for cancer cell screening.

Assessment of tissue pathology using optical polarimetry

Optical polarimetry have been extensively used for the non-invasive assessment of biological tissues. However, the knowledge regarding differences in polarimetric signatures of different tissue pathologies is very scattered, confounding the deduction of a global trend of the polarimetric variables for healthy and pathological tissues. The purpose of this study was to bridge this gap. We conducted a rigorous online survey to collect all published studies that report the two most common polarimetric variables (i.e., depolarization and retardance) for any type of tissue pathology. A total of 101 studies describing the polarimetric assessment of tissues were collected, wherein 253 (i.e., n_human = 149, n_animal = 104) different type of tissues were optically characterized. Most tissue samples (172/253) were investigated in ex vivo settings. The data showed 32 different types of tissues pathologies, where the most common pathology was cancer and its subtypes. The skin tissues were the most frequently explored tissues, followed by tissue samples from breast, colon, liver, and cervix. Although differences in polarimetric signatures of different tissue pathologies were summarized from the included studies, generalization of the results was hindered by the presentation of polarimetric data in a non-uniform format. The analyses presented in this study may provide an important reference for future polarimetric studies that conduct optical assessment of tissues at greater depth, particularly in the context of optical biopsy/digital staining.

High-fidelity and rapid cellular-level Mueller matrix imaging for tissue identification with unstained sections

Mueller matrix polarimetry is regarded as a promising technique in the field of biomedicine, especially for pathological diagnosis. However, the current studies on Mueller imaging of pathological sections are all at the tissue-level, and the cellular-level polarization information is difficult to obtain. To overcome this challenge, we first propose a cellular-level Mueller matrix imaging method for accurate quantitative identification of tissues in this study. Benefiting from the significant birefringent behavior of paraffin in unstained sections, the proposed method can locate the paraffin distribution areas of retardance images by involving Otsu's algorithm. Then, the real cellular-level polarization information (e.g., depolarization) is acquired. The efficiency of the proposed method was demonstrated on unstained rat tissue samples. The results showed that the obtained depolarization images are highly consistent with the stained microscopic images in terms of the morphology and arrangement of the tissues at cellular level. Finally, this method was preliminarily applied to the detection of human lung cancer tissue section, effectively realizing the quantitative differentiation of normal, inflamed, and malignant areas in unstained section. This study provides a possible approach for the rapid and accurate diagnosis of cancer.

Deriving Polarimetry Feature Parameters to Characterize Microstructural Features in Histological Sections of Breast Tissues

OBJECTIVE

Mueller matrix polarimetry technique has been regarded as a powerful tool for probing the microstructural information of tissues. The multiplying of cells and remodeling of collagen fibers in breast carcinoma tissues have been reported to be related to patient survival and prognosis, and they give rise to observable patterns in hematoxylin and eosin (H&E) sections of typical breast tissues (TBTs) that the pathologist can label as three distinctive pathological features (DPFs)-cell nuclei, aligned collagen, and disorganized collagen. The aim of this paper is to propose a pixel-based extraction approach of polarimetry feature parameters (PFPs) using a linear discriminant analysis (LDA) classifier. These parameters provide quantitative characterization of the three DPFs in four types of TBTs.

METHODS

The LDA-based training method learns to find the most simplified linear combination from polarimetry basis parameters (PBPs) constrained under the accuracy remains constant to characterize the specific microstructural feature quantitatively in TBTs.

RESULTS

We present results from a cohort of 32 clinical patients with analysis of 224 regions-of-interest. The characterization accuracy for PFPs ranges from 0.82 to 0.91.

CONCLUSION

This work demonstrates the ability of PFPs to quantitatively characterize the DPFs in the H&E pathological sections of TBTs.

SIGNIFICANCE

This technique paves the way for automatic and quantitative evaluation of specific microstructural features in histopathological digitalization and computer-aided diagnosis.

Probing variations of fibrous structures during the development of breast ductal carcinoma tissues via Mueller matrix imaging

Recently, we developed a label-free method to probe the microstructural information and optical properties of unstained thin tissue slices based on microscopic Mueller matrix imaging technique. In this paper, we take the microscopic Mueller matrix images of human breast ductal carcinoma tissue samples at different pathological stages, and then calculate and analyze their retardance-related Mueller matrix-derived parameters. To reveal the microstructural features more quantitatively and precisely, we propose a new method based on first-order statistical properties of image to transform the 2D images of Mueller matrix parameters into several statistical feature vectors. We evaluate each statistical feature vector by corresponding classification characteristic value extracted from the statistical features of Mueller matrix parameters images of healthy breast duct tissue samples. The experimental results indicate that these statistical feature vectors of Mueller matrix derived parameters may become powerful tools to quantitatively characterize breast ductal carcinoma tissue samples at different pathological stages. It has the potential to facilitate automating the staging process of breast ductal carcinoma tissue, resulting in the improvement of diagnostic efficiency.

Shh Overexpression Is Correlated with GRP78 and AR Expression in Primary Prostate Cancer: Clinicopathological Features and Outcomes in a Chinese Cohort

Introduction

Shh plays an important role in prostate cancer progression, but its correlation with GRP78 and AR is elusive.

Methods

The study included 539 patients in total, of which 443 had primary prostate carcinoma and 96 patients had benign prostatic hyperplasia (BPH). The clinicopathologic features, histologic scores of protein expression, and correlations between protein and disease state were studied in this cohort. Kaplan–Meier and Pearson correlation analyses were used to compare measures between groups. We performed immunohistochemistry to evaluate the expression of the Shh protein in benign prostatic hyperplasia (n=96) and prostate cancer (Gleason scores ≤6 [n=399] or ≥7 [n=44]). We quantified the expression of Shh, AR, and GRP78 using the weighted histoscore method, studied the correlation between Shh expression and AR and GRP78, and evaluated the impact of Shh protein expression on patient survival.

Results

Shh expression was significantly higher in prostate cancer with Gleason scores ≥7 than in cancer with lower Gleason scores or benign hyperplasia and was much higher in AR-positive cancer than in AR-negative cancer. Shh is overexpressed in high-grade prostate cancer and is positively correlated with the expression of both GRP78 and AR.

Conclusion

Therefore, Shh may be a useful prognostic marker and therapeutic target for prostate cancer.

Comparative study of the imaging contrasts of Mueller matrix derived parameters between transmission and backscattering polarimetry

Mueller matrix polarimetry is a potentially powerful tool for biomedical diagnosis. Recently, the transmission Mueller matrix microscope and backscattering Mueller matrix endoscope were developed and applied to various pathological samples. However, a comparative study of imaging contrasts of Mueller matrix derived parameters between transmission and backscattering measurements is still needed to help decide which information obtained from transmission Mueller matrix microscope can be directly applied to in vivo Mueller matrix imaging. Here, to compare the imaging contrasts of Mueller matrix derived parameters between transmission and backscattering polarimetry, we measure porcine liver tissue samples and human breast carcinoma tissue specimens. The experiments and corresponding Monte Carlo stimulation results demonstrate that the backscattering and transmission retardance-related Mueller matrix parameters have very similar contrasts to characterize the anisotropic and isotropic structures of pathological tissues, meaning that the conclusions made from Mueller matrix microscopic imaging based on retardance can also be helpful to guide the in situ backscattering Mueller matrix polarimetric diagnosis. However, the values and contrasts of depolarization-related Mueller matrix parameters have some differences between transmission and backscattering polarimetry.

Quantitatively characterizing the microstructural features of breast ductal carcinoma tissues in different progression stages by Mueller matrix microscope

Polarization imaging has been recognized as a potentially powerful technique for probing the microstructural information and optical properties of complex biological specimens. Recently, we have reported a Mueller matrix microscope by adding the polarization state generator and analyzer (PSG and PSA) to a commercial transmission-light microscope, and applied it to differentiate human liver and cervical cancerous tissues with fibrosis. In this paper, we apply the Mueller matrix microscope for quantitative detection of human breast ductal carcinoma samples at different stages. The Mueller matrix polar decomposition and transformation parameters of the breast ductal tissues in different regions and at different stages are calculated and analyzed. For more quantitative comparisons, several widely-used image texture feature parameters are also calculated to characterize the difference in the polarimetric images. The experimental results indicate that the Mueller matrix microscope and the polarization parameters can facilitate the quantitative detection of breast ductal carcinoma tissues at different stages.

Changes of collagen ultrastructure in breast cancer tissue determined by second-harmonic generation double Stokes-Mueller polarimetric microscopy

Second-harmonic generation (SHG) double Stokes-Mueller polarimetric microscopy is applied to study the alteration of collagen ultrastructure in a tissue microarray containing three pathological human breast cancer types with differently overexpressed estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2). Kleinman symmetry is experimentally validated in breast tissue for 1028 nm laser wavelength and it has been shown that measurements with only linearly polarized incoming and outgoing states can determine molecular nonlinear susceptibility tensor component ratio, average in-plane orientation of collagen fibers and degree of linear polarization of SHG. Increase in the susceptibility ratio for ER, PgR, HER2 positive cases, reveals ultrastructural changes in the collagen fibers while the susceptibility ratio increase and decrease in degree of linear polarization for ER and PgR positive cases indicate alteration of the ultrastructure and increased disorder of the collagen fibers within each focal volume. The study demonstrates a potential use of polarimetric SHG microscopy for collagen characterization and cancer diagnostics.

Guidelines for standard photography in gross and clinical anatomy

Photography has a widespread usage in medicine and anatomy. In this review, authors focused on the usage of photography in gross and clinical anatomy. Photography in gross and clinical anatomy is not only essential for accurate documentation of morphological findings but also important in sharing knowledge and experience. Photographs of cadavers are supposed to demonstrate the required information clearly. Thus, photographs should be taken with certain techniques in order to obtain high quality and standardization. Camera, lens, lighting, background, and certain photographic techniques are among the factors to achieve precise images. A set of suggested guidelines for accomplishing these standards are given for anatomists.

Shifting gears higher--digital slides in graduate education--4 years experience at Semmelweis University

Background

The spreading of whole slide imaging or digital slide systems in pathology as an innovative technique seems to be unstoppable. Successful introduction of digital slides in education has played a crucial role to reach this level of acceptance. Practically speaking there is no university institute where digital materials are not built into pathology education. At the 1st. Department of Pathology and Experimental Cancer Research, Semmelweis University optical microscopes have been replaced and for four years only digital slides have been used in education. The aim of this paper is to summarize our experiences gathered with the installation of a fully digitized histology lab for graduate education.

Methods

We have installed a digital histology lab with 40 PCs, two slide servers - one for internal use and one with external internet access. We have digitized hundreds of slides and after 4 years we use a set of 126 slides during the pathology course. A Student satisfaction questionnaire and a Tutor satisfaction questionnaire have been designed, both to be completed voluntarily to have feed back from the users. The page load statistics of the external slide server were evaluated.

Results

The digital histology lab served ~900 students and ~1600 hours of histology practice. The questionnaires revealed high satisfaction with digital slides. The results also emphasize the importance of the tutors' attitude towards digital microscopy as a factor influencing the students' satisfaction. The constantly growing number of page downloads from the external server confirms this satisfaction and the acceptance of digital slides.

Conclusions

We are confident, and have showed as well, that digital slides have got numerous advantages over optical slides and are more suitable in education.

Telepathology for patient care: what am I getting myself into?

The vast advancements in telecommunications and converting medical information to a digital format have increased the number of applications within telemedicine. Telepathology, in simplest terms, is the practice of formally rendering a pathologic diagnosis based upon examination of an image rather than of a glass slide through traditional microscopy. The use of telepathology for clinical patient care has so far been limited to relatively few large academic institutions. Although a number of challenges remain, there is increasing demand for the use of information technology in pathology as a whole owing to the expansion of health care networks and the opportunity to enhance the quality of service delivered to patients. The software used to acquire, display, and manage digital images for clinical patient care may be subject to national and federal regulations just as is any other electronic information system. Despite the barriers, telepathology systems possess the capability to help manage pathology cases on a global scale, improve laboratory workload distribution, increase standardization of practice and enable new classes of ancillary studies to facilitate diagnosis and education even in the most remote parts of the earth.

Fluorescence lifetime imaging of endogenous fluorophores in histopathology sections reveals differences between normal and tumor epithelium in carcinoma in situ of the breast

The classical examination of histology slides from a mouse model of breast cancer has been extended in this study to incorporate modern multiphoton excitation and photon-counting techniques. The advantage of such approaches is quantification of potential diagnostic parameters from the fluorescence emission signal, whereby the traditional descriptive staging process is complemented by measurements of fluorescence intensity, lifetime, and spectra. We explored whether the clinical "gold standard" of eosin and hematoxylin stained histology slides would provide optical biomarker signatures of diagnostic value. Alternatively, we examined unstained slides for changes in intensity and/or fluorescence lifetime of relevant endogenous fluorophores. Although eosin provided a strong emission signal and had distinct spectra and lifetime, we found that it was not useful as a fluorescent biological marker, particularly when combined with hematoxylin. Instead, we found that the properties of the fluorescence from the endogenous fluorophores NADH and FAD were indicative of the pathological state of the tissue. Comparing regions of carcinoma in situ to adjacent histologically normal regions, we found that tumor cells produced higher intensity and had a longer fluorescence lifetime. By imaging at 780 nm and 890 nm excitation, we were able to differentiate the fluorescence of FAD from NADH by separating the emission spectra. The shift to a longer lifetime in tumor cells was independent of the free or bound state of FAD and NADH, and of the excitation wavelength. Most forms of cancer have altered metabolism and redox ratios; here we present a method that has potential for early detection of these changes, which are preserved in fixed tissue samples such as classic histopathology slides.

Unison or cacophony: postgraduate training in pathology in Europe

With the free movement of people in the European Union, medical mobility has increased significantly. This is notably the case for disciplines for which shortage of well-trained staff has occurred. Pathology is among those specialties and effectively the discipline is confronted with a striking increase in mobility among trainees and qualified specialists. The presumption underlying unlimited mobility is that the competencies of the medical specialists in the European countries are more or less equal, including significant similarities in the postgraduate training programs. In order to assess whether reality corresponds with this presumption, we conducted a survey of the content and practice requirements of the curricula in the EU and affiliated countries. The results indicate a striking heterogeneity in the training program content and practice requirements. To name a few elements: duration of the training program varied between 4 and 6 years; the number of autopsies required varied between none at all and 300; the number of biopsies required varied between none at all and 15,000. We conclude that harmonization of training outcomes in Europe is a goal that needs to be pursued. This will be difficult to reach through harmonization of training programs, as these are co-determined by political, cultural, and administrative factors, difficult to influence. Harmonization might be attained by defining the general and specific competencies at the end of training and subsequent testing them through a test to which all trainees in Europe are subjected.

Flow cytometric immunophenotyping (FCI) of lymphoma: correlation with histopathology and immunohistochemistry

BACKGROUND

To evaluate the role of flow cytometric immunophenotyping (FCI) in diagnosis and characterization of lymphoma tissue specimens from Egyptian patients.

METHODS

FCI using 2 and 3 color staining approaches, was performed on 50 fresh lymph nodes specimen from Cairo NCI patients with suspected lymphoma presenting with either localized or generalized lymphadenopathy.FCI results were correlated with histopathologic as well as immunophenotypic[by immunohistochemistry (IHC)] findings.

RESULTS

By FCI, cases were diagnosed as follows: 9(18%) reactive hyperplasia (RH), 32(64%) B-cell non-Hodgkin's lymphoma (B-NHL) [24 diffuse large (DLBCL), 2 follicular, 3 small lymphocytic, 2 mantle cell lymphoma and a case of T cell rich B cell lymphoma], 3 (6%) T cell NHL [2 peripheral T cell lymphoma and a case of anaplastic large cell lymphoma], 2(4%) Hodgkin's lymphoma (HL) while 4 (8%) were non-lymphomatous tumors (NLT). Light chain restriction (LCR) was detected in the 32 FCI diagnosed B-NHL. The overall concordance between FCI versus histopathology and IHC was 88%. The sensitivity and specificity of FCI in diagnosis of NHL was 94.9% and 100% respectively; in HL they were 40% and 100% respectively and in NLT, both sensitivity and specificity were 100% while for RH were 100% and 89.1% respectively.

CONCLUSION

FCI is a sensitive and specific method in diagnosis and classification of NHL as well as in detection of monoclonality. False negative results could be due to the presence of heterogeneous populations of lymphocytes in special types of lymphoma.