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Kim CA, An HR, Yoo J, Lee YM, Sung TY, Kim WG, Song DE. Morphometric Analysis of Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma Using Digital Pathology. Endocr Pathol 2024; 35:113-121. [PMID: 38064165 DOI: 10.1007/s12022-023-09790-0] [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] [Accepted: 11/02/2023] [Indexed: 06/14/2024]
Abstract
Digital pathology uses digitized images for cancer research. We aimed to assess morphometric parameters using digital pathology for predicting recurrence in patients with papillary thyroid carcinoma (PTC) and lateral cervical lymph node (LN) metastasis. We analyzed 316 PTC patients and assessed the longest diameter and largest area of metastatic focus in LNs using a whole slide imaging scanner. In digital pathology assessment, the longest diameters and largest areas of metastatic foci in LNs were positively correlated with traditional optically measured diameters (R = 0.928 and R2 = 0.727, p < 0.001 and p < 0.001, respectively). The optimal cutoff diameter was 8.0 mm in both traditional microscopic (p = 0.009) and digital pathology (p = 0.016) evaluations, with significant differences in progression-free survival (PFS) observed at this cutoff (p = 0.006 and p = 0.002, respectively). The predictive area's cutoff was 35.6 mm2 (p = 0.005), which significantly affected PFS (p = 0.015). Using an 8.0-mm cutoff in traditional microscopic evaluation and a 35.6-mm2 cutoff in digital pathology showed comparable predictive results using the proportion of variation explained (PVE) methods (2.6% vs. 2.4%). Excluding cases with predominant cystic changes in LNs, the largest metastatic areas by digital pathology had the highest PVE at 3.9%. Furthermore, high volume of LN metastasis (p = 0.001), extranodal extension (p = 0.047), and high ratio of metastatic LNs (p = 0.006) were associated with poor prognosis. Both traditional microscopic and digital pathology evaluations effectively measured the longest diameter of metastatic foci in LNs. Moreover, digital pathology offers limited advantages in predicting PFS of patients with lateral cervical LN metastasis of PTC, especially those without predominant cystic changes in LNs.
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Affiliation(s)
- Chae A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong Rok An
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jungmin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Shaker N, Shilo K, Esnakula AK, Shafi S, Challa B, Patel A, Kellough DA, Hammond S, Javaid S, Satturwar S, Yearsley MM, Li Z, Limbach AL, Lujan G, Parwani AV. Comparison of four different displays for identification of select pathologic features extracted from whole slide images of surgical pathology cases. Pathol Res Pract 2023; 251:154843. [PMID: 37826873 DOI: 10.1016/j.prp.2023.154843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The establishment of minimum standards for display selection for the whole slide image (WSI) interpretation has not been fully defined. Recently, pathologists have increasingly preferred using remote displays for clinical diagnostics. Our study aims to assess and compare the performance of three fixed work displays and one remote personal display in accurately identifying ten selected pathologic features integrated into WSIs. DESIGN Hematoxylin and eosin-stained glass slides were digitized using Philips scanners. Seven practicing pathologists and three residents reviewed ninety WSIs to identify ten pathologic features using the LG, Dell, and Samsung and an optional consumer-grade display. Ten pathologic features included eosinophils, neutrophils, plasma cells, granulomas, necrosis, mucin, hemosiderin, crystals, nucleoli, and mitoses. RESULTS The accuracy of the identification of ten features on different types of displays did not significantly differ among the three types of "fixed" workplace displays. The highest accuracy was observed for the identification of neutrophils, eosinophils, plasma cells, granuloma, and mucin. On the other hand, a lower accuracy was observed for the identification of crystals, mitoses, necrosis, hemosiderin, and nucleoli. Participant pathologists and residents preferred the use of larger displays (>30″) with a higher pixel count, resolution, and luminance. CONCLUSION Most features can be identified using any display. However, certain features posed more challenges across the three fixed display types. Furthermore, the use of a remote personal consumer-grade display chosen according to the pathologists' preference showed similar feature identification accuracy. Several factors of display characteristics seemed to influence pathologists' display preferences such as the display size, color, contrast ratio, pixel count, and luminance calibration. This study supports the use of standard "unlocked" vendor-agnostic displays for clinical digital pathology workflow rather than purchasing "locked" and more expensive displays that are part of a digital pathology system.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Konstantin Shilo
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ashwini K Esnakula
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Saba Shafi
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bindu Challa
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ankush Patel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David A Kellough
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Scott Hammond
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sehrish Javaid
- Woody L. Hunt School of Dental Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Swati Satturwar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Martha M Yearsley
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Abberly Lott Limbach
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Giovanni Lujan
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anil V Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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A comprehensive review of computer-aided whole-slide image analysis: from datasets to feature extraction, segmentation, classification and detection approaches. Artif Intell Rev 2022. [DOI: 10.1007/s10462-021-10121-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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4
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Bertram CA, Stathonikos N, Donovan TA, Bartel A, Fuchs-Baumgartinger A, Lipnik K, van Diest PJ, Bonsembiante F, Klopfleisch R. Validation of digital microscopy: Review of validation methods and sources of bias. Vet Pathol 2021; 59:26-38. [PMID: 34433345 PMCID: PMC8761960 DOI: 10.1177/03009858211040476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Digital microscopy (DM) is increasingly replacing traditional light microscopy (LM) for performing routine diagnostic and research work in human and veterinary pathology. The DM workflow encompasses specimen preparation, whole-slide image acquisition, slide retrieval, and the workstation, each of which has the potential (depending on the technical parameters) to introduce limitations and artifacts into microscopic examination by pathologists. Performing validation studies according to guidelines established in human pathology ensures that the best-practice approaches for patient care are not deteriorated by implementing DM. Whereas current publications on validation studies suggest an overall high reliability of DM, each laboratory is encouraged to perform an individual validation study to ensure that the DM workflow performs as expected in the respective clinical or research environment. With the exception of validation guidelines developed by the College of American Pathologists in 2013 and its update in 2021, there is no current review of the application of methods fundamental to validation. We highlight that there is high methodological variation between published validation studies, each having advantages and limitations. The diagnostic concordance rate between DM and LM is the most relevant outcome measure, which is influenced (regardless of the viewing modality used) by different sources of bias including complexity of the cases examined, diagnostic experience of the study pathologists, and case recall. Here, we review 3 general study designs used for previous publications on DM validation as well as different approaches for avoiding bias.
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Affiliation(s)
- Christof A Bertram
- University of Veterinary Medicine, Vienna, Austria.,Freie Universität Berlin, Berlin, Germany
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Cho WC, Gill P, Aung PP, Gu J, Nagarajan P, Ivan D, Curry JL, Prieto VG, Torres-Cabala CA. The utility of digital pathology in improving the diagnostic skills of pathology trainees in commonly encountered pigmented cutaneous lesions during the COVID-19 pandemic: A single academic institution experience. Ann Diagn Pathol 2021; 54:151807. [PMID: 34418768 PMCID: PMC8450757 DOI: 10.1016/j.anndiagpath.2021.151807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
Digital pathology has become an integral part of pathology education in recent years, particularly during the COVID-19 pandemic, for its potential utility as a teaching tool that augments the traditional 1-to-1 sign-out experience. Herein, we evaluate the utility of whole slide imaging (WSI) in reducing diagnostic errors in pigmented cutaneous lesions by pathology fellows without subspecialty training in dermatopathology. Ten cases of 4 pigmented cutaneous lesions commonly encountered by general pathologists were selected. Corresponding whole slide images were distributed to our fellows, along with two sets of online surveys, each composed of 10 multiple-choice questions with 4 answers. Identical cases were used for both surveys to minimize variability in trainees' scores depending on the perceived level of difficulty, with the second set being distributed after random shuffling. Brief image-based teaching slides as self-assessment tool were provided to trainees between each survey. Pre- and post-self-assessment scores were analyzed. 61% (17/28) and 39% (11/28) of fellows completed the first and second surveys, respectively. The mean score in the first survey was 5.2/10. The mean score in the second survey following self-assessment increased to 7.2/10. 64% (7/11) of trainees showed an improvement in their scores, with 1 trainee improving his/her score by 8 points. No fellow scored less post-self-assessment than on the initial assessment. The difference in individual scores between two surveys was statistically significant (p = 0.003). Our study demonstrates the utility of WSI-based self-assessment learning as a source of improving diagnostic skills of pathology trainees in a short period of time.
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Affiliation(s)
- Woo Cheal Cho
- Department of Pathology, University of Texas, MD Anderson Cancer Center, United States of America
| | - Pavandeep Gill
- Department of Pathology, University of Texas, MD Anderson Cancer Center, United States of America
| | - Phyu P Aung
- Department of Pathology, University of Texas, MD Anderson Cancer Center, United States of America
| | - Jun Gu
- School of Health Professions, University of Texas, MD Anderson Cancer Center, United States of America
| | - Priyadharsini Nagarajan
- Department of Pathology, University of Texas, MD Anderson Cancer Center, United States of America
| | - Doina Ivan
- Department of Pathology, University of Texas, MD Anderson Cancer Center, United States of America
| | - Jonathan L Curry
- Department of Pathology, University of Texas, MD Anderson Cancer Center, United States of America
| | - Victor G Prieto
- Department of Pathology, University of Texas, MD Anderson Cancer Center, United States of America
| | - Carlos A Torres-Cabala
- Department of Pathology, University of Texas, MD Anderson Cancer Center, United States of America.
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6
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Buabbas AJ, Mohammad T, Ayed AK, Mallah H, Al-Shawaf H, Khalfan AM. Evaluating the success of the tele-pathology system in governmental hospitals in Kuwait: an explanatory sequential mixed methods design. BMC Med Inform Decis Mak 2021; 21:229. [PMID: 34340685 PMCID: PMC8326651 DOI: 10.1186/s12911-021-01567-x] [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: 03/24/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telepathology is the practice of reviewing and exchanging pathological images through telecommunication systems to obtain diagnoses remotely. Studying the factors that make such a system successful and favourable is important to ensure the merits of its implementation in clinical practice. OBJECTIVE This study aims to evaluate the success of a telepathology system from the users' perspectives, using specific evaluation criteria, namely: system quality, information quality, technical service quality, user satisfaction, and benefits. METHODS A sequential explanatory mixed methods design was adopted in this study, which consists of two phases. Initially, a questionnaire was distributed via WhatsApp to all of the pathologists (total: 45) working at governmental hospitals in Kuwait. Followed by, semi-structured interviews with ten senior pathologists. RESULTS Forty pathologists responded to the questionnaire, giving an 89% response rate. There were 42.5% of the respondents aged between 35-44 years old, and 52.5% were male. The quantitative results reveal that most of the respondents were satisfied with the quality of the telepathology system with a mean of 2.6025 (Standard Deviation (SD) = 0.47176), whereas they were dissatisfied with the quality of the information with a mean of 2.4100 (SD = 1.580) and the technical support services with a mean of 2.2750 (SD = 0.99535). In addition, there was disagreement on the benefits of telepathology in clinical practice among the pathologists with a mean of 2.4667 (SD = 0.77552). The qualitative results indicate that the lack of interest in and little experience with using the system were behind the general dissatisfaction of most of the respondents. All of the interviewees were satisfied with the performance of the telepathology system and considered it successful; however, the quality of the technical support services, including training workshops, was deemed deficient. CONCLUSION This study concluded that telepathology system in Kuwait is functioning well and has been successful in its implementation; however, pathologists are dissatisfied with it, mainly due to the deficient quality of the technical support services provided. In addition, the successful implementation of such advanced technologies requires careful steps to be taken on multiple levels: technical, organisational, and managerial. Recommendations were suggested.
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Affiliation(s)
- Ali Jasem Buabbas
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Safat 13110, P.O. Box 24923, Jabriya, Kuwait.
| | - Tareq Mohammad
- Department of Pathology, Jaber Al Ahmad Al Sabah Hospital, Ministry of Health, South Surra, Kuwait
| | - Adel K Ayed
- Department of Surgery, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Hawraa Mallah
- Department of Internal Medicine, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Kuwait
| | - Hamza Al-Shawaf
- Department of Health Informatics and Information Management, Allied Health Sciences, Kuwait University, Jabriya, Kuwait
| | - Abdulwahed Mohammed Khalfan
- Department of Computing and Information Systems, The Public Authority for Applied Education and Training, Ardhiya, Kuwait
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7
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Redline RW, Vik T, Heerema-McKenney A, Jamtoy AH, Ravishankar S, Ton Nu TN, Vogt C, Ng P, Nelson KB, Lydersen S, Oskoui M. Interobserver Reliability for Identifying Specific Patterns of Placental Injury as Defined by the Amsterdam Classification. Arch Pathol Lab Med 2021; 146:372-378. [PMID: 34252177 DOI: 10.5858/arpa.2020-0753-oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Placental pathology is an essential tool for understanding neonatal illness. The recent Amsterdam international consensus has standardized criteria and terminology, providing harmonized data for research and clinical care. OBJECTIVE.— To evaluate the interobserver reliability of these criteria between pathologists at different levels of experience using digitally scanned slides from placentas in a birth population including a large proportion of normal deliveries. DESIGN.— This was a secondary analysis of selected placentas from a large case-control study of placental lesions associated with neonatal encephalopathy. Histologic slides from 80 placentas were digitally scanned and blindly evaluated by 6 pathologists. Interobserver reliability was assessed by positive and negative agreement, Fleiss κ, and interrater correlation coefficients. RESULTS.— Overall agreement on the diagnosis, grading, and staging of acute chorioamnionitis and villitis of unknown etiology was moderate to good for all observers and good to excellent for a subset of 4 observers. Agreement on the diagnosis and subtyping of fetal vascular malperfusion was poor to fair for all observers and fair to moderate for the subset of 4 pathologists. Agreement on accelerated villous maturation was poor. CONCLUSIONS.— This study critically evaluates interobserver reliability for lesions defined by the Amsterdam consensus using scanned images with a low frequency of pathologic lesions. Although reliability was good to excellent for inflammatory lesions, lower reliability for vascular lesions emphasizes the need to more explicitly define the specific histologic features and boundaries for these patterns.
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Affiliation(s)
- Raymond W Redline
- From the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Redline, Ravishankar)
| | - Torstein Vik
- The Department of Clinical and Molecular Medicine (Vik, Vogt), Norwegian University of Science and Technology, Trondheim, Norway
| | - Amy Heerema-McKenney
- The Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Heerema-McKenney)
| | - Ann-Helen Jamtoy
- The Department of Pathology, St Olavs Hospital, Trondheim University Hospital, Norway (Jamtoy, Vogt)
| | - Sanjita Ravishankar
- From the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Redline, Ravishankar)
| | | | - Christina Vogt
- The Department of Clinical and Molecular Medicine (Vik, Vogt), Norwegian University of Science and Technology, Trondheim, Norway.,The Department of Pathology, St Olavs Hospital, Trondheim University Hospital, Norway (Jamtoy, Vogt)
| | - Pamela Ng
- The Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada (Ng)
| | - Karin B Nelson
- The National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (Nelson)
| | - Stian Lydersen
- Department of Mental Health (Lydersen), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Maryam Oskoui
- The Departments of Pediatrics and Neurology and Neurosurgery (Oskoui), McGill University, Montreal, Quebec, Canada
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Validation of Whole Slide Imaging for Intraoperative Consultation During Mohs Micrographic Surgery. Dermatol Surg 2021; 47:703-705. [PMID: 33259167 DOI: 10.1097/dss.0000000000002545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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9
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Gavrielides MA, Ronnett BM, Vang R, Sheikhzadeh F, Seidman JD. Selection of Representative Histologic Slides in Interobserver Reproducibility Studies: Insights from Expert Review for Ovarian Carcinoma Subtype Classification. J Pathol Inform 2021; 12:15. [PMID: 34012719 PMCID: PMC8112350 DOI: 10.4103/jpi.jpi_56_20] [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: 06/25/2020] [Revised: 09/02/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Observer studies in pathology often utilize a limited number of representative slides per case, selected and reported in a nonstandardized manner. Reference diagnoses are commonly assumed to be generalizable to all slides of a case. We examined these issues in the context of pathologist concordance for histologic subtype classification of ovarian carcinomas (OCs). MATERIALS AND METHODS A cohort of 114 OCs consisting of 72 cases with a single representative slide (Group 1) and 42 cases with multiple representative slides (148 slides, 2-6 sections per case, Group 2) was independently reviewed by three experts in gynecologic pathology (case-based review). In a follow-up study, each individual slide was independently reviewed in a randomized order by the same pathologists (section-based review). RESULTS Average interobserver concordance varied from 100% for Group 1 to 64.3% for Group 2 (86.8% across all cases). Across Group 2, 19 cases (45.2%) had at least one slide classified as a different subtype than the subtype assigned from case-based review, demonstrating the impact of intratumoral heterogeneity. Section-based concordance across individual sections from Group 2 was comparable to case-based concordance for those cases indicating diagnostic challenges at the individual section level. Findings demonstrate the increased diagnostic complexity of heterogeneous tumors that require multiple section sampling and its impact on pathologist performance. CONCLUSIONS The proportion of cases with multiple representative slides in cohorts used in validation studies, such as those conducted to evaluate artificial intelligence/machine learning tools, can influence diagnostic performance, and if not accounted for, can cause disparities between research and real-world observations and between research studies. Case selection in validation studies should account for tumor heterogeneity to create balanced datasets in terms of diagnostic complexity.
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Affiliation(s)
- Marios A. Gavrielides
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA, (Currently at AstraZeneca, Precision Medicine and Biosamples, Gaithersburg, Maryland, USA)
| | - Brigitte M. Ronnett
- Department of Pathology and Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Russell Vang
- Department of Pathology and Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Fahime Sheikhzadeh
- Electrical and Computer Engineering Department, University of British Columbia, Vancouver, Canada, (Currently at Roche Diagnostics, San Francisco, California, USA)
| | - Jeffrey D Seidman
- Division of Molecular Genetics and Pathology, Office of In Vitro Diagnostics and Radiological Health, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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10
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Blum AE, Murphy GF, Lee JJ. Digital dermatopathology: The time is now. J Cutan Pathol 2021; 48:469-471. [PMID: 33345364 DOI: 10.1111/cup.13944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/02/2020] [Accepted: 12/13/2020] [Indexed: 12/16/2022]
Abstract
To continue to provide expert specialized care during the COVID-19 pandemic, our dermatopathology service transitioned to a secure virtual microscopy platform. In our experience, this digitally-enabled dermatopathology practice revealed myriad benefits, including an improved diagnostic workflow and increased access to teaching. Whole slide imaging (WSI) is a related system that digitizes glass slides with high resolution and has been clinically validated for primary diagnosis. While WSI requires an initial institutional investment, its benefits include expanded access to subspecialized expertise and collaborations, digital histopathologic data generation for research, unification of patient clinical and pathologic information, and archiving of educational resources. The switch to digitally-enabled remote dermatopathology at our institution and across the United States presents a rare opportunity to critically examine newly implemented systems and to develop permanent digital solutions, thereby taking a leap forward for the benefit of patient care, research, and medical education.
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Affiliation(s)
- Amy E Blum
- Harvard Medical School, Boston, Massachusetts, USA
| | - George F Murphy
- Harvard Medical School, Boston, Massachusetts, USA.,Program in Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jonathan J Lee
- Harvard Medical School, Boston, Massachusetts, USA.,Program in Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Alcaraz-Mateos E, Turic I, Nieto-Olivares A, Pérez-Ramos M, Poblet E. Head-tracking as an interface device for image control in digital pathology: a comparative study. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2020; 53:213-217. [PMID: 33012490 PMCID: PMC7343653 DOI: 10.1016/j.patol.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Inasmuch as the conventional mouse is not an ideal input device for digital pathology, the aim of this study was to evaluate alternative systems with the goal of identifying a natural user interface (NUI) for controlling whole slide images (WSI). DESIGN Four pathologists evaluated three webcam-based, head-tracking mouse emulators: Enable Viacam (eViacam, CREA Software), Nouse (JLG Health Solutions Inc), and Camera Mouse (CM Solutions Inc). Twenty WSI dermatopathological cases were randomly selected and examined with Image Viewer (Ventana, AZ, USA). The NASA-TLX was used to rate the perceived workload of using these systems and time was recorded. In addition, a satisfaction survey was used. RESULTS The mean total time needed for diagnosis with Camera Mouse, eViacam, and Nouse was 18'57", 19'37" and 22'32", respectively (57/59/68seconds per case, respectively). The NASA-TLX workload score, where lower scores are better, was 42.1 for eViacam, 53.3 for Nouse and 60.62 for Camera Mouse. This correlated with the pathologists' degree of satisfaction on a scale of 1-5: 3.4 for eViacam, 3 for Nouse, and 2 for Camera Mouse (p<0.05). CONCLUSIONS Head-tracking systems enable pathologists to control the computer cursor and virtual slides without their hands using only a webcam as an input device. - Of the three software solutions examined, eViacam seems to be the best of those evaluated in this study, followed by Nouse and, finally, Camera Mouse. - Further studies integrating other systems should be performed in conjunction with software developments to identify the ideal device for digital pathology.
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Affiliation(s)
- Eduardo Alcaraz-Mateos
- Servicio de Anatomía Patológica. Hospital Universitario Morales Meseguer, Murcia, España. Av. Marqués de los Vélez s/n, 30008, Murcia, España.
| | - Iva Turic
- Faculty of Medicine, University of Split, Split, Croatia. Poljička cesta 35, 21000, Split, Croacia
| | - Andrés Nieto-Olivares
- Servicio de Anatomía Patológica. Hospital Universitario Morales Meseguer, Murcia, España. Av. Marqués de los Vélez s/n, 30008, Murcia, España
| | - Miguel Pérez-Ramos
- Servicio de Anatomía Patológica. Hospital Universitario Morales Meseguer, Murcia, España. Av. Marqués de los Vélez s/n, 30008, Murcia, España
| | - Enrique Poblet
- Servicio de Anatomía Patológica. Hospital Universitario Reina Sofía, Murcia, España. Av. Intendente Jorge Palacios, 1, 30003, Murcia, España
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“Teledermatopathology: A Review”. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Onega T, Barnhill RL, Piepkorn MW, Longton GM, Elder DE, Weinstock MA, Knezevich SR, Reisch LM, Carney PA, Nelson HD, Radick AC, Elmore JG. Accuracy of Digital Pathologic Analysis vs Traditional Microscopy in the Interpretation of Melanocytic Lesions. JAMA Dermatol 2018; 154:1159-1166. [PMID: 30140929 PMCID: PMC6233746 DOI: 10.1001/jamadermatol.2018.2388] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/29/2018] [Indexed: 11/14/2022]
Abstract
Importance Use of digital whole-slide imaging (WSI) for dermatopathology in general has been noted to be similar to traditional microscopy (TM); however, concern has been noted that WSI is inferior for interpretation of melanocytic lesions. Since approximately 1 of every 4 skin biopsies is of a melanocytic lesion, the use of WSI requires verification before use in clinical practice. Objective To compare pathologists' accuracy and reproducibility in diagnosing melanocytic lesions using Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) categories when analyzing by TM vs WSI. Design, Setting, and Participants A total of 87 pathologists in community-based and academic settings from 10 US states were randomized with stratification based on clinical experience to interpret in TM format 180 skin biopsy cases of melanocytic lesions, including 90 invasive melanoma, divided into 5 sets of 36 cases (phase 1). The pathologists were then randomized via stratified permuted block randomization with block size 2 to interpret cases in either TM (n = 46) or WSI format (n = 41), with each pathologist interpreting the same 36 cases on 2 separate occasions (phase 2). Diagnoses were categorized as MPATH-Dx categories I through V, with I indicating the least severe and V the most severe. Main Outcomes and Measures Accuracy with respect to a consensus reference diagnosis and the reproducibility of repeated interpretations of the same cases. Results Of the 87 pathologists in the study, 46% (40) were women and the mean (SD) age was 50.7 (10.2) years. Except for class III melanocytic lesions, the diagnostic categories showed no significant differences in diagnostic accuracy between TM and WSI interpretation. Discordance was lower among class III lesions for the TM interpretation arm (51%; 95% CI, 46%-57%) than for the WSI arm (61%; 95% CI, 53%-69%) (P = .05). This difference is likely to have clinical significance, because 6% of TM vs 11% of WSI class III lesions were interpreted as invasive melanoma. Reproducibility was similar between the traditional and digital formats overall (66.4%; 95% CI, 63.3%-69.3%; and 62.7%; 95% CI, 59.5%-65.7%, respectively), and for all classes, although class III showed a nonsignificant lower intraobserver agreement for digital. Significantly more mitotic figures were detected with TM compared with WSI: mean (SD) TM, 6.72 (2.89); WSI, 5.84 (2.56); P = .002. Conclusions and Relevance Interpretive accuracy for melanocytic lesions was similar for WSI and TM slides except for class III lesions. We found no clinically meaningful differences in reproducibility for any of the diagnostic classes.
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Affiliation(s)
- Tracy Onega
- Departments of Medicine and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Raymond L. Barnhill
- Department of Pathology, Institut Curie, Paris Sciences and Lettres Research University, and Faculty of Medicine University of Paris Descartes, Paris, France
| | - Michael W. Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle
- Dermatopathology Northwest, Bellevue, Washington
| | - Gary M. Longton
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David E. Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Martin A. Weinstock
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island
- Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island
| | | | - Lisa M. Reisch
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Patricia A. Carney
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland
| | - Heidi D. Nelson
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland
- Department of Medicine, School of Medicine, Oregon Health & Science University, Portland
- Providence Cancer Center, Providence Health and Services, Portland, Oregon
| | - Andrea C. Radick
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Joann G. Elmore
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Zarella MD, Quaschnick MR, Breen DE, Garcia FU. Estimation of Fine-Scale Histologic Features at Low Magnification. Arch Pathol Lab Med 2018; 142:1394-1402. [PMID: 29911887 DOI: 10.5858/arpa.2017-0380-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Whole-slide imaging has ushered in a new era of technology that has fostered the use of computational image analysis for diagnostic support and has begun to transfer the act of analyzing a slide to computer monitors. Due to the overwhelming amount of detail available in whole-slide images, analytic procedures-whether computational or visual-often operate at magnifications lower than the magnification at which the image was acquired. As a result, a corresponding reduction in image resolution occurs. It is unclear how much information is lost when magnification is reduced, and whether the rich color attributes of histologic slides can aid in reconstructing some of that information. OBJECTIVE.— To examine the correspondence between the color and spatial properties of whole-slide images to elucidate the impact of resolution reduction on the histologic attributes of the slide. DESIGN.— We simulated image resolution reduction and modeled its effect on classification of the underlying histologic structure. By harnessing measured histologic features and the intrinsic spatial relationships between histologic structures, we developed a predictive model to estimate the histologic composition of tissue in a manner that exceeds the resolution of the image. RESULTS.— Reduction in resolution resulted in a significant loss of the ability to accurately characterize histologic components at magnifications less than ×10. By utilizing pixel color, this ability was improved at all magnifications. CONCLUSIONS.— Multiscale analysis of histologic images requires an adequate understanding of the limitations imposed by image resolution. Our findings suggest that some of these limitations may be overcome with computational modeling.
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Affiliation(s)
| | | | | | - Fernando U Garcia
- From the Departments of Pathology & Laboratory Medicine (Dr Zarella) and Computer Science (Mr Quaschnick and Dr Breen), Drexel University, Philadelphia, Pennsylvania; and the Department of Pathology & Laboratory Medicine, Cancer Treatment Centers of America, Eastern Regional Medical Center, Philadelphia, Pennsylvania (Dr Garcia)
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Bertram CA, Gurtner C, Dettwiler M, Kershaw O, Dietert K, Pieper L, Pischon H, Gruber AD, Klopfleisch R. Validation of Digital Microscopy Compared With Light Microscopy for the Diagnosis of Canine Cutaneous Tumors. Vet Pathol 2018; 55:490-500. [PMID: 29402206 DOI: 10.1177/0300985818755254] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Integration of new technologies, such as digital microscopy, into a highly standardized laboratory routine requires the validation of its performance in terms of reliability, specificity, and sensitivity. However, a validation study of digital microscopy is currently lacking in veterinary pathology. The aim of the current study was to validate the usability of digital microscopy in terms of diagnostic accuracy, speed, and confidence for diagnosing and differentiating common canine cutaneous tumor types and to compare it to classical light microscopy. Therefore, 80 histologic sections including 17 different skin tumor types were examined twice as glass slides and twice as digital whole-slide images by 6 pathologists with different levels of experience at 4 time points. Comparison of both methods found digital microscopy to be noninferior for differentiating individual tumor types within the category epithelial and mesenchymal tumors, but diagnostic concordance was slightly lower for differentiating individual round cell tumor types by digital microscopy. In addition, digital microscopy was associated with significantly shorter diagnostic time, but diagnostic confidence was lower and technical quality was considered inferior for whole-slide images compared with glass slides. Of note, diagnostic performance for whole-slide images scanned at 200× magnification was noninferior in diagnostic performance for slides scanned at 400×. In conclusion, digital microscopy differs only minimally from light microscopy in few aspects of diagnostic performance and overall appears adequate for the diagnosis of individual canine cutaneous tumors with minor limitations for differentiating individual round cell tumor types and grading of mast cell tumors.
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Affiliation(s)
- Christof A Bertram
- 1 Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Corinne Gurtner
- 1 Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany.,2 Institute of Animal Pathology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Martina Dettwiler
- 2 Institute of Animal Pathology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Olivia Kershaw
- 1 Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Kristina Dietert
- 1 Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Laura Pieper
- 3 Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| | - Hannah Pischon
- 1 Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Achim D Gruber
- 1 Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Robert Klopfleisch
- 1 Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
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Validation of Digital Pathology for Primary Histopathological Diagnosis of Routine, Inflammatory Dermatopathology Cases. Am J Dermatopathol 2018; 40:17-23. [DOI: 10.1097/dad.0000000000000888] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fertig RM, Gaudi S, Cervantes J, Maddy A, Sangueza O, Vu J, Ho J, Jukic DM. Feasibility study in teledermatopathology: An examination of the histopathologic features of mycosis fungoides and spongiotic dermatitis. J Cutan Pathol 2017; 44:919-924. [PMID: 28796294 DOI: 10.1111/cup.13018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/28/2017] [Accepted: 08/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Digital pathology offers numerous advantages, allowing remote information sharing using whole slide imaging (WSI) to digitize an entire glass slide (GS) at high resolution, creating a digital slide (DS). METHODS In this study, we examine the concordance in diagnoses made on 40 digital slides (DSs) vs traditional GSs in differentiating between spongiotic dermatitis (SD) and patch/plaque-stage mycosis fungoides (MF). RESULTS Greater interobserver concordance rate in final diagnosis of SD vs MF was observed with the utilization of DS (86.7%) compared with the utilization of GS (80%). Intraobserver concordance rate between the diagnoses rendered by a particular dermatopathologist on GS and DS was 86.7%. For all histopathological criteria, a correlation in the magnitudes of interobserver vs intraobserver discordances suggests that discordance between glass vs digital evaluation of these criteria may be largely expected subjective read variation independent of the media. Discordance in identification of histopathological features did not have a statistically significant link to discordance in diagnosis for 7 out of the 8 features. CONCLUSIONS The similarity between interobserver and intraobserver discordances suggests that WSI does not introduce additional barriers or variability to accurately identify histopathologic feature and to discriminate between MF and SD beyond interobserver variability.
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Affiliation(s)
- Raymond M Fertig
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Sudeep Gaudi
- Pathology and Laboratory Medicine Service, James A Haley VA Hospital, Tampa, Florida
| | - Jessica Cervantes
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Austin Maddy
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Omar Sangueza
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John Vu
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jonhan Ho
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Drazen M Jukic
- Pathology and Laboratory Medicine Service, James A Haley VA Hospital, Tampa, Florida.,Georgia Dermatopathology, Savannah, Georgia.,Department of Dermatology, University of Florida, Gainesville, Florida
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