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Chen W, Ziebell J, Arole V, Parkinson B, Yu L, Dai H, Frankel WL, Yearsley M, Esnakula A, Sun S, Gamble D, Vazzano J, Mishra M, Schoenfield L, Kneile J, Reuss S, Schumacher M, Satturwar S, Li Z, Parwani A, Lujan G. Comparing Accuracy of Helicobacter pylori Identification Using Traditional Hematoxylin and Eosin-Stained Glass Slides With Digital Whole Slide Imaging. J Transl Med 2024; 104:100262. [PMID: 37839639 DOI: 10.1016/j.labinv.2023.100262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023] Open
Abstract
With advancements in the field of digital pathology, there has been a growing need to compare the diagnostic abilities of pathologists using digitized whole slide images against those when using traditional hematoxylin and eosin (H&E)-stained glass slides for primary diagnosis. One of the most common specimens received in pathology practices is an endoscopic gastric biopsy with a request to rule out Helicobacter pylori (H. pylori) infection. The current standard of care is the identification of the organisms on H&E-stained slides. Immunohistochemical or histochemical stains are used selectively. However, due to their small size (2-4 μm in length by 0.5-1 μm in width), visualization of the organisms can present a diagnostic challenge. The goal of the study was to compare the ability of pathologists to identify H. pylori on H&E slides using a digital platform against the gold standard of H&E glass slides using routine light microscopy. Diagnostic accuracy rates using glass slides vs digital slides were 81% vs 72% (P = .0142) based on H&E slides alone. When H. pylori immunohistochemical slides were provided, the diagnostic accuracy was significantly improved to comparable rates (96% glass vs 99% digital, P = 0.2199). Furthermore, differences in practice settings (academic/subspecialized vs community/general) and the duration of sign-out experience did not significantly impact the accuracy of detecting H. pylori on digital slides. We concluded that digital whole slide images, although amenable in different practice settings and teaching environments, does present some shortcomings in accuracy and precision, especially in certain circumstances and thus is not yet fully capable of completely replacing glass slide review for identification of H. pylori. We specifically recommend reviewing glass slides and/or performing ancillary stains, especially when there is a discrepancy between the degree of inflammation and the presence of microorganisms on digital images.
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Affiliation(s)
- Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jennifer Ziebell
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vidya Arole
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryce Parkinson
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lianbo Yu
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Harrison Dai
- Eastern Virginia Medical School, Norfolk, Virginia
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Martha Yearsley
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ashwini Esnakula
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shaoli Sun
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Denise Gamble
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jennifer Vazzano
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Manisha Mishra
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lynn Schoenfield
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey Kneile
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sarah Reuss
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Melinda Schumacher
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Swati Satturwar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anil Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Giovanni Lujan
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Arole V, Shaker N, Kim LR, Iwenofu OH. Multiple Cutaneous Solitary Circumscribed Neuroma in a Patient with Neurofibromatosis Type 2: An "Incidentaloma" or New Association? Int J Surg Pathol 2022:10668969221120782. [PMID: 36128789 DOI: 10.1177/10668969221120782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solitary circumscribed neuroma formerly known as palisaded encapsulated neuroma is a rare, benign neural tumor that usually presents as a painless firm nodule or papule on the face and within oral cavity, although they can occur elsewhere on the body. No association with neurofibromatosis has been reported in the literature. Herein, we report, a previously unreported unique association of neurofibromatosis type 2 (NF-2) with multiple cutaneous solitary circumscribed neuromas in a 24-year-old female. A 24-year-old female with history of NF-2 presented with two slow-growing soft-to-firm papules on the chin and forehead that had been gradually increasing in size over a period of 5 years. The papule on the chin was increasingly tender to palpation. Histologic sections demonstrated a dermal based almost encapsulated, smoothly contoured tumefactive mass composed of spindle cell proliferation with neuroid structures and foci of palisaded growth (resembling schwannoma) and intralesional cleft like spaces. By immunohistochemistry, the lesional cells were strongly and diffusely positive for S-100 and SOX10 with multifocal neurofilament expression while the "capsule" was diffusely reactive for epithelial membrane antigen. The overall features were considered prototypic for solitary circumscribed neuroma. The patient is 18-months post-surgical resection with no evidence of recurrence. In summary, we report for the first time a case of multiple solitary circumscribed neuromas in a patient with known NF2. We highlight pertinent diagnostic clues relevant to surgical pathologist to facilitate recognition (as this tumor is often mistaken for schwannoma or neurofibroma). The clinical behavior is excellent and surgical resection is considered curative.
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Affiliation(s)
- Vidya Arole
- Department of Pathology & Laboratory Medicine, 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nada Shaker
- Department of Pathology & Laboratory Medicine, 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Leslie R Kim
- Department of Otolaryngology-Head & Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - O Hans Iwenofu
- Department of Pathology & Laboratory Medicine, 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA.,The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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Scarl R, Parkinson B, Arole V, Hardy T, Allenby P. The hospital autopsy: the importance in keeping autopsy an option. Autops Case Rep 2022; 12:e2021333. [PMID: 35252044 PMCID: PMC8890781 DOI: 10.4322/acr.2021.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/04/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Rachel Scarl
- The Ohio State University, Wexner Medical Center, Department of Pathology, Columbus, Ohio, USA
| | - Bryce Parkinson
- The Ohio State University, Wexner Medical Center, Department of Pathology, Columbus, Ohio, USA
| | - Vidya Arole
- The Ohio State University, Wexner Medical Center, Department of Pathology, Columbus, Ohio, USA
| | - Tanner Hardy
- The Ohio State University, Wexner Medical Center, Department of Pathology, Columbus, Ohio, USA
| | - Patricia Allenby
- The Ohio State University, Wexner Medical Center, Department of Pathology, Columbus, Ohio, USA
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Tavolara TE, Niazi MKK, Arole V, Chen W, Frankel W, Gurcan MN. Author Correction: A modular cGAN classification framework: Application to colorectal tumor detection. Sci Rep 2020; 10:2398. [PMID: 32024961 PMCID: PMC7002676 DOI: 10.1038/s41598-020-59307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Thomas E Tavolara
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, USA
| | - M Khalid Khan Niazi
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, USA.
| | - Vidya Arole
- Department of Pathology, The Ohio State University, Columbus, USA
| | - Wei Chen
- Department of Pathology, The Ohio State University, Columbus, USA
| | - Wendy Frankel
- Department of Pathology, The Ohio State University, Columbus, USA
| | - Metin N Gurcan
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, USA
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Tavolara TE, Niazi MKK, Arole V, Chen W, Frankel W, Gurcan MN. A modular cGAN classification framework: Application to colorectal tumor detection. Sci Rep 2019; 9:18969. [PMID: 31831792 PMCID: PMC6908583 DOI: 10.1038/s41598-019-55257-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/11/2019] [Indexed: 01/24/2023] Open
Abstract
Automatic identification of tissue structures in the analysis of digital tissue biopsies remains an ongoing problem in digital pathology. Common barriers include lack of reliable ground truth due to inter- and intra- reader variability, class imbalances, and inflexibility of discriminative models. To overcome these barriers, we are developing a framework that benefits from a reliable immunohistochemistry ground truth during labeling, overcomes class imbalances through single task learning, and accommodates any number of classes through a minimally supervised, modular model-per-class paradigm. This study explores an initial application of this framework, based on conditional generative adversarial networks, to automatically identify tumor from non-tumor regions in colorectal H&E slides. The average precision, sensitivity, and F1 score during validation was 95.13 ± 4.44%, 93.05 ± 3.46%, and 94.02 ± 3.23% and for an external test dataset was 98.75 ± 2.43%, 88.53 ± 5.39%, and 93.31 ± 3.07%, respectively. With accurate identification of tumor regions, we plan to further develop our framework to establish a tumor front, from which tumor buds can be detected in a restricted region. This model will be integrated into a larger system which will quantitatively determine the prognostic significance of tumor budding.
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Affiliation(s)
- Thomas E Tavolara
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, USA
| | - M Khalid Khan Niazi
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, USA.
| | - Vidya Arole
- Department of Pathology, The Ohio State University, Columbus, USA
| | - Wei Chen
- Department of Pathology, The Ohio State University, Columbus, USA
| | - Wendy Frankel
- Department of Pathology, The Ohio State University, Columbus, USA
| | - Metin N Gurcan
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, USA
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Niazi MKK, Senaras C, Pennell M, Arole V, Tozbikian G, Gurcan MN. Relationship between the Ki67 index and its area based approximation in breast cancer. BMC Cancer 2018; 18:867. [PMID: 30176814 PMCID: PMC6122570 DOI: 10.1186/s12885-018-4735-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 08/08/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Ki67 Index has been extensively studied as a prognostic biomarker in breast cancer. However, its clinical adoption is largely hampered by the lack of a standardized method to assess Ki67 that limits inter-laboratory reproducibility. It is important to standardize the computation of the Ki67 Index before it can be effectively used in clincial practice. METHOD In this study, we develop a systematic approach towards standardization of the Ki67 Index. We first create the ground truth consisting of tumor positive and tumor negative nuclei by registering adjacent breast tissue sections stained with Ki67 and H&E. The registration is followed by segmentation of positive and negative nuclei within tumor regions from Ki67 images. The true Ki67 Index is then approximated with a linear model of the area of positive to the total area of tumor nuclei. RESULTS When tested on 75 images of Ki67 stained breast cancer biopsies, the proposed method resulted in an average root mean square error of 3.34. In comparison, an expert pathologist resulted in an average root mean square error of 9.98 and an existing automated approach produced an average root mean square error of 5.64. CONCLUSIONS We show that it is possible to approximate the true Ki67 Index accurately without detecting individual nuclei and also statically demonstrate the weaknesses of commonly adopted approaches that use both tumor and non-tumor regions together while compensating for the latter with higher order approximations.
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Affiliation(s)
| | - Caglar Senaras
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, USA
| | - Michael Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, USA
| | - Vidya Arole
- Department of Biomedical Informatics, The Ohio State University, Columbus, USA
| | - Gary Tozbikian
- Department of Pathology, The Ohio State University, Columbus, USA
| | - Metin N. Gurcan
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, USA
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Niazi MKK, Tavolara TE, Arole V, Hartman DJ, Pantanowitz L, Gurcan MN. Identifying tumor in pancreatic neuroendocrine neoplasms from Ki67 images using transfer learning. PLoS One 2018; 13:e0195621. [PMID: 29649302 PMCID: PMC5896941 DOI: 10.1371/journal.pone.0195621] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/26/2018] [Indexed: 12/17/2022] Open
Abstract
The World Health Organization (WHO) has clear guidelines regarding the use of Ki67 index in defining the proliferative rate and assigning grade for pancreatic neuroendocrine tumor (NET). WHO mandates the quantification of Ki67 index by counting at least 500 positive tumor cells in a hotspot. Unfortunately, Ki67 antibody may stain both tumor and non-tumor cells as positive depending on the phase of the cell cycle. Likewise, the counter stain labels both tumor and non-tumor as negative. This non-specific nature of Ki67 stain and counter stain therefore hinders the exact quantification of Ki67 index. To address this problem, we present a deep learning method to automatically differentiate between NET and non-tumor regions based on images of Ki67 stained biopsies. Transfer learning was employed to recognize and apply relevant knowledge from previous learning experiences to differentiate between tumor and non-tumor regions. Transfer learning exploits a rich set of features previously used to successfully categorize non-pathology data into 1,000 classes. The method was trained and validated on a set of whole-slide images including 33 NETs subject to Ki67 immunohistochemical staining using a leave-one-out cross-validation. When applied to 30 high power fields (HPF) and assessed against a gold standard (evaluation by two expert pathologists), the method resulted in a high sensitivity of 97.8% and specificity of 88.8%. The deep learning method developed has the potential to reduce pathologists’ workload by directly identifying tumor boundaries on images of Ki67 stained slides. Moreover, it has the potential to replace sophisticated and expensive imaging methods which are recently developed for identification of tumor boundaries in images of Ki67-stained NETs.
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Affiliation(s)
- Muhammad Khalid Khan Niazi
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston Salem, NC, United States of America
- * E-mail:
| | - Thomas Erol Tavolara
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - Vidya Arole
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States of America
| | - Douglas J. Hartman
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Metin N. Gurcan
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston Salem, NC, United States of America
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Hemminger J, Arole V, Ayoub I, Brodsky SV, Nadasdy T, Satoskar AA. Acute glomerulonephritis with large confluent IgA-dominant deposits associated with liver cirrhosis. PLoS One 2018; 13:e0193274. [PMID: 29634718 PMCID: PMC5892865 DOI: 10.1371/journal.pone.0193274] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Small glomerular IgA deposits have been reported in patients with liver cirrhosis, mainly as an incidental finding in autopsy studies. We recently encountered nine cirrhotic patients who presented with acute proliferative glomerulonephritis with unusually large, exuberant glomerular immune complex deposits, in the absence of systemic lupus erythematosus (SLE) or monoclonal gammopathy-related kidney disease. Deposits were typically IgA dominant/codominant. Our aim was to further elucidate the etiology, diagnostic pitfalls, and clinical outcomes. METHODS We present clinical features and kidney biopsy findings of nine cirrhotic patients with an unusual acute immune complex glomerulonephritis. We also identified native kidney biopsies from all patients with liver cirrhosis at our institution over a 13-year period (January 2004 to December 2016) to evaluate presence of glomerular IgA deposits in them (n = 118). RESULTS Six of nine cirrhotic patients with the large immune deposits had a recent/concurrent acute bacterial infection, prompting a diagnosis of infection-associated glomerulonephritis and treatment with antibiotics. In the remaining three patients, no infection was identified and corticosteroids were initiated. Three of nine patients recovered kidney function (one recovered kidney function after liver transplant); three patients developed chronic kidney disease but remained off dialysis; two patients became dialysis-dependent and one patient developed sepsis and expired shortly after biopsy. Within the total cohort of 118 patients with cirrhosis, 67 others also showed IgA deposits, albeit small; and 42 patients had no IgA deposits. CONCLUSIONS These cases provide support to the theory that liver dysfunction may compromise clearance of circulating immune complexes, enabling deposition in the kidney. At least in a subset of cirrhotic patients, a superimposed bacterial infection may serve as a "second-hit" and lead to acute glomerulonephritis with exuberant immune complex deposits. Therefore, a trial of antibiotics is recommended and caution is advised before immunosuppressive treatment is offered. Unfortunately, most of these patients have advanced liver failure; therefore both diagnosis and management remain a challenge.
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Affiliation(s)
- Jessica Hemminger
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Vidya Arole
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Isabelle Ayoub
- Department of Internal Medicine, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Sergey V. Brodsky
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Tibor Nadasdy
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Anjali A. Satoskar
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- * E-mail:
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Niazi MKK, Tavolara T, Arole V, Parwani A, Lee C, Gurcan M. MP58-06 AUTOMATED STAGING OF T1 BLADDER CANCER USING DIGITAL PATHOLOGIC H&E IMAGES: A DEEP LEARNING APPROACH. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bharambe V, Arole V, Vatsalaswamy P, Kulkarni P, Kulkarni P. Knowledge and attitude towards body and organ donation among people in Lanja – A rural town in India. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mishra PP, Manvikar P, Arole V, Swami V, Mishra A. Morphometric measurements of tricuspid valve in cadaveric heart from Maharashtra population. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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