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This Month in AJP. The American Journal of Pathology 2021; 191:2041. [PMID: 34666040 PMCID: PMC8520165 DOI: 10.1016/j.ajpath.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
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Schüffler PJ, Geneslaw L, Yarlagadda DVK, Hanna MG, Samboy J, Stamelos E, Vanderbilt C, Philip J, Jean MH, Corsale L, Manzo A, Paramasivam NHG, Ziegler JS, Gao J, Perin JC, Kim YS, Bhanot UK, Roehrl MHA, Ardon O, Chiang S, Giri DD, Sigel CS, Tan LK, Murray M, Virgo C, England C, Yagi Y, Sirintrapun SJ, Klimstra D, Hameed M, Reuter VE, Fuchs TJ. Integrated digital pathology at scale: A solution for clinical diagnostics and cancer research at a large academic medical center. J Am Med Inform Assoc 2021; 28:1874-1884. [PMID: 34260720 PMCID: PMC8344580 DOI: 10.1093/jamia/ocab085] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 11/25/2020] [Revised: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Broad adoption of digital pathology (DP) is still lacking, and examples for DP connecting diagnostic, research, and educational use cases are missing. We blueprint a holistic DP solution at a large academic medical center ubiquitously integrated into clinical workflows; researchapplications including molecular, genetic, and tissue databases; and educational processes. MATERIALS AND METHODS We built a vendor-agnostic, integrated viewer for reviewing, annotating, sharing, and quality assurance of digital slides in a clinical or research context. It is the first homegrown viewer cleared by New York State provisional approval in 2020 for primary diagnosis and remote sign-out during the COVID-19 (coronavirus disease 2019) pandemic. We further introduce an interconnected Honest Broker for BioInformatics Technology (HoBBIT) to systematically compile and share large-scale DP research datasets including anonymized images, redacted pathology reports, and clinical data of patients with consent. RESULTS The solution has been operationally used over 3 years by 926 pathologists and researchers evaluating 288 903 digital slides. A total of 51% of these were reviewed within 1 month after scanning. Seamless integration of the viewer into 4 hospital systems clearly increases the adoption of DP. HoBBIT directly impacts the translation of knowledge in pathology into effective new health measures, including artificial intelligence-driven detection models for prostate cancer, basal cell carcinoma, and breast cancer metastases, developed and validated on thousands of cases. CONCLUSIONS We highlight major challenges and lessons learned when going digital to provide orientation for other pathologists. Building interconnected solutions will not only increase adoption of DP, but also facilitate next-generation computational pathology at scale for enhanced cancer research.
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Affiliation(s)
- Peter J Schüffler
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Luke Geneslaw
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - D Vijay K Yarlagadda
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer Samboy
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evangelos Stamelos
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chad Vanderbilt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John Philip
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc-Henri Jean
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lorraine Corsale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allyne Manzo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neeraj H G Paramasivam
- Department of Information Systems, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John S Ziegler
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jianjiong Gao
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Juan C Perin
- Department of Information Systems, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Young Suk Kim
- School of Medicine, Stanford University, Stanford, California, USA
| | - Umeshkumar K Bhanot
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael H A Roehrl
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dilip D Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carlie S Sigel
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lee K Tan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Melissa Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christina Virgo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christine England
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukako Yagi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - S Joseph Sirintrapun
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Thomas J Fuchs
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Hofman P, Ilié M, Chamorey E, Brest P, Schiappa R, Nakache V, Antoine M, Barberis M, Begueret H, Bibeau F, Bonnetaud C, Boström P, Brousset P, Bubendorf L, Carvalho L, Cathomas G, Cazes A, Chalabreysse L, Chenard MP, Copin MC, Côté JF, Damotte D, de Leval L, Delongova P, Thomas de Montpreville V, de Muret A, Dema A, Dietmaier W, Evert M, Fabre A, Forest F, Foulet A, Garcia S, Garcia-Martos M, Gibault L, Gorkiewicz G, Jonigk D, Gosney J, Hofman A, Kern I, Kerr K, Kossai M, Kriegsmann M, Lassalle S, Long-Mira E, Lupo A, Mamilos A, Matěj R, Meilleroux J, Ortiz-Villalón C, Panico L, Panizo A, Papotti M, Pauwels P, Pelosi G, Penault-Llorca F, Pop O, Poté N, Cajal SRY, Sabourin JC, Salmon I, Sajin M, Savic-Prince S, Schildhaus HU, Schirmacher P, Serre I, Shaw E, Sizaret D, Stenzinger A, Stojsic J, Thunnissen E, Timens W, Troncone G, Werlein C, Wolff H, Berthet JP, Benzaquen J, Marquette CH, Hofman V, Calabrese F. Clinical and molecular practice of European thoracic pathology laboratories during the COVID-19 pandemic. The past and the near future. ESMO Open 2020; 6:100024. [PMID: 33399086 PMCID: PMC7780004 DOI: 10.1016/j.esmoop.2020.100024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases. Materials and methods A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID-19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019. Results Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples. Conclusions The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe. Biosafety measures used in the first wave of the COVID-19 crisis were heterogeneous in 53 European pathology laboratories. A dramatic decrease of the workload in pathology laboratories was noted. No case of healthcare workers contaminated with SARS-CoV-2 associated with samples handling was identified.
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Affiliation(s)
- P Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France.
| | - M Ilié
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - E Chamorey
- Epidemiology and Biostatistics Unit, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
| | - P Brest
- Team 4, IRCAN, INSERM, CNRS, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
| | - R Schiappa
- Epidemiology and Biostatistics Unit, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
| | - V Nakache
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - M Antoine
- Department of Pathology, Hôpital Tenon, AP-HP, Paris, France
| | - M Barberis
- Unit of Histopathology and Molecular Diagnostics, Division of Pathology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - H Begueret
- Department of Pathology, University Hospital of Bordeaux, Bordeaux, France
| | - F Bibeau
- Department of Pathology, CHU de Caen, Université de Caen Normandie, Caen, France
| | - C Bonnetaud
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - P Boström
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - P Brousset
- Department of Pathology, IUC-T-Oncopole, Inserm U1037 CRCT, Université de Toulouse, Toulouse, France
| | - L Bubendorf
- Institute of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - L Carvalho
- Institute of Anatomical and Molecular Pathology and University Hospital, University of Coimbra, Coimbra, Portugal
| | - G Cathomas
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - A Cazes
- Department of Pathology, Bichat Hospital, AP-HP, Inserm UMR 1152, Université de Paris, Paris, France
| | - L Chalabreysse
- Department of Pathology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - M-P Chenard
- Department of Pathology, University Hospital of Strasbourg, Strasbourg, France
| | - M-C Copin
- Institut de Pathologie, CHU Lille, Université de Lille, Lille, France
| | - J-F Côté
- Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | - D Damotte
- Department of Pathology, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Inserm U1138, Université de Paris, Paris, France
| | - L de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - P Delongova
- Institute of Pathology, University Hospital Ostrava, Ostrava, Czech Republic
| | | | - A de Muret
- Department of Pathology, University Hospital of Tours, Tours, France
| | - A Dema
- Department of Pathology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - W Dietmaier
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - M Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - A Fabre
- Department of Histopathology, St Vincent's University Hospital, University College Dublin School of Medicine, Dublin, Ireland
| | - F Forest
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - A Foulet
- Department of Pathology, Centre Hospitalier, Le Mans, France
| | - S Garcia
- Department of Pathology, Hôpital Nord, AP-HM, Aix Marseille University, Marseille, France
| | - M Garcia-Martos
- Pulmonary Pathology Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - L Gibault
- Department of Pathology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - G Gorkiewicz
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - D Jonigk
- Institute of Pathology, German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Hannover Medical School, Hannover, Germany
| | - J Gosney
- Liverpool University Hospitals, Royal Liverpool University Hospital, Liverpool, UK
| | - A Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - I Kern
- Department of Pathology, University Clinic Golnik, Golnik, Slovenia
| | - K Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M Kossai
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France
| | - M Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, and German Center for Lung Research (DZL), Germany
| | - S Lassalle
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - E Long-Mira
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - A Lupo
- Department of Pathology, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Inserm U1138, Université de Paris, Paris, France
| | - A Mamilos
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - R Matěj
- Department of Pathology and Molecular Medicine, Third Faculty of Medicine, Charles University, Thomayer Hospital and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - J Meilleroux
- Department of Pathology, IUC-T-Oncopole, Inserm U1037 CRCT, Université de Toulouse, Toulouse, France
| | - C Ortiz-Villalón
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - L Panico
- Unit of Pathology, Azienda Ospedaliera dei Colli, Monaldi-Cotugno-CTO, Naples, Italy
| | - A Panizo
- Department of Pathology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M Papotti
- Department of Oncology, University of Torino, Torino, Italy
| | - P Pauwels
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - G Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, and IRCCS MultiMedica, Milan, Italy
| | - F Penault-Llorca
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France
| | - O Pop
- Department of Pathology, University of Oradea, Oradea, Romania
| | - N Poté
- Department of Pathology, Bichat Hospital, AP-HP, Inserm UMR 1152, Université de Paris, Paris, France
| | - S R Y Cajal
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J-C Sabourin
- Department of Pathology, Inserm 1245, Rouen University Hospital Normandy University, Rouen, France
| | - I Salmon
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - M Sajin
- Department of Pathology, Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - S Savic-Prince
- Institute of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - H-U Schildhaus
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - P Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, and German Center for Lung Research (DZL), Germany
| | - I Serre
- Department of Biopathology, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - E Shaw
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Sizaret
- Department of Pathology, University Hospital of Tours, Tours, France
| | - A Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, and German Center for Lung Research (DZL), Germany
| | - J Stojsic
- Department of Thoracic Pathology, Service of Pathology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - E Thunnissen
- Department of Pathology, Amsterdam University Medical Centres, Location VUmc, Amsterdam, The Netherlands
| | - W Timens
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Troncone
- Department of Public Health, University of Naples Frederico II, Naples, Italy
| | - C Werlein
- Institute of Pathology, German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Hannover Medical School, Hannover, Germany
| | - H Wolff
- Laboratory of Pathology, Finnish Institute of Occupational Health, Helsinki, Finland
| | - J-P Berthet
- Department of Thoracic Surgery, FHU OnoAge, Louis Pasteur Hospital, University Côte d'Azur, Nice, France
| | - J Benzaquen
- Department of Pneumology, FHU OncoAge, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - C-H Marquette
- Department of Pneumology, FHU OncoAge, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - V Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - F Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Pathological Anatomy Section, University of Padova Medical School, Padova, Italy
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Rao J. Computational Technology with Artificial Intelligence and Machine Learning: What Should a Cytologist Do with It? Acta Cytol 2020; 65:283-285. [PMID: 32640461 DOI: 10.1159/000508215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Jianyu Rao
- Department of Pathology and Laboratory Medicine, UCLA, David Geffen School of Medicine, Los Angeles, California, USA,
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Allen TC. Philip T. Cagle, MD-Editor-in-Chief of the Archives of Pathology & Laboratory Medicine, 2005-2019. Arch Pathol Lab Med 2020; 144:133-135. [PMID: 31990227 DOI: 10.5858/arpa.2019-0905-sa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
• The Archives of Pathology & Laboratory Medicine was first published in 1926 as a specialty journal of the American Medical Association. It became the official journal of the College of American Pathologists in 1995. Under the dynamic leadership of its most recent editor-in-chief, Philip T. Cagle, MD, the Archives has dramatically increased its impact factor and become the most widely read general pathology journal. Dr. Cagle has consistently added leading pathologists to the editorial board, and the collective expertise of these individuals is clearly evident in new, cutting-edge journal masthead sections. The Archives has featured innovative content in the field of digital pathology, including articles on the utilization of smart phones in pathology and the incorporation of whole-slide images and videos into the content of articles. During the current editorial board's tenure, special sections were introduced and have proven immensely popular with the journal's readership. As the Archives celebrates its 94th anniversary, its editorial board remains committed to providing insightful and relevant medical knowledge. The journal's open access Web site ( www.archivesofpathology.org ) allows the dissemination of this information to every corner of the globe at no expense to those who wish to expand their knowledge or improve their medical practice. Dr. Cagle, with support from the editorial board and journal staff, has worked tirelessly during his tenure as Archives editor-in-chief to greatly enhance the content of the journal and its stature within pathology and laboratory medicine.
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Prabodh K Gupta
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
OBJECTIVE To explore the current and anticipated changes in the practice of cytopathology. STUDY DESIGN The present review is based on a review of recent literature and an evaluation of the authors' personal experiences. RESULTS AND CONCLUSION In recent years the practice of cytopathology, nationwide and in our institute, has witnessed a major change affecting gynecologic and nongynecologic cytology. There has been a decline in the number of Papanicolaou tests which has affected the utilization of cytotechnologists and provoked a reorganization of their work flow. The "need to do more with less" in the era of targeted therapy/personalized medicine has resulted in an increasing preference for needle core biopsy when performing a rapid on-site evaluation. We feel that this change is unavoidable. It is pertinent that cytopathologists as a group recognize this change and prepare themselves and the trainees not only to become adapt but also to use this as an opportunity to discover the yet unexplored world of cytology.
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Affiliation(s)
- Maria F Gonzalez
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
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Natkunam Y, Gratzinger D, de Jong D, Chadburn A, Goodlad JR, Chan JKC, Said J, Jaffe ES. Immunodeficiency and Dysregulation: Report of the 2015 Workshop of the Society for Hematopathology/European Association for Haematopathology. Am J Clin Pathol 2017; 147:124-128. [PMID: 28395103 DOI: 10.1093/ajcp/aqw200] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Dita Gratzinger
- From the Stanford University School of Medicine, Stanford, CA
| | - Daphne de Jong
- VU University Medical Center, Amsterdam, the Netherlands
| | - Amy Chadburn
- Weill Medical College of Cornell University, New York, NY
| | - John R Goodlad
- HMDS, St James's University Hospital, Leeds, United Kingdom
| | | | - Jonathan Said
- University of California Los Angeles Medical Center, Los Angeles
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Bartley AN, Washington MK, Ventura CB, Ismaila N, Colasacco C, Benson AB, Carrato A, Gulley ML, Jain D, Kakar S, Mackay HJ, Streutker C, Tang L, Troxell M, Ajani JA. HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology. Arch Pathol Lab Med 2016; 140:1345-1363. [PMID: 27841667 DOI: 10.5858/arpa.2016-0331-cp] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - ERBB2 (erb-b2 receptor tyrosine kinase 2 or HER2) is currently the only biomarker established for selection of a specific therapy for patients with advanced gastroesophageal adenocarcinoma (GEA). However, there are no comprehensive guidelines for the assessment of HER2 in patients with GEA. OBJECTIVES - To establish an evidence-based guideline for HER2 testing in patients with GEA, to formalize the algorithms for methods to improve the accuracy of HER2 testing while addressing which patients and tumor specimens are appropriate, and to provide guidance on clinical decision making. DESIGN - The College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology convened an expert panel to conduct a systematic review of the literature to develop an evidence-based guideline with recommendations for optimal HER2 testing in patients with GEA. RESULTS - The panel is proposing 11 recommendations with strong agreement from the open-comment participants. RECOMMENDATIONS - The panel recommends that tumor specimen(s) from all patients with advanced GEA, who are candidates for HER2-targeted therapy, should be assessed for HER2 status before the initiation of HER2-targeted therapy. Clinicians should offer combination chemotherapy and a HER2-targeted agent as initial therapy for all patients with HER2-positive advanced GEA. For pathologists, guidance is provided for morphologic selection of neoplastic tissue, testing algorithms, scoring methods, interpretation and reporting of results, and laboratory quality assurance. CONCLUSIONS - This guideline provides specific recommendations for assessment of HER2 in patients with advanced GEA while addressing pertinent technical issues and clinical implications of the results.
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Affiliation(s)
- Angela N Bartley
- From the Department of Pathology, St. Joseph Mercy Hospital, Ann Arbor, Michigan (Dr Bartley); the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Washington); Surveys (Ms Ventura) and Governance (Ms Colasacco), College of American Pathologists, Northfield, Illinois; Quality and Guidelines Department, American Society of Clinical Oncology, Alexandria, Virginia (Dr Ismaila); the Division of Hematology/Oncology, Northwestern University, Chicago, Illinois (Dr Benson); Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain (Dr Carrato); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Gulley); the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Dr Jain); the Department of Pathology and Laboratory Medicine, UCSF, San Francisco, California (Dr Kakar); the Division of Medical Oncology and Hematology, University of Toronto/Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada (Dr Mackay); the Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (Dr Streutker); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Tang); the Department of Pathology, Stanford University Medical Center, Stanford, California (Dr Troxell); and the Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston (Dr Ajani)
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Abstract
Requirements for information technology in pathology now extend well beyond the provision of purely analytical data. With the aim of achieving seamless integration of laboratory data into the total clinical pathway, 'informatics' - the art and science of turning data into useful information - is becoming increasingly important in laboratory medicine. Informatics is a powerful tool in pathology - whether in implementing processes for pathology modernization, introducing new diagnostic modalities (e.g. proteomics, genomics), providing timely and evidence-based disease management, or enabling best use of limited and often costly resources. Providing appropriate information to empowered and interested patients - which requires critical assessment of the ever-increasing volume of information available - can also benefit greatly from appropriate use of informatics. General trends in medical informatics are reflected in current priorities for laboratory medicine, including the need for unified electronic records, computerized order entry, data security and recovery, and audit. The increasing demands placed on pathology information systems in the context of wider developmental change in healthcare delivery are explored in this paper.
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Affiliation(s)
- Rick Jones
- Department of Chemical Pathology and Immunology, Leeds General Infirmary, Leeds LS1 3EX, UK
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13
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Affiliation(s)
- Yuri Fedoriw
- University of North Carolina School of Medicine, Department of Pathology and Laboratory Medicine, NC Cancer Hospital C3162-D, 101 Manning Drive, Chapel Hill, NC 27599, USA.
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14
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Nelson B. Digital dynamo, delayed: Despite progress, whole slide imaging faces more hurdles on the path to broader acceptance in primary diagnostics. Cancer Cytopathol 2015; 123:569-70. [PMID: 26465235 DOI: 10.1002/cncy.21625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Kawai T. [A Perspective on Innovation for Efficient Medical Practice in View of Undergraduate and Postgraduate Education and Training in Laboratory Medicine]. Rinsho Byori 2015; 63:1161-1168. [PMID: 26897851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Continuous advances in medical laboratory technology have driven major changes in the practice of laboratory medicine over the past two decades. The importance of the overall quality of a medical laboratory has been ever-increasing in order to improve and ensure the quality and safety of clinical practice by physicians in any type of medical facility. Laboratory physicians and professional staff should challenge themselves more than ever in various ways to cooperate and contribute with practicing physicians for the appropriate utilization of laboratory testing. This will certainly lead to a decrease in inappropriate or unnecessary laboratory testing, resulting in reducing medical costs. In addition, not only postgraduate, but also undergraduate medical education/training systems must be markedly innovated, considering recent rapid progress in electronic information and communication technologies.
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Loughrey MB, Kelly PJ, Houghton OP, Coleman HG, Houghton JP, Carson A, Salto-Tellez M, Hamilton PW. Digital slide viewing for primary reporting in gastrointestinal pathology: a validation study. Virchows Arch 2015; 467:137-44. [PMID: 25982098 DOI: 10.1007/s00428-015-1780-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/30/2015] [Indexed: 01/27/2023]
Abstract
Despite the increasing availability of digital slide viewing, and numerous advantages associated with its application, a lack of quality validation studies is amongst the reasons for poor uptake in routine practice. This study evaluated primary digital pathology reporting in the setting of routine subspecialist gastrointestinal pathology, commonplace in most tissue pathology laboratories and representing one of the highest volume specialties in most laboratories. Individual digital and glass slide diagnoses were compared amongst three pathologists reporting in a gastrointestinal subspecialty team, in a prospective series of 100 consecutive diagnostic cases from routine practice in a large teaching hospital laboratory. The study included a washout period of at least 6 months. Discordant diagnoses were classified, and the study evaluated against recent College of American Pathologists (CAP) recommendations for evaluating digital pathology systems for diagnostic use. The study design met all 12 of the CAP recommendations. The 100 study cases generated 300 pairs of diagnoses, comprising 100 glass slide diagnoses and 100 digital diagnoses from each of the three study pathologists. 286 of 300 pairs of diagnoses were concordant, representing intraobserver concordance of 95.3 %, broadly comparable to rates previously published in this field. In ten of the 14 discordant pairs, the glass slide diagnosis was favoured; in four cases, the digital diagnosis was favoured, but importantly, the 14 discordant intraobserver diagnoses were considered to be of minor clinical significance. Interobserver, or viewing modality independent, concordance was found in 94 of the total of 100 study cases, providing a comparable baseline discordance rate expected in any second viewing of pathology material. These overall results support the safe use of digital pathology in primary diagnostic reporting in this setting.
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Affiliation(s)
- Maurice B Loughrey
- Department of Pathology, Royal Victoria Hospital, Belfast Trust, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, UK,
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17
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Liang Y, Zhang F, Dong Y. [Sixty years of the development of pathology techniques in China: past, present and future]. Zhonghua Bing Li Xue Za Zhi 2015; 44:466-468. [PMID: 26705033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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18
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Tolonen T, Näpänkangas J, Isola J. [Clinical pathology on the verge of virtual microscopy]. Duodecim 2015; 131:1981-1987. [PMID: 26677548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
For more than 100 years, examinations of pathology specimens have relied on the use of the light microscope. The technological progress of the last few years is enabling the digitizing of histologic specimen slides and application of the virtual microscope in diagnostics. Virtual microscopy will facilitate consultation possibilities, and digital image analysis serves to enhance the level of diagnostics. Organizing and monitoring clinicopathological meetings will become easier. Digital archive of histologic specimens and the virtual microscopy network are expected to benefit training and research as well, particularly what applies to the Finnish biobank network which is currently being established.
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Hofman P. [What place and what future for the pathology of infectious and tropical diseases in France?]. Ann Pathol 2014; 34:171-82. [PMID: 24950861 PMCID: PMC7131493 DOI: 10.1016/j.annpat.2014.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/06/2014] [Accepted: 04/08/2014] [Indexed: 11/24/2022]
Abstract
The management of tissues and cellular samples by the pathologists in the infectious and tropical diseases pathology field in 2014 needs a strong knowledge of both morphological and molecular domains which includes the good control: (i) of the taxonomy of infectious and tropical diseases pathology leading to the pathogens identification and (ii) of the ancillary methods which can be used in fixed samples in order to detect or better identify these pathogens. There is a recent paradox in France concerning the frequency of infectious diseases to be diagnosed in pathology laboratories and the progressive loss of pathologist's expertise in this domain. Different reasons could explain this statement including the omnipresence of the tumour lesions to be managed in a pathology laboratory as well as the recent constraints associated with the different biomarkers that are mandatory to be detected by immunohistochemistry and/or by molecular biology. Even if the microbiologists play a pivotal role for identifying the different pathogens as well as for the assessment of their sensitivity to the anti-microbial drugs, a large number of infectious diseases can be diagnosed only on fixed tissue and/or cells by the pathologists. The purpose of this review is to describe the current and future issues of infectious and tropical diseases diagnoses in pathology laboratories, in particular in France.
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Affiliation(s)
- Paul Hofman
- Laboratoire de pathologie clinique et expérimentale (LPCE), hôpital Pasteur, CHU, BP 69, 06002 Nice, France; Biobanque CHUN, hôpital Pasteur, 06002 Nice, France.
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Willems SM, Engelsman-Theelen W, Blaauwgeers JLGH. [Molecular pathology in tumour classification: the present and future molecular revolution]. Ned Tijdschr Geneeskd 2014; 158:A7364. [PMID: 24642124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The way we classify somatic diseases changes rapidly. Whereas at one time examination by the naked eye was used as a guide and then microscopy was used to view a tissue's properties, diseases are increasingly being classified according to their molecular properties. Due to this 'molecular revolution' the diagnostic classification is increasingly predictive. Parallel to this development the boundaries between clinical disciplines are disappearing.
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21
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Penault-Llorca F. [Breast cancer classification is evolving]. Biol Aujourdhui 2014; 208:251-9. [PMID: 25840451 DOI: 10.1051/jbio/2014028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Indexed: 11/14/2022]
Abstract
Diagnostic strategy of breast cancer has changed enormously during the last thirty years. To classical obligatory morphological data on the macroscopical and microscopical levels are now added imunocytochemistry, which is capable of detecting therapeutic targets such hormonal receptors and HER2 (Human Epidermal growth factor Receptor2), and molecular biology, which yields the molecular profile of tumors and their multigenic properties. By leaning on up-to-date classifications (TNM system and UICC grades), the pathologist is able to evaluate not only diagnostic but also pronostic criteria, leading to personalized and predictive treatments.
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Schwartz J, Haffner S. ePathology: defining the new paradigm of anatomic pathology. MLO Med Lab Obs 2013; 45:30-31. [PMID: 24313123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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23
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Penault-Llorca F. [Pathologic anatomy and cytology: a specialty at the heart of innovations]. Bull Cancer 2013; 100:795-796. [PMID: 24180006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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24
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Puri PK, Somani N, Roehmholdt BF, Pollack B, Winfield H, Knopp E. The future of dermatopathology. J Cutan Pathol 2013; 40:685-6. [PMID: 23639105 DOI: 10.1111/cup.12156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 03/21/2013] [Indexed: 11/27/2022]
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25
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Murphy MJ. A call to action: dermatopathology in the age of molecular testing--education in molecular diagnostics, genomics and personalized medicine. J Cutan Pathol 2013; 40:687-9. [PMID: 23593970 DOI: 10.1111/cup.12157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022]
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26
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Pouget J. [Address from the President, January 2013]. Rev Neurol (Paris) 2013; 169:211-3. [PMID: 23522288 DOI: 10.1016/j.neurol.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/04/2013] [Indexed: 11/19/2022]
Affiliation(s)
- J Pouget
- Centre de référence des maladies neuromusculaires et de la SLA, hôpital-de-La-Timone, 264 rue Saint-Pierre, 13005 Marseille, France.
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Anim JT. Towards an improved pathology service in Ghana. Ghana Med J 2013; 47:40-45. [PMID: 23661855 PMCID: PMC3645180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- J T Anim
- Department of Pathology, University of Ghana Medical School, Korle Bu, Accra, Ghana.
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28
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Angress D. The future of imaging technology in the science of pathology. MLO Med Lab Obs 2013; 45:10-12. [PMID: 24133872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Cochand-Priollet B, Vielh P. Special issue "Cytopathology". Ann Pathol 2012; 32:e1-2, 387-8. [PMID: 23244479 DOI: 10.1016/j.annpat.2012.09.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/13/2012] [Indexed: 11/18/2022]
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Montironi R, Srigley JR, Egevad L, Delahunt B. Recent advances in urological pathology. Anal Quant Cytopathol Histpathol 2012; 34:293-295. [PMID: 23304814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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31
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Gaulard P. [Pitfalls and update in haematopathology. Introduction and summary of the main take home messages]. Ann Pathol 2012; 32:328-30. [PMID: 23141939 DOI: 10.1016/j.annpat.2012.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/02/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Philippe Gaulard
- Département de pathologie, Inserm U955, université Paris-Est Créteil (UPEC), hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Abstract
Array-based comparative genomic hybridization (array CGH) genome scanning is a powerful method for the global detection of gains and losses of genetic material in both congenital and neoplastic disorders. When used as a clinical diagnostic test, array CGH combines the whole genome perspective of traditional G-banded cytogenetics with the targeted identification of cryptic chromosomal abnormalities characteristic of fluorescence in situ hybridization (FISH). However, the presence of structural variants in the human genome can complicate analysis of patient samples, and array CGH does not provide morphologic information about chromosome structure, balanced translocations, or the actual chromosomal location of segmental duplications. Identification of such anomalies has significant diagnostic and prognostic implications for the patient. We therefore propose that array CGH should be used as a guide to the presence of genomic structural rearrangements in germline and tumor genomes that can then be further characterized by FISH or G-banding, depending on the clinical scenario. In this article, we share some of our experiences with diagnostic array CGH and discuss recent progress and challenges involved with the integration of array CGH into clinical laboratory medicine.
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Affiliation(s)
- Shelly R Gunn
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas 78229-3900, USA.
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AbdullGaffar B. Systematic review, meta-analysis and randomized controlled trials in cytopathology. Acta Cytol 2012; 56:221-7. [PMID: 22555521 DOI: 10.1159/000335486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 11/30/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Evidence-based medicine (EBM) relies on systematic review (SR), meta-analysis (MA) and randomized controlled trials (RCTs). These EBM tools are more commonly used in clinical medicine than in laboratory medicine. The extent of their use in cytopathology is not clear. The purpose of this study was to investigate the frequency of SR, MA and RCTs in cytopathology compared to other laboratory and clinical medicine specialties. STUDY DESIGN A literature-based search for SRs, MAs and RCTs in cytopathology was performed. Several electronic databases were searched without date restrictions. Four journals in cytopathology, pathology and clinical medicine were also searched over 6 years. RESULTS Gynecology cytology utilized SRs, MAs and RCTs more frequently (83%) than nongynecology and fine needle aspiration cytology. Cytopathology, histopathology and laboratory medicine journals showed comparable rates of 0.5-1.1% in papers reporting SRs, MAs and RCTs. Specialty medical journals showed a higher rate of 5.6% and general medical journals showed a much higher rate of 30%. CONCLUSIONS SR, MA and RCTs are less frequently utilized in pathology than in clinical medicine. Cytopathologists should be more aware of the benefits of SR and MA in resolving uncertainties and improving the clinical applicability of level III diagnostic studies.
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Song JY, Chu YC, Kim L, Park IS, Han JY, Kim JM. Reclassifying formerly indeterminate thyroid FNAs using the Bethesda system reduces the number of inconclusive cases. Acta Cytol 2012; 56:122-9. [PMID: 22378073 DOI: 10.1159/000334200] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) and to analyze the causes of unclear diagnoses following BSRTC adoption. STUDY DESIGN According to the BSRTC, we reclassified cytologic samples originally diagnosed as 'indeterminate' with sequential surgical resection. Then, we analyzed the causes of cases, which were recategorized as 'atypia undetermined significance/follicular lesion of undetermined significance (AUS/FLUS)'. RESULTS According to the BSRTC, 154 'indeterminate' cases were reclassified as follows: unsatisfactory, n = 5 (3.2%); benign, n = 43 (27.9%); AUS/FLUS, n = 77 (50.0%); suspicious for a follicular neoplasm, n = 7 (7.1%); suspicious for a Hürthle cell neoplasm, n = 4 (2.6%); suspicious for malignancy, n = 15 (9.7%), and malignancy, n = 3 (1.9%). Then, the AUS/FLUS group was analyzed according to the scenarios proposed by the BSRTC. Fifty-nine (58.9%) cases of AUS/FLUS were due to suboptimal preparation. In addition, papillary microcarcinoma and coexisting Hashimoto's thyroiditis caused inconclusive diagnoses. CONCLUSION The BSRTC can be easily applied to thyroid fine-needle aspiration. We were able to reclassify indeterminate thyroid nodules into more detailed categories and thus reduce the number of cases classified as indeterminate. However, suboptimal preparation, papillary microcarcinoma, and coexisting Hashimoto's thyroiditis precluded cytopathologists from making definitive diagnoses.
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MESH Headings
- Adenocarcinoma, Follicular/classification
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Biopsy, Fine-Needle/methods
- Biopsy, Fine-Needle/standards
- Biopsy, Fine-Needle/trends
- Diagnosis, Differential
- Hashimoto Disease/classification
- Hashimoto Disease/diagnosis
- Hashimoto Disease/pathology
- Humans
- Pathology, Clinical/methods
- Pathology, Clinical/standards
- Pathology, Clinical/trends
- Practice Guidelines as Topic/standards
- Predictive Value of Tests
- Retrospective Studies
- Thyroid Gland/pathology
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Ju Young Song
- Department of Pathology, Inha University Hospital, Incheon, South Korea
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35
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Farge D, Robert L, Verecchia F. [Pathologie Biologie: an evolution]. ACTA ACUST UNITED AC 2011; 59:293. [PMID: 22137193 DOI: 10.1016/j.patbio.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Tsuchiya T. [Education for medical students and post-graduates--Training of laboratory medicine at Nihon University Medical School and Surugadai Nihon University Hospital]. Rinsho Byori 2011; 59:886-892. [PMID: 22111307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Laboratory medicine is defined as 'a field which analyzes the patients' clinical condition and contributes to the procedures such as diagnosis, treatment, follow-up, and prognostic determination'. In other words, it involves not only in every process of medical treatment for patients, but also in the field of preventive medicine and occupational health. Therefore, it is unavoidable for every department to interpret the laboratory data. This necessarily requires all medical students to master laboratory test procedures, comprehend various impediments to the accurate laboratory data, and acquire the basics of the interpretation of laboratory data. During postgraduate training period, they must acquire enough skill of test procedures and determination methods such as Gram stain, and their interpretation of the test results should also be wide and directly connected to the treatment. Physicians who are trained in each particular department and aim to become a laboratory physician are in need of enough understanding of the specialized tests relate to each specialized area. Based on the fact that laboratory physicians involve in all of these educations, this symposium addresses the early training during pre- and post-graduation in Nihon University.
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Affiliation(s)
- Tatsuyuki Tsuchiya
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan.
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Orlov SN, Churilov LP, Stroev II. [What is pathophysiology nowadays? The reflections of the participants of ISP-2010 Congress in Montreal]. Patol Fiziol Eksp Ter 2011:3-12. [PMID: 21847827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The main tendencies in the development of Pathophysiology as a science and teaching discipline are analyzed in the light of last 6th ISP-2010 Congress. The witnesses for the growing integration between Pathophysiology and other basic medical sciences are given, along with the preserved specifics of the pathophysiological knowledge on the etiology, pathogenesis and models of the diseases and pathological processes. The current role and place of Pathophysiology as Systemic Pathobiology within the structure of medical sciences are discussed.
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Lynn K. Digital pathology and imaging--past, present, and future. MLO Med Lab Obs 2011; 43:40. [PMID: 21446584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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41
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Honda T. [My hybrid carrier of clinical pathologist]. RINSHO BYORI. THE JAPANESE JOURNAL OF CLINICAL PATHOLOGY 2011; 59:255-263. [PMID: 21560407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this review, I showed a brief summary of my carrier in multiple special fields (clinical pathologist, anatomical pathologist of lung, respiratory physician and infection control doctor), my studies and my own view of laboratory medicine. We chiefly study pathology of the lung, especially about type II pneumocytes. Type II pneumocytes had abundant surface coat on the apical surface containing a specific carbohydrate structure of Thomsen-Friedenreich (TF) antigen. TF antigen is a marker of type II pneumocytes beyond animal species, and can be used for evaluating activity of various interstitial pneumonia as type II pneumocyte index (number/lmm alveolar length). Three dimensional views generated from thick sections of ordinary processed paraffin blocks showed new information of normal and abnormal lung morphology. Type II pneumocytes linearly located along the elastic fibers forming framework of polygonal alveoli, and in usual interstitial pneumonia, destruction of these elastic fibers were observed. In Japan, roles of a clinical pathologist are not definite as a radiologist, and clinical laboratory in a hospital is recognized as a section only performing blood and chemical tests. Evaluation of the data and participation in diagnosis were not requested. In future, medical doctors devote themselves to treat patients, and clinical pathologists and laboratory technicians have to help the doctors in diagnostic process. Routine tests (blood and urine) are most frequently performed in clinical medicine, but the data are not adequately used. Therefore, a system is necessary for interpreting routine tests and reporting them to other medical staffs.
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Affiliation(s)
- Takayuki Honda
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan.
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42
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Teramoto T. [Significance of clinical pathology in the field of internal medicine]. Rinsho Byori 2011; 59:273-278. [PMID: 21748903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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43
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van Noesel CJM. [The clinical molecular pathologist: beyond the image]. Ned Tijdschr Geneeskd 2011; 155:A2971. [PMID: 21466725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pathology has always held a key position in medical science by providing an anatomical description of diseases on which the therapeutic regimens could be based. The role of pathology in medical diagnosis is changing considerably. Three elements are being discussed: (a) to date microscopic anatomy has been important in the classification of diseases; (b) immunohistochemical colouring agents enable pathologists to visualize proteins in tissues and thus to define normal and deviant cells with great accuracy with respect to lineage derivation and differentiation stage; (c) current developments in molecular biology will have a decisive influence on the classification, diagnosis and treatment of tumours as they allow the evaluation of the function and genetic characteristics of tumour tissue. Although molecular pathology now also covers purely genetic diagnostics of isolated DNA or RNA it is expected that imaging DNA diagnostics within the tissue itself will become increasingly important.
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Bibeau F, Boissière-Michot F. [Molecular pathology: in the beginning was the pre-analytic step!]. Ann Pathol 2010; 30:71-2. [PMID: 20451061 DOI: 10.1016/j.annpat.2010.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen J. [Tasks and challenges]. Zhonghua Bing Li Xue Za Zhi 2010; 39:217. [PMID: 20654117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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What's the buzz on anatomic pathology? MLO Med Lab Obs 2010; 42:38, 40-2. [PMID: 20446470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Dehner LP. The medical autopsy: past, present, and dubious future. Mo Med 2010; 107:94-100. [PMID: 20446515 PMCID: PMC6188261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The medical autopsy is the most reliable and thorough means after the death of a patient that a physician has to evaluate the validity of his/her clinical diagnosis on which care was delivered. There is virtually no dispute in the literature of its value in the assessment of the quality of care. Today the medical autopsy has been largely abandoned except in academic medical centers. Even in the latter setting, the number of autopsies has steadily declined over the past 30-40 years. Approximately 360 autopsies are performed per year at the Washington University Medical Center in St. Louis; this number represents only 20% of all deaths in this medical center. The autopsy is time intensive and expensive in the environment of ever increasing pressure to reduce medical costs on all fronts. Will the autopsy survive? There are many reasons to advocate for the autopsy and they are considered in this discussion. The reasons to perform an autopsy remain as pertinent and relevant today as they did 50 to 100 years ago.
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Affiliation(s)
- Louis P Dehner
- Department of Pathology and Immunology of Washington University School of Medicine , St. Louis, USA.
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Gotoh S. [My research on clinical pathology in the past 45 years]. Rinsho Byori 2010; 58:285-291. [PMID: 20469543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Visscher DW, Myers JL. New frontiers in pathology. Arch Pathol Lab Med 2009; 133:1761-2. [PMID: 19886709 DOI: 10.5858/133.11.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2009] [Indexed: 11/06/2022]
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