-
Modern Pathology : An Official Journal... Jan 2020Inflammatory dermatopathology remains a challenging area for surgical pathologists. Yet every surgical pathologist encounters inflammatory dermatoses as part of routine... (Review)
Review
Inflammatory dermatopathology remains a challenging area for surgical pathologists. Yet every surgical pathologist encounters inflammatory dermatoses as part of routine practice. This review will focus on selected diagnoses that are either commonly encountered in the routine practice of surgical pathology or are critically important. The following entities will be covered: spongiotic dermatoses, lichen simplex chronicus, and early lichen sclerosus in the setting of vulvar biopsies, as well as graft versus host disease, Stevens-Johnson syndrome/toxic epidermal necrolysis, granuloma anulare, pyoderma gangrenosum, and calciphylaxis. Practical points and key histologic features will be emphasized.
Topics: Biopsy; Dermatitis; Diagnosis, Differential; Humans; Pathologists; Predictive Value of Tests; Skin
PubMed: 31676787
DOI: 10.1038/s41379-019-0400-z -
Journal of Clinical Pathology Apr 2018The evolution of cellular pathology as a specialty has always been driven by technological developments and the clinical relevance of incorporating novel investigations... (Review)
Review
The evolution of cellular pathology as a specialty has always been driven by technological developments and the clinical relevance of incorporating novel investigations into diagnostic practice. In recent years, the molecular characterisation of cancer has become of crucial relevance in patient treatment both for predictive testing and subclassification of certain tumours. Much of this has become possible due to the availability of next-generation sequencing technologies and the whole-genome sequencing of tumours is now being rolled out into clinical practice in England via the 100 000 Genome Project. The effective integration of cellular pathology reporting and genomic characterisation is crucial to ensure the morphological and genomic data are interpreted in the relevant context, though despite this, in many UK centres molecular testing is entirely detached from cellular pathology departments. The CM-Path initiative recognises there is a genomics knowledge and skills gap within cellular pathology that needs to be bridged through an upskilling of the current workforce and a redesign of pathology training. Bridging this gap will allow the development of an integrated 'morphomolecular pathology' specialty, which can maintain the relevance of cellular pathology at the centre of cancer patient management and allow the pathology community to continue to be a major influence in cancer discovery as well as playing a driving role in the delivery of precision medicine approaches. Here, several alternative models of pathology training, designed to address this challenge, are presented and appraised.
Topics: Humans; Pathologists; Pathology, Molecular
PubMed: 29113995
DOI: 10.1136/jclinpath-2017-204821 -
Archives of Pathology & Laboratory... Aug 2023With the adoption of Epic/Beaker at our institution, surgical pathology specimens are assigned a Current Procedural Terminology (CPT) charge code at the time of... (Review)
Review
CONTEXT.—
With the adoption of Epic/Beaker at our institution, surgical pathology specimens are assigned a Current Procedural Terminology (CPT) charge code at the time of accessioning, and pathologists have been made responsible for verifying the accuracy of the code before signing out the case.
OBJECTIVE.—
To determine with what frequency attending pathologists reassigned the correct charge code to a specimen when the code assigned at accessioning was incorrect, as well as to estimate the potential financial impact of missed changes.
DESIGN.—
We reviewed all specimens received for frozen section during a 7-month period, identified specimens where the default charge code that our departmental protocol assigns at frozen section (88305) was incorrect, and assessed the rate of successful code change by pathologists and the potential financial cost of each missed change.
RESULTS.—
Three hundred fifty-two of 2191 frozen section specimens (16%) required a change in the 88305 charge code. The codes for 195 specimens (55%) were correctly changed by the attending pathologist, while 157 (45%) were not changed (149) or were changed to an incorrect charge code (8). Individual pathologist change rates ranged from 0% to 100%, with a mean and median change rate of 43% and 24%, respectively. Using average code reimbursements at our institution, the loss in revenue from the 157 missed and incorrect frozen section changes was estimated at $13 788 ($1970 per month).
CONCLUSIONS.—
Pathologists showed highly variable rates of correcting CPT charge codes when the incorrect code had been previously assigned to a case, with associated loss of revenue from missed and incorrect code changes.
Topics: Humans; Frozen Sections; Pathologists; Pathology, Surgical
PubMed: 36287188
DOI: 10.5858/arpa.2022-0158-OA -
Indian Journal of Pathology &... Jun 2021Newer molecular diagnostics and improved understanding of cancer pathogenesis have identified multiple pathways that can be potentially targeted with the use of novel... (Review)
Review
Newer molecular diagnostics and improved understanding of cancer pathogenesis have identified multiple pathways that can be potentially targeted with the use of novel therapeutics in development. These developments have ushered cancer therapeutics in newer era of personalized medicine. Same is reflected on current management strategies for advanced gastrointestinal malignancies. Molecular profiling for BRAF and RAS is standard for colorectal cancer while Her2 and PDL1 status is needed for planning therapy of advanced gastroesophageal cancers. Tissue agnostic markers like MSI, TMB and NTRK are making headways in therapeutic armamentarium. While newer targeted therapies against FGFR, EGFR, PI3K-AKT, DDR pathways are showing promising results in initial studies. Here we review traditional as well as upcoming molecular markers in field of GI malignancies, methods of testing and evidence for rational use in clinical practice.
Topics: Antineoplastic Agents; Biomarkers, Tumor; Gastrointestinal Neoplasms; Humans; Molecular Targeted Therapy; Mutation; Pathologists; Pathology, Molecular; Precision Medicine
PubMed: 34135137
DOI: 10.4103/IJPM.IJPM_1239_20 -
Journal of Clinical Pathology Feb 2019In recent times, there has been a growing tendency to treat advanced gynaecological malignancies with neoadjuvant chemotherapy (NACT), with the goal of reducing tumour... (Review)
Review
In recent times, there has been a growing tendency to treat advanced gynaecological malignancies with neoadjuvant chemotherapy (NACT), with the goal of reducing tumour volume and enhancing operability resulting in optimal cytoreduction. This approach is used in particular for patients with advanced high-grade serous carcinoma of the ovary, fallopian tube or peritoneum. Pathology plays a crucial role in the management of these patients, both before and after NACT. Prior to initiation of NACT, a biopsy should be performed, usually of the omental cake, to confirm that a malignancy is present, to identify the site of origin of the tumour and to type and grade the tumour. Histopathologists must be aware of the resultant morphological effects of NACT when examining specimens following interval cytoreduction surgery. Tumour typing and grading, and even the identification of residual neoplasia, are particular challenges. Immunohistochemistry, when used judiciously, can be a useful adjunct in certain scenarios. A pathological assessment of the response to chemotherapy, and the pathological stage should be provided in the pathology report, as these may inform prognosis and subsequent management. We present a comprehensive overview of the relevant clinical and pathological aspects pertaining to NACT for gynaecological malignancies for the practicing surgical pathologist.
Topics: Female; Genital Neoplasms, Female; Humans; Neoadjuvant Therapy; Pathologists; Pathology, Surgical
PubMed: 30670562
DOI: 10.1136/jclinpath-2018-205634 -
Der Urologe. Ausg. A Jul 2019Besides evidence- and guideline-based tumor therapy, personalized targeted therapies within study settings or individual experimental settings in advanced cancers... (Review)
Review
Besides evidence- and guideline-based tumor therapy, personalized targeted therapies within study settings or individual experimental settings in advanced cancers without further therapeutic options are emerging. A comprehensive molecular analysis of the tumor in a molecular pathology laboratory is important for all targeted therapy approaches. However, the interpretation of the molecular results is crucial and potential therapeutic conclusions can only be drawn by considering the clinical situation and within a setting of oncological experience. Therefore, the molecular results and their potential impact have to be discussed at a molecular tumor board, an interdisciplinary expert team consisting of clinicians, oncologists, (molecular) pathologists, systems physicians, study teams and where required geneticists. If the molecular tumor board decides a targeted therapeutic approach is appropriate, patients should be enrolled in studies or registries with controlled settings and documentation in order to evaluate the therapeutic concepts. Furthermore, molecular-based individual experimental therapies are possible within extreme clinical situations.
Topics: Genetic Testing; Humans; Interdisciplinary Research; Molecular Targeted Therapy; Neoplasms; Pathologists; Pathology, Molecular; Patient Care Team; Precision Medicine; Urologic Neoplasms; Urologists
PubMed: 31049636
DOI: 10.1007/s00120-019-0934-1 -
The Journal of Dermatological Treatment Aug 2022Erroneous diagnoses of melanocytic lesions (benign, atypical, and malignant types) result in inappropriate surgical treatment plans.
BACKGROUND
Erroneous diagnoses of melanocytic lesions (benign, atypical, and malignant types) result in inappropriate surgical treatment plans.
OBJECTIVE
To propose a deep learning (DL)-based fully automated diagnostic method using whole slide images (WSIs) for melanocytic lesions.
METHODS
The method consisted of patch prediction using a DL model and patient diagnosis using an aggregation module. The method was developed with 745 WSIs and evaluated using internal and external testing sets comprising 182 WSIs and 54 WSIs, respectively. The results were compared with those of the classification by one junior and two senior pathologists. Furthermore, we compared the performance of the three pathologists in the classification of melanocytic lesions with and without the assistance of our method.
RESULTS
The method achieved an accuracy of 0.963 and 0.930 on the internal and external testing sets, respectively, which was significantly higher than that of the junior pathologist (0.419 and 0.535). With assistance from the method, all three pathologists achieved higher accuracy on the internal and external testing sets; the accuracy of the junior pathologist increased by 39.0% and 30.2%, respectively ( < .05).
CONCLUSION
This generalizable method can accurately classify melanocytic lesions and effectively improve the diagnostic accuracy of pathologists.
Topics: Deep Learning; Humans; Pathologists
PubMed: 35112978
DOI: 10.1080/09546634.2022.2038772 -
Cancer Cytopathology Jun 2018
Topics: Humans; Paris; Pathologists
PubMed: 29757490
DOI: 10.1002/cncy.22007 -
Histopathology Dec 2022The reporting of tumour cellularity in cancer samples has become a mandatory task for pathologists. However, the estimation of tumour cellularity is often inaccurate....
AIMS
The reporting of tumour cellularity in cancer samples has become a mandatory task for pathologists. However, the estimation of tumour cellularity is often inaccurate. Therefore, we propose a collaborative workflow between pathologists and artificial intelligence (AI) models to evaluate tumour cellularity in lung cancer samples and propose a protocol to apply it to routine practice.
METHODS AND RESULTS
We developed a quantitative model of lung adenocarcinoma that was validated and tested on 50 cases, and a collaborative workflow where pathologists could access the AI results and adjust their original tumour cellularity scores (adjusted-score) that we tested on 151 cases. The adjusted-score was validated by comparing them with a ground truth established by manual annotation of haematoxylin and eosin slides with reference to immunostains with thyroid transcription factor-1 and napsin A. For training, validation, testing the AI and testing the collaborative workflow, we used 40, 10, 50 and 151 whole slide images of lung adenocarcinoma, respectively. The sensitivity and specificity of tumour segmentation were 97 and 87%, respectively, and the accuracy of nuclei recognition was 99%. One pathologist's visually estimated scores were compared to the adjusted-score, and the pathologist's scores were altered in 87% of cases. Comparison with the ground truth revealed that the adjusted-score was more precise than the pathologists' scores (P < 0.05).
CONCLUSION
We proposed a collaborative workflow between AI and pathologists as a model to improve daily practice and enhance the prediction of tumour cellularity for genetic tests.
Topics: Humans; Pathologists; Artificial Intelligence; Workflow; Deep Learning; Adenocarcinoma of Lung; Lung Neoplasms
PubMed: 35989443
DOI: 10.1111/his.14779 -
Veterinary Pathology Mar 2021Animal models have critical roles in biomedical research in promoting understanding of human disease and facilitating development of new therapies and diagnostic...
Animal models have critical roles in biomedical research in promoting understanding of human disease and facilitating development of new therapies and diagnostic techniques to improve human and animal health. In the study of myriad human conditions, each model requires in-depth characterization of its assets and limitations in order for it to be used to greatest advantage. Veterinary pathology expertise is critical in understanding the relevance and translational validity of animal models to conditions under study, assessing morbidity and mortality, and validating outcomes as relevant or not to the study interventions. Clear communication with investigators and education of research personnel on the use and interpretation of pathology endpoints in animal models are critical to the success of any research program. The veterinary pathologist is underutilized in biomedical research due to many factors including misconceptions about high fiscal costs, lack of perceived value, limited recognition of their expertise, and the generally low number of veterinary pathologists currently employed in biomedical research. As members of the multidisciplinary research team, veterinary pathologists have an important role to educate scientists, ensure accurate interpretation of pathology data, maximize rigor, and ensure reproducibility to provide the most reliable data for animal models in biomedical research.
Topics: Animals; Biomedical Research; Humans; Pathologists; Pathology, Veterinary; Reproducibility of Results; Veterinarians
PubMed: 33327888
DOI: 10.1177/0300985820974005