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Laboratory Investigation; a Journal of... Nov 2023Digital pathology has transformed the traditional pathology practice of analyzing tissue under a microscope into a computer vision workflow. Whole-slide imaging allows... (Review)
Review
Digital pathology has transformed the traditional pathology practice of analyzing tissue under a microscope into a computer vision workflow. Whole-slide imaging allows pathologists to view and analyze microscopic images on a computer monitor, enabling computational pathology. By leveraging artificial intelligence (AI) and machine learning (ML), computational pathology has emerged as a promising field in recent years. Recently, task-specific AI/ML (eg, convolutional neural networks) has risen to the forefront, achieving above-human performance in many image-processing and computer vision tasks. The performance of task-specific AI/ML models depends on the availability of many annotated training datasets, which presents a rate-limiting factor for AI/ML development in pathology. Task-specific AI/ML models cannot benefit from multimodal data and lack generalization, eg, the AI models often struggle to generalize to new datasets or unseen variations in image acquisition, staining techniques, or tissue types. The 2020s are witnessing the rise of foundation models and generative AI. A foundation model is a large AI model trained using sizable data, which is later adapted (or fine-tuned) to perform different tasks using a modest amount of task-specific annotated data. These AI models provide in-context learning, can self-correct mistakes, and promptly adjust to user feedback. In this review, we provide a brief overview of recent advances in computational pathology enabled by task-specific AI, their challenges and limitations, and then introduce various foundation models. We propose to create a pathology-specific generative AI based on multimodal foundation models and present its potentially transformative role in digital pathology. We describe different use cases, delineating how it could serve as an expert companion of pathologists and help them efficiently and objectively perform routine laboratory tasks, including quantifying image analysis, generating pathology reports, diagnosis, and prognosis. We also outline the potential role that foundation models and generative AI can play in standardizing the pathology laboratory workflow, education, and training.
Topics: Humans; Artificial Intelligence; Image Processing, Computer-Assisted; Machine Learning; Neural Networks, Computer; Pathologists; Pathology
PubMed: 37757969
DOI: 10.1016/j.labinv.2023.100255 -
Diagnostic Pathology May 2018Telepathology (TP) provides remote pathology services for primary diagnosis practices, including intraoperative consultation of surgical pathology; it has not been...
BACKGROUND
Telepathology (TP) provides remote pathology services for primary diagnosis practices, including intraoperative consultation of surgical pathology; it has not been widely implemented in China. In this study, the results of an implementation were reported, which lasted for two and a half years, and demonstrated the experience of the diagnosis of the intraoperative frozen sections by using TP consultation platform of Southern Medical University and Guangzhou Huayin Medical Laboratory Center (SMU-HUAYIN TP) in China.
METHODS
The SMU-HUAYIN TP consultation platform connects 71 participating basic hospitals and 11 senior pathologists. Nanfang Hospital is a high-level hospital located in a large city in China. This retrospective study summarizes the experience and results of TP for frozen section diagnosis by comparing the data of the platform and Nanfang Hospital over a period of 2.5 years from January 2015 to June 2017.
RESULTS
A total of 5233 cases were submitted to the platform, including 1019 cases in 2015, 2320 cases in 2016, and 1894 cases in 2017. The most common cases were breast (30.42%), followed by thyroid (29.05%) and gynecological (24.86%). Average turn-around time (TAT) of the cases from the platform in 2015 and 2016 was controlled within 30 min. In most TP cases (90.31%) and cases from Nanfang Hospital (86.14%), a definitive diagnosis was provided. The coincidence rate was 99.77% in the TP cases and 99.35% in the cases from Nanfang Hospital. The false positive and false negative rates of TP cases were 0.04 and 0.19%, respectively and no significant difference was found among different senior pathologists (P = 0.974, P = 0.989, P > 0.05). Similarly, there was no significant difference between TP cases and cases from Nanfang Hospital that were diagnosed by the same senior pathologist (P > 0.05).
CONCLUSIONS
Our results indicate that TP in frozen section diagnosis could improve patient care and solve the problem of unevenly distributed pathology resources in China. We believe that in the near future, TP in frozen section diagnosis will become an important component of telemedicine and will play a significant role in health care reform in China.
Topics: China; Frozen Sections; Humans; Intraoperative Period; Neoplasms; Pathology, Surgical; Remote Consultation; Telepathology
PubMed: 29759085
DOI: 10.1186/s13000-018-0705-0 -
Expert Review of Molecular Diagnostics 2016Lysosomal storage disorders (LSDs) are a group of almost 50 monogenic diseases characterized by mutations causing deficiency of lysosomal enzymes or non-enzyme proteins... (Review)
Review
Lysosomal storage disorders (LSDs) are a group of almost 50 monogenic diseases characterized by mutations causing deficiency of lysosomal enzymes or non-enzyme proteins involved in transport across the lysosomal membrane, protein maturation or lysosomal biogenesis. Usually, affected patients are normal at birth and have a progressive and severe disease with high morbidity and reduced life expectancy. The overall incidence of LSDs is usually estimated as 1:5000, but newborn screening studies are indicating that it could be much higher. Specific therapies were already developed for selected LSDs, making the timely and correct diagnosis very important for successful treatment and also for genetic counseling. In most LSD cases the biochemical techniques provide a reliable diagnosis. However, the identification of pathogenic mutations by genetic analysis is being increasingly recommended to provide additional information. In this paper we discuss the conventional methods for genetic analysis used in the LSDs [restriction fragment length polymorphism (RFLP), amplification-refractory mutation system (ARMS), single strand conformation polymorphism (SSCP), denaturing high performance liquid chromatography (dHPLC), real-time polymerase chain reaction, high resolution melting (HRM), multiplex ligation-dependent probe amplification (MLPA), Sanger sequencing] and also the newer approaches [massive parallel sequencing, array comparative genomic hybridization (CGH)].
Topics: Genetic Counseling; Genetic Testing; High-Throughput Nucleotide Sequencing; Humans; Lysosomal Storage Diseases; Mutation; Pathology, Molecular; Proteins
PubMed: 26567866
DOI: 10.1586/14737159.2016.1121101 -
Journal of Forensic and Legal Medicine May 2022Sharp force injuries represent a major constituent of physical assaults and homicidal fatalities, especially in countries with strict firearm legislations. In forensic... (Review)
Review
Sharp force injuries represent a major constituent of physical assaults and homicidal fatalities, especially in countries with strict firearm legislations. In forensic investigations, the examination of homicidal sharp force cases remains a challenge for both determining the cause and manner of a death. The aim of this study is to analyze the patterns of homicidal sharp force cases in Northern Tunisia. We perform a descriptive study with a retrospective data collection over an 11-year period (January 2007-December 2017). During the study period, 405 cases of homicidal sharp force casualties were observed. The mean age was 33.9 years, with a range of 2 months-89 years. We note a male predominance (male to female ratio of 4.7), most of who were single (91.2%). The casualties lived mainly in urban areas (68.4%) and were unemployed or daily workers in 61% of cases. Assaults occurred mainly during summer (52.4%) at weekends (38%) in a public place (62.4%) with essentially one perpetrator (68.6%) who was an acquaintance of the deceased in 32.6% of cases. The injuries were primarily located in the thorax (75%) and were associated with defensive wounds in the upper limbs. The most frequent cause of death observed was hemorrhage (82.9%). The analysis of patterns in homicidal sharp force cases allows us to construct specific preventive measures that target young males. Lesion analysis aids forensic specialists in following a thorough autopsy to determine the causes of death.
Topics: Autopsy; Female; Forensic Medicine; Forensic Pathology; Homicide; Humans; Infant; Male; Retrospective Studies
PubMed: 35367718
DOI: 10.1016/j.jflm.2022.102347 -
The American Journal of Dermatopathology Feb 2016Immunohistochemistry (IHC) is an ancillary technique to improve diagnostic accuracy and prognosis in histopathology of both inflammatory and neoplastic cutaneous...
Immunohistochemistry (IHC) is an ancillary technique to improve diagnostic accuracy and prognosis in histopathology of both inflammatory and neoplastic cutaneous disorders. However, only a few studies address specifically the set of antibodies available for inflammatory or neoplastic skin diseases. In this study, we analyzed the IHC studies performed for inflammatory and neoplastic skin disorders in cutaneous biopsies taken in our department during 1 year. From a total of 8579 skin biopsies performed throughout the year 2011 in our department, IHC studies were performed in 283 cutaneous biopsies. The total number of different antibodies used in the IHC studies of those 283 skin biopsies was 129. These antibodies were used in 1421 studies, with a mean of 5 cases per antibody studied. The proliferative marker MIB-1 was the single antibody with the highest number of studies, with a total of 119 (8.3% of all IHC studies performed), followed by 113 of CD3 (7.9% of total IHC studies) and 108 of Melan-A (7.6% of total IHC studies). Other hematopoietic differentiation markers, such as CD20, CD4, and CD8, and other melanocytic markers, such as S-100 protein, Melan-A, and HMB-45, were all investigated with a frequency greater than 50 studies each. The 2 most frequent categories were melanocytic neoplasms, which represented 25% of all specimens studied by IHC, and the proliferations of lymphohematopoietic nature, which were 20% of all studied samples and represented by far the highest number of IHC stains per case to reach a final diagnosis. Both previous categories together accounted for 45% of all diagnoses in which IHC was performed. We compare our results with the only similar study previously published in the literature. The gold standard panel of antibodies that should be available in everyday practice in dermatopathology to arrive at a specific diagnosis in each cutaneous inflammatory disease or neoplastic process involving the skin is still a matter of discussion.
Topics: Antibodies; Antibody Specificity; Biomarkers, Tumor; Biopsy; Cell Differentiation; Cell Proliferation; Dermatitis; Dermatology; Diagnosis, Differential; Humans; Immunohistochemistry; Pathology; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Skin; Skin Neoplasms
PubMed: 26825156
DOI: 10.1097/DAD.0000000000000361 -
Archives of Pathology & Laboratory... Sep 2016-Distinguishing between a reactive and a neoplastic lymphoid proliferation is a clinically significant task frequently performed by the surgical pathologist in routine... (Review)
Review
CONTEXT
-Distinguishing between a reactive and a neoplastic lymphoid proliferation is a clinically significant task frequently performed by the surgical pathologist in routine practice.
OBJECTIVES
-To highlight common situations in lymph node pathology where reactive changes and lymphoma may be misdiagnosed.
DATA SOURCES
-Data sources are peer-reviewed journal articles, textbooks, and clinical experience.
CONCLUSIONS
-This review aims to refresh and enhance the surgical pathologist's awareness of the shared and distinguishing features of select reactive and neoplastic lymphoproliferations, which in turn will allow the surgical pathologist to make more accurate diagnoses and avoid the pitfalls of misdiagnosis. This will be done by describing a selection of commonly encountered reactive histologic changes observed in lymph nodes, present the lymphomas with which they share overlapping features, outline the features that distinguish them, and describe an approach to making an accurate diagnosis and avoiding a misdiagnosis in each scenario.
Topics: Diagnosis, Differential; Diagnostic Errors; Humans; Lymph Nodes; Lymphadenopathy; Lymphatic Diseases; Lymphoma; Pathology, Clinical; Pathology, Surgical
PubMed: 27575263
DOI: 10.5858/arpa.2015-0482-SA -
Anatomical Sciences Education Mar 2019This descriptive article describes the use of clinical case-based portfolios in histopathology teaching laboratories in conjunction with virtual microscopy not only to...
This descriptive article describes the use of clinical case-based portfolios in histopathology teaching laboratories in conjunction with virtual microscopy not only to integrate histology and pathology disciplines for first and second year medical students but also to stimulate student engagement, promote self-directed and group-based learning and enhance student-to-student interaction in a structured manner. Portfolios consisted of PowerPoint files encompassing four to five clinical case studies relevant to the topics covered that week. Portfolios integrated study materials provided in the module-specific lectures, clinical skill lectures, and online interactive content. Two sets of portfolios, Individual and Group, were used. Individual Portfolios were completed by each student and uploaded prior to the laboratory session. Group Portfolios were completed by students working together in small groups during the laboratory session with minimal faculty assistance. The functional utility and acceptance of Individual and Group Portfolios among first- and second-year medical students was evaluated using electronic surveys and examination performances. Both first- and second-year students agreed that the use of portfolios in conjunction with virtual microscopy promoted understanding and encouraged discussion of the topics covered during the week and that group members worked well together and contributed to the completion of the portfolios. Performances on the Histology and Cell Biology and Pathology sections on the United States Medical Licensing Examination (USMLE ) remained consistent and in line with national averages. Overall, use of portfolios promoted peer teaching and contributed towards successful transition to the new system-based integrated curriculum with continued strong performance on the USMLE.
Topics: Computer-Assisted Instruction; Curriculum; Education, Medical, Undergraduate; Educational Measurement; Histology; Humans; Pathology; Personal Satisfaction; Students, Medical; Surveys and Questionnaires; User-Computer Interface
PubMed: 30118571
DOI: 10.1002/ase.1794 -
Alzheimer's & Dementia : the Journal of... Nov 2023Neuropathological substrates associated with neurodegeneration occur in brains of the oldest old. How does this affect cognitive performance?
INTRODUCTION
Neuropathological substrates associated with neurodegeneration occur in brains of the oldest old. How does this affect cognitive performance?
METHODS
The 100-plus Study is an ongoing longitudinal cohort study of centenarians who self-report to be cognitively healthy; post mortem brain donation is optional. In 85 centenarian brains, we explored the correlations between the levels of 11 neuropathological substrates with ante mortem performance on 12 neuropsychological tests.
RESULTS
Levels of neuropathological substrates varied: we observed levels up to Thal-amyloid beta phase 5, Braak-neurofibrillary tangle (NFT) stage V, Consortium to Establish a Registry for Alzheimer's Disease (CERAD)-neuritic plaque score 3, Thal-cerebral amyloid angiopathy stage 3, Tar-DNA binding protein 43 (TDP-43) stage 3, hippocampal sclerosis stage 1, Braak-Lewy bodies stage 6, atherosclerosis stage 3, cerebral infarcts stage 1, and cerebral atrophy stage 2. Granulovacuolar degeneration occurred in all centenarians. Some high performers had the highest neuropathology scores.
DISCUSSION
Only Braak-NFT stage and limbic-predominant age-related TDP-43 encephalopathy (LATE) pathology associated significantly with performance across multiple cognitive domains. Of all cognitive tests, the clock-drawing test was particularly sensitive to levels of multiple neuropathologies.
Topics: Aged, 80 and over; Humans; Amyloid beta-Peptides; Centenarians; Longitudinal Studies; Alzheimer Disease; Brain; Neurofibrillary Tangles; Neuropathology; Cognition
PubMed: 37092333
DOI: 10.1002/alz.13087 -
Journal of Cutaneous Pathology Nov 2021Occasionally specimen containers are received in the dermatopathology laboratory without an accompanying specimen. The consequences in this scenario can range from delay...
BACKGROUND
Occasionally specimen containers are received in the dermatopathology laboratory without an accompanying specimen. The consequences in this scenario can range from delay in care and inconvenience to patients to increased morbidity and even mortality. Data regarding incidence and associated characteristics of missing specimens are scant.
METHODS
Over a 10-year period (7 January 2010 to 7 January 2020) all cases with a missing specimen in a single academic dermatopathology laboratory and a single dermatopathology practice embedded within a dermatology practice were reviewed.
RESULTS
Out of 270,754 specimens received, 83 empty specimen containers were identified for an incidence of 0.031%. There were 14 (0.005%) cases in which patients had a separate procedure and a second container with both specimens in it accompanying the empty container. The most common missing specimen-generating procedures were shave biopsies (51%) with most common clinical diagnosis being unspecified (30%). The most common specimen location from the 97 total specimen bottles containing either zero or two specimens was head/neck (53%). Although no further procedures were performed after the specimen was lost for 48% of cases, re-biopsy occurred for 28%.
CONCLUSIONS
Failure to insert specimens into the correct container is rare, but represents a potential significant negative event where vigilance and improvement is required.
Topics: Biopsy; Dermatology; Humans; Medical Errors; Pathology, Surgical; Specimen Handling
PubMed: 34075625
DOI: 10.1111/cup.14071 -
Diagnostic Pathology Mar 2021The role of Artificial intelligence (AI) which is defined as the ability of computers to perform tasks that normally require human intelligence is constantly expanding.... (Review)
Review
Artificial intelligence (AI) in medicine, current applications and future role with special emphasis on its potential and promise in pathology: present and future impact, obstacles including costs and acceptance among pathologists, practical and philosophical considerations. A comprehensive review.
BACKGROUND
The role of Artificial intelligence (AI) which is defined as the ability of computers to perform tasks that normally require human intelligence is constantly expanding. Medicine was slow to embrace AI. However, the role of AI in medicine is rapidly expanding and promises to revolutionize patient care in the coming years. In addition, it has the ability to democratize high level medical care and make it accessible to all parts of the world.
MAIN TEXT
Among specialties of medicine, some like radiology were relatively quick to adopt AI whereas others especially pathology (and surgical pathology in particular) are only just beginning to utilize AI. AI promises to play a major role in accurate diagnosis, prognosis and treatment of cancers. In this paper, the general principles of AI are defined first followed by a detailed discussion of its current role in medicine. In the second half of this comprehensive review, the current and future role of AI in surgical pathology is discussed in detail including an account of the practical difficulties involved and the fear of pathologists of being replaced by computer algorithms. A number of recent studies which demonstrate the usefulness of AI in the practice of surgical pathology are highlighted.
CONCLUSION
AI has the potential to transform the practice of surgical pathology by ensuring rapid and accurate results and enabling pathologists to focus on higher level diagnostic and consultative tasks such as integrating molecular, morphologic and clinical information to make accurate diagnosis in difficult cases, determine prognosis objectively and in this way contribute to personalized care.
Topics: Artificial Intelligence; Attitude of Health Personnel; Attitude to Computers; Cost-Benefit Analysis; Health Care Costs; Health Knowledge, Attitudes, Practice; Humans; Image Interpretation, Computer-Assisted; Microscopy; Pathologists; Pathology; Practice Patterns, Physicians'; Predictive Value of Tests; Reproducibility of Results
PubMed: 33731170
DOI: 10.1186/s13000-021-01085-4