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Seminars in Diagnostic Pathology Jan 2024Microscopes, more than any other instrument, reflect advances in clinical medicine over the past several hundred years. As the primary tool of the pathologist, they... (Review)
Review
Microscopes, more than any other instrument, reflect advances in clinical medicine over the past several hundred years. As the primary tool of the pathologist, they were, and continue to be, a key connector between the bedside and basic sciences. One specific example is the science of clinical dermatology, which relies on clinical-pathologic correlation to make a definitive diagnosis. The microscopes used by pathologists, however, are more than scientific artifacts. Many antique microscopes are hand-crafted works of art. Even while recognizing that light microscopes may soon be obsolete as scanned slides and computer joy-sticks replace optical instruments in patient care and teaching, their significance will not be diminished. The microscope will never be forgotten in the history, art, and science of medicine, for these instruments set the social and cultural stage for modern, scientific patient care.
PubMed: 38627186
DOI: 10.1053/j.semdp.2024.01.002 -
American Journal of Clinical Pathology May 2024The appendix, although considered a vestigial organ, is of considerable clinical importance because acute appendicitis is a common medical problem. There are also other... (Review)
Review
OBJECTIVES
The appendix, although considered a vestigial organ, is of considerable clinical importance because acute appendicitis is a common medical problem. There are also other disease processes involving the appendix. The appendix is among the first specimens that the pathologist (and surgeon) cuts one's teeth on. Thus, there may be a tendency to underestimate the clinically and prognostically significant appendiceal pathologies.
METHODS
We provide a vade mecum of the pathologic features of a wide range of nonneoplastic appendiceal pathologies, with an emphasis on developing a practical approach to grossing, microscopy, and reporting-all with clinical and therapeutic implications. Much of this is based on literature on MEDLINE with reference to years 2008 to 2023, as well as on personal experiences and interpretations.
RESULTS
The appendix can harbor a myriad of nonneoplastic pathologies, including infections, inflammations of varying etiologies (including interval appendectomy), endometriosis, diverticulosis, and so on. Chronic appendicitis, Crohn disease, and clinical audit are recurring themes while COVID-19 is a new entity.
CONCLUSIONS
Most importantly, all pathologists should appreciate that the appendix is not as "routine" a specimen as one would want to believe.
Topics: Humans; Appendix; COVID-19; Appendicitis; Cecal Diseases; SARS-CoV-2
PubMed: 38217538
DOI: 10.1093/ajcp/aqad175 -
American Journal of Speech-language... Nov 2023The purpose of this study was to examine school-based speech-language pathologists' (SLPs') implementation of services to address students' executive function (EF)...
PURPOSE
The purpose of this study was to examine school-based speech-language pathologists' (SLPs') implementation of services to address students' executive function (EF) needs, with particular emphasis on the prevalence and characteristics of EF interventions and the factors and barriers that influence service provision for students with EF needs.
METHOD
We applied an explanatory sequential mixed-methods research design, beginning with a quantitative survey followed by a series of qualitative interviews. We analyzed the survey results using descriptive data and binary logistic regressions and used the emergent trends to inform our interview protocol, so that we could explore those trends in greater detail and context. We synthesized our quantitative and qualitative data to evaluate the characteristics of EF interventions and the factors influencing services.
RESULTS
Most SLPs reported that they addressed their students' EF needs through some sort of direct or indirect intervention. Direct interventions varied by targeted domain, service delivery setting, and teaching techniques, though most SLPs favored strategy instruction and highly contextualized services. Indirect services included accommodations and consultation. SLPs commonly reported the lack of collaborative support, time, and knowledge as barriers, and most reported that professional development would be helpful to improve their services.
CONCLUSIONS
Speech-language pathology graduate programs and providers of professional development should be mindful of their role in preparing SLPs to address EF needs, while SLPs may use these results to inform their own practice. Further guidance and research are necessary to elucidate the SLPs' role in mitigating the negative impact of EF challenges on students' education.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.24101241.
Topics: Humans; Executive Function; Pathologists; Speech; Communication Disorders; Surveys and Questionnaires; Speech-Language Pathology
PubMed: 37707364
DOI: 10.1044/2023_AJSLP-22-00238 -
Histopathology Jul 2024The significant clinical benefits of human epidermal growth factor receptor 2 (HER2)-targeted therapeutic agents have revolutionized the clinical treatment landscape in... (Review)
Review
The significant clinical benefits of human epidermal growth factor receptor 2 (HER2)-targeted therapeutic agents have revolutionized the clinical treatment landscape in a variety of human solid tumours. Accordingly, accurate evaluation of HER2 status in these different tumour types is critical for clinical decision making to select appropriate patients who may benefit from life-saving HER2-targeted therapies. HER2 biomarker scoring criteria is different in different organ systems, and close adherence to the corresponding HER2 biomarker testing guidelines and their updates, if available, is essential for accurate evaluation. In addition, knowing the unusual patterns of HER2 expression is also important to avoid inaccurate evaluation. In this review, we discuss the key considerations when evaluating HER2 status in solid tumours for clinical decision making, including tissue handling and preparation for HER2 biomarker testing, as well as pathologist's readout of HER2 testing results in breast carcinomas, gastroesophageal adenocarcinomas, colorectal adenocarcinomas, gynaecologic carcinomas, and non-small cell lung carcinomas.
Topics: Humans; Receptor, ErbB-2; Biomarkers, Tumor; Clinical Decision-Making; Neoplasms; Breast Neoplasms; Female; Immunohistochemistry
PubMed: 38443321
DOI: 10.1111/his.15170 -
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 -
Gynecologic and Obstetric Investigation 2024Gestational trophoblastic disease (GTD), comprising hydatidiform moles and gestational trophoblastic tumours, is extremely rare. Exact diagnosis is crucial to indicate... (Review)
Review
BACKGROUND
Gestational trophoblastic disease (GTD), comprising hydatidiform moles and gestational trophoblastic tumours, is extremely rare. Exact diagnosis is crucial to indicate the appropriate treatment and to prevent complications. The scarcity and variability in the number of cases available for reporting, lack of specialised training in GTD, and non-existence of refresher courses implies that the pathologist dealing with these rare and, at times, extremely challenging cases is not completely confident in their diagnosis.
OBJECTIVES
The objective of this study was to explore the benefits of implementation of an international multidisciplinary conference (virtual) to aid diagnosis of difficult cases and support clinical management of GTD.
METHODS
A short survey was circulated to all 46 members of the EOTTD pathology and genetics working party and further spread to other colleagues who practice GTD. This showed that the pathologists and geneticists working with GTD patients do not feel adequately supported and equipped with dealing with these rare diseases.
OUTCOME
Virtual cross-border multidisciplinary team meetings (MDTs) were initiated in April 2022, bringing together participants from 11 European countries on a bi-yearly basis. Mean numbers of 3 patients are discussed during the MDTs followed by 3-4 quality assessment cases. A participant survey was conducted at the end of virtual meeting with an average satisfaction rate of 9.5. The pathologists felt supported and benefited from networking and clinical collaboration.
CONCLUSIONS AND OUTLOOK
This international MDT continues to provide support in managing the uncertainty with difficult and rare cases and enhances the pathologists training and experience. The frequency of meetings and the number of cases discussed per meeting will be increased in 2023 given the positive response. This will empower individuals and organisations to work together and improve diagnosis and the prognosis for these young patients.
Topics: Humans; Gestational Trophoblastic Disease; Female; Pregnancy; Patient Care Team; Pathologists; Surveys and Questionnaires; Europe; Uterine Neoplasms; Congresses as Topic
PubMed: 38190817
DOI: 10.1159/000536028 -
Current Protocols Sep 2023Advances in genomic technologies have enabled the development of abundant mouse models of human disease, requiring accurate phenotyping to elucidate the consequences of... (Review)
Review
Advances in genomic technologies have enabled the development of abundant mouse models of human disease, requiring accurate phenotyping to elucidate the consequences of genetic manipulation. Anatomic pathology, an important component of the mouse phenotyping pipeline, is ideally performed by human or veterinary pathologists; however, due to insufficient numbers of pathologists qualified to assess these mouse models morphologically, research scientists may perform "do-it-yourself" pathology, resulting in diagnostic error. In the biomedical literature, pathology data is commonly presented as images of tissue sections, stained with either hematoxylin and eosin or antibodies via immunohistochemistry, accompanied by a figure legend. Data presented in such images and figure legends may contain inaccuracies. Furthermore, there is limited guidance for non-pathologist research scientists concerning the elements required in an ideal pathology image and figure legend in a research publication. In this overview, the components of an ideal pathology image and figure legend are outlined and comprise image quality, image composition, and image interpretation. Background knowledge is important for producing accurate pathology images and critically assessing these images in the literature. This foundational knowledge includes understanding relevant human and mouse anatomy and histology and, for cancer researchers, an understanding of human and mouse tumor classification and morphology, mouse stain background lesions, and tissue processing artifacts. Accurate interpretation of immunohistochemistry is also vitally important and is detailed with emphasis on the requirement for tissue controls and the distribution, intensity, and intracellular location of staining. Common pitfalls in immunohistochemistry interpretation are outlined, and a checklist of questions is provided by which any pathology image may be critically examined. Collaboration with pathologist colleagues is encouraged. This overview aims to equip researchers to critically assess the quality and accuracy of pathology images in the literature to improve the reliability and reproducibility of published pathology data. © 2023 The Authors. Current Protocols published by Wiley Periodicals LLC.
Topics: Animals; Humans; Mice; Antibodies; Artifacts; Disease Models, Animal; Hyaluronic Acid; Pathologists; Physicians; Reproducibility of Results
PubMed: 37712877
DOI: 10.1002/cpz1.891 -
European Archives of... Sep 2023
Topics: Humans; Pathologists; Retrospective Studies; Adenoma, Pleomorphic; Pathology, Clinical; Salivary Glands
PubMed: 36947250
DOI: 10.1007/s00405-023-07930-0 -
Frontiers in Oncology 2023This review synthesises past research into how machine and deep learning can improve the cyto- and histopathology processing pipelines for thyroid cancer diagnosis. The... (Review)
Review
This review synthesises past research into how machine and deep learning can improve the cyto- and histopathology processing pipelines for thyroid cancer diagnosis. The current gold-standard preoperative technique of fine-needle aspiration cytology has high interobserver variability, often returns indeterminate samples and cannot reliably identify some pathologies; histopathology analysis addresses these issues to an extent, but it requires surgical resection of the suspicious lesions so cannot influence preoperative decisions. Motivated by these issues, as well as by the chronic shortage of trained pathologists, much research has been conducted into how artificial intelligence could improve current pipelines and reduce the pressure on clinicians. Many past studies have indicated the significant potential of automated image analysis in classifying thyroid lesions, particularly for those of papillary thyroid carcinoma, but these have generally been retrospective, so questions remain about both the practical efficacy of these automated tools and the realities of integrating them into clinical workflows. Furthermore, the nature of thyroid lesion classification is significantly more nuanced in practice than many current studies have addressed, and this, along with the heterogeneous nature of processing pipelines in different laboratories, means that no solution has proven itself robust enough for clinical adoption. There are, therefore, multiple avenues for future research: examine the practical implementation of these algorithms as pathologist decision-support systems; improve interpretability, which is necessary for developing trust with clinicians and regulators; and investigate multiclassification on diverse multicentre datasets, aiming for methods that demonstrate high performance in a process- and equipment-agnostic manner.
PubMed: 38023130
DOI: 10.3389/fonc.2023.958310 -
Endocrine Pathology Dec 2023Endocrine neoplasia represents an increasingly broad spectrum of disorders. Endocrine neoplasms range from incidental findings to potentially lethal malignancies. In... (Review)
Review
Endocrine neoplasia represents an increasingly broad spectrum of disorders. Endocrine neoplasms range from incidental findings to potentially lethal malignancies. In this paper, we cover the impact of pathology in the interpretation of the clinic-pathological, genetic, and radiographic features underpinning these neoplasms. We highlight the critical role of multidisciplinary interactions in structuring a rational diagnostic and efficient therapeutic plan and emphasize the role of histopathological input in decision-making. In this context, standardized pathology reporting and second opinion endocrine pathology review represent relevant tools to improve the overall diagnostic workup of patients affected by endocrine tumors in every specific scenario. In fact, although a relevant proportion of cases may be correctly identified based on clinical presentation and biochemical/imaging investigations, a subset of cases presents with atypical findings that may lead to an inappropriate diagnosis and treatment plan based on a wrong pathological diagnosis if all pieces of the puzzle are not correctly considered. Pathologists have a responsibility to actively guide clinicians before and during surgical procedures to prevent unnecessary interventions. In all areas of endocrine pathology, pathologists must understand the complexity of tissue preservation and assay sensitivities and specificities to ensure the optimal quality and interpretation of diagnostic material. Finally, pathologists are central actors in tumor tissue biobanking, which is an expanding field in oncology that should be promoted while adhering to strict ethical and methodological standards.
Topics: Humans; Pathologists; Biological Specimen Banks; Neoplasms; Medical Oncology; Sensitivity and Specificity
PubMed: 37166678
DOI: 10.1007/s12022-023-09768-y