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Surgical Pathology Clinics Sep 2021The identification of targetable genomic alterations in lung cancer is required as standard of care to guide optimal therapy selection. With a constantly evolving... (Review)
Review
The identification of targetable genomic alterations in lung cancer is required as standard of care to guide optimal therapy selection. With a constantly evolving landscape of ancillary molecular and biomarker testing in lung cancer, pathologists need to be aware of what specimens to test, how the testing should be performed, and which targets to test for to provide the clinically relevant genomic information necessary to treat these patients. Several guideline statements on the topic are currently available to help pathologists and laboratory personnel best use the small specimens obtained from patients with lung cancer for ancillary molecular testing.
Topics: Biomarkers, Tumor; Genomics; Humans; Lung Neoplasms; Pathologists; Pathology, Molecular
PubMed: 34373089
DOI: 10.1016/j.path.2021.05.002 -
The American Journal of Pathology Sep 2019With the rapid development of image scanning techniques and visualization software, whole slide imaging (WSI) is becoming a routine diagnostic method. Accelerating... (Review)
Review
With the rapid development of image scanning techniques and visualization software, whole slide imaging (WSI) is becoming a routine diagnostic method. Accelerating clinical diagnosis from pathology images and automating image analysis efficiently and accurately remain significant challenges. Recently, deep learning algorithms have shown great promise in pathology image analysis, such as in tumor region identification, metastasis detection, and patient prognosis. Many machine learning algorithms, including convolutional neural networks, have been proposed to automatically segment pathology images. Among these algorithms, segmentation deep learning algorithms such as fully convolutional networks stand out for their accuracy, computational efficiency, and generalizability. Thus, deep learning-based pathology image segmentation has become an important tool in WSI analysis. In this review, the pathology image segmentation process using deep learning algorithms is described in detail. The goals are to provide quick guidance for implementing deep learning into pathology image analysis and to provide some potential ways of further improving segmentation performance. Although there have been previous reviews on using machine learning methods in digital pathology image analysis, this is the first in-depth review of the applications of deep learning algorithms for segmentation in WSI analysis.
Topics: Algorithms; Deep Learning; Diagnostic Imaging; Humans; Image Processing, Computer-Assisted; Pathology, Clinical
PubMed: 31199919
DOI: 10.1016/j.ajpath.2019.05.007 -
Archives of Pathology & Laboratory... Apr 2021Controversies and uncertainty persist in prostate cancer grading. (Review)
Review
CONTEXT.—
Controversies and uncertainty persist in prostate cancer grading.
OBJECTIVE.—
To update grading recommendations.
DATA SOURCES.—
Critical review of the literature along with pathology and clinician surveys.
CONCLUSIONS.—
Percent Gleason pattern 4 (%GP4) is as follows: (1) report %GP4 in needle biopsy with Grade Groups (GrGp) 2 and 3, and in needle biopsy on other parts (jars) of lower grade in cases with at least 1 part showing Gleason score (GS) 4 + 4 = 8; and (2) report %GP4: less than 5% or less than 10% and 10% increments thereafter. Tertiary grade patterns are as follows: (1) replace "tertiary grade pattern" in radical prostatectomy (RP) with "minor tertiary pattern 5 (TP5)," and only use in RP with GrGp 2 or 3 with less than 5% Gleason pattern 5; and (2) minor TP5 is noted along with the GS, with the GrGp based on the GS. Global score and magnetic resonance imaging (MRI)-targeted biopsies are as follows: (1) when multiple undesignated cores are taken from a single MRI-targeted lesion, an overall grade for that lesion is given as if all the involved cores were one long core; and (2) if providing a global score, when different scores are found in the standard and the MRI-targeted biopsy, give a single global score (factoring both the systematic standard and the MRI-targeted positive cores). Grade Groups are as follows: (1) Grade Groups (GrGp) is the terminology adopted by major world organizations; and (2) retain GS 3 + 5 = 8 in GrGp 4. Cribriform carcinoma is as follows: (1) report the presence or absence of cribriform glands in biopsy and RP with Gleason pattern 4 carcinoma. Intraductal carcinoma (IDC-P) is as follows: (1) report IDC-P in biopsy and RP; (2) use criteria based on dense cribriform glands (>50% of the gland is composed of epithelium relative to luminal spaces) and/or solid nests and/or marked pleomorphism/necrosis; (3) it is not necessary to perform basal cell immunostains on biopsy and RP to identify IDC-P if the results would not change the overall (highest) GS/GrGp part per case; (4) do not include IDC-P in determining the final GS/GrGp on biopsy and/or RP; and (5) "atypical intraductal proliferation (AIP)" is preferred for an intraductal proliferation of prostatic secretory cells which shows a greater degree of architectural complexity and/or cytological atypia than typical high-grade prostatic intraepithelial neoplasia, yet falling short of the strict diagnostic threshold for IDC-P. Molecular testing is as follows: (1) Ki67 is not ready for routine clinical use; (2) additional studies of active surveillance cohorts are needed to establish the utility of PTEN in this setting; and (3) dedicated studies of RNA-based assays in active surveillance populations are needed to substantiate the utility of these expensive tests in this setting. Artificial intelligence and novel grading schema are as follows: (1) incorporating reactive stromal grade, percent GP4, minor tertiary GP5, and cribriform/intraductal carcinoma are not ready for adoption in current practice.
Topics: Biomarkers, Tumor; Biopsy, Needle; Consensus; Humans; Image-Guided Biopsy; Immunohistochemistry; Magnetic Resonance Imaging; Male; Molecular Diagnostic Techniques; Neoplasm Grading; Pathology; Predictive Value of Tests; Prostatic Neoplasms
PubMed: 32589068
DOI: 10.5858/arpa.2020-0015-RA -
Nature Communications Aug 2021Pathology is practiced by visual inspection of histochemically stained tissue slides. While the hematoxylin and eosin (H&E) stain is most commonly used, special stains...
Pathology is practiced by visual inspection of histochemically stained tissue slides. While the hematoxylin and eosin (H&E) stain is most commonly used, special stains can provide additional contrast to different tissue components. Here, we demonstrate the utility of supervised learning-based computational stain transformation from H&E to special stains (Masson's Trichrome, periodic acid-Schiff and Jones silver stain) using kidney needle core biopsy tissue sections. Based on the evaluation by three renal pathologists, followed by adjudication by a fourth pathologist, we show that the generation of virtual special stains from existing H&E images improves the diagnosis of several non-neoplastic kidney diseases, sampled from 58 unique subjects (P = 0.0095). A second study found that the quality of the computationally generated special stains was statistically equivalent to those which were histochemically stained. This stain-to-stain transformation framework can improve preliminary diagnoses when additional special stains are needed, also providing significant savings in time and cost.
Topics: Algorithms; Biopsy, Large-Core Needle; Coloring Agents; Deep Learning; Diagnosis, Computer-Assisted; Diagnosis, Differential; Humans; Kidney; Kidney Diseases; Pathology, Clinical; Reference Standards; Reproducibility of Results; Sensitivity and Specificity; Staining and Labeling
PubMed: 34385460
DOI: 10.1038/s41467-021-25221-2 -
Zhonghua Bing Li Xue Za Zhi = Chinese... Jan 2022With the technological progresses and applications of human genome sequencing, bioinformatics analysis and data mining, and molecular pathology and artificial...
With the technological progresses and applications of human genome sequencing, bioinformatics analysis and data mining, and molecular pathology and artificial intelligence-assisted pathological diagnosis, the development of clinical medicine is moving towards the era of precision diagnosis and treatment. In the context of this era, the traditional diagnostic pathology is facing unprecedented opportunities and challenges in our history and is striving towards the "next-generation diagnostic pathology" (NGDP). NGDP is based on histomorphology and clinical data, and characterized by the combination of molecular detection and bioinformatics analysis, intelligent sampling and process quality control, intelligent diagnosis and remote consultation, lesion visualization and "non-invasive" pathology as well as other innovative cutting edge interdisciplinary technologies. The NGDP reports will include the results from multi-omics and cross-scale integrated diagnosis for final diagnosis. NGDP will also be applied for predicting disease progression and outcomes, and determining optional therapeutics as well as assessing treatment responses, so that a novel "golden standard" of disease diagnosis can be established. In the near fature, it is necessary to stimulate the innovative vitality of pathology disciplines, accelerate the maturity and application for NGDP, update the theory and technical system of pathology, and perform its important applicable role in the prevention, diagnosis, treatment of diseases so that the futher development of clinical medicine will be promoted and the strategy for maintenance of being healthy in China will be served.
Topics: Artificial Intelligence; China; Computational Biology; Humans; Pathology, Molecular
PubMed: 34979745
DOI: 10.3760/cma.j.cn112151-20211005-00726 -
Diagnostic Cytopathology Jan 2023In the era of personalized medicine, molecular testing plays a critical role in patient care. The rapid advance of molecular techniques, especially next-generation...
In the era of personalized medicine, molecular testing plays a critical role in patient care. The rapid advance of molecular techniques, especially next-generation sequencing, makes molecular diagnosis feasible in daily practice. Molecular testing can be used as a valuable ancillary test to increase diagnostic sensitivity and specificity, especially in small biopsy or cytology samples. In addition, molecular testing plays an important role in selecting patients for appropriate treatment by detecting therapeutic and predictive biomarkers in tissue or cytology samples. Molecular studies can be applied in all cytology samples, sometimes with better results than histology. As molecular testing has become essential for patient care and is often requested to be performed in cytology samples, it is critical for cytopathologists to understand the basics of molecular diagnostic methods, indications for molecular testing, and how to best utilize different cytologic samples for this purpose. In this special issue, experts in various areas of cytopathology and molecular pathology review the literature and discuss the basics of molecular techniques and the application of molecular testing in various types of cytology samples. It is our hope that after reading the articles in this special issue, the readers can know better about the possibilities of molecular cytology, a very exciting field of pathology.
Topics: Humans; Pathology, Molecular; Molecular Diagnostic Techniques
PubMed: 36367273
DOI: 10.1002/dc.25071 -
The Veterinary Clinics of North... Apr 2020The assessment of blood analytes in racehorses can provide useful data on performance and health. The horses' adaptive responses to training that occur to optimize... (Review)
Review
The assessment of blood analytes in racehorses can provide useful data on performance and health. The horses' adaptive responses to training that occur to optimize performance should be considered when interpreting alterations seen on laboratory results. Similarly, the alterations observed in laboratory test results can identify subclinical and clinical disease and be helpful for identifying organ dysfunction and, in many cases, monitoring progress and response to treatment. This article discusses hematologic and biochemical tests that are important in the evaluation of performance and health in racehorses.
Topics: Animals; Horse Diseases; Horses; Pathology, Clinical; Physical Conditioning, Animal
PubMed: 31992502
DOI: 10.1016/j.cveq.2019.12.004 -
American Journal of Clinical Pathology May 2022To demonstrate how the educational presentation and targeted review of cases with discrepant interpretive findings between pathologists can raise awareness for specific... (Review)
Review
OBJECTIVES
To demonstrate how the educational presentation and targeted review of cases with discrepant interpretive findings between pathologists can raise awareness for specific diagnostic errors through identification of common overarching patterns of error in interpretive pathology.
METHODS
We performed a review of 147 surgical pathology and cytopathology cases of discordances from 23 PowerPoint presentations presented between 2010 and 2017. Pathologists and pathology residents, blinded from the official interpretations, were presented each case and surveyed for their own diagnostic assessments. Survey results were compared with the final/correct interpretations of the signing pathologists.
RESULTS
Of the 134 cases with available survey results, there were 87 (64.9%) for which most survey respondents proposed a diagnostic interpretation concordant with the final/correct diagnosis. There were 37 (27.6%) cases for which most survey responses were either wholly or partially discordant with the final/correct diagnosis. For 10 (7.5%) cases, there were equal numbers of concordant and discordant survey responses.
CONCLUSIONS
Our analyses of the cases with frequent erroneous diagnoses reveal common patterns of error that are widely applicable and outline specific error-prone interpretive tendencies. Greater awareness for these tendencies, highlighted by presentation of discordant cases, can improve the quality of diagnostic pathology services.
Topics: Diagnostic Errors; Humans; Pathology, Surgical
PubMed: 35512255
DOI: 10.1093/ajcp/aqab190 -
Wiener Medizinische Wochenschrift (1946) Sep 2021Dementia is the clinical consequence of various neurological disorders with a multitude of etiologies. Precise knowledge of the underlying pathologies is essential for... (Review)
Review
Dementia is the clinical consequence of various neurological disorders with a multitude of etiologies. Precise knowledge of the underlying pathologies is essential for an accurate treatment of patients and for the development of suitable disease biomarkers. A definite diagnosis of many of the disorders, particularly for neurodegenerative ones, can only be made after a thorough postmortem neuropathological examination. This highlights the importance of performing a brain autopsy and the relevance of a close interaction between clinicians, neuroimaging disciplines and neuropathologists as well as with basic researchers. This article aims to give a brief overview on the neuropathology of dementia focusing on neurodegenerative diseases, to further facilitate interdisciplinary collaboration.
Topics: Autopsy; Brain; Dementia; Humans; Neurodegenerative Diseases; Neuropathology
PubMed: 34129141
DOI: 10.1007/s10354-021-00848-4 -
Histopathology Jan 2024Currently, lung cancer is treated by the highest number of therapeutic options and the benefits are based on multiple large-scale sequencing studies, translational... (Review)
Review
Currently, lung cancer is treated by the highest number of therapeutic options and the benefits are based on multiple large-scale sequencing studies, translational research and new drug development, which has promoted our understanding of the molecular pathology of lung cancer. According to the driver alterations, different characteristics have been revealed, such as differences in ethnic prevalence, median age and alteration patterns. Consequently, beyond traditional chemoradiotherapy, molecular-targeted therapy and treatment with immune check-point inhibitors (ICI) also became available major therapeutic options. Interestingly, clinical results suggest that the recently established therapies target distinct lung cancer proportions, particularly between the EGFR/ALK and PD-1/PD-L1-positive subsets, e.g. the kinase inhibitors target driver mutation-positive tumours, whereas driver mutation-negative tumours respond to ICI treatment. These therapeutic efficacy-related differences might be explained by the molecular pathogenesis of lung cancer. Addictive driver mutations promote tumour formation with powerful transformation performance, resulting in a low tumour mutation burden, reduced immune surveillance, and subsequent poor response to ICIs. In contrast, regular tobacco smoke exposure repeatedly injures the proximal airway epithelium, leading to accumulated genetic alterations. In the latter pathway, overgrowth due to alteration and immunological exclusion against neoantigens is initially balanced. However, tumours could be generated from certain clones that outcompete immunological exclusion and outgrow the others. Consequently, this cancer type responds to immune check-point treatment. These pathogenic differences are explained well by the two-compartment model, focusing upon the anatomical and functional composition of distinct cellular components between the terminal respiratory unit and the air-conducting system.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Pathology, Molecular; Lung Neoplasms; Carcinoma; Mutation; B7-H1 Antigen
PubMed: 37936491
DOI: 10.1111/his.15080