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Clinical and Molecular Hepatology Feb 2023Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases characterized by fatty accumulation in hepatocytes, ranging from steatosis, non-alcoholic... (Review)
Review
Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases characterized by fatty accumulation in hepatocytes, ranging from steatosis, non-alcoholic steatohepatitis, to cirrhosis. While histopathological evaluation of liver biopsies plays a central role in the diagnosis of NAFLD, limitations such as the problem of interobserver variability still exist and active research is underway to improve the diagnostic utility of liver biopsies. In this article, we provide a comprehensive overview of the histopathological features of NAFLD, the current grading and staging systems, and discuss the present and future roles of liver biopsies in the diagnosis and prognostication of NAFLD.
Topics: Humans; Non-alcoholic Fatty Liver Disease; Liver; Pathologists; Liver Cirrhosis; Hepatocytes; Biopsy
PubMed: 36384146
DOI: 10.3350/cmh.2022.0329 -
Archives of Pathology & Laboratory... May 2019As part of its value-based care initiative, the College of American Pathologists has pursued research to better understand the role pathologists can have in population... (Review)
Review
CONTEXT.—
As part of its value-based care initiative, the College of American Pathologists has pursued research to better understand the role pathologists can have in population health.
OBJECTIVES.—
To answer the following questions: (1) what is the impact of population health and population health management on pathologists; (2) what roles are pathologists playing in population health management; (3) is population health something that pathologists in both larger and smaller settings can engage in; (4) are pathologists in a position to analyze laboratory data for population health, and, if so, what are the key information sources those pathologists must access; and (5) what steps can a pathologist take to become involved in population health?
DESIGN.—
We conducted 10 semistructured interviews with pathologists and other medical laboratory leaders who have been active in population health. These interviews were supplemented with a review of the medical literature.
RESULTS.—
Pathologists have demonstrated that laboratory data can provide unique value-added contributions to improving the health of populations. These contributions are not limited to pathologists in large, integrated settings. However, pathologists need to be proactive to contribute to health systems' population health efforts and may need to both enhance their own skills and the quality of their data to maximize the value of their contributions.
CONCLUSIONS.—
Although not necessarily a definitive summary of the roles that pathologists are playing in population health, this article identifies some of the promising and innovative activities occurring among pathologists and laboratorians.
Topics: Humans; Pathologists; Pathology, Clinical; Population Health
PubMed: 30398912
DOI: 10.5858/arpa.2018-0223-CP -
Current Cancer Drug Targets 2018The effectiveness of new personalized treatment procedures in oncology is based on the fact that certain tumors exhibit specific molecular features. More in detail,... (Review)
Review
The effectiveness of new personalized treatment procedures in oncology is based on the fact that certain tumors exhibit specific molecular features. More in detail, neoplastic tissues of patients should display a specific biomarker, most often a specific genetic alteration and/or under/overexpression of a definite protein, that could be the target of its respective drug. Immunohistochemical and molecular analyses, which usually include examination of nucleic acids from either tissues or fluids, are common tests to define the status of a tumor. This review focuses on the pathologist's role in carefully controlling pre- analytic procedures and standard operating procedures that are a crucial prerequisite to reach reliable and reproducible results. Six paradigmatic applications of targeted therapy, for which pathological diagnosis plays a fundamental role, are summarized. Traditional and next-generation sequencing are also addressed from the pathologist's perspective as well as the importance pathologists have in this shift to more accurate definition of disease risk and prognostication of therapy response in the personalized medicine era.
Topics: Antineoplastic Agents; Humans; Molecular Targeted Therapy; Neoplasm Proteins; Neoplasms; Pathologists; Precision Medicine; Prognosis
PubMed: 29189158
DOI: 10.2174/1568009618666171129145703 -
JPMA. the Journal of the Pakistan... Dec 2022To determine the level of understanding among speech language pathologists regarding counselling.
OBJECTIVE
To determine the level of understanding among speech language pathologists regarding counselling.
METHODS
The cross-sectional study was conducted online from July 2020 to January 2021, and comprised speech language pathologists of either gender working in public or private institutions or clinics of Punjab, Sindh and KPK. Data was collected using the Self-report on counselling and interpersonal communication skills' questionnaire. The collected data was analysed using SPSS 22.
RESULTS
Of the 190 subjects, 176(92.6%) were females and 14(7.4%) were males. Majority 173(91.1%) were aged 25-35 years, and 173(91.1%) belonged to the Punjab province. Majority 175(92%) of the respondents reported satisfaction about their own counselling skills, while 168(88.4%) also expressed the need for inclusion of more courses and training to develop counselling and interpersonal communication skills.
CONCLUSIONS
With experience, professional counselling skills improve and awareness about the need to incorporate counselling training also increases.
Topics: Male; Female; Humans; Self Report; Cross-Sectional Studies; Pathologists; Speech; Communication Disorders; Counseling; Surveys and Questionnaires
PubMed: 37246668
DOI: 10.47391/JPMA.5181 -
Virchows Archiv : An International... Jan 2022Histologic grading has been a simple and inexpensive method to assess tumor behavior and prognosis of invasive breast cancer grading, thereby identifying patients at... (Review)
Review
Histologic grading has been a simple and inexpensive method to assess tumor behavior and prognosis of invasive breast cancer grading, thereby identifying patients at risk for adverse outcomes, who may be eligible for (neo)adjuvant therapies. Histologic grading needs to be performed accurately, on properly fixed specimens, and by adequately trained dedicated pathologists that take the time to diligently follow the protocol methodology. In this paper, we review the history of histologic grading, describe the basics of grading, review prognostic value and reproducibility issues, compare performance of grading to gene expression profiles, and discuss how to move forward to improve reproducibility of grading by training, feedback and artificial intelligence algorithms, and special stains to better recognize mitoses. We conclude that histologic grading, when adequately carried out, remains to be of important prognostic value in breast cancer patients.
Topics: Artificial Intelligence; Breast Neoplasms; Female; Humans; Mitosis; Neoplasm Grading; Pathologists; Reproducibility of Results
PubMed: 34196797
DOI: 10.1007/s00428-021-03141-2 -
American Society of Clinical Oncology... Apr 2022Artificial intelligence is rapidly expanding into nearly all facets of life, particularly within the field of medicine. The diagnosis, characterization, management, and...
Artificial intelligence is rapidly expanding into nearly all facets of life, particularly within the field of medicine. The diagnosis, characterization, management, and treatment of kidney cancer is ripe with areas for improvement that may be met with the promises of artificial intelligence. Here, we explore the impact of current research work in artificial intelligence for clinicians caring for patients with renal cancer, with a focus on the perspectives of radiologists, pathologists, and urologists. Promising preliminary results indicate that artificial intelligence may assist in the diagnosis and risk stratification of newly discovered renal masses and help guide the clinical treatment of patients with kidney cancer. However, much of the work in this field is still in its early stages, limited in its broader applicability, and hampered by small datasets, the varied appearance and presentation of kidney cancers, and the intrinsic limitations of the rigidly structured tasks artificial intelligence algorithms are trained to complete. Nonetheless, the continued exploration of artificial intelligence holds promise toward improving the clinical care of patients with kidney cancer.
Topics: Algorithms; Artificial Intelligence; Humans; Kidney Neoplasms; Pathologists
PubMed: 35580292
DOI: 10.1200/EDBK_350862 -
JAMA Network Open May 2019The current state of the US pathologist workforce is uncertain, with deficits forecast over the next 2 decades. (Comparative Study)
Comparative Study
IMPORTANCE
The current state of the US pathologist workforce is uncertain, with deficits forecast over the next 2 decades.
OBJECTIVE
To examine the trends in the US pathology workforce from 2007 to 2017.
DESIGN, SETTING, AND PARTICIPANTS
A cross-sectional study was conducted comparing the number of US and Canadian physicians from 2007 to 2017 with a focus on pathologists, radiologists, and anesthesiologists. For the United States, the number of physicians was examined at the state population level with a focus on pathologists. New cancer diagnoses per pathologist were compared between the United States and Canada. These data from the American Association of Medical Colleges Center for Workforce Studies' Physician Specialty Data Books and the Canadian Medical Association Masterfile were analyzed from January 4, 2019, through March 26, 2019.
MAIN OUTCOMES AND MEASURES
Numbers of pathologists were compared with overall physician numbers as well as numbers of radiologists and anesthesiologists in the United States and Canada.
RESULTS
Between 2007 and 2017, the number of active pathologists in the United States decreased from 15 568 to 12 839 (-17.53%). In contrast, Canadian data showed an increase from 1467 to 1767 pathologists during the same period (+20.45%). When adjusted for each country's population, the number of pathologists per 100 000 population showed a decline from 5.16 to 3.94 in the United States and an increase from 4.46 to 4.81 in Canada. As a percentage of total US physicians, pathologists have decreased from 2.03% in 2007 to 1.43% in 2017. The distribution of US pathologists varied widely by state; per 100 000 population, Idaho had the fewest (1.37) and the District of Columbia had the most (15.71). When adjusted by new cancer cases per year, the diagnostic workload per US pathologist has risen by 41.73%; during the same period, the Canadian diagnostic workload increased by 7.06%.
CONCLUSIONS AND RELEVANCE
The US pathologist workforce decreased in both absolute and population-adjusted numbers from 2007 to 2017. The current trends suggest a shortage of US pathologists.
Topics: Adult; Canada; Cross-Sectional Studies; Female; Forecasting; History, 21st Century; Humans; Male; Middle Aged; Pathologists; United States; Workforce
PubMed: 31150073
DOI: 10.1001/jamanetworkopen.2019.4337 -
Modern Pathology : An Official Journal... May 2021Hematopathologists are witnessing very exciting times, as a new era of unsurpassed technological advances is unfolding exponentially, enhancing our understanding of...
Hematopathologists are witnessing very exciting times, as a new era of unsurpassed technological advances is unfolding exponentially, enhancing our understanding of diseases at the genomic and molecular levels. In the evolving field of precision medicine, our contributions as hematopathologists to medical practice are of paramount importance. Social media platforms such as Twitter have helped facilitate and enrich our professional interactions and collaborations with others in our field and in other medical disciplines leading to a more holistic approach to patient care. These platforms also have created a novel means for instantaneous dissemination of new findings and recent publications, and are proving to be increasingly useful tools that can be harnessed to expand our knowledge and amplify our presence in the medical community. In this Editorial, we share our experience as hematopathologists with Twitter, and how we leveraged this platform to boost scholarly activities within and beyond our subspecialty, and as a powerful medium for worldwide dissemination of educational material and to promote our remote teaching activities during the COVID-19 pandemic.
Topics: COVID-19; Congresses as Topic; Education, Medical, Continuing; Hematology; Humans; Information Dissemination; Pathologists; Pathology; Scholarly Communication; Social Media; Specialization; Texas; Videoconferencing
PubMed: 33219298
DOI: 10.1038/s41379-020-00715-4 -
Modern Pathology : An Official Journal... Sep 2022Correctly diagnosing a rare childhood cancer such as sarcoma can be critical to assigning the correct treatment regimen. With a finite number of pathologists worldwide...
Correctly diagnosing a rare childhood cancer such as sarcoma can be critical to assigning the correct treatment regimen. With a finite number of pathologists worldwide specializing in pediatric/young adult sarcoma histopathology, access to expert differential diagnosis early in case assessment is limited for many global regions. The lack of highly-trained sarcoma pathologists is especially pronounced in low to middle-income countries, where pathology expertise may be limited despite a similar rate of sarcoma incidence. To address this issue in part, we developed a deep learning convolutional neural network (CNN)-based differential diagnosis system to act as a pre-pathologist screening tool that quantifies diagnosis likelihood amongst trained soft-tissue sarcoma subtypes based on whole histopathology tissue slides. The CNN model is trained on a cohort of 424 centrally-reviewed histopathology tissue slides of alveolar rhabdomyosarcoma, embryonal rhabdomyosarcoma and clear-cell sarcoma tumors, all initially diagnosed at the originating institution and subsequently validated by central review. This CNN model was able to accurately classify the withheld testing cohort with resulting receiver operating characteristic (ROC) area under curve (AUC) values above 0.889 for all tested sarcoma subtypes. We subsequently used the CNN model to classify an externally-sourced cohort of human alveolar and embryonal rhabdomyosarcoma samples and a cohort of 318 histopathology tissue sections from genetically engineered mouse models of rhabdomyosarcoma. Finally, we investigated the overall robustness of the trained CNN model with respect to histopathological variations such as anaplasia, and classification outcomes on histopathology slides from untrained disease models. Overall positive results from our validation studies coupled with the limited worldwide availability of sarcoma pathology expertise suggests the potential of machine learning to assist local pathologists in quickly narrowing the differential diagnosis of sarcoma subtype in children, adolescents, and young adults.
Topics: Adolescent; Animals; Child; Humans; Machine Learning; Mice; Neural Networks, Computer; Pathologists; Rhabdomyosarcoma; Rhabdomyosarcoma, Embryonal; Young Adult
PubMed: 35449398
DOI: 10.1038/s41379-022-01075-x -
Archives of Pathology & Laboratory... Jul 2022Pathology reports are the main modality in which results are communicated to other physicians. For various reasons, the diagnosis may be qualified on a spectrum of...
CONTEXT.—
Pathology reports are the main modality in which results are communicated to other physicians. For various reasons, the diagnosis may be qualified on a spectrum of uncertainty.
OBJECTIVE.—
To examine how communication of uncertainty is an unexamined source of possible medical error. No study to our knowledge has examined pathology reports across multiple institutions. This study seeks to identify commonly used phrases of diagnostic uncertainty and their interpreted meanings by surgical pathologists and clinicians.
DESIGN.—
Anonymous surveys were completed at 3 major US academic institutions by 18 practicing staff pathologists, 12 pathology residents, 53 staff clinicians, and 50 resident/allied health professional clinicians at 5 standard tumor boards. All participants rated percentage certainty associated with 7 diagnostic terms. Pathologists answered 2 questions related to the ability to clarify a diagnosis using a comment and comfort wording pathology reports. Clinicians answered questions on how often they read a pathology report comment, if they found the comment helpful, and how comfortable they were in reading pathology reports.
RESULTS.—
A wide range in percentage certainty was found for each of the 7 diagnostic phrases. Both staff and resident clinicians and residents showed wide variability in interpreting the phrases. Twenty-five of 50 staff clinicians (52%) were very comfortable reading a pathology report, whereas only 4 of 53 resident clinicians (8%) were very comfortable reading a pathology report. Twenty-four of 53 staff clinicians (63%) reported always reading the comment, yet only 20 of 53 (27%) always found the comment helpful. The phrases "diagnostic of" and "consistent with" had the strongest agreement in meaning. The weakest agreement was between "suspicious for" and "compatible with."
CONCLUSIONS.—
Efforts to standardize diagnostic terms may improve communication.
Topics: Communication; Humans; Pathologists; Physicians; Surveys and Questionnaires; Uncertainty
PubMed: 34669920
DOI: 10.5858/arpa.2020-0761-OA