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Cardiovascular Pathology : the Official... 2022This article stems from the intersection of the author's long-standing interests in science, medicine, pathology and oenology. A discussion is provided of selected... (Review)
Review
This article stems from the intersection of the author's long-standing interests in science, medicine, pathology and oenology. A discussion is provided of selected aspects of the science of viticulture and wine production as well as qualities of the finished product crafted by the art of the wine maker. The case for health benefits of moderate consumption of wine and other alcoholic beverages also is discussed. Based on the "French paradox," an analysis is presented of the evidence for the special effects of red wine consumption, particularly as part of the Mediterranean diet and lifestyle. A concluding perspective is given in support of wine as a promoter of civility and social engagement.
Topics: Alcohol Drinking; Cardiovascular System; Humans; Pathologists; Wine
PubMed: 35654336
DOI: 10.1016/j.carpath.2022.107446 -
Pathologica Feb 2022Pediatric liver transplantation represents a safe and long-lasting treatment option for various disease types, requiring the pathologist's input. Indeed, an accurate and... (Review)
Review
Pediatric liver transplantation represents a safe and long-lasting treatment option for various disease types, requiring the pathologist's input. Indeed, an accurate and timely diagnosis is crucial in reporting and grading native liver diseases, evaluating donor liver eligibility and identifying signs of organ injury in the post-transplant follow-up. However, as the procedure is more frequently and widely performed, deceptive and unexplored histopathologic features have emerged with relevant consequences on patient management, particularly when dealing with long-term treatment and weaning of immunosuppression. In this complex and challenging scenario, this review aims to depict the most relevant histopathologic conditions which could be encountered in pediatric liver transplantation. We will tackle the conditions representing the main indications for transplantation in childhood as well as the complications burdening the post-transplant phases, either immunologically ( rejection) or non-immunologically mediated. Lastly, we hope to provide concise, yet significant, suggestions related to innovative pathology techniques in pediatric liver transplantation.
Topics: Child; Humans; Liver Diseases; Liver Transplantation; Living Donors; Pathologists
PubMed: 35212319
DOI: 10.32074/1591-951X-753 -
Archives of Pathology & Laboratory... Jun 2022Prostate cancer is a common malignancy, and accurate diagnosis typically requires histologic review of multiple prostate core biopsies per patient. As pathology volumes... (Review)
Review
CONTEXT.—
Prostate cancer is a common malignancy, and accurate diagnosis typically requires histologic review of multiple prostate core biopsies per patient. As pathology volumes and complexity increase, new tools to improve the efficiency of everyday practice are keenly needed. Deep learning has shown promise in pathology diagnostics, but most studies silo the efforts of pathologists from the application of deep learning algorithms. Very few hybrid pathologist-deep learning approaches have been explored, and these typically require complete review of histologic slides by both the pathologist and the deep learning system.
OBJECTIVE.—
To develop a novel and efficient hybrid human-machine learning approach to screen prostate biopsies.
DESIGN.—
We developed an algorithm to determine the 20 regions of interest with the highest probability of malignancy for each prostate biopsy; presenting these regions to a pathologist for manual screening limited the initial review by a pathologist to approximately 2% of the tissue area of each sample. We evaluated this approach by using 100 biopsies (29 malignant, 60 benign, 11 other) that were reviewed by 4 pathologists (3 urologic pathologists, 1 general pathologist) using a custom-designed graphical user interface.
RESULTS.—
Malignant biopsies were correctly identified as needing comprehensive review with high sensitivity (mean, 99.2% among all pathologists); conversely, most benign prostate biopsies (mean, 72.1%) were correctly identified as needing no further review.
CONCLUSIONS.—
This novel hybrid system has the potential to efficiently triage out most benign prostate core biopsies, conserving time for the pathologist to dedicate to detailed evaluation of malignant biopsies.
Topics: Biopsy; Humans; Machine Learning; Male; Pathologists; Prostate; Prostatic Neoplasms
PubMed: 34591085
DOI: 10.5858/arpa.2020-0850-OA -
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 -
Ghana Medical Journal Jun 2018One of the neglected areas of clinical medical practice in developing countries is the field of Laboratory Medicine. As a result, the important role of the laboratory...
UNLABELLED
One of the neglected areas of clinical medical practice in developing countries is the field of Laboratory Medicine. As a result, the important role of the laboratory physician in diagnosis of disease and subsequent management of patients is not much appreciated. Even more worrying is lack of appreciation of the research potential of laboratory medicine, considering that it provides a repository of confirmatory data on many human disorders; data that have been usefully employed for the study of various diseases in developed parts of the world. It is perhaps, the reason that many diseases peculiar to developing countries still remain untamed. My experience in the practice of anatomical pathology in several countries has taught me that the specialty, as with other specialties of laboratory medicine in Ghana needs more attention, with regards to its development to the level where it can meet its clinical functions satisfactorily. When this is ensured, it would also provide the necessary vital contribution to research that has characterised its practice in more advanced countries. More exposure of the specialty to undergraduate medical students must be encouraged in order to attract trainees into the specialty. Along with this exposure must go an increase in infrastructure and the necessary facilities to permit growth of the specialty. Research potential of the specialty must be harnessed and fully supported financially to help in unravelling peculiar disease problems of our locality. To achieve this, I have re-emphasised the need for a special fund to drive scientific research in Ghana.
FUNDING
None.
Topics: Biomedical Research; Ghana; Humans; Pathologists; Pathology
PubMed: 30662083
DOI: 10.4314/gmj.v52i2.7 -
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 -
Archives of Pathology & Laboratory... Jul 2018
Topics: Cell-Free Nucleic Acids; Humans; Lung Neoplasms; Pathologists; Pathology, Molecular; Protein-Tyrosine Kinases; United States
PubMed: 29607664
DOI: 10.5858/arpa.2018-0064-ED -
The American Journal of Pathology Oct 2021Deep learning has rapidly advanced artificial intelligence (AI) and algorithmic decision-making (ADM) paradigms, affecting many traditional fields of medicine, including... (Review)
Review
Deep learning has rapidly advanced artificial intelligence (AI) and algorithmic decision-making (ADM) paradigms, affecting many traditional fields of medicine, including pathology, which is a heavily data-centric specialty of medicine. The structured nature of pathology data repositories makes it highly attractive to AI researchers to train deep learning models to improve health care delivery. Additionally, there are enormous financial incentives driving adoption of AI and ADM due to promise of increased efficiency of the health care delivery process. AI, if used unethically, may exacerbate existing inequities of health care, especially if not implemented correctly. There is an urgent need to harness the vast power of AI in an ethically and morally justifiable manner. This review explores the key issues involving AI ethics in pathology. Issues related to ethical design of pathology AI studies and the potential risks associated with implementation of AI and ADM within the pathology workflow are discussed. Three key foundational principles of ethical AI: transparency, accountability, and governance, are described in the context of pathology. The future practice of pathology must be guided by these principles. Pathologists should be aware of the potential of AI to deliver superlative health care and the ethical pitfalls associated with it. Finally, pathologists must have a seat at the table to drive future implementation of ethical AI in the practice of pathology.
Topics: Artificial Intelligence; Humans; Pathologists; Pathology; Risk; Stakeholder Participation
PubMed: 34252382
DOI: 10.1016/j.ajpath.2021.06.011 -
The Journal of Pathology. Clinical... Mar 2022Digital Pathology (DP) is a platform which has the potential to develop a truly integrated and global pathology community. The generation of DP data at scale creates...
Digital Pathology (DP) is a platform which has the potential to develop a truly integrated and global pathology community. The generation of DP data at scale creates novel challenges for the histopathology community in managing, processing, and governing the use of these data. The current understanding of, and confidence in, the legal and ethical aspects of DP by pathologists is unknown. We developed an electronic survey (e-survey), comprising 22 questions, with input from the Royal College of Pathologists (RCPath) Digital Pathology Working Group. The e-survey was circulated via e-mail and social media (Twitter) through the RCPath Digital Pathology Working Group network, RCPath Trainee Committee network, the Pathology image data Lake for Analytics, Knowledge and Education (PathLAKE) digital pathology consortium, National Pathology Imaging Co-operative (NPIC), local contacts, and to the membership of both The Pathological Society of Great Britain and Ireland and the British Division of the International Academy of Pathology (BDIAP). Between 14 July 2020 and 6 September 2020, we collected 198 responses representing a cross section of histopathologists, including individuals with experience of DP research. We ascertained that, in the UK, DP is being used for diagnosis, research, and teaching, and that the platform is enabling data sharing. Our survey demonstrated that there is often a lack of confidence and understanding of the key issues of consent, legislation, and ethical guidelines. Of 198 respondents, 82 (41%) did not know when the use of digital scanned slide images would fall under the relevant legislation and 93 (47%) were 'Not confident at all' in their interpretation of consent for scanned slide images in research. With increasing uptake of DP, a working knowledge of these areas is essential but histopathologists often express a lack of confidence in these topics. The need for specific training in these areas is highlighted by the findings of this study.
Topics: Humans; Ireland; Pathologists; Pathology, Clinical; United Kingdom
PubMed: 34796679
DOI: 10.1002/cjp2.251 -
Archives of Pathology & Laboratory... Jul 2019
Topics: Humans; Medical Overuse; Pathologists; Radiologists; Thyroid Neoplasms
PubMed: 31225995
DOI: 10.5858/arpa.2019-0145-LE