Review of the current state of digital image analysis in breast pathology

Advances in digital image analysis have the potential to transform the practice of breast pathology. In the near future, a move to a digital workflow offers improvements in efficiency. Coupled with artificial intelligence (AI), digital pathology can assist pathologist interpretation, automate time‐consuming tasks, and discover novel morphologic patterns. Opportunities for digital enhancements abound in breast pathology, from increasing reproducibility in grading and biomarker interpretation, to discovering features that correlate with patient outcome and treatment. Our objective is to review the most recent developments in digital pathology with clear impact to breast pathology practice. Although breast pathologists currently undertake limited adoption of digital methods, the field is rapidly evolving. Care is needed to validate emerging technologies for effective patient care.     

5/6肾切除大鼠肾脏病理图像分析与中医证型的研究

目的 :探讨 5 / 6肾切除 (5 / 6nephrectomy ,5 / 6NT)大鼠肾脏病理动态变化与图像分析、中医证型的关系。方法 :5 / 6NT大鼠肾组织标本的PAS、PAM染色片 ,用图像分析仪分别对PAM染色片的肾小球直径、肾小球截面积、系膜基质及血管壁面积进行定量分析 ,观察肾脏病理动态变化情况。结果 :5 / 6NT大鼠肾脏病理变化的基本特征为肾小球系膜细胞 (glomenrulusmesangialcells,GMC)增生 ,肾小管扩张 ,肾间质炎症反应 ,肾小管蛋白管型形成 ,并逐渐形成肾小球纤维化、硬化。这些病理变化与中医“瘀血”、“瘀浊”的概念相符合。病理变化轻重与肾小球直径、系膜基质面积、肾小球截面积、肾小球体积及血管壁面积肾小球基底膜、肾小球及肾血管壁面积呈正比例关系。结论 :肾小球直径、系膜基质面积、肾小球截面积、肾小球体积及血管壁面积肾小球基底膜、肾小球及肾血管壁面积可以作为肾纤维化、硬化的评价指标 ;5 / 6NT大鼠肾脏病理相当于中医的“瘀血”、“瘀浊”证     

The untapped potential of digital pathology in prostate cancer diagnosis and medical education in sub-Saharan Africa

Introduction

Prostate cancer exerts a significant burden of disease in sub-Saharan Africa. Late clinical presentation with metastatic disease at diagnosis and the lack of structured national screening programs are unsolved issues. The delay in prostate cancer diagnosis is in part due to the severe shortage of African pathologists with inadequate or inaccessible diagnostic infrastructure playing a contributory role to this problem.

Digital transplantation pathology: combining whole slide imaging, multiplex staining and automated image analysis

Conventional histopathology is the gold standard for allograft monitoring, but its value proposition is increasingly questioned. "-Omics" analysis of tissues, peripheral blood and fluids and targeted serologic studies provide mechanistic insights into allograft injury not currently provided by conventional histology. Microscopic biopsy analysis, however, provides valuable and unique information: (a) spatial-temporal relationships; (b) rare events/cells; (c) complex structural context; and (d) integration into a "systems" model. Nevertheless, except for immunostaining, no transformative advancements have "modernized" routine microscopy in over 100 years. Pathologists now team with hardware and software engineers to exploit remarkable developments in digital imaging, nanoparticle multiplex staining, and computational image analysis software to bridge the traditional histology-global "-omic" analyses gap. Included are side-by-side comparisons, objective biopsy finding quantification, multiplexing, automated image analysis, and electronic data and resource sharing. Current utilization for teaching, quality assurance, conferencing, consultations, research and clinical trials is evolving toward implementation for low-volume, high-complexity clinical services like transplantation pathology. Cost, complexities of implementation, fluid/evolving standards, and unsettled medical/legal and regulatory issues remain as challenges. Regardless, challenges will be overcome and these technologies will enable transplant pathologists to increase information extraction from tissue specimens and contribute to cross-platform biomarker discovery for improved outcomes.     

Digital image analysis versus clinical assessment of wound epithelialization: a validation study

To evaluate the progress in wound healing, wound assessment is mandatory. Epithelialization is traditionally assessed subjectively by the clinician. In a previous study, subjective assessment of epithelialization was shown to be reliable. In this study, reliability of epithelialization measured by digital image analysis was investigated and then, we validated the subjective evaluation by comparing this assessment to measurements with digital image analysis. Clinicians assessed epithelialization in 50 burn wounds that were treated with a split skin graft. Epithelialization of these wounds was also measured by three observers using digital image analysis. Reliability of digital image analysis was tested using the intraclass correlation (IC). To test validity, subjective clinical assessment was correlated with digital image analysis (IC). The results showed that interobserver reliability of epithelialization measured by digital image analysis was good (IC coefficient 0.74). Subjective clinical assessment of epithelialization showed a strong correlation with digital image analysis (IC coefficient 0.80). In conclusion, subjective clinical evaluation of wound epithelialization is as good as an objective measure, in this study digital image analysis. Since digital image analysis is more time-consuming, we recommend the use of the subjective evaluation for daily practice.     

图象细胞分析对直肠癌的辅助诊断

本院5年来手术治疗的168例直肠癌病人中,有20例(11.9%)第一次手术前活检不能明确诊断.对其中17例患者的活检组织石蜡标本进行常规病理和图象细胞分析(ICM)检测.ICM检查有53%(9/17)为异倍体,与常规病理比较,差异有统计学意义.17例患者的标本中,11例为不典型增生,5例仅有慢性炎.通过ICM检测,不典型增生中有8例为异倍体而慢性炎全部为二倍体.根据上述结果,作者认为ICM可以作为常规病理检查的补充,提高结肠良恶性病变的鉴别力.     

Digital Versus Optical Diagnosis of Follicular Patterned Thyroid Lesions

ObjectivesTo study the concordance between pathologists in the diagnosis of follicular patterned thyroid lesions using both digital and conventional optical settings.Material and MethodsFive pathologists reviewed 50 hematoxylin and eosin-stained slides of follicular patterned thyroid lesions using both digital (the D-Sight 2.0 scanner and navigator viewer) and conventional optical instruments with washout interval time.ResultsThe mean concordance rate with the ground truth (GT) was similar between conventional optical and digital observation (83.2 and 85.2%, respectively). The most frequent reason for diagnostic discordance with GT on both systems was the evaluation of nuclear features (69.1% for conventional optical observation and 59.4% for digital observation). The intraobserver diagnostic concordance mean was 86.8%. Time for digital observation (mean time per case = 2.9 ± 0.8 min) was higher than that for conventional optical observation (mean time per case = 2.0 ± 0.7 min). Interobserver correlation of measurements was higher in the digital observation than the conventional optical observation.ConclusionConventional optical and digital observation settings showed a comparable accuracy for the diagnosis of follicular patterned thyroid nodules, as well as substantial intraobserver agreement and a significant improvement in the reproducibility of the measurements that support the use of digital diagnosis in thyroid pathology. The origins underlying the variability of the diagnosis were the same in both conventional optical microscopy and digital pathology systems.     

术中冰冻病理对肺结节胸腔镜手术切除范围的指导意义

目的探讨肺结节术中冰冻病理与术后病理判断浸润范围上的一致性,明确术中冰冻病理是否可以协助术者确定肺结节手术切除的范围。方法2017年1月~2018年6月电视辅助胸腔镜手术切除肺结节156例,分析术中冰冻病理与术后病理的诊断符合率。结果术中冰冻病理诊断非典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)、原位腺癌(adenocarcinoma in situ,AIS)及微浸润腺癌(minimally invasive adenocarcinoma,MIA)103例,浸润性腺癌(invasive adenocarcinoma,IA)53例;术后病理证实AAH、AIS及MIA 106例,IA 50例。根据病灶侵袭性、复发及转移的风险程度将AAH、AIS、MIA定义为低风险病灶,IA定义位为高风险病灶。术中冰冻病理诊断高风险病灶敏感性98.0%(49/50),特异性96.2%(102/106),准确率96.8%(151/156)。术中冰冻病理诊断低风险病灶预测值99.0%(102/103),高风险病灶预测值92.5%(49/53)。结论术中冰冻病理在判断IA方面具有较高的诊断符合率,在准确区别AAH与AIS和AIS与MIA存在不确定性。在肺结节手术切除范围的制定上,术中冰冻病理可以作为重要的指导依据。     

First digital flexible ureterorenoscope: initial experience

BACKGROUND: Flexible ureterorenoscopy is a minimally invasive procedure that is rapidly gaining popularity as a treatment for patients with upper urinary tract lithiasis. One of the main drawbacks is the limited visualization imposed by fiberoptic technology in an endoscope, often only 7 to 8F and the fragility of fiber-based optics in a flexible endoscope. MATERIALS AND METHODS: We report our initial experience with digital flexible URS and holmium laser lithotripsy using digital image capture in three patients. Two patients had upper tract calculi (1 cm lower pole calculus and 8 mm caliceal diverticular stone, respectively), and one patient underwent diagnostic URS. RESULTS: After basket capture and intrarenal relocation of the lower pole stone, complete stone destruction was achieved. Similarly, the caliceal diverticular stone was destroyed after holmium laser incision of the caliceal diverticulum. Remarkable improvement in image quality was observed throughout the procedures in comparison with current fiberoptic image acquisition. Minor image interference was noted during fluoroscopic screening, which increased slightly during laser activation. CONCLUSIONS: The first digital flexible ureterorenoscope provided excellent image quality and zoom capability, with a substantial improvement compared with fiberoptic technology. It does not require a separate light source and is an important step for the continued evolution of flexible URS as a therapeutic modality for upper urinary tract pathology.     

Classification of equivocal mammograms through digital analysis

In a clinical trial, 45 equivocal mammograms were evaluated using digital image processing techniques and the results were correlated with pathology reports. 31 cases agreed with the histological diagnosis, 10 of the other 14 cases were false negatives and 4 false positive (sensitivity 33%, specificity 87%). Factors contributing to difficulties in analysis included: (a) low density calcifications, (b) high density background parenchyma and (c) tightly packed clusters of microcalcification.This work has shown that digital analysis can reduce the number of equivocal mammographic examinations and potentially decreases the need for examination by biopsy, however, many technical problems remain before this technology can be applied to all such clusters.     

Artificial intelligence in digital breast pathology: Techniques and applications

Breast cancer is the most common cancer and second leading cause of cancer-related death worldwide. The mainstay of breast cancer workup is histopathological diagnosis - which guides therapy and prognosis. However, emerging knowledge about the complex nature of cancer and the availability of tailored therapies have exposed opportunities for improvements in diagnostic precision. In parallel, advances in artificial intelligence (AI) along with the growing digitization of pathology slides for the primary diagnosis are a promising approach to meet the demand for more accurate detection, classification and prediction of behaviour of breast tumours. In this article, we cover the current and prospective uses of AI in digital pathology for breast cancer, review the basics of digital pathology and AI, and outline outstanding challenges in the field.     

Cone beam computed tomography: an innovative tool for airway assessment

Improvements in airway imaging technology provide the potential for an improved understanding of airway pathology and upper airway mechanics. We present here a preliminary report on the applicability of cone beam computed tomography technology in conjunction with multidimensional digital analysis for the purposes of clinical airway management. The use of this technology for airway imaging in anesthesiology has not been reported. Traditional skeletal and soft tissue images as well as distance and volume measurements were obtained without difficulty. Three-dimensional image reconstructions as well as "virtual laryngoscopy" were achieved with resulting excellent image quality, suggesting a broad range of possibilities for upper airway examination and analysis. A modified Muller test with volumetric rendering of the airway passages under baseline and negative pressure conditions was also performed, made possible as a result of the system's short (9 s) scanning times. We believe that cone beam computed tomography technology offers an additional dimension to airway evaluation that has considerable potential.     

Early experiences with computed axial tomography colonography

BACKGROUND: Computed axial tomography (CT) colonography is the latest radiologic technique to be used to image the large bowel. We studied its role as a diagnostic tool in colorectal practice. METHODS: One hundred and three patients suspected of having colorectal pathology underwent CT colonography. RESULTS: CT colonography suggested a diagnosis of colonic carcinoma in 18 patients, and 17 of these underwent surgery. A colorectal neoplasm was not found in only 1 patient who had extrinsic colonic compression by an ovarian cyst. Twenty-one patients had suspected colonic polyps on scanning. Subsequent endoscopy in 19 of these patients confirmed the presence of polyps in only 10. CT colonography also revealed valuable extracolonic pathology: 8 occult noncolonic neoplasms and 163 other incidental findings. CONCLUSIONS: CT colonography has good patient compliance and is a useful diagnostic modality in detecting colorectal neoplasms. Its main advantage over other such investigative tools is its ability to detect extracolonic pathology.     

Telepathology as an Aid in Mohs Micrographic Surgery

BACKGROUND: Mohs surgeons are occasionally confronted by challenging pathology ideally requiring the advice of a dermatopathologist. The Internet transmission of digital images of the pathology (telepathology) allows for such opinions to be easily and rapidly obtained. OBJECTIVE: The objective was to obtain images utilizing a digital camera focused directly through one microscope eyepiece with subsequent e-mail to a pathologist for an immediate opinion. METHODS: The particular area of interest on the slide is selected. The lens of the digital camera is placed directly on one eyepiece of the microscope and using the zoom and autofocus options of the camera a sharp image is obtained. The camera flash must be disabled. The images are immediately downloaded to computer and e-mailed to the pathologist for an opinion. RESULTS: Three case reports illustrate that the pathologist is able to offer suggestions on a diagnosis with a high degree of confidence using the e-mailed images. CONCLUSION: Digital camera technology now allows for images to be taken directly through an eyepiece of the microscope. These images can be almost instantaneously e-mailed to a pathologist anywhere in the world for an immediate opinion. The technique provides for greater surety where doubt exists about the pathology during Mohs surgery.     

Pathology Gross Photography: The Beginning of Digital Pathology

The underutilized practice of photographing anatomic pathology specimens from surgical pathology and autopsies is an invaluable benefit to patients, clinicians, pathologists, and students. Photographic documentation of clinical specimens is essential for the effective practice of pathology. When considering what specimens to photograph, all grossly evident pathology, absent yet expected pathologic features, and gross-only specimens should be thoroughly documented. Specimen preparation prior to photography includes proper lighting and background, wiping surfaces of blood, removing material such as tubes or bandages, orienting the specimen in a logical fashion, framing the specimen to fill the screen, positioning of probes, and using the right-sized scale.     

Recurrent cardiac intimal sarcoma misdiagnosed as a myxoma or malignant transformation of a cardiac myxoma?

Cardiac intimal sarcoma is extremely rare and aggressive primary malignant cardiac tumors. Here, we reported the case of a young man initially operated for a tumor of the left atrium, causing a dynamic obstruction of the mitral valve and (mis‐)diagnosed as a myxoma at the histopathological analysis. Patient presented a local recurrence at 3 months and was reoperated. Pathology revealed this time the presence of an intimal sarcoma. Patient received adjuvant chemotherapy. Despite a good local control, the 1‐year follow‐up positron emission tomography scan revealed the presence of a metastasis in the left adrenal gland that was surgically resected. This article aims to highlight the risk of misdiagnosis in case of cardiac tumors, the hypothetical concept of malignant transformation of a cardiac myxoma, the aggressive course of the extremely rare cardiac intimal sarcoma, and the therapeutic modalities available to treat this pathology.     

Pulmonary artery compression by hematoma,a rare but life-threatening complication of Stanford type A aortic dissection

Hemorrhagic extension along the pulmonary arteries should be recognized as a complication of Stanford type A aortic dissection. Radiologists and other physicians with an interest in cardiothoracic imaging should be aware of this rare but life-threatening pathology. The anatomical concept of the pathology is outlined in this text, through high-quality electrocardiogram-gated computerized tomography images.     

数字智能化诊疗技术在围肝门胆道疾病术前评估中的意义

目前三维可视化、3D打印、增强或虚拟现实技术、吲哚菁绿（ICG）分子影像学技术等数字智能化诊疗技术正广泛应用于肝胆胰疾病的临床诊治，呈蓬勃发展之势。围肝门胆道疾病是外科领域中重大疑难疾病，其解剖结构复杂、生理病理特殊，诊疗效率较低。高效的术前评估是提高其诊疗效率的关键环节。数字智能化诊疗技术可获取疾病全面的、个体化的影像诊断信息，全方位分析肝动脉、门静脉、胆管与病灶的解剖关系，测量肝脏体积，进而制定合理的手术方案，确定最佳手术入路，预判术中副损伤风险，提高围肝门胆道疾病的外科治疗效果。     

Elective surgery for diverticular disease: an audit of surgical pathology and treatment

BACKGROUND: There is a need for a better classification of the surgical pathology of diverticular disease treated by elective resection. METHODS: A prospective audit was conducted over a 25-year period, during which the surgeon studied the surgical pathology. The results of surgical treatment have been related to the pathology. RESULTS: Two hundred and six patients were managed by elective resection with a postoperative mortality of 1.0% and a total morbidity of 51.5%. The surgical pathology was classified as: non-inflammatory 25 (12.6%), localized diverticulitis 90 (43.7%) and extracolic diverticulitis 90 (44.2%). CONCLUSIONS: This classification is useful to relate the technical requirements of surgery and the outcome to the surgical pathology. Postoperative morbidity is associated with the presence and severity of inflammatory pathology and therefore the casemix of any series will have a significant impact on this aspect.