Comparing customized ChatGPT and pathology residents in histopathologic description and diagnosis of common diseases.

This study aimed to evaluate and analyze the performance of a customized Chat Generative Pre-Trained Transformer (ChatGPT), known as GPT, against pathology residents in providing microscopic descriptions and diagnosing diseases from histopathological images. A dataset of representative photomicrographs from 70 diseases across 14 organ systems was analyzed by a customized version of ChatGPT-4 (GPT-4) and pathology residents. Two pathologists independently evaluated the microscopic descriptions and diagnoses using a predefined scoring system (0-4 for microscopic descriptions and 0-2 for pathological diagnoses), with higher scores indicating greater accuracy. Microscopic descriptions that received perfect scores, which included all relevant keywords and findings, were then presented to the standard version of ChatGPT to assess its diagnostic capabilities based on these descriptions. GPT-4 showed consistency in microscopic description and diagnosis scores across five rounds, accomplishing median scores of 50 % and 48.6 %, respectively. However, its performance was still inferior to junior and senior pathology residents (73.9 % and 93.9 % description scores and 63.9 % and 87.9 % diagnosis scores, respectively). When analyzing classic ChatGPT's understanding of microscopic descriptions provided by residents, it correctly diagnosed 35 (87.5 %) of cases from junior residents and 44 (68.8 %) from senior residents, given that the initial descriptions consisted of keywords and relevant findings. While GPT-4 can accurately interpret some histopathological images, its overall performance is currently inferior to that of pathology residents. However, ChatGPT's ability to accurately interpret and diagnose diseases from the descriptions provided by residents suggests that this technology could serve as a valuable support tool in pathology diagnostics.

Interobserver variability in inconclusive diagnostic categories of thyroid fine needle aspiration cytology: An urban-based tertiary hospital experience.

INTRODUCTION: Thyroid nodules are typical lesions, usually non-malignant, and surgery is unnecessary in most patients. However, distinguishing between benign and malignant is challenging. Fine needle aspiration cytology (FNAC) is considered a primary diagnostic and prognostic tool with an effective cost for evaluating thyroid enlargement. Unfortunately, using FNAC to diagnose inconclusive lesions in the category III-Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) based on TBSRTC classification is a problematic issue. This study aimed to evaluate the interobserver variability of AUS/FLUS interpretation among pathologists. METHODS: A retro-observational study: previous 127 AUS/FLUS cases were enrolled. Seventy-two cases met inclusion criteria and were then reclassified by different anatomical pathologists under blinded-design assignments. The concordance among pathologists and the percent alteration of the risk of malignancy (ROM) were compared to the original reports and histological diagnosis. RESULTS: About 72 % of AUS/FLUS cases were changed after the reclassification. Approximately 46 % were changed to benign while 12.5 % were reclassified as carcinoma. Moreover, 30 % of those original AUS/FLUS were histologically diagnosed as malignant or carcinoma lesions. The concordances among consensus diagnosis and results from each pathologist are acceptable, Kappa(s) were 0.674 to 0.898 (p < 0.001) and Spearman correlations were 0.820 to 0.957 (p < 0.0001). CONCLUSION: There are substantial interobserver differences and changes in cytological diagnosis when re-evaluation is performed by multiple pathologists using TBSRTC. A second or third opinion should be sought routinely to establish a consensus diagnosis as a supplement to the initial diagnosis of AUS/FLUS. The reclassification reduces medical expenses and the rate of unnecessary surgery, especially in patients with cytologically confirmed benign thyroid nodules. Preoperative molecular evaluation is a promising method for assisting in the diagnosis of thyroid nodules, but additional research is necessary.

The effectiveness of using dye models for small tissue biopsies in the surgical pathology laboratory.

INTRODUCTION: Losing of small tissues during tissue preparatory steps may seriously affect pathological diagnostic performance. Using an appropriate tissue marking dye could be an alternative solution. Therefore, the aim of the study was to find a suitable tissue marking dye to enhance the observable ability of various types of small-size tissues during several steps of tissue preparation. MATERIAL AND METHODS: Various small-size samples of various organs and tissues (0.2 to 0.3 cm), including breast, endometrial, and cervical tissue, stomach, small and large intestine, lung, and kidney, were marked with different dyes such as merbromin, hematoxylin, eosin, crystal violet, and alcian blue prior to tissue processing step and their colored-observable ability was evaluated by pathology assistants. Moreover, the diagnostic interfering effect of each tissue marking dye was determined by pathologists. RESULTS: Merbromin, hematoxylin, and alcian blue increased the colored-observable ability of small tissue samples. We suggest using hematoxylin as a tissue marking dye over merbromin and alcian blue because of less toxicity and no interference effect in the step of routine pathological slide examination. CONCLUSIONS: Hematoxylin could be a suitable tissue marking dye for small-size samples and may improve the preanalytical process of tissue preparation in pathological laboratories.

Effectiveness of the Air-Filled Technique to Reduce the Dead Space in Syringes and Needles during ChAdox1-n CoV Vaccine Administration.

In the current study, we calculated the vaccine volume and amount of dead space in a syringe and needle during ChAdox1-n CoV vaccine administration using the air-filled technique. The aim is to reduce the dead space in syringes and needles in order to administer up to 12 doses per vial. The hypothetical situation uses a vial with a similar size as the ChAdox1-n CoV vial. We used distilled water (6.5 mL) to fill the same volume as five vials of ChAdox1-n CoV. When 0.48 mL of distilled water is drawn according to the number on the side of the barrel, an additional 0.10 mL of air can be used in the dead space of the distilled water in the syringe and needle for 60 doses, which can be divided into an average of 0.5 mL per dose. ChAdox1-n CoV was administered using a 1-mL syringe and 25G needle into 12 doses using this air-filled technique. The volume of the recipient vaccine will increase by 20% and save on the budget for low dead space syringes (LDS).

Cranial versus Caudal Direction Technique of Native Percutaneous Kidney Biopsy: A Randomized Controlled Trial.

Background: Percutaneous kidney biopsy (PKB) is the gold standard for diagnosing various kidney diseases, but it can result in potential complications. This study aimed to compare kidney tissue adequacy and safety between the two biopsy techniques, including cranial direction (CN) and caudal direction (CD), of needle biopsy under real-time ultrasonogram guidance. Methods: This single-center, prospective, single-blinded, randomized trial included patients undergoing native PKB from July 5, 2017, to June 30, 2019. Patients were randomized to the CN and CD groups. Adequacy and complications between the two groups were analyzed. All PKBs were performed under real-time ultrasonogram guidance with a 16-gauge kidney biopsy needle. Results: A total of 107 participants were enrolled (53 in the CD group and 54 in the CN group). The CD group has more glomeruli than the CN group but with no statistical significance (16 versus 11, p = 0.0865). The CD group obtained more adequate kidney tissue samples than the CN group (69.8% versus 59.3%, p = 0.348). The number of inadequate glomeruli tissue sampling is similar in both groups (14 versus 15, respectively). Furthermore, the CN group had more adverse events, including Hb decline ≥10% after kidney biopsy, perinephric hematoma size ≥1 cm, hematuria, and the need for blood transfusion, than the CD group. Conclusion: The CD technique of the percutaneous kidney biopsy in the native kidney has fewer complications and was possibly more effective than the CN technique.

Correlation of vascular structural changes in a cadaveric model and obesity-related cardiovascular non-communicable diseases.

INTRODUCTION: Carrying excess body weight is a vital risk factor for obesity-related chronic diseases affecting blood vessels. Obesity influences cardiovascular non-communicable diseases (NCDs) via vascular structural changes, which involve alterations in lipids, blood pressure, coagulation, fibrinolysis, and inflammation, leading to endothelial dysfunction due to vascular remodeling and stiffness. Small peripheral vessels are the first to be impacted; however, it is unclear whether this change is followed by microscopic changes in the aorta. OBJECTIVES: To determine the correlation of vascular structure with the incidence of NCDs and subcutaneous fat thickness and to study micro-scale changes in vascular structure, especially concerning collagen in the aorta, using a cadaveric model. METHODS: Twenty-four cadaveric models were classified into a control group and an NCD group. The subcutaneous fat thickness was measured on the arm, anterior abdomen, and thigh. The aorta was collected and stained with hematoxylin, eosin, and Masson's trichrome for collagen evaluation. The vessel thickness was morphometrically analyzed. Scanning electron microscopy was performed to identify the extracellular matrix organization in the vessel. RESULTS: Disorganization of the extracellular matrix and fragments of the vascular wall were found in the NCDs group. The tunica intima of the NCDs group represented endothelial dysfunction with macrophage foam cells. The thickness of the tunica intima of the NCDs group slightly increased without being significantly different compared to control group with 144.63 ± 124.38 µm and 105.60 ± 27.49 µm, respectively. However, the thickness of tunica media of the NCDs group significantly decreased compared to control group with 956.58 ± 27.80 µm and 1167.43 ± 48.6 µm, respectively. Collagen deposits in the aortic wall significantly increased by 15% in the NCDs group especially in tunica media by 17.4% compared to control. The results showed a correlation between the amount of collagen fiber and subcutaneous fat on the thigh. CONCLUSION: There was a change toward irregular microstructural patterns and increased collagen fibers in NCDs. In addition, there was a correlation between collagen fiber density and the subcutaneous fat thickness of the thigh in cadavers with a history of NCDs.

Notch signaling regulates vasculogenic mimicry and promotes cell morphogenesis and the epithelial-to-mesenchymal transition in pancreatic ductal adenocarcinoma.

Vasculogenic mimicry (VM) is the process where cancer cells adopt endothelial characteristics by forming tube-like structures and perfusing channels. This phenomenon has been demonstrated in several types of solid tumors and associated with the growth and survival of tumor cells. In this study, we investigated the presence of VM formation in human pancreatic ductal adenocarcinoma (PDAC) and elucidated the molecular mechanisms underlying the VM process. In human PDAC tissues, CD31-negative, periodic acid-Schiff (PAS)-positive channels were predominantly found in desmoplastic areas, which are generally also hypovascularized. We found a positive correlation of VM capacity to tumor size and NOTCH1 expression and nuclear localization with statistical significance, implicating that Notch activity is involved with VM formation. Additionally, our data showed that the presence of growth or angiogenic factors significantly increased Notch activity in PDAC cell lines and upregulated several mesenchymal marker genes, such as TWIST1 and SNAI1, which can be inhibited by a gamma-secretase inhibitor. Our data showed that Notch signaling plays an important role in inducing VM formation in PDAC by promoting the epithelial-to-mesenchymal transition process.