Digital Whole Slide Imaging Compared With Light Microscopy for Primary Diagnosis in Surgical Pathology.

CONTEXT.­: The adoption of digital capture of pathology slides as whole slide images (WSI) for educational and research applications has proven utility. OBJECTIVE.­: To compare pathologists' primary diagnoses derived from WSI versus the standard microscope. Because WSIs differ in format and method of observation compared with the current standard glass slide microscopy, this study is critical to potential clinical adoption of digital pathology. DESIGN.­: The study enrolled a total of 2045 cases enriched for more difficult diagnostic categories and represented as 5849 slides were curated and provided for diagnosis by a team of 19 reading pathologists separately as WSI or as glass slides viewed by light microscope. Cases were reviewed by each pathologist in both modalities in randomized order with a minimum 31-day washout between modality reads for each case. Each diagnosis was compared with the original clinical reference diagnosis by an independent central adjudication review. RESULTS.­: The overall major discrepancy rates were 3.64% for WSI review and 3.20% for manual slide review diagnosis methods, a difference of 0.44% (95% CI, -0.15 to 1.03). The time to review a case averaged 5.20 minutes for WSI and 4.95 minutes for glass slides. There was no specific subset of diagnostic category that showed higher rates of modality-specific discrepancy, though some categories showed greater discrepancy than others in both modalities. CONCLUSIONS.­: WSIs are noninferior to traditional glass slides for primary diagnosis in anatomic pathology.

Estrogen receptor expression in papillary urothelial carcinoma of the bladder and ovarian transitional cell carcinoma.

CONTEXT: Relatively little is known about estrogen receptor (ER) expression in papillary urothelial carcinoma (PUC) of the bladder. Greater understanding of this feature of PUCs could aid with the treatment and identification of the origin of metastases, particularly with relation to the morphologically similar entity of ovarian transitional cell carcinoma (TCC). OBJECTIVE: To assess the presence of ERs in PUC of the bladder, its metastases, and ovarian TCC. DESIGN: Formalin-fixed, paraffin-embedded archival tissue from 92 primary bladder PUCs, 11 PUC metastases, and 11 primary or metastatic ovarian TCCs was immunostained with a monoclonal antibody against the human ER beta-molecule. The ER-positive and ER-negative tumors were compared by the patients' sex and age, tumor grade, and the presence or absence of invasion. Statistical analysis was performed on the PUC results, first defining a positive result as staining of at least 10% of nuclei and then repeated using any percentage of staining as a positive result. RESULTS: By the 10% criterion, 11% of PUCs of the bladder were ER positive. Invasive PUCs were more likely to be ER positive (P = .10). Women with ER-positive PUCs were older than their male counterparts (P = .03). By the second criterion, 22% of all PUCs were ER positive, and both higher grade and the presence of invasion were significantly associated with ER expression (P = .004 and .01, respectively). All 11 PUC metastases were totally ER negative. Ten of the 11 ovarian TCC cases exhibited strong and diffuse ER expression. CONCLUSION: Depending on the criterion used, up to 22% of bladder PUCs were ER positive. Higher grade and the presence of invasion were significantly associated with ER expression in these bladder carcinomas. In contrast, almost all of the ovarian TCCs marked strongly for ERs, a characteristic that may help differentiate these lesions from PUCs metastatic to the ovary.

Anaplastic large cell lymphoma arising in a silicone breast implant capsule: a case report and review of the literature.

Anaplastic large cell lymphoma is a rare type of primary breast lymphoma. We report a case of anaplastic large cell lymphoma, T-cell phenotype, occurring in the periprosthetic capsule of a silicone breast prosthesis 9 years after implantation for augmentation mammoplasty. This case is unique for its unusual presentation.