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1.
Arch Pathol Lab Med ; 144(2): 133-135, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31990227

RESUMO

• The Archives of Pathology & Laboratory Medicine was first published in 1926 as a specialty journal of the American Medical Association. It became the official journal of the College of American Pathologists in 1995. Under the dynamic leadership of its most recent editor-in-chief, Philip T. Cagle, MD, the Archives has dramatically increased its impact factor and become the most widely read general pathology journal. Dr. Cagle has consistently added leading pathologists to the editorial board, and the collective expertise of these individuals is clearly evident in new, cutting-edge journal masthead sections. The Archives has featured innovative content in the field of digital pathology, including articles on the utilization of smart phones in pathology and the incorporation of whole-slide images and videos into the content of articles. During the current editorial board's tenure, special sections were introduced and have proven immensely popular with the journal's readership. As the Archives celebrates its 94th anniversary, its editorial board remains committed to providing insightful and relevant medical knowledge. The journal's open access Web site ( www.archivesofpathology.org ) allows the dissemination of this information to every corner of the globe at no expense to those who wish to expand their knowledge or improve their medical practice. Dr. Cagle, with support from the editorial board and journal staff, has worked tirelessly during his tenure as Archives editor-in-chief to greatly enhance the content of the journal and its stature within pathology and laboratory medicine.


Assuntos
Políticas Editoriais , Ciência de Laboratório Médico/história , Patologia Clínica/história , Publicações Periódicas como Assunto/história , História do Século XX , História do Século XXI , Fator de Impacto de Revistas , Ciência de Laboratório Médico/métodos , Ciência de Laboratório Médico/tendências , Patologia Clínica/métodos , Patologia Clínica/tendências , Publicações Periódicas como Assunto/normas , Publicações Periódicas como Assunto/tendências
2.
Arch Pathol Lab Med ; 144(2): 160-167, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31990228

RESUMO

CONTEXT.­: Large B-cell lymphomas represent the most common non-Hodgkin lymphomas and often present as extranodal masses with advanced stage similar to metastatic tumors. Without proper intraoperative, microscopic, immunophenotypic, and cytogenetic evaluation they may be mistaken for other hematopoietic or even nonhematopoietic tumors. Also, diffuse large B-cell lymphomas often have clinical, morphologic, immunophenotypic, and cytogenetic clinical features that are similar to those of other less common B-cell lymphomas. Furthermore, classification of these neoplasms is continually becoming more refined. OBJECTIVE.­: To provide a rational, methodic approach to the evaluation of large B-cell lymphomas for community practice pathologists who provide general pathology services. DATA SOURCES.­: This review incorporates guidelines detailed in the 2017 update to the World Health Organization's Classification of Tumours of Haematopoietic and Lymphoid Tissues in addition to other recent peer-reviewed publications. CONCLUSIONS.­: Many large B-cell neoplasms respond favorably to current treatments, but these cases also require accurate and timely diagnoses. We propose a process following a brief checklist that focuses on diffuse large B-cell lymphoma, the most common entity, and rules out other similar lymphomas in a stepwise fashion.


Assuntos
Linfoma de Células B/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Patologia Clínica/métodos , Guias de Prática Clínica como Assunto , Antígenos CD20/metabolismo , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Linfoma de Células B/metabolismo , Linfoma Difuso de Grandes Células B/metabolismo , Neprilisina/metabolismo , Proteínas Proto-Oncogênicas c-bcl-6/metabolismo
4.
J Clin Pathol ; 73(1): 1-6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31308255

RESUMO

Traditionally, immunohistochemistry (IHC) is used by pathologists to localise specific proteins or peptides in tissue slides. In the era of personalised medicine, however, molecular tissue analysis becomes indispensable for correct diagnosis, prognosis and therapeutic decision, not only on the DNA or mRNA level but also on the protein level. Combining molecular information with imaging presents many advantages. Therefore, matrix-assisted laser desorption/ionisation imaging mass spectrometry (MALDI IMS) is a promising technique to be added to the armamentarium of the pathologist. Here, we focus on the workflow, advantages and drawbacks of both MALDI IMS and IHC. We also briefly discuss a few other protein imaging modalities and give examples of applications.


Assuntos
Ensaios de Triagem em Larga Escala , Imuno-Histoquímica , Serviço Hospitalar de Patologia , Patologia Clínica/métodos , Proteômica/métodos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Difusão de Inovações , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fluxo de Trabalho
5.
Nat Rev Clin Oncol ; 16(11): 703-715, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31399699

RESUMO

In the past decade, advances in precision oncology have resulted in an increased demand for predictive assays that enable the selection and stratification of patients for treatment. The enormous divergence of signalling and transcriptional networks mediating the crosstalk between cancer, stromal and immune cells complicates the development of functionally relevant biomarkers based on a single gene or protein. However, the result of these complex processes can be uniquely captured in the morphometric features of stained tissue specimens. The possibility of digitizing whole-slide images of tissue has led to the advent of artificial intelligence (AI) and machine learning tools in digital pathology, which enable mining of subvisual morphometric phenotypes and might, ultimately, improve patient management. In this Perspective, we critically evaluate various AI-based computational approaches for digital pathology, focusing on deep neural networks and 'hand-crafted' feature-based methodologies. We aim to provide a broad framework for incorporating AI and machine learning tools into clinical oncology, with an emphasis on biomarker development. We discuss some of the challenges relating to the use of AI, including the need for well-curated validation datasets, regulatory approval and fair reimbursement strategies. Finally, we present potential future opportunities for precision oncology.


Assuntos
Inteligência Artificial , Oncologia/métodos , Neoplasias/diagnóstico , Patologia Clínica/métodos , Medicina de Precisão/métodos , Humanos
6.
Crit Rev Oncol Hematol ; 141: 36-42, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31212145

RESUMO

Liquid biopsy can quantify and qualify cell-free (cfDNA) and tumour-derived (ctDNA) DNA fragments in the bloodstream. CfDNA quantification and mutation analysis can be applied to diagnosis, follow-up and therapeutic management as novel oncologic biomarkers. However, some tumor-types release a low amount of DNA into the bloodstream, hampering diagnosis through standard liquid biopsy procedures. Several tumors, as such as brain, kidney, prostate, and thyroid cancer, are in direct contact with other body fluids and may be alternative sources for cfDNA and ctDNA. Non-blood sources of cfDNA/ctDNA useful as novel oncologic biomarkers include cerebrospinal fluids, urine, sputum, saliva, pleural effusion, stool and seminal fluid. Seminal plasma cfDNA, which can be analyzed with cost-effective procedures, may provide powerful information capable to revolutionize prostate cancer (PCa) patient diagnosis and management. In the near future, cfDNA analysis from non-blood biological liquids will become routine clinical practice for cancer patient diagnosis and management.


Assuntos
Biomarcadores Tumorais/genética , Ácidos Nucleicos Livres/isolamento & purificação , Perfilação da Expressão Gênica/métodos , Oncologia/métodos , Neoplasias/diagnóstico , Patologia Clínica/métodos , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/isolamento & purificação , Ácidos Nucleicos Livres/análise , DNA Tumoral Circulante/análise , DNA Tumoral Circulante/isolamento & purificação , DNA Tumoral Circulante/urina , Análise Mutacional de DNA/métodos , Fezes/química , Feminino , Humanos , Biópsia Líquida , Masculino , Oncologia/tendências , Neoplasias/genética , Neoplasias/patologia , Neoplasias/urina , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/terapia , Urinálise/métodos
7.
Virchows Arch ; 475(2): 131-138, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31222375

RESUMO

Machine learning techniques, especially deep learning techniques such as convolutional neural networks, have been successfully applied to general image recognitions since their overwhelming performance at the 2012 ImageNet Large Scale Visual Recognition Challenge. Recently, such techniques have also been applied to various medical, including histopathological, images to assist the process of medical diagnosis. In some cases, deep learning-based algorithms have already outperformed experienced pathologists for recognition of histopathological images. However, pathological images differ from general images in some aspects, and thus, machine learning of histopathological images requires specialized learning methods. Moreover, many pathologists are skeptical about the ability of deep learning technology to accurately recognize histopathological images because what the learned neural network recognizes is often indecipherable to humans. In this review, we first introduce various applications incorporating machine learning developed to assist the process of pathologic diagnosis, and then describe machine learning problems related to histopathological image analysis, and review potential ways to solve these problems.


Assuntos
Aprendizado de Máquina , Patologia Clínica/métodos , Humanos
8.
Eur Arch Otorhinolaryngol ; 276(7): 2055-2060, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076880

RESUMO

PURPOSE: We morphometrically analyzed human facial muscles, and evaluated the Yanagihara facial nerve grading system using our data. METHODS: We used 15 types of human facial muscle, 2 types of masticatory muscle and 2 types of skeletal muscle. The materials were obtained from 11 Japanese male cadavers aged 43-86 years. We counted the muscle fibers and measured the transverse area of the muscle fibers (TAMF), and then calculated the number of muscle fibers (NMF) per mm2 and the average TAMF. RESULTS: We found a significant correlation between average TAMF and NMF (r = - 0.70; p < 0.01). We classified facial muscles into three types based on the correlational results. Type A had a low average TAMF and high NMF. Type C had a high average TAMF and low NMF. Masticatory and skeletal muscles were characterized as Type C. Type B was intermediate between Types A and C. CONCLUSIONS: Pathological changes in the facial muscles in facial nerve palsy seem to vary according to the type of facial muscle, because each facial muscle has a unique fiber-type composition. As the nine discrete facial expressive states evaluated in the Yanagihara system involve all three facial muscle types of our classification, the Yanagihara system is an outstanding system for grading facial nerve palsy in terms of the facial muscle morphology.


Assuntos
Músculos Faciais , Nervo Facial/patologia , Paralisia Facial , Adulto , Idoso , Cadáver , Face , Músculos Faciais/inervação , Músculos Faciais/patologia , Paralisia Facial/classificação , Paralisia Facial/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Patologia Clínica/métodos
9.
Biopreserv Biobank ; 17(4): 303-311, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31107113

RESUMO

The development of precision testing for disease diagnosis has advanced medicine by specifically matching patients with drugs to treat specific diseases. High-quality diagnostics start with high-quality tissue specimens. The development and optimization of tissue handling and processing have lagged behind bioassay development. Ultrasound time-of-flight (TOF) technology has been successfully used to monitor the critical processing step of tissue fixation with formalin. In this study, we expand the use of this technology to monitor tissue dehydration and clearing by analyzing TOF signals from 270 different specimens, representing 13 different tissue types obtained through surgical resections. We determined the time constant τ90 for each tissue type for the following tissue processing solvents: 70% ethanol, 90% ethanol, 100% ethanol, and xylene. The TOF signals were correlated with tissue morphology to ensure that high-quality tissue was produced. Tissues can be grouped into those exhibiting fast and slow reagent diffusion. We monitored incomplete dehydration of tissue by skipping a key processing step, dehydration in absolute ethanol, and then correlated the τ90 with poor histomorphology, demonstrating that the technique can detect significant processing errors. Ultrasound TOF technology can therefore be used to monitor all phases of tissue processing cycle and yields an important preanalytical quality metric.


Assuntos
Técnicas de Preparação Histocitológica/métodos , Patologia Clínica/métodos , Desidratação , Humanos , Imuno-Histoquímica , Fixação de Tecidos
10.
Pancreas ; 48(4): 480-487, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946243

RESUMO

OBJECTIVE: The grading and typing of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are challenging for pathologists. We aimed to clarify the points of consistency and disagreement in assessing the grades and types of IPMNs. METHODS: Digital slide images of 20 IPMNs were independently assessed by 10 Japanese pathologists, who then held a consensus meeting to discuss the points of disagreement and develop a consensus and recommendations. RESULTS: The average agreement rates for grade and type were 83.5% (range, 100%-40%) and 82.5% (range, 100%-50%) and the Fleiss' κ values were 0.567 and 0.636, respectively. CONCLUSIONS: The disagreement points and recommendations were as follows: destructed ductal walls with desquamated neoplastic epithelia or mucin lakes partially lined with neoplastic cells could be invasion; intraductal stromal invasion could be dismissed unless vascular or lymphatic invasion existed; elastica staining may help visualize ducts in colloidal nodules; high-grade can be distinguished from low/intermediate grade by marked nuclear disarrangements and complex architecture in the intestinal papillae; oncocytic papillae are characterized by eosinophilic cells with round disoriented nuclei; high-grade gastric papillae can be distinguished from pancreatobiliary papillae by relatively low but complex architecture; and the most dysplastic papillae should be used to assess type in mixed papillae types.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias Intraductais Pancreáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Patologia Clínica/métodos , Adenoma Oxífilo/diagnóstico , Adenoma Oxífilo/metabolismo , Consenso , Humanos , Imuno-Histoquímica , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/metabolismo , Gradação de Tumores , Neoplasias Intraductais Pancreáticas/classificação , Neoplasias Intraductais Pancreáticas/metabolismo , Neoplasias Pancreáticas/classificação , Neoplasias Pancreáticas/metabolismo , Patologistas/normas , Patologistas/estatística & dados numéricos , Patologia Clínica/normas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/metabolismo
11.
Toxicol Pathol ; 47(4): 461-468, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31018785

RESUMO

Anatomic pathology and clinical pathology end points are standard components of almost every nonclinical general toxicity study conducted during the risk assessment of novel pharmaceuticals and chemicals. On occasion, an ultrastructural pathology evaluation using transmission electron microscopy (TEM) may be included in nonclinical toxicity studies. Transmission electron microscopy is most commonly used when a light microscopic finding may require further characterization that could inform on the pathogenesis and/or mechanism of action. Regulatory guidance do not address the use of TEM in general study designs nor whether these assessments should be performed in laboratories conducted in compliance with Good Laboratory Practices. The Scientific and Regulatory Policy Committee of the Society of Toxicologic Pathology (STP) formed a Working Group to assess the current practices on the use of TEM in nonclinical toxicity studies. The Working Group constructed a survey sent to members of societies of toxicologic pathology in the United States, Europe, Britain, and Japan, and responses were collected through the STP for evaluation by the Working Group. The survey results and regulatory context are discussed, as are "points to consider" from the collective experience of the Working Group. This survey indicates that TEM remains an essential diagnostic option for complementing toxicologic pathology evaluations. *This Points to Consider article is a product of a Society of Toxicologic Pathology (STP) Working Group commissioned by the Scientific and Regulatory Policy Committee (SRPC) of the STP. It has been reviewed and approved by the SRPC and Executive Committee of the STP but it does not represent a formal Best Practice recommendation of the Society; rather, it is intended to provide key "points to consider" in designing nonclinical studies or interpreting data from toxicity and safety studies intended to support regulatory submissions. The points expressed in this document are those of the authors and do not reflect views or policies of the employing institutions. Readers of Toxicologic Pathology are encouraged to send their thoughts on these articles or ideas for new topics to the Editor.


Assuntos
Microscopia Eletrônica de Transmissão , Patologia Clínica/métodos , Toxicologia/métodos , Comitês Consultivos , Animais , Avaliação Pré-Clínica de Medicamentos/métodos , Avaliação Pré-Clínica de Medicamentos/normas , Guias como Assunto , Humanos , Microscopia Eletrônica de Transmissão/métodos , Microscopia Eletrônica de Transmissão/normas , Patologia Clínica/legislação & jurisprudência , Patologia Clínica/normas , Sociedades Científicas , Testes de Toxicidade/métodos , Testes de Toxicidade/normas , Toxicologia/legislação & jurisprudência , Toxicologia/normas , Estados Unidos , United States Food and Drug Administration
12.
Arch Pathol Lab Med ; 143(5): 550-564, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30865487

RESUMO

CONTEXT.­: Within this decade, several important updates in prostate cancer have been presented through expert international consensus conferences and influential publications of tumor classification and staging. OBJECTIVE.­: To present key updates in prostate carcinoma. DATA SOURCES.­: The study comprised a review of literature and our experience from routine and consultation practices. CONCLUSIONS.­: Grade groups, a compression of the Gleason system into clinically meaningful groups relevant in this era of active surveillance and multidisciplinary care management for prostate cancer, have been introduced. Refinements in the Gleason patterns notably result in the contemporarily defined Gleason score 6 cancers having a virtually indolent behavior. Grading of tertiary and minor higher-grade patterns in radical prostatectomy has been clarified. A new classification for prostatic neuroendocrine tumors has been promulgated, and intraductal, microcystic, and pleomorphic giant cell carcinomas have been officially recognized. Reporting the percentage of Gleason pattern 4 in Gleason score 7 cancers has been recommended, and data on the enhanced risk for worse prognosis of cribriform pattern are emerging. In reporting biopsies for active surveillance criteria-based protocols, we outline approaches in special situations, including variances in sampling or submission. The 8th American Joint Commission on Cancer TNM staging for prostate cancer has eliminated pT2 subcategorization and stresses the importance of nonanatomic factors in stage groupings and outcome prediction. As the clinical and pathology practices for prostate cancer continue to evolve, it is of utmost importance that surgical pathologists become fully aware of the new changes and challenges that impact their evaluation of prostatic specimens.


Assuntos
Carcinoma/patologia , Gradação de Tumores/métodos , Estadiamento de Neoplasias/métodos , Patologia Clínica/métodos , Neoplasias da Próstata/patologia , Humanos , Masculino , Patologistas
13.
Acta Cytol ; 63(3): 182-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30889578

RESUMO

BACKGROUND: Atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) criterion in thyroid fine-needle aspirates (FNAs) has been a heterogeneous entity with much inter-observer variation. Sub-categorisation of AUS/FLUS has been observed to play an effective role in risk stratification. We aimed to validate AUS/FLUS sub-categorisation in correlation with the spectrum of malignancy. STUDY DESIGN: Subjects included patients with AUS/FLUS diagnosed between January 2015 and December 2016. AUS/FLUS cases were sub-categorised into those exhibiting (1) architectural atypia, (2) cytological atypia, (3) architectural and cytological atypia, (4) AUS with Hürthle cells, and (5) AUS not otherwise specified (AUS-NOS). Each sub-category was correlated with their corresponding incidence of malignancy in surgical resections. RESULT: The overall incidence of AUS/FLUS in our centre was 13% (132/1,018). On retrospective review of 117 patients with AUS/FLUS, smears with cytological atypia showed a higher incidence of malignancy (78.3%) than those with architectural atypia (75.3%). AUS/FLUS cases with both cytological and architectural atypia had a malignancy rate of 71.4%. CONCLUSION: AUS/FLUS cases with cytological atypia had a higher risk of malignancy than those with architectural atypia. The sub-categorisation of AUS/FLUS is diagnostically important for the proper risk stratification of patients.


Assuntos
Adenocarcinoma Folicular/patologia , Biópsia por Agulha Fina/métodos , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Biópsia por Agulha Fina/classificação , Biópsia por Agulha Fina/estatística & dados numéricos , Feminino , Humanos , Índia , Masculino , Variações Dependentes do Observador , Células Oxífilas/patologia , Patologia Clínica/métodos , Patologia Clínica/estatística & dados numéricos , Reprodutibilidade dos Testes , Estudos Retrospectivos
14.
Cell Oncol (Dordr) ; 42(3): 331-341, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30825182

RESUMO

PURPOSE: Tumor-stroma ratio (TSR) serves as an independent prognostic factor in colorectal cancer and other solid malignancies. The recent introduction of digital pathology in routine tissue diagnostics holds opportunities for automated TSR analysis. We investigated the potential of computer-aided quantification of intratumoral stroma in rectal cancer whole-slide images. METHODS: Histological slides from 129 rectal adenocarcinoma patients were analyzed by two experts who selected a suitable stroma hot-spot and visually assessed TSR. A semi-automatic method based on deep learning was trained to segment all relevant tissue types in rectal cancer histology and subsequently applied to the hot-spots provided by the experts. Patients were assigned to a 'stroma-high' or 'stroma-low' group by both TSR methods (visual and automated). This allowed for prognostic comparison between the two methods in terms of disease-specific and disease-free survival times. RESULTS: With stroma-low as baseline, automated TSR was found to be prognostic independent of age, gender, pT-stage, lymph node status, tumor grade, and whether adjuvant therapy was given, both for disease-specific survival (hazard ratio = 2.48 (95% confidence interval 1.29-4.78)) and for disease-free survival (hazard ratio = 2.05 (95% confidence interval 1.11-3.78)). Visually assessed TSR did not serve as an independent prognostic factor in multivariate analysis. CONCLUSIONS: This work shows that TSR is an independent prognosticator in rectal cancer when assessed automatically in user-provided stroma hot-spots. The deep learning-based technology presented here may be a significant aid to pathologists in routine diagnostics.


Assuntos
Aprendizado Profundo , Diagnóstico por Computador/métodos , Neoplasias Retais/diagnóstico , Células Estromais/patologia , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Patologia Clínica/métodos , Prognóstico
16.
J Clin Pathol ; 72(6): 448-451, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30787027

RESUMO

Paraffin embedding of small, thin tissue samples requires specific expertise for optimal orientation before tissue sectioning. This study evaluates the real-life utility of the agar pre-embedding technique for small skin biopsies with regards to lengthening of work times, problems in orientation (re-embedding) and ancillary techniques (immunohistochemistry and in situ hybridisation) between two high work flow pathology laboratories, one of which routinely uses the agar pre-embedding technique and one which does not. The mean time required for pre-embedding in agar was 30.4 s, but time for paraffin embedding for agar pre-embedded samples was shorter than the traditional method (177 vs 296 s; p<0.005). The number of skin samples requiring re-embedding was significantly higher with the traditional embedding method (p<0.005). No problems in immunoreactivity were observed in all 1900 reactions performed with 17 different antibodies. Fluorescence in situ hybridisation analysis was optimised with a prolonged protease K incubation time (21 vs 18 min).


Assuntos
Ágar/química , Biomarcadores Tumorais , Ensaios de Triagem em Larga Escala , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Inclusão em Parafina , Patologia Clínica/métodos , Neoplasias Cutâneas/química , Neoplasias Cutâneas/genética , Pele/química , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Biópsia , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Pele/patologia , Neoplasias Cutâneas/patologia , Fatores de Tempo , Fluxo de Trabalho
17.
Ann Pathol ; 39(2): 130-136, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30772062

RESUMO

Histopathology is the fundamental tool of pathology used for more than a century to establish the final diagnosis of lung cancer. In addition, the phenotypic data contained in the histological images reflects the overall effect of molecular alterations on the behavior of cancer cells and provides a practical visual reading of the aggressiveness of the disease. However, the human evaluation of the histological images is sometimes subjective and may lack reproducibility. Therefore, computational analysis of histological imaging using so-called "artificial intelligence" (AI) approaches has recently received considerable attention to improve this diagnostic accuracy. Thus, computational analysis of lung cancer images has recently been evaluated for the optimization of histological or cytological classification, prognostic prediction or genomic profile of patients with lung cancer. This rapidly growing field constantly demonstrates great power in the field of computing medical imaging by producing highly accurate detection, segmentation or recognition tasks. However, there are still several challenges or issues to be addressed in order to successfully succeed the actual transfer into clinical routine. The objective of this review is to emphasize recent applications of AI in pulmonary cancer pathology, but also to clarify the advantages and limitations of this approach, as well as the perspectives to be implemented for a potential transfer into clinical routine.


Assuntos
Inteligência Artificial , Neoplasias Pulmonares/patologia , Humanos , Patologia Clínica/métodos
18.
J Clin Pathol ; 72(5): 373-378, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30765419

RESUMO

AIMS: To consider the value proposition of digitisation of clinical immunohistochemistry services, and to develop an approach to digital immunohistochemistry implementation and validation in a large clinical laboratory. METHODS: A methodology for slide scanning in the laboratory was developed, in addition to a novel validation exercise, to allow pathologists to identify the strengths and weaknesses of digital immunohistochemistry reporting, and train in digital immunohistochemistry slide assessment. RESULTS: A total of 1480 digital immunohistochemistry slides were assessed by 24 consultant pathologists, with complete clinical concordance between the digital and the glass slide assessment observed. Certain stains were identified as being difficult/time consuming to assess using ×20 digital slides. These stains were rescanned at ×40, which improved the confidence of the pathologists to make a digital assessment. Full digitisation of immunohistochemistry slides was achieved, introducing six new steps into the pre-existing laboratory workflow. CONCLUSIONS: While initially encountering challenges in terms of workflow, our experience showed that a well-designed, adequately resourced and well-managed scanning process can minimise the delay in slides being made available for review. Our approach to validation highlighted the need for careful assessment of a digital pathology system and scanning protocols before pathologists are expected to transfer from the light microscope to the digital microscope for routine immunohistochemistry assessment.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imuno-Histoquímica , Patologia Clínica/métodos , Educação Médica Continuada/métodos , Humanos , Patologia Clínica/educação , Patologia Clínica/organização & administração , Reino Unido , Fluxo de Trabalho
20.
J Surg Oncol ; 119(6): 766-770, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30650183

RESUMO

BACKGROUND AND OBJECTIVES: Carnoy's fixation and compression represents a novel technique to enhance lymph node evaluation and accuracy of staging after colorectal cancer resection. METHODS: This study was performed in all adults undergoing colorectal cancer operations by Kaiser Permanente surgeons at two separate facilities. Patients were assigned to either location based upon surgeon and patient availability. One group of patients had their lymph nodes examined with current standard manual technique (MT). The other group had their specimens fixed with Carnoy's solution and then compressed (CT) to assess for lymph nodes. RESULTS: A total of 157 patients were enrolled. Seventy-eight patient specimens underwent MT and 79 patient specimens underwent the new compression technique (CT). CT resulted in a significant increase in total lymph node yield per specimen (37.6 ± 18.5 nodes with CT vs 18.9 ± 8.8 nodes with MT; P < 0.0001). CT also resulted in sufficient lymph node sampling (>12 nodes) in all 79 patients in the group compared with 13 of 78 patients (17%) with an insufficient lymph node evaluation in the MT group ( P = 0.0002). CONCLUSION: This study demonstrated that Carnoy's fixation with compression can significantly increase lymph node yields in colorectal cancer specimens and allow for a higher rate of adequate lymph node sampling.


Assuntos
Ácido Acético , Clorofórmio , Etanol , Fixadores , Excisão de Linfonodo , Linfonodos/patologia , Manejo de Espécimes/métodos , Idoso , Colectomia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Patologia Clínica/métodos , Protectomia , Estudos Retrospectivos
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