Comparative evaluation of slide scanners, scan settings, and cytopreparations for digital urine cytology

Background

Acquiring well-focused digital images of cytology slides with scanners can be challenging due to the 3-dimensional nature of the slides. This study evaluates performances of whole-slide images (WSIs) obtained from 2 different cytopreparations by 2 distinct scanners with 3 focus modes.

Methods

Fourteen urine specimens were collected from patients with urothelial carcinoma. Each specimen was equally divided into 2 portions, prepared with Cytospin and ThinPrep methods and scanned for WSIs using Leica (Aperio AT2) and Hamamatsu (NanoZoomer S360) scanners, respectively. The scan settings included 3 focus modes (default, semi-auto, and manual) for single-layer scanning, along with a manual focus mode for 21 Z-layers scanning. Performance metrics were evaluated including scanning success rate, artificial intelligence (AI) algorithm-inferred atypical cell numbers and coverage rate (atypical cell numbers in single or multiple Z-layers divided by the total atypical cell numbers in 21 Z-layers), scanning time, and image file size.

Results

The default mode had scanning success rates of 85.7% or 92.9%, depending on the scanner used. The semi-auto mode increased success to 92.9% or 100%, and manual even further to 100%. However, these changes did not affect the standardized median atypical cell numbers and coverage rates. The selection of scanners, cytopreparations, and Z-stacking influenced standardized median atypical cell numbers and coverage rates, scanning times, and image file sizes.

Discussion

Both scanners showed satisfactory scanning. We recommend using semi-auto or manual focus modes to achieve a scanning success rate of up to 100%. Additionally, a minimum of 9-layer Z-stacking at 1 μm intervals is required to cover 80% of atypical cells. These advanced focus methods do not impact the number of atypical cells or their coverage rate. While Z-stacking enhances the AI algorithm's inferred quantity and coverage rates of atypical cells, it simultaneously results in longer scanning times and larger image file sizes.

Evaluating Urine Cytology Slide Digitization Efficiency: A Comparative Study Using an Artificial Intelligence-Based Heuristic Scanning Simulation and Multiple-Z-Plane Scanning

INTRODUCTION

Digitizing cytology slides presents challenges because of their three-dimensional features and uneven cell distribution. While multi-Z-plane scan is a prevalent solution, its adoption in clinical digital cytopathology is hindered by prolonged scanning times, increased image file sizes, and the requirement for cytopathologists to review multiple Z-plane images.

METHODS

This study presents heuristic scan as a novel solution, using an artificial intelligence (AI)-based approach specifically designed for cytology slide scanning as an alternative to the multi-Z-plane scan. Both the 21 Z-plane scan and the heuristic scan simulation methods were used on 52 urine cytology slides from three distinct cytopreparations (Cytospin, ThinPrep, and BD CytoRich™ (SurePath)), generating whole-slide images (WSIs) via the Leica Aperio AT2 digital scanner. The AI algorithm inferred the WSI from 21 Z-planes to quantitate the total number of suspicious for high-grade urothelial carcinoma or more severe cells (SHGUC+) cells. The heuristic scan simulation calculated the total numbers of SHGUC+ cells from the 21 Z-plane scan data. Performance metrics including SHGUC+ cell coverage rates (calculated by dividing the number of SHGUC+ cells identified in multiple Z-planes or heuristic scan simulation by the total SHGUC+ cells in the 21 Z-planes for each WSI), scanning time, and file size were analyzed to compare the performance of each scanning method. The heuristic scan's metrics were linearly estimated from the 21 Z-plane scan data. Additionally, AI-aided interpretations of WSIs with scant SHGUC+ cells followed The Paris System guidelines and were compared with original diagnoses.

RESULTS

The heuristic scan achieved median SHGUC+ cell coverage rates similar to 5 Z-plane scans across three cytopreparations (0.78-0.91 vs. 0.75-0.88, P=0.451-0.578). Notably, it substantially reduced both scanning time (137.2-635.0 seconds vs. 332.6-1278.8 seconds, P<0.05) and image file size (0.51-2.10 GB vs. 1.16-3.10 GB, P<0.05). Importantly, the heuristic scan yielded higher rates of accurate AI-aided interpretations compared to the single Z-plane scan (62.5% vs. 37.5%).

CONCLUSION

We demonstrated that the heuristic scan offers a cost-effective alternative to the conventional multi-Z-plane scan in digital cytopathology. It achieves comparable SHGUC+ cell capture rates while reducing both scanning time and image file size, promising to aid digital urine cytology interpretations with a higher accuracy rate compared to the conventional single (optimal) plane scan. Further studies are needed to assess the integration of this new technology into compatible digital scanners for practical cytology slide scanning.

Ileal carcinoid tumors stimulating Crohn's disease: incidence among 176 consecutive cases of ileal carcinoid

OBJECTIVE

There are seven published cases of ileal carcinoid tumor misdiagnosed and treated as Crohn's disease. We evaluated 176 consecutive ileal carcinoid patients to determine the frequency with which this occurs. Clinical, hormonal, and radiographic data of those patients misdiagnosed were also analyzed to determine whether there were clinical lessons to be learned.

METHODS

Records of 176 patients with ileal carcinoid tumors were retrospectively reviewed. It was determined whether patients were diagnosed and treated for Crohn's before the diagnosis of carcinoid was established. Radiographic, hormonal, and clinical data were reviewed and comparison was made to those who were correctly diagnosed as having carcinoid.

RESULTS

Of 176 ileal carcinoid patients, 4 were initially diagnosed and treated as having Crohn's; their mean age was 51.5 +/- 8.9 yr. The hormonal data of patients treated as Crohn's was indistinguishable from patients with known carcinoid. Two of four patients had colonoscopy performed, neither had terminal ileal intubation. None responded to medical therapy and all required surgery for diagnosis. The mean time from symptom onset to the establishment of the correct diagnosis was 24 +/- 6.9 months with a range of 6 to 45 months.

CONCLUSIONS

Although rare, ileal carcinoid tumors may be misdiagnosed as Crohn's disease. In our study approximately 2.3% of patients with ileal carcinoid were initially diagnosed and treated as having Crohn's disease. The presence of disease refractory to medical therapy should alert clinicians to this possibility and urinary 5-HIAA levels should be obtained as a screening test.

Cancer in children

Cancer is a relatively unusual disease entity in children. However, its diagnosis often proves devastating for the families of afflicted youngsters. The types of cancer seen in children are very different from those found in adults. Primarily, they include leukemias, lymphomas and brain tumors. In most cases, the cause(s) of these cancers is unknown. Standard treatment modalities include surgery, radiotherapy and chemotherapy. Treatment is generally provided by a multidisciplinary team which deals with attempts to eradicate cancer and provides support when there are complications of disease and treatment. The team also pays attention to the psychosocial needs of the child and the entire family unit. With recent improvements in cancer therapy, many children are now considered to be "cures." Treatment is tailored to the different subgroups of each disease entity in order to improve response. Research on the etiology of cancer and the treatment of patients with resistant disease is continuously being carried out by cooperative groups. Attention is being directed at the long-term complications occurring in the increasing number of children who have been cured of this still devastating disease.

Marrow reticulo-fibroblastoid colonies (CFU-RF derived) spontaneously release an erythroid colony (BFU-E) enhancing factor

The marrow microenvironment is composed of an extracellular matrix as well as a heterogeneous population of cells. Isolation of the various cell types and analysis of their function is necessary for a better understanding of their roles in hemopoiesis. We have recently reported a colony assay for a cellular component of the marrow microenvironment. The assay consists of a cellular component of the marrow microenvironment. The assay consists of a plasma clot-methylcellulose marrow culture. The stimulator is PHA-stimulated leukocyte conditioned medium (PHA-LCM) and hydrocortisone (5 x 10(-5)M). The fibrin strands appear to act as a substrate for the growth of Reticulo-Fibroblastoid colonies derived from the CFU-RF precursor. RF colonies can be subcultured forming adherent layers when transferred to liquid cultures. Confluent adherent layers can be maintained for long periods of time by changing medium every 3 to 5 days. Supernatants derived from unstimulated RF cultures (RF-CM) were tested for growth promotion of hemopoietic precursors. We found: (1) RF-CM by itself does not induce colony formation. (2) In the presence of erythropoietin, RF-CM enhances the growth of BFU-E. (3) Recombinant IL 4 also enhances BFU-E formation, but in our assays IL 4 induced fewer colonies than RF-CM and the colonies were smaller. (4) Because neither IL 4 nor RF-CM, by themselves, can stimulate colony formation, we compared the effect of RF-CM on assays that are known to show other IL 4 functions. RF-CM did not induce proliferation of PHA induced blast T cells, a known property of IL 4.(ABSTRACT TRUNCATED AT 250 WORDS)