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Cima L, Nacchia F, Ghimenton C, Valotto G, Boschiero L, Gobbo S, Zaza G, Neil D, Mescoli C, Vanzo F, D’Errico A, Ghimenton C, Rugge M, Casartelli-Liviero M, Brunelli M, Novelli L, Eccher A. Histopathology and Long-Term Outcome of Kidneys Transplanted From Donors With Severe Acute Kidney Injury. Prog Transplant 2019; 29:36-42. [DOI: 10.1177/1526924818817054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background: Acute kidney injury is a treatable entity although difficult to recognize without diagnostic biopsy. We investigated the potential association between clinically defined deceased donors and acute kidney injury with preimplantation histological findings and recipient outcomes. Methods: Kidney biopsies from donors were classified using the Acute Kidney Injury Network criteria and assessed for percentage glomerulosclerosis, tubular atrophy, interstitial fibrosis, and vascular narrowing with the Remuzzi score and for acute tubular necrosis. Differences in incidence rates of delayed graft function (DGF) and cumulative rejection episodes were compared between recipients transplanted with normal and 3 levels of acute kidney injury using the analysis of variance with Bonferroni correction ( P = .0012). Results: Sixteen out of 335 donors showed a severe acute kidney injury level 3 with a median serum creatinine of 458 µmol/L. Fourteen (88%) had 0-3 Remuzzi score and were used for single kidney transplantation and 2 (12%) were used for dual kidney transplantation (score: 4-6). Recipients who received a kidney from a donor with level 3 acute kidney injury had a higher percentage of DGF (47%) without statistical significance ( P = .008). The rate of cumulative rejection (45%) at 2 years was not significantly increased ( P = .09). Conclusions: Recipients receiving level 3 acute kidney injury kidneys, selected with Remuzzi histopathological score and acute tubular necrosis assessment, had a greater incidence of DGF but a similar long-term cumulative rejection compared to no injury and level 1 and level 2 acute kidney injury donors. The application of the histopathological examination allowed expansion of the kidney donor pool.
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Affiliation(s)
- Luca Cima
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Francesco Nacchia
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Ghimenton
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Valotto
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Luigino Boschiero
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Gobbo
- Pathology Unit, Pederzoli Hospital of Peschiera Del Garda, Verona, Italy
| | - Gianluigi Zaza
- Department of Medicine, Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Desley Neil
- Department of Histopathology, Pathology Unit, Queen Elizabeth Hospital Birmingham, England
| | - Claudia Mescoli
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University and Hospital Trust of Padua, Padua, Italy
| | - Francesca Vanzo
- Arsenàl, Veneto’s Research Center for eHealth Innovation, Veneto, Italy
| | - Antonietta D’Errico
- Department of Specialised, Experimental and Diagnostic Medicine, Pathology Unit, Sant’Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Massimo Rugge
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University and Hospital Trust of Padua, Padua, Italy
| | - Marilena Casartelli-Liviero
- Department of Surgical Sciences, Neurosurgery and Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Novelli
- Pathology Unit, Carreggi University Hospital, Firenze, Italy
| | - Albino Eccher
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
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Cima L, Brunelli M, Parwani A, Girolami I, Ciangherotti A, Riva G, Novelli L, Vanzo F, Sorio A, Cirielli V, Barbareschi M, D'Errico A, Scarpa A, Bovo C, Fraggetta F, Pantanowitz L, Eccher A. Validation of Remote Digital Frozen Sections for Cancer and Transplant Intraoperative Services. J Pathol Inform 2018; 9:34. [PMID: 30450263 PMCID: PMC6187937 DOI: 10.4103/jpi.jpi_52_18] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/31/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction Whole-slide imaging (WSI) technology can be used for primary diagnosis and consultation, including intraoperative (IO) frozen section (FS). We aimed to implement and validate a digital system for the FS evaluation of cancer and transplant specimens following recommendations of the College of American Pathologists. Materials and Methods FS cases were routinely scanned at ×20 employing the "Navigo" scanner system. IO diagnoses using glass versus digital slides after a 3-week washout period were recorded. Intraobserver concordance was evaluated using accuracy rate and kappa statistics. Feasibility of WSI diagnoses was assessed by the way of sensitivity, specificity, as well as positive and negative predictive values. Participants also completed a survey denoting scan time, time spent viewing cases, preference for glass versus WSI, image quality, interface experience, and any problems encountered. Results Of the 125 cases submitted, 121 (436 slides) were successfully scanned including 93 oncological and 28 donor-organ FS biopsies. Four cases were excluded because of failed digitalization due to scanning problems or sample preparation artifacts. Full agreement between glass and digital-slide diagnosis was obtained in 90 of 93 (97%, κ = 0.96) oncology and in 24 of 28 (86%, κ = 0.91) transplant cases. There were two major and one minor discrepancy for cancer cases (sensitivity 100%, specificity 96%) and two major and two minor disagreements for transplant cases (sensitivity 96%, specificity 75%). Average scan and viewing/reporting time were 12 and 3 min for cancer cases, compared to 18 and 5 min for transplant cases. A high diagnostic comfort level among pathologists emerged from the survey. Conclusions These data demonstrate that the "Navigo" digital WSI system can reliably support an IO FS service involving complicated cancer and transplant cases.
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Affiliation(s)
- Luca Cima
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Anil Parwani
- Department of Pathology, Ohio State University, Columbus, OH, USA
| | - Ilaria Girolami
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Andrea Ciangherotti
- Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy
| | - Giulio Riva
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Novelli
- Department of Pathology, Anatomic Pathology Unit, Careggi University Hospital, Firenze, Italy
| | - Francesca Vanzo
- Veneto's Research Center for eHealth Innovation, Veneto, Italy
| | - Alessandro Sorio
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Vito Cirielli
- Department of Diagnostics and Public Health, Forensic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Mattia Barbareschi
- Department of Laboratory Medicine, Anatomic Pathology Unit, S. Chiara Hospital, Trento, Italy
| | - Antonietta D'Errico
- Department of Specialised, Experimental and Diagnostic Medicine, Anatomic Pathology Unit, S. Orsola-Malpighi University Hospital of Bologna, Bologna, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Chiara Bovo
- Medical Direction, University and Hospital Trust of Verona, Verona, Italy
| | - Filippo Fraggetta
- Department of Pathology, Anatomic Pathology Unit, Cannizzaro Hospital, Catania, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, PA, Pennsylvania, USA
| | - Albino Eccher
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
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Cirielli V, Cima L, Bortolotti F, Narayanasamy M, Scarpelli MP, Danzi O, Brunelli M, Eccher A, Vanzo F, Ambrosetti MC, El-Dalati G, Vanezis P, De Leo D, Tagliaro F. Virtual Autopsy as a Screening Test Before Traditional Autopsy: The Verona Experience on 25 Cases. J Pathol Inform 2018; 9:28. [PMID: 30167343 PMCID: PMC6106125 DOI: 10.4103/jpi.jpi_23_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Interest has grown into the use of multidetector computed tomography (CT) and magnetic resonance imaging as an adjunct or alternative to the invasive autopsy. We sought to investigate these possibilities in postmortem CT scan using an innovative virtual autopsy approach. Methods: Twenty-five postmortem cases were scanned with the Philips Brilliance CT-64 and then underwent traditional autopsy. The images were interpreted by two blinded forensic pathologists assisted by a radiologist with the INFOPSY® Digital Autopsy Software System which provides three-dimensional images in Digital Imaging and Communications in Medicine format. Diagnostic validity of virtual autopsy (accuracy rate, sensitivity, specificity, and predictive values) and concordance between the two forensic pathologists (kappa intraobserver coefficients) were determined. Results: The causes of death at traditional autopsies were hemorrhage due to traumatic injuries (n = 8), respiratory failure (5), asphyxia due to drowning (4), asphyxia due to hanging or strangulation (2), heart failure (2), nontraumatic hemorrhage (1), and severe burns (1). In two cases, the cause of death could not be ascertained. In 15/23 (65%) cases, the cause of death diagnosed after virtual autopsy matched the diagnosis reported after traditional autopsy. In 8/23 cases (35%), traditional autopsy was necessary to establish the cause of death. Digital data provided relevant information for inferring both cause and manner of death in nine traumatic cases. The validity of virtual autopsy as a diagnostic tool was higher for traumatic deaths than other causes of death (accuracy 84%, sensitivity 82%, and specificity 86%). The concordance between the two forensic pathologists was almost perfect (>0.80). Conclusions: Our experience supports the use of virtual autopsy in postmortem investigations as an alternative diagnostic practice and does suggest a potential role as a screening test among traumatic deaths.
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Affiliation(s)
- Vito Cirielli
- Department of Diagnostics and Public Health, Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Luca Cima
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Federica Bortolotti
- Department of Diagnostics and Public Health, Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Murali Narayanasamy
- Department of Forensic Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Maria Pia Scarpelli
- Department of Diagnostics and Public Health, Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Olivia Danzi
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Albino Eccher
- Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Francesca Vanzo
- Center Research and Innovation for Digital Health, Veneto, Italy
| | - Maria Chiara Ambrosetti
- Department of Diagnostics and Public Health, Radiology Unit, University and Hospital Trust of Verona, Italy
| | - Ghassan El-Dalati
- Department of Diagnostics and Public Health, Radiology Unit, University and Hospital Trust of Verona, Italy
| | - Peter Vanezis
- Department of Clinical Pharmacology, Cameron Forensic Medical Sciences, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Domenico De Leo
- Department of Diagnostics and Public Health, Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Franco Tagliaro
- Department of Diagnostics and Public Health, Forensic Pathology Unit, University and Hospital Trust of Verona, Italy.,Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, Russian Federation, Russia
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Eccher A, Cima L, Ciangherotti A, Montin U, Violi P, Carraro A, Tedeschi U, Nacchia F, Fior F, Rostand M, Boschiero L, D'Errico A, Scarpa A, Casartelli-Liviero M, Ferrari G, Rodini V, Tomaselli E, Zampicinini L, Vanzo F, Bovo C, Feltrin G, Neil D, Brunelli M. Rapid screening for malignancy in organ donors: 15-year experience with the Verona “Alert” protocol and review of the literature. Clin Transplant 2017; 31:e13045. [DOI: 10.1111/ctr.13045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Albino Eccher
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
| | - Luca Cima
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
| | - Andrea Ciangherotti
- Department of Surgical Science; General and Hepatobiliary Surgery; University and Hospital Trust of Verona; Verona Italy
| | - Umberto Montin
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Paola Violi
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Amedeo Carraro
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Umberto Tedeschi
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Francesco Nacchia
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Francesca Fior
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Momo Rostand
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Luigino Boschiero
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Antonietta D'Errico
- Pathology Unit; Department of Specialised; Experimental and Diagnostic Medicine; S. Orsola-Malpighi University Hospital of Bologna; Bologna Italy
| | - Aldo Scarpa
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
| | - Marilena Casartelli-Liviero
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Giuseppe Ferrari
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Viviana Rodini
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Elisabetta Tomaselli
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Laura Zampicinini
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Francesca Vanzo
- Arsenàl, Veneto's Research Center for eHealth Innovation; Veneto Italy
| | - Chiara Bovo
- Medical Direction; University and Hospital Trust of Verona; Verona Italy
| | - Giuseppe Feltrin
- Transplant Regional Center; Veneto Region; Hospital Trust of Padova; Padova Italy
| | - Desley Neil
- Pathology Unit; Department of Histopathology; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Matteo Brunelli
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
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Caliò A, Bria E, Pilotto S, Gilioli E, Nottegar A, Eccher A, Cima L, Santo A, Pedron S, Turri G, Knuutila S, Chilosi M, Vanzo F, Bogina G, Terzi A, Tortora G, Scarpa A, Loda M, Martignoni G, Brunelli M. ALK gene copy number in lung cancer: Unspecific polyploidy versus specific amplification visible as double minutes. Cancer Biomark 2017; 18:215-220. [PMID: 28009326 DOI: 10.3233/cbm-161680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gains of a gene due to DNA polyploidy versus amplification of the specific locus are distinct molecular alterations in tumors. OBJECTIVE We quantified copy number gains of ALK gene due to unspecific polyploidy versus amplifications of the specific locus in a series of non-small cell lung cancers. METHODS The locus specific ALK copy (LSI) number status was evaluated in 205 cases by FISH. Ratio LSI ALK copy number corrected for control probes CEP2, CEP3 and CEP17 (CEPs) was scored. Amplification of the specific ALK locus was defined when ratio set to ≥ 2 while polyploidy was interpreted when the increase in gene copy resulted < 2 in ratio (LSI/control CEPs). RESULTS Twenty one cases (10.2%) showed ≥ 8 ALK signals, 68 cases (33.2%) 3-7 signals and 116 cases (56.6%) a mean of 2 signals. Only 2/21 cases of the cohort harboring ≥ 8 signals showed a ratio ≥ 2 after CEPs correction interpretable as amplified, showing numerous doubled fluorescent spots. All the remaining cases showed a mirrored number of fluorescent spots per each CEPs, interpretable as polyploidy. CONCLUSION We detected a high prevalence of ALK gene copy number usually due to polyploidy rather than ALK locus amplification, the latter visible prevalently as double minutes.
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Affiliation(s)
- Anna Caliò
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
| | - Emilio Bria
- Medical Oncology, University and Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Medical Oncology, University and Hospital Trust, Verona, Italy
| | - Eliana Gilioli
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
| | - Alessia Nottegar
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
| | - Albino Eccher
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
| | - Luca Cima
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
| | - Antonio Santo
- Medical Oncology, University and Hospital Trust, Verona, Italy
| | - Serena Pedron
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
| | - Giona Turri
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
| | - Sakari Knuutila
- Department of Pathology, Laboratory of Molecular Cytogenetic, University of Helsinki, Helsinki, Finland
| | - Marco Chilosi
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
| | - Francesca Vanzo
- Arsenàl, Veneto's Research Center for eHealth Innovation, Veneto, Italy
| | | | - Alberto Terzi
- Thoracic Surgery, SacroCuore Hospital, Negrar, Italy
| | | | - Aldo Scarpa
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
| | - Massimo Loda
- Dana-Farber Cancer Institute, Harvard Medical School, Brigham And Women's Hospital, Boston, MA, USA
| | - Guido Martignoni
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy.,Anatomic Pathology, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust, Verona, Italy
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