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Mata LA, Retamero JA, Gupta RT, García Figueras R, Luna A. Artificial Intelligence-assisted Prostate Cancer Diagnosis: Radiologic-Pathologic Correlation. Radiographics 2021; 41:1676-1697. [PMID: 34597215 DOI: 10.1148/rg.2021210020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The classic prostate cancer (PCa) diagnostic pathway that is based on prostate-specific antigen (PSA) levels and the findings of digital rectal examination followed by systematic biopsy has shown multiple limitations. The use of multiparametric MRI (mpMRI) is now widely accepted in men with clinical suspicion for PCa. In addition, clinical information, PSA density, risk calculators, and genomic and other "omics" biomarkers are being used to improve risk stratification. On the basis of mpMRI and MRI-targeted biopsies (MRI-TBx), new diagnostic pathways have been established, aiming to improve the limitations of the classic diagnostic approach. However, these pathways still show limitations associated with mpMRI and MRI-TBx. Definitive PCa diagnosis is made on the basis of histopathologic Gleason grading, which has demonstrated an excellent correlation with clinical outcomes. However, Gleason grading is done subjectively by pathologists and involves poor reproducibility, and PCa may have a heterogeneous distribution of histologic patterns. Thus, important discrepancies persist between biopsy tumor grading and final whole-organ pathologic assessment after radical prostatectomy. PCa offers a unique opportunity to establish a real radiologic-pathologic correlation, as whole-mount radical prostatectomy specimens permit a complete spatial relationship with mpMRI. Artificial intelligence is increasingly being applied to radiologic and pathologic images to improve clinical accuracy and efficiency in PCa diagnosis. This review delineates current PCa diagnostic pathways, with a focus on the role of mpMRI, MRI-TBx, and pathologic analysis. An overview of the expected improvements in PCa diagnosis derived from the use of artificial intelligence, integrated radiologic-pathologic systems, and decision support tools for multidisciplinary teams is provided. An invited commentary by Purysko is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Lidia Alcalá Mata
- From the Department of Radiology, Clínica Las Nieves, HT Médica, Calle Carmelo Torres Núm 2, 23007 Jaén, Spain (L.A.M., A.L.); Paige.AI, New York, NY (J.A.R.); Department of Radiology, Duke University Medical Center, Durham, NC (R.T.G.); and Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain (R.G.F.)
| | - Juan Antonio Retamero
- From the Department of Radiology, Clínica Las Nieves, HT Médica, Calle Carmelo Torres Núm 2, 23007 Jaén, Spain (L.A.M., A.L.); Paige.AI, New York, NY (J.A.R.); Department of Radiology, Duke University Medical Center, Durham, NC (R.T.G.); and Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain (R.G.F.)
| | - Rajan T Gupta
- From the Department of Radiology, Clínica Las Nieves, HT Médica, Calle Carmelo Torres Núm 2, 23007 Jaén, Spain (L.A.M., A.L.); Paige.AI, New York, NY (J.A.R.); Department of Radiology, Duke University Medical Center, Durham, NC (R.T.G.); and Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain (R.G.F.)
| | - Roberto García Figueras
- From the Department of Radiology, Clínica Las Nieves, HT Médica, Calle Carmelo Torres Núm 2, 23007 Jaén, Spain (L.A.M., A.L.); Paige.AI, New York, NY (J.A.R.); Department of Radiology, Duke University Medical Center, Durham, NC (R.T.G.); and Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain (R.G.F.)
| | - Antonio Luna
- From the Department of Radiology, Clínica Las Nieves, HT Médica, Calle Carmelo Torres Núm 2, 23007 Jaén, Spain (L.A.M., A.L.); Paige.AI, New York, NY (J.A.R.); Department of Radiology, Duke University Medical Center, Durham, NC (R.T.G.); and Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain (R.G.F.)
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Lujan G, Quigley JC, Hartman D, Parwani A, Roehmholdt B, Meter BV, Ardon O, Hanna MG, Kelly D, Sowards C, Montalto M, Bui M, Zarella MD, LaRosa V, Slootweg G, Retamero JA, Lloyd MC, Madory J, Bowman D. Dissecting the Business Case for Adoption and Implementation of Digital Pathology: A White Paper from the Digital Pathology Association. J Pathol Inform 2021; 12:17. [PMID: 34221633 PMCID: PMC8240548 DOI: 10.4103/jpi.jpi_67_20] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 08/23/2020] [Revised: 09/20/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022] Open
Abstract
We believe the switch to a digital pathology (DP) workflow is imminent and it is essential to understand the economic implications of conversion. Many aspects of the adoption of DP will be disruptive and have a direct financial impact, both in short term costs, such as investment in equipment and personnel, and long term revenue potential, such as improved productivity and novel tests. The focus of this whitepaper is to educate pathologists, laboratorians and other stakeholders about the business and monetary considerations of converting to a digital pathology workflow. The components of a DP business plan will be thoroughly summarized, and guidance will be provided on how to build a case for adoption and implementation as well as a roadmap for transitioning from an analog to a digital pathology workflow in various laboratory settings. It is important to clarify that this publication is not intended to list prices although some financials will be mentioned as examples. The authors encourage readers who are evaluating conversion to a DP workflow to use this paper as a foundational guide for conducting a thorough and complete assessment while incorporating in current market pricing. Contributors to this paper analyzed peer-reviewed literature and data collected from various institutions, some of which are mentioned. Digital pathology will change the way we practice through facilitating patient access to expert pathology services and enabling image analysis tools and assays to aid in diagnosis, prognosis, risk stratification and therapeutic selection. Together, they will result in the delivery of valuable information from which to make better decisions and improve the health of patients.
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Affiliation(s)
- Giovanni Lujan
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Douglas Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anil Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian Roehmholdt
- Department of Pathology, Southern California Permanente Medical Group, La Canada Flintridge, CA, USA
| | | | - Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew G. Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Marilyn Bui
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Mark D. Zarella
- Johns Hopkins Medicine Pathology Informatics, Baltimore, MD 21287, USA
| | - Victoria LaRosa
- Education Services Department, Oracle Corp, Austin, Texas, USA
| | | | | | | | - James Madory
- Department of Pathology, Medical University of South Carolina, Charleston, SC, USA
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Retamero JA, Aneiros-Fernandez J, Del Moral RG. Microscope? No, Thanks: User Experience With Complete Digital Pathology for Routine Diagnosis. Arch Pathol Lab Med 2020; 144:672-673. [PMID: 32459536 DOI: 10.5858/arpa.2019-0355-le] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Juan Antonio Retamero
- Department of Anatomical Pathology, Granada University Hospitals, Hospital Campus de la Salud, Granada, Spain
| | - Jose Aneiros-Fernandez
- Department of Anatomical Pathology, Granada University Hospitals, Hospital Campus de la Salud, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Raimundo G Del Moral
- Department of Anatomical Pathology, Granada University Hospitals, Hospital Campus de la Salud, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada, Granada, Spain
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Retamero JA, Aneiros-Fernandez J, Del Moral RG. Complete Digital Pathology for Routine Histopathology Diagnosis in a Multicenter Hospital Network. Arch Pathol Lab Med 2019; 144:221-228. [PMID: 31295015 DOI: 10.5858/arpa.2018-0541-oa] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT.— Complete digital pathology and whole slide imaging for routine histopathology diagnosis is currently in use in few laboratories worldwide. Granada University Hospitals, Spain, which comprises 4 hospitals, adopted full digital pathology for primary histopathology diagnosis in 2016. OBJECTIVE.— To describe the methodology adopted and the resulting experience at Granada University Hospitals in transitioning to full digital diagnosis. DESIGN.— All histopathology glass slides generated for routine diagnosis were digitized at ×40 using the Philips IntelliSite Pathology Solution, which includes an ultrafast scanner and an image management system. All hematoxylin-eosin-stained preparations and immunohistochemistry and histochemistry slides were digitized. The existing sample-tracking software and image management system were integrated to allow data interchange through the Health Level 7 protocol. RESULTS.— Circa 160 000 specimens have been signed out using digital pathology for primary diagnosis. This comprises more than 800 000 digitized glass slides. The scanning error rate during the implementation phase was below 1.5%, and subsequent workflow optimization rendered this rate negligible. Since implementation, Granada University Hospitals pathologists have signed out 21% more cases per year on average. CONCLUSIONS.— Digital pathology is an adequate medium for primary histopathology diagnosis. Successful digitization relies on existing sample tracking and integration of the information technology infrastructure. Rapid and reliable scanning at ×40 equivalent was key to the transition to a fully digital workflow. Digital pathology resulted in efficiency gains in the preanalytical and analytical phases, and created the basis for computational pathology: the use of computer-assisted tools to aid diagnosis.
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Affiliation(s)
- Juan Antonio Retamero
- From the Department of Anatomical Pathology, Granada University Hospitals, Hospital Campus de la Salud, Granada 18016, Spain (Drs Retamero, Aneiros-Fernandez, and del Moral); and the Instituto de Investigación Biosanitaria de Granada, Granada, Spain (Drs Aneiros-Fernandez and del Moral)
| | - Jose Aneiros-Fernandez
- From the Department of Anatomical Pathology, Granada University Hospitals, Hospital Campus de la Salud, Granada 18016, Spain (Drs Retamero, Aneiros-Fernandez, and del Moral); and the Instituto de Investigación Biosanitaria de Granada, Granada, Spain (Drs Aneiros-Fernandez and del Moral)
| | - Raimundo G Del Moral
- From the Department of Anatomical Pathology, Granada University Hospitals, Hospital Campus de la Salud, Granada 18016, Spain (Drs Retamero, Aneiros-Fernandez, and del Moral); and the Instituto de Investigación Biosanitaria de Granada, Granada, Spain (Drs Aneiros-Fernandez and del Moral)
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Pérez-López I, Martínez-López A, Retamero JA, Gallo F, Arias-Santiago S. Paquidermodactilia, engrosamiento digital proximal. Pachydermodactyly, digital proximal thickening. Dermatol Online J 2017; 23:13030/qt2np957pj. [PMID: 29469789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 06/08/2023] Open
Abstract
We report a case of pachydermodactyly (PDD). PDD is a benign, asymptomatic soft tissue swelling affecting the skin of the lateral aspects of the proximal interphalangeal joints of the fingers, mostly in young adolescent males. It has often been interpreted as a consequence of tic-like behavior as part of an obsessive-compulsive disorder. Although the diagnosis is essentially clinical, skin biopsy shows compact orthokeratotic hyperkeratosis, increased numbers of collagen fibers and fibroblasts, and no inflammatory changes. A rapid clinical recognition of PDD should avoid many unproductive and expensive diagnostic tests.
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Affiliation(s)
- Israel Pérez-López
- Unidad de Gestión Clínica de Dermatología Médico Quirúrgica y Venereología, Complejo Hospitalario Universitario de Granada, España.
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Pérez-López I, Martínez-López A, Retamero JA, Gallo F, Arias- Santiago S. Paquidermodactilia, engrosamiento digital proximal. Pachydermodactyly, digital proximal thickening. Dermatol Online J 2017. [DOI: 10.5070/d32310037004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Aneiros-Fernandez J, Retamero JA, Husein-ElAhmed H, Carriel V, Ruiz Villaverde R, O'Valle F, Aneiros-Cachaza J. Smoothelin and WT-1 expression in glomus tumors and glomuvenous malformations. Histol Histopathol 2016; 32:153-160. [PMID: 27184662 DOI: 10.14670/hh-11-782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Smoothelin is a specific marker for smooth muscle cells with contractile capacity which has not been widely studied in glomus lesions. In the same way, the expression for Wilms tumor 1 (WT1) has only been studied occasionally in the endothelial cells of glomovenous malformations and in the glomus cells of glomus tumours. OBJECTIVE We studied the significance of immunohistochemical expression of smoothelin and WT1 in 25 glomus lesions. METHODS We assessed 9 cases of solid glomus tumors (SGT), 8 cases of glomus tumors with vascular ectasia (VEGT), 2 cases of glomangiomyomas (GMM) and 6 cases of glomuvenous malformation (GM). Immunohistochemistry was performed, evaluating the expression of WT1, smoothelin, smooth muscle actin (SMA), smooth muscle myosin (SMM), h-caldesmon and desmin. RESULTS Glomic cells showed cytoplasmic positivity for smoothelin, and WT1 expression was present in all studied cases. SGT showed WT1 positivity in all endothelia. However, in regarding VEGT and GMM, WT1 endothelial expression was positive in some areas, but not in others. GM did not show endothelial cell positivity for WT1. CONCLUSIONS Smoothelin expression in glomic cells indicates that they are contractile smooth muscle cells, and thus its role in routine diagnosis should be considered. The absence of WT1 expression in the endothelium of the vascular structures of the GM is a differential characteristic between SGT, VEGT and GMM.
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Affiliation(s)
| | | | | | - Victor Carriel
- Tissue Engineering Group, Faculty of Medicine, University of Granada and Instituto de Investigación Biosanitaria Ibs, Granada, Spain
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Abstract
A rare case of ovarian paraganglioma was incidentally found as a 1.2-cm intraovarian mass in a 68-year-old hypertensive female operated for an endometrial carcinoma. Histologically, it was arranged in characteristic Zellballen composed of polygonal clear cells with a granular cytoplasm that expressed diffusely CAM5.2 cytokeratin, chromogranin, neuron-specific enolase, synaptophysin, and CD56, while S-100 protein was only present in sustentacular cells. We analyzed differential diagnoses with other rare ovarian tumors such as Sertoli cell tumor, with which it may share an immunophenotype expressing cytokeratins, S-100, and other neural markers, and extra-axial ependymoma, which invariably expresses diffusely GFAP, that may be positive only in the sustentacular cells of paraganglioma. However, on simple hematoxylin–eosin inspection, ovarian paraganglioma displays characteristic Zellballen clusters and cells with a granular cytoplasm but lacks the distinctive Sertoli cell tubules and the characteristic rosettes and fibrillary cytoplasm of ependymoma. Pathologists should be aware of the unusual locations of paraganglioma.
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Sanchez-Uribe M, Retamero JA, Gomez Leon J, Montoya Perez J, Quiñonez E. Primary intermediate-grade cardiac myxofibrosarcoma with osseous metaplasia: an extremely rare occurrence with a previously unreported feature. Cardiovasc Pathol 2014; 23:376-8. [PMID: 25246023 DOI: 10.1016/j.carpath.2014.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 02/03/2023] Open
Abstract
Primary cardiac myxofibrosarcoma (MFS) is a very rare cardiac tumor with no more than 22 cases reported in the literature, including our case. We report an MFS arising in the left atrium in a 65-year-old woman who presented with pneumonia and cardiac failure. The 9.5-cm mass was diagnosed by echocardiogram. Histopathology examination showed an intermediate-grade MFS with osseous metaplasia, a feature that has not been reported before.
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Affiliation(s)
- Magdalena Sanchez-Uribe
- Department of Pathology, Hospital de Especialidades, CMN La Raza, Calle Seris s/n, Col. La Raza, C.P. 02990, Delegación Azcapotzalco, México D.F., Mexico.
| | - Juan Antonio Retamero
- Department of Pathology, San Cecilio University Hospital. Avenida Madrid 11, Granada, Spain.
| | - J Gomez Leon
- Department of Cardiology and Echocardiogram, Hospital de Especialidades, CMN La Raza, Calle Seris s/n, Col. La Raza, C.P. 02990, Delegación Azcapotzalco, México D.F., Mexico.
| | - Jorge Montoya Perez
- Department of Cardiology and Echocardiogram, Hospital de Especialidades, CMN La Raza, Calle Seris s/n, Col. La Raza, C.P. 02990, Delegación Azcapotzalco, México D.F., Mexico.
| | - Enoe Quiñonez
- Department of Pathology, Hospital de Especialidades, CMN La Raza, Calle Seris s/n, Col. La Raza, C.P. 02990, Delegación Azcapotzalco, México D.F., Mexico.
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