1
|
Canini V, Eccher A, d’Amati G, Fusco N, Maffini F, Lepanto D, Martini M, Cazzaniga G, Paliogiannis P, Lobrano R, L’Imperio V, Pagni F. Digital Pathology Applications for PD-L1 Scoring in Head and Neck Squamous Cell Carcinoma: A Challenging Series. J Clin Med 2024; 13:1240. [PMID: 38592086 PMCID: PMC10932078 DOI: 10.3390/jcm13051240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
The assessment of programmed death-ligand 1 (PD-L1) combined positive scoring (CPS) in head and neck squamous cell carcinoma (HNSCC) is challenged by pre-analytical and inter-observer variabilities. An educational program to compare the diagnostic performances between local pathologists and a board of pathologists on 11 challenging cases from different Italian pathology centers stained with PD-L1 immunohistochemistry on a digital pathology platform is reported. A laboratory-developed test (LDT) using both 22C3 (Dako) and SP263 (Ventana) clones on Dako or Ventana platforms was compared with the companion diagnostic (CDx) Dako 22C3 pharm Dx assay. A computational approach was performed to assess possible correlations between stain features and pathologists' visual assessments. Technical discordances were noted in five cases (LDT vs. CDx, 45%), due to an abnormal nuclear/cytoplasmic diaminobenzidine (DAB) stain in LDT (n = 2, 18%) and due to variation in terms of intensity, dirty background, and DAB droplets (n = 3, 27%). Interpretative discordances were noted in six cases (LDT vs. CDx, 54%). CPS remained unchanged, increased, or decreased from LDT to CDx in three (27%) cases, two (18%) cases, and one (9%) case, respectively, around relevant cutoffs (1 and 20, k = 0.63). Differences noted in DAB intensity/distribution using computational pathology partly explained the LDT vs. CDx differences in two cases (18%). Digital pathology may help in PD-L1 scoring, serving as a second opinion consultation platform in challenging cases. Computational and artificial intelligence tools will improve clinical decision-making and patient outcomes.
Collapse
Affiliation(s)
- Valentina Canini
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milan, Italy; (V.C.); (G.C.); (V.L.); (F.P.)
| | - Albino Eccher
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, 41124 Modena, Italy
| | - Giulia d’Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Roma, 00185 Rome, Italy;
| | - Nicola Fusco
- Division of Pathology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (F.M.); (D.L.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Fausto Maffini
- Division of Pathology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (F.M.); (D.L.)
| | - Daniela Lepanto
- Division of Pathology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (F.M.); (D.L.)
| | - Maurizio Martini
- Department of Pathology, University of Messina, 98122 Messina, Italy;
| | - Giorgio Cazzaniga
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milan, Italy; (V.C.); (G.C.); (V.L.); (F.P.)
| | - Panagiotis Paliogiannis
- Anatomic Pathology and Histology, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (R.L.)
| | - Renato Lobrano
- Anatomic Pathology and Histology, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (R.L.)
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milan, Italy; (V.C.); (G.C.); (V.L.); (F.P.)
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milan, Italy; (V.C.); (G.C.); (V.L.); (F.P.)
| |
Collapse
|
2
|
Eccher A, Becker JU, Pagni F, Cazzaniga G, Rossi M, Gambaro G, L’Imperio V, Marletta S. The Puzzle of Preimplantation Kidney Biopsy Decision-Making Process: The Pathologist Perspective. Life (Basel) 2024; 14:254. [PMID: 38398762 PMCID: PMC10890315 DOI: 10.3390/life14020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Kidney transplantation is the best treatment for end-stage renal disease since it offers the greatest survival benefit compared to dialysis. The gap between the number of renal transplants performed and the number of patients awaiting renal transplants leads to a steadily increasing pressure on the scientific community. Kidney preimplantation biopsy is used as a component of the evaluation of organ quality before acceptance for transplantation. However, the reliability and predictive value of biopsy data are controversial. Most of the previously proposed predictive models were not associated with graft survival, but what has to be reaffirmed is that histologic examination of kidney tissue can provide an objective window on the state of the organ that cannot be deduced from clinical records and renal functional studies. The balance of evidence indicates that reliable decisions about donor suitability must be made based on the overall picture. This work discusses recent trends that can reduce diagnostic timing and variability among players in the decision-making process that lead to kidney transplants, from the pathologist's perspective.
Collapse
Affiliation(s)
- Albino Eccher
- Department of Medical and Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, 41100 Modena, Italy
| | - Jan Ulrich Becker
- Institute of Pathology, University Hospital of Cologne, 50923 Cologne, Germany;
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milano, Italy; (F.P.); (G.C.); (V.L.)
| | - Giorgio Cazzaniga
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milano, Italy; (F.P.); (G.C.); (V.L.)
| | - Mattia Rossi
- Division of Nephrology, Department of Medicine, University of Verona, 37129 Verona, Italy; (M.R.); (G.G.)
| | - Giovanni Gambaro
- Division of Nephrology, Department of Medicine, University of Verona, 37129 Verona, Italy; (M.R.); (G.G.)
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milano, Italy; (F.P.); (G.C.); (V.L.)
| | - Stefano Marletta
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37129 Verona, Italy;
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy
| |
Collapse
|
3
|
Cazzaniga G, Eccher A, Munari E, Marletta S, Bonoldi E, Della Mea V, Cadei M, Sbaraglia M, Guerriero A, Dei Tos AP, Pagni F, L’Imperio V. Natural Language Processing to extract SNOMED-CT codes from pathological reports. Pathologica 2023; 115:318-324. [PMID: 38180139 PMCID: PMC10767798 DOI: 10.32074/1591-951x-952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024] Open
Abstract
Objective The use of standardized structured reports (SSR) and suitable terminologies like SNOMED-CT can enhance data retrieval and analysis, fostering large-scale studies and collaboration. However, the still large prevalence of narrative reports in our laboratories warrants alternative and automated labeling approaches. In this project, natural language processing (NLP) methods were used to associate SNOMED-CT codes to structured and unstructured reports from an Italian Digital Pathology Department. Methods Two NLP-based automatic coding systems (support vector machine, SVM, and long-short term memory, LSTM) were trained and applied to a series of narrative reports. Results The 1163 cases were tested with both algorithms, showing good performances in terms of accuracy, precision, recall, and F1 score, with SVM showing slightly better performances as compared to LSTM (0.84, 0.87, 0.83, 0.82 vs 0.83, 0.85, 0.83, 0.82, respectively). The integration of an explainability allowed identification of terms and groups of words of importance, enabling fine-tuning, balancing semantic meaning and model performance. Conclusions AI tools allow the automatic SNOMED-CT labeling of the pathology archives, providing a retrospective fix to the large lack of organization of narrative reports.
Collapse
Affiliation(s)
- Giorgio Cazzaniga
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Italy
| | - Albino Eccher
- Section of Pathology, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Enrico Munari
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Stefano Marletta
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Emanuela Bonoldi
- Unit of Surgical Pathology and Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Vincenzo Della Mea
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Moris Cadei
- Pathology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Angela Guerriero
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Italy
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Italy
| |
Collapse
|
4
|
Reggiani F, L’Imperio V, Calatroni M, Pagni F, Sinico RA. Renal involvement in eosinophilic granulomatosis with polyangiitis. Front Med (Lausanne) 2023; 10:1244651. [PMID: 37790127 PMCID: PMC10544898 DOI: 10.3389/fmed.2023.1244651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a necrotizing vasculitis, which typically affects small-to medium-sized blood vessels. It is characterized by the presence of tissue infiltrates rich in eosinophils, along with the formation of granulomatous lesions. About 40% of cases have positive anti-neutrophil cytoplasm antibodies (ANCA), with predominant perinuclear staining, and anti-myeloperoxidase (anti-MPO) specificity in about 65% of cases. Typical manifestations of EGPA include the late onset of asthma, nasal and sinus-related symptoms, peripheral neuropathy, and significant eosinophilia observed in the peripheral blood. In contrast to granulomatosis with polyangiitis and microscopic polyangiitis, renal involvement in EGPA is less frequent (about 25%) and poorly studied. Necrotizing pauci-immune crescentic glomerulonephritis is the most common renal presentation in patients with ANCA-positive EGPA. Although rarely, other forms of renal involvement may also be observed, such as eosinophilic interstitial nephritis, mesangial glomerulonephritis, membranous nephropathy, or focal sclerosis. A standardized treatment for EGPA with renal involvement has not been defined, however the survival and the renal outcomes are usually better than in the other ANCA-associated vasculitides. Nonetheless, kidney disease is an adverse prognostic factor for EGPA patients. Larger studies are required to better describe the renal involvement, in particular for patterns different from crescentic glomerulonephritis, and to favor the development of a consensual therapeutic approach. In this article, in addition to personal data, we will review recent findings on patient clinical phenotypes based on ANCA, genetics and the impact of biological drugs on disease management.
Collapse
Affiliation(s)
- Francesco Reggiani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
| | | |
Collapse
|
5
|
Caputo A, L’Imperio V, Merolla F, Girolami I, Leoni E, Mea VD, Pagni F, Fraggetta F. The slow-paced digital evolution of pathology: lights and shadows from a multifaceted board. Pathologica 2023; 115:127-136. [PMID: 37387439 PMCID: PMC10462988 DOI: 10.32074/1591-951x-868] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 07/01/2023] Open
Abstract
Objective The digital revolution in pathology represents an invaluable resource fto optimise costs, reduce the risk of error and improve patient care, even though it is still adopted in a minority of laboratories. Barriers include concerns about initial costs, lack of confidence in using whole slide images for primary diagnosis, and lack of guidance on transition. To address these challenges and develop a programme to facilitate the introduction of digital pathology (DP) in Italian pathology departments, a panel discussion was set up to identify the key points to be considered. Methods On 21 July 2022, an initial conference call was held on Zoom to identify the main issues to be discussed during the face-to-face meeting. The final summit was divided into four different sessions: (I) the definition of DP, (II) practical applications of DP, (III) the use of AI in DP, (IV) DP and education. Results Essential requirements for the implementation of DP are a fully tracked and automated workflow, selection of the appropriate scanner based on the specific needs of each department, and a strong commitment combined with coordinated teamwork (pathologists, technicians, biologists, IT service and industries). This could reduce human error, leading to the application of AI tools for diagnosis, prognosis and prediction. Open challenges are the lack of specific regulations for virtual slide storage and the optimal storage solution for large volumes of slides. Conclusion Teamwork is key to DP transition, including close collaboration with industry. This will ease the transition and help bridge the gap that currently exists between many labs and full digitisation. The ultimate goal is to improve patient care.
Collapse
Affiliation(s)
- Alessandro Caputo
- Department of Pathology, Ruggi University Hospital, Salerno, Italy
- Pathology Unit, Gravina Hospital Caltagirone ASP, Catania, Italy
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, University of Milan-Bicocca, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Francesco Merolla
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität
| | - Eleonora Leoni
- Pathology Unit, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Vincenzo Della Mea
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milan-Bicocca, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy
| | | |
Collapse
|
6
|
L’Imperio V, Wulczyn E, Plass M, Müller H, Tamini N, Gianotti L, Zucchini N, Reihs R, Corrado GS, Webster DR, Peng LH, Chen PHC, Lavitrano M, Liu Y, Steiner DF, Zatloukal K, Pagni F. Pathologist Validation of a Machine Learning-Derived Feature for Colon Cancer Risk Stratification. JAMA Netw Open 2023; 6:e2254891. [PMID: 36917112 PMCID: PMC10015309 DOI: 10.1001/jamanetworkopen.2022.54891] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
IMPORTANCE Identifying new prognostic features in colon cancer has the potential to refine histopathologic review and inform patient care. Although prognostic artificial intelligence systems have recently demonstrated significant risk stratification for several cancer types, studies have not yet shown that the machine learning-derived features associated with these prognostic artificial intelligence systems are both interpretable and usable by pathologists. OBJECTIVE To evaluate whether pathologist scoring of a histopathologic feature previously identified by machine learning is associated with survival among patients with colon cancer. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used deidentified, archived colorectal cancer cases from January 2013 to December 2015 from the University of Milano-Bicocca. All available histologic slides from 258 consecutive colon adenocarcinoma cases were reviewed from December 2021 to February 2022 by 2 pathologists, who conducted semiquantitative scoring for tumor adipose feature (TAF), which was previously identified via a prognostic deep learning model developed with an independent colorectal cancer cohort. MAIN OUTCOMES AND MEASURES Prognostic value of TAF for overall survival and disease-specific survival as measured by univariable and multivariable regression analyses. Interpathologist agreement in TAF scoring was also evaluated. RESULTS A total of 258 colon adenocarcinoma histopathologic cases from 258 patients (138 men [53%]; median age, 67 years [IQR, 65-81 years]) with stage II (n = 119) or stage III (n = 139) cancer were included. Tumor adipose feature was identified in 120 cases (widespread in 63 cases, multifocal in 31, and unifocal in 26). For overall survival analysis after adjustment for tumor stage, TAF was independently prognostic in 2 ways: TAF as a binary feature (presence vs absence: hazard ratio [HR] for presence of TAF, 1.55 [95% CI, 1.07-2.25]; P = .02) and TAF as a semiquantitative categorical feature (HR for widespread TAF, 1.87 [95% CI, 1.23-2.85]; P = .004). Interpathologist agreement for widespread TAF vs lower categories (absent, unifocal, or multifocal) was 90%, corresponding to a κ metric at this threshold of 0.69 (95% CI, 0.58-0.80). CONCLUSIONS AND RELEVANCE In this prognostic study, pathologists were able to learn and reproducibly score for TAF, providing significant risk stratification on this independent data set. Although additional work is warranted to understand the biological significance of this feature and to establish broadly reproducible TAF scoring, this work represents the first validation to date of human expert learning from machine learning in pathology. Specifically, this validation demonstrates that a computationally identified histologic feature can represent a human-identifiable, prognostic feature with the potential for integration into pathology practice.
Collapse
Affiliation(s)
- Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
| | | | - Markus Plass
- Medical University of Graz, Diagnostic and Research Institute of Pathology, Graz, Austria
| | - Heimo Müller
- Medical University of Graz, Diagnostic and Research Institute of Pathology, Graz, Austria
| | - Nicolò Tamini
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Luca Gianotti
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Nicola Zucchini
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Robert Reihs
- Medical University of Graz, Diagnostic and Research Institute of Pathology, Graz, Austria
| | | | | | - Lily H. Peng
- Google Health, Google LLC, Palo Alto, California
| | | | - Marialuisa Lavitrano
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Yun Liu
- Google Health, Google LLC, Palo Alto, California
| | | | - Kurt Zatloukal
- Medical University of Graz, Diagnostic and Research Institute of Pathology, Graz, Austria
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
| |
Collapse
|
7
|
Seminati D, Mane E, Ceola S, Casati G, Putignano P, Garancini M, Gatti A, Leni D, Pincelli AI, Fusco N, L’Imperio V, Pagni F. An Indeterminate for Malignancy FNA Report Does Not Increase the Surgical Risk of Incidental Thyroid Carcinoma. Cancers (Basel) 2022; 14:cancers14215427. [PMID: 36358845 PMCID: PMC9657155 DOI: 10.3390/cancers14215427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Incidental thyroid carcinomas (ITCs) are a fairly frequent finding in daily routine practice, with papillary thyroid microcarcinoma being the most frequent entity. In our work, we isolated incidental cases arising in thyroids removed for other cytologically indeterminate and histologically benign nodules. We retrospectively retrieved cases with available thyroid Fine Needle Aspiration (FNA, 3270 cases), selecting those with an indeterminate cytological diagnosis (Bethesda classes III−IV, 652 cases). Subsequently, we restricted the analysis to surgically treated patients (163 cases) finding an incidental thyroid carcinoma in 22 of them. We found a 13.5% ITC rate, with ITCs representing 46.8% of all cancer histologically diagnosed in this indeterminate setting. Patients received a cytological diagnosis of Bethesda class III and IV in 41% and 59% of cases, respectively. All ITC cases turned out to be papillary thyroid microcarcinomas; 36% of cases were multifocal, with foci bilaterally detected in 50% of cases. We found an overall ITC rate concordant with the literature and with our previous findings. The assignment of an indeterminate category to FNA did not increase the risk of ITCs in our cohort. Rather, a strong statistical significance (p < 0.01) was found comparing the larger size of nodules that underwent FNA and the smaller size of their corresponding ITC nodule.
Collapse
Affiliation(s)
- Davide Seminati
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
- Correspondence:
| | - Eltjona Mane
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Stefano Ceola
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Gabriele Casati
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Pietro Putignano
- Endocrinology, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | | | - Andrea Gatti
- Surgery, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Davide Leni
- Radiology ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | | | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Vincenzo L’Imperio
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Fabio Pagni
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| |
Collapse
|
8
|
Capitoli G, Piga I, L’Imperio V, Clerici F, Leni D, Garancini M, Casati G, Galimberti S, Magni F, Pagni F. Cytomolecular Classification of Thyroid Nodules Using Fine-Needle Washes Aspiration Biopsies. Int J Mol Sci 2022; 23:ijms23084156. [PMID: 35456973 PMCID: PMC9028391 DOI: 10.3390/ijms23084156] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 12/13/2022] Open
Abstract
Fine-needle aspiration biopsies (FNA) represent the gold standard to exclude the malignant nature of thyroid nodules. After cytomorphology, 20–30% of cases are deemed “indeterminate for malignancy” and undergo surgery. However, after thyroidectomy, 70–80% of these nodules are benign. The identification of tools for improving FNA’s diagnostic performances is explored by matrix-assisted laser-desorption ionization mass spectrometry imaging (MALDI-MSI). A clinical study was conducted in order to build a classification model for the characterization of thyroid nodules on a large cohort of 240 samples, showing that MALDI-MSI can be effective in separating areas with benign/malignant cells. The model had optimal performances in the internal validation set (n = 70), with 100.0% (95% CI = 83.2–100.0%) sensitivity and 96.0% (95% CI = 86.3–99.5%) specificity. The external validation (n = 170) showed a specificity of 82.9% (95% CI = 74.3–89.5%) and a sensitivity of 43.1% (95% CI = 30.9–56.0%). The performance of the model was hampered in the presence of poor and/or noisy spectra. Consequently, restricting the evaluation to the subset of FNAs with adequate cellularity, sensitivity improved up to 76.5% (95% CI = 58.8–89.3). Results also suggest the putative role of MALDI-MSI in routine clinical triage, with a three levels diagnostic classification that accounts for an indeterminate gray zone of nodules requiring a strict follow-up.
Collapse
Affiliation(s)
- Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.C.); (S.G.)
| | - Isabella Piga
- Proteomics and Metabolomics Unit, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (I.P.); (F.C.); (F.M.)
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Francesca Clerici
- Proteomics and Metabolomics Unit, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (I.P.); (F.C.); (F.M.)
| | - Davide Leni
- Department of Radiology, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy;
| | - Mattia Garancini
- Department of Surgery, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy;
| | - Gabriele Casati
- Department of Clinical Pathology, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy;
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.C.); (S.G.)
| | - Fulvio Magni
- Proteomics and Metabolomics Unit, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (I.P.); (F.C.); (F.M.)
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, 20900 Monza, Italy;
- Correspondence: ; Tel.: +39-03-9233-2090
| |
Collapse
|
9
|
Fraggetta F, L’Imperio V, Ameisen D, Carvalho R, Leh S, Kiehl TR, Serbanescu M, Racoceanu D, Della Mea V, Polonia A, Zerbe N, Eloy C. Best Practice Recommendations for the Implementation of a Digital Pathology Workflow in the Anatomic Pathology Laboratory by the European Society of Digital and Integrative Pathology (ESDIP). Diagnostics (Basel) 2021; 11:2167. [PMID: 34829514 PMCID: PMC8623219 DOI: 10.3390/diagnostics11112167] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 10/25/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022] Open
Abstract
The interest in implementing digital pathology (DP) workflows to obtain whole slide image (WSI) files for diagnostic purposes has increased in the last few years. The increasing performance of technical components and the Food and Drug Administration (FDA) approval of systems for primary diagnosis led to increased interest in applying DP workflows. However, despite this revolutionary transition, real world data suggest that a fully digital approach to the histological workflow has been implemented in only a minority of pathology laboratories. The objective of this study is to facilitate the implementation of DP workflows in pathology laboratories, helping those involved in this process of transformation to identify: (a) the scope and the boundaries of the DP transformation; (b) how to introduce automation to reduce errors; (c) how to introduce appropriate quality control to guarantee the safety of the process and (d) the hardware and software needed to implement DP systems inside the pathology laboratory. The European Society of Digital and Integrative Pathology (ESDIP) provided consensus-based recommendations developed through discussion among members of the Scientific Committee. The recommendations are thus based on the expertise of the panel members and on the agreement obtained after virtual meetings. Prior to publication, the recommendations were reviewed by members of the ESDIP Board. The recommendations comprehensively cover every step of the implementation of the digital workflow in the anatomic pathology department, emphasizing the importance of interoperability, automation and tracking of the entire process before the introduction of a scanning facility. Compared to the available national and international guidelines, the present document represents a practical, handy reference for the correct implementation of the digital workflow in Europe.
Collapse
Affiliation(s)
- Filippo Fraggetta
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Pathology Unit, “Gravina” Hospital, Caltagirone, ASP Catania, Via Portosalvo 1, 95041 Caltagirone, Italy
| | - Vincenzo L’Imperio
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Department of Medicine and Surgery, Pathology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy
| | - David Ameisen
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Imginit SAS, 152 Boulevard du Montparnasse, 75014 Paris, France
| | - Rita Carvalho
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Sabine Leh
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Department of Pathology, Haukeland University Hospital, Jonas Lies Vei 65, 5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Jonas Lies Vei 87, 5021 Bergen, Norway
| | - Tim-Rasmus Kiehl
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Mircea Serbanescu
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniel Racoceanu
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, APHP, Inria Team “Aramis”, Hôpital de la Pitié Salpêtrière, 75013 Paris, France
| | - Vincenzo Della Mea
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Department of Mathematics, Computer Science and Physics, University of Udine, 33100 Udine, Italy
| | - Antonio Polonia
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Ipatimup Diagnostics, Institute of Molecular Pathology and Immunology of Porto University (Ipatimup), 4200-804 Porto, Portugal
- Medical Faculty, University of Porto, 4200-319 Porto, Portugal
| | - Norman Zerbe
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Catarina Eloy
- European Society of Digital and Integrative Pathology (ESDIP), Rua da Constituição n°668, 1° Esq/Traseiras, 4200-194 Porto, Portugal; (F.F.); (V.L.); (D.A.); (R.C.); (S.L.); (T.-R.K.); (M.S.); (D.R.); (V.D.M.); (A.P.); (N.Z.)
- Ipatimup Diagnostics, Institute of Molecular Pathology and Immunology of Porto University (Ipatimup), 4200-804 Porto, Portugal
- Medical Faculty, University of Porto, 4200-319 Porto, Portugal
| |
Collapse
|
10
|
Seminati D, Capitoli G, Leni D, Fior D, Vacirca F, Di Bella C, Galimberti S, L’Imperio V, Pagni F. Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage. Cancers (Basel) 2021; 13:cancers13215439. [PMID: 34771602 PMCID: PMC8582424 DOI: 10.3390/cancers13215439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary From a prospective series of 480 thyroid nodules, we compared the performances of the American College of Radiology (ACR) and the European Thyroid Association (EU) scoring systems in triaging thyroid nodules for fine-needle aspiration (FNA). FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting ≥TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p < 0.0001) and positive predictive value (77.5% vs. 50.7%, p < 0.0001) of the cytology alone, maintaining an excellent sensitivity and negative predictive value. Abstract Objective: The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. Design and Methods: The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. Results: FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting ≥ TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p < 0.0001) and positive predictive values (77.5% vs. 50.7%, p < 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. Conclusions: The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.
Collapse
Affiliation(s)
- Davide Seminati
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, 20900 Monza, Italy; (D.S.); (C.D.B.); (V.L.)
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.C.); (S.G.)
| | - Davide Leni
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Davide Fior
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Francesco Vacirca
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Camillo Di Bella
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, 20900 Monza, Italy; (D.S.); (C.D.B.); (V.L.)
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.C.); (S.G.)
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, 20900 Monza, Italy; (D.S.); (C.D.B.); (V.L.)
| | - Fabio Pagni
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, 20900 Monza, Italy; (D.S.); (C.D.B.); (V.L.)
- Correspondence:
| |
Collapse
|
11
|
Leni D, Seminati D, Fior D, Vacirca F, Capitoli G, Cazzaniga L, Di Bella C, L’Imperio V, Galimberti S, Pagni F. Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study. Cancers (Basel) 2021; 13:cancers13092230. [PMID: 34066485 PMCID: PMC8124822 DOI: 10.3390/cancers13092230] [Citation(s) in RCA: 14] [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: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 01/21/2023] Open
Abstract
Simple Summary On a prospective series of 480 thyroid nodules, the ACR-TIRADS demonstrated a sensitivity and specificity in performing FNA of 58.9% and 59%, respectively. The execution of FNA on nodules with ACR class ≥3 independently from the dimensional criteria would increase the sensitivity to 95% and reduce the false negatives rate (7.3%, 7/96), prompting a re-evaluation of the size criteria. The need for reduction in inappropriate hospital admissions prompts a rigorous triage of patients, and future prospective studies to improve current performances might be considered. Abstract Ultrasound scores are used to determine whether thyroid nodules should undergo Fine Needle Aspiration (FNA) or simple clinical follow-up. Different scores have been proposed for this task, with the American College of Radiology (ACR) TIRADS system being one of the most widely used. This study evaluates its ability in triaging thyroid nodules deserving FNA on a large prospective monocentric Italian case series of 493 thyroid nodules from 448 subjects. In ACR 1–2, cytology never prompted a surgical indication. In 59% of cases classified as TIR1c-TIR2, the FNA procedure could be ancillary, according to the ACR-TIRADS score. A subset (37.9%) of cases classified as TIR4-5 would not undergo FNA, according to the dimensional thresholds used by the ACR-TIRADS. Applying the ACR score, a total of 46.5% thyroid nodules should be studied with FNA. The ACR system demonstrated a sensitivity and specificity of 58.9% and 59% in the identification of patients with cytology ≥TIR3A, with a particularly high false negative rate for ACR classes ≥3 (44.8%, 43/96), which would dramatically decrease (7.3%, 7/96) if the dimensional criteria were not taken into account. In ACR 3–4–5, a correspondence with the follow-up occurred in 60.3%, 50.2% and 51.9% of cases. The ACR-TIRADS is a useful risk stratification tool for thyroid nodules, although the current dimensional thresholds could lead to an underestimation of malignant lesions. Their update might be considered in future studies to increase the screening performances of the system.
Collapse
Affiliation(s)
- Davide Leni
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Davide Seminati
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
| | - Davide Fior
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Francesco Vacirca
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (G.C.); (S.G.)
| | - Laura Cazzaniga
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
| | - Camillo Di Bella
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
| | - Vincenzo L’Imperio
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (G.C.); (S.G.)
| | - Fabio Pagni
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
- Correspondence:
| |
Collapse
|
12
|
Vanoli J, Riva M, Vergnano B, D’Andrea G, L’Imperio V, Pozzi MR, Grassi G. Granulomatosis with polyangiitis presenting with diffuse alveolar hemorrhage requiring extracorporeal membrane oxygenation with rapid multiorgan relapse: A case report. Medicine (Baltimore) 2017; 96:e6024. [PMID: 28353556 PMCID: PMC5380240 DOI: 10.1097/md.0000000000006024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
RATIONALE Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmatic antibodies (ANCA)-associated vasculitis affecting small- and medium-sized blood vessels, mostly involving lung and kidney. PATIENT CONCERNS We report the case of a 33-year-old man that presented with acute respiratory distress syndrome caused by alveolar hemorrhage. DIAGNOSES Aggressive GPA presenting with diffuse alveolar hemorrhage and multiorgan involvement. INTEVENTIONS Immunosuppressive therapy, plasma exchange, extracorporeal membrane oxygenation (ECMO). OUTCOMES Relapse occurred very early, despite immunosuppressive treatment, with a rare involvement of genital system (epididymitis) and rapidly progressive glomerulonephritis difficult to treat. LESSONS GPA is a challenging, multifaceted disease that can require aggressive supportive therapy and is associated with a high rate of relapse that may present with uncommon site of involvement.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Guido Grassi
- Divisione di Clinica Medica
- University of Milano-Bicocca and Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni, Milano, Italy
| |
Collapse
|
13
|
Pagni F, L’Imperio V, Bono F, Garancini M, Roversi G, De Sio G, Galli M, Smith AJ, Chinello C, Magni F. Proteome analysis in thyroid pathology. Expert Rev Proteomics 2015; 12:375-90. [DOI: 10.1586/14789450.2015.1062369] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|