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[PMID]:29234806
[Au] Autor:Ehteshami Bejnordi B; Veta M; Johannes van Diest P; van Ginneken B; Karssemeijer N; Litjens G; van der Laak JAWM; Hermsen M; Manson QF; Balkenhol M; Geessink O; Stathonikos N; van Dijk MC; Bult P; Beca F; Beck AH; Wang D; Khosla A; Gargeya R; Irshad H; Zhong A; Dou Q; Li Q; Chen H; Lin HJ; Heng PA; Haß C; Bruni E; Wong Q; Halici U; Öner MÜ; Cetin-Atalay R; Berseth M; Khvatkov V; Vylegzhanin A; Kraus O; Shaban M; Rajpoot N; Awan R; Sirinukunwattana K; Qaiser T; Tsang YW; Tellez D; Annuscheit J; Hufnagl P; Valkonen M; Kartasalo K; Latonen L; Ruusuvuori P; Liimatainen K; the CAMELYON16 Consortium
[Ad] Endereço:Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
[Ti] Título:Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer.
[So] Source:JAMA;318(22):2199-2210, 2017 12 12.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Application of deep learning algorithms to whole-slide pathology images can potentially improve diagnostic accuracy and efficiency. Objective: Assess the performance of automated deep learning algorithms at detecting metastases in hematoxylin and eosin-stained tissue sections of lymph nodes of women with breast cancer and compare it with pathologists' diagnoses in a diagnostic setting. Design, Setting, and Participants: Researcher challenge competition (CAMELYON16) to develop automated solutions for detecting lymph node metastases (November 2015-November 2016). A training data set of whole-slide images from 2 centers in the Netherlands with (n = 110) and without (n = 160) nodal metastases verified by immunohistochemical staining were provided to challenge participants to build algorithms. Algorithm performance was evaluated in an independent test set of 129 whole-slide images (49 with and 80 without metastases). The same test set of corresponding glass slides was also evaluated by a panel of 11 pathologists with time constraint (WTC) from the Netherlands to ascertain likelihood of nodal metastases for each slide in a flexible 2-hour session, simulating routine pathology workflow, and by 1 pathologist without time constraint (WOTC). Exposures: Deep learning algorithms submitted as part of a challenge competition or pathologist interpretation. Main Outcomes and Measures: The presence of specific metastatic foci and the absence vs presence of lymph node metastasis in a slide or image using receiver operating characteristic curve analysis. The 11 pathologists participating in the simulation exercise rated their diagnostic confidence as definitely normal, probably normal, equivocal, probably tumor, or definitely tumor. Results: The area under the receiver operating characteristic curve (AUC) for the algorithms ranged from 0.556 to 0.994. The top-performing algorithm achieved a lesion-level, true-positive fraction comparable with that of the pathologist WOTC (72.4% [95% CI, 64.3%-80.4%]) at a mean of 0.0125 false-positives per normal whole-slide image. For the whole-slide image classification task, the best algorithm (AUC, 0.994 [95% CI, 0.983-0.999]) performed significantly better than the pathologists WTC in a diagnostic simulation (mean AUC, 0.810 [range, 0.738-0.884]; P < .001). The top 5 algorithms had a mean AUC that was comparable with the pathologist interpreting the slides in the absence of time constraints (mean AUC, 0.960 [range, 0.923-0.994] for the top 5 algorithms vs 0.966 [95% CI, 0.927-0.998] for the pathologist WOTC). Conclusions and Relevance: In the setting of a challenge competition, some deep learning algorithms achieved better diagnostic performance than a panel of 11 pathologists participating in a simulation exercise designed to mimic routine pathology workflow; algorithm performance was comparable with an expert pathologist interpreting whole-slide images without time constraints. Whether this approach has clinical utility will require evaluation in a clinical setting.
[Mh] Termos MeSH primário: Neoplasias da Mama/patologia
Metástase Linfática/diagnóstico
Aprendizado de Máquina
Patologistas
[Mh] Termos MeSH secundário: Algoritmos
Feminino
Seres Humanos
Metástase Linfática/patologia
Patologia Clínica
Curva ROC
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.14585


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[PMID]:29212763
[Au] Autor:Evans MJ
[Ad] Endereço:Royal Infirmary of Edinburgh, Scotland, UK.
[Ti] Título:Perinatal pathologists have a vital role in stillbirth review.
[So] Source:BMJ;359:j5620, 2017 12 06.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Autopsia
Patologia Clínica/legislação & jurisprudência
Natimorto
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Placenta/patologia
Gravidez
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5620


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[PMID]:29202622
[Au] Autor:Laenkholm AV; Grabau D; Møller Talman ML; Balslev E; Bak Jylling AM; Tabor TP; Johansen M; Brügmann A; Lelkaitis G; Di Caterino T; Mygind H; Poulsen T; Mertz H; Søndergaard G; Bruun Rasmussen B
[Ad] Endereço:a Department of Surgical Pathology , Zealand University Hospital , Slagelse , Denmark.
[Ti] Título:An inter-observer Ki67 reproducibility study applying two different assessment methods: on behalf of the Danish Scientific Committee of Pathology, Danish breast cancer cooperative group (DBCG).
[So] Source:Acta Oncol;57(1):83-89, 2018 Jan.
[Is] ISSN:1651-226X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: In 2011, the St. Gallen Consensus Conference introduced the use of pathology to define the intrinsic breast cancer subtypes by application of immunohistochemical (IHC) surrogate markers ER, PR, HER2 and Ki67 with a specified Ki67 cutoff (>14%) for luminal B-like definition. Reports concerning impaired reproducibility of Ki67 estimation and threshold inconsistency led to the initiation of this quality assurance study (2013-2015). The aim of the study was to investigate inter-observer variation for Ki67 estimation in malignant breast tumors by two different quantification methods (assessment method and count method) including measure of agreement between methods. MATERIAL AND METHODS: Fourteen experienced breast pathologists from 12 pathology departments evaluated 118 slides from a consecutive series of malignant breast tumors. The staining interpretation was performed according to both the Danish and Swedish guidelines. Reproducibility was quantified by intra-class correlation coefficient (ICC) and Lights Kappa with dichotomization of observations at the larger than (>) 20% threshold. The agreement between observations by the two quantification methods was evaluated by Bland-Altman plot. RESULTS: For the fourteen raters the median ranged from 20% to 40% by the assessment method and from 22.5% to 36.5% by the count method. Light's Kappa was 0.664 for observation by the assessment method and 0.649 by the count method. The ICC was 0.82 (95% CI: 0.77-0.86) by the assessment method vs. 0.84 (95% CI: 0.80-0.87) by the count method. CONCLUSION: Although the study in general showed a moderate to good inter-observer agreement according to both ICC and Lights Kappa, still major discrepancies were identified in especially the mid-range of observations. Consequently, for now Ki67 estimation is not implemented in the DBCG treatment algorithm.
[Mh] Termos MeSH primário: Neoplasias da Mama/patologia
Imuno-Histoquímica/normas
Antígeno Ki-67/metabolismo
[Mh] Termos MeSH secundário: Biomarcadores/metabolismo
Conferências de Consenso como Assunto
Dinamarca
Feminino
Seres Humanos
Patologia Clínica/normas
Guias de Prática Clínica como Assunto
Reprodutibilidade dos Testes
Coloração e Rotulagem/métodos
Coloração e Rotulagem/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Ki-67 Antigen)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1080/0284186X.2017.1404127


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[PMID]:29202260
[Au] Autor:Glassford NJ; Skene A; Guardiola MB; Chan MJ; Bagshaw SM; Bellomo R; Solez K
[Ad] Endereço:Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. drneilglassford@gmail.com.
[Ti] Título:Interobserver agreement for post mortem renal histopathology and diagnosis of acute tubular necrosis in critically ill patients.
[So] Source:Crit Care Resusc;19(4):337-343, 2017 Dec.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The renal histopathology of critically ill patients dying with acute kidney injury (AKI) in intensive care units of high income countries remains uncertain. METHODS: Retrospective observational assessment of interobserver agreement in the reporting of renal post mortem histopathology, and the ability of pathologists blinded to the clinical context to independently identify the presence of pre-mortem AKI from digital images of histological sections from 34 critically ill patients dying in teaching hospitals in Australia and Canada. RESULTS: We identified a heterogeneous cohort with a median age of 65 years (interquartile range [IQR], 56.5-77), APACHE II score of 27 (IQR, 19-33), and sepsis as the most common admission diagnosis (12/34; 35%). The most common proximate causes of death were cardiovascular (19/34; 56%) and respiratory (7/34; 21%) failure. AKI was common, with 23 patients (68%) developing RIFLE-F AKI, and 21 patients (62%) receiving renal replacement therapy. Structured reporting for tubular inflammation showed excellent agreement (kappa = 1), but no other subdomain demonstrated better than moderate agreement (kappa < 0.6). Only fair agreement (55.9% of cases; kappa = 0.23) was demonstrated on the diagnosis of moderate to severe acute tubular necrosis (ATN). Pathologist A predicted RIFLE-I or worse AKI with the diagnosis of ATN, with an overall accuracy of 61.8%; pathologist B predicted AKI with an accuracy of 35.3%. CONCLUSIONS: Post mortem assessment of the renal histopathology in critically ill patients is neither robust nor reproducible; independent pathologists agree poorly on the diagnosis of ATN, and their structural assessment appears dissociated from ante-mortem renal function.
[Mh] Termos MeSH primário: Estado Terminal
Necrose Tubular Aguda/patologia
Variações Dependentes do Observador
[Mh] Termos MeSH secundário: Lesão Renal Aguda/mortalidade
Lesão Renal Aguda/patologia
Idoso
Austrália/epidemiologia
Canadá/epidemiologia
Estudos de Coortes
Feminino
Seres Humanos
Masculino
Meia-Idade
Patologia Clínica
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


  5 / 4770 MEDLINE  
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[PMID]:28741910
[Au] Autor:Carney KK
[Ti] Título:The Study of Suff erring.
[So] Source:J Calif Dent Assoc;44(9):533, 2016 Sep.
[Is] ISSN:1043-2256
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Patologia Clínica
Estresse Psicológico
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE


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[PMID]:29183058
[Ti] Título:Diagnostic Problems: Guest Editorial.
[So] Source:JAMA;318(20):2050, 2017 11 28.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Patologia Clínica/história
Visitas com Preceptor/história
[Mh] Termos MeSH secundário: Diagnóstico
História do Século XX
Seres Humanos
[Pt] Tipo de publicação:CLASSICAL ARTICLE; HISTORICAL ARTICLE; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171213
[Lr] Data última revisão:
171213
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.10496


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[PMID]:28467215
[Au] Autor:Williams BJ; DaCosta P; Goacher E; Treanor D
[Ti] Título:A Systematic Analysis of Discordant Diagnoses in Digital Pathology Compared With Light Microscopy.
[So] Source:Arch Pathol Lab Med;141(12):1712-1718, 2017 Dec.
[Is] ISSN:1543-2165
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CONTEXT: - Relatively little is known about the significance and potential impact of glass-digital discordances, and this is likely to be of importance when considering digital pathology adoption. OBJECTIVE: - To apply evidence-based medicine to collect and analyze reported instances of glass-digital discordance from the whole slide imaging validation literature. DESIGN: - We used our prior systematic review protocol to identify studies assessing the concordance of light microscopy and whole slide imaging between 1999 and 2015. Data were extracted and analyzed by a team of histopathologists to classify the type, significance, and potential root cause of discordances. RESULTS: - Twenty-three studies were included, yielding 8069 instances of a glass diagnosis being compared with a digital diagnosis. From these 8069 comparisons, 335 instances of discordance (4%) were reported, in which glass was the preferred diagnostic medium in 286 (85%), and digital in 44 (13%), with no consensus in 5 (2%). Twenty-eight discordances had the potential to cause moderate/severe patient harm. Of these, glass was the preferred diagnostic medium for 26 (93%). Of the 335 discordances, 109 (32%) involved the diagnosis or grading of dysplasia. For these cases, glass was the preferred diagnostic medium in 101 cases (93%), suggesting that diagnosis and grading of dysplasia may be a potential pitfall of digital diagnosis. In 32 of 335 cases (10%), discordance on digital was attributed to the inability to find a small diagnostic/prognostic object. CONCLUSIONS: - Systematic analysis of concordance studies reveals specific areas that may be problematic on whole slide imaging. It is important that pathologists are aware of these areas to ensure patient safety.
[Mh] Termos MeSH primário: Técnicas e Procedimentos Diagnósticos
Microscopia/métodos
[Mh] Termos MeSH secundário: Diagnóstico por Computador/métodos
Erros de Diagnóstico
Medicina Baseada em Evidências/métodos
Seres Humanos
Interpretação de Imagem Assistida por Computador/métodos
Patologia Clínica/métodos
Sociedades Médicas
Reino Unido
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171212
[Lr] Data última revisão:
171212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.5858/arpa.2016-0494-OA


  8 / 4770 MEDLINE  
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[PMID]:29187428
[Au] Autor:Berus T; Halon A; Markiewicz A; Orlowska-Heitzman J; Romanowska-Dixon B; Donizy P
[Ad] Endereço:The Clinical Ward of Ophthalmology, Fourth Military Clinical Hospital with Polyclinic, Wroclaw, Poland tberus@4wsk.pl.
[Ti] Título:Clinical, Histopathological and Cytogenetic Prognosticators in Uveal Melanoma - A Comprehensive Review.
[So] Source:Anticancer Res;37(12):6541-6549, 2017 12.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:Uveal melanoma is the most prevalent primary intraocular cancer in adults. Although it accounts for only 5% of all melanomas, it is responsible for 13% of deaths due to this type of cancer. A wide variety of therapeutic options of primary tumor is available and progress in its management is noticeable. The fact still remains, however, that almost half of patients develop metastases which may be due to practically undetectable cancer spread present as early as at diagnosis of the primary focus. Metastatic disease is uniformly fatal despite systemic therapy. Prediction of metastasis is crucial for prognosis. It also allows targeting of emerging new therapeutic methods to the appropriate group of patients. The Authors reviewed literature concerning epidemiology and etiopathogenesis of uveal melanoma, and its clinical, histopathological and cytogenetic prognosticators.
[Mh] Termos MeSH primário: Citogenética
Melanoma/genética
Patologia Clínica
Neoplasias Uveais/genética
[Mh] Termos MeSH secundário: Aberrações Cromossômicas
Regulação Neoplásica da Expressão Gênica
Predisposição Genética para Doença/genética
Seres Humanos
Melanoma/patologia
Mutação
Prognóstico
Neoplasias Uveais/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE


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[PMID]:28967956
[Au] Autor:Herman DS; Kavsak PA; Greene DN
[Ad] Endereço:Department of Pathology and Laboratory Medicine, University of Pennsylvania,Philadelphia.
[Ti] Título:Variability and Error in Cardiac Troponin Testing: An ACLPS Critical Review.
[So] Source:Am J Clin Pathol;148(4):281-295, 2017 Oct 01.
[Is] ISSN:1943-7722
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objectives: To provide a comprehensive overview of the complexities associated with cardiac troponin (cTn) testing. An emphasis is placed on the sources of error, organized into the preanalytical, analytical, and postanalytical phases of the testing pathway. Controversial areas are also explored. Methods: A case scenario and review of the relevant literature describing laboratory considerations involving cTn testing are described. Results: Advanced comprehension of the specific assay used in a given laboratory is necessary for optimal reporting, utilization, and quality monitoring of cTn. Conclusions: cTn assays are reliable diagnostic tests for acute myocardial infarction, but understanding their limitations is required for appropriate result interpretation.
[Mh] Termos MeSH primário: Testes Hematológicos/normas
Patologia Clínica/métodos
Patologia Clínica/normas
Troponina T/sangue
[Mh] Termos MeSH secundário: Idoso
Biomarcadores/sangue
Coleta de Amostras Sanguíneas/instrumentação
Coleta de Amostras Sanguíneas/métodos
Coleta de Amostras Sanguíneas/normas
Feminino
Testes Hematológicos/instrumentação
Testes Hematológicos/métodos
Seres Humanos
Infarto do Miocárdio/sangue
Infarto do Miocárdio/diagnóstico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (Troponin T)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171003
[St] Status:MEDLINE
[do] DOI:10.1093/ajcp/aqx066


  10 / 4770 MEDLINE  
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[PMID]:28967951
[Au] Autor:Gulbahce HE
[Ad] Endereço:Department of Pathology, University of Utah, Huntsman Cancer Hospital, Salt Lake City.
[Ti] Título:Impact of 2013 American Society of Clinical Oncology/College of American Pathologists Guidelines on HER2 Fluorescent In Situ Hybridization Testing in Breast Cancers : Experience From a National Reference Laboratory.
[So] Source:Am J Clin Pathol;148(4):308-313, 2017 Oct 01.
[Is] ISSN:1943-7722
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objectives: We compared the impact of 2013 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines on human epidermal growth factor receptor 2 (HER2) fluorescence in situ hybridization (FISH) testing results on breast cancers. Methods: HER2 FISH testing performed between May 2015 and April 2016 following 2013 ASCO/CAP guidelines was included. HER2 to control probe ratios, mean HER2, and control probe copy numbers were used to reassign HER2 status using 2007 ASCO/CAP and US Food and Drug Administration (FDA) guidelines. Results: HER2 FISH results were available in 2,017 cases. A total of 342 (17.0%) cases were amplified, 301 (14.9%) were equivocal, and 1,374 (68.1%) were nonamplified. After additional testing with the alternate probe, amplified cases increased to 21.6%. HER2 positivity rates following the 2013 ASCO/CAP guidelines were significantly higher compared with the 2007 ASCO/CAP and FDA guidelines. Conclusions: The 2013 ASCO/CAP guidelines lead to a higher number of HER2 FISH positive and equivocal cases. In a reference laboratory setting where an alternative control probe was used to resolve equivocal FISH cases, 31.2% of patients with initial equivocal results became HER2 positive.
[Mh] Termos MeSH primário: Biomarcadores Tumorais/análise
Neoplasias da Mama/classificação
Hibridização in Situ Fluorescente/métodos
Oncologia/normas
Patologia Clínica/normas
Receptor ErbB-2/análise
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Guias de Prática Clínica como Assunto
Receptor ErbB-2/biossíntese
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers, Tumor); EC 2.7.10.1 (ERBB2 protein, human); EC 2.7.10.1 (Receptor, ErbB-2)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171003
[St] Status:MEDLINE
[do] DOI:10.1093/ajcp/aqx079



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