Digital Pathology Blog

Surgeons complete first case of pancreatic "autotransplantation" after traumatic injury

The Washington Post (12/16, Brown) reported that Walter Reed surgeons, alongside a team at the University of Miami Miller School of Medicine, have successfully completed, by their accounts, "the first case of pancreatic 'autotransplantation' after a traumatic injury." The procedure, which "has been done only about 200 times," is "almost always" reserved for patients with pancreatitis. In those instances, patients "travel to the place where the pancreatic cells are extracted and preserved." But, a 21-year-old airman proved to be a rare exception. After being shot "in the back three times by an insurgent," Tre F. Porfirio "underwent two operations in Afghanistan, including one that removed much of his pancreas, before being flown to Germany."

 

If Porfirio "could survive long enough to get to a specialized transplant center, he could perhaps get a transplant of islet cells from a deceased donor and take anti-rejection drugs for the rest of his life," according to the Los Angeles Times (12/15, Healy) "Booster Shots" blog. "Or doctors could remove his pancreas, leaving him completely dependent on insulin. Either way, an early death from complications of type 1 diabetes was highly likely." Enter the University of Miami. "On Tuesday, Dr. Camillo Ricordi...told the story of a long-distance islet cell transplant." Once Porfirio reached the US, nearly four days after being shot, Walter Reed surgeons removed what was left of his pancreas. Then, the airman's "shattered pancreas" was flown from Walter Reed to "Ricordi's specialized laboratory, more than 1,000 miles away," on the day before Thanksgiving.

 

The Florida team "received it at 11 pm and spent the next six hours removing the insulin-producing islet cells," the Miami Herald (12/15, Tasker) reported. "Using enzymes and gentle heat, they extracted thousands of the cells, which range from .002 inches to .02 inches across, put them in a plastic bag similar to those used in blood donations, put them back in the container, this time at 46 degrees -- and, by 6:30 Thanksgiving morning -- couriered it back to Walter Reed." In Washington, DC, "doctors hoisted the bag on a pole and, by gravity, fed the islet cells into a duct in the airman's liver, with Dr. Ricordi and his team coordinating the procedure via an Internet connection." The Monday after Thanksgiving, "the new cells in his liver were producing insulin, although doctors also were giving him extra insulin to avoid stressing the new cells." The Florida Times-Union (12/16, Jackson) also covers the story.

Case of the Week @ PathXchange

There is an interesting case of the week up at PathXchange (registration required to view) from Dr. Sumire Kitahara at Cedars Sinai Medical Center.   There are nice images of an unusual breast lesion, more commonly seen in males as I recall that has a broad differential diagnosis. 

Thank you, Dr. Kitahara.

 

Use of whole slide images for teleconsultation - a pilot study

Dr. David Wilbur and colleagues from Massachusetts General Hospital and Harvard Medical School reecntly published a paper looking at their experience with whole slide imaging as a platform for teleconsultation.  Overall, the concordance was good at 91% between glass slide and digital diagnosis.

I think this provides further validation of the technology for use in surgical pathology consultation.  As the limitations mentioned in the paper are overcome, I suspect the technology will continue to approach both the speed and accuracy of glass slide interpretation.

Download Wilbur_WSIconsultation_Archives_Dec2009.pdf (209.4K)

This is your cancer

Several months ago a gentleman walked into my office and introduced himself.  The name sounded familiar but I couldn't recall the context where I had read it or heard it before.  Without mentioning how I could help him he mentioned that I had read his biopsy the week before and he would like to see his slides. 

This happens about once a year each year I have been in practice.  Sometimes they are physicians, sometimes not and occassionally they are pathologists.  It makes no difference in reviewing their slides beyond some of the terms used or amount of histology they may or may not know.  During the course of each of these encounters I seem to make the same statement - "This is your cancer".

Whatever was said up to that point and perhaps in some cases after that statement, I find that patient's get what they sought from the visit to "their" pathologist.  While few have doubted the accuracy of the diagnosis, grading or staging of their disease, they want affirmation that what was read by the lab represented their biopsy and the pathologist confirmed that this cancer was their disease.  In some cases I have come to learn that this may have been the first time a physician mentioned the word "cancer" to them since the biopsy.  Inevitably, they also check the slide labels to confirm their name is on them to dispel any doubt they may still have about ensuring the slides belonging to them and the appropriate diagnosis for the appropriate patient.

Shortly after the patient sat down opposite me at the double headed microscope in my office and I began trying to recover his slides along with three office assistants, the same questions as in the past arose in my mind.  Is this appropriate to be reviewing the slides with the patient?  What if the slides cannot be found immediately to review in a timely fashion?  What questions may arise and how will I address those? 

These occurrences also remind me that every number is a life.  Every accession number, order number and slide is a life.  In the course of a large signout on any given day it may be easy to lose sight of that fact and patients become "accessions" or "cases". 

When patients come to your office, it affirms they are not a "case" or a "biopsy". 

This particular patient asked if I remembered his slides during the course of reading slides from the week prior.  Was their anything unusual about his slides?  Did I show his slides to anyone else? 

At the time, I honestly could not recall.  His was one of 50 or so "cases" that day.  Nothing was out of the ordinary.  I diagnosed several new malignancies that day including several of the same kind of tissue he had biopsied.  Nothing was out of the ordinary with that particular group of slides or any particular patient's sample that I could recall from a week ago. 

Once we retrieved the slides from the file and surgical pathology report, I reviewed the patient's slides with him and when getting to the appropriate focus told the patient "This is your cancer". 

A grateful patient thanked me for my time.  While I may not have remembered the "case" at the time, this is one patient I will not forget.

University of Pennsylvania School of Medicine and Rutgers University Partner with BioImagene to Develop Companion Algorithms™ for Digital Pathology

Press Release from BioImagene one their use of Companion Algorithms in collaboration with UPenn and Rutgers:

BioImagene, Inc., the leading provider of innovative digital pathology solutions, announced a collaboration today with the University of Pennsylvania School of Medicine and Rutgers, The State University of New Jersey to develop Companion Algorithms™ for next generation companion diagnostics for digital pathology.

This collaboration marks a significant milestone for the diagnosis and evaluation of prostate cancer.

The scope of collaboration is broad-based and includes the application of BioImagene’s iAnalytics™ framework to develop next generation analysis, quantification, and decision support tools for anatomical pathology. Researchers and clinicians from the Penn and Rutgers University will digitize standard prostate biopsy samples using BioImagene’s Virtuoso™ framework. They will also use BioImagene’s telepathology capabilities to collaborate on development and validation of algorithms for diagnostic use.

“This collaboration marks the first step towards quantitative histoimaging in prostate cancer,” said John E. Tomaszewski, M.D., professor of Pathology and Laboratory Medicine at Penn. “Our goal is to improve the quality of prostate biopsy diagnostics by developing quantitative and reproducible algorithms that go beyond Gleason Grading, to be even more predictive of treatment outcomes.”

“Computer vision image analysis is translational technology, which if utilized properly, can be used in conjunction with molecular diagnostic tests to provide a more complete and accurate diagnosis for patients to determine the most appropriate therapy for individuals,” said Anant Madabhushi, Ph.D., director of the Laboratory for Computational Imaging and Bioinformatics (LCIB) at Rutgers and member of The Cancer Institute of New Jersey. “BioImagene was an ideal industry partner, given their success in making Companion Algorithms available for clinical use.”

“The promise of digital pathology lies at the interface between scanning hardware and advanced software algorithms. This partnership marks a transition in the nascent field of digital pathology, which is shifting away from focusing on scanning hardware to a new focus that integrates clinically relevant algorithms into an advanced platform,” said Michael Feldman, M.D., Ph.D., director pathology informatics and assistant dean for IT at the Penn School of Medicine.

 “We are honored to partner with world-renowned, prestigious institutions like Penn and Rutgers to develop next generation cancer diagnostic tools that will benefit the entire digital pathology community,” said Ajit Singh, Ph.D., chief executive officer of BioImagene.
“Our goal is to bridge the clinical practice of pathology and personalized medicine by utilizing Companion Algorithms to determine patient suitability for specific cancer therapies,” added Robert Monroe, M.D., Ph.D., chief medical officer of BioImagene. “This collaboration is another positive step we are taking to make that vision a reality.”

About Penn Medicine

One of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $3.6 billion enterprise. 

About Rutgers 

Established in 1766, Rutgers, The State University of New Jersey, is America’s eighth oldest institution of higher learning and one of the nation’s premier public research universities.  Serving more than 54,000 students on campuses in Camden, Newark and New Brunswick, Rutgers offers more than 280 bachelor’s, master’s, doctoral and professional degree programs. The university is home to 27 degree-granting schools and colleges, and more than 150 specialized centers and institutes.

 

Announcement of 20th Annual AFIP Anatomic Pathology Course

20th ANNUAL ANATOMIC PATHOLOGY COURSE
5 - 9 April 2010, Hyatt Regency Hotel
Bethesda, Maryland

COURSE DESCRIPTION
This impressive course covers general and specialized areas of anatomic pathology. An intensive session in inflammatory, infectious, and tumor-related diseases, this five-day course reviews all fields in surgical pathology, cytology and forensics. Renowned experts from all of AFIP's many departments will be teaching in every sub-specialty from vast experience in international consultation, large research studies and international continuing medical education programs.

Unique to this course are the 500+ cases that participants will review. These slides are chosen from AFIP's compilation of material dating back to 1916, which is continually reviewed and renewed by the organization's experts. Attendees can review classic and complex anatomic pathology slides and test themselves on the diagnoses during the course. Highlights of this course include:

• 40 hours of lectures.
• 25 hours of microscope time
• 65 AMA Category 1 credits
• Entire revised course syllabus available on CD
• The only anatomic course with exceptional slides to self-review AND microscopes provided
• Computer access to digital slides for one year following the course through our online educational platform, http://www.askafip.org

CONTINUING MEDICAL EDUCATION PROGRAM
AFIP received a six-year accreditation from the Accreditation Council for Continuing Medical Education (ACCME). This is the highest mark that any ACCME-accredited provider can attain, and less than 1% of the several hundred providers nationwide receive this honor. This is a true testament to the quality of our program. We encourage everyone to take advantage of our expertise for the advancement of their own career, and to make a difference in the civilian and military medical community.

REGISTRATION ON THE WEB
Steps to register for this course:

1. In order to register for an AFIP course, you must first create an AskAFIP account at http://www.askafip.org
2. Click on "Register", complete the registration form and record the User ID (we suggest last name if not previously entered) and password for future reference.
3. Once you have an account and are logged in, click on "Education"- this will bring you to the course catalog.
4. Scroll down and select the course you wish to take.

Toronto's UHN Wins Award for Telepathology

Congratulations to the University Health Network (Toronto) for their recent award with telepathology from the Cancer Quality Council of Ontario:

This year's Innovation Awards honored the University Health Network for Telepathology, "a system that allows pathologists to securely review pathology slides from remote locations, thereby significantly reducing time to cancer diagnosis and increasing access for patients who may otherwise need to travel
for appointments."

 

Call for Abstracts from Pathology Visions for 2010 Meeting

Join Us for Pathology Visions 2010
Join us October 24-27, 2010, at the Sheraton San Diego Hotel and Marina on the beautiful San Diego bay, for the largest digital pathology event in 2010! Enjoy thought-provoking discussions on digital pathology applications and enrich your conference experience through the following:

• Exciting presentations on new applications
• Peer-to-peer discussions on digital pathology 
• Hands-on workshops
• Scientific poster sessions
• Digital pathology demonstrations
• Networking events

Call for Abstracts
Submit your abstract to be an oral or poster presenter at Pathology Visions! As a presenter, you can share your experiences with digital pathology, regardless of the application, and/or discuss potential uses for digital pathology in the future.

Abstracts are now being accepted. Deadline for priority consideration is June 1. To submit your abstract, click here.

About the Digital Pathology Association
Pathology Visions is the Annual Meeting of the Digital Pathology Association (DPA). The mission of the DPA is to facilitate awareness of digital pathology applications in healthcare. Members are encouraged to share best practices and promote the use of the technology among colleagues in order to demonstrate efficiencies, awareness, and its ultimate benefits to patient care. To learn more or apply for membership, visit www.digitalpathologyassociation.org.  

For more information, visit
www.pathologyvisions.com

Computers don't save hospitals money?

Came across an interesting story from Computerworld about an a study out of Harvard that claims EMRs may not be all we think they are:

Computerworld - A Harvard Medical School study that looked at some of the nation's "most wired" hospital facilities found that computerization of those facilities hasn't saved them any money or improved administrative efficiency.

The recently released study evaluated data on 4,000 hospitals in the U.S over a four-year period and found that the immense cost of installing and running hospital IT systems is greater than any expected cost savings. And much of the software being written for use in clinics is aimed at administrators, not doctors, nurses and lab workers.

The study comes as the federal government prepares to begin dispensing $19 billion in incentives for the health industry to roll out electronic health records systems. Beginning in 2011, the Health Information Technology for Economic and Clinical Health (HITECH) Act will provide incentive payments of up to $64,000 for each physician who deploys an electronic health records system and uses it effectively.

The problem "is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients," the report's lead author, Dr. David Himmelstein, said in an interview with Computerworld.

Himmelstein, an associate professor at Harvard Medical School, said that in its current state, hospital computing might modestly improve the quality of health care processes, but it does not reduce overall administrative costs. "First, you spend $25 million dollars on the system itself and hire anywhere from a couple-dozen to a thousand people to run the system," he said. "And for doctors, generally, it increases time they spend [inputting data]."

Himmelstein said that only a handful of hospitals and clinics realized even modest savings and increased efficiency -- and those hospitals custom-built their systems after computer system architects conducted months of research.

Read rest of story and download article below

Download AJM10662S200.pdf (107.1K)

What say you?

Hand-held device may reduce time needed to diagnose cervical cancer

The UK's Daily Mail (12/1, Hagan) reports, "A hand-held device could slash the time it takes to diagnose cervical cancer from several weeks to just a couple of minutes," and "ease the trauma of smear-testing." According to its developers at Sheffield University, the device "uses a technology called electrical impedance to monitor the presence of abnormal cells." This is notable, because "electricity passes through different types of tissues at varying speeds. Cancerous cells tend to have much lower levels of impedance, which means they conduct electricity at a faster rate than healthy cervical cells." Thus, "within a couple of minutes, the APX probe can translate this information into a computerized image that details potential cancerous hot spots."

 

The device to diagnose cervical cancer apparently  looks something like this TV remote control. 

 

Several points about the short report struck me.  Turn around time for pap smears in the UK for one.  4 to 5 weeks seems long even in a socialized health care system and may negate the ability to perform HPV testing on the residual volume (the story does mention liquid based testing).  Another few weeks for colposcopic follow-up does not seem as unreasonable as the popular press makes it out to be for a disease process that is typically indolent and takes years to manifest and progress from pre-invasive states to invasive conditions.  

 

We will see the downstream effects of Ireland's agreement with Quest to perform pap smear interpretations to deal with their needs but what will become of folks trained to do this or future training within the country?  This may become a lost skill entirely in Ireland due to onshoring of pap smear services from overseas. 

 

The details on the electrical impedance are scant but naturally and tool or technology that will increase accuracy and help improve false negative and false positive results is welcome. 

Dr. Papanikolaou - Wikipedia

 

Read more: http://www.dailymail.co.uk/health/article-1232171/The-zapper-end-smear-test-misery.html#ixzz0YRUjLFVZ

Frost & Sullivan Recognizes Omnyx for Strategic Leadership in Digital Pathology

Omnyx Announcement Press Release:

PITTSBURGH - November 30, 2009 - Based on their global analysis of the digital pathology market and the vendors serving it, Frost & Sullivan presents Omnyx with the 2009 Growth Strategy Leadership Award.  This honor is also shared with GE Healthcare and the University of Pittsburgh Medical Center (UPMC).  The two global healthcare brands came together to form the joint venture in June of 2008.

"Over the last few years, a change in mindset has been evident in the pathology area, with increasing demands for automating the processes that take place in the laboratory - from improving the workflow to supporting better and faster care, and meeting the demands for advanced data management.

"Digital pathology systems enable such an environment and Omnyx has demonstrated significant knowledge and dedication to gain a strong foothold in what can potentially be a multi-billion dollar global market. The ability to envisage the IT solutions in pathology, understand customer needs and to follow a growth strategy to address those is a testament to the company's vision and the strength of the GE Healthcare and UPMC partnership and further validates the promise of digital pathology." says Frost & Sullivan Programme Leader, Konstantinos Nikolopoulos.

"We are honored to receive this distinctive recognition from Frost & Sullivan."  says Gene Cartwright, CEO of Omnyx. "Our team is very focused on building a world-class product for pathologists and it's very exciting to receive acknowledgement from thought leaders in healthcare for our efforts." Cartwright concludes.

"Omnyx has strongly invested in end-user feedback to design, test and improve its digital pathology offering. By utilizing UPMC's expertise in the pathology space the company has been able to work directly with world-class clinical users who are an integral part of the team. This is a unique arrangement and allows Omnyx to benefit both in terms of product design and by utilizing UPMC as a proving ground within its global network of hospitals and labs." continues Nikolopoulos of Frost & Sullivan.

Tony Melanson, Vice President of Strategy and Marketing of Omnyx comments "We are developing a complete system that includes scanners, imaging software and workflow software.  We are approaching digital pathology by looking at the challenge through the eyes of pathologists, histotechnicians and the information technology managers who work in and support high throughput clinical environments.  Our approach has been to develop a system for pathologists by pathologists through a close relationship with UPMC. We recognized immediately that the transition to digital would only be successful if the products were developed based on a complete understanding of the user in the context of their clinical working environment," Melanson concludes. 

The products from Omnyx also address the major technical challenges that have historically existed in digital pathology:  scanning speed, image quality, image viewing performance and image storage.  The Omnyx scanner breaks the tradeoff between speed and image quality with its patented independent dual sensor technology that was developed in conjunction with the GE Research Center.  Image viewing speed and performance have also historically been technical obstacles for digital pathology.  By working with GE engineers in Israel, Omnyx has developed a streaming technology optimized for pathology images that will allow pathologists to navigate digital pathology images with near zero-latency over standard hospital networks and even from home. Image storage has been an obstacle and Omnyx is designing their storage system to scale to the needs of large scale clinical operations like UPMC.  Omnyx is also working closely with the GE Enterprise Archive team to interoperate with that product for long term medical image archiving.

 "GE Healthcare's expertise covers several areas within medical imaging and healthcare information technologies and most of its products are the result of sustained and committed R&D investment. GE has a strong history of developing winning solutions in parallel areas to pathology - like radiology and cardiology for example - offering benefits such as multi-modality functionality, advanced image display and analysis tools, remote access capabilities and working interfaces with wider departmental and enterprise information systems to allow maximum efficiencies. Omnyx is perfectly positioned to draw from GE's experience in solving technical challenges and its deep roots in engineering and can build upon the company's proven product portfolio to deliver a market leading digital pathology platform." concludes Nikolopoulos.

Visage Imaging and Definiens Announce Partnership

Companies to Provide Advanced Oncology Imaging Solutions for the Clinical and Preclinical Domain

Munich and Berlin, Germany and Parsippany, New Jersey and Andover, Massachusetts – November 30, 2009 – Definiens, the number one Enterprise Image Intelligence® company, and Visage Imaging® Inc., a wholly owned subsidiary of Pro Medicus Ltd. (ASX: PME) announced today that they have entered into a partnership to jointly develop and market advanced oncology solutions for the clinical and preclinical imaging domain.

The partnership enables Definiens to utilize the Visage® CS enterprise visualization application in its forthcoming Definiens LymphExpert™ Version 2.0. By quantifying lymph nodes not only according to RECIST and WHO guidelines but also by their volume, the new integrated solution allows for efficient lesion analysis including automated quantification of lymph nodes. Visage’s technology provides Definiens LymphExpert™ Version 2.0 with a thin client based interface for full local and remote access as well as universal connectivity to image acquisition devices and image archives.

“Visage® CS provides an efficient workflow across different oncology applications. The platform’s intuitive user interface concept allowed us to seamlessly pair it with the Definiens LymphExpert™, resulting in an extremely fast and easy-to-use solution,” said Frank-P. Klein, Vice President, Medical Imaging at Definiens. “As a result, radiologists can now easily compare changes in lymph node size over time and thus derive additional information about the efficacy of a given therapy.”

“Definiens Lymph Expert allows for new levels of automation and efficiency in lymph node analysis. Adding this technology to the Visage platform is one important step in responding to the trend towards more quantitative and standardized diagnostics.” says Dr. Malte Westerhoff, CTO Visage Imaging.

“We are excited about this cooperation,” said David Chambers, CEO of Visage Imaging. “Definiens is one of the leading innovators in the area of image understanding and quantification. Their technology combined with our Thin Client based enterprise visualization platform will allow us to bring very attractive solutions to the clinical and pre-clinical imaging markets.”

Virtual Autopsy Table Makes a Dirty Business Clean

Sweden's Norrköping Visualization Center, in collaboration with the Center for Medical Image Science and Visualization, has developed a virtual autopsy system to substitute some of the manual work for touch manipulation on a flatscreen. A body under investigation is first scanned through a CT or MRI and the results of that can be manipulated using software that can filter images based on tissue density, luminance, and other criteria.

Check out these video demonstrations.

Onshoring of Pathology Services

Last week Dark Daily ran a story about DermatopathologyConsultations.com.  Robert Michel wrote:

"DermatopathologyConsultations.com demonstrates how innovative pathologists are stepping up to apply new information technologies to make it easier for local pathologists to refer cases to expert subspecialist pathologists. The fact that Zembowicz and his colleagues are getting second opinion case referrals from other countries outside the United States is an early sign that—when it comes to recognized pathology subspecialty expertise—borders won’t mean much. Physicians will want their specimens reviewed by the best pathologist subspecialist in the field, regardless of where that individual lives and works."

I completely agree.  While digital pathology often evokes concerns about offshoring pathology services, the fact of the matter is the vast majority of sub-specialty expertise and capacity is right here in the US of A.  If we wanted to, as a pathology community, we could create vast opportunities for onshoring pathology services. 

DPC blog has some comments on the story as well.

 

VA and Kaiser Permanente to share EMR information

The Veterans Affairs Department and Kaiser Permanente have announced a pilot health information exchange project in San Diego to be launched next month that would allow doctors and others at the two organizations to share specific health information about local patients electronically between the VA's VistA electronic health-record system and Kaiser Permanente's HealthConnect system.

Letters to San Diego-area veterans will go out this week inviting them to participate in the exchange, according to a joint news release. “No exchange of information will occur without the explicit permission of the individual patient,” the release stated. "This partnership demonstrates the power of a large-scale EHR that safely connects several care systems,” said Andrew Wiesenthal, associate executive director of the Permanente Federation, in the news release.

“Securely digitizing America's healthcare information is only the first step in realizing the cost saving and improved quality benefits possible with healthcare technology."

iPhone app from MIT Media Lab tracks H1N1 outbreaks

USA Today (11/25, Marcus) reports that a new iPhone application will allow users to "find out where in their state an H1N1 outbreak has occurred and learn the best ways to avoid it." The application, called Outbreaks Near Me, also lets users know "when vaccines will be available nearby and get news on how some of the afflicted are doing." John Brownstein, who developed the application with colleagues at Massachusetts Institute of Technology's Media Lab, says "about 100,000 people" have downloaded the app since its debut in September. Meanwhile, co-developer Clark Freifeld says the accuracy of the data being submitted "suggests the iPhone may be a sensitive tool for monitoring early outbreak trends."

Download application

YouTube video about Japanese digital consultation network

The Daily Scan has an interesting post about an Aperio customer in Japan with a video on YouTube.  

Hopefully subtitles can be added later to elucidate Dr. Sawai's comments in the video. 

i-Path Diagnostics to work with Michigan State University

As an MSU alum - good to see their interests in digital pathology.  As the only US college with 3 medical schools on the same campus perhaps there will be other opportunities on campus with human cancers.

A high-tech Belfast firm is on the road to success across the Atlantic after winning its first business in the US marketplace.

i-Path Diagnostics, which specialises in virtual microscopy, is proving its software for diagnostic pathology to researchers at Michigan State University.

Read more: http://www.belfasttelegraph.co.uk/business/business-news/success-in-usa-for-hitech-ulster-diagnostic-firm-14557703.html#ixzz0XnzA16SA

USA Today poll finds most women plan to ignore new mammography guidelines

Has effective cancer screening with earlier detection of lower stage disease become too effective with patients disregarding revised screening guidelines.  While in screening one casts a wide net to catch as much as possible, there may be "false positives" or increased benign disease being overtreated?

Are we victims of our own success?  PSA screening has also come under increased scrutiny as well and we recognize we may be overtreating small, low grade, clinically indolent prostate cancers.  As more data comes out about more successful predictions of biological behavior and risk profiles, radiology and pathology may see less mammograms, pap smears and prostate biopsies.  Ditto for screening colonoscopies (invasive and virtual). 

With pap smears, for example, we recognize that there may be some women who are "overdiagnosed" with atypical cells or even low grade dysplasia that may be of little clinical significance but we also know that few high grade precursor lesions or invasive cancers are missed in patients who get appropriate examinations, screening and follow-up.

Has public health oversold one's risk and the utility of screening?

I was a bit surprised about the ACOG coming out with the new pap smear modifications.  I have heard gynecologists mention that the yearly pap visit affords an opportunity for younger women the opportunity to see a physician which may be the only time to do so outside of pregnancies and get a physical exam, blood pressure check, routine labs, etc...

No doubt the fear of "health care reform" and insuring another 40 milion people or so forces public health organizations to look at cost:benefit ratios to maintain costs while meeting appropriate outcomes.

According to a USA Today/Gallup poll, "a vast majority of American women plan to ignore controversial new recommendations about mammograms," USA Today (11/24, Szabo) reports. "The poll also shows that most women sharply overestimate their risk of developing the disease." The survey of 1,136 women found that 76% "say they disagree or strongly disagree with the recommendations. And 84% of women ages 35 to 49 say they plan to get mammograms before age 50 despite the independent panel's advice." Meanwhile, "Women also perceive their breast cancer risk to be higher than it really is. Forty percent of women estimate that a 40-year-old's chance of developing breast cancer over the next decade is 20% to 50%. The real risk is 1.4%, according to the National Cancer Institute."

The Los Angeles Times (11/24, Adams) recounts the recent mammography guidelines controversy, noting that "somewhat lost in the fracas is the fact that the task force was not suggesting all women under 50 eschew mammograms: The recommendations did not apply to women at high risk for breast cancer." The Times analyzes statistics and risks surrounding breast cancer and mammography, before asking, "If doctors can't make up their minds about screening, how can women? Some doctors say they will take advantage of the current dust-up to have careful conversations with their patients about the risks and benefits of screening in the context of patients' own risk profiles."

 

The Washington Post (11/24) also analyzes the controversy surrounding the US Preventive Services Task Force's recommendations in a Q&A with Kay Dickersin, director of the US Cochrane Center and the Center for Clinical Trials at the Johns Hopkins Bloomberg School of Public Health. Dickersin said that the recommendations are "well thought out," explaining the task force's methodology and noting that "all the models showed about the same thing even though they used different assumptions -- screening every other year saves just as many lives but does less harm."

Use and validation of epithelial recognition and fields of view algorithms on virtual slides to guide TMA construction

Recent paper by Sanford H. Barsky^1,2, Lynda Gentchev³, Amitabha S. Basu⁴, Rafael E. Jimenez³, Kamel Boussaid⁴, and Abhi S. Gholap⁴

¹Department of Pathology, University of Nevada School of Medicine, Reno, NV, USA
²Nevada Cancer Institute, Las Vegas, NV, USA
³Ohio State University College of Medicine, Columbus, OH, USA
⁴BioImagene, Inc., Cupertino, CA, USA

BioTechniques, Vol. 47, No. 5, November 2009, pp. 927–938.

Link to PDF of article

Abstract:

While tissue microarrays (TMAs) are a form of high-throughput screening, they presently still require manual construction and interpretation. Because of predicted increasing demand for TMAs, we investigated whether their construction could be automated. We created both epithelial recognition algorithms (ERAs) and field of view (FOV) algorithms that could analyze virtual slides and select the areas of highest cancer cell density in the tissue block for coring (algorithmic TMA) and compared these to the cores manually selected (manual TMA) from the same tissue blocks. We also constructed TMAs with TMAker, a robot guided by these algorithms (robotic TMA). We compared each of these TMAs to each other. Our imaging algorithms produced a grid of hundreds of FOVs, identified cancer cells in a stroma background and calculated the epithelial percentage (cancer cell density) in each FOV. Those with the highest percentages guided core selection and TMA construction. Algorithmic TMA and robotic TMA were overall ~50% greater in cancer cell density compared with Manual TMA. These observations held for breast, colon, and lung cancer TMAs. Our digital image algorithms were effective in automating TMA construction.