Digital Pathology Blog

CAP Today Story on FDA and Whole Slide Imaging

The digital edition of CAP Today is available for December.  There is an article starting on the first page that reviews thoughts from the FDA Panel meeting on whole slide imaging written by Karen Lusky who has written similar articles.  I think the article is well written and looks at several issues concerning the industry and what many thought leaders think about the future of digital pathology and the anticipated needs/requirements that may be required from a regulatory perspective and clinical practice business model.

Your iPhone Just Called: Your Blood-Sugar Is High

Check out Your iPhone Just Called: Your Blood-Sugar Is High in The Wall Street Journal. I wonder if proposed health care reforms will help or hinder these types of technologies available to manage health care data.

"Polka, TheCarrot.com and Ringful are among a number of new services that allow consumers to input their medical information and track their conditions using a smart phone. Particularly for the small but growing number of people who use electronic health records, phone applications are appealing because they can allow mobile access to personal information.

The market is nascent, however. Currently, only about 3% of U.S. consumers put their medical information online in personal-health records, according to Forrester Research. It's mainly up to consumers to accurately log their own health data. And some consumers may be wary of putting their health information online, although there have been no known cases of security breaches involving these mobile applications. Finally, "many clinicians don't want to rely on the imperfect data provided by health plans or input by consumers," says Liz Boehm, a health-care analyst with Forrester Research."

Definiens on YouTube and Twitter

Definiens has a channel on YouTube and a Twitter page.

The YouTube page (Definiens Life TV) has some excellent videos including several webinars you can view that have been uploaded in the past week.

Another excellent example of Medicine 2.0.

 

 

 

Danaher Offers to Buy Genetix for $102M and Announces for NIH Director to Join Board of Directors

This will likely be my last post for 2009 with holiday break upon us.  My sincere thanks to all my readers and followers for your comments, criticisms, thoughts and feedback. I remain open to your suggestions on ways to strengthen the dialogue and information sharing in the spirit of Pathology 2.0.

Happy holidays and best wishes for the new year!

Potentially interesting news for SlidePath which is owned by Genetix with Danaher offer to buy Genetix.  Danaher owns Leica Microsystems.  Might make for some nice synergy between a scanning platform and image analysis.  Danaher also recently announced Elias A. Zerhouni, M.D. to Join Leica Microsystems’ Parent Company Board of Directors. 

I am sure we will see more on this to come.

Danaher has offered to buy imaging company Genetix Group for around ₤63.4 million ($102 million), or 85 pence per share, according to a news release posted on Genetix's website today. Located in New Milton, UK, Genetix provides imaging and image analysis solutions for use in development of clinical diagnostics, biotherapeutics, pharmaceuticals, and in mainstream research applications. Genetix earned around ₤26 million in revenue in 2008. The board of directors and shareholders of Genetix representing 77 percent of the firm's issued share capital have agreed to accept the offer. The deal will become firm when holders of 90 percent of Genetix shares give it the nod. Danaher said it expects to complete the acquisition during the first quarter of 2010. The deal would give Genetix shareholders a 35 percent premium to the closing share price on Dec. 17, and a 56 percent premium to the average closing price of the stock over the past 12 months. Danaher Executive VP Thomas Joyce said in a statement that the combination of Genetix's imaging and analysis with instrumentation from Leica Microsystems, which Danaher owns, "creates an attractive product offering serving both the clinical and research markets. In addition, we believe that we can strengthen Genetix's business by applying the Danaher Business System as well as by providing Genetix with access to additional capital to continue to accelerate its growth."

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.