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The Age of Economic Realism
Published in Jeremy R. Jass, Understanding Pathology, 2020
Anatomical pathology comprises research, teaching and diagnostic service, each supporting and strengthening the others. We have considered two major challenges to the discipline: the commercialisation of service, and the wide generalisation of research into the mechanisms of disease which was once the relatively exclusive province of pathologists. The challenge to its traditional role in teaching is equally if not even more serious than the other two. Excellence in teaching has long-term benefits in the fields of both research and practice, and an understanding of disease is obviously essential for safety and competency in the practice of medicine. Medical school curricula are often driven by university politics and agendas that may be far removed from practical educational needs. In the Darwinian struggle for curricular survival, the once central position occupied by pathology in the medical school has been progressively eroded and replaced by newer basic science disciplines such as molecular biology, and the burgeoning social and behavioural sciences incorporating medical ethics and communication skills. An integrated approach to teaching may at one level appear to undermine the integrity of traditional disciplines (or departments), but on the other hand, a teacher in an integrated problem-based course must, by necessity, venture from the narrow confines of his or her own discipline. The growth of mutual understanding and respect that should flow from this process may in fact strengthen rather than weaken individual disciplines.
Robust Nuclei Segmentation using Statistical Level Set Method with Topology Preserving Constraint
Published in Ayman El-Baz, Jasjit S. Suri, Level Set Method in Medical Imaging Segmentation, 2019
Shaghayegh Taheri, Thomas Fevens, Tien D. Bui
Pathology is a medical specialty which concerns laboratory examination of cells and tissue samples with the purpose of diagnosis and characterization of diseases. More specifically, cytopathological and histopathological examinations of a biopsy or surgical specimen are two main branches of anatomical pathology that are commonly applied to diagnose various diseases, including cancer. Cytopathology (or cytology) refers to the microscopic investigation of samples at the cellular level and is mainly advantageous when quick preparation, staining, and interpretation procedures are needed. Despite the fact that cytopathological imagery are highly beneficial as they provide great cellular detail at low cost, cytopathological examinations alone are not sufficient for accurate diagnosis purposes. For instance, they cannot indicate whether the cancer cells are spreading into and damaging surrounding tissues. Therefore, to obtain higher diagnostic accuracy, the preliminary cytopathological tests must be confirmed by the so-called histopathological (or histological) assessments for which the overall tissue architecture is evaluated. Pathologists usually make diagnostic interferences by visual inspection of cells based on their morphological features and architecture, such as shape, position, size, number, etc. Although still being considered as the gold standard, manual examination of biological images is tedious work which requires many hours of human labor. This highlights the requirement for an automatic system that accurately measures these features in a few seconds.
Tissue Phenomics For Diagnostic Pathology
Published in Gerd Binnig, Ralf Huss, Günter Schmidt, Tissue Phenomics, 2018
Anatomical pathology comprises all diagnostic tools and algorithms that serve diagnostic purposes from tissue, cells, or liquids. In surgical pathology, the findings may include also data that are derived from (a) image content information, (b) clinical history, (c) expertise of the pathologist, and (d) pre-existing knowledge about the disease. Digital pathology uses such anatomical and surgical pathology approaches together with statistical and decision algorithms (neural networks, discriminate analysis, factor analysis, etc.) to identify the most probable diagnosis (Kayser et al., 2015). Several categories can be distinguished, namely (a) conventional or classical histological and cytological diagnosis, (b) prospective diagnosis, (c) indicative diagnosis, and (d) risk-assigned diagnosis (Görtler et al., 2006).
Lean and Six Sigma as continuous quality improvement frameworks in the clinical diagnostic laboratory
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Vinita Thakur, Olatunji Anthony Akerele, Edward Randell
Technological advances and automation have affected many parts of laboratory medicine. However, processes in the anatomic pathology laboratory have remained largely unchanged over decades. Anatomic pathology is distinguished by a wide variety of tissue specimens received, but specimens of gastrointestinal and gynecologic origin dominate. Typical processing steps within the pathology laboratory follow mainly along the sequence of specimen accessioning, identification, and labeling, grossing and fixation, processing, embedding, cutting and slide preparation, and staining by hematoxylin and eosin prior to review by a pathologist for primary diagnosis. When indicated, ancillary testing uses special stains, immunohistochemistry, in situ hybridization and molecular-based studies to contribute information for a final diagnosis and to inform treatment decisions. Like other areas of the laboratory, the TAT is the major quality indicator in the surgical pathology and cytology laboratories. Meeting TAT targets set out by the College of American Pathologists requires 90% of routine surgical cases to be reported within 2 days; this presents a major challenge for many laboratories.
Disruptive innovations in the clinical laboratory: catching the wave of precision diagnostics
Published in Critical Reviews in Clinical Laboratory Sciences, 2021
Ziyad Khatab, George M. Yousef
The value of digital pathology exceeds the replacement of glass slides with digital images, with potential to revolutionize the workflow of pathology and redefine pathology practice [32–34]. While other divisions of laboratory medicine (e.g. chemistry) have gone through significant automation, the practice of anatomical pathology has been almost the same for many decades, with the basic process of tissue processing and creating glass slides to be manually evaluated by pathologists. This workflow is manual, time-consuming, expensive, and is liable to multiple human errors throughout the process. Digitalization can help with the establishment of a faster and more efficient workflow. It can provide flexibility in the workspace and working hours for pathologists, in addition to the potential for performing image analysis thus enhancing the value of pathology diagnosis for patient care. It also allows proper integration into laboratory information systems, improving accessibility for the entire clinical team to pathology results.
Immunohistochemical evaluation of the prognostic and predictive power of epidermal growth factor receptor ligand levels in patients with metastatic colorectal cancer
Published in Growth Factors, 2020
Siavash Foroughi, Ryan A. Hutchinson, Hui-li Wong, Michael Christie, Ahida Batrouney, Rachel Wong, Margaret Lee, Jeanne Tie, Antony Wilks Burgess, Peter Gibbs
Sections were freshly cut at 4 μm and left to dry at room temperature for 2 h. The EGF-receptor (intracellular and extracellular domains), amphiregulin and epiregulin proteins were detected by IHC using CONFIRM anti-EGFR (5B7) rabbit monoclonal antibody (mAb) which binds to the internal domain of the EGFR, CONFIRM anti-EGFR (3C6) mouse mAb (both from Ventana Medical Systems/Roche Diagnostics, Tucson, AZ, USA) which binds to the external domain of the EGFR, anti-AREG (sc-74501) mouse mAb (Santa Cruz Biotech (Santa Cruz, CA, USA) and anti-EREG (D4O5I) rabbit mAb (Cell Signalling Technology, Danvers, MA, USA), respectively. Assays were performed using prediluted antibodies; EGFR antibodies are packaged ready-to-use, with the Ventana OptiView DAB IHC Detection Kit on the Ventana Benchmark ULTRA automated slide stainer (Ventana Medical Systems/Roche Diagnostics, Tucson, AZ, USA). Sectioning and staining of all samples were performed at the Department of Anatomical Pathology, The Royal Melbourne Hospital (Parkville, VIC, AUS). The staining procedure included baking sections, on-board deparaffinization, pre-treatment using Ventana Ultra Cell Conditioning Solution 1 (ULTRA CC1), except for EGFR 3C6 which used Ventana Protease 1 digestion, and incubation with target antibody (Supplementary Table 1). In addition, H&E staining was performed for each case to aid in orientation of the IHC slides.