Pathology, clinical

病理学, 临床
  • 文章类型: Journal Article
    传统的手工血涂片诊断方法耗时长,容易出错,通常在很大程度上依赖于临床实验室分析师的经验来保证准确性。随着神经网络和深度学习等关键技术的突破不断推动医疗领域的数字化转型,图像识别技术正越来越多地被利用来增强现有的医疗流程。近年来,计算机技术的进步通过使用图像识别技术提高了血液涂片中血细胞识别的效率。本文全面总结了利用图像识别算法诊断血涂片疾病的方法和步骤,重点是疟疾和白血病。此外,它为开发全面的血细胞病理检测系统提供了前瞻性的研究方向。
    Traditional manual blood smear diagnosis methods are time-consuming and prone to errors, often relying heavily on the experience of clinical laboratory analysts for accuracy. As breakthroughs in key technologies such as neural networks and deep learning continue to drive digital transformation in the medical field, image recognition technology is increasingly being leveraged to enhance existing medical processes. In recent years, advancements in computer technology have led to improved efficiency in the identification of blood cells in blood smears through the use of image recognition technology. This paper provides a comprehensive summary of the methods and steps involved in utilizing image recognition algorithms for diagnosing diseases in blood smears, with a focus on malaria and leukemia. Furthermore, it offers a forward-looking research direction for the development of a comprehensive blood cell pathological detection system.
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  • 文章类型: Journal Article
    数字病理学提出了独特的计算挑战,作为标准的千兆像素幻灯片可以包括成千上万的图像tiles1-3。以前的模型通常会对每张幻灯片的一小部分瓷砖进行二次采样,因此缺少重要的幻灯片级别context4。这里我们介绍Prov-GigaPath,整个幻灯片病理学基础模型在来自普罗维登斯的171,189个完整幻灯片中的13亿个256×256个病理学图像图块上进行了预训练,一个由28个癌症中心组成的大型美国卫生网络。载玻片来自涵盖31种主要组织类型的30,000多名患者。要预先训练Prov-GigaPath,我们提出了GigaPath,一种用于训练前千兆像素病理学幻灯片的新型视觉变压器架构。为了扩展GigaPath,使用数万个图像块进行幻灯片级学习,GigaPath使新开发的LongNet5方法适应数字病理学。要评估Prov-GigaPath,我们构建了一个数字病理学基准,包括9个癌症亚型任务和17个病理组学任务,使用普罗维登斯和TCGA数据6。通过大规模的预训练和超大型环境建模,Prov-GigaPath在26个任务中的25个中获得了最先进的性能,在18个任务上比第二好的方法有了显著的改进。通过纳入病理报告,我们进一步证明了Prov-GigaPath在病理7,8的视觉语言预训练中的潜力。总之,Prov-GigaPath是一个开放权重的基础模型,可在各种数字病理学任务上实现最先进的性能,展示真实世界数据和整体幻灯片建模的重要性。
    Digital pathology poses unique computational challenges, as a standard gigapixel slide may comprise tens of thousands of image tiles1-3. Prior models have often resorted to subsampling a small portion of tiles for each slide, thus missing the important slide-level context4. Here we present Prov-GigaPath, a whole-slide pathology foundation model pretrained on 1.3 billion 256 × 256 pathology image tiles in 171,189 whole slides from Providence, a large US health network comprising 28 cancer centres. The slides originated from more than 30,000 patients covering 31 major tissue types. To pretrain Prov-GigaPath, we propose GigaPath, a novel vision transformer architecture for pretraining gigapixel pathology slides. To scale GigaPath for slide-level learning with tens of thousands of image tiles, GigaPath adapts the newly developed LongNet5 method to digital pathology. To evaluate Prov-GigaPath, we construct a digital pathology benchmark comprising 9 cancer subtyping tasks and 17 pathomics tasks, using both Providence and TCGA data6. With large-scale pretraining and ultra-large-context modelling, Prov-GigaPath attains state-of-the-art performance on 25 out of 26 tasks, with significant improvement over the second-best method on 18 tasks. We further demonstrate the potential of Prov-GigaPath on vision-language pretraining for pathology7,8 by incorporating the pathology reports. In sum, Prov-GigaPath is an open-weight foundation model that achieves state-of-the-art performance on various digital pathology tasks, demonstrating the importance of real-world data and whole-slide modelling.
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  • 文章类型: Journal Article
    随着机器学习在越来越多的应用中的应用,机器学习中的可解释性变得越来越重要。包括那些具有高风险后果的人,例如医疗保健,其中可解释性被认为是成功采用机器学习模型的关键。然而,在通过深度学习模型进行预测时使用混杂/不相关的信息,即使是可解释的,对他们的临床接受提出了严峻的挑战。这最近引起了研究人员的关注,不仅仅是对深度学习模型的解释。在本文中,我们首先研究一个固有的可解释的基于原型的体系结构的应用,被称为ProtoPNet,数字病理学中的乳腺癌分类,并强调其在此应用中的缺点。然后,我们提出了一种新方法,该方法使用更多的医学相关信息,并做出更准确和可解释的预测.我们的方法利用了聚类概念,并隐式地增加了训练数据集中的类的数量。所提出的方法在没有任何像素级注释数据的情况下学习更多相关的原型。为了进行更全面的评估,除了分类准确性,我们根据一组熟练的病理学家的意见,定义了一个新的指标来评估可解释性程度.在BreakHis数据集上的实验结果表明,该方法有效地将分类准确率和可解释性分别提高了8%和18%。因此,所提出的方法可以看作是实现可解释的深度学习模型的步骤,用于使用组织病理学图像检测乳腺癌。
    Interpretability in machine learning has become increasingly important as machine learning is being used in more and more applications, including those with high-stakes consequences such as healthcare where Interpretability has been regarded as a key to the successful adoption of machine learning models. However, using confounding/irrelevant information in making predictions by deep learning models, even the interpretable ones, poses critical challenges to their clinical acceptance. That has recently drawn researchers\' attention to issues beyond the mere interpretation of deep learning models. In this paper, we first investigate application of an inherently interpretable prototype-based architecture, known as ProtoPNet, for breast cancer classification in digital pathology and highlight its shortcomings in this application. Then, we propose a new method that uses more medically relevant information and makes more accurate and interpretable predictions. Our method leverages the clustering concept and implicitly increases the number of classes in the training dataset. The proposed method learns more relevant prototypes without any pixel-level annotated data. To have a more holistic assessment, in addition to classification accuracy, we define a new metric for assessing the degree of interpretability based on the comments of a group of skilled pathologists. Experimental results on the BreakHis dataset show that the proposed method effectively improves the classification accuracy and interpretability by respectively 8 % and 18 % . Therefore, the proposed method can be seen as a step toward implementing interpretable deep learning models for the detection of breast cancer using histopathology images.
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  • 文章类型: Journal Article
    爱泼斯坦-巴尔病毒(EBV)是一种已知引起许多恶性肿瘤的病原体,通常在初次感染后需要数年才能发展。EBV相关胃癌(EBVaGC)就是这样一种恶性肿瘤,是一种免疫学,在分子和病理上与EBV阴性胃癌(EBVnGC)不同。与EBVnGC相比,EBVaGCs过表达许多免疫调节基因,以帮助形成免疫抑制肿瘤微环境(TME),预后改善,总体上具有“免疫热”表型。这篇综述概述了组织病理学,EBVaGCs的临床特征和临床结局。我们还总结了EBVaGCs和EBVnGCs的TMEs之间的差异,其中包括细胞组成和免疫浸润的显著差异。本综述还提供了可用的EBVaGC和EBVnGC基因表达数据集和计算工具列表。最后,概述了可用于治疗胃癌(GC)的各种化学疗法和免疫疗法,专注于EBVaGC。
    Epstein-Barr virus (EBV) is a pathogen known to cause a number of malignancies, often taking years for them to develop after primary infection. EBV-associated gastric cancer (EBVaGC) is one such malignancy, and is an immunologically, molecularly and pathologically distinct entity from EBV-negative gastric cancer (EBVnGC). In comparison with EBVnGCs, EBVaGCs overexpress a number of immune regulatory genes to help form an immunosuppressive tumor microenvironment (TME), have improved prognosis, and overall have an \"immune-hot\" phenotype. This review provides an overview of the histopathology, clinical features and clinical outcomes of EBVaGCs. We also summarize the differences between the TMEs of EBVaGCs and EBVnGCs, which includes significant differences in cell composition and immune infiltration. A list of available EBVaGC and EBVnGC gene expression datasets and computational tools are also provided within this review. Finally, an overview is provided of the various chemo- and immuno-therapeutics available in treating gastric cancers (GCs), with a focus on EBVaGCs.
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  • 文章类型: Journal Article
    慢性肾脏病(CKD)是当今主要的公共卫生问题之一。血清肌酐测量和肾小球滤过率(GFR)的估计是评估肾功能的主要工具。有几个方程来估计GFR,CKD-EPI方程(慢性肾脏病-流行病学)是最推荐的方程。关于血清肌酐的测量和GFR的估计仍存在一些争议,因为有几个因素会干扰这个过程。最近的一个重要变化是从估计GFR的方程中删除了种族校正,高估了肾功能,并因此推迟了透析和肾移植等治疗方法的实施。在巴西肾脏病学与临床病理学和实验室医学学会的这份共识文件中,回顾了与肾功能评估相关的主要概念,以及临床实践中可能存在的估计GFR的争议和建议。
    Chronic kidney disease (CKD) represents one of today\'s main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.
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  • 文章类型: Journal Article
    数字病理学(以高分辨率扫描玻璃组织学载玻片的技术,数字化,储存并与病理学家分享,谁可以在屏幕上使用显微镜软件查看它们)正在改变世界各地临床诊断病理学服务的交付。除了增加临床组织病理学实践的价值,数字组织学幻灯片提供了一个多功能的媒介,以实现各种学习者,包括本科生的教育需求,培训中的研究生博士和追求持续专业发展的人。在本指南中,我们将回顾数字幻灯片在培训和教育中的主要使用案例,我将分享成功使用数字病理学的技巧,以根据利兹教学医院国家卫生服务信托基金和国家病理影像协作组在过去5年数字幻灯片使用中收集的经验,为一系列学习者提供支持.
    Digital pathology (the technology whereby glass histology slides are scanned at high resolution, digitised, stored and shared with pathologists, who can view them using microscopy software on a screen) is transforming the delivery of clinical diagnostic pathology services around the world. In addition to adding value to clinical histopathology practice, digital histology slides provide a versatile medium to achieve the educational needs of a variety of learners including undergraduate students, postgraduate doctors in training and those pursuing continuing professional development portfolios. In this guide, we will review the principal use cases for digital slides in training and education and I will share tips for successful use of digital pathology to support a range of learners based on experience gathered at Leeds Teaching Hospitals National Health Service Trust and the National Pathology Imaging Co-Operative during the last 5 years of digital slide usage.
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  • 文章类型: Journal Article
    背景:大疱性绒毛瘤是一种罕见的绒毛瘤变种。正如它已经在零星病例报告中公布的那样,对其临床病理特征的有限了解限制了其有效的诊断和治疗。
    目的:本研究旨在分析大疱性毛囊瘤的临床病理和免疫组织化学特征,以更好地了解毛囊瘤的大疱性转化。
    方法:作者对12例大疱性绒毛瘤患者进行了回顾性研究,并比较了他们的临床,组织病理学,以及普通绒毛瘤患者的免疫组织化学数据。
    结果:大疱性绒毛瘤没有性别偏好,平均发病年龄为31.2岁。常见部位为上肢和躯干。大疱性毛囊瘤的病程较短,更大的直径,与普通的毛囊瘤相比,尺寸增加的趋势更大。组织病理学,大疱性毛囊瘤的持续时间较短,钙化较少,更多的有丝分裂图,与普通的毛囊瘤有明显的真皮特征。免疫组织化学,基质金属蛋白酶(MMP)-2、MMP-9、血管内皮生长因子受体-3(VEGFR-3)的表达,VEGF-C升高。
    结论:这项研究是回顾性的,样本量很小。
    结论:大疱性毛囊瘤的独特特征可能是由与血管生成因子和蛋白水解酶释放相关的真皮变化引起的。这种综合分析为大疱性毛囊瘤的临床特征和发病机理提供了新的见解。
    BACKGROUND: Bullous pilomatricoma is a rare variant of pilomatricoma. As it has been published in sporadic case reports, a limited understanding of its clinicopathological characteristics restricts its effective diagnosis and treatment.
    OBJECTIVE: This study aimed to analyze the clinicopathological and immunohistochemical characteristics of bullous pilomatricoma to better understand the bullous transformation of pilomatricoma.
    METHODS: The authors conducted a retrospective study of 12 patients with bullous pilomatricoma and compared their clinical, histopathological, and immunohistochemical data with those of patients with ordinary pilomatricoma.
    RESULTS: Bullous pilomatricoma showed no sex preference, with a mean onset age of 31.2 years. The common sites were the upper extremities and trunk. Bullous pilomatricoma had a shorter disease duration, a larger diameter, and a greater tendency to increase in size than those of ordinary pilomatricoma. Histopathologically, bullous pilomatricoma had a shorter duration, lesser calcification, more mitotic figures, and distinct dermal features from those of ordinary pilomatricoma. Immunohistochemically, the expression of Matrix Metalloprotease (MMP)-2, MMP-9, vascular endothelial growth factor receptor-3 (VEGFR-3), and VEGF-C was elevated.
    CONCLUSIONS: The study was retrospective, and the sample size was small.
    CONCLUSIONS: The distinctive features of bullous pilomatricoma potentially result from dermal changes associated with the release of angiogenic factors and proteolytic enzymes. This comprehensive analysis provides novel insights into the clinical features and pathogenesis of bullous pilomatricoma.
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  • 文章类型: Journal Article
    肝胆系统的案例研究会议是在萨默林举行的第42届毒理学病理学学会年度研讨会上举行的,内华达。该案例研究突出了潜在的肝和胆汁毒性责任。本文包括在会议期间提出的几个案例研究,其中包括狗的铜相关肝炎,非人类灵长类动物的正弦阻塞综合征,小鼠和大鼠的肝细胞质改变,大鼠枯否细胞增生/肉芽肿性炎症。演示者,适用时,提供的案件信号,解剖/临床病理数据,诊断和讨论潜在的病因。
    This case study session of the hepatobiliary system was held during the 42nd Annual Society of Toxicologic Pathology Symposium in Summerlin, Nevada. The case studies highlighed potential hepatic and biliary toxicity liabilities. This article comprises several of the case studies that were presented during the session which included copper-associated hepatitis in a dog, sinusoidal obstruction syndrome in non-human primates, hepatic cytoplasmic alteration in mice and rats, and Kupffer cell hyperplasia/granulomatous inflammation in rats. Presenters, when applicable, provided case signalment, anatomic/clinical pathology data, and diagnoses and discussed potential pathogeneses.
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  • 文章类型: Journal Article
    随着新的硬件和软件变得可用,将数字病理学(DP)集成到临床诊断工作流程中越来越受到关注。为了促进DP的采用,瑞士数字病理学协会(SDiPath)组织了一个Delphi程序,为瑞士临床环境中的DP整合提出了一系列建议.在这个过程中,成立了4个工作组,专注于DP系统的各种组件(1)扫描仪,质量保证和扫描验证,(2)将全幻灯片图像(WSI)扫描仪和DP系统集成到病理实验室信息系统中,(3)数字化工作流程-符合一般质量方针,和(4)图像分析(IA)/人工智能(AI),每个招募的主题专家进行讨论和陈述生成。Delphi过程的工作成果是这里提出的83个共识声明,形成“数字病理学SDiPath建议”的基础。它们代表了国内和国际医院的最新资源,研究人员,设备制造商,算法开发人员,和所有支持领域,旨在提供期望和最佳实践,以帮助确保安全和高效的DP使用。
    Integration of digital pathology (DP) into clinical diagnostic workflows is increasingly receiving attention as new hardware and software become available. To facilitate the adoption of DP, the Swiss Digital Pathology Consortium (SDiPath) organized a Delphi process to produce a series of recommendations for DP integration within Swiss clinical environments. This process saw the creation of 4 working groups, focusing on the various components of a DP system (1) scanners, quality assurance and validation of scans, (2) integration of Whole Slide Image (WSI)-scanners and DP systems into the Pathology Laboratory Information System, (3) digital workflow-compliance with general quality guidelines, and (4) image analysis (IA)/artificial intelligence (AI), with topic experts for each recruited for discussion and statement generation. The work product of the Delphi process is 83 consensus statements presented here, forming the basis for \"SDiPath Recommendations for Digital Pathology\". They represent an up-to-date resource for national and international hospitals, researchers, device manufacturers, algorithm developers, and all supporting fields, with the intent of providing expectations and best practices to help ensure safe and efficient DP usage.
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  • 文章类型: Journal Article
    Digital pathology (DP) is increasingly entering routine clinical pathology diagnostics. As digitization of the routine caseload advances, implementation of digital image analysis algorithms and artificial intelligence tools becomes not only attainable, but also desirable in daily sign out. The Swiss Digital Pathology Consortium (SDiPath) has initiated a Delphi process to generate best-practice recommendations for various phases of the process of digitization in pathology for the local Swiss environment, encompassing the following four topics: i) scanners, quality assurance, and validation of scans; ii) integration of scanners and systems into the pathology laboratory information system; iii) the digital workflow; and iv) digital image analysis (DIA)/artificial intelligence (AI). The current article focuses on the DIA-/AI-related recommendations generated and agreed upon by the working group and further verified by the Delphi process among the members of SDiPath. Importantly, they include the view and the currently perceived needs of practicing pathologists from multiple academic and cantonal hospitals as well as private practices.
    UNASSIGNED: Digitale Pathologe (DP) wird zunehmend in der Routinediagnostik der klinischen Pathologie eingesetzt. Mit fortschreitender Digitalisierung der Routinefälle wird die Implementierung digitaler Bildanalysealgorithmen und künstlicher Intelligenz nicht nur machbar, sondern auch für die tägliche Praxis wünschenswert. Das Schweizer Konsortium für Digitale Pathologie (Swiss Digital Pathology Consortium, SDiPath) hat einen Delphi-Prozess initiiert, um Empfehlungen für das beste Vorgehen in Bezug auf verschiedene Phasen des Digitalisierungsprozesses in der Pathologie für die lokalen Verhältnisse in der Schweiz zu erstellen, dazu gehören die folgenden 4 Themen: i) Scanner, Qualitätssicherung und Validierung der eingescannten Schnittpräparate; ii) Integration von Scannern und Systemen in das Laborinformationssystem; iii) der digitale Arbeitsablauf; und iv) digitale Bildanalyse (DIA)/künstliche Intelligenz (KI). Im vorliegenden Beitrag liegt der Schwerpunkt auf den Empfehlungen hinsichtlich DIA und KI, die von einer Arbeitsgruppe erarbeitet und mittels Delphi-Prozess durch die Mitglieder des SDiPath-Konsortiums bestätigt wurden. Wichtig ist, dass sie die Ansichten und die aktuellen Bedürfnisse praktisch tätiger Pathologen aus verschiedenen Lehr- und Kantonsspitälern sowie aus privaten Praxen einbeziehen.
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