Ovarian Frozen Section Diagnosis: Use of Whole-Slide Imaging Shows Excellent Correlation Between Virtual Slide and Original Interpretations in a Large Series of Cases

Abstract Context.—Whole-slide images (WSI) are a tool for remote interpretation, archiving, and teaching. Ovarian frozen sections (FS) are common and hence determination of the operating characteristics of the interpretation of these specimens using WSI is important. Objectives.—To test the reproducibility and accuracy of ovarian FS interpretation using WSI, as compared with routine analog interpretation, to understand the technology limits and unique interpretive pitfalls. Design.—A sequential series of ovarian FS slides, representative of routine practice, were converted to WSI. Whole-slide images were examined by 2 pathologists, masked to all prior results. Correlation characteristics among the WSI, the original, and the final interpretations were analyzed. Results.—A total of 52 cases, consisting of 71 FS slides, were included; 34 cases (65%) were benign, and 18 cases (35%) were malignant, borderline, and of uncertain potential (9 [17%], 7 [13%], and 2 [4%] of 52 cases, respectively). The correlation between WSI and FS interpretations was 96% (50 of 52) for each pathologist for benign versus malignant, borderline, and uncertain entities. Each pathologist undercalled 2 borderline malignant cases (4%) as benign cysts on WSI. There were no overcalls of benign cases. Specific issues within the benign and malignant groups involved endometriosis versus hemorrhagic corpora lutea, and granulosa cell tumor versus carcinoma, respectively. Conclusions.—The correlation between original FS and WSI interpretations was very high. The few discordant cases represent recognized differential diagnostic issues. Ability to examine gross pathology and real-time consultation with surgeons might be expected to improve performance. Ovarian FS diagnosis by WSI is accurate and reproducible, and thus, remote interpretation, teaching, and digital archiving of ovarian FS specimens by this method can be reliable.

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Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience

Human Pathology ◽

10.1016/j.humpath.2009.04.012 ◽

2009 ◽

Vol 40 (8) ◽

pp. 1070-1081 ◽

Cited By ~ 72

Author(s):

Andrew J. Evans ◽

Runjan Chetty ◽

Blaise A. Clarke ◽

Sidney Croul ◽

Danny M. Ghazarian ◽

...

Keyword(s):

Frozen Section ◽

Virtual Slide ◽

Health Network ◽

Frozen Section Diagnosis ◽

The University

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Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience

Seminars in Diagnostic Pathology ◽

10.1053/j.semdp.2009.09.006 ◽

2009 ◽

Vol 26 (4) ◽

pp. 165-176 ◽

Cited By ~ 16

Author(s):

Andrew J. Evans ◽

Runjan Chetty ◽

Blaise A. Clarke ◽

Sidney Croul ◽

Danny M. Ghazarian ◽

...

Keyword(s):

Frozen Section ◽

Virtual Slide ◽

Health Network ◽

Frozen Section Diagnosis ◽

The University

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Deep Learning Global Glomerulosclerosis in Transplant Kidney Frozen Sections

10.1101/292789 ◽

2018 ◽

Cited By ~ 1

Author(s):

Jon N. Marsh ◽

Matthew K. Matlock ◽

Satoru Kudose ◽

Ta-Chiang Liu ◽

Thaddeus S. Stappenbeck ◽

...

Keyword(s):

Deep Learning ◽

Frozen Section ◽

Extended Model ◽

Donor Kidney ◽

Automated Method ◽

Image Patches ◽

Transplant Kidney ◽

Global Glomerulosclerosis ◽

Whole Slide Images

AbstractTransplantable kidneys are in very limited supply. Accurate viability assessment prior to transplantation could minimize organ discard. Rapid and accurate evaluation of intra-operative donor kidney biopsies is essential for determining which kidneys are eligible for transplantation. The criteria for accepting or rejecting donor kidneys relies heavily on pathologist determination of the percent of glomeruli (determined from a frozen section) that are normal and sclerotic. This percentage is a critical measurement that correlates with transplant outcome. Inter- and intra-observer variability in donor biopsy evaluation is, however, significant. An automated method for determination of percent global glomerulosclerosis could prove useful in decreasing evaluation variability, increasing throughput, and easing the burden on pathologists. Here, we describe the development of a deep learning model that identifies and classifies non-sclerosed and sclerosed glomeruli in whole-slide images of donor kidney frozen section biopsies. This model extends a convolutional neural network (CNN) pre-trained on a large database of digital images. The extended model, when trained on just 48 whole slide images, exhibits slide-level evaluation performance on par with expert renal pathologists. The model substantially outperforms a model trained on image patches of isolated glomeruli. Encouragingly, the model’s performance is robust to slide preparation artifacts associated with frozen section preparation. As the first model reported that identifies and classifies normal and sclerotic glomeruli in frozen kidney sections, and thus the first model reported in the literature relevant to kidney transplantation, it may become an essential part of donor kidney biopsy evaluation in the clinical setting.

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Systematic Review of the Use of Telepathology During Intraoperative Consultation

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz155 ◽

2019 ◽

Vol 153 (2) ◽

pp. 198-209 ◽

Cited By ~ 4

Author(s):

Robin L Dietz ◽

Douglas J Hartman ◽

Liron Pantanowitz

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Frozen Section ◽

Strong Support ◽

Risk Of Bias ◽

Low Risk ◽

Reference Standard ◽

Weighted Mean ◽

Frozen Section Diagnosis ◽

Conventional Microscopy

Abstract Objective To compare studies that used telepathology systems vs conventional microscopy for intraoperative consultation (frozen-section) diagnosis. Methods A total of 56 telepathology studies with 13,996 cases in aggregate were identified through database searches. Results The concordance of telepathology with the reference standard was generally excellent, with a weighted mean of 96.9%. In comparison, we identified seven studies using conventional intraoperative consultation that showed a weighted mean concordance of 98.3%. Evaluation of the risk of bias showed that most of these studies were low risk. Conclusions Despite limitations such as variation in reporting and publication bias, this systematic review provides strong support for the safety of using telepathology for intraoperative consultations.

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Torrential Flood Water Management: Rainwater Harvesting through Relation Based Dam Suitability Analysis and Quantification of Erosion Potential

ISPRS International Journal of Geo-Information ◽

10.3390/ijgi10010027 ◽

2021 ◽

Vol 10 (1) ◽

pp. 27

Author(s):

Bilal Ahmad Munir ◽

Sajid Rashid Ahmad ◽

Raja Rehan

Keyword(s):

Sediment Yield ◽

Soil Loss ◽

Rainwater Harvesting ◽

Suitability Analysis ◽

Valley Bottom ◽

The North ◽

Roughness Index ◽

Dam Site ◽

Very High

In this study, a relation-based dam suitability analysis (RDSA) technique is developed to identify the most suitable sites for dams. The methodology focused on a group of the most important parameters/indicators (stream order, terrain roughness index, slope, multiresolution valley bottom flatness index, closed depression, valley depth, and downslope gradient difference) and their relation to the dam wall and reservoir suitability. Quantitative assessment results in an elevation-area-capacity (EAC) curve substantiating the capacity determination of selected sites. The methodology also incorporates the estimation of soil erosion (SE) using the Revised Universal Soil Loss Equation (RUSLE) model and sediment yield at the selected dam sites. The RDSA technique identifies two suitable dam sites (A and B) with a maximum collective capacity of approximately 1202 million m3. The RDSA technique was validated with the existing dam, Gomal-Zam, in the north of Sanghar catchment, where RDSA classified the Gomal-Zam Dam in a very high suitability class. The SE estimates show an average of 75 t-ha−1y−1 of soil loss occurs in the study area. The result shows approximately 298,073 and 318,000 tons of annual average sediment yield (SY) will feed the dam A and B respectively. The SE-based sediment yield substantiates the approximate life of Dam-A and Dam-B to be 87 and 90 years, respectively. The approach is dynamic and can be applied for any other location globally for dam site selection and SE estimation.

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Validation of an HPLC–MS/MS Method for the Determination of Plasma Ticagrelor and Its Active Metabolite Useful for Research and Clinical Practice

Molecules ◽

10.3390/molecules26020278 ◽

2021 ◽

Vol 26 (2) ◽

pp. 278

Author(s):

Jennifer Lagoutte-Renosi ◽

Bernard Royer ◽

Vahideh Rabani ◽

Siamak Davani

Keyword(s):

Active Metabolite ◽

Plasma Concentrations ◽

Antiplatelet Agent ◽

High Plasma ◽

Therapeutic Drug ◽

Routine Practice ◽

Daily Routine ◽

Limit Of Quantification ◽

Wide Range

Ticagrelor is an antiplatelet agent which is extensively metabolized in an active metabolite: AR-C124910XX. Ticagrelor antagonizes P2Y12 receptors, but recently, this effect on the central nervous system has been linked to the development of dyspnea. Ticagrelor-related dyspnea has been linked to persistently high plasma concentrations of ticagrelor. Therefore, there is a need to develop a simple, rapid, and sensitive method for simultaneous determination of ticagrelor and its active metabolite in human plasma to further investigate the link between concentrations of ticagrelor, its active metabolite, and side effects in routine practice. We present here a new method of quantifying both molecules, suitable for routine practice, validated according to the latest Food and Drug Administration (FDA) guidelines, with a good accuracy and precision (<15% respectively), except for the lower limit of quantification (<20%). We further describe its successful application to plasma samples for a population pharmacokinetics study. The simplicity and rapidity, the wide range of the calibration curve (2–5000 µg/L for ticagrelor and its metabolite), and high throughput make a broad spectrum of applications possible for our method, which can easily be implemented for research, or in daily routine practice such as therapeutic drug monitoring to prevent overdosage and occurrence of adverse events in patients.

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Integrated Framework for Detecting the Areas Prone to Flooding Generated by Flash-Floods in Small River Catchments

Water ◽

10.3390/w13060758 ◽

2021 ◽

Vol 13 (6) ◽

pp. 758 ◽

Cited By ~ 1

Author(s):

Romulus Costache ◽

Alina Barbulescu ◽

Quoc Bao Pham

Keyword(s):

Analytical Hierarchy Process ◽

Process Model ◽

Buffer Zone ◽

Training Sample ◽

Flash Floods ◽

Operating Characteristics ◽

Conditioning Factors ◽

Flood Susceptibility ◽

Hierarchy Process ◽

Very High

In the present study, the susceptibility to flash-floods and flooding was studied across the Izvorul Dorului River basin in Romania. In the first phase, three ensemble models were used to determine the susceptibility to flash-floods. These models were generated by a combination of three statistical bivariate methods, namely frequency ratio (FR), weights of evidence (WOE), and statistical index (SI), with fuzzy analytical hierarchy process (FAHP). The result obtained from the application of the FAHP-WOE model had the best performance highlighted by an Area Under Curve—Receiver Operating Characteristics Curve (AUC-ROC) value of 0.837 for the training sample and another of 0.79 for the validation sample. Furthermore, the results offered by FAHP-WOE were weighted on the river network level using the flow accumulation method, through which the valleys with a medium, high, and very high torrential susceptibility were identified. Based on these valleys’ locations, the susceptibility to floods was estimated. Thus, in the first stage, a buffer zone of 200 m was delimited around the identified valleys along which the floods could occur. Once the buffer zone was established, ten flood conditioning factors were used to determine the flood susceptibility through the analytical hierarchy process model. Approximately 25% of the total delimited area had a high and very high flood susceptibility.

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The Application of Electromagnetic Sensors for Determination of Cherenkov Cone Inside and in the Vicinity of the Detector Volume in Any Environment Known

Sensors ◽

10.3390/s21030992 ◽

2021 ◽

Vol 21 (3) ◽

pp. 992

Author(s):

Valeriu Savu ◽

Mădălin Ion Rusu ◽

Dan Savastru

Keyword(s):

Energy Levels ◽

Cherenkov Detector ◽

Electromagnetic Sensors ◽

The Cost ◽

Information Errors ◽

The Universe ◽

Large Frequency ◽

Very High ◽

Detector Volume

The neutrinos of cosmic radiation, due to interaction with any known medium in which the Cherenkov detector is used, produce energy radiation phenomena in the form of a Cherenkov cone, in very large frequency spectrum. These neutrinos carry with them the information about the phenomena that produced them and by detecting the electromagnetic energies generated by the Cherenkov cone, we can find information about the phenomena that formed in the universe, at a much greater distance, than possibility of actually detection with current technologies. At present, a very high number of sensors for detection electromagnetic energy is required. Thus, some sensors may detect very low energy levels, which can lead to the erroneous determination of the Cherenkov cone, thus leading to information errors. As a novelty, we propose, to use these sensors for determination of the dielectrically permittivity of any known medium in which the Cherenkov detector is used, by preliminary measurements, the subsequent simulation of the data and the reconstruction of the Cherenkov cone, leading to a significant reduction of problems and minimizing the number of sensors, implicitly the cost reductions. At the same time, we offer the possibility of reconstructing the Cherenkov cone outside the detector volume.

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Right choice of a method for determination of cut-off values: A statistical tool for a diagnostic test

Asian Journal of Medical Sciences ◽

10.3126/ajms.v5i3.9296 ◽

2014 ◽

Vol 5 (3) ◽

pp. 30-34 ◽

Cited By ~ 19

Author(s):

Balkishan Sharma ◽

Ravikant Jain

Keyword(s):

Logistic Regression ◽

Discriminant Analysis ◽

Diagnostic Test ◽

Roc Curve ◽

Traditional Method ◽

Statistical Technique ◽

Curve Analysis ◽

Operating Characteristics ◽

Roc Curve Analysis

Objective: The clinical diagnostic tests are generally used to identify the presence of a disease. The cutoff value of a diagnostic test should be chosen to maximize the advantage that accrues from testing a population of human and others. When a diagnostic test is to be used in a clinical condition, there may be an opportunity to improve the test by changing the cutoff value. To enhance the accuracy of diagnosis is to develop new tests by using a proper statistical technique with optimum sensitivity and specificity. Method: Mean±2SD method, Logistic Regression Analysis, Receivers Operating Characteristics (ROC) curve analysis and Discriminant Analysis (DA) have been discussed with their respective applications. Results: The study highlighted some important methods to determine the cutoff points for a diagnostic test. The traditional method is to identify the cut-off values is Mean±2SD method. Logistic Regression Analysis, Receivers Operating Characteristics (ROC) curve analysis and Discriminant Analysis (DA) have been proved to be beneficial statistical tools for determination of cut-off points.Conclusion: There may be an opportunity to improve the test by changing the cut-off value with the help of a correctly identified statistical technique in a clinical condition when a diagnostic test is to be used. The traditional method is to identify the cut-off values is Mean ± 2SD method. It was evidenced in certain conditions that logistic regression is found to be a good predictor and the validity of the same can be confirmed by identifying the area under the ROC curve. Abbreviations: ROC-Receiver operating characteristics and DA-Discriminant Analysis. Asian Journal of Medical Science, Volume-5(3) 2014: 30-34 http://dx.doi.org/10.3126/ajms.v5i3.9296

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Intraosseous Epidermoid Inclusion Cyst in a Great Toe

Archives of Pathology & Laboratory Medicine ◽

10.5858/2003-127-e298-ieicia ◽

2003 ◽

Vol 127 (7) ◽

pp. e298-e300 ◽

Cited By ~ 1

Author(s):

Beverly Y. Wang ◽

Jesse Eisler ◽

Dempsey Springfield ◽

Michael J. Klein

Keyword(s):

Frozen Section ◽

Inclusion Cyst ◽

Great Toe ◽

Imaging Studies ◽

Benign Lesions ◽

Work Related ◽

Frozen Section Diagnosis ◽

History Of ◽

Radiolucent Lesion ◽

Epidermoid Inclusion Cyst

Abstract Epidermoid inclusion cysts are benign lesions that occasionally occur in the distal phalanges of the fingers but are less frequently identified and underreported in the toes. We describe a 55-year-old man with a history of work-related trauma followed by painful expansion of his right great toe, resulting in great anxiety. Imaging studies revealed a radiolucent lesion in the distal phalanx of his right hallux. Clinical differential diagnoses included the possibility of an intramedullary inclusion cyst and other various radiolucent lesions. During surgery, a cystic lesion that contained creamy material was discovered. Frozen section diagnosis of the lesion was an intraosseous epidermoid inclusion cyst. The lesion was removed and the patient recovered uneventfully. Although it has been reported that an unduly large number of phalangeal cysts have been treated by amputation, the judicious use of intraoperative frozen sections can prevent this scenario.

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