Multimodality MRI-Based Radiomics For Aggressiveness Prediction In Papillary Thyroid Cancer

Objective: To investigate the ability of a multimodality MRI-based radiomics model in predicting the aggressiveness of papillary thyroid carcinoma (PTC).Methods: This study included consecutive patients who underwent neck magnetic resonance (MR) scans and subsequent thyroidectomy during the study period. The pathological diagnosis of thyroidectomy specimens was the gold standard to determine the aggressiveness. Thyroid nodules were manually segmented on three modal MR images, and then radiomics features were extracted. A machine learning model was established to evaluate the prediction of PTC aggressiveness.Results: The study cohort included 107 patients with PTC confirmed by pathology (training cohort: n = 71; test cohort: n = 36). A total of 1584 features were extracted from contrast-enhanced T1-weighted (CE-T1 WI), T2-weighted (T2 WI) and diffusion weighted (DWI) images of each patient. Sparse representation method is used for radiation feature selection and classification model establishment. The accuracy of the independent test set that using only one mode, like CE-T1WI, T2WI or DWI was not particularly satisfactory. In contrast, the result of these three modes combined achieved 0.917.Conclusion: Our study shows that multimodality MR image based on radiomics model can accurately distinguish aggressiveness in PTC from non-aggressiveness PTC before operation. This method may be helpful to inform the treatment strategy and prognosis of patients with aggressiveness PTC.

Firsthand Experience in Graduating Three Cohorts of Forensic Pathologists Trained With Competency by Design (CBD) Curriculum

Introduction: The University of Toronto experienced graduating three cohorts of forensic pathologists trained with Competency by Design (CBD) curriculum. We achieved this as a result of multiyear development of Entrustable Professional Activities (EPAs), Required Training Experience (RTEs), and Specialty Competency Requirements (SCRs) by the Royal College of Physicians and Surgeons of Canada’s Forensic Pathology Speciality Committee, the Ontario Forensic Pathology Service, and the University of Toronto. Method: Our academic year is comprised of 13 blocks. We divided the 13-block period into 4 stages to map all the EPAs and RTEs. The first stage, Transition to Discipline, is 1 block, the second stage, Foundation of Discipline, consists of 3 blocks; the third stage, Core of Discipline, consists of 6 blocks, and the final fourth stage, Transition to Practice, consists of 3 blocks. Board-certified faculty members in Forensic Pathology with more than five years of experience supervised the trainees. We graduated 5 Canadian and 4 international trainees at the end of the third cycle of CBD-based training program. Conclusion: Using the Royal College Speciality Committee blueprint, the University of Toronto started in 2016 planning the CBD curriculum in the forensic pathology training program. By the end of June 2021, we graduated nine trainees from our CBD-based Forensic Pathology training program. We are training the fourth cohort, and they will be graduating at the end of June 2022. This article aims to share our firsthand experiencing in CBD training in forensic pathology.

Pathology Informatics Education during the COVID-19 Pandemic at Memorial Sloan Kettering Cancer Center (MSKCC)

<p>This review details the development and structure of a four-week rotation in pathology informatics for a resident trainee at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City so that other programs interested in such a rotation can refer to. The role of pathology informatics is exponentially increasing in research and clinical practice. With an ever-expanding role, training in pathology informatics is paramount as pathology training programs and training accreditation bodies recognize the need for pathology informatics in training future pathologists. However, due to its novelty, many training programs are unfamiliar with implementing pathology informatics training. The rotation incorporates educational resources for pathology informatics, guidance in the development, and general topics relevant to pathology informatics training. Informatics topics include anatomic pathology related aspects such as whole slide imaging, laboratory information systems, image analysis, and molecular pathology associated issues such as the bioinformatics pipeline and data processing. Additionally, we highlight how the rotation pivoted to meet the department’s informatics needs while still providing an educational experience during the onset of the COVID-19 pandemic.</p><p><strong>Conclusion</strong>. As pathology informatics continues to grow and integrate itself into practice, infor- matics education must also grow to meet the future needs of pathology. As informatics programs develop across institutions, such as the one detailed in this paper, these programs will better equip future pathologists with informatics to approach disease and pathology.</p>

Strategies to Enhance Diversity, Equity, and Inclusion in Pathology Training Programs: A Comprehensive Review of the Literature

Context.— Like many medical specialties, pathology faces the ongoing challenge of effectively enriching diversity, equity, and inclusion within training programs and the field as a whole. This issue is furthered by a decline in US medical student interest in the field of pathology, possibly attributable to increasingly limited pathology exposure during medical school and medical student perceptions about careers in pathology. Objective.— To review the literature to identify the challenges to diversity, equity, and inclusion in pathology, with an emphasis on the pathology trainee pipeline. To evaluate the medical education literature from other medical specialties for diversity and inclusion–focused studies and initiatives, and determine the outcomes and/or approaches relevant for pathology training programs. Data Sources.— A literature review was completed by a search of the PubMed database, as well as a similar general Google search. Additional resources, including the Web sites of the Association of American Medical Colleges, the Electronic Residency Application Service, and the National Resident Matching Program, were used. Conclusions.— Many strategies exist to increase diversity and encourage an inclusive and equitable training environment, and many of these strategies may be applied to the field of pathology. Interventions such as increasing exposure to the field, using a holistic application review process, and addressing implicit biases have been shown to promote diversity, equity, and inclusion in many medical specialties. In addition, increasing access to elective and pipeline programs may help to bolster medical student interest in careers in pathology.

Pushed Across the Digital Divide: COVID-19 Accelerated Pathology Training onto a New Digital Learning Curve

Bringing digital teaching materials into residency training programs has seen slow adoption, expected for many new technologies. The COVID-19 pandemic dramatically shifted the paradigm for many resident teaching modalities as institutions instituted social distancing to prevent spread of the novel coronavirus. The impact of this shift on pathology trainee education has not been well studied. We conducted an online survey of pathology trainees, program directors, and faculty to assess pre- and post-COVID-19 use of, and response to, various digital pathology modalities. Responses were solicited through both social media and directed appeals. A total of 261 respondents (112 faculty, 52 program directors, and 97 trainees) reported a dramatic and significant increase in the use of digital pathology-related education tools. A significant majority of faculty and program directors agreed that this shift had adversely affected the quality (59% and 62%, respectively) and effectiveness (66%) of their teaching. This perception was similar among learners relative to the impact on quality (59%) and effectiveness (64%) of learning. Most respondents (70%-92%) anticipate that their use of digital pathology education tools will increase or remain the same post-COVID. The global COVID-19 pandemic created a unique opportunity and challenge for pathology training programs. Digital pathology resources were accordingly readily adopted to continue supporting educational activities. The learning curve and utilization of this technology was perceived to impair the quality and effectiveness of teaching and learning. Since the use of digital tools appears poised to continue to grow post-COVID19, challenges due to impaired quality and effectiveness will need to be addressed.

The Relationship Between Medical School–Based Pathology Departments and Affiliated Forensic Pathology Training Sites

Medical school–based pathology departments were surveyed in order to evaluate their relationship with sites providing forensic pathology training. Of 59 departments surveyed, 49 (83%) responded. Most (88%) respondents indicated that training occurs at an affiliated medical examiner/coroner office, and 78% indicated that the facility is 10 miles or less from the academic health center. The majority (61%) of respondents require 4 weeks of forensic pathology training for their residents while the others require none (3); 6, 8, or 12 weeks (2 each); and 16 weeks (3, with two having integrated forensic and medical autopsies). The majority (81%) send one resident at a time to the forensic pathology training site, and almost always (92%) the experience is dedicated to forensic pathology without mixing with other training. Two-thirds of respondents send between 1 and 5 residents per year for training. Prior autopsy experience is required by 79% of departments. Medical student rotations in forensic pathology are available to 86% of reporting departments. Almost 3 quarters of respondents indicated that a forensic pathology fellowship is available through the training site with 83% being funded by the training site. About half of departments indicated that they provide some financial support to the site. Of reporting departments, 71% indicated that they give faculty appointments to forensic pathologists at the training site, with 3 quarters being voluntary appointments. Affiliated forensic pathology training sites are a valuable asset although 6 respondents report offering such training either totally or partially within the pathology department itself.