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A computer analyzer is regularly used in the department of pathology in formalized macrodescription of the stomach. Advantages of this method are described.
PURPOSE: To correlate pathologic, computed tomographic (CT), and ultrasound (US) characteristics of nephrogenic adenofibromas and embryonal adenomas (uncommon pediatric renal tumors) in children. MATERIALS AND METHODS: Medical records and imaging and pathologic findings were reviewed in three children (aged 6 1/2, 7, and 11 years) with adenomatous renal tumors and polycythemia. Specimens were reviewed at the National Wilms Tumor Study Pathology Center (Loma Linda, Calif). RESULTS: All tumors were smaller than 3 cm in greatest dimension. They were hyperechoic on US scans and had high attenuation on unenhanced CT scans. Two patients underwent nephrectomy for initial diagnosis of Wilms tumor. The third underwent local excision. At pathologic examination, embryonal-appearing adenomatous epithelial cells were found to form tubules and papillae with abundant psammomatous calcifications. Two masses were classified as embryonal adenomas and one as nephrogenic adenofibroma. CONCLUSION: Increased attenuation on CT scans and increased echogenicity on US scans of renal adenomatous tumors are distinctive findings that may reflect the presence of tubulopapillary structures and psammomatous calcifications.
Pleural fluid in the azygoesophageal recess may present as a mass lesion on plain films of the chest. This occurs in the absence of underlying parenchymal or pleural pathology. Computed tomography proves to be useful in demonstrating the location of the abnormal fluid collection and in differentiating it from mass lesions.
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A unique computerized management system has been used to control the anticoagulation of over 400 patients at a large teaching hospital for the last eighteen months. The system is located on the main pathology computer which can be interfaced with the patient administration system (PAS). This enables files in the anticoagulant program to be linked with files in the PAS and files in the haematology database. This system has many advantages over a stand-alone microcomputer system and will form the basis for the next generation of computerized anticoagulant management systems.
Computed tomography was obtained in 15 patients with extracranial nerve sheath tumors, including eight with neurofibromatosis. The studies included two schwannomas, six neurofibromas, four plexiform neurofibromas, and three neurofibrosarcomas. Lesions with attenuation values exceeding 30 Hounsfield units had dense bands of collagen in resected specimens. Eleven of the lesions had attenuation values which were significantly lower than muscle. Histological examination of hypodense lesions revealed five factors contributing to reduced attenuation values: (a) a population of lipid-rich Schwann cells; (b) the presence of adipocytes (transformed fibroblasts) in neurofibromas; (c) entrapment of perineural adipose tissue by plexiform neurofibromas; (d) a coalescence of interstitial fluid to form cystic spaces in schwannoma with Antoni B tissue; and (e) cystic degeneration secondary to infarction or necrosis within neurofibromas and neurofibrosarcomas.
OBJECTIVES: (1) To define normative nasalance data for Dutch language with "the NasalView System", and obtain a reference for normality when nasality is evaluated in children. (2) To investigate the minimal number of required speech tasks for a reliable nasalance measurement. METHODS: 55 children (30 normal and 25 velopharyngeal insufficient), aged between 4 and 11 were included. All children had to read or repeat two Dutch passages ((one with a normal amount of nasal consonants (normal passage) and one with none (nonnasal passage)). Further, one normal and one velopharyngeal insufficient subject read a passage in repetition to test the NasalViews reproducibility: (1) For both passages, group means (GM) and standard deviations (S.D.) were used to compute "pathological nasalance boundaries" [GM +/- (2 x S.D.)], in combination with the coefficient of variation (CV), sensitivity, specificity and positive predictive values. (2) With ANOVA all sentences within each passage were tested for significant differences in nasalance. RESULTS: (1) The pathological boundaries were 28.6-41.4% (GM: 35.0) and 21.4-34.7% (GM: 28.1), for the normal and nonnasal passage, respectively. For the normal passage a sensitivity of 96%, a specificity of 93% and a positive predictive value of 92% was computed. For the nonnasal passage these parameters were 96, 95 and 96%, respectively. Intra subject CVs of 3.6% (normal subject) and 1.5% (VI subject) showed good reproducibility of measurements. (2) Within the normal passage only the third sentence was significantly different in nasalance, compared to the entire passage (31.2% versus 35.0%). Within the nonnasal passage the second and fifth sentences were significantly different (23.8 and 24.8% versus 28.1%). However, the individual nonsignificantly different sentences showed a higher variation in nasalance compared to the entire passages. CONCLUSIONS: The NasalView System seems to be reliable and quantifies valid nasalance values when nasality is evaluated. Within both passages high levels of sensitivity, specificity and positive predictive values were obtained. The nonnasal passage discriminates slightly better for hypernasal speech. For the most reliable nasalance measurements, the entire passage should be used.
We evaluated a novel method of computed tomography (CT) analysis using formalin-fixed lungs of autopsy cases with mild emphysema. Eight formalin-inflated lungs (FILs) obtained at autopsy were examined using CT after draining off the formalin and air inflation with an air pump, and subjected to pathological study including pathological scoring of emphysema and microscopic image analysis (MIA). Satisfactory CT examination was carried out within 5 h of lung fixation. The mean alveolar area determined by MIA correlated highly with the lung volume (r = 0.845) and CT score (r = 0.722). This method is simple compared with conventional polyethylene glycol fixation for CT and enables CT examination of resected lungs without anxiety about biohazards, Mild emphysema can be detected by MIA.
PURPOSE: We developed an algorithm for predicting the likelihood of organ confined disease in patients with clinical stage T1c prostate cancer using biopsy pathology, computer assisted image analysis and serum prostate specific antigen (PSA). MATERIALS AND METHODS: Of the 557 consecutive men enrolled in this study between October 1998 and January 2000 scheduled for radical prostatectomy at a single institution 386 (69%) presented with clinical stage T1c disease. Study exclusion criteria included neoadjuvant hormonal treatment with luteinizing hormone-releasing hormone, antiandrogen or 5alpha-reductase inhibitors. Preoperative serum, biopsy histology slides, clinical demographic information, prostatectomy pathology and prostate weight data were obtained. Biomarkers assessed included total PSA, complexed PSA, free PSA, the free-to-total PSA ratio, quantitative nuclear grade determined by image analysis, complexed PSA density, and biopsy Gleason grade and score. To determine patient specific quantitative nuclear grade values, images from approximately 125 cancer nuclei were captured per patient from the area of the biopsy section with the highest Gleason score. The variance in 60 nuclear size, shape and chromatin texture descriptors was calculated for each gallery of nuclei. Logistic regression was done to determine the most accurate combination of variables for predicting organ confined prostate cancer. RESULTS: Complete results and data were available on 255 of the 386 men (66%) with an average age plus or minus standard deviation of 58.8 +/- 6 years who had stage T1c disease, including 49 (19%) with pathologically nonorgan confined disease. Logistic regression analysis revealed that quantitative nuclear grade, biopsy Gleason score, total PSA, the calculated free-to-total PSA ratio, complexed PSA and complexed PSA density were univariately significant for predicting organ confined disease (p <0.05). On backward stepwise logistic regression only quantitative nuclear grade, complexed PSA density and Gleason score remained in a model yielding an area under the receiver operating characteristics curve of 82.4%. CONCLUSIONS: The quantitative nuclear grade biomarker was the strongest independent predictor of pathological stage in men with clinical stage T1c prostate cancer when combined with biopsy Gleason score and complexed PSA density data.
Artificial intelligence models using digital histopathology slides stained with hematoxylin and eosin offer promising, tissue-preserving diagnostic tools for patients with cancer. Despite their advantages, their clinical utility in real-world settings remains unproven. Assessing EGFR mutations in lung adenocarcinoma demands rapid, accurate and cost-effective tests that preserve tissue for genomic sequencing. PCR-based assays provide rapid results but with reduced accuracy compared with next-generation sequencing and require additional tissue. Computational biomarkers leveraging modern foundation models can address these limitations. Here we assembled a large international clinical dataset of digital lung adenocarcinoma slides (N = 8,461) to develop a computational EGFR biomarker. Our model fine-tunes an open-source foundation model, improving task-specific performance with out-of-center generalization and clinical-grade accuracy on primary and metastatic specimens (mean area under the curve: internal 0.847, external 0.870). To evaluate real-world clinical translation, we conducted a prospective silent trial of the biomarker on primary samples, achieving an area under the curve of 0.890. The artificial-intelligence-assisted workflow reduced the number of rapid molecular tests needed by up to 43% while maintaining the current clinical standard performance. Our retrospective and prospective analyses demonstrate the real-world clinical utility of a computational pathology biomarker.
The introduction of high resolution computed tomography (CT) has significantly improved the quality of imaging of neck masses. Incremental dynamic scanning immediately after a quick bolus injection of contrast medium is essential in a majority of patients in order to obtain an optimum of information. This is especially true in the identification, mapping and staging of malignant lesions, which is the main indication for the examination. CT is also very sensitive, and yields detailed information about the location and extent of cystic and other benign lesions. Owing to the low attenuation of fat, the examination is very specific with respect to lipomas. CT has low specificity in the differentiation between benign and malignant lesions, and between cysts and solid tumours of the thyroid gland. In thyroid and parathyroid imaging other modalities such as ultrasound and scintigraphy are often more specific.
Flow phenomena occurring after the bolus injection of contrast material can simulate the presence of pathology on thoracic computed tomography. In a review of 50 dynamic scans performed after contrast medium injection, apparent filling defects in the superior vena cava were seen in 46. In four cases, retrograde filling of the azygos or hemiazygos veins occurred. In two cases, layering of contrast material within the descending aorta simulated dissection. In many cases, the dynamic series of scans helped in diagnosing these appearances as flow related.
BACKGROUND: Because most low-grade squamous intraepithelial lesions (LSIL) regress spontaneously, the appropriate follow-up of women with a cytologic diagnosis of LSIL has engendered discussion. This retrospective study was undertaken to assess the feasibility of limiting colposcopy to women with cytologic interpretations of high-grade squamous intraepithelial lesions (HSIL) in a high-risk population. METHODS: The pathology computer files (including files from January to December 1997) of The University Hospital, University of Oklahoma Health Sciences Center, revealed 197 women whose histologic samples were coded as severe dysplasia. Of these, 138 had a cervical smear interpreted in our laboratory before the colposcopic visit. On review, the tissue samples of 119 women met consensus criteria for severe dysplasia. RESULTS: Original cytologic diagnoses for 119 cytologic smears included 80 (62.7%) that were interpreted as HSIL. After retrospective review, 28 cases with LSIL or less were reclassified as HSIL and were considered to be discrepant for the purpose of this study. Major confounding factors in the original categorization include lack of consistency among the pathologists for the interpretation of metaplastic patterns and specimen adequacy, particularly air-drying artifact. Eleven cases (10.2%) did not have cells identifiable as HSIL because of sampling error and/or severe air-drying artifact. CONCLUSIONS: These results indicate that a substantial number of histologically verified cases of severe dysplasia can have a smear interpretation of LSIL or less. The factors that hampered recognition of the true severity of the lesion in this series were identified and tabulated.
The 2001 Bethesda System diagnostic category of atypical squamous cells cannot exclude a high grade squamous intraepithelial lesion (ASC-H) was developed and implemented after many studies that proved its clinical relevance. In this study, we describe the practice experience of a hospital-based reference laboratory with this new diagnostic category. The anatomic pathology computer database was searched, and 414 Papanicolaou (Pap) smears signed out as ASC-H were discovered among 60,390 Pap smear accessions over a 17-month period of time. One hundred four cases had corresponding tissue specimens. Slides from all Pap smears and tissue specimens were reviewed, and five Pap smears were reclassified, leaving 99 study cases. In our laboratory, 88.9% of the study cases had either low or high grade dysplasia diagnosed on subsequent tissue specimens. The positive predictive value of ASC-H for histologically proven high-grade squamous intraepithelial lesions (HSIL's) was 40.4%. Of those having human papillomavirus (HPV) hybrid capture II testing, high-risk HPV types were detected in 73.9% of cases. The majority of study cases had less than 25 atypical cells. In two hysterectomy cases and three loop electrosurgical excession procedure (LEEP) conization cases, high-grade dysplasia was present as a single microscopic focus, suggesting that the paucity of atypical cells in ASC-H Pap smears may be secondary to small lesion sampling. Thirteen study patients were postmenopausal and 30.8% had low-grade dysplasia, and of these, 46.2% had high-grade dysplasia on subsequent tissue specimens. In conclusion, our practice experience with ASC-H is similar to that reported in the literature before the 2001 Bethesda System.
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The aim of this study was to compare the sensitivity and specificity of plain abdominal films plus ultrasound, vs nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. During a 4-month period, 66 patients (mean age 48 years) with acute flank pain were prospectively studied by means of plain abdominal film, US, and unenhanced CT. The presence of lithiasis and of obstructive uropathy signs were determined. The plain film was only used as a guide for the US exam. Clinical follow-up of all patients was obtained. Ureteral lithiasis was confirmed in 56 patients. The CT had a greater sensitivity (93 vs 79%) and negative predictive value (71 vs 46%) for the detection of lithiasis. The combination of lithiasis plus obstructive signs showed a sensitivity and a specificity of 100% for CT and of 100 and 90%, respectively, for US. The 11 lithiasis not detected by US were passed spontaneously (10 were <5 mm). Both techniques showed similar extraurinary pathology. Computed tomography is the most accurate technique for the detection of ureteral lithiasis; however, the combination of plain film and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value.
The use of laparoscopy in the assessment and treatment of blunt abdominal trauma has been reported for both adults and children. With increasing surgical experience and improvements in equipment, an expanding range of therapeutic interventions is available. The management of a 7-year-old boy who sustained blunt abdominal trauma during a fall from a bicycle is described. He was hemodynamically stable, but his abdomen remained tender, with guarding in the right upper quadrant. Serial ultrasound scans showed a thick-walled gallbladder and increasing intraabdominal fluid. Laparoscopy was used both as a diagnostic tool, and then as a therapeutic method. Diagnostic laparoscopy showed a ruptured gallbladder treated by laparoscopic cholecystectomy. A 3-cm grade 1 liver laceration also was identified, which required no intervention. Free bile was aspirated and the peritoneal cavity thoroughly lavaged. The child made a rapid postoperative recovery. The ultimate aim in the management of blunt trauma is to avoid unnecessary laparotomy while preventing undue delay in the detection of significant intraabdominal pathology. Computed tomography scanning, ultrasound scanning, and diagnostic peritoneal lavage all have strengths for detecting different injury types, but they also have a low specificity in determining the need for laparotomy. The advantages and limitations of laparoscopy in hemodynamically stable children who have sustained injuries from blunt trauma are discussed. The authors recommend laparoscopy in experienced hands as an additional tool for the optimal management of selected trauma cases.
Because surgical repair is indicated for the treatment of diaphragmatic hernia (DH), preoperative imaging of the diaphragmatic defect, hernia content, and associated complications with other organ's pathologies is important. While various techniques can be used on imaging of DHs, selection of the most effective but the least invasive technique will present the most accurate findings about DH, and will facilitate the management of DH. We reviewed the diaphragmatic hernia types associated with our cases, and we discussed the preferred imaging modalities for different DHs with review of the literature. We evaluated the imaging findings of 21 DH cases. They were Morgagni's hernia (n=4), Bochdalek hernia (n=2), iatrogenic DH (n=4), traumatic DH (n=6), and hiatal hernia (n=5). Although its limited findings on DH and indirect findings about the diaphragmatic rupture, plain radiography is firstly preferred technique on DH. We found that ultrasound (US) is a useful tool on DH, on traumatic DH cases especially. Not only it shows diaphragmatic continuity and herniated organs, but also it reveals associated abdominal organ's pathologies. Computed tomography (CT) scan is most effective in many DH cases. It shows the herniated abdominal organs together with complications, such as intestinal strangulation, haemothorax, and rib fractures. We stressed that Multislice CT scan with coronal and sagittal reformatted images is the most effective and useful imaging technique on DH. With high sensitivity for soft tissue, MR imaging may be performed in the selected patients, on the late presenting DH cases or on the cases of the diagnosis still in doubt especially.