Mobile device smartphones for intraoperative diagnosis at the University Hospital Trust of Modena/UNIMORE: from validation process to costs analysis.

21. The emerging role of nanotechnology in anatomical pathology

In patients who underwent breast-conserving surgery, we attempted to identify the histological characteristics of margin-exposed tumor components on intraoperative frozen section examinations that were predictive of residual tumor components in additionally resected specimens. Of 1835 patients who underwent breast-conserving surgery, we identified 220 patients who had positive surgical margins determined by intraoperative frozen section examinations and who had undergone immediate additional resections. Two observers (M.K., H.T.) reviewed the slides of frozen sections and confirmed the presence of tumor components. In additionally resected specimens, residual tumors were detected in 115 cases (52.3%) but not in 105 cases (47.7%). The primary tumor characteristics of extensive intraductal component (+), younger age, invasive lobular carcinoma and pathological T3 classification were significantly associated with the residual tumor components. The margin-exposed tumor components of the maximum diameter, number of positive margins and histological type were correlated with the residual tumors. Multivariate analysis showed that the maximum tumor diameter was an independent risk factor for residual tumors. Diagnosis of positive margins by intraoperative frozen section examinations was useful for predicting residual tumors, and three histological properties of the margin-exposed tumor components were correlated with the status of residual tumor components. Although it was impossible to clearly identify the single main factor for predicting patients for whom additional resections were not necessary, it may be possible to consider stratification of additional surgical therapy according to the characteristics of margin-exposed tumor components on intraoperative frozen section examinations.

Many studies have examined the diagnostic concordance of whole slide imaging (WSI) and light microscopy (LM) for surgical pathology. In cytopathology, WSI use has been more limited, mainly because of technical issues. The aim of this study was to review the literature and determine the overall diagnostic concordance of WSI and LM in cytopathology. A systematic search of PubMed, Scopus, and the Cochrane Library was performed, with data extracted from the included articles. A quality assessment of studies was performed with a modified Quality Assessment of Diagnostic Accuracy Studies 2 tool. The primary outcome was concordance for the diagnoses rendered by WSI and LM as shown by the concordance rate with the original diagnosis, intra-observer and interobserver concordance with the κ coefficient, or a percentage. Secondary outcomes included the time taken to reach a diagnosis and the quality and perception of WSI. A descriptive survey was provided. Among 1867 publications, a total of 19 studies (1%) were included. Overall, the concordance between WSI and the original diagnosis was 84.1%, the intra-observer concordance between WSI and LM was 92.5% with a κ coefficient of 0.66, and the interobserver κ coefficient was 0.69. The time to reach a diagnosis was longer with WSI in all studies. The quality of WSI was good, but diagnostic confidence and cytologist preference were higher for LM. In conclusion, the concordance of WSI with LM is acceptable and in line with systematic reviews in surgical pathology. However, the time required for scanning and technical issues represent barriers to complete adoption. It is foreseeable that technical advances and rigorous validation study design will help to improve the diagnostic concordance of WSI with LM in cytopathology.

Purpose: The assessment of surgical margins is important in breast conserving surgery (BCS). In BCS, we usually resect additional specimens after the diagnosis of positive margin by intraoperative frozen-section examinations (IFE). However, we often experience the patients who received additional resections after positive results by IFE but no tumors were detected in the permanent sections. If we can predict the absence of residual tumor components from IFE, it may be possible to avoid additional mastectomy. In the present study, we tried to identify histological characteristics of margin-exposed tumor components on IFE as predictive factors for the residual tumor components in the additionally resected specimens. Methods: 1,835 cases underwent BCS between October 1999 and July 2008 at the National Cancer Center Hospital, Tokyo, Japan. By the review of the pathological database, we chose patients who had positive surgical margins determined by IFE and had undergone immediate additional resection. Two observers (MK, HT) reviewed the slides of frozen sections and confirmed the presence of tumor components. Results: 220 cases (12%) were eligible for this study. Within the specimens of additional resection, residual tumors existed in 114 cases (51.8%) and no tumors existed in 106 cases (48.2%). As characteristics of the primary tumors, invasive lobular carcinoma, pT3, EIC(+) and lymphatic invasion were significantly associated with the residual tumor components. As characteristics of margin-exposed tumor components on IFE, the number of positive margins, their maximum diameter and histological type were correlated with the residual tumors. The rate of detection of the residual tumors was significantly higher in the group with multiple positive margins (50/72, 69%) than in the group with a single positive margin (64/148, 43%) (p=0.0003). The residual tumors were detected in 36.5% (38/104), 60.8% (62/102), and 100% (14/14) of the groups with <6 mm, ≥6 to <20 mm, and ≥20 mm of the maximum diameter of the exposed tumor components, respectively (p=0.0005). Although there was no significant relationship in the rate between the group with exposed noninvasive components and that with exposed invasive components, the residual tumor components were detected more frequently in the group with exposed lobular carcinoma components (20/29, 69%) than in the group with exposed ductal carcinoma components (94/191, 49%) (p=0.047). By a multivariate analysis, the number of positive margins and the maximum diameter were independent risk factors of the residual tumors. Conclusion: The diagnosis of positive margins by IFE was useful for the prediction of residual tumors, and three histological properties of margin-exposed tumor components were correlated with the absence of residual tumor components. It may be possible to consider stratification of additional surgical therapy according to the characteristics of margin-exposed tumor components on IFE. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4118.

Comparing the use of virtual and conventional light microscopy in practical sessions: Virtual reality in Tabuk University

Pathology has benefited from the rapid progress of image-digitizing technology during the last decade. However, the application of digital whole slide images (WSI) in forensic pathology still needs to be improved. WSI validation is crucial to ensure diagnostic performance, at least equivalent to glass slides and light microscopy. The College of American Pathologists Pathology and Laboratory Quality Center recently updated internal digital pathology system validation recommendations. Following these guidelines, this pilot study aimed to validate the performance of a digital approach for forensic histopathological diagnosis. Six independent skilled forensic pathologists from different forensic medicine institutes evaluated 100 glass slides of forensic interest (80 stained with standard hematoxylin and eosin, 20 with special staining), including different organs and tissues, with light microscopy (Olympus BX51, Tokyo, Japan). Glass slides were scanned using the Aperio GT 450 DX Digital Slides Scanner (Leica Biosystems, Nussloch, Germany). After two wash-out weeks, forensic pathologists evaluated WSIs in front of a widescreen using computer devices with dedicated software (O3 viewer, O3 Enterprise, Zucchetti, Trieste, Italy). Side-by-side comparisons between diagnoses performed on tissue glass slides versus WSIs were above the threshold stated in the validation guidelines (mean concordance of 97.8%). CSUQ Version 3 questionnaire showed high satisfaction for all pathologists (mean result: 6.6/7). Our institutional digital forensic pathology system has been validated for practical casework application. This approach opens new scenarios in practical forensic casework investigations, such as sharing live histological ex-glass slides online, as well as educational and research perspectives, with improving impacts on the whole daily workflow.

This paper explores the intersection of photography and education at a time when both are facing significant changes, partly as a result of the increasing use of digital, mobile devices. Mobile smart phones not only include increasingly good quality built-in cameras, they also enable the immediate editing and sharing of photos through social networks. This reduces the importance of the image as an artifact and increases the social aspect of photography. Similarly, Bring Your Own Device (BYOD) policies in schools and universities provide opportunities to reconsider how and where learning happens. Mobile digital devices allow students to explore, create, communicate and collaborate with their peers in the classroom and with others beyond. Following a review of how networked smart phones are used for photography and in education, I report on two innovative photography courses that make effective use of mobile devices and social networks to empower students and enhance the learning experience. Phonar (photography and narrative) is a hybrid course that is offered to fee-paying place-based students at the University of Coventry and is also open for others to access for free. Phonar Nation is a free, non-credit course designed for teenagers and delivered through a mobile Web app with the help of community mentors. I discuss how their use of mobile media and social networks, together with collaboration and open strategies, serve as examples of how mobile devices can be effectively used to serve creative practice and extend learning.

To determine the accuracy of fine needle aspiration (FNA) and intraoperative frozen section examination (IFSE) on thyroid nodules. The study group consisted of 470 patients who underwent thyroidectomy. FNA was performed on 289 patients and IFSE on 326. The FNA and IFSE results were compared with the final histologic diagnosis obtained after examination of permanent sections. The overall FNA sensitivity was 65%, specificity 88% and positive predictive value 61%. The IFSE sensitivity was 50%, and the specificity and positive predictive value were 100%. When both procedures were used together, FNA identified 16 of 45 (36%) carcinomas as malignant and an additional 13 (29%) as follicular proliferative lesions; IFSE correctly identified only 23 of 45 (51%) carcinomas. FNA provides enough information for determining the extent of thyroid surgery when a diagnosis of cancer is made. However, IFSE should be considered a supplementary procedure when FNA is not positive for cancer.

ABSTRACTINTRODUCTIONFor this case, when the preoperative diagnosis indicated malignant tumor with metastasis, intraoperative frozen section examination was performed to adjust the surgical plan accordingly. This approach helped avoid overtreatment, minimizing the patient’s pain and surgical trauma. This case holds educational significance.CASE PRESENTATIONA 45-year-old female patient underwent open myomectomy 12 years ago for uterine fibroids and laparoscopic subtotal hysterectomy 10 years ago for the same condition. During this check-up, her CA125 was found to be elevated. Further examinations, including ultrasound, enhanced CT, and enhanced MRI, all suggested a pelvic malignant tumor with liver metastasis. The patient underwent tumor resection, and both intraoperative frozen section and routine histopathologic examination confirmed that the pelvic and subphrenic tumors (which had been considered as liver metastases preoperatively) were both conventional leiomyomas.CONCLUSIONSThis case highlights that leiomyomas, when metastatic, are easily misdiagnosed as malignant tumors with metastasis, presenting a significant challenge for preoperative diagnosis. Clinicians should maintain a high level of suspicion in such cases to avoid overtreatment. In this case, the intraoperative frozen section played a crucial role in preventing unnecessary pelvic lymph node dissection.

Provisioning web services from mobile devices are originated in the picture due to advancement in mobile smart phone capabilities, unexpected use of open source Android smart phones, wide development in wireless networking, improvement in internet uploading and downloading speed in a wireless environment, use of smart mobile phones other than its basic functionality and new advanced web technologies. Mobile smart phones are only device, it supports the ubiquitous concept is existing everywhere on every mobile device. REST based web service provisioning is the need of the next generation mobile users with 2G, 3G, 4G and LTE. The aim of this paper is to design a novel hybrid framework prototype for provisioning of web services on mobile smart phones. This paper deals the design and implements of a hybrid framework to provide alternative way to access web services from non-java mobile phones. Also support to access web services in low mobile network range area using SMS and improve web service accessibility and service availability.

Whole slide imaging diagnostic concordance with light microscopy for breast needle biopsies

To determine whether diagnostic concordance, case deferral rate, and/or time required to review slides changed significantly as telepathologists gained additional experience using a hybrid dynamic/store-and-forward (HDSF) telepathology (TP) system on the 2000 cases following an initial 200 consecutive surgical cases, previously reported. Gross surgical pathology specimens were prepared by specially trained personnel in Iron Mountain, Michigan. For TP, glass slides were placed on the stage of a robotic microscope at the Iron Mountain VAMC (remote site); control of the motorized microscope was then transferred to a pathologist located 220 miles away at the Milwaukee, Wisconsin, VAMC (host site). For each case, a telepathologist had the option of either rendering a diagnosis or deferring the case for later analysis by conventional light microscopy (LM). After the slides were read by TP and a surgical pathology report had been generated (for nondeferred cases), the slides were transported to Milwaukee, where they were reexamined by the same pathologist, now using LM. When there was disagreement between the TP and LM diagnosis, a supplemental or revised report was issued, and the referring physician was notified by telephone immediately. All supplemental and revised reports were reviewed by a third pathologist in the group. The slides were then reviewed by the pathology group practice or, when there was no consensus, by the Armed Forces Institute of Pathology to establish a "truth" diagnosis. To determine changes in telepathologist performance with experience after the initial start-up of the service, their performance in handling 10 consecutive sets of 200 surgical pathology cases was analyzed. Concordance rates for clinically significant TP and LM diagnoses were high for all 10 sets, ranging from 99% to 100%. Comparing the first set (Cases 201-400) with the last set (Cases 2001-2200), viewing times per case were reduced from 10.26 min to 3. 58 min. Viewing times per slide were reduced from 3.44 min to 1.13 min per slide, comparing the first and last sets. Case turnaround times (TAT) decreased from 2.46 days to < or =1.5 days. Thes results demonstrate that improvements in TP services occur over time as the result of additional experience using the TP system. The high diagnostic concordance and low rate of case deferral lend additional support to the proposal that a host-site pathologist using HDSF TP can substitute effectively for an on-site pathologist as a service provider.

Introduction What is a mobile catalogue? A mobile catalogue is a view of a library's collection, with corresponding services, targeted at customers using mobile devices. This definition summarizes the issues involved and the questions that need to be answered. What are mobile devices? What are mobile applications? Who are mobile users? What type of library are we talking about? What is the collection? Is the mobile view different from the standard view? Which services are targeted at mobile customers? In this chapter we will find out the answers to these questions. Beginning with defining exactly what a mobile device is, and what it is not, we will then move on to explore the different kinds of mobile applications it is possible to implement and look at the advantages and disadvantages of each. An overview of a range of mobile platforms is followed by a brief explanation of the mobile phone network technology. As mobile library services need to be developed for the endusers, the user needs of the target audience from a range of different types of library will be explored. Building on this understanding of user needs, the different types of mobile library services are then explored, before looking specifically at what functionalities of a library catalogue can be provided via a mobile device. With this background knowledge in place, we will then turn our attention to putting it into practice. Using the University of Amsterdam Library's ‘UBA Mobile’ implementation as a case study, the practical steps that need to be undertaken to ‘get a mobile catalogue’ will be followed. This part includes practical tips and lessons learned to assist in making the task of implementing a mobile catalogue easier. Next comes a selection of implementation examples spanning various types of library and different software platforms. The chapter concludes with a tenpoint checklist outlining the steps to set up a mobile catalogue. Mobile devices The first question to be answered is: which mobile devices are we referring to? The main feature that distinguishes mobile computing from previous technologies is the fact that it enables people to have internet access literally any time, anywhere. This limits the type of mobile devices to the ones small enough to carry around in a pocket or handbag such as mobile smart phones and small internet devices like the iPod Touch.

Prostate biopsies are crucial for diagnosing prostate lesions, including cancer. The procedure typically involves obtaining tissue samples using a needle. While the severity of complications is generally low, common adverse effects include mild bleeding, infection, and discomfort. Severe complications are rare. The incidence of clinically significant prostate cancer detection through core biopsies is significant, making it an indispensable diagnostic tool. The biopsies are traditionally viewed on glass slides by Conventional Light Microscopy (C.L.M.). Whole Slide Imaging (WSI): Whole Slide Imaging (WSI) involves scanning entire glass slides to produce high-resolution digital images. These images can be viewed, analysed, and shared electronically, enabling remote consultation and diagnosis. Aim: To assess the diagnostic accuracy of WSI compared to CLM. Material and methods: This single-center, cross-sectional study assessed diagnostic concordance in prostate lesion biopsies using Conventional Light Microscopy (CLM), with evaluations by two pathologists. It included core, tru-cut, and sextant biopsies, focusing on CLM accuracy. Inclusion criteria covered all available prostate biopsy specimens, while exclusion criteria included inadequate samples or those unsuitable for analysis. Selective sampling ensured a representative distribution of various prostate lesions. Results: The table shows diagnostic concordance and discrepancies between two pathologists using Conventional Light Microscopy (CLM) for prostate biopsies. While there was strong agreement in benign cases like BPH, differences were noted in adenocarcinoma grading, Gleason scores (G.S.), and perineural invasion (PNI). Some cases showed variations in Gleason pattern interpretation, affecting final diagnoses. These findings highlight inter-observer variability, suggesting the need for further analysis, possibly incorporating Whole Slide Imaging (WSI) to improve diagnostic consistency. Conclusion: This study aim

Several reports have demonstrated the use of whole-slide imaging (WSI) for primary pathological diagnosis, but no such studies have been published from Asia. We retrospectively collected 1070 WSI specimens from 900 biopsies and small surgeries conducted in nine hospitals. Nine pathologists, who participated in this study, trained for the College of American Pathologists guidelines, reviewed the specimens and made diagnoses based on digitized, 20× or 40× optically magnified images with a WSI scanner. After a washout interval of over 2 weeks, the same observers reviewed conventional glass slides and diagnosed them by light microscopy. Discrepancies between microscopy- and WSI-based diagnoses were evaluated at the individual institutes, and discrepant cases were further reviewed by all pathologists. Nine diagnoses (0.9%) showed major discrepancies with significant clinical differences between the WSI- and microscopy-based diagnoses, and 37 (3.5%) minor discrepancies occurred without a clinical difference. Eight out of nine diagnoses with a major discrepancy were considered concordant with the microscopy-based diagnoses. No association was observed between the level of discrepancy and the organ type, collection method, or digitized optical magnification. Our results indicate the availability of WSI-based primary diagnosis of biopsies and small surgeries in routine daily practice.