1st Congress of the International     Academy of Digital Pathology      August 3-5, 2011      Loews Hôtel Le Concorde     ...
TABLE OF CONTENTSWelcome address                2Congress organization          3Sponsors and Exhibitors        4General i...
Welcome to the 1st Congress of the International Academy ofDigital PathologyDear colleagues,We are delighted to have you h...
International Academy of Digital PathologyBoard MembersYukako Yagi, Boston, USA (President)Marcial Garcia Rojo, Ciudad Rea...
SPONSORS and EXHIBITORSDIAMOND SPONSORPLATINUM SPONSOR GOLD SPONSORS SILVER SPONSORSEXHIBITORS                            ...
GENERAL INFORMATIONuu Registration The congress registration is located at Cullen at the same floor where the lectures and...
GENERAL INFORMATIONRefreshment breaks and LunchesRefreshments will be served at the Foyer and lunches will be served at Pl...
7|Page
Attend the company’s presentation on August 4, 17:10 -17:20Shun Doie-Pathologist                                          ...
WEDNESDAY, August 3                                                                     Room08:00 – 17:00                 ...
12:00 – 13:00                                                       Place Montcalm                                        ...
16:30 - 16:50Shigeatsu Yoshioka,PhDJapanUltra High Speed WSI Viewing System16:50 - 17:10Yasuhiro Fukunaga,MSOlympus, Inc.,...
Anurag Sharma, MSNEC Laboratories, USADigital pathology hidden challengesMaristela L. Onozato,MD,PhDMassachusetts General ...
THURSDAY, August 4                                                                  Room08:00 – 17:00                     ...
11:00 -11:20Mari Mino-Kenudson, MDMassachusetts General Hospital, USARole of 3D reconstruction in the classification of lu...
15:30 - 15:50Tokiya Abe, PhdKeio University,JapanQuantification of Liver Fibrosis by Whole Slide Image Analysis15:50 - 16:...
FRIDAY, August 5                                                                    Room08:00 - 12:00                     ...
11:10 -11:40Essam Ayad, MDCairo University, EgyptVirtual Microscopy Beyond the Pyramids, Application of WSI in Cairo Unive...
18 | P a g e
Attend the company’s presentation on August 4, 17:00 – 17:10Pierre F. Le FèvreThe difference between the "professional med...
The challenges of implementing a                                      services that were unavailable for so many years ; 2...
for traditional histology, after which comparison of the           processes according to feedbacks we have gotten fromLig...
cause the problem. We have developed the methodology            development will be slow and availability of suchto standa...
Pathology and Laboratory Quality Center convened a non-           for cases in which specimens are imaged in a single foca...
Judit Zubovits1, Kashan Shaikh3, Alex Corwin3, DanWang4, Sean Dinn2, Gina Clarke4 Chris Peressotti4 ,Zhengyu Pang2, Robert...
Mitotic Figure Recognition: Agreement                              some strong biases exist (-.35, -.05, and .27). Thus, i...
one of the most complex fields, and the accurate                  three major regional hospitals in Kyoto, Japan weredisti...
speed to complete the tasks in many situations such as           compression rate. Results: Due to the effect of high-prim...
August 3, 17 :10-17 :30   Background: Image analysis algorithms, coupled with                                             ...
Tissue refractive index as an objective                                different biopsies. Conclusions: Our data demonstra...
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
1st congress of international academy of digital pathology
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1st congress of international academy of digital pathology

  1. 1. 1st Congress of the International Academy of Digital Pathology August 3-5, 2011 Loews Hôtel Le Concorde Québec City, Canada Program and Abstract book http://iadphomepage.org ORGANIZERS: MASSACHUSETTS  GENERAL HOSPITAL 
  2. 2. TABLE OF CONTENTSWelcome address 2Congress organization 3Sponsors and Exhibitors 4General information 5-6ScheduleWednesday, August 3 9-12Thursday, August 4 13-15Friday, August 5 16-17AbstractsWednesday, August 3 20-32Thursday, August 4 35-43Friday, August 5 43-47 1|Page
  3. 3. Welcome to the 1st Congress of the International Academy ofDigital PathologyDear colleagues,We are delighted to have you here to participate and share in the 1st Congress of the International Academy ofDigital Pathology organized by the International academy of Digital Pathology (IADP) in Quebec, Canada andpartners.We are living in the era of great scientific achievements. Like other scientific areas, pathology is transforming fast inthis age of innovation. Digital pathology is not only here to stay, it has already gone way beyond the scanners andexternal hard drive. Nevertheless, we still have a lot of challenges. One challenge is to standardize the systems aftertaking various aspects into consideration, be it common image format, data privacy issues, business process re-engineering, regulations, or medico- legal issues.The other big challenge is to spread the benefits of digital pathology to a larger part of the humanity by includingthe developing world into its fold.With warm regards,Dr.Yukako Yagi, USA Dr. Marcial Rojo, SpainPresident Vice-PresidentInternational Academy of Digital International Academy of DigitalPathology (IADP) Pathology (IADP) 2|Page
  4. 4. International Academy of Digital PathologyBoard MembersYukako Yagi, Boston, USA (President)Marcial Garcia Rojo, Ciudad Real, Spain (Vice president)Gian Kayser, Freiburg, GermanyKlaus Kayser, Berlin, GermanyJacques Klossa, Paris, FranceArvydas Laurinavicius, Vilnius, LithuaniaVincenzo Della Mea, Udine, ItalyJanusz Szymas, Poznan, PolandYasunari Tsuchihashi, Kyoto, JapanGuillermo Tearney, Boston, USABernard Têtu, Quebec City, CanadaTreasurersJohn Gilbertson,USAAndrew Bajko,USASecretariesMaristela Onozato, USAPinky Bautista, USAInternational AdvisorRonald Weinstein,USA 3|Page
  5. 5. SPONSORS and EXHIBITORSDIAMOND SPONSORPLATINUM SPONSOR GOLD SPONSORS SILVER SPONSORSEXHIBITORS 4|Page
  6. 6. GENERAL INFORMATIONuu Registration The congress registration is located at Cullen at the same floor where the lectures and exhibits are held. Registration desk will be opened every day. August 3 – 07:30 – 05:00 August 4 – 07:30 – 12:00 August 5 – 08:00 – 12:00 Badges Registered participants will receive their badges. The badge serves as a ticket to conference sessions, refreshment breaks and lunches. Participants are kindly requested to wear their badges when attending the congress. Presentation Please submit your PowerPoint presentation file at least 2- 3 hours before your scheduled presentation in the speaker’s ready room in Pilot. Poster Session The poster session will take place at Boduas-krieghoff1 on August 3, 17:30 -18:30. Authors should put up their posters on August 3, between 10- 12 Noon. The posters should stay in the same location until lunch break on Friday August 5, 2011 for viewing during breaks. Wireless Internet Connection Wireless internet connection is provided in the congress venue. Use the following code to access the wireless internet connection: QUELO01 COJADU. 5|Page
  7. 7. GENERAL INFORMATIONRefreshment breaks and LunchesRefreshments will be served at the Foyer and lunches will be served at Place Montcalm.Welcome receptionHors doeuvres reception during the poster session on August 3, 17:30 -18:30ExhibitionTechnical exhibits will be held at the Borduas-krieghoff1 and at the Foyer of the congress venue.Exhibition hours: August 3 9:20 – 18:30 August 4 8:00 – 18:30 August 5 8:00 – 12:00 6|Page
  8. 8. 7|Page
  9. 9. Attend the company’s presentation on August 4, 17:10 -17:20Shun Doie-Pathologist 8|Page
  10. 10. WEDNESDAY, August 3 Room08:00 – 17:00 REGISTRATION Cullen 07:00-08:00 Foyer BREAKFAST 8:00 - 08:30 Suzor-kote,Krieghoff2 OPENING PLENARY08:00 - 08:15Dr. Yukako Yagi & Dr. Bernard TêtuOpening talks08:15 - 08:30THE QUEBEC MINISTER OF HEALTHShort talk PLENARY SESSION Suzor-kote,Krieghoff2 Chair: Dr. Yukako Yagi, USA, & Dr. Marcial Rojo,Spain08:30 - 09:00Bernard Têtu, MDLaval University, CanadaThe challenges of implementing a “patient-oriented” telepathology network; the Eastern Quebec telepathology projectexperience09:00 -09:20Michael Riben, MDMD Anderson, USANon-Destructive Digital Pathology using Light-CT ™ on Fresh and Fixed Tissue: Initial Experience for Clinical and ResearchApplications 09:20-09:30 Foyer, Borduas SHORT BREAK PANEL DISCUSSION: STANDARDIZATION IN DIGITAL PATHOLOGY Suzor-kote,Krieghoff2 Chair: Dr. Klaus Kayser & Dr. Bernard Têtu09:30 -10:00Marcial Rojo, MDHospital de Ciudad Real, SpainStandardization Efforts of Digital Pathology in Europe10:00 - 10:30Yukako Yagi,PhDMassachusetts General Hospital, USAToward Standardization: Color and Image Quality Validation in Whole Slide Imaging (WSI)10:30 - 11:00Michael Meissner,PhDCo-Chair of DICOM WG26,USADICOM Working Group Activity11:00 - 11:30Andrew Evans ,MD,PhDCollege of American Pathologists, CAPValidating Whole Slide Imaging for Diagnostic Purposes in Pathology: Recommendations of the College of AmericanPathologists (CAP) Pathology and Laboratory Quality11:30-12:00 DISCUSSION/ Q&A 9|Page
  11. 11. 12:00 – 13:00 Place Montcalm LUNCH BREAK 13:00-14:10 Suzor-kote,Krieghoff PLENARY SESSION Chairs: Dr. Yukako Yagi, USA, & Dr. Marcial Rojo,Spain13:00 - 13:40Ronald Weinstein, MD Keynote speakerThe University of Arizona,USAZ-Axis Challenges in Whole Slide Imaging (WSI) Telepathology13:40 - 14:10Guillermo Tearney, MD,PhDMassachusetts General Hospital,USAEndoscopic microscopy: bridging the radiology-pathology divide 14:10-15:10 Suzor-kote,Krieghoff SCIENTIFIC SESSION Chairs: Dr. Gian Kayser,Germany & Dr. Arvydas Laurinavicius,Lithuania14:10 -14:30Judit Zubovits, MDSunnybrook Health Science Center, CanadaProof of principle: Colocalization of pan cytokeratins (AE1/AE3), pan cytokeratin (PCK26), and cytokeratin 8/18 using anIntegrated Sequential Staining and Imaging Device14:30 - 14:50Catherine Bor,MDFrancois Baclesse Center, FranceBenefits of a two resolution strategy for analyzing virtual slides of immunostained tumors14:50 - 15:10Christopher Malon,PhDNEC Laboratories America,USAMitotic Figure Recognition: Agreement Among Pathologists and Computerized Detector 15:10 – 15:30 Foyer, Borduas BREAK 15:30 – 17:10 SCIENTIFIC SESSION Suzor-kote,Krieghoff Chairs: Dr. Janus Szymas, Poland, & Dr. Robert Osamura,Japan15:30 - 15:50Junya Fukuoka, MDToyama University, JapanApplication of digital pathology to create pathology assisting software to standardize the diagnosis of interstitial pneumonia15:50 - 16:10Yasunari Tsuchihashi, MDLouis Pasteur Centre for Medical Research, JapanPossibilities of Digital Navigation Systems for Pathology Diagnosis16:10 -16:30Yukako Yagi, PhDMassachusetts General Hospital, USAEvaluation of Ultra High WSI Viewing System 10 | P a g e
  12. 12. 16:30 - 16:50Shigeatsu Yoshioka,PhDJapanUltra High Speed WSI Viewing System16:50 - 17:10Yasuhiro Fukunaga,MSOlympus, Inc., JapanSpectral sensing method for practical use17:10 - 17:30Shinsuke Tani,MSOlympus, Inc., JapanColor Standardization System Implementing Estimation Method for Absorption Spectra of Dye 17:30 – 18:30 Borduas-Krieghoff1 POSTER SESSION Chair: Dr. Bruce LevyJason Hipp, MDUniversity of Michigan, Department of Pathology, USAOptimization of detection of complex cancer morphology using the SIVQ pattern recognition algorithmRajyasree Emmadi , MDUniversity of Illinois at Chicago, USATissue refractive index as an objective and quantitative measure of pathologic processesRajyasree Emmadi , MDUniversity of Illinois at Chicago, USAMid-Infrared Spectroscopic Imaging for Breast Tissue Histopathology: Towards ‘Stainless StainingRajyasree Emmadi , MDUniversity of Illinois at Chicago, USAMedical School Pathology education supplemented with web-based virtual microscopySushmita Mukherjee, MDCornell University, USAToward an annotated digital Multiphoton Microscopy (MPM) histology atlas of fresh human bladder biopsies for intra-cystoscopy guidance in bladder cancer diagnosisYasuhiro FukunagaOlympus, Inc,JapanSpectral sensing method for practical useShinsuke TaniOlympus, Inc.,JapanColor Standardization System Implementing Estimation Method for Absorption Spectra of DyePinky A. Bautista, PhDMassachusetts General Hospital, USAMultispectral enhancement towards digital stainingPeter Kragel, MDBrody School of Medicine, East Carolina University, USAA Pathology Imagery Interpretability Rating Scale for Virtual MicroscopyAnurag Sharma, MSNEC Laboratories, USABalancing image quality and compression factor of special stains whole slide images 11 | P a g e
  13. 13. Anurag Sharma, MSNEC Laboratories, USADigital pathology hidden challengesMaristela L. Onozato,MD,PhDMassachusetts General Hospital,USAAutomated 3D-reconstruction of histological sectionsMaristela L. Onozato, MD,PhDMassachusetts General Hospital, USAAutomated sectioning machine for paraffin blocks 12 | P a g e
  14. 14. THURSDAY, August 4 Room08:00 – 17:00 REGISTRATION Cullen 07:00 – 08:00 Foyer BREAKFAST 08:00 – 09:00 Suzor-kote,Krieghoff2 PLENARY SESSION Chairs: Dr. Yasunari Tsuchihashi & Dr.Andrew Evans08:00 – 08:30Philippe Camparo, MDHôpital Foch, Suresnes, FranceWhole slide imaging and expert analysis in adenocarcinoma of the prostate08:30 – 09:00Robert Osamura, MDInternational University of Health and Welfare (IUHW) Mita Hospital, JapanDigital Pathology in Asia 09:00 -10:00 Suzor-kote,Krieghoff2 SCIENTIFIC SESSION chairs: Dr. Yasunari Tsuchihashi & Dr. Andrew Evans09:00 - 09:20Arvydas Laurinavicius,MDNational Centre of Pathology and Vilnius, LithuaniaDigital Image Analysis in Pathology: Benefits and Obligations09:20 – 09:40Janusz Szymas,MD University of Medical Sciences, PolandWeb Microscope as a computer - based system for practical examination of dental students in oral pathology09:40 – 10:00Gian Kayser,MDUniversity of Freiburg, GermanyVirtual microscopy - a new tool in quality control and assurance of automated laboratory processes 10:00 – 10:20 Foyer BREAK 10:20 – 12:00 Suzor-kote,Krieghoff2 SCIENTIFIC SESSION Chairs: Dr. Philippe Camparo , France & Dr. Guillermo Tearney, USA10:20 – 10:40David McClintock,MDMassachusetts General Hospital, USAUsing Computerized Workflow Simulations to Assess the Feasibility of Whole Slide Imaging Full Adoption in High VolumeHistology Laboratory10:40 – 11:00Manabu Fukumoto,MD,PhDTohoku University, JapanThe e-Pathologists Cancer Diagnosis Assistance System for Gastric Biopsy Tissues 13 | P a g e
  15. 15. 11:00 -11:20Mari Mino-Kenudson, MDMassachusetts General Hospital, USARole of 3D reconstruction in the classification of lung adenocarcinoma11:20 - 11:40Peter Gould, MD,FRCPCLaval University, CanadaA comparison of digitized frozen section and smear preparations for intraoperative neurotelepathology11:40 - 12:00Slawomir Walkowski, MDUniversity of Medical Sciences, PolandHistopathologic patterns of nervous system tumors based on computer vision methods and whole slide imaging (WSI) 12:00 – 13:00 Place Montcalm LUNCH BREAK 13:00 – 14:10 Suzor-kote,Krieghoff2 PLENARY SESSION Chairs: Dr. Yukako Yagi, USA & Dr. Ronald Weinstein,USA13:00 - 13:40Klaus Kayser,MD keynote speakerUICC-TPCC, Institute of Pathology, GermanyHow to Introduce virtual microscopy (VM) in routine diagnostic pathology: constraints, ideas and solutions13:40 - 14:10Katia Manova,PhDMemorial Sloan-Kettering Cancer Center,USAMolecular Cytology Core Facility- Efforts to Accelerate the Research Process 14:10 – 15:10 Suzor-kote,Krieghoff2 SCIENTIFIC SESSION Chairs: Dr. Gian Kayser, Germany & Dr. Janus Szymas, Poland14:10 -14:30Nicolas Ellie, MDCLCC Francois, CAEN,FranceAutomatic analysis of virtual slides to help in the determination of well established prognostic parameters in breastcarcinomas14:30 - 14:50Roy Lee, MDMassachusetts General Hospital, USAAutomated quantification of liver steatosis by WSI based image analysis14:50 - 15:10Hatice Cinar-Akakin,PhDThe Ohio University, USAApplication of Multi-scale Filtering to Cell Nucleus Detection with Automated Scale Selection 15:10 -15:30 Foyer, Borduas BREAK 15:30 – 16:50 Suzor-kote,Krieghoff2 SCIENTIFIC SESSION Chairs: Dr. Katia Manova,USA & Dr. Jun Fukuoka 14 | P a g e
  16. 16. 15:30 - 15:50Tokiya Abe, PhdKeio University,JapanQuantification of Liver Fibrosis by Whole Slide Image Analysis15:50 - 16:10Chamidu Atupelage, PhDTokyo Institute of Technology,JapanMultifractal Feature Descriptor for Histopathology16:10 - 16:30Peter Kragel, MDBrody School of Medicine at ECU,USAA Pathology Imagery Interpretability Rating Scale for Virtual Microscopy16:30 -16:50Noriaki Hashimoto, MSTokyo Institute of Technology,JapanDevelopment of Image Quality Evaluation Method for Whole Slide Imaging 16:50 – 17:00 Foyer, Borduas SHORT BREAK 17:00 – 18:30 Suzor-kote,Krieghoff2 COMPANY DISCUSSION FORUM Chairs: Dr. Klaus Kayser, Germany, & Dr. Bernard Têtu, Canada17:00 – 17:10Pierre F. Le FèvreAurora Interactive Ltd.The difference between the "professional medical" part of digital pathology versus the "Infrastructure part"17:10 – 17:20Shun DoiNEC Corporation,Japane- Pathologist17:20 -17:30Name:Olympus, Inc.Title:17:30 -17:40John Wellbank & Jose CastanonPhilipsNext Generation Digital Pathology17:40 – 17:50Philippe NoreRoche DiagnosticsRoche Tissue Diagnostics’ Digital Pathology Strategy17:50 -18:30DISCUSSIONS/Q&A 15 | P a g e
  17. 17. FRIDAY, August 5 Room08:00 - 12:00 REGISTRATION Cullen 07:00-08:00 Foyer, Borduas BREAKFAST 08:00 – 09:00 Suzor-kote,Krieghoff2 PLENARY SESSION Chairs: Dr. Paul Fontelo,USA & Dr. Essam Ayad,Egypt08:00 - 08:30Andrew Evans, MD, PhDUniversity of Health Networks (UHN), Toronto, CanadaTelepathology Based on Whole Slide Imaging for Primary Frozen Section Diagnosis: The University Health NetworkExperience and Learned Along The Way08:30 - 09:00Jean –Paul Fortin, MDLaval University, CanadaPromoting knowledge translation through telehealth evaluation: A strategic choice for telepathology projects 09:00 – 10:00 Suzor-kote,Krieghoff2 APPLICATION & IMPLEMENTATION OF DIGITAL PATHOLOGY Chairs: Dr. Andrew Evans,Canada & Dr.Jean-Paul Fortin,Canada09:00 - 09:20Martin Yaffe, PhDSunnybrook Research Institute & University of Toronto, CanadaApplications of Digitized Whole-mount Histopathology09:20 - 09:40Kar-Ming Fung, MD, PhDUniversity of Oklahoma Health Sciences Center, USAWhole Slide Images and Digital Media in Pathology Education, Testing and Practice: The Oklahoma Experience09:40 - 10:00 Bernard Têtu,MD Laval University, CanadaLaval University Telepathology System (demonstration at exhibit booth) 10:00 – 10:10 Foyer, Borduas SHORT BREAK 10:10 -12:15 Suzor-kote,Krieghoff2 DIGITAL PATHOLOGY IN THE DEVELOPING COUNTRIES AND BEYOND Chairs: Dr. Yukako Yagi,USA & Dr. Marcial Rojo, Spain10:10 - 10:40Paul Fontelo, MDNational Library of Medicine,USADigital Pathology – Implementation Challenges in Developing Countries Context10:40 -11:10Aliyah Sohani, MDMassachusetts General Hospital,USAStatic Digital Pathology: A Model for a Regional Diagnostic and Educational Support Network for Pathologists in thedeveloping World 16 | P a g e
  18. 18. 11:10 -11:40Essam Ayad, MDCairo University, EgyptVirtual Microscopy Beyond the Pyramids, Application of WSI in Cairo University for E-education & Telepathology11:40 - 12:10Gian Kayser, MDUniversity of Freiburg, GermanyHistory, experiences, and perspectives of expert consultation in diagnostic surgical pathology12:10 - 12:30Marcial Rojo, MDHospital de Ciudad Real, SpainAwards and Closing remarks 12:30 – 13:30 Foyer, Borduas LUNCH/CONGRESS ADJOURNMENT 17 | P a g e
  19. 19. 18 | P a g e
  20. 20. Attend the company’s presentation on August 4, 17:00 – 17:10Pierre F. Le FèvreThe difference between the "professional medical" part of digital pathology versus the"Infrastructure part" 19 | P a g e
  21. 21. The challenges of implementing a services that were unavailable for so many years ; 2) The network must adapt to a changing situation occurring in"patient-oriented" telepathology the course of the deployment, such as the moving andnetwork; the Eastern Quebec retirement of pathologists; 3) This unique networktelepathology project experience combining centers with or without laboratory requires the development of innovative solutions (new report format,Bernard Têtu gross station for large specimens and discussions with the surgeon); 4) Pathologists used to send consultations byRUIS-Laval University telepathology project mail must get used to send and read images; 5) The network must be developed within each region becauseQuébec, Canada University hospital are unable to absorb an increased August 3, 8:30 – 9:00 workload; 6) Surgeons and pathology personnel mustBackground: The Eastern Québec telepathology project develop new working methods; 7) Technicians in hospitalswas initiated by the Laval University Integrated University without pathology laboratory have limited experience withHealth Network (in french: RUIS: Réseau Universitaire histology techniques. Conclusion: The EasternIntégré en Santé). The RUIS was created by the Québec Québec telepathology network has been designed toministry of health as an authority of coordination and improve medical care to patients in this territory.consensus which mandate is to encourage the integration However, the project team is confronted with majorof health cares, teaching and research activities in the challenges mostly related to change management andinstitutions under the umbrella of the faculty of medicine. requiring innovative solutions.This project is aimed at providing uniform diagnostictelepathology services in a territory of 408,760 km2 with a Non-Destructive Digital Pathology usingpopulation of 1.7 millions inhabitants and which density, incertain areas, is as low as 0.4 inhabitant/km2. Clinical Light-CT ™ on Fresh and Fixed Tissue:context: Many surgeons in smaller community hospitals Initial Experience for Clinical andmust postpone surgeries requiring a frozen-section or to Research Applicationstransfer certain patients to regional hospitals because ofthe lack of stable pathology coverage. Younger Michael Ribenpathologists in early practice feel insecure and are oftenreluctant to work alone because of the impossibility to MD Anderson, USArapidly obtain a second opinion from a colleague and can August 3, 9:00 –9:20hardly be absent without disturbing the surgical unitorganization. In this context, the ministry of heath and Context: It is increasingly important to maximize theCanada Health Infoway decided to financially support this volume and quality of tissue obtained for both clinical andinnovative initiative with the objective of providing the research use, particularly in the current push for deliveringpopulation with uniform pathology services on the territory. personalized cancer therapy. Given the expandingThe project is particularly timely because of the reports of potential uses for collected tissue, minimizing consumptiontwo recent commissions of inquiry in Canada while confirming the histologic diagnosis and assessingrecommending the deployment of telepathology to help the quality of tissue obtained, both of which plague currentproviding professional support and improve the quality of methods such as frozen section or cytologic assessment,cares in Canada. Scope of the project : this is a is critical. To this end, we have begun testing a novel“patient-oriented” project aimed at providing surgeons and commercial device for full-field optical coherencepathologists with frozen sections and second opinions tomography called Light-CT™ which facilitates rapid non-anywhere and anytime on the whole territory of the RUIS- destructive histologic digital imaging of both fresh andLaval University. Each hospital is equipped with a whole fixed tissue. The technique is based on the principle ofslide scanner, a gross station, a videoconferencing device white light interferometry and generates quick image slicesand with a viewer and an image sharing solution. The in three-dimensions of the specimen. Our initialproject has been implemented in 21 sites, of which 6 are experience includes evaluation of the ability to use thedevoid of pathology laboratory. Of the remaining 15 sites, images for quality control and the potential for diagnostic6 have one pathologist, 7 have 2 or more pathologists and assessment. Methods: We obtained residual tissue fromtwo have no pathologist. Change management is the gastrointestinal tract, breast, and skin for imaging. Fullmajor challenge encountered in the implementation of this field and virtual sectioned slides of tissues at a variety ofnetwork. Basically, we found that 1) Although the depths were acquired using a 10x/0.3 numerical aperturesurgeons of the 6 hospitals devoid of pathology laboratory immersion objective. Images were processed andand the 2 devoid of pathologists are motivated by the visualized in real-time. The imaged tissue was submittedpotential of the technology, they must get used to request 20 | P a g e
  22. 22. for traditional histology, after which comparison of the processes according to feedbacks we have gotten fromLight-CT™ image and the glass slide were undertaken. the pathologists. These results can be beneficial toResults: Initial experience show architectural and improve the organization of digitizing centers, since theymorphologic similarity between the Light-CT image and can used to create models and protocols enablinghistologic preparations. Distinct morphologic criteria telepathology international network websites forincludes pixel intensity, patterns which correlate with teleconsultation services. In the next future, this work canhistologic features, and architectural variability. Together, also be applied in the documentation of pathologythese provide adequate information for a quality processes described in many standardization documentsdetermination. Image correlation with the stained H&E (DICOM, HL7, IHE).section highlights image features with associatedhistologic features including architecture, tumor invasion, Working Group 2 has been dedicated to Informaticstissue reaction, and normal structures. Conclusions: Standards in Pathology, and promoting their application inLight-CT™ represents a paradigm shift for histologic Pathology Departments in European institutions. The mainassessment of both fresh and fixed tissue. We have research is focused in: A) Advances in Integratingshown that the images produced show great potential for Healthcare Enterprise (IHE)- Anatomic Pathology:use-cases in which pattern recognition and architectural Anatomic Pathology Workflow (APW) within the hospital,assessment are used to evaluate both for quality of tissue Anatomic Pathology Reporting to Public Health (ARPH)obtained and diagnostic criteria. Future work includes and Anatomic Pathology Structured Report (APSR), basedassessing molecular markers after imaging. in HL7 Clinical Document Architecture (CDA). B) The practical application of DICOM standard (medical image) in Pathology. C) Image compression. D) SemanticStandardization Efforts of Digital interoperability: PathLex and SNOMED CT in Pathology.Pathology in Europe Image compression research discussion has been performed in collaboration with JPEG committee. As aMarcial García Rojo conclusion of this discussion, it seems that JPEG 2000Hospital General Unviersitario de Ciudad Real. Spain image compression has proved to be a most efficient August 3, 09 :30 – 10 :00 image compression standard, but is has not become widely implemented. JPEG commitee is working in theEURO-TELEPATH stands for “Telepathology Network in development of a new compression method, JPEG XR,Europe”, a European COST Action mainly aimed at those digital photography applications(http://www.conganat.org/eurotelepath/) that started in where JPEG 2000 penetration has been limited due to2007 and will end in November 2011. This project is aimed complexity reasons, and they are also interested into foster collaboration between European research groups evaluating Advanced Image Coding (AIC) in medicalworking in an adequate technological framework for the images.management of multimedia electronic healthcare records,in informatics applied to Anatomic Pathology, and, mostimportantly in IT standards applied to digital medical Toward Standardization: Color andimages, collaborate with international standardization Image Quality Validation in Whole Slidebodies. Imaging (WSI)Working Group 1 “Business modeling in Pathology” Yukako Yagi, Noriaki Hashimoto, and Pinky Bautistaperformed a comparison study between different notationsin business modeling (Business Process Modeling Department of Pathology, Harvard Medical School,Notation – BPMN, Event Process Chain – EPC, and UML Massachusetts General Hospital, Boston, MAActivity Diagram). They have concluded that BPMN is themodeling notation which is clearer and more August 3, 10 :00 – 10 :30understandable to pathologists. EPC is harder for Context: Standardization of the image quality and thepathologists to read and understand. It is probably color displayed by digital slides are important aspects ofbecause EPC is not as popular as BPMN and UML AD, so digital pathology implementation. While the most commonpathologists are not so familiar with the concept of event- reason for the variations of color and image quality is thedriven process. variance in the protocols and practices in the histology lab, the image displayed can also be affected by variation inMain pathology processes – Frozen Study, Formalin Fixed capture parameters (for example, focus, illumination andSpecimen Study, Telepathology, Cytology, Autopsy – are filters), image processing and display factors in the digitalnow complete. Further work will be needed to modify the systems themselves. It is difficult to identify which exactly 21 | P a g e
  23. 23. cause the problem. We have developed the methodology development will be slow and availability of suchto standardize color and evaluate image quality of any algorithms will not be as widespread as it could potentiallyWSI. Design: Two types of calibration slides were be. DICOM WG26 continues its efforts and activities todeveloped in our laboratory: color and image quality establish and enhance interoperability, most recentlycalibration slides. These slides were scanned using targeting the adoption of DICOM Worklists to definedifferent scanners. The color information from the scanned procedures and procedure steps that allow devices in theimage of the color calibration slide was used to pathology space to communicate respective status. In thischaracterize the color settings of the scanners. The session, we will provide an update on the ongoingeffectiveness of the proposed color standardization and activities in DICOM WG26 as well as seek ideas forimage quality evaluation algorithms was demonstrated additional topics that WG26 could/should tackle in theusing the image quality evaluation slide, which is a ideally future. While Informatics is not something pathologists arestained embryo tissue slide. Results: The scanned very familiar with / commonly exposed to, the future ofimages showed varying color appearance on the same pathology lies heavily in Pathology Informatics andmonitor. However, after the implementation of the color DICOM WG26 would benefit from more active end userstandardization algorithm the color variance was (pathologists) participation which we would like to improve.minimized. Moreover, there was a good correlationbetween the results of the proposed image quality This talk will give an overview of the accomplishments ofevaluation method with the evaluation results by human DICOM WG26, current activities, and potential futureeyes. We have developed a tentative protocol for color efforts. We believe educating about such progress andstandardization and image quality validation. getting more active participation by various parties is a keyConclusions: Initial results of the standardization ingredient to moving Pathology into the Digital Age.experiments are promising although there are still severalfactors that we need to consider. We have beenconducting a series of research towards Standardization. Validating Whole Slide Imaging forHowever, to promote the importance to have standardized Diagnostic Purposes in Pathology:color of image and high quality of image and also Recommendations of the College ofstandardize validation protocol, the collaboration betweenAcademic, Industry, Governmental organization may be American Pathologists (CAP) Pathologynecessary. and Laboratory Quality Center Andrew J. Evans1, John H. Sinard2, Lisa A. Fatheree3,DICOM Working Group Activity Walter H. Henricks4, Alexis B. Carter5, Lydia Contis6, Bruce A. Beckwith7, , Christopher N. Otis8, JamesMichael Meissner MacDonald3, Anil V. Parwani6, Liron Pantanowitz6 1Co-Chair of Dicom WG26,USA Laboratory Medicine Program, University Health Network, 2 Toronto, ON, Canada; Department of Pathology, Yale August 3, 10:30 – 11:00 3 University School of Medicine, New Haven, CT; College of 4 American Pathologists, Northfield, IL; Pathology and LaboratoryDICOM WG26 has successfully completed two 5 Medicine Institute, Cleveland Clinic, Cleveland, OH; Departmentsupplements, Supplement 122 targeting primarily LIS of Pathology and Laboratory Medicine, Emory University, Atlanta, 6 7vendors to exchange specimen information and GA; North Shore Medical Center Salem Hospital, Salem, MA;supplement 145 primarily targeting imaging vendors to Department of Pathology, University of Pittsburgh Medical Center, 8exchange WSI information. Without any doubt, those two Pittsburgh, PA; Department of Pathology, Baystate Medicalare major milestones in the process of establishing a Center, Tufts University School of Medicine, Sprinfield, MAframework for standardized digital Pathology Informatics. August 3, 11:00 – 11:30With standards being established, it is now up to the Introduction: There is an increasing interest in usingvendors to implement those but even more so up to the whole slide imaging (WSI) for diagnostic purposespathology institutions to demand vendors to support of (primary and/or consultation). An important question isthese standards so that the adoption can occur more whether WSI can replace conventional light microscopy asquickly. Having those standards is important but even if the method by which pathologists review histologicthose were supported by most vendors todays, sections and/or cytology slides to render diagnoses.standardized Pathology Informatics needs more: i.e. most Validation of WSI is crucial to ensure that diagnosticdevices today do not support device independent image performance based on digitized slides is at leastinformation and support ICC profiles is critically important equivalent to that of glass slides and light microscopy.for the development of image algorithms that can be Currently, there are no standardized guidelines regardingapplied across different vendors’ images. Without it, validation of WSI for diagnostic use. Methods: The CAP 22 | P a g e
  24. 24. Pathology and Laboratory Quality Center convened a non- for cases in which specimens are imaged in a single focalvendor panel from North America with expertise in digital plane. The participating pathologists had experience withpathology. A total of 611 international publications that met both digital robotic telepathology and whole slide imagingsearch term requirements were identified. Papers outside telepathology. The pathologists listed potential “problem”the scope and related solely to technical components, surgical pathology cases where through-focal imagingeducation and image analysis were subsequently (imaging of multiple planes in the Z-axis) could beexcluded. Publication year, author country, WSI clinical especially important.application, number of observers and cases used,validation method and outcome measurement were In this survey, the following types of cases were identifiedrecorded. Twenty two articles cleared the work group as potentially dependent on imaging multiple focal planesrequirements and were submitted for quality of evidence (Z-axis imaging). In surgical pathology, identifying andgrading by a contracted methodologist. Draft classifying microorganisms by conventional lightrecommendations were developed from this microscopy can be challenging. This is especially so forcomprehensive literature review and panel consensus. certain bacteria such as Helicobacter pylori, because ofFinal recommendations will be completed after a public their small size and shape, fungi, and parasites. Thecomment period. Results and Conclusions : Validation of identification of viral inclusions in single focal plane digitalWSI is essential to ensure that pathologists using this images is challenging. Interpretation of renal biopsies fortechnology for diagnostic purposes will consistently make transplantation rejection benefits from examining thethe same clinical interpretation as they would from glass distribution of lymphocytes in multiple planes. Also, inslides and a light microscope. Validation should address surgical pathology, identifying crystals in single planeboth technical and interpretative components to digital images of biopsies can be difficult. In cancer cases,demonstrate that the WSI system under review produces identification of mitotic figures in surgical pathologyacceptable digital slides for diagnostic interpretation. A sections, and differentiating normal from abnormal mitoticpathologist must be involved in the validation process. In figures, can be problematic. There are many examples oforder to simulate actual clinical practice, a validation cytopathology specimens benefiting from multiple focalsample set should be of a minimum size and include the plane imaging. Examples of cytology cases that mightspectrum of specimen types and diagnoses likely to be benefit from digital imaging in multiple planes include PAPencountered with the intended clinical use. Measurable smears, and body fluids in which there might be aoutcomes should document diagnostic concordance tendency for cells to aggregate into balls. Cells in FNAs(accuracy) between digital and glass slides for the same (fine needle aspirates) can also “ball up” into largeobserver (intra-observer variability) with a reasonable aggregates greater in diameter than the thickness of awashout period. Approved clinical use of WSI should be single Z-axis focal plane digital image. Identification oflimited to the conditions under which validation occurred. crystals and casts in urine specimens can be problematic with single Z-axis plane viewing. Hematopathology studies, using smears, can be challenging, because of theZ-Axis Challenges in Whole Slide need for imaging in exquisite detail, often requiring oil-Imaging (WSI) Telepathology immersion imaging with a through-focal series of images. Interestingly, these “consensus” diagnostic accuracyRonald S. Weinstein, Anna R. Graham, Fangru Lian, challenges often correspond to problem areas that areand Achyut K. Bhattacharyya underrepresented in the digital pathology literature. ThisDepartment of Pathology, University of Arizona College of may reflect the well-known predilection of clinicalMedicine and Arizona Telemedicine Program, Tucson, Arizona investigators to study questions that are likely to yield a August 3, 13 :00 – 13 :40 positive outcome. Before digital pathology is incorporated into routine practice, guidelines for handling of potentialSurgical pathology diagnostic accuracy studies comparing “problem cases” should be incorporated into standardtelepathology (i.e., digital imaging, whole slide imaging, operating procedures.virtual microscopy) and conventional light microscopyoften show slightly lower diagnostic accuracy fortelepathology. When the differences in diagnostic Proof of principle: Colocalization of panaccuracy are not statistically significant, isolated cytokeratins (AE1/AE3), pan cytokeratindiagnostic errors can still have serious implications for (PCK26), and cytokeratin 8/18 using anindividual patients. Integrated Sequential Staining andWe surveyed experienced telepathologists in order to Imaging Deviceidentify potential sources of diagnostic difficulty, especially 23 | P a g e
  25. 25. Judit Zubovits1, Kashan Shaikh3, Alex Corwin3, DanWang4, Sean Dinn2, Gina Clarke4 Chris Peressotti4 ,Zhengyu Pang2, Robert Filkins2, Martin J. Yaffe4 Benefits of a two resolution strategy for1 analyzing virtual slides of Department of Anatomic Pathology, Sunnybrook Health 2Sciences Centre; Diagnostic and Biomedical Technologies, GE immunostained tumors 3Global Research Center; Electrical Technologies & Systems, GE 4Global Research Center; Ontario Institute for Cancer Research Catherine Bor1,2, Paulette Herlin1, Nicolas Elie1, 1and Sunnybrook Research Institute Benoît Plancoulaine August 3, 14 :10-14 :30 1 GRECAN, EA 1772, IFR146 ICORE, Caen University and 2 François Baclesse Cancer centre, Caen, France; PathologyBackground:Co-localization of biochemical and molecular Department, François Baclesse Cancer centre, Caen, France.markers at the cellular and subcellular levels remains anactive area of research and development within image August 3, 14 :30-14 :50analysis. Cytokeratins (CK) are a family of about 20different water-soluble proteins that form the cytoskeleton Background: The quantitative estimation ofof epithelial cells. All of them are used in the clinical lab to immunostained biomarkers on histological sections ofrecognize epithelial cells. We demonstrate a unique tumors provides oncologists with prognostic andoptofluidic instrument and a multiplexing therapeutic indicators. To take into account the frequentimmunohistochemistry technique for sequentially labeling structural and functional heterogeneity of tumors, thedifferent proteins on the same section of breast cancer study of sampled representative whole sections of theand illustrate its use in analyzing the co-localization tumors is mandatory. The fully automated analysis of highbetween 3 fluorescent cytokeratin markers. Methods: resolution virtual slides offers a new opportunity in thisAntibodies: Pan cytokeratin (panCK) AE1/AE3 (Catalog# context. Nevertheless, due to their huge size, it isM3515, DAKO, Carpinteria, CA); cytokeratin 8/18 necessary to define a swift and efficient strategy of(CK8/18) (Clone K8.8 +DC 10), (Catalog# MS-1603-P0, analysis. Methods : The proposed approach includes theLab Vision Fremont, CA); panCK (clone PCK26) (Catalog# carefull subsampling of the high resolution image (0.5 orC1801, Sigma, St. Louis, MS). A de-identified breast 0.25µm) up to the critical resolution of 4µm and thecancer sample was collected from the archives of combined automatic analysis at both levels. The collectionAnatomic Pathology Department at Sunnybrook Health of data dealing with the whole tumor tissue is done at theSciences Centre. Biomarker multiplexing was performed low resolution level and on the whole image (mean andusing an automatic, sequential staining and imaging maximum density of the marker under study andsystem. Images were registered, and the autofluorescence characterization of its distribution). The additionalsignal removed. Co-localization was quantified on a pixel information concerning the cellular and subcellularby pixel basis using Pearson’s correlation coefficient (r). A parameters is done at high resolution, taking advantage ofmean value of r was obtained over multiple regions of a cloning of the structures of interest or of a systematicinterest (ROIs) on the section. Results :Initially, to sampling of tissue details. The low resolution level allowsestimate operational stability, perfectly correlated samples to isolate the tissue compartments and immunostainedwere obtained by imaging the same section but using markers of interest, while the high resolution level helps indifferent exposure times. Due to noise in the image refining the segmentation done at low resolution. Theacquisition system, the r value was not 1 but 0.988 superimposition, on the full resolution image, of the±0.001. A total of 14 ROIs each measuring 758 microns upscaled segmentation masks obtained at low resolution,by 758 microns were acquired on a single section of allows pathologist’ visual control. The intersection of theseinvasive ductal carcinoma of the breast. The correlations masks with the results of an interactive reference markingbetween CK8/18 and panCK(PCK26), panCK(AE1/AE3) of a stereological grid, done at full resolution, leads to anand panCK(PCK26), panCK(AE1/AE3) and CK8/18 were evaluation of the quality of the automatic analysis method0.959 ± 0.016, 0.918 ± 0.03, 0.904 ± 0.029, respectively. which was implemented. Results : The two resolutionSince CK8/18 recognizes all simple epithelia including analysis which is illustrated through several examplesglandular epithelium, it is very likely that CK8/18 is the (quantification of nuclear markers and blood vessels) runsprimary CK in this breast cancer specimen, or all other on commercially available personal computers and allowstypes of CKs are highly correlated to the expression of collection of data from the whole tumor sections in a veryCK8/18.Conclusion: Our work demonstrates a novel and short delay, compatible with the routine practice.versatile system for co-localization studies that can be Conclusions : Thanks to this simple and easy toeasily adapted to work with existing commercially implement strategy, the swift analysis of variousavailable antibodies in a translational research setting. pathological virtual slides seems at hand. 24 | P a g e
  26. 26. Mitotic Figure Recognition: Agreement some strong biases exist (-.35, -.05, and .27). Thus, in the weak agreement between A and B, pathologist C’s ownAmong Pathologists and Computerized vote often determined the majority result. Prediction wouldDetector be much harder for an independent observer. Conclusions : We have trained a computer to recognizeChristopher Malon2, Elena Brachtel5, Eric Cosatto2, Hans mitotic figures, using the pathologists’ consensus. ThePeter Graf2, Atsushi Kurata3, Masahiko Kuroda3, recall of this system for a high precision is within theJohn S. Meyer4, Akira Saito1, Shulin Wu5, bounds of the performance of the original pathologists, ifand Yukako Yagi5 they had to commit only to affirmative or negative1 2 Innovative Service Solutions Division, NEC Corporation; Dept. decisions. Previous work has investigated agreement in 3of Machine Learning, NEC Laboratories America; Dept. of mitotic grades, which are determined by the total number 4Pathology, St. Lukes Hospital; Dept. of Molecular Pathology, of mitotic figures detected. We have evaluated pathologist 5Tokyo Medical University; Dept. of Pathology, Massachusetts agreement on individual mitotic figure recognition, on anGeneral Hospital and Harvard Medical School unprecedented number of figure samples. In so doing, we have exposed systematic differences in the kinds of August 3, 14 :50-15 :10 patterns counted by different pathologists.Background: We compare three pathologists’ Referencesassessments of mitotic figures and develop a system torecognize mitosis using machine learning. Identification of 1. J. P. A. Baak, E. Gudlaugsson, I. Skaland, L. H. R. Guo, J. Klos, T. H. Lende,H. Soiland, E. A. M. Janssen, and A. zur Hausen.mitotic figures is a laborious task that is essential to Proliferation is the strongest prognosticator in node-negative breastgrading and prognosis for breast cancer. A mitotic count cancer: significance, error sources, alternatives, and comparison with molecular prognostic markers. Breast Cancer Res. Treat.,provides one of the three components of the Bloom– 115:241–254, 2009.Richardson grade for invasive carcinoma [2]. Yet, 2. H. J. Bloom and W. W. Richardson. Histological grading andaccording to several studies ([3], [4], and [1]), pathologist prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years. Br. J. Cancer, 11:359–377, 1957.agreement for mitotic grade is rather modest, with [3] 3. J. S. Meyer, C. Alvarez, C. Milikowski, N. Olson, I. Russo, J. Russo,reporting agreement of κ =0.38. An automated mitosis A. Glass, B. A. Zehnbauer, K. Lister, and R. Parwaresch. Breast carcinoma malignancy grading by Bloom-Richardson system vscount could accelerate a pathologist’s work while proliferation index: reproducibility of grade and advantages ofimproving reproducibility. Methods: We ask three proliferation index. Modern Pathology, 18:1067–1078, 2005.pathologists to classify 4,204 sites as “mitosis,” “might or 4. P. Robbins, S. Pinder, N. de Klerk, H. Dawkins, J. Harvey, G. Sterrett, I. Ellis, and C. Elston. Histological grading of breastmight not be mitosis,” or “not mitosis.” We compute carcinomas: a study of interobserver agreement. Hum. Pathol.,statistics of agreement among these pathologists. Based 26(8):873–9, Aug 1995.on majority–agreed sites, we train a computer to recognizethe mitotic figures. The computer uses image analysis Application of digital pathology to createheuristics to extract candidates, then combines manuallydesigned features with features automatically learned by a pathology assisting software toconvolutional neural network, to make a final decision for standardize the diagnosis of interstitialeach candidate point, using a support vector machine. pneumonia.Results: The machine’s performance falls within therange of the humans’ performance if “maybe” labels must Junya Fukuoka, Manami Saito, Tomonori Tanaka,be committed to be affirmative or negative: Kyoko Otani, Takashi Hori, Sayuri Nunomura August 3, 15 :30-15 :50 Table 1. Prediction of test figures where two pathologists agreed Background: Pathological diagnosis in the field of rare disease usually requires special education and training. Especially for the many non-neoplastic diseases, the pathological diagnoses can only be judged by combination of non-specific findings. Usually, the order of importance and/or specificity for each finding is not well described in the textbook, and experience of cases only can give pathologists senses of judgment in each field. Considering the amount of complexity and increase in number of biopsy for upcoming personalized medicine and the shortage of pathologists throughout the world, pathologyAmong the three pathologists, we observe pairwise assisting system to standardize pathological diagnosis isagreements of κAB = .13, κAC = .44, and κBC = .39, but highly needed. The area of interstitial lung disease (ILD) is 25 | P a g e
  27. 27. one of the most complex fields, and the accurate three major regional hospitals in Kyoto, Japan weredistinction of usual interstitial pneumonia (UIP), highly investigated in view of potential pitfalls for human errorslethal disease, from other types of ILD is a critical but and efficiency of the diagnostic works. Possible digitaldifficult role for the surgical pathologists. Material and pathology navigational systems for idealistic pathologyMethods: We have first examined the agreement of diagnosis were also extensively investigated. Results:diagnosis for the 20 cases of interstitial lung disease Automatic review of such basic patient records as name,among 29 pathologists including experts and non-experts age, sex, clinical records, etc, were possible in the routinefor pulmonary pathology. Second, to know the importance laboratory diagnosis of the regional hospitals but not inof findings which leads to the diagnosis of UIP, a system their telepathology diagnostic systems. The lack of theto record evaluating process of each finding before calling automatic review of the information constituted a potentiala specific pathological diagnosis was created using whole for human error. Review of digital radiology images of aslide scanning images (WSI). In short, WSI of the same 20 patient was not available in two of the three regionalcases were analyzed by four pulmonary pathologists. The hospitals owing to limited function of their hospitalsoftware was designated to evaluate 17 queries regarding information system (HIS). Comparison of digital radiologyhistological findings using WSI of the 20 cases before images to digital macroscopic pathology images isreaching to the final diagnosis. Region of interests (ROI) functionally possible but still not in common use.images for positively scored findings were all captured for Comparison of digital macroscopic image at a specificfurther discussion. Scoring data in each finding given by point of tissue sampling of an extirpated organ to itsfour panelists were analyzed statistically using linear specific microscopic image is experimentally possible butregression analysis, and the skewness coefficients (SC) currently not in practical use. Automatic detection offor each finding toward the diagnosis of UIP were fragmented tissues on a slide and their realignment for acalculated. Results and Discussions:The generalized certain diagnostic purpose as modified digital images iskappa coefficient among 29 panelists was confirmed to be experimentally possible but still not in practical use.low as 0.21. If it was limited to pulmonary experts, the Automatic detection of a certain tumour area in a givenkappa value was still not greatest (0.41). Among recorded digital microscopic image is now experimentally possible17 findings by the software, 6 showed significant but still not in practical use.positive/negative SC. The 6 findings include levels ofscarring and architectural destruction. Currently, we are Conclusions: It is clear that there are a lot of possibilitiescreating the software that assists pathological diagnosis for digital navigational systems for pathology diagnosis tofor general surgical pathologists using the 6 findings. The enhance diagnostic efficiency or to ensure correctutility of the software and digital pathology for the diagnosis. We need navigations for idealistic pathology diagnostic processes and digital pathology will provide theroutine clinic will be discussed in the session as solution.well. Evaluation of Ultra High Speed WSIPossibilities of Digital Navigation Viewing SystemSystems for Pathology Diagnosis Yukako Yagi1, Hiroshi Kyusojin2, Shigeatsu Yoshioka2,Yasunari Tsuchihashi Maristela Onozato1, Eugene J Mark1, Matthew P Frosch1,Department of Clinical Pathology Research, Louis Pasteur Centre David N Louis1for Medical Research, Kyoto, Japan 1 2 Massachusetts General Hospital, Boston, MA, USA; Sony August 3, 15 :50-16 :10 Corporation, Tokyo, JapanBackground: Pathology diagnosis is a series of August 3, 16 :10-16 :30informational processes starting from a biopsy material or Context: The ability to digitize histopathology slidesfrom an extirpated surgical material to finally reach one automatically, rapidly and with high resolution has beensentence of diagnosis. The diagnostic processes are pursued by numerous investigators around the world. Oneknown to harbor pitfalls for human errors and may include of the goals is to implement into the clinical practice inmonotonous laborious processes. In the age of digital Pathology. One of the pending issues is the “speed” of thepathology we may be able to create various navigational entire process. The scanning time is faster and thesystems for ideal pathology diagnosis to ensure a correct performance of the scanner is more stable, however, thediagnosis or enhance diagnostic efficiency. In the present viewing speed is still not satisfactory for most users. Westudy possibilities of digital navigations in pathology have evaluated a new whole slide imaging viewing stationdiagnosis are investigated. Methods: Pathology focusing on accessing speed, not only the speed todiagnostic work flows of pathology laboratories of the manipulate the Whole Slide Images (WSI) but also the 26 | P a g e
  28. 28. speed to complete the tasks in many situations such as compression rate. Results: Due to the effect of high-primary diagnosis, conference, teaching, etc. Design: speed processor and cache hit rate improvement usingPlayStation®3 and wireless controllers were adapted to movement prediction prefetch, most of operations areour study because it can manipulate huge graphic data reflected by the display in 1/60s. Even in the case ofwithout any stress locally and also over the network. We cache miss, browsing latency is several times shorter thanhave evaluated the system at three situations at the existing viewers. Moreover, applying game controllerDepartment of Pathology of MGH. 1. Simulation of brings several advantages including tireless panning andsigning-out cases, 2 Discussion tool at a consensus simultaneous multiuser operation. Conclusions: Byconference, 3. Usage at a teaching course. Prior to the using PS3®, our viewer eliminated the negative effects oftrials, we analyzed the required functions of the Graphic- pathology digitalization and derived the benefits. It can beUser Interface (GUI) and Human Interface for each the tool that improves the efficiency of daily operations.purpose and slightly different GUI was made to fit eachpurpose ideally. Results: The system had a remarkable Acknowledgment: The authors thank Department ofperformance. The points of evaluation were 1. user- Pathology, Massachusetts General Hospital, Boston, MA, USA forfriendliness, 2. less frustration, 3 fit to the collaborationpurpose.Pathologists were able to use the systemcomfortably after 0-15 min training. Pathologists whoplayed the game regularly at home required 0-3 minutes Spectral sensing method for practicaltraining. Pathologists who never played the game required use10-15 min training session. There were no complaintsregarding the speed. Most pathologists were satisfied with Yasuhiro Fukunaga, Saori Shimizu, Kensuke Ishii, andthe functionality, usability and speed of the system. The Kosei Tamiyamost difficult situation was to simulate signing-out of Olympus, Inc.,Japancases.Conclusions: The preliminary results of our UltraHigh Speed WSI Viewing System were promising. The August 3, 16 50:10-17 :10speed of viewing the images demonstrated the possibility Background: Digital color correction technology for imageto use WSI in the daily practice in a near future. We analysis and/or diagnosis is developed. Prior researcherscontinue to evaluate the system for further improvements. have used monochrome camera with VariSpecTM tunable imaging filter or field/frame sequential color camera.Acknowledgment: The authors thank Department of However,it takes a long time to capture a number ofPathology, Massachusetts General Hospital, Boston, MA, spectral images in series. Methods:The objective of thisUSA for the collaboration work is to develop a spectral sensing method for practical use. A light beam is divided into two by half mirror. One light beam is for RGB camera and the other is for spectralUltra High Speed WSI Viewing System sensing unit. The spectrum can be sensed at the same time of capturing image by RGB camera. An area ofShigeatsu Yoshioka1, Yukako Yagi2, Naoki Tagami1, spectral sensing is smaller than image and larger thanHiroshi Kyusojin1, Masashi Kimoto1, Yoichi Mizutani1, 1 1 picture element of RGB camera. Result: We applied theKiyoshi Osato , Hiroaki Yada spectral sensing unit for color correction of stained tissue1 2 Sony Corporation, Tokyo, Japan; Harvard Medical School and images. 20 spectrums of specimens were enough for colorMassachusetts General Hospital, Boston, MA, USA correction of whole slide image. Each spectrum was taken within 235msec. We found it corrected the color variation August 3, 16 :30-16 :50 of H&E images successfully. Conclusions: We proposed a spectral sensing method suitable for digital colorBackground: Over the years, we have gained real-time correction for image analysis. We will evaluateprocessing technology for minimum latency operation in effectiveness of the proposed method for diagnosis withgame area. Among its many perceived applications to Whole Slide Imaging system.different areas, this technology will be especially useful fordigital pathology where it will allow the handling of hugeimage data without delay. Methods: In this work, we Color Standardization Systemapplied PS3® to digital pathology viewer for whole-slideimages to evaluate the potential benefit. A wide variety of Implementing Estimation Method forimages were used for the evaluation of viewing speed and Absorption Spectra of Dyeusability – surgical biopsy, needle biopsy, mucosal biopsy,polypectomy, cytology, H&E stain, IHC stain, etc. In terms Shinsuke Tani,Kensuke Ishi, Munenori Fukunishiof data size, the largest one is about 2GB at 1/10 Olympus, Inc.,Japan 27 | P a g e
  29. 29. August 3, 17 :10-17 :30 Background: Image analysis algorithms, coupled with maturing digital whole slide imaging (WSI) technology,Content : Color standardization is indispensable for holds promise to provide tools for morphometricimplementing “tele-pathology” and “computer assisted quantitation in surgical pathology. However,diagnosis” for clinical uses, because the color variations implementation of such strategies will require developmentaffect the performance of digital image analysis as well as and optimization of pattern recognition algorithmsconfusion of pathologists. These color variations are adaptable to diseases showing complex architecturalcaused by not only device conditions but also staining features and cytologic atypias. One such example ismethods, agent, environment, and so on. We developed urothelial carcinoma (UC), of which the aggressivecolor standardization based on multi-spectral techniques. micropapillary variant (MPUC), an aggressive variant ofIn our previous method, however, the workflow is not UC which is frequently under-recognized causingpractical for pathologists, because it is necessary for them diagnostic difficulties. Herein, we demonstrate theto measure the absorption spectra using training samples potential of a recently described pattern recognitionstained by pure dye. We propose the advanced method to algorithm and its application to this challenging use case.improve the accuracy and flexibility of color Methods: We have recently reported SIVQ (Spatiallystandardization without training samples. Method : We Invariant Vector Quantization), an algorithm that uses ringdevelop the method with a multi-spectral sensor module vector predicates for pattern recognition (Hipp and Cheng,and software installed into a digital microscope system. 2010). However, the relative contributions of key SIVQThe algorithm is consists of the following procedure: 1) we ring parameters have not been fully characterized.acquire both the RGB image and the multi-spectral signals Consequently, we systematically tested SIVQ ringfrom multiple points on the specimens. 2) We estimate the parameters for detection of micropapillary nests in fields ofabsorption spectra of dye from the multi-spectral signals a classic case of MPUC by comparing pattern matchbased on statistical method. 3) We implement color quality scores at pixels inside and outside of a pathologist-standardization using the estimated results. Experimental determined “ground truth,” using the receiver operatingresults : Without any training sample, we successfully characteristic (ROC) curve. Results: To standardize ringestimate the absorption spectra of dye and standardize parameter optimization, we tested various ring diameters,colors of H&E images. We evaluate the effectiveness of number of subrings, and inter-ring rotational “wobble”our proposed method at the viewpoint of image feature angles. First, we modulated the number of sub-ringsdetection for digital diagnostic assistance. Conclusion : (skipping every other ring) from 0 to max (diameter inFor color standardization, we proposed an advanced pixels-1), finding incrementally increased AUCmethod suitable for pathological workflow. Wesuccessfully standardized the color variation of H&E performance (from 0.66 to 0.86). Secondly, increasing ringimages by applying the method to digital microscope vector diameter (3-25 pixels) demonstrated initial improvementsystems. through 11 pixels, then degradation in performance, identifying an optimal ring size of 11 (max AUC 0.82). In contrast, adjusting the angle of inter-ring “wobble” from minimum to maximum (1-180 degrees) showed little effect POSTER SESSION on the AUCs (<0.01 variation in AUC). Conclusions: Optimization of SIVQ can yield impressive performance for August 3, 17:30 18:30 detection of complex tumor architectural features. Using a novel iterative discovery workflow applied to this use caseOptimization of detection of complex of MPUC tumor nest detection, we found that maximal subrings showed better ROCs, identified an optimal ringcancer morphology using the SIVQ diameter, and identified minimal contribution of inter-ringpattern recognition algorithm “wobble” to performance. This strategy constitutes the first description of an algorithm capable of histologicJason Hipp1, Steven Christopher Smith1, Jerome Cheng1, identification of MPUC and provides a model workflow 1 2 2 broadly adaptable for future applications.Scott Tomlins , James Monaco , Anant Madabhushi , 1 1Priya Kunju , Ulysses J. Balis1 University of Michigan, Department of PathologyM4233A Medical Science I 1301 Catherine, Ann Arbor, Michigan 248109-0602; Rutgers The State University of New JerseyDepartment of Biomedical Engineering 599 Taylor RoadPiscataway, NJ 28 | P a g e
  30. 30. Tissue refractive index as an objective different biopsies. Conclusions: Our data demonstrate that the refractive index distribution of tissue is a valuableand quantitative measure of pathologic intrinsic marker of disease and can set the basis for a newprocesses generation of computer-assisted, label-free histopathology, to enable earlier disease detection, moreZhou Wang1, Rajyasree Emmadi2, Krishnarao Tangella3, accurate diagnosis, and high-sensitivity screening.Andre Balla1, Shamira Sridharan1 and Gabriel Popescu11 Department of Electrical and Computer Engineering, University Mid-Infrared Spectroscopic Imaging forof Illinois Urbana- Champaign (UIUC) andThe BeckmanInstitute for Advanced Science and Technology Breast Tissue Histopathology:2 Department of Pathology, University of Illinois at Chicago (UIC) Towards ‘Stainless Staining’3Provena United Samaritans Medical Center Walsh MJ1, Mayerich D1, Wiley EL, Emmadi R,2 2 1Background: Traditional tissue examination and Kajdacsy-Balla A, Bhargava R .pathology diagnosis comprises light microscopic 1 Department of Electrical and Computer Engineering, Universityevaluation of formalin-fixed paraffin-embedded (FFPE) of Illinois Urbana- Champaign (UIUC) andThe Beckmansections with various chemical stains. This is, however, a Institute for Advanced Science and Technologyfairly subjective process with inter and intra-observer 2variability. Quantitative phase imaging (QPI) of unstained Department of Pathology, University of Illinois at Chicago (UIC)FFPE tissue sections provides objective, label-free, highlysensitive and quantitative data based on the intrinsic Background: Histopathology is the gold standard fortissue refractive index. We developed Spatial Light disease diagnosis. Current histopathological techniquesInterference Microscopy (SLIM), a new white-light QPI use a panel of special stains and immunohistochemistrymethod that combines Zernike’s phase contrast (IHC) to assess tissue architecture, determine cell typesmicroscopy and Gabor’s holography. Using SLIM we present and to classify cancers. Mid-Infrared (IR)imaged entire unstained prostate tissues with a side-by- spectroscopic imaging is a novel approach to deriveside comparison with adjacent sections of H&E stained chemical images from tissues based on their inherentslides. Methods: Eleven prostate biopsies from 9 patients biochemistry. Methods: Mid-IR images were obtainedwere imaged with both SLIM and traditional light from over 200 individual patients using breast tissuemicroscopy. We utilized SLIM to analyze 4 µm sections of microarrays. Serial sections were stained with a panel ofFFPE prostate tissues that had been de-paraffinized and 13 routinely used special stains and IHC stains. Aplaced in xylene. Three successive slices were stained modified Bayesian classifier was built to assign imagewith H&E and immunohistochemical stains using pixels to the correct cell types and Artificial Neuralantibodies against Cytokeratin 34 beta E12 (high Networks (ANN) to replicate staining. Using Mid-IRmolecular weight CK903) and Alpha methylacyl-CoA- imaging coupled with the modified Bayesian classifier itracemase (AMACR, p504s) and imaged with the same was possible to segment breast tissue into the main 8-cellmicroscope (10x objective) via the bright field channel types of breast tissue from a single unstained tissueequipped with a color camera. For each biopsy, section. Results: The sensitivity and specificity aspathologist identified regions of normal and cancer were measured by average Area Under the Curve (AUC) weredesignated the gold standard and compared to the phase very high (AUC=0.9). Mid-IR imaging coupled with ANNshift variance data obtained by SLIM. Results: The demonstrated that it was possible to accurately reproducespatially resolved scattering map obtained by SLIM the staining of the panel of stains, all in a single unstainedshowed very good correlation with the designated benign slide. Conclusions: Mid-IR imaging coupled withand malignant areas. Regions of high variance (short Bayesian classification and ANN could potentially be ascattering mean free path) corresponded to the darker very valuable tool as an adjunct to currentstaining associated with tumor in H&E sections. Our histopathological procedures, with the ability to take afindings indicate that prostate cancer renders tissue more single unstained tissue section and give a decision on theinhomogeneous, making it more strongly scattering than cell types present and also to replicate staining patterns.adjacent benign tissue. These findings were further This approach could be particularly advantageous whereconfirmed by anisotropy factor measurements wherein limited histological and cytological specimen is availablemalignant tissues consistently exhibited higher g values. A for analysis. Moreover, it is amenable to quantitativemode vs fluctuation contrast histogram constructed from analysis of each component. This novel approachthe SLIM data separates prostate cancer from normal with promises to revolutionize and expand the role of the100% accuracy as tested on 100 tissue regions from 11 pathologists in both research and tissue diagnosis. 29 | P a g e

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