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関 来未 バーチャルスライドのアノテーションを用いた病理所見の標準化研究
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関 来未 バーチャルスライドのアノテーションを用いた病理所見の標準化研究
1.
バーチャルスライドのアノテーションを 用いた病理所見の標準化研究 関 来未¹, 田中
伴典², 奥寺 康司³, 功刀 しのぶ⁴, 齊藤 涼子⁵, 笠井 考彦⁶, 福岡 順也¹ 1)亀田総合病院 臨床病理科 2)神戸大学医学部附属病院 病理診断科 3)横浜市立大学 病態病理学 4)東北大学大学院医学系研究科病理診断 学分野 5)奈良県立医科大学 6)日本医科大学 解析人体病理学
2.
introduction ・病理診断は主観的な所見の判断に基づくことが多く、評価者間のば らつきを生むことがある。間質性肺炎はその代表例と言える。 ・過敏性肺炎のガイドラインが2020年に改訂されたが、病理診断基準 の1つに気道中心性線維化(ACF)が加えられた。診断を大きく左右す る所見であるが、病理医間における判断一致度は不明瞭である。 ・本研究では、バーチャルスライドとアノテーション機能を用いて、病理 医によるACFの判定におけるばらつきについて検討した。
3.
ガイドライン American Journal of
Respiratory and Critical Care Medicine Volume 202 Number 3 | August 1 2020
4.
1. 間質の慢性 線維化病変 2. 気道中心性 線維化(ACF) 3.
Poorly formedな 非壊死性肉芽腫 +他疾患を示唆 する所見がない HP Probable HP +他疾患を示唆 する所見がない ガイドライン 1. 間質の慢性 線維化病変 2. 気道中心性 線維化(ACF) 気道中心性線維化があればprobable HP以上の診断となる and and and
5.
ACFとは Airway-centered (Interstitial) FibrosisまたはBronchiolocentric Fibrosis(BCF)と呼ばれる、末梢気道周囲の線維化 airway
6.
the key finding
was a distinctive pattern of airway-centered interstitial fibrosis centered on membranous and respiratory bronchioles 1)より ・気道中心性病変の1所見として、喫煙、鳥、農薬などの吸入暴露歴 のある症例にみられると報告された ・さまざまな疾患・組織学的パターンにみられ、 HPに特異的な所見で はないが、 ATS/JRS/ALAT過敏性肺炎(Hypersensitivity pneumonitis: HP)ガイドライン2020年改訂版で診断基準の指標の1つ に加わった。 ACFとは 吸入曝露歴・画像診断・予後との相関に統一した見解が得 られていない
7.
Pilot研究 ①一般病理医5人がバーチャルスライドを用いて、間質性肺炎のVATS検 体10例についてACFと判断した領域をアノテーションした ②バーチャルスライドをパッチ化し、パッチ内にアノテーションがある=1、な し=0、組織なし=9としてカウントした ③同じ領域をアノテーションした病理医同士を、ACFの認識が類似してい ると判断し、 ②のデータから5人の病理医をクラスター化した ④大きく2つにクラスター化された
8.
5人のアノテーションを重ねた結果 病理医1:blue 病理医2:yellow 病理医3:green 病理医4:red 病理医5:light blue ACFと認識する領域が異なった
10.
本研究 ・症例を特発性肺線維症(IPF)と過敏性肺炎(HP)に限定し、HPの診断と一 番一致するACFの認識をもつ病理医のクラスターを特定できれば、ACFの 標準化につながると予想した。 方法 ①過去にHPと診断された症例とコントロールとしてIPFと診断された症例 の外科的肺生検標本50例を抽出した。 ②バーチャルスライドを使用し、5人の病理医により、Objective Viewerを 用いてACFと考える部位にアノテーションを行った。 ③全アノテーションをオーバーレイし、その一致度について検討を行った。 スライド画像をパッチ化し、アノテーションの有無により2値化(あり=1、な し=0)されたデータに基づきクラスター解析を行った。
11.
結果:5人の病理医がそれぞれACIFと判断した領域(例) 病理医A:green 病理医B:blue 病理医C:pink 病理医D:light blue 病理医A:red
12.
解析結果 ・同様の判断基準をもつクラスターはクラスター化されなかった (Fleiss κ値: 0.1)
13.
・病理医それぞれのアノテーションの数とHPの有無を比較(Mann-Whitney の検定)すると、HPの診断と相関する病理医が分かった。 →これらの病理医が示すACIFの特徴を抽出すれば、HPの診断に相関する ACIFを定義できると推測する B (p値<0.001) C
(p値=0.054) D (p値=0.206) E (p値=0.118) A (p値=0.045)
14.
結論 バーチャルスライドのアノテーション機能を用いることで、標本上に複数病 理医の評価をオーバーレイすることが可能となり、病理医間のACFの認識 に違いがあることが描出された。診断者間にばらつきのある診断の標準化 につながる方法として提唱したい。
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