A Better Lens on Disease

May, Mike

doi:10.1038/scientificamerican0510-74

Cited by 48 publications

(26 citation statements)

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“…Digital imaging technology is revolutionizing the practice of medicine 8,9 . The advent of WSI in pathology has removed traditional barriers to studying glass slide interpretation, allowing researchers to understand not only physician magnification and panning behavior but also unobtrusively monitor eye movements to gain high fidelity information regarding the visual interpretive process.…”

Section: Introductionmentioning

confidence: 99%

Accuracy is in the eyes of the pathologist: The visual interpretive process and diagnostic accuracy with digital whole slide images

Bruny

Mercan

Weaver

et al. 2017

Journal of Biomedical Informatics

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Digital whole slide imaging is an increasingly common medium in pathology, with application to education, telemedicine, and rendering second opinions. It has also made it possible to use eye tracking devices to explore the dynamic visual inspection and interpretation of histopathological features of tissue while pathologists review cases. Using whole slide images, the present study examined how a pathologist’s diagnosis is influenced by fixed case-level factors, their prior clinical experience, and their patterns of visual inspection. Participating pathologists interpreted one of two test sets, each containing 12 digital whole slide images of breast biopsy specimens. Cases represented four diagnostic categories as determined via expert consensus: benign without atypia, atypia, ductal carcinoma in situ (DCIS), and invasive cancer. Each case included one or more regions of interest (ROIs) previously determined as of critical diagnostic importance. During pathologist interpretation we tracked eye movements, viewer tool behavior (zooming, panning), and interpretation time. Models were built using logistic and linear regression with generalized estimating equations, testing whether variables at the level of the pathologists, cases, and visual interpretive behavior would independently and/or interactively predict diagnostic accuracy and efficiency. Diagnostic accuracy varied as a function of case consensus diagnosis, replicating earlier research. As would be expected, benign cases tended to elicit false positives, and atypia, DCIS, and invasive cases tended to elicit false negatives. Pathologist experience levels, case consensus diagnosis, case difficulty, eye fixation durations, and the extent to which pathologists’ eyes fixated within versus outside of diagnostic ROIs, all independently or interactively predicted diagnostic accuracy. Higher zooming behavior predicted a tendency to over-interpret benign and atypia cases, but not DCIS cases. Efficiency was not predicted by pathologist- or visual search-level variables. Results provide new insights into the medical interpretive process and demonstrate the complex interactions between pathologists and cases that guide diagnostic decision-making. Implications for training, clinical practice, and computer-aided decision aids are considered.

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Section: Introductionmentioning

confidence: 99%

Accuracy is in the eyes of the pathologist: The visual interpretive process and diagnostic accuracy with digital whole slide images

Bruny

Mercan

Weaver

et al. 2017

Journal of Biomedical Informatics

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“…Analysis of the expression profiles of multiple markers in a common region of interest, such as a tumour region, can potentially reveal important information about the tumour’s molecular composition. Visual analysis is subjective and prone to human error, and in a number of studies these have been shown to result in significant inter- and intra-observer variability 1–3 . This observation demonstrates the need for high-quality automated analysis.…”

Section: Introductionmentioning

confidence: 99%

Hyper-Stain Inspector: A Framework for Robust Registration and Localised Co-Expression Analysis of Multiple Whole-Slide Images of Serial Histology Sections

Trahearn

Epstein

Cree

et al. 2017

Sci Rep

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In this paper, we present a fast method for registration of multiple large, digitised whole-slide images (WSIs) of serial histology sections. Through cross-slide WSI registration, it becomes possible to select and analyse a common visual field across images of several serial section stained with different protein markers. It is, therefore, a critical first step for any downstream co-localised cross-slide analysis. The proposed registration method uses a two-stage approach, first estimating a fast initial alignment using the tissue sections’ external boundaries, followed by an efficient refinement process guided by key biological structures within the visual field. We show that this method is able to produce a high quality alignment in a variety of circumstances, and demonstrate that the refinement is able to quantitatively improve registration quality. In addition, we provide a case study that demonstrates how the proposed method for cross-slide WSI registration could be used as part of a specific co-expression analysis framework.

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“…Certainly the computer processing power now available is approaching the point where there could feasibly be the capability to scan bone marrow aspirate slides as a matter of routine 43. Would the use of digital images be an advantage, permitting collective or expert interpretation even at a distance, thus avoiding some of the interpretation pitfalls which have been discussed in this article, or if coupled with automated interpretation, would it lead to a deskilling of haematologists and thus contribute to misdiagnoses?…”

Section: Future Pitfallsmentioning

confidence: 99%

Pitfalls in obtaining and interpreting bone marrow aspirates: to err is human

Bain

Bailey

2011

J Clin Pathol

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Pitfalls relating to bone marrow aspirates and their interpretation start even before the aspirate is obtained. There can be failure to perform an aspiration that is clinically indicated or, conversely, an aspiration may be done that is not actually necessary. Once an aspirate is obtained it may be unhelpful because it is a blood tap or very dilute, or because of the sampling error that is intrinsic to the procedure. Even if an adequate aspirate is obtained, it may be misinterpreted. Megaloblastic marrows and children's marrows with increased haematogones or marked reactive changes are particularly prone to misinterpretation. A constant awareness of potential pitfalls and an assessment of the aspirate in the appropriate clinical context will help to reduce errors.

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A Better Lens on Disease

Cited by 48 publications

References 0 publications

Accuracy is in the eyes of the pathologist: The visual interpretive process and diagnostic accuracy with digital whole slide images

Accuracy is in the eyes of the pathologist: The visual interpretive process and diagnostic accuracy with digital whole slide images

Hyper-Stain Inspector: A Framework for Robust Registration and Localised Co-Expression Analysis of Multiple Whole-Slide Images of Serial Histology Sections

Pitfalls in obtaining and interpreting bone marrow aspirates: to err is human

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