Seminars in Diagnostic Pathology最新文献

英文中文

Breast Pathology Through the Digital Lens 数字镜头下的乳腺病理学

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-04-24 DOI: 10.1016/j.semdp.2025.150914

Alexis Heller, Lakshmi Kowtha, Kriti Tiwari, Malini Harigopal

Digital pathology (DP) has significantly transformed breast pathology at Mount Sinai Hospital by enhancing diagnostic accuracy, collaboration, and education. The institution has integrated the Philips IntelliSite Pathology Solution (PIPS) for primary diagnostic use, which allows for high-resolution whole slide imaging (WSI) of surgical pathology slides. The workflow involves the scanning of glass slides to create digital images, which are then reviewed and annotated by pathologists. Key benefits of this workflow include immediate slide sharing with colleagues, efficient sign-outs, improved detection of low-positive immunohistochemical staining, and detailed measurements of tumors and margins. The ability to access a digital archive for retrospective case reviews further enhances diagnostic capabilities. However, limitations persist, including challenges in visualizing small calcium oxalate crystals and the need for manual interpretation of certain stains. Although the process of digitizing slides initially increased turnaround times, this has been mitigated by increased staffing and scanner availability. Additionally, the transition to DP has already paved the way for artificial intelligence, serving as a benchmark to develop algorithms for prognostic and predictive biomarkers, predict immunotherapy response, and thus transform cancer care. The overall impact of DP on breast pathology is overwhelmingly positive, with continued efforts to address its limitations.

数字病理学（DP）通过提高诊断准确性、协作和教育，显著改变了西奈山医院的乳腺病理学。该机构集成了飞利浦IntelliSite病理学解决方案（PIPS）用于初级诊断，允许手术病理切片的高分辨率全切片成像（WSI）。该工作流程包括扫描玻片以创建数字图像，然后由病理学家审查和注释。该工作流程的主要优点包括与同事即时共享幻灯片、高效签到、改进的低阳性免疫组织化学染色检测以及肿瘤和边缘的详细测量。访问回顾性病例审查的数字档案的能力进一步增强了诊断能力。然而，局限性仍然存在，包括可视化小草酸钙晶体的挑战和需要人工解释某些污渍。虽然数字化幻灯片的过程最初增加了周转时间，但随着人员配备和扫描仪可用性的增加，这一问题得到了缓解。此外，向DP的过渡已经为人工智能铺平了道路，作为开发预后和预测性生物标志物算法的基准，预测免疫治疗反应，从而改变癌症治疗。DP对乳腺病理的总体影响是压倒性的积极，继续努力解决其局限性。

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引用次数: 0

The role of frozen section in gynecologic pathology 冷冻切片在妇科病理中的作用

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-04-23 DOI: 10.1016/j.semdp.2025.150913

Harsimar Kaur, Minhua Wang

Intraoperative consultation using frozen sections in gynecologic surgery aids in determining the scope of the surgery. The main indications are to evaluate the presence of malignancy, determine the primary site, histologic type, and grade of the tumor, and assess the extent of local tumor invasion and distant spread.

A thorough gross examination of submitted specimens helps identify critical features such as specimen integrity, tumor size, serosa and ovarian surface involvement, myometrial involvement, and lymph node status. Uterine endometrial carcinomas are classified based on histologic type and grade, with attention to features such as myometrial invasion, cervical stromal involvement, and gross tumor size. Correct evaluation of uterine mesenchymal tumors, ovarian epithelial tumors, sex-cord stromal tumors, and germ cell tumors is essential to guide the decision between conservative and extensive surgical staging. It is challenging but essential to distinguish primary ovarian tumors from metastatic neoplasms. Prompt and clear communication with the operating surgeon is crucial for successful consultation. Providing definitive diagnoses on frozen sections can sometimes be difficult; however, understanding the management algorithm and maintaining an open dialogue with the surgeon about differential diagnoses can help in offering the necessary information for subsequent management steps.

在妇科手术中使用冷冻切片进行术中会诊有助于确定手术范围。主要适应症是评估恶性肿瘤的存在，确定肿瘤的原发部位、组织学类型和分级，评估肿瘤局部侵袭和远处扩散的程度。对提交的标本进行彻底的大体检查有助于确定关键特征，如标本完整性、肿瘤大小、浆膜和卵巢表面受累情况、肌层受累情况和淋巴结状况。子宫内膜癌是根据组织学类型和分级进行分类的，主要关注子宫肌层侵犯、宫颈间质累及和肿瘤大体大小等特征。正确评估子宫间质肿瘤、卵巢上皮性肿瘤、性索间质肿瘤和生殖细胞肿瘤对于指导保守和广泛手术分期的决定至关重要。区分原发性卵巢肿瘤和转移性肿瘤是一项具有挑战性的工作。与外科医生及时、清晰的沟通是成功会诊的关键。对冷冻切片提供明确的诊断有时是困难的；然而，了解管理算法并与外科医生就鉴别诊断保持开放的对话有助于为后续的管理步骤提供必要的信息。

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引用次数: 0

Intraoperative examination in bone and soft tissue pathology 术中骨及软组织病理检查

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-04-17 DOI: 10.1016/j.semdp.2025.150904

Ali Alani , Julio A. Diaz-Perez

Intraoperative consultation is a vital tool in bone and soft tissue pathology. Cytologic and histologic interpretation within the clinical, radiologic, and surgical context is crucial for accurate analysis. This review highlights the most significant aspects of this procedure for evaluating musculoskeletal diseases. We outline the process and guide on determining differentiation lines in primary connective tissue neoplasms, assessing malignant potential, evaluating resection margins, investigating metastatic disease, and examining suppurative infections, particularly those associated with prosthetic materials. Furthermore, we summarize additional applications of the procedure.

术中会诊是骨和软组织病理的重要工具。临床、放射学和外科背景下的细胞学和组织学解释是准确分析的关键。这篇综述强调了评估肌肉骨骼疾病的最重要的方面。我们概述了确定原发性结缔组织肿瘤分化线的过程和指南，评估恶性潜能，评估切除边缘，调查转移性疾病，检查化脓性感染，特别是与假体材料相关的感染。此外，我们总结了该程序的其他应用。

引用次数: 0

An adapted & improved validation protocol for digital pathology implementation 一种适应和改进的数字病理学实施验证协议

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-04-15 DOI: 10.1016/j.semdp.2025.150905

Ying-Han R. Hsu , Iman Ahmed , Juliana Phlamon , Charlotte Carment-Baker , Joyce Yin Tung Chan , Ioannis Prassas , Karen Weiser , Shaza Zeidan , Blaise Clarke , George M. Yousef

Digital Pathology (DP) is transforming disease diagnosis by providing rapid and efficient analysis of tissue samples. However, ensuring the accuracy and reliability of diagnoses is crucial. This manuscript outlines University Health Network (UHN)'s journey towards the development of a customized validation protocol for implementing a digital workflow for primary clinical assessment. Drawing on guidelines from the Royal College of Pathologists (RCPath) UK and the College of American Pathologists (CAP), UHN has tailored its approach to accommodate the unique needs of its 14 subspecialty groups. Our protocol emphasizes pathologist-led self-validation, integration of diverse subspecialty cases, and a phased rollout with continuous monitoring. Additionally, the use of change management principles inspired by Leeds University (CCP) played a critical role in guiding the process, ensuring pathologists’ comfort with digital workflows, and addressing subspecialty-specific challenges. This comprehensive validation protocol supports UHN’s broader goals of leveraging DP for clinical practice while ensuring patient safety and data integrity.

数字病理学（Digital Pathology，DP）通过对组织样本进行快速高效的分析，正在改变疾病诊断的方式。然而，确保诊断的准确性和可靠性至关重要。本手稿概述了大学健康网络（UHN）为实施初级临床评估的数字化工作流程而开发定制验证协议的历程。借鉴英国皇家病理学家学会 (RCPath) 和美国病理学家学会 (CAP) 的指导方针，UHN 对其方法进行了调整，以适应其 14 个亚专科小组的独特需求。我们的方案强调病理学家主导的自我验证、整合不同的亚专科病例以及分阶段推出并持续监控。此外，受利兹大学（CCP）启发而采用的变革管理原则在指导流程、确保病理学家适应数字化工作流程以及应对亚专科特定挑战方面发挥了至关重要的作用。这一全面的验证协议支持了 UHN 更广泛的目标，即在确保患者安全和数据完整性的同时，将 DP 用于临床实践。

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引用次数: 0

Frozen section analysis in community settings: Diagnostic challenges and key considerations 冰冻切片分析在社区设置：诊断的挑战和关键考虑

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-04-15 DOI: 10.1016/j.semdp.2025.150903

Rashna Meunier, Kisong Kim, Noureldien Darwish, Syed M. Gilani

The frozen section is a useful tool for pathologists and surgeons as it provides rapid microscopic evaluation of tissue in the intraoperative setting. The diagnosis rendered on the frozen section assists the surgeon in making intraoperative decisions. In community hospitals, which usually have a general surgical pathology coverage model, frozen section requests occur in various clinical settings. This review covers the everyday situations that require frozen section analysis in a community-based hospital setting. It outlines the frozen section procedure, discusses histologic evaluation, and highlights the diagnostic challenges that may arise during this process.

对于病理学家和外科医生来说，冷冻切片是一种有用的工具，因为它可以在术中对组织进行快速的显微评估。冰冻切片的诊断有助于外科医生做出术中决定。在社区医院，通常有一个普通的外科病理覆盖模式，冷冻切片的要求出现在各种临床设置。本综述涵盖了在社区医院环境中需要冷冻切片分析的日常情况。它概述了冷冻切片程序，讨论了组织学评估，并强调了在此过程中可能出现的诊断挑战。

引用次数: 0

The importance of frozen section analysis in head, neck, and endocrine pathology 冰冻切片分析在头颈部及内分泌病理中的重要性

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-04-08 DOI: 10.1016/j.semdp.2025.150902

Noureldien Darwish, Syed M. Gilani

The diagnosis of head, neck, and endocrine (HNE) malignancies involves the correlation of histologic features with clinical and radiological findings and, ideally, in a multidisciplinary approach. Frozen section examination of HNE lesions from the oral cavity, sinonasal area, pharynx and larynx, salivary gland, or thyroid gland provides an immediate intraoperative evaluation for a tissue diagnosis, specimen margin assessment, tumor depth of invasion, and determining other important histologic features. Frozen sections of the salivary gland tumors help to differentiate benign from malignant and low-grade from high-grade tumors and evaluate lymph node involvement. Advances in diagnostic modalities, including updates in the WHO 5th edition, have enhanced pathologists' ability to navigate these challenging diagnoses. This review highlights the frequently encountered frozen section requests in daily HNE practice and discusses diagnostic challenges and differential diagnosis.

头颈部和内分泌（HNE）恶性肿瘤的诊断涉及组织学特征与临床和放射学表现的相关性，理想情况下，采用多学科方法。冰冻切片检查从口腔、鼻窦区、咽、喉、唾液腺或甲状腺的HNE病变，为术中组织诊断、标本边缘评估、肿瘤浸润深度和确定其他重要的组织学特征提供了即时的评估。唾液腺肿瘤的冰冻切片有助于区分良性和恶性、低级别和高级别肿瘤，并评估淋巴结累及情况。诊断方式的进步，包括世卫组织第5版的更新，提高了病理学家应对这些具有挑战性的诊断的能力。这篇综述强调了在日常HNE实践中经常遇到的冷冻切片要求，并讨论了诊断挑战和鉴别诊断。

引用次数: 0

Intraoperative frozen section diagnosis of lung specimens: An updated review 术中肺标本冰冻切片诊断：最新综述

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-04-01 DOI: 10.1016/j.semdp.2025.150901

Yuchen Han , Guoping Cai

Intraoperative frozen section (FS) diagnosis is a critical step in the management of patients with pulmonary lesions, which provides guidance for surgical resection procedures. Intraoperative FS diagnosis requires a comprehensive approach that integrates clinical information, imaging findings, and histopathological evaluation. Effective communication between pathologists and surgeons is vital for achieving the best practice result. Intraoperative FS diagnosis faces new challenges in the era of new lung cancer screening strategy, changes in histological tumor classification and addition of new lung tumor entities. Below we discuss the challenges in pre-intraoperative assessment and intraoperative diagnosis of pulmonary nodules. Key considerations include clinical information and CT imaging findings. Multiple nodules require strategic sampling, focusing on the most malignant-appearing lesion. Intraoperative FS diagnosis involves recognizing growth patterns and cellular atypia that help distinction of preinvasive lesions, minimal invasive, and invasive tumor although it might be challenging. Distinguishing benign from malignant tumors is also discussed, with emphasis on histological and imaging features. Special considerations include spread through air spaces (STAS), margin assessment, lymphoproliferative disorders, infectious diseases, and benign or uncertain-behavior tumors.

术中冷冻切片（FS）诊断是肺病变患者治疗的关键步骤，为手术切除提供指导。术中FS诊断需要综合临床信息、影像学表现和组织病理学评估。病理学家和外科医生之间的有效沟通对于获得最佳实践结果至关重要。在新的肺癌筛查策略、组织学肿瘤分类的变化和新的肺肿瘤实体的增加的时代，术中FS的诊断面临新的挑战。下面我们讨论在术前评估和术中诊断肺结节的挑战。主要考虑因素包括临床信息和CT成像结果。多发结节需要有策略的取样，集中在最恶性的病灶上。术中FS的诊断包括识别生长模式和细胞异型性，这有助于区分侵袭前病变、微创性和侵袭性肿瘤，尽管这可能具有挑战性。良恶性肿瘤的区分也进行了讨论，重点是组织学和影像学特征。特殊的考虑包括通过空气间隙扩散（STAS）、边缘评估、淋巴增生性疾病、感染性疾病和良性或行为不确定的肿瘤。

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引用次数: 0

Neuropathology Intraoperative Consultation 术中会诊

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-03-21 DOI: 10.1016/j.semdp.2025.150899

Nalin Leelatian , Declan McGuone

The goals of surgical neuropathology intra-operative consultation, (IOC), are to confirm sampling of diagnostic specimens and to guide surgical approaches. Understanding the clinical and imaging findings, and clear communication with the neurosurgeons, are critical for IOC to be informative. While neuropathologists typically lead this process at large academic institutions, other institutions may rely on surgical pathologists to provide neuropathology IOC. Thus, a stepwise approach for the evaluation of neuropathology specimens can be valuable. This review provides a diagnostic algorithm for neuropathology IOC and illustrates its utilization through nine example clinical vignettes. Pre-operative clinical and imaging findings, differential diagnosis, and critical diagnostic pitfalls are discussed. We discuss key findings that should be conveyed to the neurosurgery team at the time of IOC for optimal specimen handling and surgical guidance, to ensure adequate tissue sampling for subsequent pathologic and ancillary studies.

外科神经病理学术中会诊（IOC）的目的是确认诊断标本的取样并指导手术入路。了解临床和影像学表现，以及与神经外科医生的清晰沟通，对于IOC的信息提供至关重要。虽然神经病理学家通常在大型学术机构领导这一过程，但其他机构可能依赖外科病理学家提供神经病理学IOC。因此，逐步评估神经病理标本的方法是有价值的。这篇综述提供了一种神经病理学IOC的诊断算法，并通过9个临床实例说明了它的应用。术前临床和影像学表现，鉴别诊断，和关键的诊断陷阱进行了讨论。我们讨论了在IOC时应传达给神经外科团队的关键发现，以获得最佳的标本处理和手术指导，以确保后续病理和辅助研究中有足够的组织采样。

引用次数: 0

Frozen section evaluation of deceased donor kidney biopsies: A field guide 冷冻切片评估已故供体肾活检：现场指南

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-03-20 DOI: 10.1016/j.semdp.2025.150900

Andrea R. Lightle

The demand for donated kidneys is steadily increasing, making it critical that the transplant community maximizes the use of organs procured from deceased donors. When a donated kidney becomes available, a transplant program evaluates the suitability of the organ for their patients and will choose whether to decline or accept. A pre-implantation biopsy may be performed if the transplant center is unsure about the suitability of the organ. More than half of deceased donor kidneys are biopsied prior to implantation, and “biopsy findings” is the most commonly cited reason for a kidney not being accepted for transplantation. This is despite the fact that retrospective analyses at multiple centers have revealed that the results of kidney pre-implantation biopsies are poorly reproducible, inaccurate, and do not correlate with clinical outcomes. A prospective study comparing the scores of paraffin-embedded pre-implantation biopsies given by on-call pathologists to scores given by experienced renal pathologists found that only the evaluation by the renal pathologist was significantly associated with graft function and survival. In 2023, the Organ Procurement and Transplantation Network implemented the Standardized Kidney Biopsy Reporting and Data Collection policy, specifying how kidney pre-implantation biopsies should be scored and reported. This article aims to increase awareness of the reporting criteria for kidney pre-implantation biopsies, thereby increasing the accuracy and reproducibility of the results and decreasing the number of deceased donor kidneys that are inappropriately discarded.

对捐赠肾脏的需求正在稳步增长，因此，移植界必须最大限度地利用从已故捐赠者处获得的器官。当捐赠的肾脏可用时，移植项目会评估该器官是否适合他们的病人，并选择是拒绝还是接受。如果移植中心不确定该器官是否适合移植，可以进行移植前活检。超过一半的已故供体肾脏在移植前进行了活组织检查，“活组织检查结果”是肾脏不被接受移植的最常见原因。尽管多个中心的回顾性分析表明，肾脏植入前活检的结果重复性差、不准确，且与临床结果无关。一项前瞻性研究比较了随叫随到的病理学家给出的石蜡包埋植入前活检的评分与经验丰富的肾脏病理学家给出的评分，发现只有肾脏病理学家的评估与移植物功能和存活有显著相关性。2023年，器官获取和移植网络实施了标准化肾活检报告和数据收集政策，规定了肾脏植入前活检的评分和报告方式。本文旨在提高人们对肾脏植入前活检报告标准的认识，从而提高结果的准确性和可重复性，并减少因不当丢弃而死亡的供体肾脏的数量。

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Frozen sections in gastrointestinal, pancreatobiliary and hepatic pathology: A review 胃肠道、胰胆管和肝脏病理的冰冻切片：综述

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Seminars in Diagnostic Pathology

Pub Date : 2025-03-12 DOI: 10.1016/j.semdp.2025.150894

Tony El Jabbour , Kisong Kim , Mohamad Besher Ourfali , Hwajeong Lee

In the digestive system, intraoperative frozen sections are commonly requested to assess surgical margins, obtain diagnostic material, and evaluate incidental lesions. Frozen section results may alter surgical planning or lead to the discontinuation of the procedure. As a practicing pathologist, understanding the indication for frozen section and its impact on patient management would improve communication with surgeons. Likewise, understanding what to look for and focus on, what to relay to the requester and common diagnostic pitfalls would improve the quality of service one provides and patients’ outcome. Herein we provide an overview of common frozen sections encountered during variable abdominal procedures to include pancreaticoduodenectomy, gastrectomy, appendectomy, colorectal resection and Hirschsprung pull-through along with ample microscopic images.

在消化系统中，术中冷冻切片通常被要求评估手术边缘，获得诊断材料，并评估偶然病变。冰冻切片结果可能会改变手术计划或导致手术终止。作为一名执业病理学家，了解冰冻切片的适应证及其对患者管理的影响将有助于改善与外科医生的沟通。同样，了解要寻找和关注什么，向请求者传达什么以及常见的诊断缺陷，将提高所提供服务的质量和患者的结果。在此，我们概述了各种腹部手术中常见的冷冻切片，包括胰十二指肠切除术、胃切除术、阑尾切除术、结肠切除术和巨结肠切除术，并提供了大量的显微镜图像。

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