Pathologie (Heidelberg, Germany)最新文献

Joint endoprosthetics is one of the most successful surgical-orthopedic procedures worldwide, enabling pain reduction and complete restoration of mobility. In the Federal Republic of Germany, around 400,000 joint endoprostheses, hip and knee joints are currently implanted every year ( https://www.eprd.de/de ) and around 30,000 replacement operations or revisions are carried out. Although there is constant optimization in the various technical and medical sectors of material development, construction, antibiotic therapy strategies, and surgical methodology of surgical joint replacement, factors that reduce service life and a variety of prosthesis-associated pathologies still exist. For implant revisions, the SLIM consensus classification, which is internationally accepted in the scientific literature, should be applied. The revised version of the SLIM consensus classification defines a comprehensive etiological spectrum of local joint endoprosthesis-associated pathologies histopathologically using nine types. In addition, this includes particle characterization and differentiation from endogenous particles. The analysis of the removed explant is the task of technical disciplines. Their mechanical and physical tests can provide information on the cause of the damage. For example, an examination of the fracture surface can determine whether the fracture occurred over a longer period of time (fatigue fracture, sustained fracture) or whether it occurred suddenly (forced fracture). It is therefore important to note that this diagnosis is carried out in an interdisciplinary manner, particularly in the context of peri-implant, mostly bacterial infections, and in the case of primarily functional and material-related causes. This interdisciplinary approach is particularly necessary for complex endoprosthesis pathologies, which require precise causal and technology-based damage analysis. In addition to histopathology, definitive diagnosis is only possible in a clinical-orthopedic, microbiological, laboratory medicine-related, radiological, nuclear medicine-related, material-technical and, in particular, biomechanical-technical context.

Background: Pathology, traditionally focused on classification and diagnosis, is continuously evolving through new technologies. Advances in proteomics, epigenetics, tissue staining, and 3D imaging expand the possibilities of classical morphology.

Aim of the study: The aim of this study was to investigate how modern technologies can improve diagnostic accuracy and therapy selection and how they can be integrated into pathologic routine diagnostics.

Materials and methods: Recent studies in proteomics, epigenetics, multiplex tissue staining, and 3D tissue imaging were analyzed to assess their application and the challenges of clinical implementation.

Results: The analysis shows significant potential for pathologic diagnostics. Proteomics provides a deeper understanding of the molecular architecture of tumors, while epigenetics and 3D genome architecture offer new insights into genetic regulation and tumor heterogeneity. Multiplex tissue staining and 3D tissue imaging improve spatial tissue analysis.

Discussion: Despite the potential to improve diagnostics, high costs, technical complexity, and lack of standardization hinder integration into clinical practice. Nevertheless, these technologies offer promising approaches for optimizing diagnostics and therapy selection. Research and interdisciplinary collaboration are crucial to successfully integrating these innovations into routine clinical practice.

As in general pathology, digitalization is also inexorably making its way into dermatopathology. This article examines the current state of digitalization in German dermatopathology laboratories based on the authors' own experiences, the current study situation, and a survey of members of the Dermatological Histology Working Group (ADH). Experiences with the establishment of a digital laboratory workflow, artificial intelligence (AI)-based assistance systems, and whole slide images (WSI)-based training programs are discussed. Digitalization in dermatopathology is an opportunity to simplify and accelerate processes, but there are some hurdles to overcome.

Numerous diagnostic clues are used in routine dermatopathological diagnostics. Ideally, a diagnostic clue can lead directly to a specific diagnosis and save further time-consuming additional diagnostic procedures. This article discusses the concept of "clues to diagnosis" starting from its historical beginnings with a review of relevant studies and including current literature. Selected clues to dermatophytosis, psoriasis, and mycosis fungoides are analyzed. In addition, some newer and still little-known dermatopathological clues to inflammatory and infectious skin disease are presented. The aim is to specify the use of clues on the basis of current findings and to draw attention to scientifically sound clues.

Background: The structured recording of data from histopathological findings and their interoperability is critical for quality assurance in pathology.

Materials and methods: To harmonize the content of the reports, the International Collaboration on Cancer Reporting (ICCR) has defined standardized datasets. These datasets are not yet available in German nationwide. This gap is addressed here using the transurethral bladder resection (TUR-B) dataset as a use case.

Results: We describe the process of establishing the datasets by carrying out translation, mapping on SNOMED CT codes, and using SNOMED CTs hierarchy to fill dropdown menus. Furthermore, we identified rules for checking for self-consistency of reports by using the example of the TUR bladder.

Discussion: With this article, we have created an example of a German version of the ICCR TUR‑B dataset including mapping to the SNOMED CT terminology. Further activities should include the definition of overarching cancer disease models to further exploit the potential of SNOMED CT.