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Informatics, digital & computational pathology



Authors: Aisha Abdelhafez, M.Sc., Syeda F. Absar, M.D., M.P.H., Vitria Adisetiyo, Ph.D., Yomna Amer, M.B.B.Ch., Swikrity Upadhyay Baskota, M.B.B.S., M.D., Harsh Batra, M.B.B.S., D.C.P., D.N.B., Darci R. Block, Ph.D., Dariusz Borys, M.D., Charles Caldwell, Ph.D., Po-Hsuan Cameron Chen, Ph.D., Jerome Cheng, M.D., John D. Cochran, M.D., Robin L. Dietz, M.D., Samreen Fathima, M.B.B.S., Julie Feldstein, M.D., Roberto Gianani, M.D., Ricardo Gonzalez, M.D., M.Sc., M.P.H., Lewis A. Hassell, M.D., Ashley Hein, M.D., Ugochukwu John Jonah, M.B.B.S., Sigfred Lajara, M.D., Michael Landau, M.D., Minh-Khang Le, M.D., Ph.D., Joshua Levy, Ph.D., Yun Liu, Ph.D., Cris Luengo, Ph.D., David McClintock, M.D., Craig Mermel, M.D., Ph.D., Kunal Nagpal, M.S., David Nai, M.D., Andrew P. Norgan, M.D., Ph.D., Michael Olp, M.D., Ph.D., Liron Pantanowitz, M.D., Akash Parvatikar, Ph.D., Anil Parwani, M.D., Ph.D., M.B.A., Nat Pernick, M.D., Jeffrey W. Prichard, D.O., Rebecca Rojansky, M.D., Ph.D., Monika Lamba Saini, M.D., Ph.D., Jasmine Saleh, M.D., M.P.H., Ruhani Sardana, M.B.B.S., Swati Satturwar, M.D., Snehal S. Sonawane, M.B.B.S., M.D., David F. Steiner, M.D., Ph.D., Nadeem Tanveer, M.D., D.N.B., Ngoc Tran, M.D., M.S., Patricia Tsang, M.D., M.B.A., Louis Vaickus, M.D., Ph.D., Patrick Vanderboom, Ph.D., Chris Williams, M.D., Keefer Wu, Ana Yuil-Valdes, M.D., Mark D. Zarella, Ph.D.
Editorial Board Members: Andrey Bychkov, M.D., Ph.D., Jerome Cheng, M.D., Lewis A. Hassell, M.D., Patricia Tsang, M.D., M.B.A., Debra L. Zynger, M.D.
Deputy Editors-in-Chief: Andrey Bychkov, M.D., Ph.D., Patricia Tsang, M.D., M.B.A.
Editor-in-Chief: Debra L. Zynger, M.D.

Informatics related: Jobs, Fellowships, Conferences, CME, Board Review

Table of Contents review: Jerome Cheng, M.D. (last reviewed November 2023)


APLIS
Diagrams / tables

Table 1: APLIS components (Adv Anat Pathol 2012;19:81)
Layer Description Examples
APLIS application The software interface to the end user; usually programmed for a specific operating system and almost always programmed for a specific DBMS; has user interfaces for data entry and manipulation Cerner, CoPath, Cerner, PathNet, Orchard, Harvest, LIS, SSC SoftPath
Database management systems A specialized software package for the persistent storage and manipulation of data; currently the vast majority of these use the relational model and implement an SQL interface; in the LIS, high performance is not as important as high reliability, requiring certain tradeoffs to be made Microsoft SQL Server, mySQL, PostgreSQL, Oracle Database, MUMPS
Operating system The fundamental control program through which the end user interacts with a computer; there are different operating systems that are suitable for different niches (e.g., it is far more common for Linux to be the operating system of choice for a server than for a personal computer) Microsoft, Windows, Mac OS X, Linux
Hardware Any physical device that either hosts or interfaces with the APLIS; requires both a hardware and a software interface for the operating system (and APLIS) to function Server computer, client computer, barcode scanner, label printer, slide printer, H&E autostainer
Videos

What is an LIS (laboratory information system) and how does it work?

Laboratory management information system


Application of graph neural networks to whole slide images
Diagrams / tables

Contributed by Joshua Levy, Ph.D., Minh-Khang Le, M.D., Ph.D. and Louis Vaickus, M.D., Ph.D.
Components of graph neural networks Components of graph neural networks Components of graph neural networks Components of graph neural networks

Components of graph neural networks


Examples of node and graph level prediction tasks Examples of node and graph level prediction tasks

Examples of node and graph level prediction tasks

Example of node level immune cell classification

Example of node level immune cell classification


Artificial intelligence
Diagrams / tables

Contributed by Joshua Levy, Ph.D. and Louis Vaickus, M.D., Ph.D.
Rules based AI system used in electronic medical records

Rules based AI system used in electronic medical records

Digital pathology workflow for training and validation

Digital pathology workflow for training and validation

AI applications in anatomic pathology

AI applications in anatomic pathology

AI applications in molecular pathology

AI applications in molecular pathology

AI applications for pathology reports

AI applications for pathology reports


Augmented reality microscopy (ARM)
Videos

Google and ARM

Augmentiqs and ARM


Automated assessment of cytology specimens
Diagrams / tables

Contributed by Joshua Levy, Ph.D. and Louis Vaickus, M.D., Ph.D.
Cytology assessment workflow overview

Cytology assessment workflow, urine example

Thyroid cytopathology example

Thyroid cytopathology example

Cervical cancer screening example

Cervical cancer screening example

Videos

AutoParis-X Demo Tutorial


Autoverification in the core clinical laboratory
Diagrams / tables

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Master algorithm template for biochemical tests

Master algorithm template for biochemical tests


Cognition and human - computer interaction in pathology
Diagrams / tables

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NovoPath Anatomic Pathology

NovoPath Anatomic Pathology

VitalAxis VitalDx

VitalAxis VitalDx

CoPathPlus Application Manager

CoPathPlus Application Manager icons


Computational pathology fundamentals & applications
Diagrams / tables

Traditional image analysis versus computational pathology
Traditional image analysis
(J Pathol 2019;249:286)
Deep learning powered computational pathology
(J Pathol Inform 2019;10:9)
Typical tasks Detection of a morphological pattern (Lab Invest 2021;101:412) Integration of all aspects of clinical workflow for more accurate diagnosis, prognosis and personalized treatment (Lab Invest 2021;101:412)
Parameter tuning Image features / parameters are
manually tuned
Algorithm learns and extracts a large number of features automatically
Typical algorithm testing Often on a few regions of the slide Usually whole slide
Computer unit best suited for task CPU (central processing unit) GPU (graphics processing unit)
Number of training images required Depending on application, may be low Usually remarkably high

Computer aided detection
Microscopic (histologic) images

Contributed by David F. Steiner, M.D., Ph.D.

Detection of metastatic tumor in lymph nodes


Convolutional neural networks
Diagrams / tables
  • The figure below illustrates the type of calculations that image data goes through in convolution and pooling operations
    • Convolution operations involve an elementwise product between the filter and different segments of equal dimensions from the input matrix
    • Pooling operations perform an aggregate operation (e.g., maximum or average) on a region
    • In the example below, the maximum value was returned from 2 x 2 regions of the input matrix

Contributed by Jerome Cheng, M.D.

Convolution and pooling



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Typical CNN architecture

CNN layers in 3D

Neurons of convolutional layer connected to receptive field


Cybersecurity
Diagrams / tables

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Cyberattack costs by industry

Cyberattack costs by industry

Healthcare vulnerabilities and cybersecurity strategies

Healthcare vulnerabilities, cybersecurity strategies


Data repositories
Videos

Data management playlist - IBM Technology

Data storage essentials playlist - IBM Technology


Data representation and communication standards
Diagrams / tables

Contributed by Chris Williams, M.D.
Highlighting pixels

Highlighting pixels

PNG (lossless)

PNG (lossless)

JPG (lossy) high quality

JPG (lossy) high quality

JPG (lossy) low quality

JPG (lossy) low quality



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Tagged diagnostic data within CCD

Untidy dataset and tidy equivalent

Relative pixel density and size of display resolution

Videos

Healthcare data standards

HL7


Digital imaging fundamentals & standards
Diagrams / tables

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Comparison of digital pathology and traditional workflow


Education
Videos

Benefits of digital pathology

Digital pathology advances medical education and training

Social media in pathology education


Fluorescent microscopy fundamentals & applications
Diagrams / tables

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Image generation

Visualization of pinhole principle

Molecular / cytogenetics images

Contributed by Ruhani Sardana, M.B.B.S. and Anil Parwani, M.D., Ph.D., M.B.A.
Translocation involving EWSR1 gene at 22q12 (FISH)

Translocation involving EWSR1 gene at 22q12 (FISH)



Contributed by António Polónia, M.D., Ph.D., Ana Caramelo, B.Sc., Catarina Eloy, M.D. and João Vale, M.Sc.
1p/19q codeletion

1p/19q codeletion

Gastric lymphoma

Gastric lymphoma

Lymph node

Lymph node

Videos

Fluorescence microscopy animation

Intro to fluorescence microscopy


Hematopathology
Diagrams / tables

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Neural network

Lymphomas analyzed using deep learning

WSI images

Machine learning for hematologic malignancies

Machine learning for
mature lymphoproliferative
diagnosis, grading
and prognostication

Videos

Neural networks

OLYMPUS cellSens tutorial: real time panoramic imaging


Image analysis applications
Diagrams / tables

Contributed by Charles Caldwell, Ph.D., Vitria Adisetiyo, Ph.D., Cris Luengo, Ph.D., Roberto Gianani, M.D.
Image Analysis of PD-L1 in NSCLC

Image analysis of PDL1 in NSCLC

Image Analysis Pathology Endpoint Measures

Image analysis pathology endpoint measures

Videos

Example of image analysis workflow: evaluation of PDL1 IHC staining in non small cell lung cancer


Intraoperative consultation telepathology
Diagrams / tables

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Network topology
for interinstitutional
frozen section
telepathology


Introduction to programming
Diagrams / tables

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Most popular programming languages

Most popular programming languages

Videos

What a computer program is

Programming languages

Integrated development environment (IDE)


Debugging

Source code


LIS additional features
Diagrams / tables

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Useful flags for test results

Useful flags for test results


LIS fundamentals
Diagrams / tables

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Modules of an LIS

Videos

Laboratory information management system


LIS installation & implementation
Diagrams / tables

Contributed by Harsh Batra, M.B.B.S., D.C.P., D.N.B. and Anil Parwani, M.D., Ph.D., M.B.A.
Lifecycle of LIS

Lifecycle of LIS


Multiplex immunofluorescence
Diagrams / tables

Contributed by Harsh Batra, M.B.B.S., D.C.P., D.N.B., Maria Gabriela Raso, M.D. and Edwin Roger Parra Cuentas, M.D., Ph.D.
Procedure

Procedure


Natural language processing (NLP)
Diagrams / tables

Images hosted on other servers:

Architecture of deep neural network

Bag of words model

Word embedding


Quality control
Diagrams / tables

Contributed by Akash Parvatikar, Ph.D.
Schematic overview of QC workflow

Schematic overview of QC workflow

Microscopic (histologic) images

Contributed by Akash Parvatikar, Ph.D.
No QC issue

No QC issue

Tissue blur

Tissue blur

Tissue coverslip

Tissue coverslip

Tissue dirt

Tissue dirt


Tissue folds

Tissue folds

Tissue microvibrations

Tissue microvibrations

Tissue cracking

Tissue cracking

Tissue separation

Tissue separation


Spectral imaging
Diagrams / tables

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Concept of spectral data cube

Typical biomedical spectral imaging system

Videos

Spectral imaging laboratory

Medical applications of hyperspectral imaging


Surgical pathology
Diagrams / tables

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Applications of informatics in surgical / anatomic pathology Incorporating informatics into surgical / anatomical pathology

Applications / incorporation of informatics into surgical / anatomical pathology


Telecytology
Diagrams / tables

Contributed by Jason A. Thomas, C.T. and Sigfred Lajara, M.D.
Dynamic telecytology in USE

Dynamic telecytology in use

Dynamic telecytology workflow for ROSE

Dynamic telecytology workflow for ROSE


Teledermatopathology
Diagrams / tables

Contributed by Jasmine Saleh, M.D.
Real time

Real time

Store and forward

Store and forward

Clinical images

Contributed by Nadeem Tanveer, M.D., D.N.B.
Mobile assisted teledermatopathology

Mobile assisted
teledermatopathology

Freehand technique smartphone teledermatopathology

Freehand technique
smartphone
teledermatopathology


Telepathology fundamentals
Diagrams / tables

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Remote consultation

Use for frozen sections at remote site

Videos

Real time high definition video demo


Virtual staining
Diagrams / tables

Contributed by Joshua Levy, Ph.D. and Louis Vaickus, M.D., Ph.D.

Approaches for developing algorithms

Example of steps
to prepare a
paired approach
for SOX10

Conversion of H&E stained slides

Example of paired translation of H&E


WSI applications
Diagrams / tables

Contributed by Rebecca Rojansky, M.D., Ph.D.

WSI annotation

Videos

Creating whole slide images with a robotic microscope stage

Whole slide images for diagnostic pathology


WSI fundamentals
Videos

Whole slide imaging overview

Scanning (MikroScan D2)

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Recent Informatics, digital & computational pathology Pathology books

Baron: 2023

Cohen: 2020

Holzinger: 2020

Huss: 2022

Pantanowitz: 2016

Pantanowitz: 2012

Parwani: 2016

Parwani: 2022

Zuraw: 2023



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