V. Della Mea

Large core biopsy for diagnostic and prognostic evaluation of invasive breast carcinomas

Large core biopsy is a recently introduced method for pre-operative evaluation of breast lumps. The aim of this study was to evaluate the usefulness of this technique in providing pre-operative diagnostic and prognostic information that can lead to a correct line of treatment. We compared 41 cases of breast carcinomas diagnosed both by core biopsies and surgically removed samples. A high (93%) diagnostic agreement was obtained. Moreover, we found a significant correlation for mitotic count (r = 0.76), oestrogen receptor (r = 0.78), progesterone receptor (r = 0.80), p53 (r = 0.86) and c-erbB-2 (r = 0.90) analysis between core biopsy and definitive surgical pathology. An agreement for histological grading evaluation between the two techniques was obtained in 32 out of 40 cases (k = 0.65) whereas in the other cases, a lower grade was assigned by evaluating core biopsies. These findings suggest that percutaneous core breast biopsy is a valid tool for pre-operative management of breast lesions, but this should be confirmed in larger, prospective studies.

The Context-Aware Browser

The typical scenario of a user seeking information on the Web requires significant effort to get the desired information. In a world where information is essential, it can be crucial for users to get the desired information quickly even when they are away from their desktop computers. The Context-Aware Browser for mobile devices senses the surrounding environment, infers the users current context, and proactively searches for and activates relevant Web documents and applications.

Telepathology applications of the Internet multimedia electronic mail

Telepathology is based on the sharing of medical images coming from the microscope, and comprises different applications: intra-operative telediagnosis, second opinion teleconsultation, reference case archives, remote data and image processing, quality assessment. Since the Internet is available worldwide, it can be of interest to define which of these tasks can be performed by means of some telepathology method based on it. This paper focuses particularly on the use of Internet multimedia electronic mail for exchanging multimedia cases. To test the validity of the proposed approach for transmission of multimedia cases, the first step is to evaluate its diagnostic accuracy. Trials involving the transmission of 299 cases have been carried out between two departments of Pathology in Italy (at the University of Udine and at the City Hospital of Trento, respectively) in order to evaluate the diagnostic accuracy as well as the time needed for acquisition and transmission. First results show that good diagnostic agreement can be reached, but the time needed for transmission, generally low, is not sufficiently affordable to be adopted in those cases where time is important. In particular, telepathology through multimedia e-mail can be adopted for second opinion consultation, remote image processing, quality assessment and continuing education possibly by means of software that integrates acquisition and delivery of cases with HIS functionalities.

Image sampling in static telepathology for frozen section diagnosis

BACKGROUND: A frozen section diagnostic service is often not directly available in small rural or mountain hospitals. In these cases, it could be possible to provide frozen section diagnosis through telepathology systems. Telepathology is based on two main methods: static and dynamic. The former is less expensive, but involves the crucial problem of image sampling. AIMS: To characterise the differences in image sampling for static telepathology when undertaken by pathologists with different experience. METHODS: As a test field, a previously studied telepathology method based on multimedia email was adopted. Using this method, three pathologists with different levels of experience sampled images from 155 routine frozen sections and sent them to a distant pathology institute, where diagnoses were made on digital images. After the telepathology diagnoses, the glass slides of both the frozen sections and the definitive sections were sent to the remote pathologists for review. RESULTS: Four of 155 transmissions were considered inadequate by the remote pathologist. In the remaining 151 cases, the telepathology diagnosis agreed with the gold standard in 146 (96.7%). There was no significant divergence between the three pathologists in their sampling of the images. Each case comprised five images on average, acquired in four minutes. The overall time for transmission was about 19 minutes. CONCLUSIONS: The results suggest that in routine frozen section diagnosis an inexperienced pathologist can sample images sufficiently well to permit remote diagnosis. However, as expected, the internet is too unreliable for such a time dependent task. An improvement in the system would involve integrated real time features, so that there could be interaction between the two pathologists.

MANTHA: agent-based management of hypermedia documents

We present an open architecture for the authoring, publishing and archiving of hypermedia documents on the Internet. The multi-agent approach is adopted, and provides solutions to design a new software layer on the top of the Internet protocol suite. We propose an agent model with the requirements of autonomy, social ability, reactivity and pro-activeness. An agent template, JAMES, has been developed using JAVA and KQML as the agent communication language. On this basis, an agency is proposed and designed according to a federated model. The architecture is domain-independent, but a prototype application has been designed in the telepathology domain. The user is given an integrated set of services, based on a structure model of the clinical case (i.e., the document), as well as metadata representation techniques. Results of the prototype implementation are presented and discussed.

Health Information Technology in Oncology Practice: A Literature Review

The adoption and implementation of information technology are dramatically remodeling healthcare services all over the world, resulting in an unstoppable and sometimes overwhelming process. After the introduction of the main elements of electronic health records and a description of what every cancer-care professional should be familiar with, we present a narrative review focusing on the current use of computerized clinical information and decision systems in oncology practice. Following a detailed analysis of the many coveted goals that oncologists have reached while embracing informatics progress, the authors suggest how to overcome the main obstacles for a complete physicians’ engagement and for a full information technology adoption, and try to forecast what the future holds.

eSlide suite: an open source software system for whole slide imaging

This short report briefly describes the principles underlying the telepathology technique known as whole slide imaging, and the design and implementation of a system for acquisition and visualisation of digital slides. The developed system, including an acquisition module and a visualisation module, is available as an open source on the Internet, together with sample acquired slides.

FRI0282 Serological biomarkers of b-cell lymphoproliferative disorders in patients with primary sjögren’s syndrome: retrospective study in a large italian cohort

Background primary Sjögren’s syndrome (pSS) is the autoimmune disease with the highest risk of lymphoma. Lymphoma and mixed cryoglobulinemic vasculitis (CV) occur in a minority of cases, but they are the most relevant clinical features characterizing the B cell lymphoproliferation in pSS. Objectives to provide serological biomarkers associated with lymphoproliferative complications (B-cell lymphoma, cryoglobulinemic vasculitis (CV) and non malignant major salivary gland swelling) in primary Sjögren’s syndrome (pSS). Methods data in 1170 patients with pSS diagnosis were retrospectively collected. The analyses were then performed in patients fulfilling the following criteria: 1. European or AECG criteria, 2. Hepatitis C virus infection antibody negative, 3. serum cryoglobulins tested. Multinomial analyses (P<0.05) were performed by distinguishing 4 groups: 1. lymphoma (including patients with lymphoma and CV associated), 2. CV without lymphoma, 3. Salivary gland swelling without lymphoma, 4. other pSS patients. Group 4 was assumed as “base outcome”. The following variables were considered: presence/absence of antinuclear antibodies, anti-Ro, anti-La, low C3, low C4, rheumatoid factor, hypergammaglobulinemia, monoclonal component, leucopoenia, and cryoglobulinemia. Results 661 patients were selected. Group 1 comprised 40/661 (6.1%), group 2 comprised 17/661 (2.6%), group 3 comprised 180/661 (27.2%), and group 4 comprised 424 (64.1%). Anti-La, hypergammaglobulinemia (IgG > 16 g/l), leucopoenia (<3000/mmc), rheumatoid factor, serum monoclonal component, low C3, low C4, and cryoglobulinemia were selected by univariate analyses. Low C4 [relative-risk ratio (RRR) 8.3, 95% CI 3.6-19.2], anti-La (RRR 5.2, 95% CI 2.3-11.9), cryoglobulins (RRR 6.8, 95% CI 2.1-22.1) and leucopenia (RRR 3.3, 95% CI 1.5-7.05) were the selected variables, by multinomial logistic analyses, that distinguished group 1 from group 4. At least one of the biomarkers selected by univariate analyses was present in all patients with lymphoma, and at least one of the biomarkers selected by multivariate analyses were present in 39/40 patients with lymphoma (97.5%). The majority of variables distinguishing Group 1 from Group 4 were shared with Group 2, while rheumatoid factor and hypergammaglobulinemia were shared with Group 3. Conclusions Serological biomarkers which raise the level of suspicion of lymphoma or suggest a close follow-up in pSS patients may be identified and confirmed. Rheumatoid factor and hypergammaglobulinemia may reflect the B-cell hyperactivation in patients with salivary gland swelling, which predisposes to lymphoma in pSS. The absence of all the lymphoma-associated biomarkers in pSS may identify patients at lower risk of lymphoma, when CV or salivary gland swelling are not present. Disclosure of Interest: None Declared

IMAGENCIES: network image services for telemedicine applications

A network of distributed image-based medical services (Imagencies) is proposed. Each one is a community of specialised, co-operating programs (Imagents), providing acquisition, processing, archiving and management facilities. Both synchronous and asynchronous communication are proposed, based on the standard protocols available on the Internet. We describe a prototype implementation in the field of telepathology. At present, the Imagency includes a secretary and an image processing specialist; asynchronous communication is realised by the standard MIME protocol for multimedia electronic mail. Practical results and future perspectives are presented and discussed.