Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Mod Pathol. 2022 Jan;35(1):52-59. doi: 10.1038/s41379-021-00908-5. Epub 2021 Sep 13.
Progression in digital pathology has yielded new opportunities for a remote work environment. We evaluated the utility of digital review of breast cancer immunohistochemical prognostic markers (IHC) using whole slide images (WSI) from formalin fixed paraffin embedded (FFPE) cytology cell block specimens (CB) using three different scanners.CB from 20 patients with breast cancer diagnosis and available IHC were included. Glass slides including 20 Hematoxylin and eosin (H&E), 20 Estrogen Receptor (ER), 20 Progesterone Receptor (PR), 16 Androgen Receptor (AR), and 20 Human Epidermal Growth Factor Receptor 2 (HER2) were scanned on 3 different scanners. Four breast pathologists reviewed the WSI and recorded their semi-quantitative scoring for each marker. Kappa concordance was defined as complete agreement between glass/digital pairs. Discordances between microscopic and digital reads were classified as a major when a clinically relevant change was seen. Minor discordances were defined as differences in scoring percentages/staining pattern that would not have resulted in a clinical implication. Scanner precision was tabulated according to the success rate of each scan on all three scanners.In total, we had 228 paired glass/digital IHC reads on all 3 scanners. There was strong concordance kappa ≥0.85 for all pathologists when comparing paired microscopic/digital reads. Strong concordance (kappa ≥0.86) was also seen when comparing reads between scanners.Twenty-three percent of the WSI required rescanning due to barcode detection failures, 14% due to tissue detection failures, and 2% due to focus issues. Scanner 1 had the best average precision of 92%. HER2 IHC had the lowest intra-scanner precision (64%) among all stains.This study is the first to address the utility of WSI in breast cancer IHC in CB and to validate its reporting using 3 different scanners. Digital images are reliable for breast IHC assessment in CB and offer similar reproducibility to microscope reads.
数字病理学的进展为远程工作环境带来了新的机遇。我们使用来自福尔马林固定石蜡包埋（FFPE）细胞学细胞块标本（CB）的全切片图像（WSI）评估了使用三种不同扫描仪对乳腺癌免疫组织化学预后标志物（IHC）进行数字复查的效用。纳入了 20 名乳腺癌诊断和可用 IHC 的患者的 CB。20 张苏木精和伊红（H&E）、20 张雌激素受体（ER）、20 张孕激素受体（PR）、16 张雄激素受体（AR）和 20 张人类表皮生长因子受体 2（HER2）的载玻片在三种不同的扫描仪上进行扫描。四位乳腺病理学家对 WSI 进行了复查，并记录了他们对每个标志物的半定量评分。Kappa 一致性定义为玻璃/数字对之间的完全一致。当看到临床相关变化时，显微镜和数字读取之间的差异被归类为主要差异。次要差异定义为不会导致临床影响的评分百分比/染色模式差异。根据所有三个扫描仪上每个扫描的成功率，列出了扫描仪精度。在总共三个扫描仪上，我们对所有 228 对玻璃/数字 IHC 读取进行了分析。当比较配对的显微镜/数字读取时，所有病理学家的一致性 kappa 值均≥0.85。当比较扫描仪之间的读取时，也观察到了强一致性（kappa≥0.86）。由于条形码检测失败，23%的 WSI 需要重新扫描，14%的 WSI 由于组织检测失败，2%的 WSI 由于焦点问题需要重新扫描。扫描仪 1 的平均精度最高，为 92%。在所有染色剂中，HER2 IHC 的内扫描仪精度（64%）最低。本研究首次解决了在 CB 中使用 WSI 进行乳腺癌 IHC 的效用问题，并使用三种不同的扫描仪验证了其报告的准确性。数字图像可可靠地用于 CB 中的乳腺 IHC 评估，并提供与显微镜读数相似的可重复性。
