Anatomic pathology is a vital component of veterinary medicine but as a primarily subjective qualitative or semiquantitative discipline, it is at risk of cognitive biases. Logistic regression is a statistical technique used to explain relationships between data categories and outcomes and is increasingly being applied in medicine for predicting disease probability based on medical and patient variables. Our aims were to evaluate histologic features of canine and feline bladder diseases and explore the utility of logistic regression modeling in identifying associations in veterinary histopathology, then formulate a predictive disease model using urinary bladder as a pilot tissue. The histologic features of 267 canine and 71 feline bladder samples were evaluated, and a logistic regression model was developed to identify associations between the bladder disease diagnosed, and both patient and histologic variables. There were 102 cases of cystitis, 84 neoplasia, 42 urolithiasis and 63 normal bladders. Logistic regression modeling identified six variables that were significantly associated with disease outcome: species, urothelial ulceration, urothelial inflammation, submucosal lymphoid aggregates, neutrophilic submucosal inflammation, and moderate submucosal hemorrhage. This study demonstrated that logistic regression modeling could provide a more objective approach to veterinary histopathology and has opened the door toward predictive disease modeling based on histologic variables.
Inter-pathologist variation is widely recognized across human and veterinary pathology and is often compounded by missing animal or clinical information on pathology submission forms. Variation in pathologist threshold levels of resident inflammatory cells in the tissue of interest can further decrease inter-pathologist agreement. This study applied a predictive modeling tool to bladder histology slides that were assessed by four pathologists: first without animal and clinical information, then with this information, and finally using the predictive tool. All three assessments were performed twice, using digital whole-slide images (WSI) and then glass slides. Results showed marked variation in pathologists’ interpretation of bladder slides, with kappa agreement values of 7–37% without any animal or clinical information, 23–37% with animal signalment and history, and 31–42% when our predictive tool was applied, for digital WSI and glass slides. The concurrence of test pathologists to the reference diagnosis was 60% overall. This study provides a starting point for the use of predictive modeling in standardizing pathologist agreement in veterinary pathology. It also highlights the importance of high-quality whole-slide imaging to limit the effect of digitization on inter-pathologist agreement and the benefit of continued standardization of tissue assessment in veterinary pathology.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence. Individual articles may be copied or downloaded for private, scholarly and not-for-profit use. Quotations may be extracted provided that the author and The Royal Society of Queensland are acknowledged. Queries regarding republication of papers, or parts of papers such as figures and photographs, should be addressed to the Secretary of The Royal Society of Queensland (
Dogs and cats commonly present to veterinary hospitals with urinary bladder disease, but despite their clinical importance and comparative potential to human diseases, bladder diseases in Australian dogs and cats are under investigated. In veterinary pathology, insufficient levels of diagnostic agreement can occur, and this is influenced by sample quality as well as the pathologist's own experience, training, and cognitive biases. Logistic regression is a statistical technique which, when applied to veterinary histopathology, could improve pathologist agreement. Thus, there were two overarching goals of this thesis-to investigate the pathology and comparative potential of canine and feline urinary bladder disease in Australia, and to explore the utility of logistic regression modelling in improving inter-pathologist agreement. This project conducted a retrospective evaluation of pathology cases of canine and feline urinary bladder tissue from the veterinary pathology archives of the
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.