The prognostic value of cytonuclear grade in ductal carcinoma in situ (DCIS) is debated, partly due to high interobserver variability and the use of multiple guidelines. The aim of this study was to evaluate interobserver agreement in grading DCIS between Dutch, British, and American pathologists. Haematoxylin and eosin-stained slides of 425 women with primary DCIS were independently reviewed by nine breast pathologists based in the Netherlands, the UK, and the USA. Chance-corrected kappa (κ ma ) for association between pathologists was calculated based on a generalised linear mixed model using the ordinal package in R. Overall κ ma for grade of DCIS (low, intermediate, or high) was estimated to be 0.50 (95% confidence interval [CI] 0.44-0.56), indicating a moderate association between pathologists. When the model was adjusted for national guidelines, the association for grade did not change (κ ma = 0.53; 95% CI 0.48-0.57); subgroup analysis for pathologists using the UK pathology guidelines only had significantly higher association (κ ma = 0.58; 95% CI 0.56-0.61). To assess if concordance of grading relates to the expression of the oestrogen receptor (ER) and HER2, archived immunohistochemistry was analysed on a subgroup (n = 106). This showed that non-high grade according to the majority opinion was associated with ER positivity and HER2 negativity (100 and 89% of non-high grade cases, respectively). In conclusion, DCIS grade showed only moderate association using whole slide images scored by nine breast pathologists. As therapeutic decisions and inclusion in ongoing clinical trials are guided by DCIS grade, there is a pressing need to reduce interobserver variability in grading. ER and HER2 might be supportive to prevent the accidental and unwanted inclusion of high-grade DCIS in such trials.

AimsPrimary lung adenocarcinoma consists of a spectrum of clinical and pathological subtypes that may impact on overall survival (OS). Our study aims to evaluate the impact of adenocarcinoma subtype and intra-alveolar spread on survival after anatomical lung resection and identify different prognostic factors based on stage and histological subtype.MethodsNewly diagnosed patients undergoing anatomical lung resections without induction therapy, for pT1-3, N0-2 lung adenocarcinoma from April 2011 to March 2013, were included. The effect of clinical–pathological factors on survival was retrospectively assessed.ResultsTwo hundred and sixty-two patients were enrolled. The 1-year, 3-year and 5-year OS were 88.8%, 64.3% and 51.1%, respectively. Univariate analysis showed lymphovascular, parietal pleural and chest wall invasion to confer a worse 1-year and 5-year prognosis (all p<0.0001). Solid predominant adenocarcinomas exhibited a significantly worse OS (p=0.014). Multivariate analysis did not identify solid subtype as an independent prognostic factor; however, identified stage >IIa, lymphovascular invasion (p=0.002) and intra-alveolar spread (p=0.009) as significant independent predictors of worse OS. Co-presence of intra-alveolar spread and solid predominance significantly reduced OS. Disease-free survival (DFS) was reduced with parietal pleural (p=0.0007) and chest wall invasion (p<0.0001), however, adenocarcinoma subtype had no significant impact on DFS.ConclusionsOur study demonstrates that solid predominant adenocarcinoma, intra-alveolar spread and lymphovascular invasion confer a worse prognosis and should be used as a prognostic tool to determine appropriate adjuvant treatment.

Computational pathology refers to applying deep learning techniques and algorithms to analyse and interpret histopathology images. Advances in artificial intelligence (AI) have led to an explosion in innovation in computational pathology, ranging from the prospect of automation of routine diagnostic tasks to the discovery of new prognostic and predictive biomarkers from tissue morphology. Despite the promising potential of computational pathology, its integration in clinical settings has been limited by a range of obstacles including operational, technical, regulatory, ethical, financial, and cultural challenges. Here, we focus on the pathologists’ perspective of computational pathology: we map its current translational research landscape, evaluate its clinical utility, and address the more common challenges slowing clinical adoption and implementation. We conclude by describing contemporary approaches to drive forward these techniques. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

No abstract

The production of concrete emits greenhouse gases which aggravate global warming. Meanwhile, ceramic tile wastes generated from manufacturing factories, construction sites, and building demolition projects disposed of by landfills create land and water pollution. Therefore, in this study, the suitability of ceramic tile wastes (CTW) in powder form to partially replace cement in lightweight foamed concrete was investigated with the aim to discover a greener construction material. Once the research outputs show that the ceramic tile dust can appropriately serve as a replacement, environmental impact on air, land, and water pollution can all be reduced. Three types of lightweight foamed concrete with 0%, 25%, and 50% ceramic tile wastes as partial cement replacement material were prepared with a target density of 1,200 kg/m3, namely, LFC-CTW0, LFC-CTW25, and LFC-CTW50, respectively. The effects of ceramic tile wastes on the engineering properties of lightweight foamed concrete were investigated. Concrete specimens were water-cured and tested for various mechanical properties at the concrete ages of 7, 28, and 56 days. Results from the lab experiments showed that the incorporation of 25% ceramic tile wastes into lightweight foamed concrete was more feasible than that of 50%. LFC-CTW25, which performed better than LFC-CTW0 for the splitting tensile strength test at day 56. The results for the compressive strength test, modulus of elasticity, and compressive toughness test showed a minor reduction after the incorporation of ceramic tile wastes. Based on the results, it can be concluded that it is feasible to use ceramic tile wastes up to 25% as partial cement replacement material to produce foamed concrete.

Introduction: Virtual microscopy (VM) allows a whole slide once scanned, to be visualised, navigated and annotated at different magnifications on a digital viewing platform. Advantages for trainees are numerous; slides can be viewed simultaneously by large numbers of students or accessed remotely at the student’s time and place of preference. In the UK all Haematology trainees are required to be competent in diagnostic evaluation of blood films, bone marrow aspirates and trephines. The drive towards laboratory centralisation, increasing automation and full shift working patterns has decreased access to traditional small group teaching using a multi-headed microscope. VM has the potential to realise new modes of training delivery and to prepare haematologists for the advent of VM as a mainstream diagnostic tool. Aim: To review the utility and acceptability of incorporating virtual microscopy into a virtual learning environment (VLE) for haematology trainees. Methods : Over a 6 month period a VLE has been developed centred on the use of VM comprising of: basic morphology tutorials including interactive learning modules and instructional videosannotated image bankclinical case scenario simulationmock examination practice Curriculum mapped content was created to develop acquisition of morphological skills from first principles. 4 interactive modules take users through a step-wise approach to examining a blood film, recognising normal appearances, identifying morphological abnormalities and interpreting their findings in the film report. Case scenarios, requiring trainees to identify morphological abnormalities and put these into clinical context were developed using structured questioning, providing instant feedback on performance at each stage of the case. Additional resources include an annotated image bank of >250 slides and mock examination cases. The use of VM to support large group teaching was piloted at an afternoon for haematology trainees in London. Haematopathology slides were made available on-line prior to the session with videos introducing an approach to examining trephines and lymph nodes. Questions to facilitate examination of the slides were built in to promote learning. The interactive session was facilitated by trainees using the VLE site and case discussions made available on-line for future reference. Informal feedback on the site was encouraged alongside its development and formal surveys were undertaken to evaluate the quality and utility of the VLE both for self-directed and large group teaching. Results: The VLE was piloted to 40 trainee haematology physicians and 10 biomedical scientists only 1 of whom had previous experience of VM. 100% of participants viewed the experience as ‘useful’ or ‘very useful’ and would recommend to other colleagues. Junior trainees particularly valued the structured tutorials on blood film reporting and annotated practice cases. The novel application of the VLE for simulating haematological emergencies presenting with laboratory abnormalities (e.g. APML) was found to be invaluable by new trainees in preparation for out of hours work. 88 trainees attended the large group teaching session. Slides were viewed on-line by 53/88 (60%) trainees in preparation. 78% of trainees rated the training experience as 5/5 (very good). Free text comments included: “pre-course material very useful; really liked the digital microscopy; the most useful day this year”. The use of VLE in this context has been incorporated into future training events. When comparing to light microscopy the key benefits of VM identified by users were: AccessibilityAbility to return to review material as desiredAnnotation of digital imagesAbility to compare different slides side by side within the same screen windowAvailability of slides of rare diagnoses. Overall, image quality was rated as equivalent to viewing glass slides. Technicalities of viewing the slides (panning, changing magnification and adjusting focus) were easier using a light microscope compared to the digital microscope interface. Conclusions: Incorporation of VM into a VLE is an innovative and effective platform for transforming haematology training for the 21st century. Its versatility, quality and accessibility facilitate its implementation into a wide range of learning settings. Minor technical limitations can be easily addressed to improve the user experience. Disclosures No relevant conflicts of interest to declare.

No abstract