A web-based pilot study of inter-pathologist reproducibility using the ISHLT 2004 working formulation for biopsy diagnosis of cardiac allograft rejection: The European experience

Angelini, Annalisa; Andersen, Claus B; Bartoloni, Giovanni; Black, Fiona; Bishop, Paul; Doran, Helen; Fedrigo, Marny; Fries, Jochen W.U.; Goddard, Martin; Goebel, Heike; Neil, Desley; Leone, Ornella; Marzullo, Andrea; Ortmann, Monika; Paraf, François; Rotman, Samuel; Turhan, Nesrin; Bruneval, Patrick; Frigo, Anna Chiara; Grigoletto, Francesco; Gasparetto, Alessio; Mencarelli, Roberto; Thiene, Gaetano; Burke, Margaret

doi:10.1016/j.healun.2011.05.011

Cited by 53 publications

(42 citation statements)

References 30 publications

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“…[250265] In addition to telecardiology, the development of telemedicine applications in Europe was formed by other medical fields that use images for diagnosis, such as dermatology, pathology, and radiology. [177316321–325327–341]…”

Section: Europementioning

confidence: 99%

The history of pathology informatics: A global perspective

Park

Parwani

Aller

et al. 2013

Journal of Pathology Informatics

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Pathology informatics has evolved to varying levels around the world. The history of pathology informatics in different countries is a tale with many dimensions. At first glance, it is the familiar story of individuals solving problems that arise in their clinical practice to enhance efficiency, better manage (e.g., digitize) laboratory information, as well as exploit emerging information technologies. Under the surface, however, lie powerful resource, regulatory, and societal forces that helped shape our discipline into what it is today. In this monograph, for the first time in the history of our discipline, we collectively perform a global review of the field of pathology informatics. In doing so, we illustrate how general far-reaching trends such as the advent of computers, the Internet and digital imaging have affected pathology informatics in the world at large. Major drivers in the field included the need for pathologists to comply with national standards for health information technology and telepathology applications to meet the scarcity of pathology services and trained people in certain countries. Following trials by a multitude of investigators, not all of them successful, it is apparent that innovation alone did not assure the success of many informatics tools and solutions. Common, ongoing barriers to the widespread adoption of informatics devices include poor information technology infrastructure in undeveloped areas, the cost of technology, and regulatory issues. This review offers a deeper understanding of how pathology informatics historically developed and provides insights into what the promising future might hold.

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Section: Europementioning

confidence: 99%

The history of pathology informatics: A global perspective

Park

Parwani

Aller

et al. 2013

Journal of Pathology Informatics

View full text Add to dashboard Cite

show abstract

“…Likewise, the limited sample area provided by biopsy, combined with subtle graft pathology found in early rejection, may lead to false-negatives or “indeterminate” diagnosis (7, 8). The subjective nature of pathologist diagnosis and inherent differences between individual pathologist scoring can also cloud biopsy interpretations (9, 10). Given the lack of any reliable alternatives, biopsy remains of paramount importance for rejection diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Elevated ST2 Distinguishes Incidences of Pediatric Heart and Small Bowel Transplant Rejection

Mathews

Lott

Isse

et al. 2016

American Journal of Transplantation

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Elevated serum soluble (s) Suppressor of Tumorigenicity 2 (ST2) is observed during cardiovascular and inflammatory bowel diseases. To ascertain whether modulated ST2 levels signify heart (HTx) or small bowel transplant (SBTx) rejection, we quantified sST2 in serially obtained pediatric HTx (n=41) and SBTx recipient (n=18) sera. At times of biopsy-diagnosed HTx rejection (cellular and/or antibody-mediated), serum sST2 was elevated compared to rejection-free time points (1714±329 vs. 546.5±141.6 pg/ml; P=0.0002). SBTx recipients also displayed increased serum sST2 during incidences of rejection (7536±1561 vs. 2662±543.8 pg/ml; P=0.0347). Receiver operator characteristic (ROC) analysis showed that serum sST2>600 pg/ml could discriminate time points of HTx rejection and non-rejection (Area under the curve (AUC)=0.724±0.053; P=0.0003). ROC analysis of SBTx measures revealed a similar discriminative capacity (AUC=0.6921±0.0820; P=0.0349). Quantitative evaluation of both HTx and SBTx biopsies revealed rejection significantly increased allograft ST2 expression. Pathway and Network Analysis of biopsy data pinpointed ST2 in the dominant pathway modulated by rejection and predicted TNF-α and IL-1β as upstream activators. In total, our data indicate that alloimmune-associated pro-inflammatory cytokines increase ST2 during rejection. They also demonstrate that routine serum sST2 quantification, potentially combined with other biomarkers, should be investigated further to aid in the non-invasive diagnosis of rejection.

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“…While endomyocardial biopsy remains the gold standard for identification of rejection, it provides only ordinal data on the degree of rejection, is invasive, is prone to sampling error, and has limited interobserver reproducibility (5, 6). The glucose analogue 2-[ 18 F]fluoro-2-deoxy-D-glucose ([ 18 F]FDG) can be used to quantify glucose uptake and glycolytic activity in native and transplanted hearts (7–9).…”

Section: Introductionmentioning

confidence: 99%

Use of [18F]FDG Positron Emission Tomography to Monitor the Development of Cardiac Allograft Rejection

et al. 2015

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Background Positron Emission Tomography (PET) has the potential to be a specific, sensitive and quantitative diagnostic test for transplant rejection. To test this hypothesis, we evaluated 18F-labeled fluorodeoxyglucose ([18F]FDG) and 13N-labeled ammonia ([13N]NH3) small animal PET imaging in a well-established murine cardiac rejection model. Methods Heterotopic transplants were performed using minor MHC mismatched B6.C-H2bm12 donor hearts in C57BL/6(H-2b) recipients. C57BL/6 donor hearts into C57BL/6 recipients served as isograft controls. [18F]FDG PET imaging was performed weekly between post-transplant days 7 and 42 and the percent injected dose was computed for each graft. [13N]NH3 imaging was performed to evaluate myocardial perfusion. Results There was a significant increase in [18F]FDG uptake in allografts from day 14 to day 21 (1.6% to 5.2%; P<0.001) and uptake in allografts was significantly increased on post-transplant days 21 (5.2% vs. 0.9%; P=0.005) and 28 (4.8% vs. 0.9%; P=0.006) compared to isograft controls. Furthermore, [18F]FDG uptake correlated with an increase in rejection within allografts between days 14 and 28 post-transplant. Finally, the uptake of [13N]NH3 was significantly lower relative to the native heart in allografts with chronic vasculopathy compared to isograft controls on day 28 (P=0.01). Conclusions PET imaging with [18F]FDG can be used following transplantation to monitor the evolution of rejection. In addition, decreased uptake of [13N]NH3 in rejecting allografts may be reflective of decreased myocardial blood flow. These data suggest that combined [18F]FDG and [13N]NH3 PET imaging could be used as a non-invasive, quantitative technique for serial monitoring of allograft rejection and has potential application in human transplant recipients.

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A web-based pilot study of inter-pathologist reproducibility using the ISHLT 2004 working formulation for biopsy diagnosis of cardiac allograft rejection: The European experience

Cited by 53 publications

References 30 publications

The history of pathology informatics: A global perspective

The history of pathology informatics: A global perspective

Elevated ST2 Distinguishes Incidences of Pediatric Heart and Small Bowel Transplant Rejection

Use of [18F]FDG Positron Emission Tomography to Monitor the Development of Cardiac Allograft Rejection

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