Electronic expert consultation using digital still images for evaluation of atypical small acinar proliferations of the prostate: a comparison with immunohistochemistry.
This study was performed on a series of prostate needle biopsies with diagnosis of atypical small acinar proliferation (ASAP) to verify to what extent the application of immunohistochemistry (IHC) for p504s and p63 markers as well as expert consultation by still images could affect the diagnosis. The results of these 2 methods were compared. Immunohistochemistry staining for p504s and p63 was performed on sections from 42 patients with a primary diagnosis of ASAP. Meanwhile, digital still images were taken from hematoxylin and eosin-stained slides of cases and were sent to an expert uropathologist, blind to IHC staining interpretations. The results of IHC staining were compared with diagnostic interpretations of the consultant pathologist. In 13 cases, the focus of concern was not detectable on IHC slides. In the remaining 29 cases, IHC showed a benign and malignant expression pattern in 17 and 9 patients, respectively. In 3 cases, IHC findings were inconclusive and retained the diagnosis of ASAP. The consultant pathologist diagnosed 11 cases of benign and 7 cases of malignant processes. He retained the diagnosis of ASAP in 11 cases. There was high concordance between the results of IHC and electronic consultation in the group of benign cases. All 11 cases with the diagnosis of benignancy by electronic consultation showed a benign IHC pattern. Among 7 cases with the diagnosis of malignancy by the consultant pathologist, 5 were classified as malignant, 1 as benign, and 1 as inconclusive IHC groups. Considering problems with IHC staining of prostate needle biopsy, including loss of focus of interest, expert consultation using still images can provide very useful diagnostic information. This approach can be used as an adjunct to other diagnostic activities like IHC or even as an independent source of information to reach more accurate diagnoses in ASAP cases, particularly in institutions with limited resources.
Pathology Department, Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran. Electronic address: abanihashemi1977@gmail.com.
Amir
A
Banihashemi
Pathology Laboratory, Hasheminejad Kidney Center and Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran. Electronic address: mojgan_asgari@yahoo.com.
Mojgan
M
Asgari
Pathology Laboratory, Hasheminejad Kidney Center, Iran University of Medical Sciences (IUMS), Tehran, Iran. Electronic address: najva23@yahoo.com.
Tina
T
Shooshtarizade
Pathology Laboratory, Hasheminejad Kidney Center, Iran University of Medical Sciences (IUMS), Tehran, Iran. Electronic address: mar.abolhasani@gmail.com.
Maryam
M
Abolhasani
Institute of Pathology, Jena University Hospital, Friedrich Schiller University, Jena, Germany. Electronic address: masoud.mireskandari@med.uni-jena.de.
Masoud
M
Mireskandari
D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D049109:Cell Proliferation; D003906:Developing Countries; D003937:Diagnosis, Differential; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D007492:Iran; D008297:Male; D008875:Middle Aged; D010338:Pathology, Clinical / Q000379:methods; D011470:Prostatic Hyperplasia / Q000473:pathology*; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012017:Referral and Consultation; D019113:Telepathology / Q000379:methods*
Atypical small acinar proliferation; Immunohistochemistry; Prostatic adenocarcinoma; Telepathology