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Grant Details

Grant Number: 5R01CA172343-05 Interpret this number
Primary Investigator: Shapiro, Linda
Organization: University Of Washington
Project Title: Digital Pathology_accuracy Viewing Behavior and Image Characterization
Fiscal Year: 2017


Abstract

DESCRIPTION (provided by applicant): Approximately 1.4 million women per year depend on pathologists to accurately interpret breast biopsies for a diagnosis of benign disease or cancer. Diagnostic errors are alarmingly frequent and likely lead to altered patient treatment, especially at the thresholds of atypical hyperplasia and ductal carcinoma in situ, where up to 50% of cases are misclassified. The causes underlying these errors remain largely unknown. Technology similar to Google Maps now allows pan and zoom manipulation of high-resolution digital images of glass microscope slides. This technology has virtually replaced the microscope in medical schools and is rapidly diffusing into U.S. pathology practices. No research has evaluated the accuracy and efficiency of pathologists' interpretion of digital images vs. glass slides. However, these "digital slides" offer a novel opportunity to study the accuracy, efficiency, and viewing behavior of a large number of pathologists as they manipulate and interpret images. The innovative analytic techniques proposed in this application are similar to those used to improve the performance of pilots and air traffic controllers. Our specific aims are: Aim 1. Digital Image vs. Glass Slides: To compare the interpretive accuracy of pathologists viewing digitized slide images over the Internet to their performance viewing original glass slides under a microscope. A randomized national sample of pathologists (N=200) will interpret 240 test cases in one or both formats in two phases. Measures will include a diagnostic assessment for each test case and for digital slides, cursor- (i.e., mouse) tracking data and region of interest (ROI) markings. Completion of this aim will establish benchmarks for the comparative diagnostic accuracy of whole-slide digital images. Aim 2. Interpretive Screening Behavior: To identify visual scanning patterns associated with diagnostic accuracy and efficiency. Detailed simultaneous eye-tracking and cursor-tracking data will be collected on 60 additional pathologists while they interpret digital slides to complement data from Aim 1. Viewing patterns will be analyzed from computer representations of raw movement data. Videos depicting accurate, efficient visual scanning and cursor movement will be valuable tools in educating the next generation of digital pathologists. Aim 3. Image Analyses: To examine and classify the image characteristics (including color, texture, and structure) of ROIs captured in Aims 1 and 2. Computer-based statistical learning techniques will be used to identify image characteristics that lead to correct and incorrect diagnoses. Characteristics of both diagnostic and distracting ROIs will be identified, linking all three aims. In summary, we will determine whether digitized whole-slide images are diagnostically equivalent to original glass slides. Our in-depth scientific evaluation of viewing patterns and characteristics of ROIs identified by pathologists will be critical to understanding diagnostic errors and sources of distraction. Optimization of viewing techniques will improve diagnostic performance and thus, the quality of clinical care.



Publications

Do Physicians Remember Cases? Implications for Longitudinal Designs in Medical Research and Competency Assessment.
Authors: Brunyé T.T. , Konold C.E. , Wang J. , Kerr K.F. , Drew T. , Shucard H. , Soroka K. , Weaver D.L. , Elmore J.G. .
Source: Research Methods In Medicine & Health Sciences, 2024 Jul; 5(3), p. 76-82.
EPub date: 2023-08-29 00:00:00.0.
PMID: 39896337
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Machine learning classification of diagnostic accuracy in pathologists interpreting breast biopsies.
Authors: Brunyé T.T. , Booth K. , Hendel D. , Kerr K.F. , Shucard H. , Weaver D.L. , Elmore J.G. .
Source: Journal Of The American Medical Informatics Association : Jamia, 2023-11-29 00:00:00.0; , .
EPub date: 2023-11-29 00:00:00.0.
PMID: 38031453
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From Image to Diagnosis: Characterizing Sources of Error in Histopathologic Interpretation.
Authors: Brunyé T.T. , Balla A. , Drew T. , Elmore J.G. , Kerr K.F. , Shucard H. , Weaver D.L. .
Source: Modern Pathology : An Official Journal Of The United States And Canadian Academy Of Pathology, Inc, 2023 Jul; 36(7), p. 100162.
EPub date: 2023-03-21 00:00:00.0.
PMID: 36948400
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End-to-End diagnosis of breast biopsy images with transformers.
Authors: Mehta S. , Lu X. , Wu W. , Weaver D. , Hajishirzi H. , Elmore J.G. , Shapiro L.G. .
Source: Medical Image Analysis, 2022 07; 79, p. 102466.
EPub date: 2022-04-27 00:00:00.0.
PMID: 35525135
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Analysis of Regions of Interest and Distractor Regions in Breast Biopsy Images.
Authors: Lu X. , Mehta S. , Brunyé T.T. , Weaver D.L. , Elmore J.G. , Shapiro L.G. .
Source: ... Ieee-embs International Conference On Biomedical And Health Informatics. Ieee-embs International Conference On Biomedical And Health Informatics, 2021 Jul; 2021, .
EPub date: 2021-08-10 00:00:00.0.
PMID: 36589620
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Deep Feature Representations for Variable-Sized Regions of Interest in Breast Histopathology.
Authors: Mercan C. , Aygunes B. , Aksoy S. , Mercan E. , Shapiro L.G. , Weaver D.L. , Elmore J.G. .
Source: Ieee Journal Of Biomedical And Health Informatics, 2021 Jun; 25(6), p. 2041-2049.
EPub date: 2021-06-03 00:00:00.0.
PMID: 33166257
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Classifying Breast Histopathology Images with a Ductal Instance-Oriented Pipeline.
Authors: Li B. , Mercan E. , Mehta S. , Knezevich S. , Arnold C.W. , Weaver D.L. , Elmore J.G. , Shapiro L.G. .
Source: Proceedings Of The ... Iapr International Conference On Pattern Recognition. International Conference On Pattern Recognition, 2021 Jan; 2020, p. 8727-8734.
EPub date: 2021-05-05 00:00:00.0.
PMID: 36745147
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Eye tracking reveals expertise-related differences in the time-course of medical image inspection and diagnosis.
Authors: Brunyé T.T. , Drew T. , Kerr K.F. , Shucard H. , Weaver D.L. , Elmore J.G. .
Source: Journal Of Medical Imaging (bellingham, Wash.), 2020 Sep; 7(5), p. 051203.
EPub date: 2020-10-27 00:00:00.0.
PMID: 37476351
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MLCD: A Unified Software Package for Cancer Diagnosis.
Authors: Wu W. , Li B. , Mercan E. , Mehta S. , Bartlett J. , Weaver D.L. , Elmore J.G. , Shapiro L.G. .
Source: Jco Clinical Cancer Informatics, 2020 03; 4, p. 290-298.
PMID: 32216637
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SURVEY Computer Vision: the Last 50 years.
Authors: Shapiro L.G. .
Source: International Journal Of Parallel, Emergent And Distributed Systems : Ijpeds, 2020; 35(2), p. 112-117.
EPub date: 2018-06-05 00:00:00.0.
PMID: 33719359
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Assessment of Machine Learning of Breast Pathology Structures for Automated Differentiation of Breast Cancer and High-Risk Proliferative Lesions.
Authors: Mercan E. , Mehta S. , Bartlett J. , Shapiro L.G. , Weaver D.L. , Elmore J.G. .
Source: Jama Network Open, 2019-08-02 00:00:00.0; 2(8), p. e198777.
EPub date: 2019-08-02 00:00:00.0.
PMID: 31397859
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Breast Cancer Prognostic Factors in the Digital Era: Comparison of Nottingham Grade using Whole Slide Images and Glass Slides.
Authors: Davidson T.M. , Rendi M.H. , Frederick P.D. , Onega T. , Allison K.H. , Mercan E. , Brunyé T.T. , Shapiro L.G. , Weaver D.L. , Elmore J.G. .
Source: Journal Of Pathology Informatics, 2019; 10, p. 11.
EPub date: 2019-04-03 00:00:00.0.
PMID: 31057980
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Detection and classification of cancer in whole slide breast histopathology images using deep convolutional networks.
Authors: Gecer B. , Aksoy S. , Mercan E. , Shapiro L.G. , Weaver D.L. , Elmore J.G. .
Source: Pattern Recognition, 2018 Dec; 84, p. 345-356.
EPub date: 2018-07-20 00:00:00.0.
PMID: 30679879
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Complexities of Perceived and Actual Performance in Pathology Interpretation: A Comparison of Cutaneous Melanocytic Skin and Breast Interpretations.
Authors: Carney P.A. , Frederick P.D. , Reisch L.M. , Titus L. , Knezevich S.R. , Weinstock M.A. , Piepkorn M.W. , Barnhill R.L. , Elder D.E. , Weaver D.L. , et al. .
Source: Journal Of Cutaneous Pathology, 2018-03-30 00:00:00.0; , .
EPub date: 2018-03-30 00:00:00.0.
PMID: 29603324
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Characterizing Diagnostic Search Patterns in Digital Breast Pathology: Scanners and Drillers.
Authors: Mercan E. , Shapiro L.G. , Brunyé T.T. , Weaver D.L. , Elmore J.G. .
Source: Journal Of Digital Imaging, 2018 Feb; 31(1), p. 32-41.
PMID: 28681097
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Second opinion strategies in breast pathology: a decision analysis addressing over-treatment, under-treatment, and care costs.
Authors: Tosteson A.N.A. , Yang Q. , Nelson H.D. , Longton G. , Soneji S.S. , Pepe M. , Geller B. , Carney P.A. , Onega T. , Allison K.H. , et al. .
Source: Breast Cancer Research And Treatment, 2018 Jan; 167(1), p. 195-203.
EPub date: 2017-09-06 00:00:00.0.
PMID: 28879558
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Multi-Instance Multi-Label Learning for Multi-Class Classification of Whole Slide Breast Histopathology Images.
Authors: Mercan C. , Aksoy S. , Mercan E. , Shapiro L.G. , Weaver D.L. , Elmore J.G. .
Source: Ieee Transactions On Medical Imaging, 2018 Jan; 37(1), p. 316-325.
EPub date: 2017-10-02 00:00:00.0.
PMID: 28981408
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Surgical implications and variability in the use of the flat epithelial atypia diagnosis on breast biopsy specimens.
Authors: Samples L.S. , Rendi M.H. , Frederick P.D. , Allison K.H. , Nelson H.D. , Morgan T.R. , Weaver D.L. , Elmore J.G. .
Source: Breast (edinburgh, Scotland), 2017 Aug; 34, p. 34-43.
EPub date: 2017-05-03 00:00:00.0.
PMID: 28475933
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The diagnostic challenge of low-grade ductal carcinoma in situ.
Authors: Onega T. , Weaver D.L. , Frederick P.D. , Allison K.H. , Tosteson A.N.A. , Carney P.A. , Geller B.M. , Longton G.M. , Nelson H.D. , Oster N.V. , et al. .
Source: European Journal Of Cancer (oxford, England : 1990), 2017 Jul; 80, p. 39-47.
EPub date: 2017-05-20 00:00:00.0.
PMID: 28535496
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Risk-based Breast Cancer Screening: Implications of Breast Density.
Authors: Lee C.I. , Chen L.E. , Elmore J.G. .
Source: The Medical Clinics Of North America, 2017 Jul; 101(4), p. 725-741.
PMID: 28577623
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Characteristics associated with requests by pathologists for second opinions on breast biopsies.
Authors: Geller B.M. , Nelson H.D. , Weaver D.L. , Frederick P.D. , Allison K.H. , Onega T. , Carney P.A. , Tosteson A.N.A. , Elmore J.G. .
Source: Journal Of Clinical Pathology, 2017-05-02 00:00:00.0; , .
EPub date: 2017-05-02 00:00:00.0.
PMID: 28465449
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Diagnostic Reproducibility: What Happens When the Same Pathologist Interprets the Same Breast Biopsy Specimen at Two Points in Time?
Authors: Jackson S.L. , Frederick P.D. , Pepe M.S. , Nelson H.D. , Weaver D.L. , Allison K.H. , Carney P.A. , Geller B.M. , Tosteson A.N. , Onega T. , et al. .
Source: Annals Of Surgical Oncology, 2017 May; 24(5), p. 1234-1241.
EPub date: 2016-12-02 00:00:00.0.
PMID: 27913946
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Accuracy Is In The Eyes Of The Pathologist: The Visual Interpretive Process And Diagnostic Accuracy With Digital Whole Slide Images
Authors: Brunyé T.T. , Mercan E. , Weaver D.L. , Elmore J.G. .
Source: Journal Of Biomedical Informatics, 2017-01-10 00:00:00.0; , .
PMID: 28087402
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The Influence of Disease Severity of Preceding Clinical Cases on Pathologists' Medical Decision Making.
Authors: Frederick P.D. , Nelson H.D. , Carney P.A. , Brunyé T.T. , Allison K.H. , Weaver D.L. , Elmore J.G. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2017 Jan; 37(1), p. 91-100.
PMID: 27037007
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A Randomized Study Comparing Digital Imaging to Traditional Glass Slide Microscopy for Breast Biopsy and Cancer Diagnosis.
Authors: Elmore J.G. , Longton G.M. , Pepe M.S. , Carney P.A. , Nelson H.D. , Allison K.H. , Geller B.M. , Onega T. , Tosteson A.N. , Mercan E. , et al. .
Source: Journal Of Pathology Informatics, 2017; 8, p. 12.
EPub date: 2017-03-10 00:00:00.0.
PMID: 28382226
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Histological features associated with diagnostic agreement in atypical ductal hyperplasia of the breast: illustrative cases from the B-Path study.
Authors: Allison K.H. , Rendi M.H. , Peacock S. , Morgan T. , Elmore J.G. , Weaver D.L. .
Source: Histopathology, 2016 Dec; 69(6), p. 1028-1046.
PMID: 27398812
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Region of interest identification and diagnostic agreement in breast pathology.
Authors: Nagarkar D.B. , Mercan E. , Weaver D.L. , Brunyé T.T. , Carney P.A. , Rendi M.H. , Beck A.H. , Frederick P.D. , Shapiro L.G. , Elmore J.G. .
Source: Modern Pathology : An Official Journal Of The United States And Canadian Academy Of Pathology, Inc, 2016 Sep; 29(9), p. 1004-11.
PMID: 27198567
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Localization of Diagnostically Relevant Regions of Interest in Whole Slide Images: a Comparative Study.
Authors: Mercan E. , Aksoy S. , Shapiro L.G. , Weaver D.L. , Brunyé T.T. , Elmore J.G. .
Source: Journal Of Digital Imaging, 2016 Aug; 29(4), p. 496-506.
PMID: 26961982
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Pupil diameter changes reflect difficulty and diagnostic accuracy during medical image interpretation.
Authors: Brunyé T.T. , Eddy M.D. , Mercan E. , Allison K.H. , Weaver D.L. , Elmore J.G. .
Source: Bmc Medical Informatics And Decision Making, 2016-07-05 00:00:00.0; 16, p. 77.
EPub date: 2016-07-05 00:00:00.0.
PMID: 27378371
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Identifying and processing the gap between perceived and actual agreement in breast pathology interpretation.
Authors: Carney P.A. , Allison K.H. , Oster N.V. , Frederick P.D. , Morgan T.R. , Geller B.M. , Weaver D.L. , Elmore J.G. .
Source: Modern Pathology : An Official Journal Of The United States And Canadian Academy Of Pathology, Inc, 2016 Jul; 29(7), p. 717-26.
PMID: 27056072
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Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study.
Authors: Elmore J.G. , Tosteson A.N. , Pepe M.S. , Longton G.M. , Nelson H.D. , Geller B. , Carney P.A. , Onega T. , Allison K.H. , Jackson S.L. , et al. .
Source: Bmj (clinical Research Ed.), 2016-06-22 00:00:00.0; 353, p. i3069.
EPub date: 2016-06-22 00:00:00.0.
PMID: 27334105
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Variability in Pathologists' Interpretations of Individual Breast Biopsy Slides: A Population Perspective.
Authors: Elmore J.G. , Nelson H.D. , Pepe M.S. , Longton G.M. , Tosteson A.N. , Geller B. , Onega T. , Carney P.A. , Jackson S.L. , Allison K.H. , et al. .
Source: Annals Of Internal Medicine, 2016-05-17 00:00:00.0; 164(10), p. 649-55.
EPub date: 2016-05-17 00:00:00.0.
PMID: 26999810
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Medical malpractice concerns and defensive medicine: a nationwide survey of breast pathologists.
Authors: Reisch L.M. , Carney P.A. , Oster N.V. , Weaver D.L. , Nelson H.D. , Frederick P.D. , Elmore J.G. .
Source: American Journal Of Clinical Pathology, 2015 Dec; 144(6), p. 916-22.
PMID: 26572999
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Trends in breast biopsy pathology diagnoses among women undergoing mammography in the United States: a report from the Breast Cancer Surveillance Consortium.
Authors: Allison K.H. , Abraham L.A. , Weaver D.L. , Tosteson A.N. , Nelson H.D. , Onega T. , Geller B.M. , Kerlikowske K. , Carney P.A. , Ichikawa L.E. , et al. .
Source: Cancer, 2015-05-01 00:00:00.0; 121(9), p. 1369-78.
EPub date: 2015-05-01 00:00:00.0.
PMID: 25603785
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Demographic and practice characteristics of pathologists who enjoy breast tissue interpretation.
Authors: Oster N.V. , Geller B.M. , Carney P.A. , Reisch L.M. , Onega T. , Weaver D.L. , Frederick P. , Elmore J.G. .
Source: Breast (edinburgh, Scotland), 2015 Apr; 24(2), p. 107-11.
PMID: 25554017
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Diagnostic concordance among pathologists interpreting breast biopsy specimens.
Authors: Elmore J.G. , Longton G.M. , Carney P.A. , Geller B.M. , Onega T. , Tosteson A.N. , Nelson H.D. , Pepe M.S. , Allison K.H. , Schnitt S.J. , et al. .
Source: Jama, 2015-03-17 00:00:00.0; 313(11), p. 1122-32.
PMID: 25781441
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Second Opinion In Breast Pathology: Policy, Practice And Perception
Authors: Geller B.M. , Nelson H.D. , Carney P.A. , Weaver D.L. , Onega T. , Allison K.H. , Frederick P.D. , Tosteson A.N. , Elmore J.G. .
Source: Journal Of Clinical Pathology, 2014 Nov; 67(11), p. 955-60.
PMID: 25053542
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Digitized whole slides for breast pathology interpretation: current practices and perceptions.
Authors: Onega T. , Weaver D. , Geller B. , Oster N. , Tosteson A.N. , Carney P.A. , Nelson H. , Allison K.H. , O'Malley F.P. , Schnitt S.J. , et al. .
Source: Journal Of Digital Imaging, 2014 Oct; 27(5), p. 642-8.
PMID: 24682769
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Eye movements as an index of pathologist visual expertise: a pilot study.
Authors: Brunyé T.T. , Carney P.A. , Allison K.H. , Shapiro L.G. , Weaver D.L. , Elmore J.G. .
Source: Plos One, 2014; 9(8), p. e103447.
PMID: 25084012
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Mouse cursor movement and eye tracking data as an indicator of pathologists' attention when viewing digital whole slide images.
Authors: Raghunath V. , Braxton M.O. , Gagnon S.A. , Brunyé T.T. , Allison K.H. , Reisch L.M. , Weaver D.L. , Elmore J.G. , Shapiro L.G. .
Source: Journal Of Pathology Informatics, 2012; 3, p. 43.
EPub date: 2012-12-20 00:00:00.0.
PMID: 23372984
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