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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations
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
Related Citations