Ensuring the Future of Digital Pathology

NORTHFIELD, Ill., May 1, 2013 /PRNewswire-USNewswire/ -- The College of American Pathologists (CAP) released today a new evidence-based guideline, "Validating Whole Slide Imaging for Diagnostic Purposes in Pathology."  The guideline is the first of its kind and is now available in the CAP's peer-reviewed journal, Archives of Pathology & Laboratory Medicine.

The document serves as a practical guide for pathologists and laboratories seeking to confirm the accuracy and concordance of their own whole slide imaging (WSI) systems for diagnostic work, while ensuring the digital tool is being properly used for its intended clinical purpose in an effort to deliver optimal patient care. 

"We developed the guideline in anticipation of wider adoption of WSI in clinical practice," said Liron Pantanowitz, MD, FCAP, the lead author of the guideline and associate professor in the Departments of Pathology and Biomedical Informatics at the University of Pittsburgh. "The guideline marks a significant step forward in demonstrating the value of this emerging technology for diagnostic use."

Dr. Pantanowitz, editor-in-chief of the Journal of Pathology Informatics and president of the Association for Pathology Informatics, led a panel of North American experts in digital pathology to develop the guideline.  Based on collective experiences and an extensive global literature review, the expert panel concluded that validation of WSI is crucial to ensure that diagnostic performance based on digitized slides is at least equivalent to that of glass slides and light microscopy.

Among the key points of the 12 recommendations outlined in the guideline are:

• Validation of the entire WSI system, involving pathologists trained to use the system, should be performed in a manner which emulates the laboratory's actual clinical environment.
• It is recommended that such a validation study include at least 60 routine cases per application, assessing intraobserver diagnostic concordance between digitized and glass slides viewed at least two weeks apart.
• It is important that the validation process confirms that all material present on a glass slide to be scanned is included in the digital image.

Currently, the US Food and Drug Administration does not approve WSI systems for primary diagnosis. However, pathologists practicing abroad can implement the guideline immediately in concordance with their country's regulatory guidelines for using WSI in making primary diagnoses.

"The pathology community has been awaiting the development of guidelines by organizations such as CAP concerning the implementation of WSI for diagnostic work," said Andrew J. Evans, MD, PhD, FRCPC, staff pathologist and associate professor at the University Health Network, Laboratory Medicine Program at Toronto General Hospital in Canada and member of the expert panel. "Following the completion of our own validation study at UHN, we have begun using WSI to render primary diagnoses. Since many other centers in Canada are preparing to implement WSI for clinical use, there is a substantial appetite north of the border for the final version of this paper."

WSI technology has several advantages for pathologists, including portability; ease of sharing and retrieval of archival images; and ability to make use of computer-aided diagnostic tools. Pathologists today are using WSI in teaching, research, and for handling consults from small, rural hospitals with no on-site pathologist. As the use of WSI expands, pathologists are seeing quicker turnaround times with the same quality of care.

The CAP Pathology & Laboratory Quality Center (the Center), a forum for developing evidence-based guidelines and consensus recommendations, provided the process for creating the guideline. The guideline will be updated as appropriate as new evidence-based research becomes available.

The CAP offers tools and resources to help further understanding and implementation of the guideline, including a summary of the recommendations. More information about how others are using digital pathology can be found in the CAP's ebook, New Paths…New Choices: Pathology in an Era of Advancing Science and Disruptive Health Economics, specifically chapter 7, "Digital Pathology: New Technology Breaks the Distance Barrier,"

The CAP also will host a webcast on Friday, May 17 to provide an overview of the guideline. Registration information will be available on cap.org in the near future.

About the College of American Pathologists
As the leading organization for board-certified pathologists, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. With more than 18,000 physician members, the CAP has led as the gold standard in laboratory accreditation for 50 years with more than 7,300 CAP-accredited laboratories in 50 countries. Find more information about the CAP at cap.org.

SOURCE College of American Pathologists

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Alabama Education Budget Prevents Future Misappropriation of Funds from Reading/Math Initiatives to Common Core

TUSCALOOSA, Ala., April 11, 2013 /PRNewswire-USNewswire/ --  The Alabama House amended the education budget Wednesday to prevent the Superintendent of Education from diverting millions of additional dollars from the Alabama Reading and Math Initiatives to implement Common Core.  This was in response to investigations by conservative grassroots groups that revealed Alabama State Superintendent Dr. Tommy Bice had diverted over fifty million dollars from these two initiatives to pay for Common Core.

Elois Zeanah, president of the Alabama Federation of Republican Women, stated, "If Dr. Bice had been in private industry, he would have been fired for diverting millions of dollars to his pet project!  These are tax dollars of hard-working Alabamians and should be treated no differently by legislators than how CEOs treat dollars from private investors or for-profit companies." 

Zeanah continued, "We are excited about the amendment that was passed to prevent future misappropriations.  Our children have lost at least one year of the reading instruction that had made Alabama number one in reading gains in the nation and decreased the reading gap between black and white students by four points since 2003.  This unauthorized diversion should anger everyone."

Sharon Sewell, a retired teacher and director of Alabamians for Excellence in Education stated:  "The state board of education seems to think they can do whatever they want without transparency and accountability to parents, teachers, taxpayers, the legislature, or even the governor.  That is my view.  It is very important that parents understand what Common Core is, where it came from, where it is going, and how it will impact their children's lives."

Conservative advocates say Common Core is "one-size-fits-all" national standards and if legislators don't repeal Common Core, they will voluntarily give away Alabama's education freedom under the Tenth Amendment to bureaucrats in Washington, D.C. who care more about power and money than about children and education. 

Sewell who taught school for 32 years added, "Common Core is not a reform as we have known in the past.  It is a total transformation of schools.  The federal government has our healthcare.  They're trying to get our guns.  Now they want our children, too!"

Bills to repeal Common Core (SB 403/404 and HB 565) are expected to be voted on by the Education Policy Committees next week.   

SOURCE Alabama Federation of Republican Women

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Former US Commander in Afghanistan John Allen Hopeful, Realistic About Country's Future

Gen. John Allen, the former commander of international forces in Afghanistan, said Afghan security forces have proven themselves to be more capable than anyone expected, and will be ready to take over securing the country 2014.

"They turned out to be better than we thought. They turned out to be better than they thought," said Allen.

Allen said he generally was hopeful as he sat down at the Brookings Institute today to give his thoughts on the state of Afghanistan and how it might fare after the U.S. draw-down that starts next year.

He credited the progress made by Afghan security forces to developmental strategies as much as building military capacity, citing the push for literacy within Afghan forces. Allen said the literacy program was championed by international forces commanders - Stanley McChrystal, David Petraeus and then himself - and that he expected Gen. Joseph Dunford to continue the program because of its success. Allen said more than half the Afghan troops now have the capacity to read and write at a first grade level.

"We intend ultimately … to not just emphasize the continuation of that program at the basic or entry level," he said, "but to continue to emphasize the continued learning of the Afghan soldiers and police throughout the period of time when they're enlisted so that this becomes not just an initiative which is useful for military or police operations; it's an initiative that has the potential to change society."

Allen added that despite a turbulent 2012 dealing with the fallout of a video that purportedly showed troops urinating on the corpses of suspected Taliban fighters, the furor over the burning of Korans at a U.S. base in Afghanistan, and an increase in insider attacks, the U.S. was still able to accomplish its major goals for Afghanistan this year, completing the draw-down of 23,000 troops brought in during a surge in force levels and continuing to serve as support for the Afghan forces who are increasingly taking the lead in the fighting. He called the achievement "momentous," noting that already in 2013, U.S. troop positions in Afghanistan mostly are serving advisory roles.

But for all the good news, Allen sounded the alarm on some of the issues that could upend progress. His biggest concern he said was not Afghanistan, but the role it's neighbor Pakistan continues to play in securing peace and stability in the region. He described the relationship between Pakistan, Afghanistan and, by extension, the U.S. as "complicated." He said Pakistan doesn't always get enough credit for the counter-terrorism measures it has taken, but acknowledged that not enough is being done to secure the porous border between the two countries where militants are known to cross easily.

"The border area on both sides remains a principle obstacle and potential problems for a downturn of the campaign," he said, alluding to "safe havens" that he said Pakistan needs to crack down on.

The general said it was unrealistic to expect the insurgency to completely end by Jan 1, 2015.

"The fact that the ISAF mission has ended and resolute support is under way as an advisory mission, there's still going to be fighting," said Allen. "And Afghanistan will join a long and distinguished list of countries that will be struggling in a post-conflict environment, where it will have an insurgency in some parts of that country for an extended period of time."

Allen said the measure of success shouldn't be whether there is still a presence of an insurgency, but whether the Afghanistan security forces and police have the capacity to continue to erode and ultimately defeat the insurgency's power base. Allen believes that, with continued support from the U.S. and other international partners, Afghan security forces will be successful.

He said President Karzai's statements criticizing the U.S. are unhelpful to the partnership, but he said the Afghanistan president was in a "complex" position. Calling Karzai's job "the hardest in the world," Allen said that the leader is constantly stuck between serving his domestic constituency and keeping the international community happy.

"He has to balance his rhetoric for the potential for peace," said Allen. "Sometimes, that rhetoric is harsh. And we don't have to agree with it. We don't have to condone it. We don't have to like it. And on those occasions where I've publicly been confronted - in testimony, primarily - with some of his rhetoric, I, in fact, reject it. And I reject comments which would put our troops at risk, that would put his troops at risk."

Referencing the latest controversy over Karzai accusing the U.S. of colluding with the Taliban, Allen joked, "In fact, if the president truly does believe that the U.S. is colluding with the Taliban, I'm here to tell you: I would know, and we ain't and we don't intend to."

The four-star general got personal as he reflected on the end of his 36-year military career, telling the crowd that serving as the commander of international forces in Afghanistan was the greatest honor of his life. He said he thinks every day about the 561 coalition troops who were killed and 5,500 who were wounded in action fighting under his command.

"While we all may have different views of the war and the struggle and the conflict, none of us should have anything other than the utmost respect for these young women and men who have, in some cases, given everything," he said. "And we should never forget that."

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