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Clinical Laboratories and Pathology Groups

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UCLA’s Virtual Histology Could Eliminate Need for Invasive Biopsies for Some Skin Conditions and Cancers

Though the new technology could speed diagnoses of cancers and other skin diseases, it would also greatly reduce dermatopathology biopsy referrals and revenue

What effect would elimination of tissue biopsies have on dermatopathology and clinical laboratory revenue? Quite a lot. Dermatologists alone account for a significant portion of skin biopsies sent to dermatopathologists. Thus, any new technology that can “eliminate the need for invasive skin biopsies” would greatly reduce the number of histopathological referrals and reduce revenue to those practices.

Nevertheless, one such new technology may have been created by Ozcan Research Group in a proof-of-concept study they conducted at the University of California, Los Angeles (UCLA).

Called Virtual Histology, the technology applies artificial intelligence (AI) deep learning methods to reflectance confocal microscopy (RCM) images “to rapidly perform virtual histology of in vivo, label-free RCM images of normal skin structure, basal cell carcinoma, and melanocytic nevi with pigmented melanocytes, demonstrating similar histological features to traditional histology from the same excised tissue,” the UCLA scientists wrote in their study, published in the Nature peer-reviewed journal Light: Science and Applications.

Aydogan Ozcan, PhD

“What if we could entirely bypass the biopsy process and perform histology-quality staining without taking tissue and processing tissue in a noninvasive way? Can we create images that diagnosticians can benefit from?” asked Aydogan Ozcan, PhD (above), Chancellor’s Professor of Electrical and Computer Engineering at UCLA’s Samueli School of Engineering, one of the scientists who developed UCLA’s new virtual histology method, during an interview with Medical Device + Diagnostic Industry (MD+DI). (Photo copyright: Nature.)

Could Skin Biopsies be Eliminated?

The UCLA researchers believe their innovative deep learning-enabled imaging framework could possibly circumvent the need for skin biopsies to diagnose skin conditions.

“Here, we present a deep learning-based framework that uses a convolutional neural network to rapidly transform in vivo RCM images of unstained skin into virtually-stained hematoxylin and eosin-like images with microscopic resolution, enabling visualization of the epidermis, dermal-epidermal junction, and superficial dermis layers.

“This application of deep learning-based virtual staining to noninvasive imaging technologies may permit more rapid diagnoses of malignant skin neoplasms and reduce invasive skin biopsies,” the researchers added in their published study.

“This process bypasses several standard steps typically used for diagnosis, including skin biopsy, tissue fixation, processing, sectioning, and histochemical staining,” Aydogan Ozcan, PhD, Chancellor’s Professor of Electrical and Computer Engineering at UCLA’s Samueli School of Engineering, told Optics.org.

AI and Deep Learning in Dermatopathology

According to the published study, the UCLA team trained their neural network under an adversarial machine learning scheme to transform grayscale RCM images into virtually stained 3D microscopic images of normal skin, basal cell carcinoma, and pigmented melanocytic nevi. The new images displayed similar morphological features to those shown with the widely used hematoxylin and eosin (H&E) staining method.

“In our studies, the virtually stained images showed similar color contrast and spatial features found in traditionally stained microscopic images of biopsied tissue,” Ozcan told Photonics Media. “This approach may allow diagnosticians to see the overall histological features of intact skin without invasive skin biopsies or the time-consuming work of chemical processing and labeling of tissue.”

The framework covers different skin layers, including the epidermis, dermal-epidermis, and superficial dermis layers. It images deeper into tissue without being invasive and can be quickly performed.

“The virtual stain technology can be streamlined to be almost semi real time,” Ozcan told Medical Device + Diagnostic Industry (MD+DI). “You can have the virtual staining ready when the patient is wrapping up. Basically, it can be within a couple of minutes after you’re done with the entire imaging.”

Currently, medical professionals rely on invasive skin biopsies and histopathological evaluations to diagnose skin diseases and cancers. These diagnostic techniques can result in unnecessary biopsies, scarring, multiple patient visits and increased medical costs for patients, insurers, and the healthcare system.

Improving Time to Diagnosis through Digital Pathology

Another advantage of this virtual technology, the UCLA researchers claim, is that it can provide better images than traditional staining methods, which could improve the ability to diagnose pathological skin conditions and help alleviate human error.

“The majority of the time, small laboratories have a lot of problems with consistency because they don’t use the best equipment to cut, process, and stain tissue,” dermatopathologist Philip Scumpia, MD, PhD, Assistant Professor of Dermatology and Dermatopathology at UCLA Health and one of the authors of the research paper, told MD+DI.

“What ends up happening is we get tissue on a histology slide that’s basically unevenly stained, unevenly put on the microscope, and it gets distorted,” he added, noting that this makes it very hard to make a diagnosis.  

Scumpia also added that this new technology would allow digital images to be sent directly to the pathologist, which could reduce processing and laboratory times.

“With electronic medical records now and the ability to do digital photography and digital mole mapping, where you can obtain a whole-body imaging of patients, you could imagine you can also use one of these reflectance confocal devices. And you can take that image from there, add it to the EMR with the virtual histology stain, which will make the images more useful,” Scumpia said. “So now, you can track lesions as they develop.

“What’s really exciting too, is that there’s the potential to combine it with other artificial intelligence, other machine learning techniques that can give more information,” Scumpia added. “Using the reflectance confocal microscope, a clinician who might not be as familiar in dermatopathology could take images and send [them] to a practitioner who could give a more expert diagnosis.”

Faster Diagnoses but Reduced Revenue for Dermatopathologists, Clinical Labs

Ozcan noted that there’s still a lot of work to be done in the clinical assessment, validation, and blind testing of their AI-based staining method. But he hopes the technology can be propelled into a useful tool for clinicians.

“I think this is a proof-of-concept work, and we’re very excited to make it move forward with further advances in technology, in the ways that we acquire 3D information [and] train our neural networks for better and faster virtual staining output,” he told MD+DI.

Though this new technology may reduce the need for invasive biopsies and expedite the diagnosis of skin conditions and cancers—thus improving patient outcomes—what affect might it have on dermatopathology practices?

More research and clinical studies are needed before this new technology becomes part of the diagnosis and treatment processes for skin conditions. Nevertheless, should virtual histology become popular and viable, it could greatly impact the amount of skin biopsy referrals to pathologists, dermatopathologists, and clinical laboratories, thus diminishing a great portion of their revenue. 

—JP Schlingman

Related Information:

Virtual Histology Eliminates Need for Invasive Skin Biopsies

UCLA Deep-learning Reduces Need for Invasive Biopsies

AI Imaging Method Provides Biopsy-free Skin Diagnosis

Light People: Professor Aydogan Ozcan

Histology Process Bypasses Need for Biopsies, Enables Diagnoses

Reflection-Mode Virtual Histology Using Photoacoustic Remote Sensing Microscopy

Introduction to Reflectance Confocal Microscopy and Its Use in Clinical Practice

Biopsy-free In Vivo Virtual Histology of Skin Using Deep Learning

Can This New Tech Reduce the Need for Skin Biopsies?

University of Alberta Researchers Develop Surgical Mask That Traps and Kills Infectious Viruses; Protects Hospital Workers and Clinical Laboratory Technicians from Deadly Diseases

As standard masks are used they collect exhaled airborne pathogens that remain living in the masks’ fibers, rendering them infectious when handled

Surgical-style facial masks harbor a secret—viruses that could be infectious to the people wearing them. However, masks can become effective virus killers as well. At least that’s what researchers at the University of Alberta (UAlberta) in Edmonton, Canada, have concluded.

If true, such a re-engineered mask could protect clinical laboratory workers from exposure to infectious diseases, such as, SARS (Severe Acute Respiratory Syndrome), MERS (Middle East Respiratory Syndrome), and Swine Influenza.

“Surgical masks were originally designed to protect the wearer from infectious droplets in clinical settings, but it doesn’t help much to prevent the spread of respiratory diseases such as SARS or MERS or influenza,” Hyo-Jick Choi, PhD, Assistant Professor in UAlberta’s Department of Chemical and Materials Engineering, noted in a press release.

So, Choi developed a mask that effectively traps and kills airborne viruses.

Clinical Laboratory Technicians at Risk from Deadly Infectious Diseases

The global outbreak of SARS in 2003 is a jarring reminder of how infectious diseases impact clinical laboratories, healthcare workers, and patients. To prevent spreading the disease, Canadian-based physicians visited with patients in hotel rooms to keep the virus from reaching their medical offices, medical laboratory couriers were turned away from many doctors’ offices, and hospitals in Toronto ceased elective surgery and non-urgent services, reported The Dark ReportDark Daily’s sister publication. (See The Dark Report, “SARS Challenges Met with New Technology,” April 14, 2003.)

UAlberta materials engineering professor Hyo-Jick Choi, PhD, (right) and graduate student Ilaria Rubino (left) examine filters treated with a salt solution that kills viruses. Choi and his research team have devised a way to improve the filters in surgical masks, so they can trap and kill airborne pathogens. Clinical laboratory workers will especially benefit from this protection. (Photo and caption copyright: University of Alberta.)

How Current Masks Spread Disease

How do current masks spread infectious disease? According to UAlberta researchers:

  • A cough or a sneeze transmits airborne pathogens such as influenza in aerosolized droplets;
  • Virus-laden droplets can be trapped by the mask;
  • The virus remains infectious and trapped in the mask; and,
  • Risk of spreading the infection persists as the mask is worn and handled.

“Aerosolized pathogens are a leading cause of respiratory infection and transmission. Currently used protective measures pose potential risk of primary and secondary infection and transmission,” the researchers noted in their paper, published in Scientific Reports.

That’s because today’s loose-fitting masks were designed primarily to protect healthcare workers against large respiratory particles and droplets. They were not designed to protect against infectious aerosolized particles, according to the Centers for Disease Control and Prevention (CDC).

In fact, the CDC informed the public that masks they wore during 2009’s H1N1 influenza virus outbreak provided no assurance of infection protection.

“Face masks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing the face mask. They are not designed to protect against breathing in very small particle aerosols that may contain viruses,” a CDC statement noted.

Pass the Salt: A New Mask to Kill Viruses

Choi and his team took on the challenge of transforming the filters found on many common protective masks. They applied a coating of salt that, upon exposure to virus aerosols, recrystallizes and destroys pathogens, Engineering360 reported.

“Here we report the development of a universal, reusable virus deactivation system by functionalization of the main fibrous filtration unit of surgical mask with sodium chloride salt,” the researchers penned in Scientific Reports.

The researchers exposed their altered mask to the influenza virus. It proved effective at higher filtration compared to conventional masks, explained Contagion Live. In addition, viruses that came into contact with the salt-coated fibers had more rapid infectivity loss than untreated masks.

How Does it Work?

Here’s how the masks work, according to the researchers:

  • Aerosol droplets carrying the influenza virus contact the treated filter;
  • The droplet absorbs salt on the filter;
  • The virus is exposed to increasing concentration of salt; and,
  • The virus is damaged when salt crystallizes.

“Salt-coated filters proved highly effective in deactivating influenza viruses regardless of [influenza] subtypes,” the researchers wrote in Scientific Reports. “We believe that [a] salt-recrystallization-based virus deactivation system can contribute to global health by providing a more reliable means of preventing transmission and infection of pandemic or epidemic diseases and bioterrorism.”

Other Reports on Dangerous Exposure for Clinical Laboratory Workers

This is not the first time Dark Daily has reported on dangers to clinical laboratory technicians and ways to keep them safe.

In “Health of Pathology Laboratory Technicians at Risk from Common Solvents like Xylene and Toluene,” we reported on a 2011 study that determined medical laboratory technicians who handle common solvents were at greater risk of developing auto-immune connective tissue diseases.

And more recently, in “Europe Implements New Anatomic Pathology Guidelines to Reduce Nurse Exposure to Formaldehyde and Other Toxic Histology Chemicals,” we shared information on new approaches to protect nurses from contacting toxic chemicals, such as formalin, toluene, and xylene.

The UAlberta team may have come up with an inexpensive, simple, and effective way to protect healthcare workers and clinical laboratory technicians. Phlebotomists, laboratory couriers, and medical technologists also could wear the masks as protection from accidental infection and contact with specimens. It will be interesting to follow the progress of this special mask with its salty filter.

—Donna Marie Pocius

Related Information:

Researcher Turns “SARS Mask” into a Virus Killer

Universal Reusable Virus Deactivation System for Respiratory Protection

Understanding Respiratory Protection Options in Healthcare

H1N1 Flu and Masks

Arming Surgical Masks to Kill Viruses

New Surgical Mask Designed to Kill Viruses

SARS Challenges Met with New Technology

Toronto Hospital Labs Cope with SARS Impact

Europe Implements New Anatomic Pathology Guidelines to Reduce Nurse Exposure to Formaldehyde and Other Toxic Histology Chemicals

Health of Laboratory Technicians at Risk from Common Solvents Like Xylene and Toluene

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