As the cancer registry expands it will increasing become more useful to anatomic pathologists, histopathologists, oncologists, and even clinical laboratories
Oncologists, histopathologists, anatomic pathologists, and other cancer physicians now have a powerful new Wikipedia-style tumor registry to help them with their diagnoses and in educating patients on their specific types of cancer. Clinical laboratory managers may find it useful to understand the value this searchable database, and it can help their staff pathologists as well.
Free to use by both physicians and patients the World Tumor Registry (WTR) is designed “to minimize diagnostic errors by giving doctors a searchable online database of cancers that have been collected and categorized with cellular images collected from around the world,” Pittsburg-Post Gazette reported.
Prompt, accurate cancer diagnoses offer cancer patients the best chance for optimal treatment outcomes. However, many medical professionals around the globe do not have the training and resources to offer superior cancer diagnoses. That deficiency can translate to inferior treatment options and lower survival rates among cancer patients.
To help improve cancer diagnoses, pathologist Yuri E. Nikiforov, MD, PhD, Division Director, Molecular and Genomic Pathology, Vice Chair of the Department of Pathology, and Professor of Pathology, University of Pittsburgh, developed the WTR to provide educational and practical resources for individuals and organizations involved in cancer research.
Officially announced at the United States and Canadian Academy of Pathology (USCAP) annual convention, the WTR is an open-access catalog of digital microscopic images of human cancer types and subtypes.
The lower cost of technology and improved speed of access via the internet are technologies enabling this effort.
“We are creating sort of a Wikipedia for cancer images,” said Alyaksandr V. Nikitski, MD, PhD (above), Research Assistant Professor of Pathology, Division of Molecular and Genomic Pathology at Pittsburg School of Medicine and Administrative Director of the WTR, in an exclusive interview with Dark Daily. “Anyone in the world, if they can access the internet, can look at the well-annotated, diagnostic digital slides of cancer,” said Nikitski. Clinical laboratories may also find this new pathology tool useful. (Photo copyright: Alyaksandr V. Nikitski)
Minimizing Diagnostic Errors
Based in Pittsburgh, the WTR is freely available to anyone for viewing digital pathology slides of known cancer tumors as well as borderline and questionable cases. On the website, individuals can search for pictures of tumors in the registry by diagnosis, specific cohorts, and by microscopic features. Individuals may search further by tumor type and subtype to receive a picture of related tumors.
According to the WTR website, the mission of the nonprofit “is to minimize diagnostic errors, eliminate inequality in cancer recognition, diagnosis, and treatment in diverse populations, and improve outcomes by increasing access to the diagnostic pathology expertise and knowledge of microscopic characteristics of cancers that occur in different geographic, environmental, and socio-economic settings.”
This new comprehensive initiative will eventually encompass cancer images from all over the world.
“Let’s assume that I am a pathologist or a trainee who has little experience, or I don’t have access to collections of atypical tumors,” Nikitski explained. “I can view tumor collections online [in the WTR database] and check how typical and rare tumors look in various geographic regions and environmental settings.”
Once an image of a slide is selected, users will then receive a brief case history of the tumor in addition to such data as the age of the patient, their geographic location, sex, family history of the disease, and the size and stage of the tumor.
Increasing Probability of Correct Diagnosis
Pathologists and clinicians may also predict the probability of a particular diagnosis by searching under the microscopic feature of the database. This feature utilizes an innovative classifier known as PathDxFinder, where users may compare a slide from their lab to slides in the database by certain criteria. This includes:
After completing the questions above, the user presses the “predict diagnosis” button to receive the probability of cancer and most likely diagnosis based on the answers provided in the questionnaire.
WTR Editorial Boards
The WTR represents collections for each type of cancer site, such as lung or breast. A chairperson and editorial board are responsible for reviewing submitted slides before they are placed online. The editorial boards include 20 pathologists who are experts in diagnosing cancer categories, Nikitski explained.
Thousands of identified microscopic whole slide images (WSI) representing various types of cancer are deposited by the editors and other contributors to the project. The editorial board then carefully analyzes and compiles the data before posting the images for public viewing.
The editorial boards are located in five world regions:
Africa and the Middle East
Asia and Oceania
Central and South America
North America and Europe
Northern Asia
Any physicians or pathologists can contribute images to the database, by “simply selecting the editor of their region on the website, writing their name, and asking if they can submit tumor cases,” Nikitski stated.
“We have established a platform that allows pathologists to contact editors who are in the same geographic region,” he added.
Helping Physicians Identify Cancer Types
In a YouTube video, Nikiforov states that the WTR is an “educational nonprofit organization rooted in [the] beliefs that every cancer patient deserves accurate and timely diagnosis as the first and essential step in better treatment and outcomes.”
“We believe this can be achieved only when modern diagnostic tools and technologies are freely available to every physician and pathologist. Only when we understand how microscopic features of cancer vary in different geographic, environmental and ethnic populations, and only by integrating histopathology with clinical immunohistochemical and molecular genetic information for every cancer type,” he stated.
Since patient privacy is important, the database contains only basic data about patients, and all patient information is protected.
Launched in March, there are currently more than 400 thyroid tumor slides available to view in the online database. At the time of the announcement, the WTR platform was planned to be implemented in three phases:
Thyroid cancer (released in March of this year).
Lung cancer and breast cancer (anticipated to be completed by the third quarter of 2026).
Remaining cancers, including brain, soft tissue and bone, colorectal, head and neck, hematolymphoid, female genital, liver, pancreatic, prostate and male genital, skin, urinary system, pediatric, other endocrine cancers, and rare cancers (anticipated to be completed by the end of 2029).
“We believe that this resource will help physicians and pathologists practicing in small or big or remote medical centers to learn how cancer looks under a microscope in their own communities,” Nikiforov said in the video. “We also see WTR as a platform that connects physicians and scientists from different parts of the world who can work together to better understand and treat cancer.”
Catalogs like the World Tumor Registry might potentially create a pool of information that that could be mined by analytical and artificial intelligence (AI) platforms to ferret out new ways to improve the diagnosis of certain types of cancer and even enable earlier diagnoses.
“It is an extremely useful resource,” Nikitski said.
Anatomic pathologists will certainly find it so. And clinical laboratory managers may find the information useful as well when interacting with histopathologists and oncologists.
Researchers intend their new AI image retrieval tool to help pathologists locate similar case images to reference for diagnostics, research, and education
Researchers at Stanford University turned to an unusual source—the X social media platform (formerly known as Twitter)—to train an artificial intelligence (AI) system that can look at clinical laboratory pathology images and then retrieve similar images from a database. This is an indication that pathologists are increasingly collecting and storing images of representative cases in their social media accounts. They then consult those libraries when working on new cases that have unusual or unfamiliar features.
The Stanford Medicine scientists trained their AI system—known as Pathology Language and Image Pretraining (PLIP)—on the OpenPath pathology dataset, which contains more than 200,000 images paired with natural language descriptions. The researchers collected most of the data by retrieving tweets in which pathologists posted images accompanied by comments.
“It might be surprising to some folks that there is actually a lot of high-quality medical knowledge that is shared on Twitter,” said researcher James Zou, PhD, Assistant Professor of Biomedical Data Science and senior author of the study, in a Stanford Medicine SCOPE blog post, which added that “the social media platform has become a popular forum for pathologists to share interesting images—so much so that the community has widely adopted a set of 32 hashtags to identify subspecialties.”
“It’s a very active community, which is why we were able to curate hundreds of thousands of these high-quality pathology discussions from Twitter,” Zou said.
“The main application is to help human pathologists look for similar cases to reference,” James Zou, PhD (above), Assistant Professor of Biomedical Data Science, senior author of the study, and his colleagues wrote in Nature Medicine. “Our approach demonstrates that publicly shared medical information is a tremendous resource that can be harnessed to develop medical artificial intelligence for enhancing diagnosis, knowledge sharing, and education.” Leveraging pathologists’ use of social media to store case images for future reference has worked out well for the Stanford Medicine study. (Photo copyright: Stanford University.)
Retrieving Pathology Images from Tweets
“The lack of annotated publicly-available medical images is a major barrier for innovations,” the researchers wrote in Nature Medicine. “At the same time, many de-identified images and much knowledge are shared by clinicians on public forums such as medical Twitter.”
In this case, the goal “is to train a model that can understand both the visual image and the text description,” Zou said in the SCOPE blog post.
“Pathology is perhaps even more suited to Twitter than many other medical fields because for most pathologists, the bulk of our daily work revolves around the interpretation of images for the diagnosis of human disease,” wrote Jerad M. Gardner, MD, a dermatopathologist and section head of bone/soft tissue pathology at Geisinger Medical Center in Danville, Pa., in a blog post about the Pathology Hashtag Ontology project. “Twitter allows us to easily share images of amazing cases with one another, and we can also discuss new controversies, share links to the most cutting edge literature, and interact with and promote the cause of our pathology professional organizations.”
The researchers used the 32 subspecialty hashtags to retrieve English-language tweets posted from 2006 to 2022. Images in the tweets were “typically high-resolution views of cells or tissues stained with dye,” according to the SCOPE blog post.
The researchers collected a total of 232,067 tweets and 243,375 image-text pairs across the 32 subspecialties, they reported. They augmented this with 88,250 replies that received the highest number of likes and had at least one keyword from the ICD-11 codebook. The SCOPE blog post noted that the rankings by “likes” enabled the researchers to screen for high-quality replies.
They then refined the dataset by removing duplicates, retweets, non-pathology images, and tweets marked by Twitter as being “sensitive.” They also removed tweets containing question marks, as this was an indicator that the practitioner was asking a question about an image rather than providing a description, the researchers wrote in Nature Medicine.
They cleaned the text by removing hashtags, Twitter handles, HTML tags, emojis, and links to websites, the researchers noted.
The final OpenPath dataset included:
116,504 image-text pairs from Twitter posts,
59,869 from replies, and
32,041 image-text pairs scraped from the internet or obtained from the LAION dataset.
The latter is an open-source database from Germany that can be used to train text-to-image AI software such as Stable Diffusion.
Training the PLIP AI Platform
Once they had the dataset, the next step was to train the PLIP AI model. This required a technique known as contrastive learning, the researchers wrote, in which the AI learns to associate features from the images with portions of the text.
As explained in Baeldung, an online technology publication, contrastive learning is based on the idea that “it is easier for someone with no prior knowledge, like a kid, to learn new things by contrasting between similar and dissimilar things instead of learning to recognize them one by one.”
“The power of such a model is that we don’t tell it specifically what features to look for. It’s learning the relevant features by itself,” Zou said in the SCOPE blog post.
The resulting AI PLIP tool will enable “a clinician to input a new image or text description to search for similar annotated images in the database—a sort of Google Image search customized for pathologists,” SCOPE explained.
“Maybe a pathologist is looking at something that’s a bit unusual or ambiguous,” Zou told SCOPE. “They could use PLIP to retrieve similar images, then reference those cases to help them make their diagnoses.”
The Stanford University researchers continue to collect pathology images from X. “The more data you have, the more it will improve,” Zou said.
Pathologists will want to keep an eye on the Stanford Medicine research team’s progress. The PLIP AI tool may be a boon to diagnostics and improve patient outcomes and care.
First was the USCAP meeting, conducted in San Diego, California. This is a growing meeting and attracts more than 3,000 pathologists from countries around the world. One can hear many different languages spoken as one walks among the crowd between sessions. The exhibit hall of USCAP is also growing. It featured 245 exhibitors and represented a good cross section of companies selling instrument systems, consumables, and services to anatomic pathology laboratories.
Of particular note were two things seen in USCAP’s exhibition hall. First, there was an intriguing spread of companies offering digital solutions for anatomic pathology. Technology is advancing and, even if the current generation of products fall a bit short of the functionality desired by customers, it is clear that lots of money is being invested to advance all aspects of pathology informatics and digital imaging. Second, molecular pathology was definitely a major product sector at this exhibition. Whether it was the marketing of new diagnostic assays or companies offering services in molecular pathology, there was high interest in how molecular pathology could be used to provide higher quality diagnostic support to pathologists and their referring clinicians.
Following the USCAP meeting, I flew to Houston, Texas to catch the CLMA annual meeting. Just as laboratory consolidation in the hospital industry over the past decade has steadily concentrated laboratory management duties into the hands of fewer people, CLMA has seen a corresponding shift in the numbers of attendees and the composition of vendors in its exhibition hall. One obvious difference from past years is the lower profile of several in vitro diagnostic (IVD) companies at this year’s event. Yet, a survey of vendors throughout the exhibition hall indicated that the people passing through the exhibition were qualified buyers and their expectation was that new business would be result from their participation at the exhibition.
Just as at the USCAP exhibition hall, CLMA’s exhibitor line-up featured a growing number of software and informatics vendors compared to past years. I take this as a sign that laboratory directors and pathologists are taking active steps to use information technology to guide their management of laboratory operations and work flow. The range of middleware solutions and vendors on the exhibition floor would be a response by vendors to the demand for those functions by laboratory customers.
Another observation was gained from attendance at the annual meetings of USCAP and CLMA. There is plenty of optimism about the future of laboratory medicine among attendees and vendors at both events. Despite the rapid pace of change in healthcare and unfavorable reimbursement trends, pathologists and laboratory managers believe that new diagnostic tests and advances in laboratory medicine are giving them important new tools to help patients and their physicians.
