Diagnostic proficiency test using digital cytopathology and comparative assessment of whole slide images of cytologic samples for quality assurance program in Korea

정요셉,홍순옥,오훈규,정수진,김보성,정지윤,이호창,공경엽,The Committee of Quality Improvement of Korean Society for Cytopathology 대한병리학회 2023 Journal of Pathology and Translational Medicine Vol.57 No.5

Background: The Korean Society for Cytopathology introduced a digital proficiency test (PT) in 2021. However, many doubtful opinions remain on whether digitally scanned images can satisfactorily present subtle differences in the nuclear features and chromatin patterns of cytological samples. Methods: We prepared 30 whole-slide images (WSIs) from the conventional PT archive by a selection process for digital PT. Digital and conventional PT were performed in parallel for volunteer institutes, and the results were compared using feedback. To assess the quality of cytological assessment WSIs, 12 slides were collected and scanned using five different scanners, with four cytopathologists evaluating image quality through a questionnaire. Results: Among the 215 institutes, 108 and 107 participated in glass and digital PT, respectively. No significant difference was noted in category C (major discordance), although the number of discordant cases was slightly higher in the digital PT group. Leica, 3DHistech Pannoramic 250 Flash, and Hamamatsu NanoZoomer 360 systems showed comparable results in terms of image quality, feature presentation, and error rates for most cytological samples. Overall satisfaction was observed with the general convenience and image quality of digital PT. Conclusions: As three-dimensional clusters are common and nuclear/chromatin features are critical for cytological interpretation, careful selection of scanners and optimal conditions are mandatory for the successful establishment of digital quality assurance programs in cytology.

Recommendations for pathologic practice using digital pathology: consensus report of the Korean Society of Pathologists

정요셉,김대철,정찬권,김동철,송상용,주희재,이상엽 대한병리학회 2020 Journal of Pathology and Translational Medicine Vol.54 No.6

Digital pathology (DP) using whole slide imaging (WSI) is becoming a fundamental issue in pathology with recent advances and the rapid development of associated technologies. However, the available evidence on its diagnostic uses and practical advice for pathologists on implementing DP remains insufficient, particularly in light of the exponential growth of this industry. To inform DP implementation in Korea, we developed relevant and timely recommendations. We first performed a literature review of DP guidelines, recommendations, and position papers from major countries, as well as a review of relevant studies validating WSI. Based on that information, we prepared a draft. After several revisions, we released this draft to the public and the members of the Korean Society of Pathologists through our homepage and held an open forum for interested parties. Through that process, this final manuscript has been prepared. This recommendation contains an overview describing the background, objectives, scope of application, and basic terminology; guidelines and considerations for the hardware and software used in DP systems and the validation required for DP implementation; conclusions; and references and appendices, including literature on DP from major countries and WSI validation studies.

Current status of cytopathology practices in Korea: annual report on the Continuous Quality Improvement program of the Korean Society for Cytopathology for 2018

정요셉,정해연,표정수,홍순원,오훈규 대한병리학회 2020 Journal of Pathology and Translational Medicine Vol.54 No.4

Background: The Korean Society for Cytopathology has conducted the Continuous Quality Improvement program for cytopathology laboratories in Korea since 1995. In 2018 as part of the program, an annual survey of cytologic data was administered to determine the current status of cytopathology practices in Korea. Methods: A questionnaire was administered to 211 cytopathology laboratories. Individual laboratories submitted their annual statistics regarding cytopathology practices, diagnoses of gynecologic samples, inadequacy rates, and gynecologic cytology-histology correlation review (CHCR) data for 2018. In addition, proficiency tests and sample adequacy assessments were conducted using five consequent gynecologic slides. Results: Over 10 million cytologic exams were performed in 2018, and this number has almost tripled since this survey was first conducted in 2004 (compounded annual growth rate of 7.2%). The number of non-gynecologic samples has increased gradually over time and comprised 24% of all exams. The overall unsatisfactory rate was 0.14%. The ratio of the cases with atypical squamous cells to squamous intraepithelial lesions accounted for up to 4.24. The major discrepancy rate of the CHCR in gynecologic samples was 0.52%. In the proficiency test, the major discrepancy rate was approximately 1%. In the sample adequacy assessment, a discrepancy was observed in 0.1% of cases. Conclusions: This study represents the current status of cytopathology practices in Korea, illustrating the importance of the Continuous Quality Improvement program for increasing the accuracy and credibility of cytopathologic exams as well as developing national cancer exam guidelines and government projects on the prevention and treatment of cancer.

Lycorine induces apoptosis by enhancing protein degradation of survivin in human oral cancer cell lines

정요셉,조남표,장분실 대한구강악안면병리학회 2017 대한구강악안면병리학회지 Vol.41 No.1

Lycorine, a natural alkaloid extracted from the Amaryllidaceae plant family, was reported to various physiological and pharmacological effects including anti-cancer activity. Nevertheless, there is no report of the anticancer effect of lycorine in oral cancer cells. The effects of lycorine on cell proliferation and apoptosis were examined through trypan blue exclusion assay, 4’-6-diamidino-2-phenylindole (DAPI) stain, Live/Dead assay, Western blot analysis and RT-PCR. Lycorine suppressed cell viability and induced apoptosis in MC3 and HSC-3 cell lines. Lycorine decreased survivin protein but did not affect its mRNA. It regulated survivin through accelerating protein degradation in a time-dependent manner although neither proteasome nor lysosome was not associated with lycorine-mediated protein degradation. Collectively, our results suggest that lycorine may be a potential therapeutic anti-cancer drug candidate for the treatment of human oral cancer.

Nodal involvement of extranodal marginal zone lymphoma with extreme plasmacytic differentiation (Mott cell formation) simulating plasma cell neoplasm and lymphoplasmacytic lymphoma

정요셉,강창석,오우진,김태정,이은정 대한혈액학회 2014 Blood Research Vol.49 No.4

A stepwise approach to fine needle aspiration cytology of lymph nodes

정요셉,박경신,차희정,김현정,강창석,Jamshid Abdul-Ghafar,이승숙 대한병리학회 2023 Journal of Pathology and Translational Medicine Vol.57 No.4

The cytological diagnosis of lymph node lesions is extremely challenging because of the diverse diseases that cause lymph node enlargement, including both benign and malignant or metastatic lymphoid lesions. Furthermore, the cytological findings of different lesions often resemble one another. A stepwise diagnostic approach is essential for a comprehensive diagnosis that combines: clinical findings, including age, sex, site, multiplicity, and ultrasonography findings; low-power reactive, metastatic, and lymphoma patterns; high-power population patterns, including two populations of continuous range, small monotonous pattern and large monotonous pattern; and disease-specific diagnostic clues including granulomas and lymphoglandular granules. It is also important to remember the histological features of each diagnostic category that are common in lymph node cytology and to compare them with cytological findings. It is also essential to identify a few categories of diagnostic pitfalls that often resemble lymphomas and easily lead to misdiagnosis, particularly in malignant small round cell tumors, poorly differentiated squamous cell carcinomas, and nasopharyngeal undifferentiated carcinoma. Herein, we review a stepwise approach for fine needle aspiration cytology of lymphoid diseases and suggest a diagnostic algorithm that uses this approach and the Sydney classification system.

A machine-learning expert-supporting system for diagnosis prediction of lymphoid neoplasms using a probabilistic decision-tree algorithm and immunohistochemistry profile database

정요셉,이지영,김예진,최진균,유환조,박경신,조미연,Thakur Nishant 대한병리학회 2020 Journal of Pathology and Translational Medicine Vol.54 No.6

Background: Immunohistochemistry (IHC) has played an essential role in the diagnosis of hematolymphoid neoplasms. However, IHC interpretations can be challenging in daily practice, and exponentially expanding volumes of IHC data are making the task increasingly difficult. We therefore developed a machine-learning expert-supporting system for diagnosing lymphoid neoplasms. Methods: A probabilistic decision-tree algorithm based on the Bayesian theorem was used to develop mobile application software for iOS and Android platforms. We tested the software with real data from 602 training and 392 validation cases of lymphoid neoplasms and compared the precision hit rates between the training and validation datasets. Results: IHC expression data for 150 lymphoid neoplasms and 584 antibodies was gathered. The precision hit rates of 94.7% in the training data and 95.7% in the validation data for lymphomas were not statistically significant. Results in most B-cell lymphomas were excellent, and generally equivalent performance was seen in T-cell lymphomas. The primary reasons for lack of precision were atypical IHC profiles for certain cases (e.g., CD15-negative Hodgkin lymphoma), a lack of disease-specific markers, and overlapping IHC profiles of similar diseases. Conclusions: Application of the machine-learning algorithm to diagnosis precision produced acceptable hit rates in training and validation datasets. Because of the lack of origin- or disease-specific markers in differential diagnosis, contextual information such as clinical and histological features should be taken into account to make proper use of this system in the pathologic decision-making process.

Development of quality assurance program for digital pathology by the Korean Society of Pathologists

정요셉,배정모,강동욱,김광일,한혜승 대한병리학회 2022 Journal of Pathology and Translational Medicine Vol.56 No.6

Background: Digital pathology (DP) using whole slide imaging is a recently emerging game changer technology that can fundamentally change the way of working in pathology. The Digital Pathology Study Group (DPSG) of the Korean Society of Pathologists (KSP) published a consensus report on the recommendations for pathologic practice using DP. Accordingly, the need for the development and implementation of a quality assurance program (QAP) for DP has been raised. Methods: To provide a standard baseline reference for internal and external QAP for DP, the members of the Committee of Quality Assurance of the KSP developed a checklist for the Redbook and a QAP trial for DP based on the prior DPSG consensus report. Four leading institutes participated in the QAP trial in the first year, and we gathered feedback from these institutes afterwards. Results: The newly developed checklists of QAP for DP contain 39 items (216 score): eight items for quality control of DP systems; three for DP personnel; nine for hardware and software requirements for DP systems; 15 for validation, operation, and management of DP systems; and four for data security and personal information protection. Most participants in the QAP trial replied that continuous education on unfamiliar terminology and more practical experience is demanding. Conclusions: The QAP for DP is essential for the safe implementation of DP in pathologic practice. Each laboratory should prepare an institutional QAP according to this checklist, and consecutive revision of the checklist with feedback from the QAP trial for DP needs to follow.

PowerPlex^® 16 HS System의 유효성 확인

정요셉,김지영,박정현,홍승범,한시내,안희중 한국과학수사학회 2012 과학수사학회지 Vol.6 No.3

본 연구는 PowerPlex^® 16 HS System (Promega)의 감정적용에 앞서 법의유전학 분야의 사건증 거물들을 분석할 때 적절한 수준의 실험결과를 얻을 수 있는지 확인하는데 그 목표를 두고 있다. 구강상피 세포와 혈액 시료에서 PrepFilerô Forensic DNA Extraction kit로 추출한 DNA를 Quantifiler Duoô Human DNA Quantification kit와 7500 real time PCR system을 이용하여 정량하였다. 정량된 DNA로써 유효성 검증을 위한 민감성, 재현성, 정확성, 혼합반 및 오염에 대한 실험에 사용하였다. 유전자 증폭은 9700 GeneAmp PCR system을 이용하였고, 유전자형 분석은 3130 Genetic Analyzer로 하였다. 그 결과, 1.0 ng DNA로 시행한 반복실험에서 0.07 bp 이하의 표준편차를 보였고, 62.5 pg이상의 template DNA에서 전체 유전자형이 분석되었다. 혼합반의 경우, 1:9의 90%이상에서 부공여자의 유전자형이 분석되었고 유전자형이 알려진 대조 시료와 검증되지 않은 증거물 시료의 유전자형을 비교분석한 결과, 서로 일치함을 확인할 수 있었다.

Nodal involvement of extranodal marginal zone lymphoma with extreme plasmacytic differentiation (Mott cell formation) simulating plasma cell neoplasm and lymphoplasmacytic lymphoma

정요셉,강창석,오우진,김태정,이은정 대한혈액학회 2014 Blood Research Vol.49 No.4