The Application of Digital Pathology to Improve Accuracy in Glomerular Enumeration in Renal Biopsies.
Biopsy; Glomerulonephritis, IGA; Glomerulonephritis, Membranous; Glomerulosclerosis, Focal Segmental; Humans; Kidney Glomerulus; Microscopy; Nephrotic Syndrome; Signal Processing, Computer-Assisted
BACKGROUND: In renal biopsy reporting, quantitative measurements, such as glomerular number and percentage of globally sclerotic glomeruli, is central to diagnostic accuracy and prognosis. The aim of this study is to determine the number of glomeruli and percent globally sclerotic in renal biopsies by means of registration of serial tissue sections and manual enumeration, compared to the numbers in pathology reports from routine light microscopic assessment.
DESIGN: We reviewed 277 biopsies from the Nephrotic Syndrome Study Network (NEPTUNE) digital pathology repository, enumerating 9,379 glomeruli by means of whole slide imaging. Glomerular number and the percentage of globally sclerotic glomeruli are values routinely recorded in the official renal biopsy pathology report from the 25 participating centers. Two general trends in reporting were noted: total number per biopsy or average number per level/section. Both of these approaches were assessed for their accuracy in comparison to the analogous numbers of annotated glomeruli on WSI.
RESULTS: The number of glomeruli annotated was consistently higher than those reported (p
CONCLUSIONS: Although glass slides were not available for direct comparison to whole slide image annotation, this study indicates that routine manual light microscopy assessment of number of glomeruli is inaccurate, and the magnitude of this error is proportional to the total number of glomeruli.
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Rosenberg, A., Palmer, M., Merlino, L., Troost, J., Gasim, A., Bagnasco, S., Avila-Casado, C., Johnstone, D., Hodgin, J., Conway, C., Gillespie, B., Nast, C., Barisoni, L., & Hewitt, S. (2016). The Application of Digital Pathology to Improve Accuracy in Glomerular Enumeration in Renal Biopsies.. PLoS One, 11 (6). http://dx.doi.org/10.1371/journal.pone.0156441
Reproduced with permission of PLoS ONE