Cheltenham General Hospital is an NHS district general hospital in Cheltenham, Gloucestershire, run by Gloucestershire Hospitals NHS Foundation Trust. It provides general hospital services including Accident and Emergency.
BACKGROUND AND AIMS:Tip control (TC) is a core endoscopic skill, yet objective and practical in vivo assessment tools are lacking. We developed and gathered validity evidence for a scoring method using snare-tip soft coagulation (STSC) of the post-EMR defect margin as a standardized task. METHODS:A prospective, single-center observational study of consecutive patients undergoing EMR for large (≥20 mm) nonpedunculated colorectal polyps was conducted. Live or video observers used a web tool to classify STSC applications as correct ("on-margin") or incorrect. Outcomes were accuracy, speed (correct hits/min), z-standardized composite score (z_accuracy + z_speed = performance index), and rater subjective impression. Group differences (experts >500 EMRs vs trainees <50 EMRs) were estimated with generalized linear mixed-effects models, with random intercepts for endoscopist, observer, and procedure. Interrater reliability (intraclass coefficient [2,k]) was calculated. RESULTS:Sixty-eight procedures performed by 14 endoscopists were scored by 19 observers (170 ratings; median 2 per procedure; IQR, 1-3). Experts (n = 3) outperformed trainees (n = 11) for accuracy (adjusted mean, 90.0% vs 81.2%; adjusted mean difference [AMD], +8.9 percentage points [95% CI, 4.6-12.9]; P < .001) and speed (13.3 correct hits/min [95% CI, 11.0-15.6] vs 9.7 [95% CI, 8.0-11.4]; AMD, +3.6 correct hits/min [95% CI, 0.9-6.3]; P = .01). The performance index for experts was significantly higher than for trainees (AMD, +1.4 [95% CI, 0.7-2.2]; P < .001). Overall impression scores also favored experts (AMD, +1.0 points on 0-10 scale [95% CI, 0.5-1.6]; P < .001). ICC(2,k) for overall impression and accuracy was excellent (ICC[2,k] = 0.98 and 0.97, respectively). Convergent validity was demonstrated by significant associations between overall impression and both accuracy (β = 0.8 per 10 percentage points [95% CI, 0.7-1.0]; P < .001) and speed (β= 0.7 per 10 hits/min [95% CI, 0.4-1.0]; P < .001). CONCLUSIONS:A simple, in vivo, procedure-level score captured during routine STSC provided an objective measure of endoscopic tip TC, separating experts from trainees.
INTRODUCTION:Pancreatic cancer (PC) treatment in the UK is coordinated via regional referral networks, but formal neoadjuvant chemotherapy (NAC) pathways for borderline resectable and locally advanced PC (BR/LAPC) are rare. This cohort study assessed intranetwork variation in access to diagnostics, time to treatment and patient outcomes following NAC for BR/LAPC in our network. METHODS:All patients with BR/LAPC referred from regional network hospitals between 2017 and 2021 were reviewed. Data were collected on time from first diagnostic computed tomography scan to endoscopy, commencement of NAC, NAC regimens administered and patient outcomes. RESULTS:In the 155 patients who commenced NAC, there were significant differences in median time to biliary drainage and endoscopic ultrasound between referral hospitals. Time from decision to treat to first administration of NAC was long (median 64 days). There were significant differences in the proportion of patients commenced on mFOLFIRINOX (0-100%, p<0.001) and the proportion completing NAC (0-100%, p=0.012). The likelihood of proceeding to surgical resection was similar between centres. CONCLUSIONS:There is significant intranetwork variation in access to interventional endoscopy and choice of NAC regimen. Centralised tracking of patients receiving NAC, development of locally agreed treatment protocols and an update to national guidelines are needed to standardise NAC pathways for BR/LAPC.
We demonstrate that broadband coherent anti-Stokes Raman scattering (BCARS) on hematoxylin and eosin (H&E)-stained tissue generates a hybrid vibrational-electronic spectroscopic contrast arising from coupled Raman-active vibrations and chromatin-hematoxylin electronic resonances. This hybrid response, inaccessible to conventional spontaneous Raman or infrared microscopy due to fluorescence and substrate interference, transforms routine histology slides into sources of quantitative molecular information. The resulting spectra encode both Raman-active vibrations and resonance-modulated four-wave-mixing contributions arising from hemalum-chromatin interactions, thereby linking histological color contrast to quantitative, machine-readable spectral features. In breast tissue microarrays, we show (i) pixel-wise wavenumber-shift mapping that resolves subnuclear domains and highlights necrosis-associated nuclear shrinkage; (ii) phase-retrieved Raman-like spectra that separate hemalum-associated resonant features from nonpigmented contributions attributable to processing reagents; and (iii) nucleus-level discrimination of ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and invasive lobular carcinoma (ILC) using a PCA-LDA workflow. This study is a feasibility demonstration rather than a clinical validation, but establishes electronically enhanced BCARS on routine H&E slides as a route to unlock archival repositories for molecular phenotyping and AI-enabled histopathology.
Background:The shortage of pathologists presents a significant bottleneck in delivering timely and accurate diagnoses. To address this challenge, we developed the POLyp Artificial Intelligence-based RISk classifier (POLARIS), a prescreening tool designed to assist pathologists in handling the increasing volume of colorectal biopsies. Methods:Using 15,079 whole-slide images (WSIs) from 2993 patients in the UK bowel cancer screening program between 2014 and 2018 and the histological diagnoses as ground truth, POLARIS was developed applying the open-source foundation model H-optimus-0, multiple instance learning, and a training scheme designed to provide robust models. Each WSI was categorised into one of five classes based on the diagnosis, reflecting increasing risk of malignancy, and regrouped into two broader categories for clinical interpretation. One category includes only samples not requiring pathological review, specifically those classified as normal tissue or tubular adenomas with low-grade dysplasia (LGD). The second category includes all other types of polyps, which are polyps recommended for review by a pathologist. A prespecified validation protocol defined how a specific model should be evaluated on a geographically external dataset comprising 10,842 WSIs from Cheltenham General Hospital between 2008 and 2019 and acquired using two scanners, Leica Aperio AT2 and Hamamatsu NanoZoomer XR. After validation, three experienced pathologists independently assessed the cases in which model prediction differed most from clinical diagnosis and, blinded to model output, reached a consensus. Findings:In the external validation, POLARIS correctly identified 98.94% (95% CI 96.92-99.78%) of polyps with high-grade dysplasia (HGD) and adenocarcinoma as POLARIS-positive, and correctly classified 83.04% (81.66-84.36%) of normal and tubular adenomas with LGD as POLARIS-negative. The overall balanced accuracy was 86.65% for this prespecified primary analysis. In the tuning set, balanced accuracy was 87.64%, the sensitivity for polyps with HGD and adenocarcinoma was 100% (95% CI 97.14-100), and the specificity for normal and tubular adenomas with LGD was 81.89% (79.94-83.70). POLARIS achieved an area under the receiver operating characteristic curve (AUROC) in external validation of 0.9449 (95% CI 0.9384-0.9507) for distinguishing normal and tubular adenomas with LGD from polyps recommended for review by a pathologist and 0.9788 (0.9718-0.9844) for polyps with HGD and adenocarcinoma cases specifically. The model predicted the same class for both scanners in 97.93% (97.49-98.32%) of the cases. In the review of selected cases, the pathologists agreed with the model and not the clinical diagnosis in 92.5% of the cases. Heatmaps highlighting regions where the model indicates high-risk features closely correlated with areas annotated by expert pathologists as high-risk. Interpretation:POLARIS has the potential to enhance diagnostic workflows in colorectal pathology by reliably identifying high-risk lesions and highlighting high-risk regions while substantially reducing the number of slides requiring pathologist review. Funding:The Norwegian Cancer Society.
