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Pathology Imagebase 8 December 2015

Stockholm 8 December 2015
Dear ISUP member,
This email describes the functions of Pathology Imagebase, a novel reference image database developed by ISUP for ISUP members. The idea behind this project is to let acknowledged experts upload images and then approve them by independent voting. The aim is to create a catalogue of expert vetted images illustrating different aspects of urological pathology, including diagnosis, grading and staging.

The easiest way to enter Imagebase is to go to the new ISUP website at www.isupweb.org. A separate email about the new ISUP website has just been sent out. The direct link to the start page of Imagebase is www.isupweb.org/pib-start/ but it is easier to reach it through www.isupweb.org. Start by logging in with your ISUP login. Your new ISUP login should be sent to you in a separate email today and gives access to both the ISUP website and the Imagebase. See detailed information in the ISUP website email about the login and how to toggle between these websites.

At the top of the ISUP website you will find 2 tabs: ISUP Home and Pathology Imagebase. This makes it very easy to navigate between these two websites. Once you have logged in you have access to both. Another way to enter Imagebase is through the Imagebase portal in the center of the ISUP website.

Imagebase currently has three expert panels covering each of these organs: prostate, bladder and kidney. Each panel has 24 international experts representing several continents (around 12 from North America and 12 from other continents). The panel members have been selected based on their expertise and academic production on each organ but we have also aimed to reach a certain geographic representation as pathology practice may vary between continents. The system is designed for the exact number of 24 experts per panel which means that we can unfortunately not include additional experts for the moment. We are well aware that there are many other ISUP members who have a very high level of expertise in these fields but we have to balance between many aspects when composing the groups. Thus, new expert members can only be accepted when others have dropped out or if we find that some panelists have not been active.

Each of the 24 experts will upload jpg images into a non-public database (accessible only for the experts themselves and the database administrator) together with a proposed diagnosis, grade or stage. The other 23 experts can then vote independently, ie. without knowing the diagnosis given by the others. Once a pre-defined consensus level has been reached (for the moment 2/3, i.e. at least 16 votes in favor of a single diagnostic alternative), the case is automatically transferred to a public database that can be accessed by all ISUP members.

The aim of this project is to set up a standard for urological pathology. We hope to create a catalogue of images that provide ample illustrations of entities, grades and stages, including not only typical textbook cases but also borderline cases. The experts are asked to tell not only the diagnosis but also judge whether the case is a typical or borderline case.

When you have logged into Imagebase you will be on the start page which announces the different projects that have been set up so far. You can immediately see the number of cases that have been uploaded and the number of consensus cases (= Public cases). A separate database has to be set up for each project because the voting options (e.g. the grades) are different. Thus, launching a new project can only be done by the administrator. Please contact Lars Egevad (lars.egevad@ki.se) if you have requests or proposals. We already have a number of projects in pipeline and aim to cover different aspects of diagnosis, grading and staging. For the moment we are running the following projects:

Grading of prostate, bladder and renal cell carcinoma.

Diagnosis of papillary and flat lesions of the bladder.

Classification of renal cell tumors.

Now click on e.g. Prostate cancer grading. This will lead you to the Prostate cancer grading page of Imagebase. A new tab with the project name will appear at the top, which makes it easy to know which part of Imagebase you are in. You can anytime go back directly to the ISUP start page by clicking at the top of the page.

The public domain with consensus cases is found under Public cases in the top menu. Imagebase will later be showcased to the general public by displaying a small set of selected cases. However, to view of most cases and benefit from the complete function of the database, ISUP membership is required.

The cases in the list of Public cases can be viewed by clicking on the View button. A brief description of the case will be given. You can vote by clicking on the Evaluate button. This vote will not affect whether the case is considered a consensus case but your vote is registered in the system and will be very helpful for us when monitoring how urological pathology is practiced in different parts of the world and also if the expert panels are representative of the general histopathology community. Your vote will be very important for the upcoming ISUP conference at USCAP in Seattle, see information further down. It would be very helpful if you could vote by using the Evaluate button before you click View and read the comments and expert diagnoses. This will ensure that we get an independent opinion from our members.

You can also search e.g. a certain grade in the roll down menu on top. Once you have made a search, you can flip through the cases by clicking Previous or Next.

After you have voted, you will be able to see a pie chart for each case showing the distribution of the expert replies and another pie chart showing the member replies. It is also possible to view a table with the replies and comments of individual experts. The experts are anonymized as we do not want to reveal the diagnostic patterns of any individual colleague. Their internal order just depends on when the vote was cast, i.e. a specific voter’s number differs between cases. Thus, pathologist 1 is not always the same.

The voting results of all experts and members are displayed for the Administrator under a Statistics tab but this will not appear for others for confidentiality reasons. The data will be used for studies and general feedback but also to monitor if there are missing votes.

FAQ: Frequently asked questions. The nice feature is that the system can know if you are logged in as a panel member or as an ordinary ISUP member and will display FAQs accordingly. ISUP members do not need to know about uploading for example.

At USCAP Sunday 13 March 2016,
12:30-5:00 pm, an ISUP Interactive Conference on Standardization of Diagnosis and Grading
 will be held. The aim is to discuss standards of diagnosis and grading based on the results of the Imagebase project. For this meeting we now need your input! We would like to ask you to vote on the consensus cases that will be made available the next few months. For the moment we have 50 public prostate cancer cases for grading and they are ready for voting.

We hope that this new ISUP feature will become a useful tool in your everyday practice and that it will contribute to better standardization of histopathology, often requested by clinicians.

Any feedback or proposals for improvements are welcome!

With best regards,

Lars Egevad
President of ISUP