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Observation and Reporting Experiment Undertaken in the Development of an Image Desription Language for the Reporting by Pathologists of the Grading of Cancers

Abstract - Variation exists in the diagnosis of cancers by different pathologists. An Image Description Language is being developed by the researchers for Pathologists to aid in the avoidance of ambiguity. In order to investigate the nature of the reporting and the variations that can occur an experiment was undertaken with participants with varying experience. The results were analysed and a set of feature descriptions extracted, together with variations found in the reporting. A subset of the IDL for oesophageal images is currently under development. The continuing steps of the research are noted in section 3. Finally we note the need for further testing and research into the possibility of widening the scope of the IDL. Keywords: Image Description Language, Cancer, Pathology, Diagnosis. 1 Introduction: Background and Basic Concerns Diagnosis of cancers and pre-cancerous tissues, and their likely progression is generally reached through the microscopic examination of slides prepared from abnormal tissue sectioned during biopsy. Cancers can be classified as Non Dysplastic (ND) - benign, Low Grade Dysplasia (LGD), High Grade Dysplasia (HGD), or Intra Mucosal Carcinoma (ImCa) - fully malignant. In many conditions in the gastrointestinal tract there is a morphological continuum between benign and malignant lesions, and the classification becomes that much more difficult. The accuracy of the grading directly influences the diagnosis and the value of the prognosis, and is therefore of concern to pathologists. Studies have shown that considerable variation occurs in diagnostic medical cognition between individuals in many areas of medicine [10], [22], [18], and in the grading of cancers between pathologists [2], [5] [9] [15]. This is of particular concern in the field of gastrointestinal pathology [17], and especially in the grading of oesophageal dysplasias where a cancerous condition can lead to radical surgery [8] [11] [13] [14]. A need exists for the phraseology in reporting to be more consistent, avoiding “… descriptive terms that have no clinical applications” [12]. It is apparent [20] that a wide range of descriptive phrases are in use among diagnosticians, and that the interpretation of the phrases used is not consistent and the adoption of a set of phrases avoiding interpretive ambiguity is needed. Other authors have acknowledged the need for better reporting procedures [1], [7], [16]. As a response to the problems of variation noted above, the authors are investigating the development of an Image Description Language (IDL) as an aid to the articulation of the features noted in a cancer image. Shepherd suggests that diagnosis in columnar-lined oesophagus (Barrett’s oesophagus) relies upon pathology for determination, or as corroboration of endoscopy, in approximately 45% of cases [19]. The development of an Image Description Language (IDL) as an aid to articulation of the features of a cancer would appear to be appropriate. This could be expected to provide a consistency in the verbal descriptions of cancers by different observers and provide a formal basis for comparison, facilitating the communication of the image features, and a reduction in the variation of grading of cancers.A review of the literature concerned with the recognition of features in cancer images has been undertaken. Much of the research concerns image comparison and retrieval at the bit map level [21], while the IDL is concerned with the appearance of features at the human cognition level. The various papers do however describe many features including the form and extent of cell types present e.g. goblet cells and columnar cells, comparative size of the nuclei, and the regularity or otherwise of cell alignment.