[The importance of autopsy for quality assurance in medical care]. / Zur Bedeutung der Obduktion für die Qualitätssicherung der medizinischen Betreuung.

For all persons who died in the city of Dresden and 7 surrounding counties from 1967 to 1978, documents relating to the clinical and pathologic diagnosis were examined and findings compared. The study covered nearly two thirds of all deaths which occurred in the district of Dresden during this time period. The autopsy rate overall was found to be 22.8%. In 57.3% the clinical diagnoses were found to have been correct, in 19.7% they corresponded in part, but in 23% there was no concordance whatsoever between the clinical and autopsy diagnoses. The influence of age, place of death and disease group on the agreement between clinical and underlying pathoanatomic diagnosis was also examined. The analysis highlighted the degree to which death statistics based on the death certificate are misleading. In up to 28.8% of cases there were formal errors in the underlying disease diagnosis listed by the certifying physician on the death certificate. The value of regular comparison between the diagnoses, and its usefulness for training and continuing medical education are emphasized. The results of the study underline the importance of making available more prospectors in the district of Dresden to meet the expanding tasks of the clinically active pathologist in autopsy and biopsy diagnostic efforts.

Metastasizing APUD cell tumours of the human gastrointestinal tract. Light microscopic and karyometric studies.

A total of 11 metastasizing gastrointestinal APUD cell tumours from biopsy and autopsy files were reclassified according to Soga and Tazawa as well as to WHO Histologic Classification of Tumours. The much higher proportion of APUD cell tumours in autopsies (11 cases from 1000 autopsies in comparison with 22 cases from 22 000 biopsies) demonstrate that the majority of them will not be discovered during the patient's life. EC cell carcinoids (type A) predominate in both non-metastasizing and metastasizing gastrointestinal APUD cell tumours. Metastases from EC cell carcinoids occurred only in regional lymph nodes and in the liver. The APUD cell tumours originating in the pancreas represent the most frequently metastasizing gastrointestinal carcinoids. Besides in the liver and in regional lymph nodes metastases from pancreatic APUD cell tumours were seen in the skin, the brain and the skeleton. One case with two (pancreatic, bronchial) competitive primary APUD cell tumours and a skin metastasis was studied by means of automated cell image analysis. Cell populations of these three tumour sites were characterized by morphometric and densitometric nuclear parameters. It could be demonstrated that the skin metastasis consisted of a cell population, which occurred as a subpopulation in the primary tumour of the bronchus. The results of karyometric investigations supported the hypothesis that single components of tumours can metastasis selectively.

Image processing in pathology. XII. Automated morphometry of tumour cell nuclei in hypernephroma: comparison between renal tumour and late metastases.

Changes of nineteen features of tumour cell nuclei in hypernephroma and three following late metastases were investigated by use of the automated image system. Histograms of nuclei features from primary tumours and metastases were compared. They showed objectively an increased cellular dedifferentiation during metastases. Various aspects of the capability of automated morphometry for investigation of tumours are discussed.

The ZYPAB image-processing system for cytologic prescreening for cervical cancer.

The ZYPAB (Zytologisches Prescreeing durch Automatische Bildverarbeitung) system was developed over the past eight years as a special application of our microscope image-processing system. The data-acquisition device consists of a commercial research microscope and an image-dissector camera. The diagnostic decision on the entire sample is based on the evaluation of 18 nuclear features. The result of classification is statistical information on the probability of coincidence of an unknown case with the normal object sample. In addition, the program automatically assesses the number of isolated epithelial cell nuclei. With this information it is possible to differentiate between tumor-suggestive, negative and inadequate smears.

Image processing in pathology. IX. A new morphometry system and its application on gangliocytes of the nucleus olivaris.

This paper describes a new software system for automatic image processing in pathology. The system is based on the hardware NU2/ODD/PDP8 and the thereby yielded results. The effectiveness of the system esp. its velocity has been essentially improved by a significant modification of the primary data sampling and by the new implementation of feature determination. The first application of this new system concerns age-dependent alterations of the gangliocytes in the nucleus olivaris.

Image processing in pathology.

The present study is an effort to ally biopsies to well defined groups of diseases by means of automatic analysis of liver cell nuclei. The results obtained should support the morphologic differential diagnosis of liver diseases. A total of 78 liver biopsies from patients with obstructive jaundice, chronic hepatitis, acute viral hepatitis or with alcoholic liver injury were investigated. Performing automatic analysis of the microscopic pictures 95% of the equatorial sectioned liver cell nuclei are correctly recognized.

An image analysing method for automated cytologic prescreening of cervix carcinoma and its prestages: demonstration and preliminary results.

The image analysing method for automated cytologic prescreening is founded on the evaluation of epithelial cell nuclei in regularly stained and prepared smears. The technical equipment consists of a fast scanning microscope and a software-oriented computer. The device is able to isolate all objects present in the visual fields. Clumps, artefacts, detritus and other disturbing objects are eliminated. Among the cell nuclei the nonepithelial forms (histiocytes, leukocytes, lymphocytes) are distinguished from the epithelial ones. The latter are compared with a representative sample of normal epithelial cell nuclei, exactly classified by cytologists. All objects are described by 18 mathematically defined parameters. The results of classification is a statistical information on the probability of coincidence of an unknown case with the normal object sample. In addition the evaluation program provides the number of automatic isolated cell nuclei. By these informations it is possible to differentiate between positive (tumor-suspicious), negative and inadequate smears.

[Use of automatic picture processing in clinical-morphological diagnostics]. / Einsatz der automatischen Bildverabeitung in der medizinisch-morphologischen Diagnostik.

The use of the automatic elaboration of pictures for the evaluation of microscopic pictures gives the possibility to automise histological and cytological routine examinations and to improve the recognition of morphological findings by quantitative investigations in the medical morphological diagnostics. The effective practical use of the method is bound to certain device-technical prerequisites which are mentioned in short. At the same time a survey of the principal possibilities in the medical morphological diagnostics is given. By the analysis of the digitalised pictures of cells, cell organelles and other tissue structures reproducible quantitative data on outline and texture as well as on the special arrangement of the objects present in the picture are obtained. On the basis of these characteristics it is possible to identify cells, to find perhaps existing subgroupings in cell populations or to perform an automatic preselection of the material to be investigated. At the instance of the normal white differential blood picture the modern possibilities and limits of the method are described.