Quality assurance: Evaluation and comparison of methods for electron microscopic measurement of GBM width and the effect of in‐lab calibration in diagnostic renal pathology
Replacing equipment and software can improve efficiency and allow updates to laboratory procedures, but has the potential to introduce changes in established values for a laboratory. Replacement of an electron microscope (EM), fitted with an updated digital camera, and use of new software for imagin...
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| Abstract | Replacing equipment and software can improve efficiency and allow updates to laboratory procedures, but has the potential to introduce changes in established values for a laboratory. Replacement of an electron microscope (EM), fitted with an updated digital camera, and use of new software for imaging and analysis prompted this QA study to ensure that new equipment, imaging, and measurement of the glomerular basement membrane (GBM) produced data consistent with the laboratory's established range of normal width. GBM measurements from 14 randomly selected human renal biopsies were compared using five different approaches. Original measurements of GBMs obtained on the laboratory's previous EM were compared to images collected on the new microscope with measurements performed using new software, as well as the original images and the new images measured using a separate software method as a control. The widths obtained by five approaches were compared to each other. While measurements showed minor variability between the approaches, significant difference in GBM width was noted in three of the paired comparisons. In some cases, these differences suggested slight diagnostic changes. Evaluation of new equipment, software, and techniques is important for a laboratory's quality assurance. While new equipment and/or procedures can introduce errors in test outcomes, we found that different EMs, cameras, and software made slight differences in our laboratory's values for kidney GBM width. However, a few cases showed enough difference in GBM width to suggest a change in diagnosis, illustrating the necessity of calibration adjustments in the setting of new equipment and software.
Updating equipment and software has the potential to introduce errors in some aspects of established values for a given laboratory.
To reduce diagnostic mistakes and misinterpretation, establishing an “in house” normal range for GBM thickness and re‐evaluating the range consequent to any replacement of equipment and software is recommended.
Checking new software via a control method may provide a more precise calibration.
Comparison of five glomerular basement membrane (GBM) measurement approaches using different EM camera and software combinations demonstrated a significant difference in GBM width that may have important consequences for pathologic diagnosis. |
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| AbstractList | Replacing equipment and software can improve efficiency and allow updates to laboratory procedures, but has the potential to introduce changes in established values for a laboratory. Replacement of an electron microscope (EM), fitted with an updated digital camera, and use of new software for imaging and analysis prompted this QA study to ensure that new equipment, imaging, and measurement of the glomerular basement membrane (GBM) produced data consistent with the laboratory's established range of normal width. GBM measurements from 14 randomly selected human renal biopsies were compared using five different approaches. Original measurements of GBMs obtained on the laboratory's previous EM were compared to images collected on the new microscope with measurements performed using new software, as well as the original images and the new images measured using a separate software method as a control. The widths obtained by five approaches were compared to each other. While measurements showed minor variability between the approaches, significant difference in GBM width was noted in three of the paired comparisons. In some cases, these differences suggested slight diagnostic changes. Evaluation of new equipment, software, and techniques is important for a laboratory's quality assurance. While new equipment and/or procedures can introduce errors in test outcomes, we found that different EMs, cameras, and software made slight differences in our laboratory's values for kidney GBM width. However, a few cases showed enough difference in GBM width to suggest a change in diagnosis, illustrating the necessity of calibration adjustments in the setting of new equipment and software. Replacing equipment and software can improve efficiency and allow updates to laboratory procedures, but has the potential to introduce changes in established values for a laboratory. Replacement of an electron microscope (EM), fitted with an updated digital camera, and use of new software for imaging and analysis prompted this QA study to ensure that new equipment, imaging, and measurement of the glomerular basement membrane (GBM) produced data consistent with the laboratory's established range of normal width. GBM measurements from 14 randomly selected human renal biopsies were compared using five different approaches. Original measurements of GBMs obtained on the laboratory's previous EM were compared to images collected on the new microscope with measurements performed using new software, as well as the original images and the new images measured using a separate software method as a control. The widths obtained by five approaches were compared to each other. While measurements showed minor variability between the approaches, significant difference in GBM width was noted in three of the paired comparisons. In some cases, these differences suggested slight diagnostic changes. Evaluation of new equipment, software, and techniques is important for a laboratory's quality assurance. While new equipment and/or procedures can introduce errors in test outcomes, we found that different EMs, cameras, and software made slight differences in our laboratory's values for kidney GBM width. However, a few cases showed enough difference in GBM width to suggest a change in diagnosis, illustrating the necessity of calibration adjustments in the setting of new equipment and software.Replacing equipment and software can improve efficiency and allow updates to laboratory procedures, but has the potential to introduce changes in established values for a laboratory. Replacement of an electron microscope (EM), fitted with an updated digital camera, and use of new software for imaging and analysis prompted this QA study to ensure that new equipment, imaging, and measurement of the glomerular basement membrane (GBM) produced data consistent with the laboratory's established range of normal width. GBM measurements from 14 randomly selected human renal biopsies were compared using five different approaches. Original measurements of GBMs obtained on the laboratory's previous EM were compared to images collected on the new microscope with measurements performed using new software, as well as the original images and the new images measured using a separate software method as a control. The widths obtained by five approaches were compared to each other. While measurements showed minor variability between the approaches, significant difference in GBM width was noted in three of the paired comparisons. In some cases, these differences suggested slight diagnostic changes. Evaluation of new equipment, software, and techniques is important for a laboratory's quality assurance. While new equipment and/or procedures can introduce errors in test outcomes, we found that different EMs, cameras, and software made slight differences in our laboratory's values for kidney GBM width. However, a few cases showed enough difference in GBM width to suggest a change in diagnosis, illustrating the necessity of calibration adjustments in the setting of new equipment and software. Replacing equipment and software can improve efficiency and allow updates to laboratory procedures, but has the potential to introduce changes in established values for a laboratory. Replacement of an electron microscope (EM), fitted with an updated digital camera, and use of new software for imaging and analysis prompted this QA study to ensure that new equipment, imaging, and measurement of the glomerular basement membrane (GBM) produced data consistent with the laboratory's established range of normal width. GBM measurements from 14 randomly selected human renal biopsies were compared using five different approaches. Original measurements of GBMs obtained on the laboratory's previous EM were compared to images collected on the new microscope with measurements performed using new software, as well as the original images and the new images measured using a separate software method as a control. The widths obtained by five approaches were compared to each other. While measurements showed minor variability between the approaches, significant difference in GBM width was noted in three of the paired comparisons. In some cases, these differences suggested slight diagnostic changes. Evaluation of new equipment, software, and techniques is important for a laboratory's quality assurance. While new equipment and/or procedures can introduce errors in test outcomes, we found that different EMs, cameras, and software made slight differences in our laboratory's values for kidney GBM width. However, a few cases showed enough difference in GBM width to suggest a change in diagnosis, illustrating the necessity of calibration adjustments in the setting of new equipment and software. Updating equipment and software has the potential to introduce errors in some aspects of established values for a given laboratory. To reduce diagnostic mistakes and misinterpretation, establishing an “in house” normal range for GBM thickness and re‐evaluating the range consequent to any replacement of equipment and software is recommended. Checking new software via a control method may provide a more precise calibration. Comparison of five glomerular basement membrane (GBM) measurement approaches using different EM camera and software combinations demonstrated a significant difference in GBM width that may have important consequences for pathologic diagnosis. |
| Author | Arend, Lois J. Demirkol Canlı, Secil Uner, Meral |
| Author_xml | – sequence: 1 givenname: Meral orcidid: 0000-0001-9927-1246 surname: Uner fullname: Uner, Meral organization: Hacettepe University – sequence: 2 givenname: Secil surname: Demirkol Canlı fullname: Demirkol Canlı, Secil organization: Hacettepe University – sequence: 3 givenname: Lois J. orcidid: 0000-0001-5434-7630 surname: Arend fullname: Arend, Lois J. email: ljarend@jhu.edu organization: Johns Hopkins University School of Medicine |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34387014$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.5858/133.2.224 10.1136/jcp.43.6.457 10.1054/cdip.2002.0123 10.1136/jcp.49.3.233 10.1080/01913120390248728 10.5858/2006-130-699-TGBMNI |
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| References_xml | – volume: 18 start-page: 42 issue: 1 year: 1968 end-page: 48 article-title: The ultastructure of the normal human glomerulus. Thickness of glomerular basement membrane publication-title: Laboratory Investigation – volume: 43 start-page: 457 issue: 6 year: 1990 end-page: 460 article-title: Incidence of thin membrane nephropathy: Morphometric investigation of a population sample publication-title: Journal of Clinical Pathology – volume: 8 start-page: 207 year: 2002 end-page: 215 article-title: Electron microscopy in diagnostic renal pathology publication-title: Current Diagnostic Pathology – volume: 116 start-page: 43 issue: 1 year: 1992 end-page: 49 article-title: Measurement of glomerular basement membrane thickness and its application to the diagnosis of thin‐membrane nephropathy publication-title: Archives of Pathology & Laboratory Medicine – volume: 49 start-page: 233 issue: 3 year: 1996 end-page: 237 article-title: Electron microscopy and immunocytochemistry in the assessment of renal biopsy specimens: Actual and optimal practice publication-title: Journal of Clinical Pathology – volume: 130 start-page: 699 issue: 5 year: 2006 end-page: 706 article-title: Thin glomerular basement membrane nephropathy: Incidence in 3471 consecutive renal biopsies examined by electron microscopy publication-title: Archives of Pathology & Laboratory Medicine – year: 2019 – volume: 27 start-page: 409 issue: 6 year: 2003 end-page: 416 article-title: A simplified method for measuring the thickness of glomerular basement membranes publication-title: Ultrastructural Pathology – volume: 133 start-page: 224 issue: 2 year: 2009 end-page: 232 article-title: Alport syndrome and thin glomerular basement membrane nephropathy: A practical approach to diagnosis publication-title: Archives of Pathology & Laboratory Medicine – year: 2015 – volume: 49 start-page: 82 issue: 1 year: 1983 end-page: 86 article-title: Quantitative glomerular morphology of the normal human kidney publication-title: Laboratory Investigation – year: 2020 – volume-title: Diagnostic pathology: Kidney diseases year: 2019 ident: e_1_2_9_2_1 – volume: 116 start-page: 43 issue: 1 year: 1992 ident: e_1_2_9_3_1 article-title: Measurement of glomerular basement membrane thickness and its application to the diagnosis of thin‐membrane nephropathy publication-title: Archives of Pathology & Laboratory Medicine – ident: e_1_2_9_7_1 doi: 10.5858/133.2.224 – ident: e_1_2_9_4_1 doi: 10.1136/jcp.43.6.457 – ident: e_1_2_9_13_1 doi: 10.1054/cdip.2002.0123 – volume: 49 start-page: 82 issue: 1 year: 1983 ident: e_1_2_9_14_1 article-title: Quantitative glomerular morphology of the normal human kidney publication-title: Laboratory Investigation – ident: e_1_2_9_8_1 – volume-title: Heptinstall's pathology of the kidney year: 2015 ident: e_1_2_9_10_1 – ident: e_1_2_9_5_1 doi: 10.1136/jcp.49.3.233 – ident: e_1_2_9_15_1 – ident: e_1_2_9_12_1 doi: 10.1080/01913120390248728 – volume: 18 start-page: 42 issue: 1 year: 1968 ident: e_1_2_9_11_1 article-title: The ultastructure of the normal human glomerulus. Thickness of glomerular basement membrane publication-title: Laboratory Investigation – ident: e_1_2_9_9_1 – ident: e_1_2_9_6_1 doi: 10.5858/2006-130-699-TGBMNI |
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| SubjectTerms | Biopsy Calibration Cameras Computer programs Digital cameras Digital imaging Electrons Evaluation Glomerular Basement Membrane Humans Kidney Laboratories Medical imaging Microscopy, Electron Quality assurance Quality control Software transmission electron microscopy validation |
| Title | Quality assurance: Evaluation and comparison of methods for electron microscopic measurement of GBM width and the effect of in‐lab calibration in diagnostic renal pathology |
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