Pub Date : 2022-09-01DOI: 10.1097/PCR.0000000000000528
T. Bosse
Abstract The discovery of 4 distinct molecular endometrial cancer subgroups by The Cancer Genome Atlas has fundamentally changed the way we look at endometrial carcinoma today. The proven robustness of surrogate markers in a diagnostic algorithm endorsed by the World Health Organization classification of female genital tumors 2020 has opened the gates for worldwide implementation. This advance delivers a reproducible classification system with improved prognostication and a biological basis for future targeted treatments. Although we all embrace this exciting development, we now struggle how to position the traditional histology-based classification (histotype/International Federation of Gynecology and Obstetrics grade). The author discusses the strengths, weaknesses, opportunities, and threats and deliberates on how we could bring the best of both worlds together.
{"title":"The Best of Both Worlds: Combining the Molecular and Traditional (Histotype/Grade) Endometrial Cancer Classification","authors":"T. Bosse","doi":"10.1097/PCR.0000000000000528","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000528","url":null,"abstract":"Abstract The discovery of 4 distinct molecular endometrial cancer subgroups by The Cancer Genome Atlas has fundamentally changed the way we look at endometrial carcinoma today. The proven robustness of surrogate markers in a diagnostic algorithm endorsed by the World Health Organization classification of female genital tumors 2020 has opened the gates for worldwide implementation. This advance delivers a reproducible classification system with improved prognostication and a biological basis for future targeted treatments. Although we all embrace this exciting development, we now struggle how to position the traditional histology-based classification (histotype/International Federation of Gynecology and Obstetrics grade). The author discusses the strengths, weaknesses, opportunities, and threats and deliberates on how we could bring the best of both worlds together.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76772606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1097/PCR.0000000000000516
S. Findeis, Aaron R. Huber, Christa L. Whitney-Miller
Abstract Diagnostic uncertainty and the communication of this uncertainty is inherent in all specialties of medicine. The surgical pathology community uses a wide variety of phrases to express diagnostic uncertainty, even though there is literature that has shown use of uncertainty phrases leads to misunderstandings. We present a case that shows how uncertainty phrasing in a final diagnosis contributed to confusion surrounding patient care and resulted in sending the case for outside consultation. In addition, we review the literature surrounding uncertainty phrasing and discuss reporting of altered or amended reports.
{"title":"Compatible With Confusion: Phrasing Pitfalls in Anatomic Pathology Reports","authors":"S. Findeis, Aaron R. Huber, Christa L. Whitney-Miller","doi":"10.1097/PCR.0000000000000516","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000516","url":null,"abstract":"Abstract Diagnostic uncertainty and the communication of this uncertainty is inherent in all specialties of medicine. The surgical pathology community uses a wide variety of phrases to express diagnostic uncertainty, even though there is literature that has shown use of uncertainty phrases leads to misunderstandings. We present a case that shows how uncertainty phrasing in a final diagnosis contributed to confusion surrounding patient care and resulted in sending the case for outside consultation. In addition, we review the literature surrounding uncertainty phrasing and discuss reporting of altered or amended reports.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73802032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1097/PCR.0000000000000522
M. DeSimone, Yael K. Heher
Abstract Timeliness of surgical pathology result reporting is a critical quality metric for patients and treating clinicians. Over the past several decades, studies have sought to define laboratory turnaround time (TAT) in the context of the surgical pathology workflow, investigate the various factors that influence TAT, and develop a framework to monitor, measure, and track TAT within and across laboratories. However, the complexity of health care delivery and health information technology creates barriers to tracking TAT that should be considered in the context of local environments. We seek to provide background and context as well as a framework for tracking TAT as a key quality metric in surgical pathology. We outline a roadmap to monitoring local TAT to maximize efficiency and customer satisfaction while reducing diagnostic error and near-miss safety events.
{"title":"A Framework for Utilization of Turnaround Time as a Quality Metric in Surgical Pathology","authors":"M. DeSimone, Yael K. Heher","doi":"10.1097/PCR.0000000000000522","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000522","url":null,"abstract":"Abstract Timeliness of surgical pathology result reporting is a critical quality metric for patients and treating clinicians. Over the past several decades, studies have sought to define laboratory turnaround time (TAT) in the context of the surgical pathology workflow, investigate the various factors that influence TAT, and develop a framework to monitor, measure, and track TAT within and across laboratories. However, the complexity of health care delivery and health information technology creates barriers to tracking TAT that should be considered in the context of local environments. We seek to provide background and context as well as a framework for tracking TAT as a key quality metric in surgical pathology. We outline a roadmap to monitoring local TAT to maximize efficiency and customer satisfaction while reducing diagnostic error and near-miss safety events.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81115866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1097/PCR.0000000000000521
Jonathan Jacobs, Paul N. Staats
Abstract A case of a sudden increase in reports of a specific error in the anatomic pathology laboratory is evaluated, yielding insights into the value, challenges, and limitations of using error reports as a quality management tool. The discussion considers the utility of a robust error-reporting system for anatomic pathology laboratories and identifies key factors at each step to improve success. Initial reporting must be easy and rewarding to reporters, and they must have confidence that reporting will not result in adverse impacts on coworkers. Categorization of common errors simplifies reporting, investigation, tracking, and data presentation. Response to errors should focus on addressing system design failures, while also providing nonjudgmental, nonpunitive feedback to individuals. Error categories can be chosen for systematic quality improvement projects based on severity and frequency of the error. When monitoring trends in error data, it is important to remember that the data are very sensitive to changes in reporting rates as well as changes in error rates, so they must be interpreted with great caution.
{"title":"The Value and Challenges of Internal Error Tracking in Anatomic Pathology Quality Management","authors":"Jonathan Jacobs, Paul N. Staats","doi":"10.1097/PCR.0000000000000521","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000521","url":null,"abstract":"Abstract A case of a sudden increase in reports of a specific error in the anatomic pathology laboratory is evaluated, yielding insights into the value, challenges, and limitations of using error reports as a quality management tool. The discussion considers the utility of a robust error-reporting system for anatomic pathology laboratories and identifies key factors at each step to improve success. Initial reporting must be easy and rewarding to reporters, and they must have confidence that reporting will not result in adverse impacts on coworkers. Categorization of common errors simplifies reporting, investigation, tracking, and data presentation. Response to errors should focus on addressing system design failures, while also providing nonjudgmental, nonpunitive feedback to individuals. Error categories can be chosen for systematic quality improvement projects based on severity and frequency of the error. When monitoring trends in error data, it is important to remember that the data are very sensitive to changes in reporting rates as well as changes in error rates, so they must be interpreted with great caution.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85573719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1097/PCR.0000000000000518
M. Kallen, C. Otis, Paul N. Staats
Abstract Critical value reporting is an important facet of laboratory management and represents a significant potential challenge in patient care delivery, as well as a high-value target for quality improvement initiatives in both anatomic and clinical pathology settings. A recurring problem concerns successfully contacting unavailable health care providers with unexpected and/or time-sensitive results. We report a case of an incidentally detected and unexpected finding of tumor cells in a routine hip arthroplasty, in a patient under surgical management for a variety of chronic issues including peripheral arterial disease and traumatic fall. The abnormal result proved to be the first presentation of a widely disseminated metastatic melanoma. Although multiple associated health care providers were successfully contacted with the unexpected finding and acknowledged awareness of the concern for metastatic melanoma, one provider was not successfully contacted with the pathology result, leading to frustrations among multiple parties and a slight delay in appropriate patient referral. The sequence of events presents an opportunity to review standards of care regarding urgent diagnosis reporting in anatomic pathology and assess the published literature surrounding this issue.
{"title":"Reporting Critical/Urgent/Significant Results in Anatomic Pathology: The Devil Is in the Details","authors":"M. Kallen, C. Otis, Paul N. Staats","doi":"10.1097/PCR.0000000000000518","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000518","url":null,"abstract":"Abstract Critical value reporting is an important facet of laboratory management and represents a significant potential challenge in patient care delivery, as well as a high-value target for quality improvement initiatives in both anatomic and clinical pathology settings. A recurring problem concerns successfully contacting unavailable health care providers with unexpected and/or time-sensitive results. We report a case of an incidentally detected and unexpected finding of tumor cells in a routine hip arthroplasty, in a patient under surgical management for a variety of chronic issues including peripheral arterial disease and traumatic fall. The abnormal result proved to be the first presentation of a widely disseminated metastatic melanoma. Although multiple associated health care providers were successfully contacted with the unexpected finding and acknowledged awareness of the concern for metastatic melanoma, one provider was not successfully contacted with the pathology result, leading to frustrations among multiple parties and a slight delay in appropriate patient referral. The sequence of events presents an opportunity to review standards of care regarding urgent diagnosis reporting in anatomic pathology and assess the published literature surrounding this issue.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83291548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1097/PCR.0000000000000517
Julia Dahl, J. Myers, L. Pantanowitz
Data-driven decision-making using information extracted from existing sources and analyzed using commercially available or homegrown analytical tools is key to sustaining and improving effective laboratory services. Abstract Pathology laboratories generate large amounts of patient and operational data, usually housed in laboratory information systems. Linking that information to other data sources for data mining and analytics is essential to inform decision-making by multiple stakeholders to effectively manage the pathology laboratory. We review and illustrate examples of how data-driven decision-making can support laboratory operations, resource management, personnel performance and productivity, quality assurance, and business activities. The application of dashboards and informatics tools for data-driven decision-making in pathology is highlighted.
{"title":"Data-Driven Decision-Making in Support of Managing Pathology Laboratories","authors":"Julia Dahl, J. Myers, L. Pantanowitz","doi":"10.1097/PCR.0000000000000517","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000517","url":null,"abstract":"Data-driven decision-making using information extracted from existing sources and analyzed using commercially available or homegrown analytical tools is key to sustaining and improving effective laboratory services. Abstract Pathology laboratories generate large amounts of patient and operational data, usually housed in laboratory information systems. Linking that information to other data sources for data mining and analytics is essential to inform decision-making by multiple stakeholders to effectively manage the pathology laboratory. We review and illustrate examples of how data-driven decision-making can support laboratory operations, resource management, personnel performance and productivity, quality assurance, and business activities. The application of dashboards and informatics tools for data-driven decision-making in pathology is highlighted.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80018018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1097/PCR.0000000000000515
Jessica D. Anderson, M. Amin, Kurt D. Bernacki
Abstract Tissue contamination, where extraneous tissue becomes embedded into the paraffin block or fixed onto the slide, is a relatively common quality issue in surgical pathology and can occur at any step between specimen collection by the clinician and slide coverslipping. We report a case of tissue contamination within a paraffin block and describe our subsequent investigation, which was successful in identifying the source of contamination.
{"title":"Successful Identification of a Neoplastic Tissue Contaminant in Surgical Pathology","authors":"Jessica D. Anderson, M. Amin, Kurt D. Bernacki","doi":"10.1097/PCR.0000000000000515","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000515","url":null,"abstract":"Abstract Tissue contamination, where extraneous tissue becomes embedded into the paraffin block or fixed onto the slide, is a relatively common quality issue in surgical pathology and can occur at any step between specimen collection by the clinician and slide coverslipping. We report a case of tissue contamination within a paraffin block and describe our subsequent investigation, which was successful in identifying the source of contamination.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73611945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1097/PCR.0000000000000514
Paul A. Vander Laan
Abstract Quality assurance measures in the cytology laboratory help ensure accurate and consistent diagnoses. For thyroid fine-needle aspirations (FNAs), various cytologist performance metrics have been proposed to help monitor and explain cytologist practice patterns. Thoughtful implementation of metrics such as diagnostic category utilization rates, ratios of key diagnostic categories, surgical outcome data, and correlation with ancillary molecular testing results have been proposed to help minimize the use of indeterminate diagnostic categories in thyroid FNAs, such as atypia of undetermined significance. Development of laboratory dashboards coupled with periodic confidential feedback to the cytopathologist or cytotechnologist can help monitor and correct practice patterns that fall outside target norms.
{"title":"Quality Metrics to Assess Cytopathology Practice Patterns: Focus on Thyroid Fine-Needle Aspiration Cytology","authors":"Paul A. Vander Laan","doi":"10.1097/PCR.0000000000000514","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000514","url":null,"abstract":"Abstract Quality assurance measures in the cytology laboratory help ensure accurate and consistent diagnoses. For thyroid fine-needle aspirations (FNAs), various cytologist performance metrics have been proposed to help monitor and explain cytologist practice patterns. Thoughtful implementation of metrics such as diagnostic category utilization rates, ratios of key diagnostic categories, surgical outcome data, and correlation with ancillary molecular testing results have been proposed to help minimize the use of indeterminate diagnostic categories in thyroid FNAs, such as atypia of undetermined significance. Development of laboratory dashboards coupled with periodic confidential feedback to the cytopathologist or cytotechnologist can help monitor and correct practice patterns that fall outside target norms.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86913719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1097/pcr.0000000000000503
Allen Burke, Teklu Legesse
A 57-year-old man developed a mesothelial proliferation in the peritoneum, several months after he was diagnosed with biopsy-proven epithelioid mesothelioma of the pleura and having undergone several treatments with checkpoint inhibitor immunotherapy. The differential diagnosis was metastatic mesothelioma from the lung primary, versus a reactive process. A diagnosis of atypical mesothelial proliferation was made. Follow-up CT showed no evidence of abdominal disease 5 months later. The complication of serositis following checkpoint inhibitor therapy is reviewed, as well as the differential diagnosis between reactive mesothelial hyperplasia and epithelioid mesothelioma.
{"title":"Nivolumab-induced peritonitis with peritoneal mesothelial hyperplasia mimicking metastatic mesothelioma.","authors":"Allen Burke, Teklu Legesse","doi":"10.1097/pcr.0000000000000503","DOIUrl":"https://doi.org/10.1097/pcr.0000000000000503","url":null,"abstract":"<p><p>A 57-year-old man developed a mesothelial proliferation in the peritoneum, several months after he was diagnosed with biopsy-proven epithelioid mesothelioma of the pleura and having undergone several treatments with checkpoint inhibitor immunotherapy. The differential diagnosis was metastatic mesothelioma from the lung primary, versus a reactive process. A diagnosis of atypical mesothelial proliferation was made. Follow-up CT showed no evidence of abdominal disease 5 months later. The complication of serositis following checkpoint inhibitor therapy is reviewed, as well as the differential diagnosis between reactive mesothelial hyperplasia and epithelioid mesothelioma.</p>","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201942/pdf/nihms-1784894.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9379834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1097/PCR.0000000000000511
Brian Vadasz, K. Wolniak, M. Sukhanova, Yi-Hua Chen, A. Behdad
Abstract Anaplastic large cell lymphoma (ALCL) is a rare systemic T-cell neoplasm that typically involves nodal and extranodal sites and is further classified into 2 subgroups: anaplastic lymphoma kinase (ALK-) positive (ALK+) and ALK-negative. Leukemic presentation of ALCL is extremely rare. Most cases with leukemic presentation are the small-cell variant of ALK+ ALCL, are positive for the t(2;5)(p23;q35) translocation, and are associated with a poor prognosis. We report a case of ALK+ ALCL that presented with a high white blood cell count and morphologic and phenotypic features resembling T-cell prolymphocytic leukemia.
{"title":"Leukemic Presentation of Anaplastic Large Cell Lymphoma: A Diagnostic Challenge Mimicking T-Cell Prolymphocytic Leukemia","authors":"Brian Vadasz, K. Wolniak, M. Sukhanova, Yi-Hua Chen, A. Behdad","doi":"10.1097/PCR.0000000000000511","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000511","url":null,"abstract":"Abstract Anaplastic large cell lymphoma (ALCL) is a rare systemic T-cell neoplasm that typically involves nodal and extranodal sites and is further classified into 2 subgroups: anaplastic lymphoma kinase (ALK-) positive (ALK+) and ALK-negative. Leukemic presentation of ALCL is extremely rare. Most cases with leukemic presentation are the small-cell variant of ALK+ ALCL, are positive for the t(2;5)(p23;q35) translocation, and are associated with a poor prognosis. We report a case of ALK+ ALCL that presented with a high white blood cell count and morphologic and phenotypic features resembling T-cell prolymphocytic leukemia.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88542583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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