American journal of clinical pathology最新文献

Objectives: External quality assessment (EQA) helps evaluate and improve the quality of laboratory testing by providing unbiased reviews. The study aimed to synthesize pooled EQA performance of clinical laboratories across the African region.

Methods: The review was registered in PROSPERO (CRD42024562987) and reported based on the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. An extensive search was employed using the PubMed, Scopus, Cochrane, and Embase databases as well as gray literature. After duplicates were removed, the remaining articles were evaluated based on title, abstract, and full text. Methodologic quality was assessed using the JBI critical appraisal checklist. Random effects meta-analysis was used to estimate the pooled performance of EQA at 95% CIs. In addition, the I2 statistic was used to assess heterogeneity, and a funnel plot along with Egger regression were employed to evaluate publication bias. Trim and fill analysis was also performed to adjust the publication bias.

Results: From an electronic database search, a total of 622 articles were retrieved. Of these, 17 articles met the inclusion criteria, encompassing a total sample size of 4509 participating laboratories. In this study, the overall pooled performance of EQA in the African region was 71.25% (95% CI, 63.12-79.39). The result indicated statistically significant heterogeneity (I2 = 96.36). The funnel plot displayed an asymmetrical distribution of the studies, and Egger regression revealed significant publication bias (P = .002).

Conclusions: The findings revealed that the pooled EQA performance of laboratories in Africa did not meet the typical standard of 80%, indicating a need for continuous improvement. We suggest conducting further studies to gain better insights.

Objectives: Immune checkpoint inhibitors have revolutionized treatment of platinum-refractory advanced bladder cancer, offering hope where options are limited. Response varies, however, influenced by factors such as the tumor's immune microenvironment and prior therapy. Muscle-invasive bladder cancer (MIBC) is stratified into molecular subtypes, with distinct clinicopathologic features affecting prognosis and treatment. This study assessed the expression of programmed cell death 1 ligand 1 (PD-L1) and other immune markers in MIBC, categorized by molecular phenotype.

Methods: Using GATA3 and CK5/6 immunohistochemistry, 90 neoadjuvant chemotherapy-naive MIBC cases were classified into luminal and non-luminal subtypes. The immune microenvironment was characterized through immunostaining for PD-L1, CD4, and CD8. We applied PD-L1 positivity thresholds of 1% or greater for tumor cells and 5% or greater for immune cells. Tumors were examined for PD-L1 expression, histologic subtypes, and immune cell infiltration.

Results: Varied expression of PD-L1 and T-cell subtype densities were observed among MIBC subtypes. The double-negative subtype displayed the highest PD-L1 immune cell expression and stromal CD4 and CD8 T-cell densities, indicating an active immune profile. The basal subtype exhibited the highest PD-L1 positivity in tumor cells. In contrast, the luminal type showed the lowest PD-L1 tumor and immune cell expression, with high intratumoral CD4 T-cell density. Although PD-L1 expression in tumor or immune cells did not independently affect survival, patients with basal and double-negative tumors had poorer overall survival.

Conclusions: This study highlighted the immune diversity of MIBC in the context of molecular subtypes. Distinct molecular and immune profiles could guide the development of predictive signatures for enhanced immunotherapy response in advanced bladder cancer.

Objectives: Social media platforms like Facebook, X (formally Twitter), and Instagram bridge pathology programs with other health professionals, prospective students, and the public, but the extent of social media usage by residency programs remains unexplored. This study investigates the current landscape of social media utilization by pathology programs.

Methods: Using the National Resident Matching Program (NRMP) Match Data from 2022, 139 anatomic and clinical pathology residency programs were analyzed and categorized into 3 prestige tiers based on Doximity ratings. There were 32,067 posts examined between January 2018 and August 2022. Statistical analyses, including analysis of variance and Tukey honestly significant difference post hoc analysis, were performed to evaluate likes/views about post type.

Results: X emerged as the most used platform (68%), focusing on pathology education (27.02%). Instagram centered on resident life (25.84%), while Facebook showcased person-specific posts (35.61%). Notably, there was a correlation between program prestige and the number of posts on X and Instagram, with the most prestigious programs posting more frequently than those considered more intermediate or low in prestige rank.

Conclusions: Social media is vital in connecting pathology programs with various stakeholders. Despite seasonal fluctuations, the overall utilization of social media continues to rise, underscoring its value as a long-term resource for pathology education and communication.

Objectives: The College of American Pathologists (CAP) Cancer Protocols are developed to facilitate cancer synoptic reporting. CAP offers these Cancer Protocols in both free printable and commercially licensed electronic formats. Several academic institutions have also implemented these Cancer Protocols as web-based services. Due to financial and technical limitations, many resource-limited pathology laboratories still rely on the free printable Cancer Protocols that involve extensive text editing and secretarial support, and they are error-prone.

This study: implemented low-cost, low-barrier, and flexible electronic CAP Cancer Protocols to automate cancer synoptic reporting.

Methods: For each printable CAP Cancer Protocol, a dynamic data entry form is created using HyperText Markup Language (HTML) with embedded JavaScript, which is then presented in a web browser for pathologists to enter cancer case-specific information. Once the data entry form is complete, the case-specific information entered by the pathologists will be collected, and a synoptic report will be automatically created in the web browser by a companion JavaScript program. The synoptic report can then be copied into the corresponding pathology report.

Results: We implemented the commonly used CAP Cancer Protocols into electronic form using HTML/JavaScript. Using this tool, our pathologist reported at least 50% time savings compared to the previous manual process.

Conclusions: The proposed HTML/JavaScript-based Cancer Protocols are low-cost, low-barrier, and flexible alternatives to current commercially and academically available electronic CAP Cancer Protocols, especially for pathologists working in resource-limited laboratories. The same implementation methods can also be extended to implement international variants of Cancer Protocols, including non-English Cancer Protocols.

Objectives: Atrophic gastritis (AG) is characterized by atrophy of gastric glands-in particular, oxyntic glands-in the setting of chronic inflammation; it is often autoimmune. The diagnosis is confirmed by immunohistochemistry (IHC) for gastrin (to confirm biopsy site), and pathologists often use IHC for neuroendocrine markers to evaluate for enterochromaffin-like cell hyperplasia (ECL-H). The utility of neuroendocrine staining is unclear, and we undertook this study to determine whether ECL pattern provided any additional information in cases of Helicobacter-negative AG.

Methods: We reviewed clinicopathologic findings in 184 cases from 184 patients with histologic AG and no evidence of Helicobacter infection. Using neuroendocrine IHC markers, cases were divided into 3 groups: Group 1 showed complete ECL-H (both qualitative and quantitative criteria met), group 2 showed focal ECL-H (qualitative but not quantitative criteria met), and group 3 showed no ECL-H (neither criteria met).

Results: Group 1 patients were more likely to have positive autoantibody serologies (73%, P = .0007 vs group 2) and higher mean gastrin levels (700 pg/mL, P = .017 vs group 3), and only these patients developed gastric neuroendocrine tumors. Group 2 patients were more likely to take proton pump inhibitors (64%, P = .0002 vs group 1). Group 3 patients were more likely to be male (70%, P = .008 vs group 1) and to have microcytic anemia (44%, P = .022 vs group 2) and less likely to have intestinal metaplasia (50%, P = .044 vs group 1).

Conclusions: Stratification based on degree of ECL-H is not necessary for diagnosis of AG but does lead to statistically significant clinical and pathologic differences among groups.

Objectives: Urothelial carcinoma in situ (CIS) with early papillary formation is terminology sometimes used to suggest incipient high-grade papillary urothelial carcinoma (PUC) but may lead to confusion between true CIS and lateral flat spread of PUC.

Methods: It remains unclear how pathologists and urologists interpret this scenario, so a survey was circulated to 68 pathologists (group 1 = 28 academic genitourinary pathologists; group 2 = 17 pathologists with a self-reported genitourinary focus; group 3 = 23 pathologists self-reported as not genitourinary specialists) and 32 urologists.

Results: Regarding atypical urothelial lesions that appear mainly flat but contain possible papillae, group 3 was more likely to label this as CIS compared with groups 1 and 2 (35% for group 3 vs 13% for groups 1 and 2), while groups 1 and 2 more often adopted another descriptive diagnosis, such as "CIS with early papillary features" (38% for groups 1 and 2 vs 13% for group 3). Among all 3 groups, group 1 was most likely to diagnose concomitant CIS and PUC in the same specimen but in different tissue fragments (58%). Pagetoid spread was reported to favor CIS predominantly by group 1 (61%). Urologists felt that the term lateral spread/shoulder was unclear (75%) and preferred early PUC (44%) or PUC with early growth (44%). Half (53%) of urologists felt that reporting CIS instead of lateral spread of PUC would change management.

Conclusions: Documentation of flat lesions lacks consensus among pathologists and may benefit from standardized terminology. Moreover, the distinction between CIS and early or lateral spread of PUC is not always clear to urologists and can influence disease management.