American journal of clinical pathology最新文献

Objective: To investigate the predictive value of the neutrophil-to-high-density lipoprotein ratio (NHR) for residual or recurrent cervical intraepithelial neoplasia (CIN) after a loop electrosurgical excision procedure (LEEP) and to develop a nomogram model with multiple variables for identifying high-risk patients.

Methods: A retrospective cohort of 282 patients with CIN treated by LEEP was analyzed. Clinical, laboratory, and follow-up data were collected. Univariate and multivariate logistic regression were used to find independent risk factors, and a nomogram model was constructed. The model's discrimination, calibration, and clinical utility were evaluated by the receiver operating characteristic curve, Hosmer-Lemeshow test, calibration curve, and decision curve analysis.

Results: Among 282 patients, 44 (15.6%) had residual or recurrent CIN. Multivariate analysis found CIN grade 3, positive surgical margins, elevated fibrinogen levels, and increased NHR as independent risk factors. The NHR had good sensitivity and specificity in predicting post-LEEP residual or recurrent CIN. The nomogram model had an area under the curve of 0.858. Calibration plots and the Hosmer-Lemeshow test showed good fit, and decision curve analysis suggested net clinical benefit and applicability.

Conclusions: The NHR, combined with fibrinogen, CIN grading, and margin status, can predict residual or recurrent CIN after LEEP. The nomogram model can guide high-risk patients' postoperative management. Prospective validation in large cohorts is needed.

Objective: ERG gene fusions are present in up to 60% of localized prostate cancer and up to 45% of metastatic prostate cancer. Fluorescence in situ hybridization (FISH) assays can detect the vast majority of ERG gene fusions and help confirm prostatic origin. We reviewed clinical ERG FISH assays performed at our tertiary institution by our in-house consult services between 2016 and 2024 where prostatic adenocarcinoma was in the differential diagnosis.

Methods: We summarized clinical information, immunohistochemistry results (including ERG), and ERG FISH status in a cohort of 15 consecutive clinical ERG FISH assays performed for 14 patients in whom a diagnosis of prostatic adenocarcinoma was considered.

Results: ERG FISH testing was positive in 7 of 15 (46.7%) cases, indeterminate in 1 of 15 (6.7%) cases, and negative in 7 of 15 (46.7%) cases. In 6 of 7 (85.7%) positive cases, the ERG FISH-positive result supported prostatic origin in metastatic (n = 4) or undifferentiated (n = 2) disease.

Conclusions: Use of clinical ERG FISH assays may help confirm prostatic origin in the setting of localized or metastatic carcinoma showing poor differentiation or transdifferentiation and thus help determine the correct diagnosis and direct appropriate clinical management for such patients.

Objectives: Special AT-rich sequence binding protein 2 (SATB2) is a sensitive immunohistochemical marker of colorectal origin. Loss of SATB2 staining in colorectal cancer (CRC) has been associated with adverse outcomes, poor response to chemotherapy, and clinicopathologic features. This study summarizes the survival outcomes and clinicopathologic associations of SATB2 expression and CRC.

Methods: A literature search for studies of survival outcomes and clinicopathologic associations of SATB2 in CRC was undertaken. Meta-analysis with random-effects models was used to combine data.

Results: We analyzed 17 published studies comprising 7733 patients. SATB2 loss was seen in 19% of cases (risk ratio [RR], 0.19 [95% CI, 0.14-0.27]). SATB2 loss was associated with worse overall survival (RR, 0.76 [95% CI, 0.70-0.84]; P < .001) and worse disease-free survival (RR, 0.78 (95% CI, 0.72-0.86]; P < .001). SATB2 loss was associated with more advanced overall stage, nodal involvement, distant metastases, and right-sided tumor location. Loss was also associated with high-risk histologic features, including poor differentiation; lymphatic, venous, and perineural invasion; mucinous and signet ring histology; and tumor budding. SATB2 loss was also seen more commonly in microsatellite unstable and BRAF-mutated cases but was not associated with KRAS mutation.

Conclusions: Loss of SATB2 staining in CRC is associated with inferior survival outcomes and adverse clinicopathologic features.

Objective: We sought to optimize inpatient critical value reporting using an intelligent voice outbound call system to improve the timeliness of notifications and efficiency of clinical acknowledgment as well as reduce management costs.

Methods: We collaborated across departments to redesign our critical value process. Critical values are divided into 2 classes based on clinical background, the extent of clinical occurrence, predictability, and the efficiency of timely clinical acknowledgment. An intelligent voice system was integrated with the hospital information system, laboratory information system, and internal hospital platform.

Results: The outbound call system placed calls for 61.68% of critical values, achieving a 78.63% success rate and 97.96% effectiveness rate. Manual phone notifications accounted for only 3.98%. The timely notification rate reached 95.47%, with a mean notification time of 12.36 minutes (95% CI, 11.92-12.79 minutes). The timely acknowledgment rate for critical values was 72.95%, with 46.24% of critical values being promptly addressed through clinical rapid acknowledgment (Network-Acknowledgment), 26.35% through the outbound call system (Outbound call-Acknowledgment), and 0.36% through manual phone-based communication (Manual telephone-Acknowledgment).

Conclusions: The application of the intelligent outbound call system in the closed-loop management of critical values substantially improved the timeliness of notifications and acknowledgment efficiency, reduced the workload of manual phone notifications, and achieved a fully paperless critical value management process. This system not only enhanced the hospital's management level but also provided strong support for improving clinical diagnosis and treatment quality.

Objective: In this study, we aimed to determine the frequency, distribution, and phenotype of terminal deoxynucleotidyl transferase (TdT)-positive precursor cells in reactive lymphadenopathies; clarify the clinical significance of this expression; and present new data to the existing literature.

Methods: We retrospectively reviewed 152 excisional lymph node biopsy specimens diagnosed as reactive lymphoid hyperplasia (January 2023 to April 2024). Slides were evaluated primarily by hematoxylin and eosin and TdT immunohistochemistry. Then, dual immune staining (TdT/CD3, TdT/CD5, TdT/CD20, TdT/CD79a, TdT/CD10, and TdT/CD34) was applied to determine the characterization of TdT+ cells. Clinicopathologic variables (age group, sex, site, and histologic pattern) were recorded and compared.

Results: The TdT+ cells were detected in 13 of 152 cases (8.5%). These cells were primarily localized in the interfollicular regions of the lymph nodes, in areas close to the high endothelial venules. The TdT+ cells were slightly larger than lymphocytes and were seen individually or in small clusters (<10 cells). It was determined that some TdT+ cells coexpressed CD10 and/or CD34 by double immunostaining (mean 5.36%, up to 12% of TdT+ cells), suggesting that these cells are compatible with the common lymphoid precursor phenotype. No coexpression with CD3, CD5, CD20, or CD79a was observed.

Conclusions: Benign TdT+ precursor cells can occasionally be found in reactive lymphadenopathies. These cells may sometimes coexpress CD10 or CD34. Recognizing this pattern is important, as it helps avoid mistaking these benign cells for lymphoblastic lymphoma or leukemia.

Objective: To identify challenges, opportunities, and best practices for improving the communication of urgent and significant unexpected diagnoses in anatomic pathology, to enhance diagnostic excellence and patient safety.

Methods and results: The American Society for Clinical Pathology convened a group of eleven pathologists from diverse practice settings who discussed the challenges, opportunities, and best practices for improving communication of urgent and significant unexpected findings in anatomic pathology. Through structured discussions, the group identified the challenges such as variability in definitions of urgent and significant unexpected diagnoses and lack of standardized protocols. The group developed a set of best practices and strategies to support timely notification, clear documentation, and standardized communication processes within the healthcare teams to ensure appropriate patient management based on the communicated diagnoses.

Conclusions: Timely and effective communication of urgent and significant unexpected findings in anatomic pathology is essential for patient safety. Standardized definitions and protocols, combined with collaborative strategies, can improve diagnostic accuracy and clinical outcomes. Future research should focus on building an evidence base to support these practices and evaluate their impact on patient care.

Objective: Collagenous colitis (CC) is a microscopic colitis marked by chronic watery diarrhea, normal endoscopy, and a thickened subepithelial collagen layer. Here, we describe endoscopically apparent variants, including a nodular pattern.

Methods: We retrospectively reviewed 201 CC cases diagnosed at Beth Israel Deaconess Hospital. Endoscopic findings were classified as normal, subtly abnormal, or nodular CC (NCC). Clinical features, medication exposures, and histology were recorded and analyzed.

Results: Endoscopic abnormalities were seen in 26 of 201 (12.9%) cases: 16 with subtle changes and 10 with nodular mucosa (NCC). The remaining 175 (87.1%) cases had normal endoscopic findings. Statistically, clinical, histologic, and treatment features did not differ significantly (P > .05) between groups, though trends included (1) Paneth cell metaplasia being more frequent in endoscopically apparent CC (26.9%) vs normal CC (11.1%); (2) celiac disease being more common in NCC (30%) than in other groups (<6.5%); and (3) angiotensin receptor blocker use was more frequent in NCC (20%) than in other groups (<6.5%). Both subtle and nodular changes often persisted on follow-up colonoscopies, despite clinical remission.

Conclusions: Endoscopically apparent CC, including NCC, may persist but should not exclude the diagnosis when clinical, histologic, and treatment features remain similar to normal CC.