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Measuring the operational performance of an artificial intelligence-based blood tube-labeling robot, NESLI. 测量基于人工智能的血管贴标机器人 NESLI 的运行性能。
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-07 DOI: 10.1093/ajcp/aqae108
Ferhat Demirci

Objectives: Laboratory testing, crucial for medical diagnosis, has 3 phases: preanalytical, analytical, and postanalytical. This study set out to demonstrate whether automating tube labeling through artificial intelligence (AI) support enhances efficiency, reduces errors, and improves outpatient phlebotomy services.

Methods: The NESLI tube-labeling robot (Labenko Informatics), which uses AI models for tube selection and handling, was used for the experiments. The study evaluated the NESLI robot's operational performance, including labelling time, technical problems, tube handling success, and critical stock alerts. The robot's label readability was also tested on various laboratory devices. This research will contribute to the field's understanding of the potential impact of automated tube-labeling systems on laboratory processes in the preanalytical phase.

Results: NESLI demonstrated high performance in labeling processes, achieving a success rate of 99.2% in labeling parameters and a success rate of 100% in other areas. For nonlabeling parameters, the average labeling time per tube was measured at 8.96 seconds, with a 100% success rate in tube handling and critical stock warnings. Technical issues were promptly resolved, affirming the NESLI robot's effectiveness and reliability in automating the tube-labeling processes.

Conclusions: Robotic systems using AI, such as NESLI, have the potential to increase process efficiency and reduce errors in the preanalytical phase of laboratory testing. Integration of such systems into comprehensive information systems is crucial for optimizing phlebotomy services and ensuring timely and accurate diagnostics.

目标:实验室检测是医疗诊断的关键,分为三个阶段:分析前、分析中和分析后。本研究旨在证明通过人工智能(AI)支持实现试管贴标自动化是否能提高效率、减少错误并改善门诊抽血服务:实验使用了NESLI试管贴标机器人(Labenko Informatics),该机器人使用人工智能模型来选择和处理试管。研究评估了 NESLI 机器人的操作性能,包括贴标时间、技术问题、试管处理成功率和关键库存警报。此外,还在各种实验室设备上测试了机器人的标签可读性。这项研究将有助于业界了解自动试管贴标系统对分析前阶段实验室流程的潜在影响:NESLI 在贴标过程中表现出很高的性能,贴标参数的成功率达到 99.2%,其他方面的成功率达到 100%。在非贴标参数方面,每个试管的平均贴标时间为 8.96 秒,试管处理和关键库存警告的成功率为 100%。技术问题得到了及时解决,这肯定了 NESLI 机器人在试管贴标流程自动化方面的有效性和可靠性:结论:NESLI 等使用人工智能的机器人系统有可能在实验室检测的分析前阶段提高流程效率并减少错误。将此类系统集成到综合信息系统中对于优化抽血服务和确保及时准确的诊断至关重要。
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引用次数: 0
Paneth cell differentiation associated with neoadjuvant therapy in esophageal adenocarcinoma. 与食管腺癌新辅助治疗相关的潘氏细胞分化
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-07 DOI: 10.1093/ajcp/aqae098
Madhurya Ramineni, Sarah K Findeis, Jiqing Ye, Yansheng Hao

Objectives: Paneth cells and Paneth cell metaplasia are well-known in pathology as foundational components in the gastrointestinal system. When within malignant cells (Paneth cell differentiation [PCD]), however, the function and significance of these cells is less well understood. Here, we present findings from the first study focused on PCD in postneoadjuvant esophageal adenocarcinoma (EAC) resection specimens.

Methods: Patients with EAC treated with neoadjuvant chemoradioation and followed by esophagectomy between 2012 and 2018 in our institution were retrospectively evaluated. A tissue microarray was constructed, and special and immunohistochemical stains were performed.

Results: A total of 64 cases were collected, of which 8 had PCD, as highlighted by periodic acid-Schiff with diastase staining. Adenocarcinomas with PCD were more commonly seen in patients 60 to 70 years of age and typically had a poorly differentiated morphology, observationally fewer stromal mucinous changes, and less lymph node metastasis. β-catenin activation induced by neoadjuvant therapy was more frequent in the PCD-positive cases. Patients with PCD-positive disease had low programmed cell death 1 ligand 1 levels, no positive or equivocal ERBB2 (HER2) expression, and low CD8-positive T-cell infiltration; they were also mismatch repair proficient. Patients with PCD-positive disease showed a survival pattern inferior to that of patients with PCD-negative disease.

Conclusions: When induced by neoadjuvant therapy in EAC, PCD is associated with high β-catenin activation, less expression of targetable biomarkers, and a potentially worse clinical prognosis.

目的:众所周知,病理学中的Paneth细胞和Paneth细胞变性是胃肠道系统的基础成分。然而,当这些细胞进入恶性细胞(Paneth 细胞分化 [PCD])时,其功能和意义就不那么为人所知了。在此,我们将介绍第一项关于新辅助治疗后食管腺癌(EAC)切除标本中的 PCD 的研究结果:我们对本机构2012年至2018年期间接受新辅助化疗并随后进行食管切除术的EAC患者进行了回顾性评估。构建了组织芯片,并进行了特殊染色和免疫组化染色:结果:共收集到64例病例,其中8例有PCD,通过周期性酸-Schiff加二淀粉酶染色显示。伴有PCD的腺癌多见于60至70岁的患者,通常形态分化较差,基质粘液性改变较少,淋巴结转移也较少。在 PCD 阳性病例中,新辅助治疗诱导的β-catenin 激活更为常见。PCD阳性患者的程序性细胞死亡1配体1水平较低,ERBB2(HER2)无阳性表达或表达不明确,CD8阳性T细胞浸润较低;他们还具有错配修复能力。PCD阳性患者的生存模式不如PCD阴性患者:结论:当新辅助治疗诱发EAC时,PCD与β-catenin高度活化、可靶向的生物标记物表达较少以及潜在的较差临床预后有关。
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引用次数: 0
The significance of extensive HPV genotyping for cervical high-grade neoplasia among women with atypical glandular cells. 对患有非典型腺细胞的妇女进行广泛的 HPV 基因分型对宫颈高级别肿瘤的意义。
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-07 DOI: 10.1093/ajcp/aqae103
Xiao Tang, Megan L Zilla, Wei Jiang, Yanmei He, David Starr, Lei Li, Lingling Tong, Cheng Wang, Wei Wang, Kaixuan Yang, Rutie Yin, Chengquan Zhao

Objectives: To examine the associated risk of cervical intraepithelial neoplasm grade 3+ (CIN3+) lesions in patients with AGC and extensive human papillomavirus (HPV) genotyping.

Methods: Cases with atypical glandular cell (AGC) interpretation on a Papanicolaou (Pap) test were identified along with associated extensive HPV genotyping and histologic follow-up results.

Results: Within this cohort of 469,694 Pap tests, 0.4% were diagnosed as AGCs. In total, 1267 cases had concurrent high-risk HPV (hrHPV) genotyping, and 40.3% were hrHPV positive. The percentage of AGC cases with cervical CIN3+ on histologic follow-up was 52.2% when hrHPV was positive, whereas it was 4.9% with a negative hrHPV result. The top 5 hrHPV genotypes associated with cervical CIN3+ in this cohort were HPV16, HPV18, HPV58, HPV52, and HPV33. Indeed, 92.8% of the hrHPV-associated CIN3+ lesions identified in this cohort were positive for at least one of these HPV genotypes. The sensitivity of detecting cervical CIN3+ lesions was 85.6% with the top 5 hrHPV genotypes (HPV16/18/58/52/33) and only increased to 89.0% when the additional 12 genotypes were included.

Conclusions: In patients with an AGC Pap, the risk of having a cervical CIN3+ lesion is greatly increased by positivity for hrHPV types 16, 18, 58, 52, and/or 33. Incorporating comprehensive HPV genotyping into AGC cytology allows for refined risk stratification and more tailored management strategies.

目的研究AGC和广泛人乳头瘤病毒(HPV)基因分型患者发生宫颈上皮内瘤变3级+(CIN3+)病变的相关风险:方法:对巴氏试验(Pap)结果显示为非典型腺细胞(AGC)的病例进行鉴定,并同时进行广泛的人乳头瘤病毒(HPV)基因分型和组织学随访:在 469,694 例帕氏试验中,0.4% 被诊断为 AGC。共有 1267 例病例同时进行了高危 HPV(hrHPV)基因分型,其中 40.3% 为 hrHPV 阳性。在组织学随访中,hrHPV 阳性的 AGC 病例中宫颈 CIN3+ 的比例为 52.2%,而 hrHPV 阴性的比例为 4.9%。在该队列中,与宫颈 CIN3+ 相关的前 5 种 hrHPV 基因型是 HPV16、HPV18、HPV58、HPV52 和 HPV33。事实上,在该队列中发现的与 hrHPV 相关的 CIN3+ 病变中,92.8%至少有一种 HPV 基因型呈阳性。前5种hrHPV基因型(HPV16/18/58/52/33)检测宫颈CIN3+病变的灵敏度为85.6%,当包括其他12种基因型时,灵敏度才提高到89.0%:结论:在接受AGC巴氏检查的患者中,hrHPV 16、18、58、52和/或33型阳性会大大增加宫颈CIN3+病变的风险。在 AGC 细胞学检查中纳入全面的 HPV 基因分型可进行精细的风险分层,并制定更有针对性的管理策略。
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引用次数: 0
Comparison of antigenicity between frozen section vs non-frozen section tissue blocks: An immunohistochemical study of antibodies commonly used in gynecologic pathology. 冷冻切片与非冷冻切片组织块抗原性的比较:妇科病理学常用抗体的免疫组化研究。
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-07 DOI: 10.1093/ajcp/aqae080
Quratulain Obaid, Mehrdad Nadji, Matthew Schlumbrecht, Andre Pinto

Objectives: Frozen section (FS) is a technique widely used intraoperatively to render a preliminary histopathologic diagnosis, allowing for immediate decisions at the time of surgery. We aimed to investigate potential variations in tissue antigenicity induced by rapid freezing in a variety of gynecologic tumor samples.

Methods: A total of 177 FS and 177 non-frozen section (NFS) tissue slides were tested using a panel of immunostains commonly used in gynecologic pathology, including hormone receptors (estrogen receptor, progesterone receptor), HER2, mismatch repair proteins (MSH6, PMS2), programmed cell death 1 ligand 1 (PD-L1), p53, napsin A, and ɑ-methylacyl coenzyme-A racemase. Immunohistochemistry results were categorized as positive or negative, and positive cases were subsequently scored based on the distribution and intensity of the staining. Certain immunostains, such as HER2, PD-L1, and p53, were scored according to the established guidelines.

Results: The overall concordance between FS and NFS blocks was 87%; among the 13% of discrepant cases, most (10.7%) were classified as minor, with only quantitative differences without foreseeable clinical significance. In 2.3% of cases, there were major qualitative changes with potential impact on disease management.

Conclusions: We concluded that FS tissue blocks may, in most cases, safely be used for immunohistochemical studies because most discrepant cases showed only minor differences in staining, with no anticipated clinical significance. Nevertheless, for certain markers, including HER2, p53, and PMS2, a NFS block is preferred when that option is available.

目的:冷冻切片(FS)是术中广泛使用的一种技术,可提供初步的组织病理学诊断,以便在手术时立即做出决定。我们旨在研究快速冷冻各种妇科肿瘤样本可能引起的组织抗原性变化:方法:使用妇科病理学常用的一组免疫标记,包括激素受体(雌激素受体、孕激素受体)、HER2、错配修复蛋白(MSH6、PMS2)、程序性细胞死亡 1 配体 1 (PD-L1)、p53、napsin A 和 ɑ-甲基乙酰辅酶-A 消旋酶,对 177 张 FS 和 177 张非冷冻切片(NFS)组织切片进行了检测。免疫组化结果分为阳性和阴性,阳性病例随后根据染色的分布和强度进行评分。某些免疫标记,如HER2、PD-L1和p53,则根据既定指南进行评分:FS和NFS区块的总体一致性为87%;在13%的差异病例中,大多数(10.7%)被归类为轻微差异,只有数量上的差异,没有可预见的临床意义。在 2.3% 的病例中,存在对疾病管理有潜在影响的重大质变:我们的结论是,在大多数情况下,FS 组织块可安全地用于免疫组化研究,因为大多数差异病例的染色仅表现为轻微差异,没有预期的临床意义。不过,对于某些标记物,包括 HER2、p53 和 PMS2,如果可以选择 NFS 组织块,则应首选 NFS 组织块。
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引用次数: 0
Correction to: Improved Recognition of Hematogones From Precursor B-Lymphoblastic Leukemia by a Single Tube Flow Cytometric Analysis. 更正:单管流式细胞分析法提高了对前体 B 淋巴细胞白血病血液酮体的识别能力。
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-01 DOI: 10.1093/ajcp/aqae096
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引用次数: 0
Cardiothoracic operating room blood gas workflow performance improvement initiative. 心胸手术室血气工作流程绩效改进计划。
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-01 DOI: 10.1093/ajcp/aqae014
Stefanie K Forest, Kevin Kuan, Ukuemi Edema, Stephen J Forest, Jonathan D Leff

Objectives: To evaluate the current workflow of blood gas ordering and testing in a cardiothoracic operating room to identify opportunities to streamline the process, using performance improvement methodologies.

Methods: Issues with specimen relabeling were identified that lead to delayed results and potential patient safety concerns. Blood gas specimen relabeling was evaluated for operating room cases from August 2018 to December 2022. An OpTime Epic Sidebar button for arterial blood gas and venous blood gas orders was created in January 2019 to streamline the ordering process so that laboratory barcode labels were then printed in the operating room and attached to the specimen, eliminating the need for relabeling by the technologists.

Results: This Epic Sidebar intervention led to a drastic improvement of appropriate labeling, which has been sustained. From March 2019 to January 2023, with our new workflow, over 95% of blood gas specimens arrived barcode labeled compared to less than 1% in the preintervention era.

Conclusions: A multidisciplinary team with key stakeholders is important to address complex care issues. Performance improvement methodology is critical to develop interventions that hardwire the process. This intervention led to a sustained reduction in secondary relabeling of patient samples and improved timeliness of reporting of blood gas results.

目的:评估心胸手术室目前的血气订购和检测工作流程:评估心胸手术室目前的血气订购和检测工作流程,利用绩效改进方法确定简化流程的机会:方法:发现标本重新标记的问题会导致结果延迟和潜在的患者安全问题。对 2018 年 8 月至 2022 年 12 月的手术室病例进行了血气标本重新标记评估。2019 年 1 月,为动脉血气和静脉血气订单创建了一个 OpTime Epic Sidebar 按钮,以简化订单流程,这样实验室条形码标签就可以在手术室打印并贴在标本上,无需技师重新贴标签:结果:Epic Sidebar 的这一干预措施极大地改善了适当标签的使用情况,并使其得以持续。从 2019 年 3 月到 2023 年 1 月,采用我们的新工作流程后,超过 95% 的血气标本在送达时都贴上了条形码标签,而干预前只有不到 1% 的标本贴上了条形码标签:由主要利益相关者组成的多学科团队对于解决复杂的护理问题非常重要。绩效改进方法对于制定硬连接流程的干预措施至关重要。这项干预措施持续减少了患者样本的二次重新标记,并提高了血气结果报告的及时性。
{"title":"Cardiothoracic operating room blood gas workflow performance improvement initiative.","authors":"Stefanie K Forest, Kevin Kuan, Ukuemi Edema, Stephen J Forest, Jonathan D Leff","doi":"10.1093/ajcp/aqae014","DOIUrl":"10.1093/ajcp/aqae014","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the current workflow of blood gas ordering and testing in a cardiothoracic operating room to identify opportunities to streamline the process, using performance improvement methodologies.</p><p><strong>Methods: </strong>Issues with specimen relabeling were identified that lead to delayed results and potential patient safety concerns. Blood gas specimen relabeling was evaluated for operating room cases from August 2018 to December 2022. An OpTime Epic Sidebar button for arterial blood gas and venous blood gas orders was created in January 2019 to streamline the ordering process so that laboratory barcode labels were then printed in the operating room and attached to the specimen, eliminating the need for relabeling by the technologists.</p><p><strong>Results: </strong>This Epic Sidebar intervention led to a drastic improvement of appropriate labeling, which has been sustained. From March 2019 to January 2023, with our new workflow, over 95% of blood gas specimens arrived barcode labeled compared to less than 1% in the preintervention era.</p><p><strong>Conclusions: </strong>A multidisciplinary team with key stakeholders is important to address complex care issues. Performance improvement methodology is critical to develop interventions that hardwire the process. This intervention led to a sustained reduction in secondary relabeling of patient samples and improved timeliness of reporting of blood gas results.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140067998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Morules and β-catenin predict POLE mutation status in endometrial cancer: A pathway to more cost-effective diagnostic procedures. Morules和β-catenin可预测子宫内膜癌的POLE突变状态:实现更具成本效益诊断程序的途径。
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-01 DOI: 10.1093/ajcp/aqae023
Rujia Fan, Wanrun Lin, Ruijiao Zhao, Li Li, Rui Xin, Yunfeng Zhang, Yuxin Liu, Ying Ma, Yiying Wang, Yue Wang, Wenxin Zheng

Objectives: The characterization of DNA polymerase epsilon (POLE) mutations has transformed the classification of endometrial endometrioid carcinomas (EECs), highlighting the need for efficient identification methods. This study aims to examine the relationship between distinct morphologic features-namely, squamous morules and squamous differentiation (SD), as well as β-catenin expression-and the POLE mutation status in endometrial cancer (EC).

Methods: Our study included 35 POLE-mutated (POLEmut) EC cases and 395 non-POLEmut EEC cases.

Results: Notably, we observed no presence of morules in POLEmut cases, while SD was identified in 20% of instances. Conversely, morules and SD were identified in 12.7% and 26.1% of non-POLEmut EC cases, respectively, with morules consistently linked to a POLE wild-type status. The nuclear β-catenin expression is typically absent in tumors with wild-type POLE (wt-POLE) status.

Conclusions: Our findings suggest that the presence of either morules or nuclear β-catenin expression in EEC could practically rule out the presence of POLE mutations. These morphologic and immunohistochemical features can be used as preliminary screening tools for POLE mutations, offering significant savings in time and resources and potentially enhancing clinical decision-making and patient management strategies. However, further validation in larger, multi-institutional studies is required to fully understand the implications of these findings on clinical practice.

研究目的DNA聚合酶epsilon(POLE)突变的特征改变了子宫内膜样癌(EECs)的分类,凸显了对高效鉴定方法的需求。本研究旨在探讨子宫内膜癌(EC)中不同形态学特征(即鳞状蜕膜和鳞状分化(SD)以及β-catenin表达)与POLE突变状态之间的关系:我们的研究包括35例POLE突变(POLEmut)EC病例和395例非POLE突变EEC病例:结果:值得注意的是,我们在POLEmut病例中未发现蜕膜,而在20%的病例中发现了SD。相反,在12.7%和26.1%的非POLEmut型EC病例中分别发现了蜕膜和SD,蜕膜始终与POLE野生型状态相关。野生型POLE(wt-POLE)肿瘤通常没有核β-catenin表达:结论:我们的研究结果表明,EEC中存在蜕膜或核β-catenin表达实际上可以排除POLE突变的存在。这些形态学和免疫组化特征可作为 POLE 基因突变的初步筛查工具,大大节省了时间和资源,并有可能改善临床决策和患者管理策略。然而,要充分了解这些发现对临床实践的影响,还需要在更大规模的多机构研究中进一步验证。
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引用次数: 0
Mammary pilar metaplasia. 乳腺支柱变性
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-01 DOI: 10.1093/ajcp/aqae026
Carla Stephan, Sandra Demaria, Syed A Hoda
{"title":"Mammary pilar metaplasia.","authors":"Carla Stephan, Sandra Demaria, Syed A Hoda","doi":"10.1093/ajcp/aqae026","DOIUrl":"10.1093/ajcp/aqae026","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interobserver reproducibility of cervical histology interpretation with and without p16 immunohistochemistry. 使用和不使用 p16 免疫组化技术进行宫颈组织学判读的观察者间再现性。
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-01 DOI: 10.1093/ajcp/aqae029
Amy S Tao, Rosemary Zuna, Teresa M Darragh, Niels Grabe, Bernd Lahrmann, Megan A Clarke, Nicolas Wentzensen

Objectives: Histopathological diagnosis of colposcopically identified cervical lesions is a critical step for the recognition of cervical cancer precursors requiring treatment. Although there have been efforts to standardize the histologic diagnosis of cervical biopsy specimens, in terms of terminology and use of biomarkers, there is no uniform approach in the pathology community. Adjunctive p16 immunohistochemistry (IHC) can highlight precancer diagnoses, with use recommendations outlined by the Lower Anogenital Squamous Terminology project.

Methods: We assessed the diagnostic reproducibility of cervical histopathological biopsy specimens with and without p16 staining among 2 expert pathologists.

Results: Interpretation of p16 IHC as positive vs negative was highly reproducible (92.5% agreement, κ = 0.85); greater variation was seen in the choice of which biopsy specimens required adjunctive p16 staining (78.0% agreement, κ = 0.43). Adjunctive p16 IHC did not significantly increase diagnostic agreement under multitiered grading systems (benign vs cervical intraepithelial neoplasia [CIN] 1/low-grade squamous intraepithelial lesion vs atypical squamous metaplasia vs CIN2/high-grade squamous intraepithelial lesion [HSIL] vs CIN3/HSIL-CIN3 vs cancer) (65.5% agreement, κ = 0.56 without p16; 70.0% agreement, κ = 0.58 with p16). However, when dichotomizing diagnoses based on clinical management (less than HSIL vs HSIL+), diagnostic agreement increased with p16 IHC (90.5% agreement, κ = 0.79 without p16; 92.0% agreement, κ = 0.84 with p16). For biopsy specimens taken from women positive for human papillomavirus (HPV) type 16, agreement was similar with or without adjunctive p16 (κ = 0.80 without p16; κ = 0.78-0.80 with p16). In contrast, p16 IHC substantially improved diagnostic agreement for cervical biopsy specimens taken from women positive for other high-risk HPV strains, producing improvements in κ from 0.03 to 0.24.

Conclusions: Adjunctive p16 immunostaining provides useful information in the evaluation of cervical biopsies for precancer. In our study, we have demonstrated that it is highly reproducible between 2 pathologists, although the decision of which biopsies warrant its use is less so. Furthermore, although p16 IHC showed a limited increase in diagnostic reproducibility for all biopsies included in our study, it did demonstrate a more sizable gain in biopsies negative for HPV 16 but positive for other high-risk genotypes. Further studies are needed to clarify the role of p16 IHC and how it can be optimized for the detection of cervical precancer, particularly in HPV-vaccinated populations where types other than HPV 16 are relatively more important.

目的:对阴道镜确定的宫颈病变进行组织病理学诊断是识别需要治疗的宫颈癌前兆的关键步骤。尽管在术语和生物标记物的使用方面,人们一直在努力使宫颈活检标本的组织学诊断标准化,但病理学界并没有统一的方法。辅助性 p16 免疫组织化学(IHC)可以突出癌前病变的诊断,下生殖器鳞状细胞术语项目提出了使用建议:我们评估了两位病理专家对宫颈组织病理活检标本进行 p16 染色和未进行 p16 染色的诊断重现性:对 p16 IHC 阳性与阴性的解释具有很高的可重复性(92.5% 的一致性,κ = 0.85);在选择哪些活检标本需要辅助 p16 染色方面存在较大差异(78.0% 的一致性,κ = 0.43)。在多级分级系统(良性 vs 宫颈上皮内瘤变 [CIN] 1/ 低级鳞状上皮内病变 vs 不典型鳞状上皮内瘤变 vs CIN2/ 高级鳞状上皮内病变 [HSIL] vs CIN3/HSIL-CIN3 vs 癌)下,辅助 p16 IHC 并未显著提高诊断一致性(65.5% 的一致性,无 p16 时 κ = 0.56;有 p16 时 70.0% 的一致性,κ = 0.58)。然而,当根据临床管理(小于 HSIL vs HSIL+)进行二分诊断时,p16 IHC 的诊断一致性增加(无 p16 时,一致性为 90.5%,κ = 0.79;有 p16 时,一致性为 92.0%,κ = 0.84)。对于人乳头状瘤病毒(HPV)16 型阳性妇女的活检标本,是否辅助 p16 的一致性相似(无 p16 时,κ = 0.80;有 p16 时,κ = 0.78-0.80)。相比之下,p16 IHC 大大提高了其他高危 HPV 株阳性妇女宫颈活检标本的诊断一致性,使κ从 0.03 提高到 0.24:辅助 p16 免疫染色可为评估宫颈癌前病变提供有用信息。在我们的研究中,我们证明了两名病理学家之间的重复性很高,不过在决定哪些活检需要使用该方法时,重复性就不那么高了。此外,虽然 p16 IHC 对我们研究中的所有活检样本的诊断可重复性提高有限,但在 HPV 16 阴性但其他高危基因型阳性的活检样本中,其可重复性的提高幅度更大。还需要进一步研究来明确 p16 IHC 的作用,以及如何优化它在宫颈癌前病变检测中的作用,尤其是在接种过 HPV 疫苗的人群中,因为在这些人群中,HPV 16 以外的其他类型相对更重要。
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引用次数: 0
Analyzing clinical laboratory specimen rejection rates at a specialized hospital in Ethiopia: A 2-year document review. 分析埃塞俄比亚一家专科医院的临床实验室标本排斥率:两年文件回顾。
IF 2.3 4区 医学 Q2 PATHOLOGY Pub Date : 2024-08-01 DOI: 10.1093/ajcp/aqae019
Teshiwal Deress, Yeshewas Abebaw, Yezena Esayas, Semegn Nebertu, Meseret Kinidie, Germaw Abebe, Biruk Bayleyegn

Objectives: Accurate laboratory diagnosis is essential for effective patient care, but the rejection of specimens within laboratories can have serious consequences.

Methods: A retrospective cross-sectional study was conducted from September to November 2021 at the University of Gondar Comprehensive Specialized Hospital laboratory. Two years of laboratory data were collected from laboratory log books and analyzed to determine trends in specimen rejection rates and identify potential reasons for those rejections.

Results: We analyzed 114,439 specimens, of which 786 (0.70%) were rejected. The hematology service exhibited the highest rejection rate, at 273 (0.2%). The main reasons for specimen rejection were specimens without requests or requests without specimens (40.2%), poor smear preparation (12.3%), clotted specimens (11.3%), and labeling problems (8.0%).

Conclusions: This study emphasized a significant incidence of specimen rejection, particularly in the hematology laboratory, underscoring the need for immediate implementation of corrective actions and preventive measures. Furthermore, conducting comprehensive larger-scale studies is recommended to deepen our understanding of and investigate the specific factors contributing to specimen rejection in greater detail.

目的准确的实验室诊断对有效的患者护理至关重要,但实验室内标本的拒收可能会造成严重后果:2021 年 9 月至 11 月,在贡德尔大学综合专科医院实验室进行了一项回顾性横断面研究。我们从实验室记录本中收集了两年的实验室数据,并对其进行了分析,以确定标本拒收率的趋势,并找出拒收标本的潜在原因:我们分析了 114439 份标本,其中 786 份(0.70%)被拒收。血液学服务的标本拒收率最高,为 273 份(0.2%)。标本被拒的主要原因是标本无申请或申请无标本(40.2%)、涂片准备不充分(12.3%)、标本凝块(11.3%)和标签问题(8.0%):这项研究强调了标本拒收的严重性,尤其是在血液学实验室中,这突出表明有必要立即采取纠正措施和预防措施。此外,建议开展更大规模的综合研究,以加深我们对造成标本排斥的具体因素的了解和更详细的调查。
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引用次数: 0
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