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Tumor Microenvironment Prognostic Risk and Its Association With MUC5AC in Ampullary Carcinoma. 壶腹癌肿瘤微环境预后风险及其与MUC5AC的关系
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-09-01 DOI: 10.5858/arpa.2022-0131-OA
Sun-Young Jun, Eui-Jin Lee, Sang-Il Kim, Soyeon An

Context.—: The tumor-host interaction in the tumor microenvironment (TME) affects the prognosis of patients with malignant tumors. TME assessed via tumor budding (BD) and tumor-infiltrating lymphocyte (TIL) had a prognostic impact in patients with nonampullary small intestinal and colorectal carcinomas. In ampullary carcinoma (AC), MUC5AC was recently revealed as a significant prognosticator, but studies about the TME have not been conducted.

Objective.—: To assess TME-based prognostic risk in AC.

Design.—: We generated a collective TME risk index based on high-grade BD at the invasive front (BD3) and high density of stromal-TIL (>5%) in 64 surgically resected ACs. We evaluated its predictive values for overall survival (OS) and recurrence-free survival (RFS). We also investigated the relationship of TME to MUC5AC expression.

Results.—: TME prognostic risk index was classified into low-risk (BDLow/TILHigh; 26 of 64; 41%), intermediate-risk (BDLow/TILLow or BDHigh/TILHigh; 23; 36%), and high-risk (BDHigh/TILLow; 15; 23%) groups. Higher TME prognostic risk was associated with higher tumor grade (P = .03), lymphovascular invasion (P = .05), and MUC5AC immunopositivity (P = .02). TME prognostic risk index displayed better predictive ability for both OS (53.9 versus 46.1 versus 42.2) and RFS (24.8 versus 16.9 versus 15.3) than BD or TIL alone. In multivariate analysis, TME prognostic risk index was an independent prognosticator for OS (P = .003) and RFS (P = .03).

Conclusions.—: TME risk index in combination with BD and TIL was a stronger predictor of prognostic risk stratification than either BD or TIL alone for both OS and RFS in patients with AC. MUC5AC may modulate the interaction between tumor cells and immunity toward enhancing invasiveness in TME.

上下文。-:肿瘤微环境中肿瘤-宿主相互作用(tumor-host interaction, TME)影响恶性肿瘤患者的预后。通过肿瘤出芽(BD)和肿瘤浸润淋巴细胞(TIL)评估TME对非壶腹性小肠和结直肠癌患者的预后有影响。在壶腹癌(AC)中,MUC5AC最近被发现是一个重要的预后指标,但关于TME的研究尚未开展。-:评估ac设计中基于tme的预后风险。-:我们基于64例手术切除的癌前浸润性高级别BD (BD3)和间质til高密度(>5%)生成了TME风险指数。我们评估了其对总生存期(OS)和无复发生存期(RFS)的预测价值。我们还研究了TME与MUC5AC表达的关系。-: TME预后风险指数分为低危(BDLow/TILHigh;64人中有26人;41%),中等风险(BDLow/TILLow或BDHigh/TILHigh;23;36%)和高风险(BDHigh/TILLow;15;23%)组。较高的TME预后风险与较高的肿瘤分级(P = .03)、淋巴血管侵犯(P = .05)和MUC5AC免疫阳性(P = .02)相关。TME预后风险指数对OS (53.9 vs 46.1 vs 42.2)和RFS (24.8 vs 16.9 vs 15.3)的预测能力均优于单独使用BD或TIL。在多因素分析中,TME预后风险指数是OS (P = 0.003)和RFS (P = 0.03)的独立预测因子。-:对于AC患者的OS和RFS, TME风险指数联合BD和TIL比单独BD或TIL更能预测预后风险分层。MUC5AC可能调节肿瘤细胞与免疫之间的相互作用,从而增强TME的侵袭性。
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引用次数: 0
A Primer on Gene Editing: What Does It Mean for Pathologists? 基因编辑入门:对病理学家意味着什么?
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-08-23 DOI: 10.5858/arpa.2022-0410-CP
Allison Cushman-Vokoun, Ryan J Schmidt, Matthew Charles Hiemenz, Mark Fung, Bing Melody Zhang, Georganne Bradshaw, Manish Gandhi, JinJuan Yao, Sophia Yohe, Amy Beckman, Wayne W Grody, Petros Giannikopoulos

Context.—: Gene editing-based therapies are currently in development in the areas of oncology, inherited disease, and infectious disease. These potentially life-altering therapies are derived from decades of research in both academic and industry settings that developed technologies rooted in principles and products of nature. However, with such technologic developments come many important considerations, including adverse risks, high cost, and ethical questions.

Objective.—: To educate pathologists about gene editing technologies, inform them of potential indications and risks, outline regulatory and practical issues that could affect hospital-based practice and laboratory testing, and advocate that pathologists need to be present at discussions among industry and regulators pertaining to gene editing-based therapies.

Design.—: A Gene Editing Workgroup, facilitated by the College of American Pathologists Personalized Health Care Committee and consisting of pathologists of various backgrounds, was convened to develop an educational paper to serve as a stimulus to increase pathologist involvement and inquiry in gene editing therapeutic and diagnostic implementation.

Results.—: Through multiple discussions and literature review, the workgroup identified potential gaps in pathologists' knowledge of gene editing. Additional topics that could impact pathology and laboratory medicine were also identified and summarized in order to facilitate pathologists as stakeholders in gene editing therapy administration and monitoring and potential use in diagnostics.

Conclusions.—: Gene editing therapy is a complex but potentially transformative area of medicine. This article serves as an introduction to pathologists to assist them in future discussions with colleagues and potentially identify and alter pathology practices that relate to gene editing.

上下文。-:基于基因编辑的疗法目前正在肿瘤学、遗传性疾病和传染病领域开发。这些可能改变生活的治疗方法来自学术界和工业界几十年来的研究,这些研究开发的技术根植于原理和自然产物。然而,随着这种技术的发展,也带来了许多重要的考虑,包括不利的风险、高成本和伦理问题。-:对病理学家进行基因编辑技术的教育,告知他们潜在的适应症和风险,概述可能影响医院实践和实验室检测的监管和实际问题,并倡导病理学家需要参与有关基因编辑疗法的行业和监管机构之间的讨论。在美国病理学家个性化医疗委员会的推动下,由不同背景的病理学家组成的基因编辑工作组召开会议,以编写一篇教育论文,以促进病理学家参与和探索基因编辑治疗和诊断的实施。-:通过多次讨论和文献回顾,工作组发现了病理学家在基因编辑知识方面的潜在空白。还确定和总结了可能影响病理学和检验医学的其他主题,以促进病理学家作为基因编辑治疗管理和监测以及诊断中潜在应用的利益相关者。基因编辑疗法是一个复杂但具有潜在变革性的医学领域。这篇文章作为病理学家的介绍,以帮助他们在未来与同事的讨论中,潜在地识别和改变与基因编辑相关的病理实践。
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引用次数: 0
Overcoming the Interobserver Variability in Lung Adenocarcinoma Subtyping: A Clustering Approach to Establish a Ground Truth for Downstream Applications. 克服肺腺癌亚型中观察者之间的差异:一种为下游应用建立基础事实的聚类方法。
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-08-01 DOI: 10.5858/arpa.2022-0051-OA
Kris Lami, Andrey Bychkov, Keitaro Matsumoto, Richard Attanoos, Sabina Berezowska, Luka Brcic, Alberto Cavazza, John C English, Alexandre Todorovic Fabro, Kaori Ishida, Yukio Kashima, Brandon T Larsen, Alberto M Marchevsky, Takuro Miyazaki, Shimpei Morimoto, Anja C Roden, Frank Schneider, Mano Soshi, Maxwell L Smith, Kazuhiro Tabata, Angela M Takano, Kei Tanaka, Tomonori Tanaka, Tomoshi Tsuchiya, Takeshi Nagayasu, Junya Fukuoka

Context.—: The accurate identification of different lung adenocarcinoma histologic subtypes is important for determining prognosis but can be challenging because of overlaps in the diagnostic features, leading to considerable interobserver variability.

Objective.—: To provide an overview of the diagnostic agreement for lung adenocarcinoma subtypes among pathologists and to create a ground truth using the clustering approach for downstream computational applications.

Design.—: Three sets of lung adenocarcinoma histologic images with different evaluation levels (small patches, areas with relatively uniform histology, and whole slide images) were reviewed by 17 international expert lung pathologists and 1 pathologist in training. Each image was classified into one or several lung adenocarcinoma subtypes.

Results.—: Among the 4702 patches of the first set, 1742 (37%) had an overall consensus among all pathologists. The overall Fleiss κ score for the agreement of all subtypes was 0.58. Using cluster analysis, pathologists were hierarchically grouped into 2 clusters, with κ scores of 0.588 and 0.563 in clusters 1 and 2, respectively. Similar results were obtained for the second and third sets, with fair-to-moderate agreements. Patches from the first 2 sets that obtained the consensus of the 18 pathologists were retrieved to form consensus patches and were regarded as the ground truth of lung adenocarcinoma subtypes.

Conclusions.—: Our observations highlight discrepancies among experts when assessing lung adenocarcinoma subtypes. However, a subsequent number of consensus patches could be retrieved from each cluster, which can be used as ground truth for the downstream computational pathology applications, with minimal influence from interobserver variability.

上下文。-:准确识别不同的肺腺癌组织学亚型对确定预后很重要,但由于诊断特征重叠,导致观察者之间存在相当大的差异,因此可能具有挑战性。-:提供病理学家对肺腺癌亚型诊断一致性的概述,并为下游计算应用使用聚类方法创建一个基本事实。-:由17名国际肺病理学专家和1名实习病理学家对3组不同评价水平的肺腺癌组织学图像(小斑块、组织学相对均匀的区域和整张切片图像)进行评审。每张图像被分类为一种或几种肺腺癌亚型。-:在第一组的4702个斑块中,1742个(37%)在所有病理学家中获得了总体共识。所有亚型的总体Fleiss κ评分一致性为0.58。采用聚类分析方法,将病理患者分层分为2个聚类,聚类1的κ评分为0.588,聚类2的κ评分为0.563。第二组和第三组也得到了类似的结果,具有中等程度的一致性。从前2组获得18名病理学家一致的斑块中提取斑块,形成共识斑块,并将其作为肺腺癌亚型的基本事实。-:我们的观察结果突出了专家在评估肺腺癌亚型时的差异。然而,随后的共识补丁的数量可以从每个集群中检索,这可以用作下游计算病理学应用的基础真理,与观察者之间的可变性的影响最小。
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引用次数: 4
Getting Your Laboratory on Track With Neurotrophic Receptor Tyrosine Kinase. 用神经营养受体酪氨酸激酶让你的实验室走上正轨。
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-08-01 DOI: 10.5858/arpa.2022-0042-CP
Frederick Inglis Rudolf Eyerer, Georganne Bradshaw, Patricia Vasalos, Jordan Seth Laser, Chung-Che Chang, Annette Sunhi Kim, Damon R Olson, Ronald Joseph Paler, Jason N Rosenbaum, Eric E Walk, Joseph E Willis, Jinjuan Yao, Sophia Louise Yohe

Context.—: Neurotrophic receptor tyrosine kinase (NTRK) fusion testing has both diagnostic and therapeutic implications for patient care. With 2 tumor-agnostic US Food and Drug Administration-approved tropomyosin receptor kinase (TRK) inhibitors, testing is increasingly used for therapeutic decision making. However, the testing landscape for NTRK fusions is complex, and optimal testing depends on the clinicopathologic scenario.

Objective.—: To compare different NTRK testing methods to help pathologists understand test features and performance characteristics and make appropriate selections for NTRK fusion detection for their laboratory and individual patient specimens.

Data sources.—: A literature search for NTRK gene fusions and TRK protein was performed, including papers that discussed treatment, testing methodology, and detection or prevalence of fusion-positive cases.

Conclusions.—: As standard of care in some tumor types, next-generation sequencing (NGS) panel testing is a cost effective and reliable way to detect a broad range of NTRK fusions. The design of the panel and use of DNA or RNA will affect performance characteristics. Pan-TRK immunohistochemistry may be used as a rapid, less expensive screen in cases that will not undergo routine NGS testing, or on specimens unsuitable for NGS testing. Fluorescence in situ hybridization may be appropriate for low-tumor-content specimens that are unsuitable for NGS testing. Quantitative reverse transcription polymerase chain reaction is best suited for monitoring low-level disease of a specific, previously identified target. This information should help laboratories develop a laboratory-specific NTRK testing algorithm that best suits their practice setting and patients' needs.

上下文。神经营养受体酪氨酸激酶(NTRK)融合试验对患者护理具有诊断和治疗意义。由于美国食品和药物管理局批准了两种肿瘤不确定的原肌球蛋白受体激酶(TRK)抑制剂,检测越来越多地用于治疗决策。然而,NTRK融合的检测前景是复杂的,最佳的检测取决于临床病理情况。-:比较不同的NTRK检测方法,帮助病理学家了解检测特点和性能特点,并根据实验室和患者个体标本选择合适的NTRK融合检测方法。数据源。-:对NTRK基因融合和TRK蛋白进行文献检索,包括讨论治疗、检测方法、融合阳性病例的检测或流行情况的论文。-:作为某些肿瘤类型的标准治疗方法,下一代测序(NGS)面板检测是一种经济有效且可靠的方法,可检测广泛的NTRK融合。面板的设计和DNA或RNA的使用将影响性能特性。Pan-TRK免疫组织化学可作为不进行常规NGS检测的病例或不适合NGS检测的标本的快速、廉价筛查。荧光原位杂交可能适用于不适合NGS检测的低肿瘤含量标本。定量逆转录聚合酶链反应最适合于监测特定的低水平疾病,先前确定的目标。这些信息应有助于实验室开发最适合其实践环境和患者需求的实验室专用NTRK检测算法。
{"title":"Getting Your Laboratory on Track With Neurotrophic Receptor Tyrosine Kinase.","authors":"Frederick Inglis Rudolf Eyerer,&nbsp;Georganne Bradshaw,&nbsp;Patricia Vasalos,&nbsp;Jordan Seth Laser,&nbsp;Chung-Che Chang,&nbsp;Annette Sunhi Kim,&nbsp;Damon R Olson,&nbsp;Ronald Joseph Paler,&nbsp;Jason N Rosenbaum,&nbsp;Eric E Walk,&nbsp;Joseph E Willis,&nbsp;Jinjuan Yao,&nbsp;Sophia Louise Yohe","doi":"10.5858/arpa.2022-0042-CP","DOIUrl":"https://doi.org/10.5858/arpa.2022-0042-CP","url":null,"abstract":"<p><strong>Context.—: </strong>Neurotrophic receptor tyrosine kinase (NTRK) fusion testing has both diagnostic and therapeutic implications for patient care. With 2 tumor-agnostic US Food and Drug Administration-approved tropomyosin receptor kinase (TRK) inhibitors, testing is increasingly used for therapeutic decision making. However, the testing landscape for NTRK fusions is complex, and optimal testing depends on the clinicopathologic scenario.</p><p><strong>Objective.—: </strong>To compare different NTRK testing methods to help pathologists understand test features and performance characteristics and make appropriate selections for NTRK fusion detection for their laboratory and individual patient specimens.</p><p><strong>Data sources.—: </strong>A literature search for NTRK gene fusions and TRK protein was performed, including papers that discussed treatment, testing methodology, and detection or prevalence of fusion-positive cases.</p><p><strong>Conclusions.—: </strong>As standard of care in some tumor types, next-generation sequencing (NGS) panel testing is a cost effective and reliable way to detect a broad range of NTRK fusions. The design of the panel and use of DNA or RNA will affect performance characteristics. Pan-TRK immunohistochemistry may be used as a rapid, less expensive screen in cases that will not undergo routine NGS testing, or on specimens unsuitable for NGS testing. Fluorescence in situ hybridization may be appropriate for low-tumor-content specimens that are unsuitable for NGS testing. Quantitative reverse transcription polymerase chain reaction is best suited for monitoring low-level disease of a specific, previously identified target. This information should help laboratories develop a laboratory-specific NTRK testing algorithm that best suits their practice setting and patients' needs.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 8","pages":"872-884"},"PeriodicalIF":4.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10243605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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: 1
Pathologist-Verified Billing: Correction Rates of Miscoded Frozen Section Cases. 病理验证计费:错误编码冷冻切片病例的纠正率。
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-08-01 DOI: 10.5858/arpa.2022-0158-OA
John Hedgepeth, Cara Randall, Tracie Massey, Christine Bookhout

Context.—: With the adoption of Epic/Beaker at our institution, surgical pathology specimens are assigned a Current Procedural Terminology (CPT) charge code at the time of accessioning, and pathologists have been made responsible for verifying the accuracy of the code before signing out the case.

Objective.—: To determine with what frequency attending pathologists reassigned the correct charge code to a specimen when the code assigned at accessioning was incorrect, as well as to estimate the potential financial impact of missed changes.

Design.—: We reviewed all specimens received for frozen section during a 7-month period, identified specimens where the default charge code that our departmental protocol assigns at frozen section (88305) was incorrect, and assessed the rate of successful code change by pathologists and the potential financial cost of each missed change.

Results.—: Three hundred fifty-two of 2191 frozen section specimens (16%) required a change in the 88305 charge code. The codes for 195 specimens (55%) were correctly changed by the attending pathologist, while 157 (45%) were not changed (149) or were changed to an incorrect charge code (8). Individual pathologist change rates ranged from 0% to 100%, with a mean and median change rate of 43% and 24%, respectively. Using average code reimbursements at our institution, the loss in revenue from the 157 missed and incorrect frozen section changes was estimated at $13 788 ($1970 per month).

Conclusions.—: Pathologists showed highly variable rates of correcting CPT charge codes when the incorrect code had been previously assigned to a case, with associated loss of revenue from missed and incorrect code changes.

上下文。-:我院采用Epic/Beaker,手术病理标本在入院时被分配一个现行程序术语(CPT)收费代码,病理医师在签出病例前负责验证代码的准确性。-:确定当入院时分配的代码不正确时,主治病理学家以何种频率将正确的收费代码重新分配给标本,并估计错过更改的潜在财务影响。-:我们审查了7个月期间收到的所有冷冻切片标本,确定了我们部门协议在冷冻切片(88305)指定的默认收费代码不正确的标本,并评估了病理学家成功更改代码的比率以及每次错过更改的潜在财务成本。-: 2191个冷冻切片标本中有352个(16%)需要更改88305收费代码。195例(55%)标本代码被主治病理医师正确更改,157例(45%)标本代码未被更改(149例)或更改为不正确的收费代码(8例)。个体病理医师的变化率从0%到100%不等,平均变化率为43%,中位数变化率为24%。使用我们机构的平均代码报销,157个遗漏和不正确的冻结切片更改造成的收入损失估计为13788美元(每月1970美元)。-:当先前分配给一个病例的错误代码时,病理学家显示出高度可变的CPT收费代码更正率,并且由于遗漏和错误的代码更改而导致相关的收入损失。
{"title":"Pathologist-Verified Billing: Correction Rates of Miscoded Frozen Section Cases.","authors":"John Hedgepeth,&nbsp;Cara Randall,&nbsp;Tracie Massey,&nbsp;Christine Bookhout","doi":"10.5858/arpa.2022-0158-OA","DOIUrl":"https://doi.org/10.5858/arpa.2022-0158-OA","url":null,"abstract":"<p><strong>Context.—: </strong>With the adoption of Epic/Beaker at our institution, surgical pathology specimens are assigned a Current Procedural Terminology (CPT) charge code at the time of accessioning, and pathologists have been made responsible for verifying the accuracy of the code before signing out the case.</p><p><strong>Objective.—: </strong>To determine with what frequency attending pathologists reassigned the correct charge code to a specimen when the code assigned at accessioning was incorrect, as well as to estimate the potential financial impact of missed changes.</p><p><strong>Design.—: </strong>We reviewed all specimens received for frozen section during a 7-month period, identified specimens where the default charge code that our departmental protocol assigns at frozen section (88305) was incorrect, and assessed the rate of successful code change by pathologists and the potential financial cost of each missed change.</p><p><strong>Results.—: </strong>Three hundred fifty-two of 2191 frozen section specimens (16%) required a change in the 88305 charge code. The codes for 195 specimens (55%) were correctly changed by the attending pathologist, while 157 (45%) were not changed (149) or were changed to an incorrect charge code (8). Individual pathologist change rates ranged from 0% to 100%, with a mean and median change rate of 43% and 24%, respectively. Using average code reimbursements at our institution, the loss in revenue from the 157 missed and incorrect frozen section changes was estimated at $13 788 ($1970 per month).</p><p><strong>Conclusions.—: </strong>Pathologists showed highly variable rates of correcting CPT charge codes when the incorrect code had been previously assigned to a case, with associated loss of revenue from missed and incorrect code changes.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 8","pages":"969-973"},"PeriodicalIF":4.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9884391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Evaluation of a Multilevel Laboratory Stewardship Intervention Targeted to Cardiac and Thoracic Surgical Services at an Academic Medical Center. 针对学术医疗中心心脏和胸外科服务的多层次实验室管理干预评估。
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-08-01 DOI: 10.5858/arpa.2021-0593-OA
Patrick C Mathias, Sara Khor, Kathryn Harris, Suzanne J Wood, Farhood Farjah

Context.—: Unnecessary laboratory tests are ordered because of factors such as preselected orders on order sets, clinician habits, and trainee concerns. Excessive use of laboratory testing increases patient discomfort via unnecessary phlebotomy, contributes to iatrogenic anemia, increases risk of bloodstream infections, and increases the cost of care.

Objective.—: To address these concerns, we implemented a multilevel laboratory stewardship intervention to decrease unnecessary laboratory testing, measured by laboratory tests per day attributed to service, across 2 surgical divisions with high laboratory use.

Design.—: The multilevel intervention included 5 components: stakeholder engagement, provider education, computerized provider order entry modification, performance feedback, and culture change supported by leadership. The primary outcome of the study was laboratory tests ordered per patient-day. Secondary outcomes included the number of blood draws per patient-day, total lab-associated costs, length of stay, discharge to a nursing facility, 30-day readmissions, and deaths. A difference-in-differences analytic approach assessed the outcome measures in the intervention period, with other surgical services as controls.

Results.—: The primary outcome of laboratory tests per patient-day showed a significant decrease across both thoracic and cardiac surgery services, with between 1.5 and 2 fewer tests ordered per patient-day for both services and an estimated 20 000 fewer tests performed during the intervention period. Blood draws per patient-day were also significantly decreased on the thoracic surgery service but not for cardiac surgery.

Conclusions.—: A multilevel laboratory stewardship intervention targeted to 2 surgical services resulted in a significant decrease in laboratory test use without negatively impacting length of stay, readmissions, or mortality.

上下文。-:由于订单集上的预选订单、临床医生的习惯和学员的担忧等因素,订购了不必要的实验室检查。过度使用实验室检测会因不必要的静脉切开术而增加患者的不适,导致医源性贫血,增加血液感染的风险,并增加护理费用。-:为了解决这些问题,我们实施了多层次的实验室管理干预,以减少不必要的实验室检测,以实验室使用率高的2个外科部门的每天实验室检测来衡量。-:多层次干预包括5个组成部分:利益相关者参与、供应商教育、计算机化供应商订单输入修改、绩效反馈和领导层支持的文化变革。该研究的主要结果是每个病人每天订购的实验室检查。次要结局包括每位患者每天抽血次数、实验室相关总费用、住院时间、出院到护理机构、30天再入院和死亡。以其他外科服务为对照,采用差异中差异分析方法评估干预期间的结果。-:每名患者每天进行的实验室检查的主要结果显示,胸外科和心脏外科服务的每名患者每天进行的检查减少了1.5至2次,在干预期间进行的检查估计减少了2万次。每名患者每天的抽血量在胸外科服务中也显著减少,但在心脏手术中没有。-:针对2种外科服务的多层次实验室管理干预导致实验室检测使用显著减少,而未对住院时间、再入院或死亡率产生负面影响。
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引用次数: 0
Copy Number Loss at Chromosome 14q11.2 Correlates With the Proportion of T Cells in Biopsies and Helps Identify T-Cell Neoplasms. 染色体14q11.2拷贝数缺失与活组织检查中T细胞比例相关并有助于识别T细胞肿瘤
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-08-01 DOI: 10.5858/arpa.2022-0193-OA
Arzu Saglam, Kunwar Singh, Jyoti Kumar, Sumanth Gollapudi, Soham Mukherjee, Amol Singh, Alexandra Butzmann, Lawrence Kaplan, Charambalos Andreadis, Weiyun Z Ai, Bita Fakhri, Aleksander Rajkovic, Kwun Wah Wen, Courtney Onodera, Jessica Van Ziffle, Patrick W Devine, Robert S Ohgami

Context.—: Evidence of T-cell clonality is often critical in supporting the diagnosis of a T-cell lymphoma.

Objectives.—: To retrospectively explore the significance of copy number losses at the 14q11.2 T-cell receptor α locus in relation to the presence of a T-cell neoplasm and proportion of T cells by targeted next-generation sequencing.

Design.—: Targeted next-generation sequencing data from 139 tissue biopsies, including T-cell lymphomas, B-cell lymphomas, classic Hodgkin lymphomas, nonhematopoietic malignancies, and normal samples, were reviewed for copy number losses involving the T-cell receptor α gene segments at chr14q11.2.

Results.—: We found that biallelic or homozygous deletion of 14q11.2 was found in most (28 of 33, 84.8%) T-cell lymphomas. The magnitude of 14q11.2 loss showed a statistically significant correlation with the proportion of T cells in lymphoma tissue samples. Copy number losses could also be detected in other lymphomas with high numbers of T cells (8 of 32, 25% of B-cell lymphomas, 4 of 4 classical Hodgkin lymphomas), though biallelic/homozygous deletion of 14q11.2 was not significantly observed outside of T-cell lymphomas. Most nonhematopoietic neoplasms and normal tissues (59 of 64, 92.2%) showed no significant copy number losses involving the T-cell receptor α locus at chr14q11.2.

Conclusions.—: Analysis of copy number losses at the T-cell receptor α locus chr14q11.2 with targeted next-generation sequencing can potentially be used to estimate the proportion of T cells and detect T-cell neoplasms.

上下文。-: t细胞克隆的证据通常是支持t细胞淋巴瘤诊断的关键。-:回顾性探讨14q11.2 T细胞受体α位点拷贝数缺失与T细胞肿瘤存在和T细胞比例的关系。-:对139例组织活检(包括t细胞淋巴瘤、b细胞淋巴瘤、经典霍奇金淋巴瘤、非造血恶性肿瘤和正常样本)的目标下一代测序数据进行了回顾,以寻找涉及t细胞受体α基因chr14q11.2片段的拷贝数损失。-:我们发现14q11.2的双等位或纯合缺失在大多数t细胞淋巴瘤中发现(33人中有28人,84.8%)。14q11.2缺失的大小与淋巴瘤组织样本中T细胞的比例有统计学意义。拷贝数缺失也可以在其他T细胞数量较多的淋巴瘤中检测到(8 / 32,25%的b细胞淋巴瘤,4 / 4的经典霍奇金淋巴瘤),尽管在T细胞淋巴瘤之外没有显著观察到14q11.2的双等位基因/纯合子缺失。大多数非造血肿瘤和正常组织(64例中的59例,92.2%)在chr14q11位点上没有明显的拷贝数丢失。-:利用下一代靶向测序分析T细胞受体α位点chr14q11.2的拷贝数损失,可能用于估计T细胞的比例和检测T细胞肿瘤。
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引用次数: 0
MYC and TP53 Alterations but Not MAPK Pathway Mutations Are Common Oncogenic Mechanisms in Follicular Dendritic Cell Sarcomas. MYC和TP53改变而非MAPK通路突变是滤泡树突状细胞肉瘤常见的致癌机制。
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-08-01 DOI: 10.5858/arpa.2021-0517-OA
Gerard Frigola, Marco Bühler, Marta Marginet, Anna Enjuanes, Ferran Nadeu, Natalia Papaleo, Marta Salido, Eugenia Haralambieva, José Alamo, Federico Garcia-Bragado, Ramiro Álvarez, Rafael Ramos, Iban Aldecoa, Elías Campo, Lluis Colomo, Olga Balagué

Context.—: Despite their stromal origin, follicular dendritic cells (FDCs) share many functions with hematopoietic system cells. FDC neoplasms are currently classified by the World Health Organization along with those of a histiocytic nature. However, the molecular alterations driving oncogenesis in FDC sarcomas (FDCSs) are beginning to be unveiled and do not seem to concur with those described in histiocytic neoplasms, namely MAPK pathway activation.

Objective.—: To identify molecular alterations driving tumorigenesis in FDCS.

Design.—: We investigated the role of MYC and TP53 in FDC-derived tumor oncogenesis and assessed comprehensively the status of the MAPK pathway in 16 FDCSs, 6 inflammatory pseudotumor (IPT)-like FDCSs, and 8 IPTs.

Results.—: MYC structural alterations (both amplifications and rearrangements) were identified in 5 of 14 FDCSs (35.7%), all associated with MYC overexpression. TP53 mutations were identified in 4 of 14 FDCSs (28.6%), all of which displayed intense and diffuse p53 expression. None of these alterations were identified in any IPT-like FDCSs or in IPT cases. No MAPK pathway gene alterations were identified in any of the cases studied.

Conclusions.—: The presence of MYC and TP53 alterations and the lack of association with Epstein-Barr virus segregate classical FDCS from IPT-like FDCS, pointing at different oncogenic mechanisms in both entities. Our results suggest a possible oncogenic role of MYC and TP53 alterations in FDCS. The absence of MAPK pathway alterations confirms the lack of a significant role of this pathway in the oncogenesis of FDC-derived neoplasms.

上下文。-:尽管滤泡树突状细胞(fdc)起源于基质,但它们与造血系统细胞共享许多功能。目前,世界卫生组织将FDC肿瘤与组织细胞性质的肿瘤一起分类。然而,FDC肉瘤(fdcs)中驱动肿瘤发生的分子改变正开始被揭示,并且似乎与组织细胞肿瘤中描述的MAPK通路激活不一致。-:在fdcs设计中识别驱动肿瘤发生的分子改变。-:我们研究了MYC和TP53在fdc源性肿瘤发生中的作用,并综合评估了MAPK通路在16例fdcs、6例炎性假肿瘤(IPT)样fdcs和8例ipts中的地位。-: 14例fdcs中有5例(35.7%)发现MYC结构改变(扩增和重排),均与MYC过表达有关。14例fdcs中有4例(28.6%)存在TP53突变,均表现为高强度和弥漫性p53表达。在任何IPT样fdcs或IPT病例中均未发现这些改变。所有病例均未发现MAPK通路基因改变。-: MYC和TP53改变的存在以及与Epstein-Barr病毒缺乏关联将经典FDCS与ipt样FDCS区分开来,指出这两种实体的不同致癌机制。我们的研究结果表明MYC和TP53的改变可能在FDCS中起致癌作用。MAPK通路改变的缺失证实了该通路在fdc源性肿瘤的肿瘤发生中缺乏重要作用。
{"title":"MYC and TP53 Alterations but Not MAPK Pathway Mutations Are Common Oncogenic Mechanisms in Follicular Dendritic Cell Sarcomas.","authors":"Gerard Frigola,&nbsp;Marco Bühler,&nbsp;Marta Marginet,&nbsp;Anna Enjuanes,&nbsp;Ferran Nadeu,&nbsp;Natalia Papaleo,&nbsp;Marta Salido,&nbsp;Eugenia Haralambieva,&nbsp;José Alamo,&nbsp;Federico Garcia-Bragado,&nbsp;Ramiro Álvarez,&nbsp;Rafael Ramos,&nbsp;Iban Aldecoa,&nbsp;Elías Campo,&nbsp;Lluis Colomo,&nbsp;Olga Balagué","doi":"10.5858/arpa.2021-0517-OA","DOIUrl":"https://doi.org/10.5858/arpa.2021-0517-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Despite their stromal origin, follicular dendritic cells (FDCs) share many functions with hematopoietic system cells. FDC neoplasms are currently classified by the World Health Organization along with those of a histiocytic nature. However, the molecular alterations driving oncogenesis in FDC sarcomas (FDCSs) are beginning to be unveiled and do not seem to concur with those described in histiocytic neoplasms, namely MAPK pathway activation.</p><p><strong>Objective.—: </strong>To identify molecular alterations driving tumorigenesis in FDCS.</p><p><strong>Design.—: </strong>We investigated the role of MYC and TP53 in FDC-derived tumor oncogenesis and assessed comprehensively the status of the MAPK pathway in 16 FDCSs, 6 inflammatory pseudotumor (IPT)-like FDCSs, and 8 IPTs.</p><p><strong>Results.—: </strong>MYC structural alterations (both amplifications and rearrangements) were identified in 5 of 14 FDCSs (35.7%), all associated with MYC overexpression. TP53 mutations were identified in 4 of 14 FDCSs (28.6%), all of which displayed intense and diffuse p53 expression. None of these alterations were identified in any IPT-like FDCSs or in IPT cases. No MAPK pathway gene alterations were identified in any of the cases studied.</p><p><strong>Conclusions.—: </strong>The presence of MYC and TP53 alterations and the lack of association with Epstein-Barr virus segregate classical FDCS from IPT-like FDCS, pointing at different oncogenic mechanisms in both entities. Our results suggest a possible oncogenic role of MYC and TP53 alterations in FDCS. The absence of MAPK pathway alterations confirms the lack of a significant role of this pathway in the oncogenesis of FDC-derived neoplasms.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 8","pages":"896-906"},"PeriodicalIF":4.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10257232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Evaluation of Analytical Performances and Comparison of 3 NT-proBNP Assays for Diagnosing Heart Failure. 3种NT-proBNP分析方法诊断心力衰竭的分析性能评价及比较。
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-08-01 DOI: 10.5858/arpa.2021-0587-OA
Jooyoung Cho, Jong-Han Lee, Sang-Guk Lee

Context.—: The N-terminal prohormone of the brain natriuretic peptide (NT-proBNP) is a major diagnostic biomarker for heart failure.

Objective.—: To compare the analytical and clinical performance of 3 NT-proBNP immunoassays: the Atellica IM NT-proBNP assay (Siemens Healthcare Diagnostics), the Alere NT-proBNP assay (Abbott Laboratories), and the Elecsys proBNP II assay (Roche Diagnostics).

Design.—: For the Atellica IM NT-proBNP assay, analytical performance, including precision, linearity, and carryover, was fully evaluated. Method comparisons among the 3 assays were performed using the Passing-Bablok regression and the κ agreement test. To evaluate the clinical performance of the assays, 160 patient samples were used from patients with (n = 81) or without (n = 79) heart failure.

Results.—: The analytical performance of the Atellica IM NT-proBNP assay was acceptable according to the manufacturer's claims. The Atellica IM NT-proBNP assay showed a positive bias compared with the Elecsys proBNP II assay. The Cohen κ values among the 3 assays were satisfactory (>0.80) and comparable. There were no significant differences in areas under the curve. However, for the diagnosis of heart failure, the Elecsys proBNP II showed a higher specificity and positive likelihood ratio than the other assays.

Conclusions.—: All 3 NT-proBNP assays showed acceptable concordance, and their clinical performance was comparable. However, the Elecsys proBNP II might be a more discriminating NT-proBNP assay to diagnose heart failure.

上下文。脑利钠肽n端原激素(NT-proBNP)是心力衰竭的主要诊断生物标志物。-:比较3种NT-proBNP免疫测定的分析和临床性能:Atellica IM NT-proBNP测定(西门子医疗诊断)、Alere NT-proBNP测定(雅培实验室)和Elecsys proBNP II测定(罗氏诊断)。-:对于Atellica IM NT-proBNP分析,分析性能,包括精度,线性和结转,得到了充分的评估。方法比较采用passingbablok回归和κ一致性检验。为了评估试验的临床表现,160例患者的样本来自(n = 81)或(n = 79)心力衰竭患者。-:根据制造商的声明,Atellica IM NT-proBNP检测的分析性能是可接受的。与Elecsys proBNP II相比,Atellica IM NT-proBNP检测显示出正偏倚。3个试验的Cohen κ值均令人满意(>0.80)且具有可比性。曲线下面积无显著差异。然而,对于心力衰竭的诊断,Elecsys proBNP II比其他检测方法具有更高的特异性和阳性似然比。-:所有3种NT-proBNP检测均显示可接受的一致性,其临床表现具有可比性。然而,Elecsys proBNP II可能是一种更具鉴别性的NT-proBNP检测来诊断心力衰竭。
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引用次数: 1
Intraoperative Communications Between Pathologists and Surgeons: Do We Understand Each Other? 术中病理学家和外科医生之间的交流:我们彼此理解吗?
IF 4.6 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-08-01 DOI: 10.5858/arpa.2020-0632-OA
Amanda Wiggett, Gabor Fischer

Context.—: Clear communication between pathologists and surgeons during intraoperative consultations is critical for optimal patient care.

Objective.—: To examine the concordance of intraoperative diagnoses recorded in pathology reports to surgeon-dictated operative notes and assess the impact of an intervention on the discrepancy rates.

Design.—: Discrepancies between the intended communication by pathologists and the interpretation by surgeons were characterized as minor with no crucial clinical impact, and major with the potential of altering patient management. After analysis, a corrective intervention was implemented with education, information sharing, and a change in protocol, and a comparative analysis was conducted.

Results.—: We examined 223 surgical cases with 578 intraoperative consultations. In 23% (51) of the cases, the intraoperative diagnosis was not recorded in the operative reports. We found minor discrepancies in 34% (59) and major discrepancies in 2% (3) of the remaining cases. Deferrals accounted for 24% (14 of 59) of the minor and 33% (1 of 3) of the major discrepancies. Among the discrepant cases, 56% (35 of 62) were multipart cases, including all major discrepancies. Following intervention, no major discrepancies were found in 101 cases with 186 intraoperative interpretations. The cases with no operative documentation reports decreased from 23% to 16% (16 of 101). Minor discrepancies were found in 11% (9 of 85) of the cases, indicating significant improvement (P < .001).

Conclusions.—: Intraoperative diagnoses can be miscommunicated and/or misinterpreted, possibly impacting intraoperative management, particularly in multipart cases and those involving deferrals. This study highlights the importance of auditing intraoperative communications and addressing the findings through a local intervention.

上下文。在术中会诊时,病理学家和外科医生之间的清晰沟通对优化患者护理至关重要。目的:检查病理报告中记录的术中诊断与外科医生指示的手术记录的一致性,并评估干预对差异率的影响。-:病理学家的预期沟通与外科医生的解释之间的差异被认为是轻微的,没有关键的临床影响,而有可能改变患者的管理。分析后,采用教育、信息共享、方案变更等方法实施矫正干预,并进行对比分析。-:我们检查了223例手术病例,578例术中咨询。在23%(51)的病例中,术中诊断没有记录在手术报告中。在剩下的病例中,我们发现34%(59例)存在轻微差异,2%(3例)存在较大差异。延期支付占24%(59例中的14例)的轻微差异和33%(3例中的1例)的重大差异。在差异病例中,56%(62例中35例)为多部分病例,包括所有主要差异。干预后,101例186例术中判读无明显差异。无手术文件报告的病例从23%下降到16%(101例中的16例)。85例患者中有9例(11%)有轻微差异,有显著改善(P < 0.001)。术中诊断可能被误解和/或误解,可能影响术中处理,特别是在多部位病例和涉及延期的病例中。本研究强调了审计术中沟通和通过局部干预处理发现的重要性。
{"title":"Intraoperative Communications Between Pathologists and Surgeons: Do We Understand Each Other?","authors":"Amanda Wiggett,&nbsp;Gabor Fischer","doi":"10.5858/arpa.2020-0632-OA","DOIUrl":"https://doi.org/10.5858/arpa.2020-0632-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Clear communication between pathologists and surgeons during intraoperative consultations is critical for optimal patient care.</p><p><strong>Objective.—: </strong>To examine the concordance of intraoperative diagnoses recorded in pathology reports to surgeon-dictated operative notes and assess the impact of an intervention on the discrepancy rates.</p><p><strong>Design.—: </strong>Discrepancies between the intended communication by pathologists and the interpretation by surgeons were characterized as minor with no crucial clinical impact, and major with the potential of altering patient management. After analysis, a corrective intervention was implemented with education, information sharing, and a change in protocol, and a comparative analysis was conducted.</p><p><strong>Results.—: </strong>We examined 223 surgical cases with 578 intraoperative consultations. In 23% (51) of the cases, the intraoperative diagnosis was not recorded in the operative reports. We found minor discrepancies in 34% (59) and major discrepancies in 2% (3) of the remaining cases. Deferrals accounted for 24% (14 of 59) of the minor and 33% (1 of 3) of the major discrepancies. Among the discrepant cases, 56% (35 of 62) were multipart cases, including all major discrepancies. Following intervention, no major discrepancies were found in 101 cases with 186 intraoperative interpretations. The cases with no operative documentation reports decreased from 23% to 16% (16 of 101). Minor discrepancies were found in 11% (9 of 85) of the cases, indicating significant improvement (P < .001).</p><p><strong>Conclusions.—: </strong>Intraoperative diagnoses can be miscommunicated and/or misinterpreted, possibly impacting intraoperative management, particularly in multipart cases and those involving deferrals. This study highlights the importance of auditing intraoperative communications and addressing the findings through a local intervention.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 8","pages":"933-939"},"PeriodicalIF":4.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10243133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
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Archives of pathology & laboratory medicine
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