Archives of pathology & laboratory medicine最新文献

Context.—: Fine-needle aspiration is an effective tool for sampling thyroid nodules; its results are classified according to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), whose categories define malignancy risks.

Objective.—: To compare the histologic outcomes and disease-free survival (DFS) with the preceding BSRTC categories, we hypothesized that the initial cytologic categories may reflect long-term outcomes in follicular thyroid carcinoma (FTC), similar to those observed in papillary thyroid carcinoma.

Design.—: This retrospective study enrolled 134 patients with FTC who underwent preoperative cytology between April 2011 and December 2020. Results were classified into 6 categories according to the BSRTC: nondiagnostic, benign, atypia of uncertain significance (AUS), follicular neoplasm (FN), suspicious for malignancy, or malignant.

Results.—: Overall, 8 of 134 patients (6.0%) were categorized as having a nondiagnostic FTC, 35 of 134 (26.1%) as benign, 51 of 134 (38.1%) as AUS, and 40 of 134 (29.9%) as FN. No lesions were classified as suspicious for malignancy or malignant. The nondiagnostic, AUS, and FN categories were associated with a progressively higher risk of vascular invasion, disease recurrence, and high-risk FTC, based on the 2022 World Health Organization classification (P for trend = .01, .01, and .01, respectively). Disease-free survival was lower in the FN group (log-rank P = .01).

Conclusions.—: The initial BSRTC results may reflect not only the risk of malignancy but also the presence of vascular invasion and poor prognosis when the thyroid nodule is diagnosed as FTC. These results may provide prognostic information for therapeutic decision-making and clinical management of FTC.

Context.—: Placental pathology reports may contain terminology that obstetric providers do not feel comfortable discussing with their patients.

Objective.—: To determine if lay language comments appended to the placental pathology report increase provider comfort and understanding of the report.

Design.—: We drafted a priori lay language comments explaining the major pathologic findings in the placenta. To test the acceptability and value of the comments, we designed an anonymous and randomized survey aimed to assess provider understanding of the terminology in the pathology report and comfort with explaining the report to their patients. Survey respondents were randomly assigned to receive 2 hypothetical placental pathology reports, one with and one without lay language comments. Respondents were asked to rate their understanding and comfort level explaining the report to their patients on a scale of 1 to 4. Within-provider differences in understanding and comfort by report type and pathology type were assessed by using repeated measures analysis of variance.

Results.—: Thirty-one providers responded to the survey. Providers reported greater complete understanding of the report when reading the report with lay language comments as compared to the report without the comments (mean comfort of 3.5 for lay language versus 2.97 for original report, P < .001), as well as greater comfort with the report (mean comfort of 3.29 for lay language versus 2.81 for original report, P = .002). There was no difference in provider understanding or comfort by the pathology findings represented (P = .66).

Conclusions.—: Our survey results indicate that the inclusion of lay language comments in the placental pathology report can improve provider understanding of the placental findings and therefore improve their comfort when discussing the findings with a patient and considering future treatment options.

Context.—: Maternal SARS-CoV-2 infection has been associated with increased adverse events in the mother, as well as increased stillbirths (11.5 per 1000), spontaneous abortions, and premature delivery. Clinical symptomatology, or the lack thereof, does not appear to be directly related to fetal or neonatal complications. SARS-CoV-2 placentitis is now recognized as the culprit, and the presence of the virus in the syncytiotrophoblasts of the placenta has emerged as a significant predictor of fetal compromise.

Objective.—: To provide a review of the clinical presentation and outcomes, morphologic characteristics, detection methods, and differential diagnosis of SARS-CoV-2 placentitis.

Data sources.—: A case of placental pathology in a patient with COVID-19 infection at the University of Michigan, as well as a review of the available literature through a search of PubMed and Google Scholar.

Conclusions.—: SARS-CoV-2 placentitis is a well-documented outcome of symptomatic and asymptomatic COVID-19 infection during pregnancy. It can disrupt placental function and lead to severe outcomes in the neonate, including growth restriction and stillbirths. Chronic histiocytic intervillositis, perivillous fibrin deposition, and trophoblast necrosis, when present together, may act as a morphologic signature of SARS-CoV-2 placentitis. The histologic differential diagnosis includes massive perivillous fibrin deposition (MPFD)/maternal floor infarction (MFI), chronic villitis of unknown origin, or other infectious villitides. Immunohistochemistry and RNA in situ hybridization are specific to the viral antibodies and RNA, respectively, and are essential for classification.

Context.—: The current melanoma staging system does not account for 26% of the variance seen in melanoma-specific survival, therefore our ability to predict patient outcome is not fully elucidated. Morphology may be of greater significance than in other solid tumors, with Breslow thickness remaining the strongest prognostic indicator despite being subject to high levels of interobserver variation. The application of convolutional neural networks to whole slide images affords objective morphologic metrics, which may reveal new insights into patient prognosis.

Objective.—: To develop and evaluate a convolutional neural network for invasive cutaneous melanoma detection in whole slide images for the generation of objective prognostic biomarkers based on tumor morphology.

Design.—: One thousand sixty-eight whole slide images containing cutaneous melanoma from 5 data sets were used in the initial development and evaluation of the convolutional neural network. A 2-class tumor segmentation network with a fully convolutional architecture was trained using sparse annotations. The network was evaluated at per-pixel and per-tumor levels as compared to manual annotation, as well as variation across 3 scanning platforms.

Results.—: The convolutional neural network located conventional cutaneous invasive melanoma tissue with an average per-pixel sensitivity and specificity of 97.59% and 99.86%, respectively, across the 5 test sets. There were high levels of concordance between the tumor dimensions generated by the model as compared to manual annotation, and between the tumor dimensions generated by the model across 3 scanning platforms.

Conclusions.—: We have developed a convolutional neural network that accurately detects invasive cutaneous conventional melanoma in whole slide images from multiple data sources. Future work should assess the use of this network to generate metrics for survival prediction.

Context.—: Pathology reports are essential for guiding clinical decisions but are often complex and lengthy. Artificial intelligence tools like ChatGPT may offer a way to distill these reports into clear, concise summaries to improve communication and efficiency in clinical settings.

Objective.—: To evaluate the performance of ChatGPT-4o in summarizing detailed pathology reports into 1-sentence diagnoses that retain critical clinical information and are accessible to medical professionals.

Design.—: We retrospectively analyzed 120 anonymized pathology reports from 2022-2023, focusing on 40 complex cases from 3 subspecialties: breast pathology, melanocytic lesions, and lymphomas. Using a standardized brief prompt, ChatGPT-4o generated 1-sentence summaries for each report. Two independent pathologists assessed each summary for inclusion of essential information, exclusion of irrelevant details, presence of critical errors, and overall readability.

Results.—: The mean scores for inclusion of essential information were 8.09 (melanocytic lesions), 8.15 (breast cancers), and 9.55 (lymphomas). Critical error-free rates were 62.5%, 77.5%, and 95%, respectively. Exclusion of nonessential information scored consistently high across subspecialties, and readability was rated 10/10 in 119 of 120 cases.

Conclusions.—: ChatGPT-4o, when used with a standardized prompt and expert oversight, shows promising ability to generate concise and readable summaries of pathology reports. While overall performance was strong, occasional errors and limitations in handling complex or multipart cases were noted. Further refinement and domain-specific model training may enhance the reliability and clinical utility of artificial intelligence-assisted reporting.

Context.—: Ensuring equitable laboratory patient care within diverse populations is a priority. The cytopathology laboratory has an important role in providing gender-inclusive care, particularly with regard to screening and prevention of human papillomavirus-related carcinoma, for individuals who are transgender, gender nonbinary, intersex, and with same-gender sexual orientation. Providing equitable care necessitates an understanding of gender-inclusive processes within the cytopathology laboratory. Many barriers to implementation exist and include sociocultural, legal, ethical, and financial hurdles.

Objective.—: To review the current literature regarding gender-inclusive care within a multi-institutional setting and identify challenges and opportunities for future growth in cytopathology. Specific areas of focus include appropriate terminology in laboratory information systems and requisitions, and variables affecting Papanicolaou test interpretation, human papillomavirus testing, and anal Papanicolaou test screening.

Data sources.—: Primary literature was searched within the areas highlighted throughout the article. Multi-institutional experiences from the authors, in addition to editorials and expert opinion, were used.

Conclusions.—: The cytopathology laboratory has an important role in providing care that is inclusive and accurate for all patients. Gaps in care exist and further work is needed to address these disparities. This review attempts to increase awareness, educate, and share our own multi-institutional experiences, and calls for improvements in cytopathology to optimize quality in gender-inclusive patient care.

Context.—: Clot waveform analysis (CWA) is a method that provides a detailed view of the clotting process for simple clotting tests such as prothrombin time (PT) or activated partial thromboplastin time (aPTT). Coagulometers with optical clot detection systems capture detailed information during each analysis, which can be used for CWA at no additional reagent expense.

Objective.—: To investigate (1) whether CWA can detect a hypercoagulable state in different clinical conditions similar to the thrombin generation (TG) assay, and (2) whether there are differences in the texture of in vitro clots by scanning electron microscopy (SEM).

Design.—: PT INR (international normalized ratio), aPTT ratio, CWA, D-dimer, fibrinogen, von Willebrand factor antigen (vWF:Ag), von Willebrand factor ristocetin cofactor (vWF:RiCo) activity, TG assays, and clot scans by SEM were obtained for 191 patients (65 with COVID-19, 51 with systemic sclerosis, 51 with liver cirrhosis, 13 with high Padua Prediction Score [PPS] without antithrombotic prophylaxis, and 11 with low PPS). A texture analysis for images acquired by SEM was performed with MATLAB software. Data are described as median and range.

Results.—: Compared to healthy controls, patients with COVID-19, systemic sclerosis, high PPS, and low PPS had higher levels of CWA, fibrinogen, D-dimer, and TG, as well as thicker clots by SEM. The highest values of both vWF:Ag and vWF:RiCo were found in patients with COVID-19.

Conclusions.—: We have shown that similar to the TG assay, CWA can detect a hypercoagulable state in patients at increased risk of clotting. Furthermore, we identified differences of in vitro clot texture by SEM that may provide further insight into the underlying pathology. Even though CWA is currently considered a research tool, it might one day become a clinically accepted test and provide value-added information to PT or aPTT testing at minimal computational costs.

Context.—: A clinic was created for patients to review their explanted organs with a pathologist.

Objective.—: To prospectively investigate the benefits of this type of clinic as perceived by both transplant patients and their pathologists.

Design.—: In this prospective study, patients participated in a videotaped viewing of heart and/or lung explants by the patient and their guest(s) and pathologist (December 2017-August 2022). Patients received a 3D-printed replica of their explant. After viewing the explanted organ, patients and their guests participated in an interview to assess their experiences. Video-reflexive ethnography was used by pathologists for data collection and practice improvement.

Results.—: Of 143 patients who viewed their explanted organ, 21 patients consented to having the organ-viewing session taped and to participate in a postviewing interview. The study group was comprised of 12 men; the median age was 57.5 years (range, 29-67 years). Five pathologists took part in reflexive sessions. The clinics were viewed positively by patients, providing an opportunity to better understand their disease. Pathologists had a similarly positive experience and gained important insights to patient journeys. Proposals for improvement were brought forward from both patients and pathologists.

Conclusions.—: Video-reflexive ethnography provided the opportunity for patients and pathologists to reflect on patient-pathology clinic appointments. This work serves as a template to build out pathology-based clinics.

Context.—: Patients can now immediately review pathology reports via online health portals.

Objective.—: To better characterize patient perceptions of pathology report helpfulness and preferences for access of pathology reports via a patient portal.

Design.—: Semistructured interviews were conducted with oncology patients with breast, endocrine, gastrointestinal, genitourinary, and thoracic malignancies. Patient demographic information, cancer type, question responses, and thematically grouped comments were statistically analyzed.

Results.—: Among 230 patients, there was equal sex distribution (116 of 230, 50.4% female; 114 of 230, 49.6% male). Patients who viewed or had a support member view their reports in the portal (172 of 230; 74.8%) differed from those who did not (58 of 230; 25.2%) only in perception of helpfulness (P < .001) of the report. Difficulty understanding medical terminology was the most frequently cited challenge among both those who found the reports helpful (30 of 160; 18.75%) and not helpful (31 of 46; 67.4%). Most patients (196 of 230; 85.2%) preferred immediate release of results, even if the news was bad, whereas some (34 of 230; 14.7%) would opt out of immediate release for fear of misunderstanding (11 of 34; 32.4%) or receiving distressing information from reading the report (23 of 34; 67.6%).

Conclusions.—: Options for portal flexibility (ie, patient choice of opting for immediate release of some, but not all, results), patient-centered pathology reports, educational materials, clinician preparation of patients, and tailored patient support are strategies that can help more patients benefit from reviewing pathology report information.