The data warehouse as a foundation for population-based reference intervals.

The volume of data contained in a data warehouse represents a potential resource to provide the basis for detailed and specific reference intervals. Routine chemistry panel testing data were derived from an outreach laboratory patient population of 438,180 people and then screened by multiple data filters to identify a large and demographically diverse reference population. Reference intervals were determined for 4 common analytes: aspartate aminotransferase, alanine aminotransferase, total bilirubin, and alkaline phosphatase. Each derived reference population contained more than 60,000 people with sex- and age-specific subgroups comprising between 495 and 4,949 persons. These intervals are particularly representative of the aging patient population and demonstrate a degree of age and sex diversity not reflected commonly in routine laboratory reference intervals. Warehouse data also can yield other interpretative data, such as percentile ranking of results or disease-specific reference intervals. As the warehouse accumulates data from other disciplines (such as from clinical notes or pharmacy), there is increasing potential for the laboratory to enhance the clinician's ability to diagnose and treat disease.

Primary breast lymphoma: the role of mastectomy and the importance of lymph node status.

OBJECTIVE: To construct and analyze a database comprised of all reported cases of primary breast lymphoma (PBL) that include treatment and follow-up information published during the last 3 decades. SUMMARY BACKGROUND DATA: PBL accounts for 0.4% of breast malignancies and 2% of extranodal lymphomas. Surgical therapy has varied from biopsy to radical mastectomy. Chemotherapy and radiation therapy have been used as adjuvant or primary therapy. A standard consensus treatment of PBL is not available. METHODS: We reviewed all published PBL reports from June 1972 to March 2005. A database was compiled by abstracting individual patient information, limiting our study to those reports that contained specific treatment and outcome data. Patient demographics such as survival, recurrence, and time to follow-up were recorded, in addition to surgical, radiation, and/or chemotherapy treatment(s). RESULTS: We found 465 acceptable patients reported in 92 publications. Age range was 17 to 95 years (mean, 54 years). Mean tumor size was 3.5 cm. Diffuse large cell (B) lymphoma was the most common histologic diagnosis (53%). Disease-free survival was 44.5% overall. Follow-up ranged from one to 288 months (mean, 48 months). Treatment by mastectomy offered no survival benefit or protection from recurrence. Treatment that included radiation therapy in stage I patients (node negative) showed benefit in both survival and recurrence rates. Treatment that included chemotherapy in stage II patients (node positive) showed benefit in both survival and recurrence rates. Histologic tumor grade predicted survival. CONCLUSIONS: Mastectomy offers no benefit in the treatment of PBL. Nodal status predicts outcome and guides optimal use of radiation and chemotherapy.