How Do Pathologists in Academic Institutions Across the United States and Canada Evaluate Sentinel Lymph Nodes in Breast Cancer? A Practice Survey.

OBJECTIVES: There are little data on how changes in the clinical management of axillary lymph nodes in breast cancer have influenced pathologist evaluation of sentinel lymph nodes. METHODS: A 14-question survey was sent to Canadian and US breast pathologists at academic institutions (AIs). RESULTS: Pathologists from 23 AIs responded. Intraoperative evaluation (IOE) is performed for selected cases in 9 AIs, for almost all in 10, and not performed in 4. Thirteen use frozen sections (FSs) alone. During IOE, perinodal fat is completely trimmed in 8, not trimmed in 9, and variable in 2. For FS, in 12 the entire node is submitted at 2-mm intervals. Preferred plane of sectioning is parallel to the long axis in 8 and perpendicular in 12. In 11, a single H&E slide is obtained, whereas 12 opt for multiple levels. In 11, cytokeratin is obtained if necessary, and immunostains are routine in 10. Thirteen consider tumor cells in pericapsular lymphatics as lymphovascular invasion (LVI), and 10 consider it isolated tumor cells (ITCs). CONCLUSIONS: There is dichotomy in practice with near-equal support for routine vs case-by-case multilevel/immunostain evaluation, perpendicular vs parallel sectioning, complete vs incomplete fat removal, and tumor in pericapsular lymphatics as LVI vs ITCs.

Prueba diagnóstica entre la citología, biopsia por congelación e histopatología en el diagnóstico del Nódulo Tiroideo en pacientes atendidos en Solca desde el año 2009 ­2017 / Diagnostic Test between cytology, frozen biopsy and histopathology in the diagnosisof the thyroid nodule in patients treated at Solca from 2009 -2017

Introducción: La citología de nódulos tiroideos es una técnica que, evita procedimientos quirúrgicos innecesarios por lo que se lo ha determinado como primera línea dentro del algoritmo de diagnóstico, el objetivo del estudio fue determinar la sensibilidad y la especificidad de la citología y biopsia por congelación frente al estudio histopatológico en el diagnóstico de nódulos tiroideos en pacientes atendidos en Solca desde el año 2009 -2017. Métodos: Es un estudio de tipo observacional, retrospectivo y de correlación diagnóstica; los datos fueron obtenidos de las historias clínicas de pacientes intervenidos quirúrgicamente por nódulos tiroideos con biopsia por congelación, a quienes se les realizó previamente un estudio citológico en el Departamento de patología de SOLCA de la ciudad de Cuenca, Ecuador. El cálculo del tamaño de la muestra fue de 324 casos. Resultados:324 casos fueron incluidos. El 8.3% correspondió a hombres y el 91.7% a mujeres. La media de la edad fue 51.8 años; la gran mayoría provenían de la provincia Azuay con el 64.8%. En los estudios citológicos el 34.6% (112 casos)corresponden a lesiones inflamatorias benignas; el 11.1% [36 casos]a patologías malignas y 14.2% (46 casos)fueron insatisfactorios. En la biopsia por congelación el mayor porcentaje estuvo concentrado en enfermedades benignas con un 62.6% y 35.5% a lesiones malignas. Hubo 6 casos con el 1.9% en donde fue diferido el criterio diagnóstico. En el histopatológico definitivo el 60.2% (195 casos)fueron patologías benignas y el 39.8% (129 casos)fueron lesiones malignas. La sensibilidad de la PAAF frente a histopatológico es alta con un 91.79%, pero la especificidad es baja con un 51.94%. La sensibilidad y la especificidad de la biopsia por congelación frente a histopatológico es alta con un 98.97% y 90.70% respectivamente lo que le confiere una metodología óptima. Conclusiones: La PAAF de tiroides demuestra ser una metodología útil en el diagnóstico de nódulos, siempre y cuando sea realizada y observada por personal capacitado. La biopsia por congelación constituye una técnica con alta sensibilidad y especificidad que nos permite discriminar lesiones benignas de las malignas. Palabras claves: Nódulo tiroideo, Biopsia con Aguja, Servicio de Patología en Hospital, Oncología Médica, Agencias Voluntarias de Salud, Biología Celular, Biopsia con Aguja Fina

Introduction:Cytology of thyroid nodules is a technique that avoids unnecessary surgical procedures and has therefore been determined as the first line within the diagnostic algorithm.General Objective:To determine the sensitivity and specificity of cytology and freezing biopsy versus histopathological study in the diagnosis of thyroid nodules in patients treated in Solca since 2009 -2017. Methods:This is an observational, retrospective and diagnostic correlation study; the data were obtained from the clinical histories of patients surgically treated by thyroid nodules with freeze biopsy, who underwent a cytological study in the Department of pathology of the city of Cuenca, Ecuador. The calculation of the sample size was 324 cases. Results:8.3% corresponded to men and 91.7% to women. The mean age was 51.8 years; The vast majority came from the province of Azuay with 64.8%. In cytological studies, 34.6% [112 cases]correspond to benign inflammatory lesions; 11.1% [36 cases]to malignant pathologies and 14.2% [46 cases]were unsatisfactory. In the freeze biopsy the greater percentage was concentrated in benign diseases with 62.6% and 35.5% to malignant lesions. There were 6 cases with 1.9% where the diagnostic criterion was deferred. In the definitive histopathological, 60.2% [195 cases]were benign pathologies and 39.8% [129 cases]were malignant lesions. The sensitivity of FNAB to histopathological is high with 91.79%, but the specificity is low with 51.94%. The sensitivity and specificity of freezing versus histopathological biopsy is high with 98.97% and 90.70% respectively, which gives it an optimal methodology. Conclusions: Thyroid PAAF proves to be a useful methodology in the diagnosis of nodules, as long as it is performed and observed by trained personnel. Freezing biopsy is a technique with high sensitivity and specificity that allows us to discriminate benign from malignant lesions. Key words:Thyroid Nodule; Biopsy, Needle;Pathology Department, Hospital; Medical Oncology; Voluntary Health Agencies; Cell Biology; Biopsy, Fine-Needle

Occupational Exposure and Risk Assessment of Formaldehyde in the Pathology Departments of Hospitals.

BACKGROUND AND OBJECTIVE: Exposure to formaldehyde has adverse effects on health both acutely and over the long term (e.g., carcinogenicity). The substance is widely used in pathology and histology departments.  This study focused on cancer risk of formaldehyde in pathology department of five hospitals in Rasht. MATERIALS AND METHODS: Sampling and determination of formaldehyde in pathology department were carried out based on the NIOSH method of 3500. The working condition and working environment were investigated and a semi quantitative risk assessment were used to health risk assessment of formaldehyde and The individual lifetime cancer probability, which is defined as the increase in the probability of developing cancer during continuous exposure to an air pollutant were used to assess health risks with formaldehyde. RESULTS: The results showed that the exposure level of all subjects were higher than the Occupational Exposure Limit for 8 hours exposure time of formaldehyde. However, in the five occupational groups, the highest weekly exposure index was observed for the Lab Technicians (0.664 ppm) at Hospital no. 5, which could have been due to more daily working hours at this sampling site and a lack of adequate ventilation. The formaldehyde concentration was in the 0.0192 to 0.326 ppm ranges for five hospital pathology departments. The cancer risk ranged from 9.52×10-5 to 1.53×10-3, and it was greater than the WHO acceptable cancer risk level. CONCLUSIONS: The results of the risk assessments can be used for managing the chemical exposure of allocated resources for defining control actions. This process plays an important role in reducing the level of exposure to formaldehyde in pathology departments.
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A strategy for the reduction of formaldehyde concentration in a hospital pathology laboratory.

OBJECTIVES: Formaldehyde is routinely used in pathology laboratories. The threshold limit value of formaldehyde determined by American and Japanese organizations is 0.1 ppm, which is similar to the indoor air quality guideline value (0.08 ppm). Therefore, maintaining low formaldehyde concentrations in the workplace is imperative. The purpose of this study was to reduce the concentration of formaldehyde in a hospital pathology laboratory, in which approximately 15 000 pathological diagnoses are conducted yearly, using hardware and software interventions. METHODS: Although this laboratory had various ventilation systems, the formaldehyde concentration was high. Based on the Japanese work environment measurement system, the workplace was categorized as control class III, suggesting that improvements to workplace conditions were required. First, engineering controls were implemented and workers were asked not to block the ventilation system and not to keep waste fluid tanks open. However, the workplace required further improvement. Next, using a video camera and a formaldehyde detector, we attempted to visually educate workers about how much formaldehyde is emitted from the sample container based on the type of action undertaken. RESULTS: After the first intervention, the workplace improved to control class II. Control class II indicates that the workplace condition is between classes I and III; a good workplace condition is classified as class I. Although the work environment was still categorized as control class II after the second intervention, this intervention led to the further improvements. CONCLUSIONS: The hardware and software interventions and safe working habits were effective in improving the work environment.

Gross Pathology of Routine Pediatric Tonsillectomy Specimens: Optimizing the Value of Patient Care.

OBJECTIVE: This investigation seeks to evaluate the effect of gross pathologic analysis on our management of patients undergoing routine tonsillectomy and to evaluate charges and reimbursement. STUDY DESIGN: Retrospective chart review from 2005 through 2016. SETTING: Academic medical center. SUBJECTS AND METHODS: Participants were pediatric patients aged 14 years and younger undergoing tonsillectomy for either sleep-disordered breathing or tonsillitis, with tonsillectomy specimens evaluated by pathology, and without any risk factors for pediatric malignancy. Records were reviewed for demographics, surgical indications, and pathology. Abnormal reports prompted an in-depth review of the chart. Charges and reimbursement related to both hospital and professional fees for gross tonsil analysis were evaluated. RESULTS: From 2005 to 2016, 3183 routine pediatric tonsillectomy cases were performed with corresponding specimens that were sent for gross analysis revealing no significant pathologic findings; 1841 were males and 1342 were females. Ten cases underwent microscopy by pathologist order, revealing normal tonsillar tissue. The mean charge per patient for gross analysis was $60.67 if tonsils were together as 1 specimen and $77.67 if tonsils were sent as 2 separate specimens; respective reimbursement amounts were $28.74 and $35.90. CONCLUSIONS: Gross pathologic analysis did not change our management of routine pediatric tonsillectomy patients. Foregoing the practice at our institution would eliminate $19,171.72 to $24,543.72 in charges and $9081.40 to $11,344.40 in reimbursement per year. Eliminating this test would improve the value of patient care by saving health care resources without compromising clinical outcomes.

[Study of the evolution in the activity of a Department of Pathology from a third level hospital in the last decade (2007-2016)]. / Estudio de la evolución en la actividad en un Departamento de Anatomía Patológica de un hospital de tercer nivel en la última década (2007-2016).

OBJECTIVE: To study the evolution of variables of interest in a department of pathology from a third level hospital during the last decade and to evaluate the impact on these of the hospital relocation in 2014. MATERIAL AND METHOD: Retrospective observational study in which the recorded samples (biopsies, cytology specimens, FNA, autopsies, intraoperative) as well as the complementary techniques (IHC, Histochemistry, IF and FISH) and portfolio of services were analyzed during the years 2007-2016 inclusive. For the statistical analysis, the five-year periods 2007-2011 and 2012-2016 were compared. RESULTS: The following variables were statistically significant: cytology (34055.8±1994.0 vs 26590.4±2938.3, p=0.002), autopsies (156.2±27.3 vs 122.0±14.78, p=0.039), immunohistochemistry (17855.4±3424.2 vs 28559.2±4734.7, p=0.003), histochemistry (11117.8±2300.9 vs 6225.0±1330.5, p=0.003) and immunofluorescence (610.2±185.3 vs. 1205.4±154.0, p=0.001). Statistical correlations of interest among variables have been identified. In 2014, it was observed that the variables of greater specific weight (biopsies, cytology, IHQ and histochemistry) in the work load of the Department showed an average decrease of 12.5%. A generalized increase in the panel of available samples has been identified, the largest increase being seen in the number of antibodies (78.7%), histochemistry (38.7%) and FISH (400%). CONCLUSION: Relevant variations in work volume, as well as the service portfolio, have been identified, especially in the techniques aimed at improving diagnostic accuracy (IHQ and FI), and a significant decrease in the number of cytology specimens, autopsies and histochemistry. In the year 2014 a decrease of more than 12% in the main variables of the study was observed.

[The 2015 classification of lung adenocarcinomas: Reproducibility in a Tunisian department specialised in thoracic pathology]. / La nouvelle classification 2015 des adénocarcinomes pulmonaires : reproductibilité au sein d'un service Tunisien spécialisé en pathologie thoracique.

INTRODUCTION: The new classification of lung cancer contains modifications of terminology and a new subdivision of the tumors with the most relevant modifications concerning the group of adenocarcinomas. The latter has been increasing and represents nowadays the most frequent type. Our aim was to assess the reproducibility of the new classification through the experience of a Department of Pathology specialized in thoracic pathology. METHODS: Our study included initially 106 cases diagnosed as adenocarcinomas and reviewed by 2 pathologists and 1 referee. Five cases were ruled out because they corresponded to squamous carcinoma according to the immunohistochemical findings. The same number of slides was reviewed without a limit of time. Statistical analysis was performed using the SPSS software. The Kappa index was estimated and a second coefficient: rho was analyzed. RESULTS: A total concordance was noticed in 82 cases (81.2%) and a discordance was noticed in 19 cases (18.8%). The agreement degree was good with an index Kappa estimated to 0.743 and a rho index reaching 0.763. CONCLUSION: Our study highlights the good reproducibility of the 2015 WHO classification of lung cancer among a trained team. Whereas, in order to improve the reproducibility of such a classification, even in non specialised departments, a training of the pathologists is necessary in order to highlight the prognostic impact of this classification.

EGFR and KRAS molecular genotyping for pulmonary carcinomas: Feasibility of a simple and rapid technique implementable in any department of pathology.

OBJECTIVES: EGFR and KRAS genes are routinely tested in lung carcinomas with therapeutic implications. However the current testing methods require complex infrastructures and the delay for diagnosis remains often rather long, especially for initiating an appropriate treatment in patients with advanced stage tumor and short life expectancy. MATERIAL AND METHODS: We evaluated the Idylla™ fully automated molecular diagnostic system in routine conditions in 79 lung adenocarcinomas and 14 other non-small cell lung carcinomas, mostly in advanced stages (III or IV: 85%). Tests were performed on formalin-fixed paraffin-embedded (n=83) or fresh (n=10) material, including cytological (n=24) and small biopsy (n=20) samples. In prospective cases (n=82), the most likely mutated gene (EGFR in non or occasional smokers and KRAS in smokers) was tested first; the second gene being only tested in case of negativity. RESULTS: The system did not require complex training. Mutational status was obtained in few hours after making the histological diagnosis and on the day of the patient's sampling by analyzing fresh material. The sequential testing strategy avoided 15 EGFR and 15 KRAS tests that would have been negative. Compared with reference methods, global specificity and sensitivity were both 100% for EGFR mutations, and 89.1% and 91.7% for KRAS mutations, respectively. CONCLUSIONS: We demonstrated that such easy-to-use systems can permit pathologists to integrate a reliable EGFR/KRAS status in their initial pathologic report, and could be useful complementary tools to the current molecular diagnostic methods, with regard to prompt therapeutic management of lung cancer patients.

Pathology-related cases in the Norwegian System of Patient Injury Compensation in the period 2010-2015. / Patologirelaterte saker i pasientskadeordningen i perioden 2010 ­ 15.

BACKGROUND: The Norwegian System of Patient Injury Compensation (NPE) processes compensation claims from patients who complain about malpractice in the health services. A wrong diagnosis in pathology may cause serious injury to the patient, but the incidence of compensation claims is unknown, because pathology is not specified as a separate category in NPE's statistics. Knowledge about errors is required to assess quality-enhancing measures. We have therefore searched through the NPE records to identify cases whose background stems from errors committed in pathology departments and laboratories. MATERIAL AND METHOD: We have searched through the NPE records for cases related to pathology for the years 2010 ­ 2015. RESULTS: During this period the NPE processed a total of 26 600 cases, of which 93 were related to pathology. The compensation claim was upheld in 66 cases, resulting in total compensation payments amounting to NOK 63 million. False-negative results in the form of undetected diagnoses were the most frequent grounds for compensation claims (63 cases), with an undetected malignant melanoma (n = 23) or atypia in cell samples from the cervix uteri (n = 16) as the major groups. Sixteen cases involved non-diagnostic issues such as mix-up of samples (n = 8), contamination of samples (n = 4) or delayed responses (n = 4). INTERPRETATION: The number of compensation claims caused by errors in pathology diagnostics is low in relative terms. The errors may, however, be of a serious nature, especially if malignant conditions are overlooked or samples mixed up.

Hallazgos histológicos de biopsia por endoscopia digestiva superior en el paciente pediatrico / Histological findings of biopsies obtained by upper gastrointestinal tract endoscopy in children

Antecedentes: El desarrollo de la endoscopia ha dado pasos agigantados en el campo de la gastroenterología pediátrica, convirtiéndose en una prueba diagnóstica de primera línea por la posibilidad de toma de biopsia, además se ha consolidado como un tratamiento eficaz en numerosas enfermedades digestivas. Objetivo: revisar los hallazgos histológicos de biopsias obtenidas por endoscopia digestiva superior en el paciente pediátrico del Hospital Nacional Dr. Mario Catarino Rivas (HNMCR) en el período comprendido entre enero a mayo 2016. Pacientes y métodos: Estudio transversal, descriptivo, realizado en pacientes con edades comprendidas entre 28 días y 18 años. Se revisaron 40 biopsias que cumplían los criterios de inclusión. Los datos se obtuvieron de los archivos de biopsias del servicio de patología, posteriormente se hizo un análisis estadístico de las variables. Resultados: se revisaron 40 biopsias, 55% hombres, 45% mujeres, el 47.5% de los pacientes eran adolescentes. La indica-ción mas común fue el dolor abdominal crónico (33%), seguido por la gastritis crónica (28%) y reflujo gastroesofágico (20%). Los hallazgo histopatológico más frecuente fueron la gastritis crónica 43%, esofagitis crónica 30% y el Helycobacter Pylori 13%. Conclusión: En el 95% de las biopsias realizadas se encontraron anormalidades, siendo el más frecuente la gastritis crónica...AU)

Requests for VIP Treatment in Pathology: Implications for Social Justice and Systems-Based Practice.

Preferential treatment of patients whom we deem "very important" is a practice that is common in our health care system. The impact of this designation and the care that results is rarely studied or scrutinized. Although we assume that this type of treatment results in superior outcomes, this assumption can be wrong for a variety of reasons, which we discuss here. In addition to expressing unjust preferential treatment for some patients and not others, VIP medicine could compromise patient safety.

The Impact of Cross-Unit Coordination and Process Improvement Efforts in Anatomic Pathology: A Systems Perspective.

BACKGROUND: The impact of coordination and problem solving on health care quality has become increasingly prevalent within the literature. However, few studies have empirically investigated the impact of these factors across organizational boundaries. METHODS: This was an embedded, single-case study conducted within a large, academic Anatomic Pathology department. We surveyed 96 team members within 18 distinct processing or specialty units within the department and forward the Network Alignment Approach to measure coordination between units. In addition, we measure perceived safety culture and frequency of error in specimen documentation and preparation. RESULTS: Regression results suggest that downstream cross-unit coordination between units (clarity of customer requirements) significantly improves safety culture (P < .001). In addition, within-unit process improvement efforts improved safety culture (P < .001). These 2 factors alone accounted for 30% of the variation in the regression model, with safety culture as our dependent variable. CONCLUSION: Clarity of customer requirements and process improvement efforts significantly improve safety culture within the system. This approach to understanding and analyzing connections within complex systems provides insight into specific ways that leaders can begin to understand how each unit or department can improve as both a customer and a supplier within the larger system.

How Do We Make Clinical Molecular Testing for Cancer Standard of Care for Pathology Departments?

Understanding of the genetic basis and molecular pathogenesis of cancer has evolved substantially over the past century. The advent of high-throughput gene sequencing methods has unraveled hundreds of recurrent somatic genetic alterations in various malignancies, either causative or harboring major prognostic and/or predictive implications. Knowledge of these specific changes has dramatically altered diagnostic and therapeutic approaches to cancer, enabling personalized molecular therapies. This article shares approaches to adopting and fine-tuning the practice of molecular diagnostics as an essential component of diagnostic pathology in a tertiary care cancer hospital and proposes methods by which genetic testing in cancer can become standard of care in pathology departments across the nation.

Histopathological Pattern Of Soft Tissues Tumors And Tumour Like Lesions In The Pathology Department Of Lady Reading Hospital Peshawar, Pakistan.

BACKGROUND: Soft tissues tumours are tumours of mesenchymal origin excluding epithelial, skeletal tissue, reticuloendothelial system, brain coverings and solid viscera of the body. The objective of this study was to know the histopathological pattern of soft tissues tumours in the Pathology Department of Lady Reading Hospital Peshawar Khyber Pakhtunkhwa Pakistan. METHODS: This descriptive study was conducted on retrospective data from January 2009 to December 2013. All the soft tissues biopsy specimens were received in 10% formalin, labelled, gross performed, sections processed in alcohol, xylene, wax, block prepared, frozen, microtome sections taken and processed for H&E staining, mounted and reported by a Histopathologist. The inclusion criteria were any sufficient soft tissue tumour biopsy specimen of any age, sex, location in body whereas the exclusion criteria were autolysed biopsy specimen. A minimum of four and maximum of eight sections and 5 micron thick were taken from each specimen. RESULTS: A total of 267 soft tissues tumours biopsy specimens were received in the pathology laboratory with age range of 1-75 years, with mean age of 30.68±17.71 years. Male to female ratio was 1.13:1. Amongst the total, benign tumours were 176 (65.91%). Haemangioma, 73 (27.3%) was the commonest tumours followed by lipomas 41 (15.4%) cases. Amongst the total malignant tumours, i.e., 91 (34.08%), rhabdomyosarcoma, 35 (13.1%) was the commonest tumour followed by angiosarcoma 14 (5.2%) cases. CONCLUSIONS: Haemangioma is the commonest benign tumour and rhabdomyosarcoma is the commonest malignant tumour in this study.

The effect of a pathology clinic on the mental state and adjustment of patients with breast cancer.

OBJECTIVE: In this study, we examine whether a pathology clinic, conducted by pathologists, a novel medical tool that provides an explanation for the diagnosis of a cancer, can influence the mental state and adjustment of breast cancer patients. METHOD: We created a paper-based questionnaire and interviewed targeted breast cancer patients, who had undergone radical surgery, before and after they visited the clinic. RESULTS: We found that there may be increased motivation for treatment, a greater sense of reassurance, and reduced anxiety (as indicated by the Hospital Anxiety and Depression Scale (HADS)) in the group that attended the clinic. SIGNIFICANCE OF RESULTS: Our results suggest that visiting the pathology clinic may reduce anxiety over the short term. On the other hand, Mental Adjustment to Cancer (MAC) Anxious Preoccupation scores were significantly higher in this group as well, both before and after attendance, compared to the group that did not attend. The attending group may have reduced anxiety by such actions as collecting medical data on the cause of their anxiety and adopting healthier behaviors. Our findings suggest that appropriate emotional support and provision of medical information are very important in dealing with patient anxiety.

A hybrid approach to identify subsequent breast cancer using pathology and automated health information data.

PURPOSE: Many cancer registries do not capture recurrence; thus, outcome studies have often relied on time-intensive and costly manual chart reviews. Our goal was to build an effective and efficient method to reduce the numbers of chart reviews when identifying subsequent breast cancer (BC) using pathology and electronic health records. We evaluated our methods in an independent sample. METHODS: We developed methods for identifying subsequent BC (recurrence or second primary) using a cohort of 17,245 women diagnosed with early-stage BC from 2 health plans. We used a combination of information from pathology report reviews and an automated data algorithm to identify subsequent BC (for those lesions without pathologic confirmation). Test characteristics were determined for a developmental (N=175) and test (N=500) set. RESULTS: Sensitivity and specificity of our hybrid approach were robust [96.7% (87.6%-99.4%) and 92.1% (85.1%-96.1%), respectively] in the developmental set. In the test set, the sensitivity, specificity, and negative predictive value were also high [96.9% (88.4%-99.5%), 92.4% (89.4%-94.6%), and 99.5% (98.0%-99.0%), respectively]. The positive predictive value was lower (65.6%, 55.2%-74.8%). Chart review was required for 10.9% of the 17,245 women; 2946 (17.0%) women developed subsequent BC over a 14-year period. The date of subsequent BC identified by the algorithm was concordant with full chart reviews. CONCLUSIONS: We developed an efficient and effective hybrid approach that decreased the number of charts needed to be manually reviewed by approximately 90%, to determine subsequent BC occurrence and disease-free survival time.

Hipertensión arterial en la base de datos de autopsias del sistema automatizado de registro y control de anatomía patológica / Hypertension in autopsy database of automated system for registration and control of pathological anatomy

INTRODUCCIÓN: la hipertensión arterial es una de las enfermedades más frecuentes a nivel mundial, pero se ha estudiado poco como causa básica de muerte y la obtención de información a partir de las autopsias. OBJETIVO: identificar la hipertensión arterial como causa básica de muerte y establecer su relación con las restantes causas de muerte y la clínica de los pacientes fallecidos incluidos en la base de datos de autopsias del Sistema Automatizado de Registro y Control de Anatomía Patológica (SARCAP). MÉTODOS: se extrajeron las 6 133 autopsias con diagnóstico de hipertensión arterial de la base de datos de autopsias del SARCAP del Hospital Militar Central "Dr. Luis Díaz Soto", de ellas se analizaron las 1 286 diagnosticadas con hipertensión arterial como causa básica de muerte. Se utilizó el SARCAP para el estudio y presentación de los resultados. RESULTADOS: se comprobó una elevada frecuencia de la hipertensión arterial. Predominó en el sexo masculino la hipertensión arterial como causa básica de muerte; en este grupo fue significativa una disminución de la esperanza vida. La mayoría de los casos estudiados fallecieron en Medicina Intensiva y de Emergencia. Predominó la estadía de 48 h o menos. La infección, el cáncer y el daño multiorgánico fueron menos frecuentes cuando la hipertensión arterial fue la causa básica de muerte. CONCLUSIONES: es necesario profundizar en el análisis realizado para precisar la enfermedad que da inicio al proceso (causa básica de muerte), las complicaciones que producen (causa indirecta de muerte) y el episodio final que ocasiona la muerte (causa directa de muerte); pues si se prevé este proceso en el paciente pueden tomarse acciones a tiempo y evitar la muerte.

INTRODUCTION: hypertension is one of the most common diseases worldwide, but it has been little studied as the underlying cause of death and obtaining information from autopsies. OBJECTIVE: identify hypertension as underlying cause of death and establish its relation to other causes of death and the deceased clinic patients included in the autopsy database of Automated System for Registration and Control of Pathology (SARCAP). METHODS: 6 133 autopsies were extracted with hypertension diagnosis from SARCAP autopsies database at "Dr. Luis Díaz Soto" Central Military Hospital, out of which, 1286 were analyzed due to hypertension diagnosis as the underlying cause of death. SARCAP was used for the study and presentation of results. RESULTS: a high prevalence of hypertension was found. Male hypertension predominated as underlying cause of death; in this group, decreased life expectancy was significantly. Most of the cases studied died in intensive and emergency medicine. The 48 h or less stay dominated. Infection, cancer and multiple organ damage were less frequent when hypertension was the underlying cause of death. CONCLUSIONS: it is necessary to deepen the analysis to pinpoint the disease that starts the process (the underlying cause of death), complications they produce (indirect cause of death) and the final episode that brings death (direct cause of death); because if this process is expected actions can be timely taken and avoid death.

Breast pathology second review identifies clinically significant discrepancies in over 10% of patients.

BACKGROUND: Patients seeking a second opinion or continuation of care at our hospital will routinely have their pathology reviewed prior to initiating treatment. To assess the relevance of this review in patients with breast cancer, we compared original pathology reports submitted during the referral with second-review reports issued at our institution. We also assessed compliance with College of American Pathologists (CAP) requirements regarding inclusion of scientifically validated data elements (SVDE) in these pathology reports. METHODS: We retrospectively studied all 1,970 breast pathology referral cases reviewed during one calendar year. The variables studied were histologic classification; tumor grade, necrosis, size, margin status, lymphatic/vascular invasion, dermal involvement, and biomarker profile (ER, PR, and Her-2). Each variable was rated as "agree," "disagree," "missing information," or "not applicable." RESULTS: A significant discrepancy, defined as a disagreement that affected patient care, was found in 226 cases (11.47%). Additionally, in 418 resection cases (31.6%), some CAP-checklist specific required information was missing. The most common areas of significant discrepancy were histologic category (66 cases; 33%) and biomarker reporting (50 cases; 25%). The most problematic diagnostic categories were intraductal lesions, lobular carcinoma, metaplastic carcinomas, and phyllodes tumors. Most disagreements in the biomarker-profile category were interpretive, but in 20% of discrepant cases, findings were supported by repeat immunohistochemical analysis. CONCLUSIONS: Our results confirm the value and utility of obtaining a second opinion to optimize patient care. Changes in diagnoses obtained after second review should be interpreted and reported in a collaborative fashion, noting the benefit of a review from second pair of experienced eyes. Our results support the use of second review to ensure inclusion of CAP-required data elements in pathology reports.

[Histopathological diagnostic concordance in bone and soft tissue sarcomas between two comprehensive cancer centers from eastern and western Europe: a collaborative experience]. / La concordance du diagnostic histopathologique des sarcomes osseux et des tissus mous entre deux centres anticancéreux de l'Europe de l'Est et de l'Ouest : une expérience de collaboration.

INTRODUCTION: This study aims to assess the degree of concordance of histological diagnosis of bone and soft tissue sarcomas between a Comprehensive Cancer Center (CCC) of Eastern Europe - not specialized in this area of pathology - and an important CCC of Western Europe, which is one of the coordinators of a clinical reference network in sarcoma pathology. The goal is to have an overview of the sarcomatous pathology in a region of Eastern Europe and to discover diagnostic discrepancies between the two centers, while determining their cause. MATERIALS AND METHODS: The initial diagnosis was compared with the revised diagnosis on 110 specimens from 88 patients with bone or soft tissue sarcomas from East-European CCC, in a one-year period of time. RESULTS: Complete diagnostic agreement was observed in 55 cases (62.5%), a partial agreement in 23 cases (26.1%) and a major disagreement in 10 cases (11.4%). Major discrepancies of the histological type was observed in only 3 cases (3.4%): one case of discordance benign/malignant and 2 cases of discordance mesenchymal/non mesenchymal. Minor histological discrepancies - not affecting the management of the patient - were observed in 18 cases (20.4%). A major discordance in grading - potentially changing the management of the patient - was noted in 7 cases (7.9%), and a minor discrepancy in 5 cases (5.7%). DISCUSSIONS: Some histological types were clearly overdiagnosed, like "adult fibrosarcomas" and "malignant peripheral nerve sheet tumors" (MPNST), mostly converted after the audit into "undifferentiated spindle cell sarcomas" or other types of sarcomas. Some "unclassified" sarcomas and "undifferentiated pleomorphic sarcomas" could be re-classified with the aid of an extensive panel of antibodies. Overall, immunohistochemistry was responsible, but not in exclusivity, for half of the minor discrepancies, and for 2 out of 3 cases of major histological discrepancies. Otherwise, the main cause of discrepancies was the difficulties in the interpretation of the morphology. Molecular biology was decisive in one case. Most grading discrepancies resulted from the appreciation of the mitotic index. CONCLUSIONS: The profile of the sarcomatous pathology in the northwest region of Romania does not appear to differ significantly from other parts of Europe or the world, but a prospective epidemiological study would be necessary to confirm this assessment. The expansion of immunohistochemical antibody panel, the over-specialization of pathologists and, in the future, the establishment of a national network of referral centers in sarcoma pathology, are required for a high level of histological diagnosis in Eastern Europe. A periodic external audit, continuing this trans-European collaboration between the two centers, would be beneficial for monitoring progress.