Subspecialization of surgical pathology at the Massachusetts General Hospital.

The anatomic pathology unit of the Massachusetts General Hospital (MGH) serves both the MGH (an 862-bed general hospital generating about 39,000 surgical accessions and 33,500 gynecologic and 8,500 nongynecologic cytology accessions annually) and the Massachusetts Eye and Ear Infirmary (MEEI, a 52-bed specialty hospital generating about 6,500 surgical accessions and 1,000 nongynecologic cytology accessions annually); the unit has 25 full-time equivalent (FTE) staff pathologists and pathology fellows providing its diagnostic services. On July 1, 1995, diagnostic specimen signout in this unit was changed to a system of complete subspecialization. The historical context and rationale for this change and the process of its implementation are presented, with a preliminary evaluation of its effects, including the impact on pathology staff, fellows, and residents. In addition, a mechanism for evaluation of equity and efficiency of pathologist work is presented, together with some discussion of the limitations of its accuracy. The authors conclude that to date the change has achieved many of its expected effects and that the process has worked smoothly. Further experience will clarify the overall results of the change.

The use of fine-needle aspiration in the diagnosis of metastatic pulmonary adenoid cystic carcinoma.

Nine patients with a history of adenoid cystic carcinoma (ACC) arising in the head and neck and in whom transthoracic fine-needle aspiration (FNA) was performed to investigate pulmonary lesions are described. FNA yielded a definitive diagnosis of metastatic ACC in all cases. In six of the nine patients, the pulmonary metastases were asymptomatic. Lung lesions were discovered up to 19 years after primary tumor presentation, and in two, pulmonary spread was the only evidence of recurrent disease. On the basis of the FNA diagnosis, these two patients were treated surgically for their isolated pulmonary metastases, and are disease free at 107 and 139 months. Six of the nine patients received radiation or chemotherapy; one initially refused treatment. Thoracotomy was avoided in these patients on the basis of the FNA diagnosis. All are alive with disease at 25 to 246 months. The metastatic tumors were indistinguishable cytologically from two primary pulmonary ACCs that were available for comparison. Our experience suggests FNA is a useful tool in the diagnosis of ACC in pulmonary material--one which obviates the need for thoracotomy with its associated morbidity.

Selection of operating wavelength-pair for two-wavelength microspectrophotometry.

The two-wave length method is the microspectrophotometric method of choice for thick specimens. Its accuracy is dependent on the accuracy of selection of the operating wavelenght-pair. The "slope zero test", offered as a check upon the accuracy of this selection (Garcia and Iorio, '66) is shown to be invalid by analysis of experimental data, by computer model and by mathematical derivation. A means of checking the accuracy of selection of the operating wavelength-pair via scanning measurements is suggested. A new formulation of the two-wavelength method, permitting use of different operating wavelength-pairs, is also given.