Quantitative Image Analysis as an Adjunct to Manual Scoring of ER, PgR, and HER2 in Invasive Breast Carcinoma.

OBJECTIVES: Biomarker expression evaluation for estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2) is an essential prognostic and predictive parameter for breast cancer and critical for guiding hormonal and neoadjuvant therapy. This study compared quantitative image analysis (QIA) with pathologists' scoring for ER, PgR, and HER2. METHODS: A retrospective analysis was undertaken of 1,367 invasive breast carcinomas, including all histopathology subtypes, for which ER, PgR, and HER2 were analyzed by manual scoring and QIA. The resulting scores were compared, and in a subset of HER2 cases (n = 373, 26%), scores were correlated with available fluorescence in situ hybridization (FISH) results. RESULTS: Concordance between QIA and manual scores for ER, PgR, and HER2 was 93%, 96%, and 90%, respectively. Discordant cases had low positive scores (1%-10%) for ER (n = 33), were due to nonrepresentative region selection (eg, ductal carcinoma in situ) or tumor heterogeneity for PgR (n = 43), and were of one-step difference (negative to equivocal, equivocal to positive, or vice versa) for HER2 (n = 90). Among HER2 cases where FISH results were available, only four (1.0%) showed discordant QIA and FISH results. CONCLUSIONS: QIA is a computer-aided diagnostic support tool for pathologists. It significantly improves ER, PgR, and HER2 scoring standardization. QIA demonstrated excellent concordance with pathologists' scores. To avoid pitfalls, pathologist oversight of representative region selection is recommended.

A comparative study of biogasification of wheat straw, sugarcane bagasse and pressmud.

A study to compare biogas production potentials of wheat straw, sugarcane bagasse and pressmud was conducted at pH 8.0, temperature 40 °C and substrate concentration 20 g/L. Raw substrates were thermogravimetrically and Fourier-transform infrared spectroscopically characterised. TGA showed the weight loss of samples attributable to moisture, hemicellulose, cellulose and lignin losses. FTIR analysis indicated functional groups characteristics of hemicellulose, cellulose and lignin. Biogas production was the maximum between 10th and 25th day for all the tests. WS with 10% inoculum showed the highest cumulative biogas production of 370 mL/g followed by the SB (316 mL/g) and PM (211 mL/g) counterparts. The corresponding values with 5% inoculum were 303 mL/g (WS), 244 mL/g (SB) and 152 mL/g (PM). The inoculum volume also positively affected the cumulative biogas production (22.1, 29.5 and 38.8% respectively). The higher volatile fatty acids as observed in case of WS which further facilitated higher biogas production could be due to its maximum volatile solids content (88.9%) and water swelling capacity (7.37). A consistently increasing trend in the methane content (varying between 54 and 61%) in all the tests was observed till the 20th day. The biogas (7.7-21.7 mL/g) and the methane (35-42%) contents showed a decreasing trend thereafter, the lowest being observed during the 35-40-day period.

Voices from the Field: Supporting the Educational Needs of Cytotechnologists.

INTRODUCTION: Sustaining a well-trained, competitive, and marketable cytotechnology workforce is a major goal of the American Society of Cytopathology/American Society for Clinical Pathology Workgroup Focusing on Emerging Roles in Cytopathology (ASC/ASCP Workgroup). This article describes the data collection initiatives performed by the Workgroup to confirm cytotechnologist (CT) perceived educational needs to keep pace with emerging practice changes in the workplace. In response to data collected, the Workgroup created Advanced Cytopathology Education (ACE)da unique, innovative educational resource designed to fulfill this need. MATERIALS AND METHODS: Data collection efforts included annual needs assessment surveys to gauge CT participants' preferred topics and learning modalities. These data were used to design and prioritize ACE topics. Program evaluations were also administered to evaluate participants' perceptions of program quality and effectiveness at meeting their educational needs. RESULTS: Research findings reveal CT education needs to align with emerging practice areas as reported in other Workgroup data collection efforts. The incorporation of new entry-level competencies in cytotechnology training programs prepares new CT graduates, but there is no standardized mechanism for formal, robust, and recognized ongoing education for other practicing CTs. CONCLUSIONS: This article highlights the educational endeavors carried out by the Workgroup in fulfilling the educational needs of practicing CTs as communicated through various data collection efforts. As CT responsibilities evolve, ASC and Workgroup efforts will continue to focus on providing educational support for current practicing CTs who need training in emerging practice areas.

Voices from the field: supporting the educational needs of cytotechnologists.

INTRODUCTION: Sustaining a well-trained, competitive, and marketable cytotechnology workforce is a major goal of the American Society of Cytopathology/American Society for Clinical Pathology Workgroup Focusing on Emerging Roles in Cytopathology (ASC/ASCP Workgroup). This article describes the data collection initiatives performed by the Workgroup to confirm cytotechnologist (CT) perceived educational needs to keep pace with emerging practice changes in the workplace. In response to data collected, the Workgroup created Advanced Cytopathology Education (ACE)-a unique, innovative educational resource designed to fulfill this need. MATERIALS AND METHODS: Data collection efforts included annual needs assessment surveys to gauge CT participants' preferred topics and learning modalities. These data were used to design and prioritize ACE topics. Program evaluations were also administered to evaluate participants' perceptions of program quality and effectiveness at meeting their educational needs. RESULTS: Research findings reveal CT education needs to align with emerging practice areas as reported in other Workgroup data collection efforts. The incorporation of new entry-level competencies in cytotechnology training programs prepares new CT graduates, but there is no standardized mechanism for formal, robust, and recognized ongoing education for other practicing CTs. CONCLUSIONS: This article highlights the educational endeavors carried out by the Workgroup in fulfilling the educational needs of practicing CTs as communicated through various data collection efforts. As CT responsibilities evolve, ASC and Workgroup efforts will continue to focus on providing educational support for current practicing CTs who need training in emerging practice areas.

Value stream mapping of the Pap test processing procedure: a lean approach to improve quality and efficiency.

We developed a value stream map (VSM) of the Papanicolaou test procedure to identify opportunities to reduce waste and errors, created a new VSM, and implemented a new process emphasizing Lean tools. Preimplementation data revealed the following: (1) processing time (PT) for 1,140 samples averaged 54 hours; (2) 27 accessioning errors were detected on review of 357 random requisitions (7.6%); (3) 5 of the 20,060 tests had labeling errors that had gone undetected in the processing stage. Four were detected later during specimen processing but 1 reached the reporting stage. Postimplementation data were as follows: (1) PT for 1,355 samples averaged 31 hours; (2) 17 accessioning errors were detected on review of 385 random requisitions (4.4%); and (3) no labeling errors were undetected. Our results demonstrate that implementation of Lean methods, such as first-in first-out processes and minimizing batch size by staff actively participating in the improvement process, allows for higher quality, greater patient safety, and improved efficiency.

Prospective and retrospective review of gynecologic cytopathology: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 2.

CONTEXT: Two quality metrics for gynecologic cytology are the subject of this review: "prospective rescreening" and "retrospective rescreening." OBJECTIVE: To offer consensus best practice approaches based on the College of American Pathologists' laboratory-based survey funded by the Centers for Disease Control and Prevention. DESIGN: The College of American Pathologists submitted a paper-based survey to 1245 laboratories. After review of initial results, follow-up Web-based survey results, and a literature review, consensus best practice statements were presented at a national consensus conference. These statements were discussed and voted upon by conference participants. Results.-A total of 541 laboratories responded to survey questions about prospective and retrospective rescreening. Most laboratories (>85%) prospectively rescreen more than 10% of Pap tests interpreted as negative for intraepithelial lesion or malignancy. Most (72%) report inclusion of less than 20% high-risk cases. Most laboratories use multiple measures to define "high risk." Most laboratories (96.2%) retrospectively rescreen Pap tests from the preceding 5 years only. In most laboratories (71.4%) only Pap test results with high-grade squamous intraepithelial lesion or worse prompt retrospective review. CONCLUSIONS: The number of Pap tests from high-risk patients should be maximized in prospective and retrospective rescreening. Unsatisfactory Pap tests should also be included. All readily identifiable high-risk human papillomavirus-positive cases with an interpretation of negative for intraepithelial lesion or malignancy should be prospectively rescreened. Cervical biopsy results with high-grade cervical intraepithelial neoplasia or worse (CIN 2+) should trigger retrospective rescreening. Regular feedback should be provided to cytotechnologists and cytopathologists. Upgraded diagnoses from negative for intraepithelial lesion or malignancy to atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, should be monitored.