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3.
Semin Diagn Pathol ; 36(5): 312-335, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31227425

RESUMO

This review focuses on technical aspects of diagnostic immunohistochemistry (IHC), with an emphasis on aspects of methodology and interpretation that may be problematic for practicing pathologists. Pitfalls in IHC are reviewed, and the importance of good controls and the the use of multi-tissue controls is discussed. Also covered is the optimal use of IHC in cytologic specimens and specimens where no paraffin block is available. Artifacts encountered in IHC are discussed and illustrated, and a number of useful techniques are described in detail, including preparation of multi-tissue control material, tissue and cell transfer techniques, and tissue protection techniques.


Assuntos
Imuno-Histoquímica/métodos , Patologia Clínica/métodos , Controle de Qualidade , Coloração e Rotulagem/métodos , Humanos , Imuno-Histoquímica/normas , Laboratórios/normas , Patologistas , Patologia Clínica/normas , Coloração e Rotulagem/normas , Fixação de Tecidos/métodos , Fixação de Tecidos/normas
4.
Semin Diagn Pathol ; 36(5): 303-311, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31230963

RESUMO

Accuracy in morphological diagnosis is the cornerstone of anatomic pathology. Proficiency with the microscope offers values to the health care system that cannot be overestimated. However, that skill is only possible if high-quality histological substrates are available for assessment, particularly focusing on hematoxylin and eosin (H&E)-stained slides. This brief review considers the several steps that are necessary to control in the preparation of high-quality H&E sections, including those dealing with fixation, embedding, microtomy, histochemical staining, and coverslipping. A table for the troubleshooting of problem slides is also included.


Assuntos
Amarelo de Eosina-(YS) , Hematoxilina , Patologia Clínica/normas , Garantia da Qualidade dos Cuidados de Saúde , Coloração e Rotulagem/normas , Corantes , Humanos , Laboratórios/normas , Inclusão em Parafina/métodos , Inclusão em Parafina/normas , Manejo de Espécimes/métodos , Manejo de Espécimes/normas , Coloração e Rotulagem/métodos , Fixação de Tecidos/métodos , Fixação de Tecidos/normas
5.
J Clin Pathol ; 72(10): 663-668, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31177084

RESUMO

An ever-increasing number of clinical pathology departments are deploying, or planning to deploy digital pathology systems for all, or part of their diagnostic output. Digital pathology is an evolving technology, and it is important that departments uphold or improve on current standards. Leeds Teaching Hospitals NHS Trust has been scanning 100% of histology slides since September 2018, and has developed validation and validation protocols to train 38 histopathology consultants in primary digital diagnosis. In this practical paper, we will share our approach to ISO inspection of our digital pathology service, which resulted in successful ISO accreditation for primary digital diagnosis. We will offer practical advice on what types of procedure and documentation are necessary, both from the point of view of the laboratory and your reporting pathologists. We will explore topics including risk assessment, standard operating procedures, validation and training, calibration and quality assurance, and provide a checklist of the key digital pathology components you need to consider in your inspection preparations. The continuous quest for quality and safety improvements in our practice should underpin everything we do in pathology, including our digital pathology operations. We hope this publication will make it easier for subsequent departments to successfully achieve ISO 15189 accreditation and feel confident in their digital pathology services.


Assuntos
Acreditação/normas , Patologia Clínica/normas , Lista de Checagem , Hospitais/normas , Humanos , Interpretação de Imagem Assistida por Computador , Laboratórios/normas , Patologia Clínica/educação , Patologia Clínica/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Controle de Qualidade
6.
Acta Cytol ; 63(4): 280-291, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31108486

RESUMO

OBJECTIVES: To review the performance and utility of the International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy (FNAB) Cytology five category stratification and evaluate the impact of rapid onsite evaluation (ROSE). METHOD: A retrospective analysis of breast FNAB cytology cases with matched histopathological results at a single institution over a 32 months period using a structured reporting system with 5 diagnostic categories ("inadequate/insufficient," "benign," "atypical," "suspicious of malignancy" and "malignant") closely paralleling the proposed IAC System. RESULTS: Of 2,696 breast FNAB cases, there were 579 with matched histopathology and 456 of these had ROSE. ROSE decreased the number in the "insufficient" category (17.1% without ROSE to 4.0% with ROSE) and increased the number in the "malignant" (17.9 to 39.0%) with a lesser impact on the "atypical," "benign" and "suspicious of malignancy" categories. The performance data showed a positive predictive value of 96.4%, negative predictive value of 97.6%, and a risk of malignancy of a FNAB categorized as "insufficient" to be 2.6%, "benign" 1.7%, "atypical" 15.7%, "suspicious of malignancy" 84.6%, and "malignant" 99.5%. CONCLUSION: Breast FNAB is an accurate test enabling effective diagnosis of breast lesions. ROSE improved the performance by decreasing the proportion of "insufficient" and "atypical" and increasing the "suspicious of malignancy" and "malignant" diagnoses and enabling immediate triage for further biopsy where necessary.


Assuntos
Neoplasias da Mama/diagnóstico , Citodiagnóstico/normas , Patologia Clínica/normas , Guias de Prática Clínica como Assunto/normas , Biópsia por Agulha Fina , Neoplasias da Mama/classificação , Neoplasias da Mama/cirurgia , Feminino , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , Sociedades Médicas
7.
Acta Cytol ; 63(4): 328-339, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31117069

RESUMO

A variety of primary breast and metastatic lesions to the breast can present with spindle cell cytomorphology. These lesions may range from benign reactive or inflammatory lesions to high-grade malignancies. Spindle cell lesions of the breast are not often seen on fine-needle aspiration biopsy (FNAB) but need to be correctly managed when they are encountered. While mesenchymal lesions of the breast have a spindle morphology, lesions derived from the epithelium and myoepithelium can be spindled as well. By assessing if the lesion comprises spindle cells only or if other components such as epithelial cells are apparent and then determining whether the spindle cells appear bland or pleomorphic, together with close clinicoradiologic correlation and prudent use of ancillary tests, a variety of lesions can be diagnosed on FNAB. However, core needle biopsy or excision biopsy may be required in some patients. The cytomorphology, ancillary studies, and clinicoradiologic findings of a range of spindle cell lesions of the breast are further discussed.


Assuntos
Neoplasias da Mama/diagnóstico , Citodiagnóstico/normas , Neoplasias Epiteliais e Glandulares/diagnóstico , Patologia Clínica/normas , Guias de Prática Clínica como Assunto/normas , Biópsia por Agulha Fina , Neoplasias da Mama/cirurgia , Feminino , Humanos , Neoplasias Epiteliais e Glandulares/cirurgia , Valor Preditivo dos Testes
8.
Turk Patoloji Derg ; 35(3): 228-236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31140576

RESUMO

OBJECTIVE: The increase in the financial imposition of laboratories together with developing technology and evidence-based medicine applications increased the importance of quality and efficiency studies in laboratories. The aim of the study is to examine the processes of pathology laboratory, determine the causes of waste and select lean management techniques to eliminate the causes of waste. MATERIAL AND METHOD: A five-phase plan was used for the application of lean management in the pathology laboratory. After a comprehensive literature review, these phases were determined as follows; the support of the senior management, observation, training of employees, drawing of value stream maps and creation of value stream plan. Gastric biopsy process was selected as product/service family when value stream maps were generated. In addition, fishbone diagram and Pareto analysis were used to determine the causes of waste. RESULTS: In the current state, 73.6% of the time spent on a gastric biopsy sample in the pathology laboratory was wasted. The most common causes of waste were identified as problems with cleaning, equipment supply problems, lack of clinical information, equipment malfunction and errors. A value stream plan was developed with lean techniques to eliminate the causes of these wastes. In the pathology laboratory, a 4.6% improvement will be achieved with the achievement of the future stated target. CONCLUSION: A model for lean management techniques in a developing country that will enable the pathology laboratories to work more efficiently and with improved quality has been developed in this study.


Assuntos
Patologia Clínica/métodos , Patologia Clínica/normas , Gestão da Qualidade Total/métodos , Humanos , Laboratórios/organização & administração
10.
Acta Cytol ; 63(4): 292-301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141809

RESUMO

OBJECTIVE: We aimed to assess the risk of malignancy (ROM) and predictive values in prior breast cytology studies as a basis for the new International Academy of Cytology (IAC) Yokohama system for reporting breast fine-needle aspiration biopsy (FNAB) cytology, which classifies cytologic diagnoses into 5 categories: (1) insufficient material, (2) benign, (3) atypical, (4) suspicious of malignancy, and (5) malignant. STUDY DESIGN: Publications between January 1, 1997, and December 31, 2017, that studied the performance characteristics of FNAB from palpable and nonpalpable breast masses were identified through the PubMed database. Data for number of total cases and cases within each diagnostic category, if available, were collected. Performance characteristics, including absolute sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROM for each category were recorded or, when possible, calculated. RESULTS: The literature review resulted in a case cohort of 33,341 breast FNABs, drawn from 27 studies. Pooling these cases together, the ROM for insufficient material, benign, atypical, suspicious, and malignant were 30.3, 4.7, 51.5, 85.4, and 98.7%, respectively. The complete sensitivity and specificity were 96.3 and 98.8%, correspondingly. The PPV and NPV were 98.7 and 95.3%, correspondingly. The false-negative and false-positive rates were 3.7 and 1.0%, respectively. CONCLUSIONS: This meta-analysis demonstrates that the diagnostic categories of the new IAC Yokohama System each carry an implied ROM, which increases from the benign to malignant categories. This study also shows the high sensitivity and specificity of FNAB for breast lesions.


Assuntos
Neoplasias da Mama/diagnóstico , Citodiagnóstico/normas , Patologia Clínica/normas , Guias de Prática Clínica como Assunto/normas , Medição de Risco/métodos , Biópsia por Agulha Fina , Neoplasias da Mama/cirurgia , Feminino , Humanos , Valor Preditivo dos Testes , Sociedades Médicas
11.
Virchows Arch ; 475(3): 263-277, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31098802

RESUMO

The International Collaboration on Cancer Reporting (ICCR) was formed in 2011 to harmonise the datasets, protocols and checklists for pathological reporting of various cancers and develop internationally agreed upon, evidence-based datasets. A dataset for prostate cancer in radical prostatectomy specimens was developed in 2011-2012 as part of a pilot project; however, it required substantial revision following the ISUP Consensus Conference on Gleason Grading in 2014, the publication of the World Health Organisation (WHO) Classification of Tumours of the Urinary System and Male Genital Organs in 2016, and the 8th edition of the Tumour-Node-Metastasis (TNM) staging system in late 2016. This article presents the up-to-date, evidence-based ICCR dataset and associated commentary for reporting prostate cancer in radical prostatectomy specimens. PubMed and Google search engines were used to review the published literature on the subject, and the dataset was developed in line with the previously published ICCR framework for the development of cancer datasets. Substantial changes have been incorporated into the second edition of the ICCR prostate cancer (radical prostatectomy) dataset. These include revisions to prostate cancer grading, reporting of intraductal carcinoma of prostate and surgical margins, among others. Up-to-date cancer datasets underpin structured reporting and facilitate the production of consistent and accurate pathological data for patient care as well as comparisons between different cohorts and populations internationally.


Assuntos
Patologia Clínica/normas , Neoplasias da Próstata/classificação , Consenso , Bases de Dados Factuais/normas , Humanos , Masculino , Gradação de Tumores , Próstata/patologia , Prostatectomia , Neoplasias da Próstata/fisiopatologia
12.
Pancreas ; 48(4): 480-487, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946243

RESUMO

OBJECTIVE: The grading and typing of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are challenging for pathologists. We aimed to clarify the points of consistency and disagreement in assessing the grades and types of IPMNs. METHODS: Digital slide images of 20 IPMNs were independently assessed by 10 Japanese pathologists, who then held a consensus meeting to discuss the points of disagreement and develop a consensus and recommendations. RESULTS: The average agreement rates for grade and type were 83.5% (range, 100%-40%) and 82.5% (range, 100%-50%) and the Fleiss' κ values were 0.567 and 0.636, respectively. CONCLUSIONS: The disagreement points and recommendations were as follows: destructed ductal walls with desquamated neoplastic epithelia or mucin lakes partially lined with neoplastic cells could be invasion; intraductal stromal invasion could be dismissed unless vascular or lymphatic invasion existed; elastica staining may help visualize ducts in colloidal nodules; high-grade can be distinguished from low/intermediate grade by marked nuclear disarrangements and complex architecture in the intestinal papillae; oncocytic papillae are characterized by eosinophilic cells with round disoriented nuclei; high-grade gastric papillae can be distinguished from pancreatobiliary papillae by relatively low but complex architecture; and the most dysplastic papillae should be used to assess type in mixed papillae types.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias Intraductais Pancreáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Patologia Clínica/métodos , Adenoma Oxífilo/diagnóstico , Adenoma Oxífilo/metabolismo , Consenso , Humanos , Imuno-Histoquímica , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/metabolismo , Gradação de Tumores , Neoplasias Intraductais Pancreáticas/classificação , Neoplasias Intraductais Pancreáticas/metabolismo , Neoplasias Pancreáticas/classificação , Neoplasias Pancreáticas/metabolismo , Patologistas/normas , Patologistas/estatística & dados numéricos , Patologia Clínica/normas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/metabolismo
13.
Histopathology ; 75(2): 225-235, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31017314

RESUMO

AIMS: The nuclear proliferation marker Ki67 assayed by immunohistochemistry has multiple potential uses in breast cancer, but an unacceptable level of interlaboratory variability has hampered its clinical utility. The International Ki67 in Breast Cancer Working Group has undertaken a systematic programme to determine whether Ki67 measurement can be analytically validated and standardised among laboratories. This study addresses whether acceptable scoring reproducibility can be achieved on excision whole sections. METHODS AND RESULTS: Adjacent sections from 30 primary ER+ breast cancers were centrally stained for Ki67 and sections were circulated among 23 pathologists in 12 countries. All pathologists scored Ki67 by two methods: (i) global: four fields of 100 tumour cells each were selected to reflect observed heterogeneity in nuclear staining; (ii) hot-spot: the field with highest apparent Ki67 index was selected and up to 500 cells scored. The intraclass correlation coefficient (ICC) for the global method [confidence interval (CI) = 0.87; 95% CI = 0.799-0.93] marginally met the prespecified success criterion (lower 95% CI ≥ 0.8), while the ICC for the hot-spot method (0.83; 95% CI = 0.74-0.90) did not. Visually, interobserver concordance in location of selected hot-spots varies between cases. The median times for scoring were 9 and 6 min for global and hot-spot methods, respectively. CONCLUSIONS: The global scoring method demonstrates adequate reproducibility to warrant next steps towards evaluation for technical and clinical validity in appropriate cohorts of cases. The time taken for scoring by either method is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the reproducibility between laboratories further.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama , Imuno-Histoquímica/normas , Antígeno Ki-67/análise , Patologia Clínica/normas , Feminino , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes
14.
Toxicol Pathol ; 47(4): 461-468, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31018785

RESUMO

Anatomic pathology and clinical pathology end points are standard components of almost every nonclinical general toxicity study conducted during the risk assessment of novel pharmaceuticals and chemicals. On occasion, an ultrastructural pathology evaluation using transmission electron microscopy (TEM) may be included in nonclinical toxicity studies. Transmission electron microscopy is most commonly used when a light microscopic finding may require further characterization that could inform on the pathogenesis and/or mechanism of action. Regulatory guidance do not address the use of TEM in general study designs nor whether these assessments should be performed in laboratories conducted in compliance with Good Laboratory Practices. The Scientific and Regulatory Policy Committee of the Society of Toxicologic Pathology (STP) formed a Working Group to assess the current practices on the use of TEM in nonclinical toxicity studies. The Working Group constructed a survey sent to members of societies of toxicologic pathology in the United States, Europe, Britain, and Japan, and responses were collected through the STP for evaluation by the Working Group. The survey results and regulatory context are discussed, as are "points to consider" from the collective experience of the Working Group. This survey indicates that TEM remains an essential diagnostic option for complementing toxicologic pathology evaluations. *This Points to Consider article is a product of a Society of Toxicologic Pathology (STP) Working Group commissioned by the Scientific and Regulatory Policy Committee (SRPC) of the STP. It has been reviewed and approved by the SRPC and Executive Committee of the STP but it does not represent a formal Best Practice recommendation of the Society; rather, it is intended to provide key "points to consider" in designing nonclinical studies or interpreting data from toxicity and safety studies intended to support regulatory submissions. The points expressed in this document are those of the authors and do not reflect views or policies of the employing institutions. Readers of Toxicologic Pathology are encouraged to send their thoughts on these articles or ideas for new topics to the Editor.


Assuntos
Microscopia Eletrônica de Transmissão , Patologia Clínica/métodos , Toxicologia/métodos , Comitês Consultivos , Animais , Avaliação Pré-Clínica de Medicamentos/métodos , Avaliação Pré-Clínica de Medicamentos/normas , Guias como Assunto , Humanos , Microscopia Eletrônica de Transmissão/métodos , Microscopia Eletrônica de Transmissão/normas , Patologia Clínica/legislação & jurisprudência , Patologia Clínica/normas , Sociedades Científicas , Testes de Toxicidade/métodos , Testes de Toxicidade/normas , Toxicologia/legislação & jurisprudência , Toxicologia/normas , Estados Unidos , United States Food and Drug Administration
15.
Histopathology ; 75(4): 453-467, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31009090

RESUMO

The International Collaboration on Cancer Reporting (ICCR) is a not-for-profit organisation sponsored by the Royal Colleges of Pathologists of Australasia and the United Kingdom, the College of American Pathologists, the Canadian Association of Pathologists in association with the Canadian Partnership Against Cancer, the European Society of Pathology, the American Society of Clinical Pathology and the Faculty of Pathology, Royal College of Physicians of Ireland. Its goal is to produce standardised, internationally agreed-upon, evidence-based datasets for cancer pathology reporting throughout the world. This paper describes the development of a cancer dataset by the multidisciplinary ICCR expert panel for the reporting of carcinoma of the urethra in urethrectomy specimens. The dataset is composed of 'required' (mandatory) and 'recommended' (non-mandatory) elements, which are based on a review of the most recent evidence and supported by explanatory commentary. Fourteen required elements and eight recommended elements were agreed by the international dataset authoring committee to represent the essential/required (core) and recommended (non-core) information for the reporting of carcinoma of the urethra in urethrectomy specimens. Use of an internationally agreed, structured pathology dataset for reporting carcinoma of the urethra (in urethrectomy specimens) will provide the necessary information for optimal patient management, will facilitate consistent data collection and will provide valuable data for research and international benchmarking. The dataset will be valuable for those countries and institutions that are not in a position to develop their own datasets.


Assuntos
Carcinoma , Conjuntos de Dados como Assunto , Patologia Clínica/normas , Neoplasias Uretrais , Humanos , Patologia Clínica/métodos , Projetos de Pesquisa/normas
16.
Virchows Arch ; 475(3): 303-311, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30953146

RESUMO

To evaluate the effect of the 2018 ASCO/CAP guideline in the identification of HER2-positive breast carcinomas (BC) in reflex in situ hybridization (ISH) test. A total of 592 primary invasive BC cases from before and after the publication of the updated ASCO/CAP guideline were evaluated for HER2 amplification by silver ISH according to the 2013 and 2018 guidelines. Cases were mostly (95%) HER2 equivocal by immunohistochemistry (IHC), not centrally reviewed. Other reasons for referring cases were IHC confirmation, IHC discordancy (either between needle-core-biopsy (NCB) and surgical excision specimen (SES) or between different laboratories) and IHC result unexpected for histopathologic features. Cases evaluated with the 2013 guideline (1st cohort) were 14.6% HER2-positive, decreasing significantly after the reclassification with the 2018 guideline due to the exclusion of group 2 cases without HER2 protein overexpression. Cases studied after the implementation of the 2018 guideline (2nd cohort) were 8.7% HER2-positive, a frequency that was not significantly different from the reclassification of the 1st cohort with the 2018 guideline. All cases referred for IHC confirmation had the expected ISH result. Cases with IHC discordancy between NCB and SES were ISH concordant. Only one out of 14 cases with an IHC score 3+ and classified as histological grade 1 or with a Ki67 below 10% was classified as ISH HER2-positive. The 2018 ASCO/CAP guideline resulted in a decrease of HER2-positive cases in reflex ISH test, selecting less patients for anti-HER2-targeted therapy.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama/patologia , Hibridização in Situ Fluorescente/métodos , Biópsia com Agulha de Grande Calibre/métodos , Feminino , Humanos , Imuno-Histoquímica/métodos , Hibridização In Situ/métodos , Patologia Clínica/normas , Receptor ErbB-2/genética , Receptor ErbB-2/metabolismo
17.
J Clin Pathol ; 72(6): 412-417, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30846480

RESUMO

AIMS: Our laboratory is a centralised centre receiving routine non-small cell lung cancer (NSCLC) samples for programmed death ligand-1 (PD-L1) immunohistochemical (IHC) evaluation. Since literature data are not concordant here we review our clinical records to assess the rate of PD-L1 positive and negative NSCLC cases in real-world practice. METHODS: PD-L1 expression was evaluated by a validated 22C3 IHC laboratory developed test on 211 prospectively collected routine NSCLC samples, received from 10 outside institutions. PD-L1 expression was assessed by the tumour proportion score (TPS) and reported by using a three cut-point system: TPS<1, TPS 1%-49% and TPS≥50%. RESULTS: Overall, 193 out of 211 samples (91.5%) meet the criteria for adequacy (more than 100 viable neoplastic cells). In 62.7% (121/193) of samples TPS was <1%; 17.6% of samples (34/193) expressed PD-L1 with a TPS of 1%-49% and 19.7% (38/193) with a TPS of >50%. There was no significant difference in PD-L1 expression rates between different histotypes and site of sampling. Instead, a statistically significant difference was associated to the type of samples: in fact, cytological samples were more frequently negative for PD-L1 expression (TPS<1%) and less often displayed PD-L1 expression at high levels (TPS>50%) than surgical resections and biopsies. CONCLUSIONS: We present a referral laboratory experience on IHC PD-L1 expression of prospectively collected routine NSCLC samples. Data from the real-world practice can better clarify the percentage of PD-L1 positive and negative cases, to establish benchmarks for good practice standards.


Assuntos
Antígeno B7-H1/análise , Biomarcadores Tumorais/análise , Carcinoma Pulmonar de Células não Pequenas/imunologia , Técnicas de Laboratório Clínico , Imuno-Histoquímica , Neoplasias Pulmonares/imunologia , Patologia Clínica , Regionalização , Carcinoma Pulmonar de Células não Pequenas/patologia , Técnicas de Laboratório Clínico/normas , Feminino , Humanos , Imuno-Histoquímica/normas , Itália , Neoplasias Pulmonares/patologia , Masculino , Patologia Clínica/organização & administração , Patologia Clínica/normas , Valor Preditivo dos Testes , Estudos Prospectivos , Encaminhamento e Consulta , Regionalização/organização & administração , Regionalização/normas , Reprodutibilidade dos Testes
18.
Acta Cytol ; 63(4): 314-318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893685

RESUMO

CONTEXT: Fine-needle aspiration biopsy (FNAB) is frequently used to stage the axilla preoperatively in patients with primary breast carcinoma. In the light of the ACOSOG-Z0011 and AMAROS trials that specified sentinel lymph node biopsy as an inclusion criterion, the role of FNAB in axillary staging is changing. OBJECTIVE: This article will review the diagnostic accuracy of FNAB in staging of the axilla in patients with primary breast carcinoma. The efficacy of axillary FNAB compared with core-needle biopsy will be evaluated. The evolving approach to staging of the axilla, in the light of ACOSOG-Z0011 and AMAROS trials, will be discussed. DATA SOURCES: Data were sourced from published peer-reviewed articles in PubMed (US National Library of Medicine) and published guidelines including the European Guidelines for Quality Assurance in Breast Cancer and those from the European Society of Medical Oncology (ESMO), Union for International Cancer (UICC), American Society of Clinical Oncology (ASCO), and the American Society of Breast Surgeons. CONCLUSIONS: FNAB of the axilla is almost 100% specific with a sensitivity between 40 and 90%. A positive FNAB reduces the need for a second axillary procedure by up to 20% with reduced morbidity and cost. The recent ACOSOG-Z0011 and AMAROS trials have reduced the use of FNAB axilla in American protocols, but it remains the standard of care in Europe.


Assuntos
Neoplasias da Mama/diagnóstico , Citodiagnóstico/normas , Patologia Clínica/normas , Guias de Prática Clínica como Assunto/normas , Medição de Risco/métodos , Axila , Biópsia por Agulha Fina , Neoplasias da Mama/cirurgia , Feminino , Humanos , Valor Preditivo dos Testes , Sociedades Médicas
20.
Arch Pathol Lab Med ; 143(4): 472-482, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30920864

RESUMO

CONTEXT.­: The College of American Pathologists (CAP) developed proficiency testing for platelet function assays by using blood collected by the participant added to challenge tubes containing either saline (normal) or tirofiban (abnormal). OBJECTIVE.­: To analyze platelet function proficiency testing for Platelet Function Analyzer PFA-100, platelet aggregation, PlateletWorks, and PlateletMapping. DESIGN.­: Proficiency testing data from 2012-2016 were analyzed. RESULTS.­: For PFA-100, a total of 1200 laboratories participated; the coefficient variation (CV) of cartridge closure times was 22% (saline); 44,952 of 45,616 survey responses (99%) provided an interpretation, and 42,934 of 44,952 (96%) were correct. For optical platelet aggregation, 190 laboratories participated; the CV was 17% (saline), 7444 of 7813 survey responses (95%) provided an interpretation, and 7015 of 7444 (94%) were correct. For PlateletWorks, 60 laboratories participated; the CV was 3% to 11% (saline); 2412 of 2454 survey responses (98%) provided an interpretation, and 1207 of 1276 (95%) were correct for adenosine diphosphate (ADP) and 936 of 1136 (82%) for collagen. For PlateletMapping, 200 laboratories participated. For ADP, 1128 of 2697 survey responses (42%) provided an interpretation, but only 927 of 1128 (82%) were correct. For arachidonic acid, 1139 of 2604 survey responses (44%) provided an interpretation and 964 of 1139 (85%) were correct. CONCLUSIONS.­: CAP is the first to provide proficiency testing for platelet aggregation, PlateletWorks, and PlateletMapping. Platelet aggregation, PFA-100, and PlateletWorks using ADP as an agonist performed well with more than 90% of laboratories providing an interpretation and a similar number providing correct results. PlateletWorks using collagen and PlateletMapping showed worse interpretive accuracy than the other methods.


Assuntos
Ensaio de Proficiência Laboratorial , Patologia Clínica/normas , Testes de Função Plaquetária/normas , Garantia da Qualidade dos Cuidados de Saúde , Humanos
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