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1.
Surg Pathol Clin ; 15(4): 579-589, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36344176

RESUMO

The Gleason scoring system and Grade Group systems facilitate accurate grading and reporting of prostate cancer, which are essential tasks for surgical pathologists. Gleason Pattern 4 is critical to recognize because it signifies a risk for more aggressive behavior than Gleason Pattern 3 carcinoma. Prostatic adenocarcinoma with radiation or androgen therapy effect, with aberrant P63 expression, or with Paneth cell-like differentiation represent pitfalls in prostate cancer grading because although they display architecture associated with aggressive behavior in usual prostatic adenocarcinoma, they do not behave aggressively and using conventional Gleason scoring in these tumors would significantly overstate their biologic potential.


Assuntos
Adenocarcinoma , Carcinoma , Neoplasias da Próstata , Masculino , Humanos , Gradação de Tumores , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Carcinoma/patologia , Patologistas , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia
2.
Surg Pathol Clin ; 15(4): 759-785, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36344188

RESUMO

As machine learning (ML) solutions for genitourinary pathology image analysis are fostered by a progressively digitized laboratory landscape, these integrable modalities usher in a revolution in histopathological diagnosis. As technology advances, limitations stymying clinical artificial intelligence (AI) will not be extinguished without thorough validation and interrogation of ML tools by pathologists and regulatory bodies alike. ML solutions deployed in clinical settings for applications in prostate pathology yield promising results. Recent breakthroughs in clinical artificial intelligence for genitourinary pathology demonstrate unprecedented generalizability, heralding prospects for a future in which AI-driven assistive solutions may be seen as laboratory faculty, rather than novelty.


Assuntos
Inteligência Artificial , Patologistas , Humanos , Processamento de Imagem Assistida por Computador
3.
Rozhl Chir ; 101(10): 478-487, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36402559

RESUMO

Cholangiocarcinoma is a relatively rare malignant tumor arising from the biliary epithelium of the intra- and extrahepatic bile ducts, the gallbladder, and the ampulla of Vater. This review article presents cholangiocarcinoma from the routine histopathological point of view. In addition to an overview of basic morphological, immunohistochemical, and molecular genetic characteristics of cholangiocarcinoma subtypes and precancerous lesions, the article is focused on intraoperative biopsies and on changes in the 8th edition of the TNM classification. Macroscopic and microscopic photo documentation and a review of recent literature are included.


Assuntos
Neoplasias dos Ductos Biliares , Ductos Biliares Extra-Hepáticos , Colangiocarcinoma , Humanos , Neoplasias dos Ductos Biliares/cirurgia , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/patologia , Patologistas , Colangiocarcinoma/patologia , Ductos Biliares Extra-Hepáticos/patologia
4.
Indian J Pathol Microbiol ; 65(4): 966-969, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36308226

RESUMO

Dr. Purushottam Vishwanath Gharpure was an eminent Indian pathologist and an emeritus Professor of Pathology at the Grant Medical College, Bombay. He was a pioneer in carrying out the first field trial of polio vaccination which marked the beginning of the polio eradication program in India. Dr. Gharpure set an example by taking his laboratory work to the field and proving how the laboratory research can be used to better the society. The mesmerizing story of Dr. "Gharpure's life" is described in this paper.


Assuntos
Patologistas , Poliomielite , Humanos , Índia , Laboratórios , Poliomielite/prevenção & controle , Vacinação
5.
Eur J Obstet Gynecol Reprod Biol ; 278: 172-176, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36208523

RESUMO

OBJECTIVES: A lack of agreement is often observed in pathological reviews performed by specialized and general pathologists. Four histopathological variables influence the risk classification of endometrial cancer: histological type; histological grade; myometrial invasion; lymph-vascular space invasion (LVSI). This study aimed to evaluate if changes in the risk classification after a specialized pathological review of low- and intermediate-risk endometrial cancer (LIREC) samples may impact disease-free survival (DFS). METHODS: A retrospective cohort of 195 patients diagnosed with LIREC at Barretos Cancer Hospital was obtained. Two gynecologic pathologists re-evaluated the pathological reports. Through the histology report reviewed, we could determine their new risk classification. The Kappa concordance score was used to verify the concordance between the general's and specialized pathologists' reports, and the new risk classification was correlated with the patients' DFS. RESULTS: The final reports led to changes in the histological type, histological grade, myometrial invasion, and lymphovascular space invasion in 13.3 %, 62,8%, 18.3 %, and 11.1 % of cases, respectively. The Kappa concordance score for all variables was less than 0.7. In 54 patients (30 %), the risk classification was modified (κ = 0.396), of which 30 (55.5 %) cases upstaged. There was no difference in DFS for patients who had an upstaging in their European Society of Medical Oncology modified classification compared to those who maintained their initial risk classification (86.7 % vs 88.0 %, p = 0.77). CONCLUSION: Despite the differences in the reports reassessed by expert gynecological pathologists and the change (30%) in patients' risk classification, there was no difference in their DFS.


Assuntos
Neoplasias do Endométrio , Patologistas , Humanos , Feminino , Estudos Retrospectivos , Neoplasias do Endométrio/patologia , Intervalo Livre de Doença , Estudos de Coortes , Estadiamento de Neoplasias , Invasividade Neoplásica/patologia
6.
BMJ Open ; 12(10): e051257, 2022 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-36261243

RESUMO

OBJECTIVES: We aimed to assess the learning curves and the influence of the pathologist's performance on the endobronchial ultrasound transbronchial needle aspiration's (EBUS-TBNA's) diagnostic accuracy in a real-world study. DESIGN/SETTING: Cohort study conducted in a tertiary care university hospital (single centre) with patients referred for EBUS-TBNA. PARTICIPANTS/INTERVENTION: We initially evaluated 376 patients (673 lymph nodes), 368 (660 lymph nodes) of whom were recruited. The inclusion criterion was EBUS-TBNA indicated for the study of mediastinal or hilar lesions. The exclusion criteria were the absence of mediastinal and hilar lesions during EBUS confirmed by a normal mediastinum and hilum on chest CT (except in cases of mediastinal staging of cancer) and lost to follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: Diagnostic accuracy and related outcomes. METHODS: We included patients from a prospectively constructed database. We performed a logistic regression multivariate analysis to adjust for potential confounders of the association between pathologist performance and EBUS-TBNA accuracy. The Cumulative Summation (CUSUM) analysis was used to assess pathologists' performance and learning curves. RESULTS: Most indications for EBUS were suspicion of malignancy, including intrathoracic tumours (68.3%), extrathoracic tumours (9.8%) and cancer staging (7.0%). The patients' mean age was 63.7 years, and 71.5% were male. Overall EBUS-TBNA accuracy was 80.8%. In the multivariate logistic regression model, the factors independently associated with EBUS-TBNA accuracy included certain pathologists (ORs ranging from 0.16 to 0.41; p<0.017), a lymph node short-axis diameter <1 cm (OR: 0.36; 95% CI 0.21 to 0.62; p<0.001), and the aetiology of lymph node enlargement (ORs ranging from 7 to 37; p<0.001). CUSUM analysis revealed four different learning curve patterns, ranging from almost immediate learning to a prolonged learning phase, as well as a pattern consistent with performance attrition. CONCLUSIONS: Pathologists' proficiency conditioned EBUS-TBNA accuracy. This human factor is a potential source of error independent of factors conditioning tissue sample adequacy.


Assuntos
Curva de Aprendizado , Neoplasias , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Patologistas , Broncoscopia , Estudos de Coortes , Atenção Terciária à Saúde
7.
Semin Thromb Hemost ; 48(6): 690-699, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36223772

RESUMO

Von Willebrand factor (VWF) level and/or function is altered in von Willebrand disease (VWD), the most common heritable bleeding disorder worldwide. Laboratory assessment of VWF is continually evolving. Historically, the primary method for the assessment of VWF platelet-binding activity was the ristocetin cofactor assay (VWF:RCo). Contemporary alternative measures of VWF platelet-binding activity include VWF:GPIbR (recombinant; using ristocetin), VWF:GPIbM (recombinant; gain-of-function mutant), and monoclonal antibody. Recently, the American Society of Hematology, International Society on Thrombosis and Haemostasis, National Hemophilia Foundation, and World Federation of Hemophilia collaboration issued guidelines recommending the use of newer assays of VWF platelet-binding activity (VWF: GPIbM, VWF: GPIbR) over VWF:RCo, given known limitations of the VWF:RCo assay. Despite this recommendation, the newer VWF:GPIbM and VWF:GPIbR assays are not United States Food and Drug Administration cleared, limiting their availability in the United States. We sought to assess assay utilization trends, agreement of VWF testing methods, and imprecision of VWF testing (based on assigned sample type) from the College of American Pathologists Proficiency Testing Surveys. The analysis confirms that, while VWF antigen testing has low imprecision, the various VWF activity assays have significant interassay variability, with VWF:RCo showing greater imprecision than the newer GPIb-binding assays. The overall trends in assay utilization reflect the barriers to complete compliance with modern VWD diagnostic guidelines in North America.


Assuntos
Hemofilia A , Doenças de von Willebrand , Anticorpos Monoclonais , Humanos , Patologistas , Ristocetina , Doenças de von Willebrand/diagnóstico , Fator de von Willebrand
8.
Int J Gynecol Pathol ; 41(Suppl 1): S44-S63, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36305534

RESUMO

The International Collaboration on Cancer Reporting (ICCR) seeks to produce standardized, evidence-based protocols for the reporting of tumors with the aim of ensuring that all cancer reports generated worldwide will be of similar high quality and record the same elements. Herein, we describe the development of the data set for the reporting of uterine malignant and potentially malignant mesenchymal tumors by a panel of expert pathologists and a single clinician and provide the commentary and rationale for the inclusion of core and noncore elements. This data set, which incorporates the recent updates from the 5th edition of the World Health Organization Classification of Female Genital Tumors, addresses several subjects of debate including which mesenchymal tumors should be graded, how to document extent of invasion, mitotic counts, and the role of ancillary testing in tumor diagnosis and patient management. The inclusion of elements is evidence-based or based on consensus of the expert panel with clinical relevance being the guiding standard.


Assuntos
Carcinoma , Patologia Clínica , Sarcoma , Feminino , Humanos , Patologistas , Relatório de Pesquisa , Carcinoma/patologia
9.
Int J Gynecol Pathol ; 41(Suppl 1): S90-S118, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36305536

RESUMO

Endometrial cancer is one of the most common cancers among women. The International Collaboration on Cancer Reporting (ICCR) developed a standardized endometrial cancer data set in 2011, which provided detailed recommendations for the reporting of resection specimens of these neoplasms. A new data set has been developed, which incorporates the updated 2020 World Health Organization Classification of Female Genital Tumors, the Cancer Genome Atlas (TCGA) molecular classification of endometrial cancers, and other major advances in endometrial cancer reporting, all of which necessitated a major revision of the data set. This updated data set has been produced by a panel of expert pathologists and an expert clinician and has been subject to international open consultation. The data set includes core elements which are unanimously agreed upon as essential for cancer diagnosis, clinical management, staging, or prognosis and noncore elements which are clinically important, but not essential. Explanatory notes are provided for each element. Adoption of this updated data set will result in improvements in endometrial cancer patient care.


Assuntos
Neoplasias do Endométrio , Patologia Clínica , Feminino , Humanos , Projetos de Pesquisa , Patologistas , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/genética
10.
Int J Gynecol Pathol ; 41(Suppl 1): S64-S89, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36305535

RESUMO

Cervical carcinoma remains one of the most common cancers affecting women worldwide, despite effective screening programs being implemented in many countries for several decades. The International Collaboration on Cancer Reporting (ICCR) dataset for cervical carcinoma was first developed in 2017 with the aim of developing evidence-based standardized, consistent and comprehensive surgical pathology reports for resection specimens. This 4th edition update to the ICCR dataset on cervical cancer was undertaken to incorporate major changes based upon the updated International Federation of Obstetricians and Gynecologists (FIGO) staging for carcinoma of the cervix published in 2018 and the 5th Edition World Health Organization (WHO) Classification of Female Genital Tumors published in 2020 and other significant developments in pathologic aspects of cervical cancer. This updated dataset was developed by a panel of expert gynecological pathologists and an expert gynecological oncologist, with a period of open consultation. The revised dataset includes "core" and "noncore" elements to be reported; these are accompanied by detailed explanatory notes and references providing the rationale for the updates. Standardized reporting using datasets such as this helps facilitate consistency and accuracy, data collection across different sites and comparison of epidemiological and pathologic parameters for quality and research purposes.


Assuntos
Patologia Clínica , Neoplasias do Colo do Útero , Feminino , Humanos , Colo do Útero , Neoplasias do Colo do Útero/diagnóstico , Patologistas , Relatório de Pesquisa
11.
Int J Gynecol Pathol ; 41(Suppl 1): S119-S142, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36305537

RESUMO

The move toward consistent and comprehensive surgical pathology reports for cancer resection specimens has been a key development in supporting evidence-based patient management and consistent cancer staging. The International Collaboration on Cancer Reporting (ICCR) previously developed a data set for reporting of the ovarian, fallopian tube and primary peritoneal carcinomas which was published in 2015. In this paper, we provide an update on this data set, as a second edition, that reflects changes in the 2020 World Health Organization (WHO) Classification of Female Genital Tumours as well as some other minor modifications. The data set has been developed by a panel of internationally recognized expert pathologists and a clinician and consists of "core" and "noncore" elements to be included in surgical pathology reports, with detailed commentary to guide users, including references. This data set replaces the widely used first edition, and will facilitate consistent and accurate case reporting, data collection for quality assurance and research, and allow for comparison of epidemiological and pathologic parameters between different populations.


Assuntos
Carcinoma , Patologia Clínica , Feminino , Humanos , Tubas Uterinas/patologia , Patologistas , Carcinoma/patologia , Estadiamento de Neoplasias
12.
Indian J Pathol Microbiol ; 65(4): 961-962, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36308224

Assuntos
Patologistas , Humanos
13.
Rev. esp. patol ; 55(4): 259-266, Oct-Dic. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-210616

RESUMO

El carcinoma coloide (CC) es una variante histológica inusual del adenocarcinoma ductal del páncreas, el cual se caracteriza por la presencia de grandes lagos de mucina extracelular que contiene células neoplásicas y está asociado a una mejor sobrevida a los cinco años, comparada con los adenocarcinomas ductales (DAC) tubulares o no tipo especial (NOS).Presentamos el caso de una paciente mujer de 74 años con una lesión multiquística de tabiques finos en cola de páncreas con diagnóstico clínico radiológico sugestivo de cistoadenoma seroso vs. neoplasia mucinosa. En el acto operatorio se evidenció una lesión de 10 x 6 cm, que infiltraba hilio esplénico y mesocolon transverso. Por otro lado, se identificaron dos nódulos en la pared del fondo gástrico que también fue resecado en conjunto. El estudio anatomopatológico concluyó que la tumoración del páncreas correspondía a un CC asociado incidentalmente a un tumor del estroma gastrointestinal (GIST) de fondo gástrico.(AU)


Colloid carcinoma (CC) is a rare histological type of adenocarcinoma of the pancreatic duct and is characterized by the presence of large lakes of extracellular mucin containing neoplastic cells. Its 5 year prognosis is more favourable than that of ductal, tubular or not otherwise specified (NOS) adenocarcinomas.We present the case of a 74-year-old woman with a thin walled, multicystic lesion in the tail of the pancreas, radiologically suggestive of a serous cystadenoma as opposed to a mucinous neoplasm. Surgery revealed a 10 x 6 cm lesion invading the splenic hilum and transverse mesocolon. Two nodes on the wall of the gastric fundus were also removed. Histopathology showed the pancreatic tumour to be a colloid carcinoma with a synchronous gastrointestinal stromal tumour of the gastric fundus.(AU)


Assuntos
Humanos , Feminino , Idoso , Adenocarcinoma Mucinoso , Neoplasias Pancreáticas , Adenocarcinoma Mucinoso/patologia , Estômago/patologia , Carcinoma Ductal Pancreático , Pacientes Internados , Exame Físico , Avaliação de Sintomas , Anamnese , Patologia , Serviço Hospitalar de Patologia , Neoplasias , Patologistas
14.
J Plast Reconstr Aesthet Surg ; 75(10): 3804-3812, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36064511

RESUMO

Speech may be affected in patients with cleft lip and palate (CLP). Professional listeners, naïve listeners, and patients may perceive speech differently. The aim of the study was to assess speech among adults treated for unilateral CLP (UCLP) as rated by naïve listeners, speech-language pathologists (SLPs), and self-assessment and to evaluate how well these ratings correlate. All patients with complete UCLP treated at the Uppsala University Hospital, Uppsala, Sweden, in 1960-1987 were invited. A total of 73 of 109 patients (67%) participated, with a mean of 35 years since the initiation of treatment. The noncleft control group consisted of 55 volunteers. All participants answered questionnaires for self-rating of speech, and their speech was audio-recorded digitally. Fourteen naïve listeners and four SLPs rated the speech individually from blinded recordings. There were more speech abnormalities among patients compared to controls according to the ratings of naïve listeners and SLPs. In controls and patients, there were positive correlations between the speech ratings by naïve listeners and SLPs r = 0.44 to 0.71, p < 0.001, Spearman). The patients were less satisfied and rated to have more speech abnormalities than controls (p < 0.001). Although adults treated for UCLP considered their speech as fairly good, they were less satisfied than noncleft controls. The agreement between ratings by naïve listeners and SLPs were good, while the agreement between these ratings and self-assessment varied widely. When assessing speech in adults treated for UCLP, differences in perception of speech abnormalities by professionals, laymen, and patients should be considered.


Assuntos
Fenda Labial , Fissura Palatina , Adulto , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Patologistas , Fala , Distúrbios da Fala
15.
J Forensic Sci ; 67(6): 2351-2359, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36069005

RESUMO

Post-mortem computed tomography (PMCT) is now performed routinely in some medical examiner's offices, and the images are typically interpreted by forensic pathologists. In this study, the question of whether pathologists appropriately identify significant PMCT findings and incorporate them into the death investigation report and the cause and manner of death (COD and MOD) statements was addressed. We retrospectively reviewed 200 cases where PMCT was performed. The cases were divided into four categories: (1) full autopsy without radiology consultation (n = 77), (2) external exam without radiology consultation (n = 79), (3) full autopsy with radiology consultation (n = 26), (4) external exam with radiology consultation (n = 18). A radiologist (not the consult radiologist) read the PMCT images, and a pathologist (not the case pathologist) reviewed the case pathologist's post-mortem examination report in tandem to determine any PMCT findings omitted from the report. Omitted findings were classified into error types according to a modified Goldman classification including Major 1: Unrecognized fatal injury or pathology that would change COD and/or MOD, and Major 2: Unrecognized fatal injury or pathology that would not change COD and/or MOD. A total of 13 Major errors were identified (6.5%), and none definitively changed the MOD. All four Major-1 errors which could change the COD were found in Category 2. Of 9 Major-2 errors, 2 occurred in Category 1, 6 occurred in Category 2, and 1 occurred in Category 4. In conclusion, forensic pathologists who routinely utilize computed tomography (CT) interpret CT images well enough to reliably certify the COD and MOD.


Assuntos
Patologistas , Tomografia Computadorizada por Raios X , Humanos , Autopsia/métodos , Patologia Legal/métodos , Estudos Retrospectivos , Causas de Morte , Tomografia Computadorizada por Raios X/métodos
16.
Lang Speech Hear Serv Sch ; 53(4): 1117-1128, 2022 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-36054845

RESUMO

PURPOSE: The purpose of this study was to evaluate the attitudes and knowledge of school-based speech-language pathologists toward trauma-informed care. METHOD: School-based speech-language pathologists (N = 116) completed the Attitudes Related to Trauma-Informed Care Scale Version 45 Education (ARTIC-45) survey via an online survey platform and provided information about their work experience, history with trauma training, and demographic variables. RESULTS: Although speech-language pathologists had responses that, on average, aligned with trauma-informed perspectives, those perspectives varied and were not at ceiling. Characteristics such as age, years of experience, and foster care experience did not significantly influence the results, but self-rating of trauma-informed care knowledge did correlate with the ARTIC-45 survey. Participants who had engaged in trauma-informed care trainings had more trauma-informed perspectives and knowledge than participants who had not. CONCLUSIONS: The results of this study provide preliminary evidence that trauma-informed care trainings may benefit those speech-language pathologists working with children who have experienced trauma. This study also provides preliminary evidence supporting the validity of the ARTIC-45 for use with speech-language pathologists.


Assuntos
Patologia da Fala e Linguagem , Atitude do Pessoal de Saúde , Criança , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Patologistas , Fala , Patologia da Fala e Linguagem/métodos , Inquéritos e Questionários
18.
Pathologie (Heidelb) ; 43(6): 434-440, 2022 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-36156132

RESUMO

BACKGROUND: Testicular germ cell tumours (GCTs) are the most frequent solid malignancy in younger males aged 15-40. The differentiation between seminomas and non-seminomas impacts prognosis, clinical management and follow-up procedures. With stage- and risk-adapted multimodal treatment approaches, GCTs have an exceptionally good prognosis. Therefore, avoiding overtreatment to reduce treatment-related long-term side effects is of utmost importance. Clinical and histopathological risk factors aid in treatment decision-making. OBJECTIVES: Discussion of (histo-)pathological characteristics that directly influence treatment decision-making by urologists and oncologists. MATERIALS AND METHODS: Non-systematic literature review to describe histopathological features for interdisciplinary treatment planning. RESULTS: Key histopathological characteristics for clinicians are: (i) identification of a GCT, if necessary by 12p aberration analysis, (ii) description of the different subtypes, and (iii) risk factors, including lymphovascular invasion and/or rete testis infiltration and size of the primary tumour. Molecular pathological analyses, that is, genomic sequencing, is not part of routine diagnostics due to the lack of prognostic/predictive markers and effective targeted treatment approaches. DISCUSSION: Detailed histopathology reporting, ideally with a synoptic template, is the basis for planning and conducting guideline-endorsed, risk-adapted, multi-disciplinary management of GCTs. Along with radiographic imaging and assessment of the serum tumour markers AFP and ß­HCG (especially in non-seminomas), histopathology is crucial to maintain success and reduce the burden of GCT treatment.


Assuntos
Neoplasias Embrionárias de Células Germinativas , Oncologistas , Neoplasias Testiculares , Humanos , Masculino , Neoplasias Testiculares/terapia , alfa-Fetoproteínas/uso terapêutico , Patologistas , Urologistas , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/terapia , Biomarcadores Tumorais
19.
Virchows Arch ; 481(5): 759-766, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36098817

RESUMO

When not all the histopathologic and clinical features necessary for a pathology diagnosis are present in a particular specimen, pathologists may use modifying phrases to convey various degrees of certainty, e.g., "consistent with…" and "suggestive of…." However, it is unclear whether pathologists use such phrases consistently or whether treating physicians fully understand their intended meaning. A questionnaire concerning six common modifying phrases ("consistent with, suggestive of, suspicious for, highly consistent with, highly suggestive of, some features of") was sent to all physicians from a single institution who either issued or routinely received surgical pathology reports. Physicians were asked to rank their understanding of each phrase on a printed scale between 1 ("no evidence of") and 10 ("diagnostic of"). One hundred sixty physicians (74.3%) responded. Despite wide variation, there was a hierarchy (from more to less diagnostic): highly consistent > highly suspicious > consistent > suspicious > suggestive > some features (p < 1 × 10-7). There were no significant differences between pathologists and treating physicians (p = 0.72) or attendings and residents (p = 0.9). Pathologists and treating physicians share an overall common understanding of their hierarchical relationship, albeit with wide ranges. Based upon our results, we propose to use only three qualifying phrases to convey the degree of certainty for a particular diagnosis: "suggestive of" (> 25 ≤ 50% certainty), "suspicious for" (> 50 ≤ 75%), and "consistent with" (> 75%). The phrase "no evidence of" should probably be used only when there is ≤ 5% confidence in a diagnosis, and conversely, "diagnostic of" should probably be used only when there is ≥ 95% confidence in a diagnosis.


Assuntos
Patologia Cirúrgica , Humanos , Patologistas , Inquéritos e Questionários
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