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PubMed2005

How quickly can a renal transplant pathological diagnosis be completed? The demands of clinicians and the objections of pathologists.

This analyzer symposium was held in order to clarify whether pathologists were satisfying the demands of clinicians in renal transplant care in Japan. Thirty-one questions were prepared as to "Background", "Transplant results", "Basic issues concerning renal transplant biopsy diagnoses", "Renal transplant biopsy and diagnosis, and actual treatment", and "Diagnostic support". By analyzing the answers of all the questions, the current status of renal transplant treatment in Japan has been clarified as follows. Most institutions can produce a renal transplant optical microscope section 1 or 2 days after the biopsy. Over 90% of those on the clinical side would like to have the diagnosis on the same day as the biopsy or at the latest the day after. Therefore, in fact a 24 hour time lag was observed between the pathological diagnosis and the request from the clinical side. No clinicians required a pathologist to decide whether to perform a transplant or not. Nearly all clinicians provide treatment based on the renal transplant biopsy diagnosis. As renal transplant pathological diagnosis is difficult, all pathologists need a diagnostic support system. The creation of this system was thought to be a pressing matter.

Health Care Surveys↗

PubMed1987

Inter- and intra-pathologist variability in histologic diagnoses of lung cancer.

To estimate variability and reliability in histologic diagnosis (Dx) of lung cancers, lung cancer preparations were divided into eight equal sets and diagnosed independently by an eight-man pathology panel. Majority Dx (Dx affirmed by more than 4 panelists) was regarded as the consensus Dx of each cancer. The consensus rate of each panelist ranged from 78.8% to 96.1% with an average of 89.4%. The consensus rates were not significantly different among the panelists. Relatively high inter-pathologist agreement was observed in squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. However, regarding large cell carcinoma, there was occasional disagreement among the panelists. Forty-seven cancers were reexamined by the same panelists, with no preliminary announcement, 7 months after the first examination to study the intra-pathologist agreement. The rate of the intra-pathologist agreement ranged from 76.6% to 93.3%. Dx of large cell carcinoma was the most intra-changeable. It was concluded that the histologic Dx of large cell carcinoma was the most inter- and intra-changeable, and the most frequent dissenting Dx from it was poorly differentiated squamous cell carcinoma.

Adenocarcinoma↗

PubMed1990

Pulmonary tuberculosis. An occupational hazard for pathologists and pathology technicians in Japan.

The incidence of pulmonary tuberculosis among pathology workers in Japan is elevated, presumably due to frequent exposure to tubercle bacilli in the work place. To demonstrate the etiological significance of the association between this disease and occupation epidemiologically, a questionnaire survey was performed to assess the incidence of pulmonary tuberculosis among 1,201 pathologists and 1,187 pathology technicians throughout Japan. Pathology department workers other than pathologists and technicians, such as secretaries (n = 207), and workers in university departments of preventive medicine and public health (n = 732) served as control groups. While non-occupation-related tuberculosis was found in both departmental groups with nearly equal incidence, the incidence of pulmonary tuberculosis among pathologists and pathology technicians after engagement in their current specialist work was significantly higher than that in the control groups (odds ratio = 6.08-10.98). The incidence of disease among pathology technicians who assisted in autopsies was markedly higher than among those not involved in autopsies (odds ratio = 6.65). This elevated incidence was significantly related to the duration of work in pathology activities, and showed little change over the last decade. These findings indicate that specific environmental conditions in pathology departments, particularly autopsy of cadavers harboring active tuberculosis, constitute a serious occupational hazard.

Adult↗

PubMed2001

The quality of care in Barrett's esophagus: endoscopist and pathologist practices.

BACKGROUND: The diagnosis of Barrett's esophagus (BE) has important psychological and economic implications. Although accepted standards for endoscopic biopsy methods and pathological interpretation for BE exist, adherence to these standards as a measure of the quality of care in BE has not been evaluated. Our aim was to assess the quality of care in BE by evaluating the process of care and adherence to accepted standards of practice. METHODS: Explicit process-of-care criteria were developed using a systematic literature review and expert opinion in four domains of care: the quality of biopsy methods, the adequacy in identifying endoscopic landmarks, endoscopist-pathologist communication, and pathological interpretation and reporting. We reviewed all endoscopy and pathology reports of BE patients at two institutions from 1994-1997. An academic medical center (N = 237) with staff endoscopists and an academically affiliated community hospital (N = 100) with private-practice endoscopists were analyzed. RESULTS: Physicians showed the highest adherence to accepted standards of care in the "adequacy of identifying landmarks" and "endoscopist-pathologist communication" domains, with a > or =70% adherence rate in most criteria. Conversely, physicians demonstrated the poorest adherence with the "quality of biopsy methods" and "pathologist interpretation and reporting" domains, with adherence rates frequently <60%. Significantly, biopsies were taken in the presence of visible esophagitis 35% of the time. Performance on several of the quality indicators varied significantly by the practice setting. CONCLUSIONS: We have identified several opportunities for quality improvement efforts. In every domain, there is room for improvement, particularly in the quality of biopsy methods. As initiatives to screen the large population of gastroesophageal reflux disease patients for BE may be imminent, the time is now to define the critical process-of-care measures to minimize the risk of overdiagnosis and inadequate endoscopic surveillance.

Barrett Esophagus↗

PubMed1976

Attracting and training more chemical pathologists in the United Kingdom.

I have attempted to define the function of the medical graduate in the clinical biochemistry laboratory and have examined data on recrutiment in the United Kingdom into clinical biochemistry. If trainee pathologists were encouraged to become proficient in both a branch of clinical medicine and in research techniques, the resulting chemical pathologists should be able to improve the consultative and investigative functions of the laboratory. To this end I have suggested some changes in the training regulations and in the role of the chemical pathologists.

Biochemistry↗

PubMed1991

Colour perception in pathologists: the Farnsworth-Munsell 100-hue test.

The value of many histological stains depends on the ability of the observer to differentiate colour. This ability was assessed in 30 histopathologists and cytopathologists of varying experience using the Farnsworth-Munsell 100-hue test. As a group, the pathologists performed better than a reference population. Twenty eight subjects showed a wide ranging ability to differentiate colour: none was colour blind. Three of the 30 pathologists, however, fell below the twentieth centile for normal subjects and only one was aware of this deficiency! They may unknowingly misinterpret subtle stains. Two of these three had specific and major defects which could affect their ability to interpret a wide range of less subtle stains. Those with the poorest colour discrimination were not those with the least experience of microscopy. Pathologists should be apprised of the importance of their ability to discriminate colour, and that formal colour vision testing of prospective histopathologists may be appropriate.

Adult↗

PubMed1996

Phraseology in pathology reports. A comparative study of interpretation among pathologists and surgeons.

This questionnaire based study compared the interpretation, use and preferences, among pathologists and surgeons, of descriptive phrases found in surgical reports. The results show that there is a wide variation in individual interpretation of phrases in both groups. The frequency of usage of phrases by pathologists and preference for phrases by surgeons were also diverse. The adoption of a limited number of descriptive phrases that are mutually understood and acceptable for use by both pathologists and clinicians is recommended to avoid interpretive ambiguity in pathology reports.

Communication↗

PubMed1996

Use of oral pathology services by general histopathologists and their attitudes to training of oral pathologists.

AIMS: (1) To determine whether general histopathologists are aware of oral pathology as a specialist discipline and whether they use oral pathologists to identify lesions of the dental and orofacial tissues which pose diagnostic difficulties to general histopathologists. (2) To establish whether consultant histopathologists would consider dentally qualified applicants for salaried training posts within their department so that they may fulfil College accreditation requirements. METHODS: A questionnaire was sent to a consultant histopathologist in each of 226 general histopathology departments in England and Wales. RESULTS: In total, 167 (74%) consultant histopathologists completed the questionnaire, of whom 98% (163/167) were aware of the specialty and 92% (153/167) perceived a need for it. Oral biopsy specimens formed less than 5% of the workload in 76% (126/167) of departments, but 80% (134/167) of the consultants had referred at least one case to an oral pathologist during 1993. The most common sources of diagnostic difficulty were identified as salivary gland pathology, odontogenic tumours and lesions of oral mucosa. Only 22% (36/167) of consultants were aware that trainees in oral pathology are obliged to spend a year in accredited general histopathology training, but 40% (67/167) said they would consider a dentally qualified applicant for a training post in their department. CONCLUSIONS: General histopathologists are aware that oral pathologists exist and most will at some time call on their services; thus there is a need for specialists in oral pathology. Consultant histopathologists have a supportive attitude to the problem of providing the necessary general experience for oral pathology trainees, which will continue to be obtained through secondment to a histopathology department outside the trainee's main institution in most cases. Central funding would help the problem of providing cover for trainees spending a year out to complete general pathology training.

Attitude of Health Personnel↗

PubMed1993

Neural tube defects: a survey of lesion descriptions made by different European pathologists.

Recent epidemiological interest has focused on separation of neural tube defects (NTD) into subgroups which may differ pathogenetically and aetiologically, for example, 'upper' and 'lower' spina bifida. In order to validate the use of pathologists' lesion descriptions by epidemiologists and others, a postal survey of 18 European perinatal pathologists, identified by EUROCAT registries, was conducted. Pathologists were asked, anonymously, to describe and identify the lesions in 15 photographs of midtrimester termination fetuses. There was a 50% response rate. Even taking into consideration the limitations of dealing with photographs rather than the fetuses themselves, there was often marked variation in the descriptions. Standardisation of terminology and international consensus about the type of detail recorded for NTD are urgently needed.

Abortion, Therapeutic↗

PubMed1984

Mortality study of British pathologists 1974-80.

Membership lists of the Royal College of Pathologists from 1974 to 1980 were used to establish a population of 2307 men and 413 women. During the period of study 126 of these pathologists died and death certificates were obtained for 121. The standardised mortality ratios (SMR) for all causes in men were 56 and in women 99. Deaths from accidents, poisoning, violence, and especially suicide, were noted to be in excess of that expected from the general population but similar to that for medical practitioners. Drug overdose was the cause of each suicide. Excess deaths from lymphatic and haemopoietic neoplasms noted in a previous study were not present but an excess of brain tumours was found. Including 1981 data thus far collected, deaths from brain tumour were apparently in excess (observed 6, expected less than 2.0, p less than 0.02). Possible aetiological hypotheses include previous exposure to organic solvents or tuberculosis infection. In view of the pathologists' exposure to formaldehyde it is interesting to note that no nasal or nasal sinus tumours were reported and the SMR for lung cancer was 41.

Brain Neoplasms↗

PubMedDate not supplied

Blinded speech evaluation following pharyngeal flap surgery by speech pathologists and lay people in children with cleft palate.

METHODS: In order to assess intermediate-term speech outcome after pharyngeal flap surgery for velopharyngeal dysfunction in children with cleft palate between 1980 and 1998, their pre- and postoperative speech performance was analyzed in a blinded fashion by speech pathologists and adult lay people. Speech was evaluated on the basis of tape recordings with regard to resonance, intelligibility, articulation, voice and secondary speech disorders. RESULTS: Twenty-three patients could be evaluated. Both lay assessors and speech pathologists noted a significant improvement in speech performance after pharyngeal flap surgery. The percentage of children who improved was 83% (19/23, 95% confidence interval: 0.68-0.98, p = 0.002) when rated by lay people, and 87% (20/23, CI 0.73-1.01, p < 0.0001) when rated by professionals. Rated on a 5-point scale, the mean improvement per speech characteristic was 0.52 +/- 0.32 scale points when judged by lay people, and 0.75 +/- 0.8 points when judged by experts. Experts considered none of the children to have normal speech after surgery. Agreement with regard to outcome between lay people and speech pathologists occurred in 87% of the patients. CONCLUSION: The cranially based pharyngeal flap can improve speech performance in cleft palate children with chronic velopharyngeal insufficiency. However, it cannot be expected that this type of surgery will result in normal speech.

Child↗

PubMed2002

Pathologists' views on consent for autopsy.

Consent to autopsy is usually obtained by a doctor other than the one who will perform the procedure. There is an argument that, for proper informed consent, a pathologist should participate. We ascertained the views of consultant pathologists in south-east England. 53 (87%) of 61 consultants responded, of whom 50 currently do autopsies. Only 2 at present participate directly in obtaining consent, and 10 of the remaining 48 expressed willingness to do so. The general view was that consent is best obtained by a senior clinician from the team that has looked after the patient. Pathologists see their primary role as to provide guidance to clinicians. Few see it as their function to obtain consent for autopsy.

Attitude of Health Personnel↗

PubMedDate not supplied

The nomenclature of cell death: recommendations of an ad hoc Committee of the Society of Toxicologic Pathologists.

The last several years have seen considerable confusion regarding the terms "apoptosis" and "necrosis" in pathology. This situation prompted the Society of Toxicologic Pathologists to charter the Committee on the Nomenclature of Cell Death, which was charged with making recommendations about the use of the terms "apoptosis" and "necrosis" in toxicity studies. The Committee recommends use of the term "necrosis" to describe findings comprising dead cells in histological sections, regardless of the pathway by which the cells died. The modifiers "apoptotic" and "oncotic" or "mixed apoptotic and oncotic" are recommended to specify the predominant morphological cell death pathway or pathways, when appropriate. Other standard modifiers, indicating the lesion distribution and severity, may also be used in conjunction with these. "Individual cell necrosis" (also known as "single cell necrosis") may be either of the apoptotic, oncotic, or mixed types. In many cases, more traditional terms such as "coagulation necrosis" may be used to convey a meaning similar to oncotic necrosis. It is important that pathologists use terms that accurately and concisely convey the level of information appropriate to the study's needs. Furthermore, toxicologic pathologists should actively help to disseminate these recommendations to other biologists and to regulatory authorities.

Animals↗

PubMed1992

Histopathologic classification of breast cancer in Sweden and Italy: a comparison between two pathologists.

Two large series of breast cancers (BC), identified in the Pathology Departments of Malmö (Sweden) and Florence (Italy), were independently reviewed by two experienced pathologists, one from each department. Overall, comparison of diagnoses of 372 BCs according to a simplified WHO histologic classification system (in four combined categories) revealed agreement for 74% of the cases. Concordance, as measured by the kappa statistic, was relatively good (0.53 overall). Kappa values for specific categories were also acceptable, being highest for "invasive lobular" BC (0.63) and lowest for "other types" (0.45). The kappa value for "noninvasive" versus all other categories of invasive BC was 0.53. Some BCs were systematically classified as "noninvasive" by one pathologist and as "invasive ductal with a predominant intraductal component" by the other. Invasive lobular BCs were also diagnosed more frequently by one pathologist. These findings suggest that when planning geographical or temporal comparisons of distribution for BC histologic categories, standardization of classification and a centralized review may play an important role.

Aged↗

PubMed2005

Variation among pathologists in histologic grading of canine cutaneous mast cell tumors.

Ten veterinary pathologists at 1 veterinary institution independently assigned histologic grades to the same 60 canine cutaneous mast cell tumors (MCTs). There was significant variation among pathologists in grading the MCTs (P < 0.001). The probability of assigning a low grade was significantly higher for the pathologists in this study who use a published reference for histologic grading of canine cutaneous MCTs that allows subcutaneous MCTs or MCTs with mitotic figures to be included in the low-grade category (P < 0.0001 and P < 0.0001, respectively).

Animals↗

PubMed2003

A cost comparison of telepathology and a visiting pathologist service.

We compared the costs of a dynamic, robotic telepathology service for intraoperative frozen sections with the cost of a once-weekly visiting pathologist service established between the small Reutte Hospital, located in north-western Tyrol, and the department of pathology of the University of Innsbruck. Telepathology required either 15 min or 30 min per case in order to make a diagnosis, depending on the type of tissue and the operator's experience in handling the telepathology system. Costs were calculated for a five-year period. The main costs of the telepathology service were for set-up, whereas the main costs of the visiting pathologist service concerned personnel. The threshold at which telepathology was cheaper than the visiting pathologist service was 46 cases per month (15 min for diagnosis) or 135 cases per month (30 min for diagnosis). The present case-load (eight cases per month) at the study hospital was below this threshold.

Austria↗

PubMed1998

Pathologists' attitudes to implementing telepathology.

If pathologists will benefit so much from using telepathology, why is it taking so long to be introduced? This question has been discussed between experts, but the potential users are rarely asked for their opinions. A questionnaire was sent to the 256 members of the Austrian Society of Pathology; this addressed general aspects of telemedicine, telepathology in frozen-section services and expert consultation, videoconferencing technologies, teleteaching and teletraining. The response rate was 46%. In general, the pathologists thought that telemedicine could become valuable in their daily routine. However, pathologists were most afraid of sampling errors in remote diagnosis and would not readily accept an alternative to the conventional method of looking at a sample. This is only possible using realtime, remotely controlled microscopes. Telepathology systems providing only still images would not be acceptable to most respondents. There was interest in the use of videoconferencing for clinicopathological conferences. Teleteaching and teletraining were seen as welcome additional techniques, but were nevertheless judged unable to replace classical methods of teaching and training.

Attitude of Health Personnel↗

PubMed1993

Survey of speech-language pathologists' training, experience, and opinions on nasopharyngoscopy.

A questionnaire on nasopharyngoscopy was completed by 93 speech-language pathologists randomly selected from the Directory of the American Cleft Palate-Craniofacial Association. Although the majority rated nasopharyngoscopy as important in the assessment of velopharyngeal function, and believed that it should be performed by speech-language pathologists, the majority do not perform nasopharyngoscopic examinations. Moreover, 40% had no academic preparation and 20% had no clinical experience in nasopharyngoscopy. Implications of these findings concerning exposure to nasopharyngoscopy in speech-language pathology graduate training programs and in continuing education programs for practicing speech-language pathologists are discussed.

Attitude of Health Personnel↗