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PubMed2006

Colorectal polyps and cancers diagnosed by pathologists in Ile de France Region. Crisapif-Petri Study.

OBJECTIVES: The aim of this study was to evaluate the histological characteristics of adenomatous polyps (AP), non adenomatous polyps (NAP), and colorectal cancers (CRC) diagnosed in the greater Paris area. MATERIAL AND METHODS: Pathologists filled out an identification and histological questionnaire for each biopsy or surgical specimen received between 20/09/02 and 20/12/02, which had at least one colorectal polyp or CRC, taken from a patient of the greater Paris area. RESULTS: The participation rate of pathologists was 73.3% and 10,396 patients with 16,681 lesions were included. Lesions consisted in 1,223 CRC among 1,107 patients, 9,280 AP and 6,178 NAP. Mean age of patients with CRC was 68 years, with at least one AP without CRC 62 years, and with at least one NAP without CRC or AP 58 years. The mean number of polyps per patient was 1.4, and increased with age. Average size of AP was larger than that of NAP and the size increased with age for AP but not NAP. pTNM staging of CRC was: pT0, 1% pT1, 4% pT2, 13% pT3, 63% pT4, 19% N0, 55% N1, 24% N2, 19% Nx, 2%. CONCLUSION: This study provides detailed data on colorectal polyps and colorectal cancers in the greater Paris region, which does not have a cancer registry. Repeated surveys could be helpful for evaluating the efficacy of screening programs in the general population.

Adenomatous Polyps↗

PubMed2001

What the clinician needs from the pathologist: evidence-based reporting in breast cancer.

Histopathology has a vital role in determining breast cancer management and pathologists must be part of the clinical team. Carcinoma size, grade, and especially lymph node status remain the best available prognostic factors. Metastatic carcinoma in axillary nodes is more important than any other prognostic factor presently available. ER status is an important predictor of response to endocrine manipulation, but its independent prognostic significance, and that of micrometastatic disease, circulating carcinoma cells and other molecular factors, even well-studied ones such as HER2 status, are less clear. Pathology is the first clinical speciality to subject its practice to rigorous scientific analysis, and it has stood up well. However, workers without appropriate experience in Pathology or scientific design have created difficulties by undertaking poorly planned studies with ill-defined end-points, lacking appropriate quality control. New analytical techniques and therapeutic targets make it essential that we learn from past mistakes and integrate pathologists into the research teams pursing clinical trials and the assessment of new bio-markers. Without this, input resource will be wasted on false leads that could have been curtailed. Morphology alone will not be enough to select patients likely to benefit in trials of new therapies, but selection 'tests' must be appropriate. The confusion of tests for selection of patients to receive Herceptin shows what happens when this process fails. Much of the microarray data being put into data-bases has no quality control, and meta-analysis of this data will produce even more conflict than the clinical trials. This can be avoided, as the ability to standardise is available.

Bone Marrow Neoplasms↗

PubMed1997

Rudolf Virchow, not just a pathologist: a re-examination of the report on the typhus epidemic in Upper Silesia.

Rudolf Virchow (1821-1902) is mainly remembered as the "father" of cellular pathology; however, he was not just a pathologist. His contributions to anthropology, archeology, ethnography, and history, as well as his involvement in epidemiology, public health, and politics, portray a man with multiple interests, deeply engaged in the controversies of his time. In his Report on the Typhus Epidemics of Upper Silesia of 1848, the young Virchow reveals himself to be a self-assured pathologist, although his postmortem examinations failed to shed much light on typhus. Despite of his shortcomings and biases, Virchow's genius is revealed in his deep appreciation of the importance of the total physical, socio-cultural, economic, and political background of epidemic diseases. One can discern in the Report the making of Virchow, the politician and statesman who will contribute to the modernization of Germany's public health, and of the physician-scholar and physician-citizen who, despite of his shortcomings and militancy, continues to inspire and challenge us today.

Disease Outbreaks↗

PubMed2003

Speech-language pathologists' beliefs about language assessment of bilingual/bicultural individuals.

A survey of speech/language pathologists, in 5 states across the United States was conducted to determine their beliefs about the language assessment of bilingual/bicultural individuals. Most SLPs reported low efficacy in bilingual assessment for both their own skills (personal efficacy) and those of the field in general (general efficacy). SLPs who learned a second language in the context of cultural experience (the CE group) reported more personal efficacy in bilingual assessment than speech-language pathologists who learned a second language via academic study (the AS group), who in turn felt more competent than monolingual SLPs (the M group). Furthermore, the 3 groups of respondents differed in terms of attributions for their low personal efficacy. The M group was most likely to mention their lack of knowledge about bilingual issues, the AS group commented on their less than optimal language proficiency, and the CE group focused on both proficiency and experience as influences. Over half of all participants (52%) reported that bilingual input in a child's environment would influence their interpretation of that child's language assessment results. Most of these participants (40%) reported that they would be more conservative in recommending language therapy for a bilingual than a monolingual child, particularly due to the respondent's own lack of knowledge of bilingual issues. Implications regarding the relations between language learning experiences and beliefs about the assessment of bilingual/bicultural individuals among SLPs are discussed.

Adolescent↗

PubMed2004

Speech-language pathologists' roles in the delivery of positive behavior support for individuals with developmental disabilities.

Positive behavior support interventions such as functional communication training (FCT) and visual schedules are increasingly being used with individuals with autism and other severe developmental disabilities who engage in problem behavior and use augmentative and alternative communication (AAC). The increasing use of these communication interventions has implications for speech-language pathologists who provide support to these individuals. The purpose of this tutorial is to summarize the research regarding the use of FCT/AAC interventions and visual schedules, and to provide suggestions for the roles that speech-language pathologists can play with regard to assessment, intervention design, and implementation in school and home settings.

Autistic Disorder↗

PubMed2004

Nonverbal learning disability: a tutorial for speech-language pathologists.

Nonverbal learning disability (NLD) is a diagnostic category that is unfamiliar to most speech-language pathologists. This brief tutorial describes NLD's characteristics, a theoretical model proposed to explain its source, and areas of overlap between NLD and similar diagnostic categories. The communicative profile, made up of difficulties in pragmatic and semantic language in the presence of relatively preserved syntactic skill, is also discussed. Empirical evidence relevant to NLD is also evaluated. Many questions remain unresolved, but until systematic research provides definitive answers, speech-language pathologists are encouraged to rely on careful description of the individual child's communicative strengths and weaknesses to identify appropriate targets and to focus intervention on improving the child's ability to communicate effectively in everyday contexts.

Asperger Syndrome↗

PubMed1991

Development and validation of an instrument to measure occupational stress in speech-language pathologists.

The Speech-Language Pathologist Stress Inventory (SLPSI) is a 48-item questionnaire adapted from the Teacher Stress Inventory (Fimian, 1988). Factor analyses of the responses of 626 speech-language pathologists revealed four stress source factors (Bureaucratic Restrictions, Time and Workload Management, Lack of Professional Supports, and Instructional Limitations) and two stress manifestation factors (Emotional-Fatigue Manifestations and Biobehavioral Manifestations). The internal consistency reliability of scales based on these factors ranged from .71 to .87, with .93 for the entire scale. Evidence for construct validity was found in moderate positive correlations between the scales of the SLPSI and the scales of the Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1986). Stress and burnout subscale intercorrelations ranged from .10 to .82 (p less than .01), and the correlation between stress strength and burnout frequency was .66 (p less than .001).

Adult↗

PubMed2001

The imager replacing the pathologist in the diagnosis of hepatobiliary and pancreatic disease.

Advances in imaging technology, specifically cross-sectional imaging techniques (ultrasonography, computer tomography, magnetic resonance imaging), are dynamic and rapid. They have dramatically changed the management of hepatobiliary and pancreatic diseases. Although imaging is not identical to the traditional gold standard of a tissue diagnosis, it often obviates its need and provides a much better insight into clinically relevant pathology compared with a biopsy. However, this requires a thorough insight into the clinical and pathologic aspects of the disease, knowledge of limitations of imaging techniques, and insight in management implications. The clear identification of characteristic disease findings on imaging, such as a cirrhotic configuration of the liver or gallstones that match clinical findings, are most helpful. Imaging and tissue investigation often have a complementary role in patient management. Their yield is highest if they are part of a critical integration of clinical findings by a multidisciplinary team. The latter should help as much in identifying specific opportunities for treatment as preventing futile and potential harmful interventions. The contribution of imagers and pathologists to the management of patients will continue to be redefined in the new century. Noninvasive and virtual imaging will develop further. A specific and challenging role for the pathologists and clinical imagers in close cooperation with many other disciplines will be to identify sensitive molecular targets that can be used to provide noninvasive images that not only accurately provide a diagnosis, but also resolution of disease and response to specific therapy. Ann Diagn Pathol 5:57-66, 2001.

Bile Ducts↗

PubMed2001

Interobserver reproducibility of Gleason grading of prostatic carcinoma: general pathologist.

Only a few large studies of interobserver reproducibility of Gleason grading of prostatic carcinoma exist. Thirty-eight biopsies containing prostate cancer were distributed for Gleason grading to 41 general pathologists in Georgia. These cases had "consensus" Gleason grade groups (2-4, 5-6, 7, and 8-10) that were agreed on by at least 7 of 10 urologic pathologists. The overall kappa (kappa) coefficient for interobserver agreement for these 38 cases was 0.435, barely moderate agreement, with a kappa range from 0.00 to 0.88. There was consistent undergrading of Gleason scores 5-6 (47%), 7 (47%) and, to a lesser extent, 8-10 (25%). In cases with consensus primary patterns, there was consistent undergrading of patterns 2 (32%), 3 (39%), and 5 (30%). Pattern 2 was often (17%) mistaken for pattern 3. Pattern 4 was often undergraded (21%) and also mistaken for pattern 5 (17%). The most significant (P < .005) demographic factor associated with better interobserver agreement was having learned Gleason grading at a meeting or course. We believe that Gleason grading can be learned to a satisfactory level of interobserver reproducibility and have undertaken additional studies that support this belief.

Humans↗

PubMed1998

Broadsheet number 46: Internet for pathologists.

The Internet, and its most user-friendly manifestation, the World Wide Web (WWW), has undergone an exponential growth in the last few years. The volume of medical and pathology related information available has kept pace, making the Internet invaluable tool for the practising pathologist, supplementing traditional hard-copy textbooks and professional journals. E-mail, newsgroups, mailing lists, access to libraries, Medline, atlases, case studies and tutorials are only some of the additional features to which the net offers rapid access from your work-station. To make optimal use of electronic resources, a basic understanding of the hardware, software, communication protocols and information retrieval tools underlying the Internet is desirable. This paper is intended only as a brief introduction to what the Net has to offer to pathology in particular, and medicine in general, it is not meant to supplement the many excellent and more detailed reviews already available (see references). Parallel with the information explosion on the Net, concerns for the quality of posted material and possibility of misinformation have arisen. These issues will be addressed. Website addresses are given in parentheses in the text [e.g.: the website address of the Royal College of Pathologists of Australasia (RCPA) is given as (http:/(/)www.rcpa.edu.au/)] for easy retrieval on your Web browser. Because of the constantly evolving nature of the Web, I apologise in advance if some of the listed sites are no longer current.

Australia↗

PubMed2003

The role of the pathologist in the evaluation of radical prostatectomy specimens.

OBJECTIVE: To compare the difference between the routinely reported pathology records and the results of re-evaluation of the same radical retropubic prostatectomy (RRP) specimens. MATERIAL AND METHODS: The RRP specimens of 114 patients initially reported by a general pathologist for routine purposes were re-examined and re-evaluated blindly with respect to the following parameters: organ confinement; capsular invasion; seminal vesicle invasion; lymph node metastasis; surgical margin positivity; Gleason grade and pathologic stage. Repeat and step sections were performed where necessary. Prostate mapping was done for each patient. RESULTS: A statistically significant discordance between the routine evaluation and the re-evaluation was observed with regard to capsular invasion, organ confinement, Gleason grade and pathologic stage. In addition to pathologic stage, Gleason grade and surgical margin positivity became significant prognostic factors after the re-evaluation. CONCLUSIONS: RRP specimens should be evaluated by an expert prostate pathologist by submitting whole prostate specimens and should include detailed prostate mapping.

Adult↗

PubMedDate not supplied

Summary of panel discussion: past, present and future of toxicologic pathologists and the contributions to hazard identification and molecular mechanisms of action.

One of the major roles for the toxicologic pathologists now and into the future will be to determine the biologic significance of chemically induced biochemical and molecular alterations detected in whole tissue homogenates or cell cultures. The biologically significant effects will then require further analysis to determine their relevance to human health effects. The challenge is to train pathologists for toxicologic and molecular pathology experience without diluting basic pathology skills. Programs and approaches reviewed and suggested during the panel discussion should provide ideas and the impetus for those in a position to engage in similar activities.

Journal Article↗

PubMedDate not supplied

The value of historical control data-scientific advantages for pathologists, industry and agencies.

Historical control tumor data are useful in the interpretation of long-term rodent carcinogenicity bioassays, especially to assess the occurrence of rare tumors and marginally increased tumor incidences. The major prerequisites to compare historical control data with studies under evaluation are the validity and consistency of the respective databases. The RITA (Registry of Industrial Toxicology Animal-data) database for historical data of tumors and pre-neoplastic lesions collects data according to highly standardized procedures including tissue sampling and trimming, histopathology according to internationally harmonized nomenclature and diagnostic criteria, and peer review. All lesions that are entered are unanimously diagnosed according to IARC (Intermational Agency for Research on Cancer)/WHO criteria. The validity of data is additionally confirmed by a complete peer review performed by a database pathologist. Equivocal diagnoses and selected cases are additionally submitted to a panel of RITA pathologists. In the RITA database, there are currently 10,896 rats from 106 studies with more than 17,604 primary tumors and 16,551 pre-neoplastic lesions. The RITA database for historical control data for Wistar and Sprague Dawley rats as well as for different mouse strains is briefly described. Based upon RITA background data, the survival rate of Wistar rats has been consistent over a period of 10 years. The occurrence of tumor-bearing animals also shows a stable percentage over a decade. Additionally, examples of how historical control data may support carcinogenic risk assessment in cases of rare tumors or marginally increased incidences of tumors and pre-neoplastic lesions are given.

Animals↗

PubMedDate not supplied

Models of phonology in the education of speech-language pathologists.

We discuss developments in theoretical phonology and, in particular, at the divide between theories aiming to be adequate accounts of the data, as opposed to those claiming psycholinguistic validity. It would seem that the latter might have greater utility for thye speech-language pathologist. However, we need to know the dominant models of clinical phonology, in both clinical education and practise, before we can promote other theoretical approaches. This article describes preliminary results from a questionnaire designed to discover what models of phonology are taught in institutions training speech-language pathologists in the United States. Results support anecdotal evidence that only a limited number of approaches (phonemic, distinctive features, and processes) are taught in many instances. They also demonstrate that some correspondents were unable to distinguish aspects of theoretical phonology from similar sounding (but radically different) models of intervention. This ties in with the results showing that some instructors of phonology courses have little or no background in the subject.

Humans↗

PubMed1994

Quality improvement practices in clinical and anatomic pathology services. A College of American Pathologists Q-probes study of the program characteristics and performance in 580 institutions.

Participants of the College of American Pathologists Q-Probes program described their quality improvement practices for clinical and anatomic pathology. In 580 institutions, the median time required for a median of 12 indicators of quality was 40 hours/month, with the number of indicators and the time spent directly dependent on bed size (P = .0001). The overwhelming majority of participants reported benefit from their quality improvement programs in terms of patient outcomes, as a management tool, and for risk management. Six indicators in clinical pathology and four indicators in anatomic pathology were used in more than 75% of laboratories, whereas an additional seven indicators in clinical pathology and five in anatomic pathology were used in more than 50% of laboratories. The authors conclude that quality improvement practices are similar among laboratories, and irrespective of increasing regulatory requirements, pathologists and senior laboratory personnel spend large amounts of time for activities that they believe improve the quality of services rendered.

Humans↗

PubMed1991

Changing role of the pathologist.

The pathologist's role in diagnosing and managing patients with breast disorders is changing. The introduction of mammographic screening has altered the spectrum of histological changes presenting to histopathologists for diagnosis, with a greater emphasis on 'borderline' lesions, and has increased the need for specimen radiography as part of the gross examination of biopsy specimens. Reporting prognostic features of carcinomas is required as they may give an early indication of the impact of screening and increased cytological services are needed to reduce the need for open biopsy. Together with a recent Government White Paper, screening has also stimulated various quality assurance initiatives in breast pathology. Increased therapeutic options with the associated need to counsel patients demand more comprehensive pathological services--particularly pre-operative cytological diagnosis, reporting of prognostic features and determining the adequacy of excision of carcinomas. Finally, the management of patients with primarily benign biopsies may be influenced by the detection of various neoplastic or pre-neoplastic lesions of microscopic size by the pathologist.

Breast Neoplasms↗

PubMed1985

Sudden epilepsy deaths and the forensic pathologist.

Sudden unexpected deaths in epileptic persons are not rare events, most commonly encountered by the forensic pathologist rather than the clinician. Such deaths may represent 1-1.5% of all "natural" deaths certified by the medical examiner or coroner. The typical victim is a black male about 30 years of age who tends to abuse alcohol, with a history of generalized epilepsy for more than 1 year and likely for more than 10 years. There are a lack of obvious anatomic causes for the death at autopsy, but 60-70% of cases will have a lesion in the brain (most commonly old trauma) to explain the epilepsy. Most victims have no blood levels of anticonvulsant medications at the time of death. We have evolved a form for use by medical examiner/coroner's investigators at the scene to collect relevant information which will be of assistance to the pathologist in interpreting the case. Estimated prevalence of sudden epilepsy death, mechanisms, and other features of such cases are reviewed briefly.

Adult↗

PubMed1994

Embalming, body preparation, burial, and disinterment. An overview for forensic pathologists.

This article is designed as a basic guide for pathologists who are called upon to examine human remains that have been embalmed and buried for periods brief enough that soft tissues are still intact. Included is a discussion of disinterment laws; guidelines for deciding whether disinterment is warranted; funeral home and cemetery procedures; features of caskets, vaults, tombs, and gravesites; basic burial procedures; and a description of embalming chemicals and the embalming and body preparation process. Emphasis is placed on basic, routine procedures and principles of body preparation, burial, and disinterment, and on the recognition of predictable artifacts that result from such procedures. Although decomposition and skeletonization ultimately occur after burial, bodily changes that occur after burial are not discussed in this article. Disinterment is only sometimes warranted and is best accomplished in such cases through a cooperative effort among those requesting disinterment, the funeral director, the cemetery administrator, and the pathologist. If possible, autopsies should be performed according to law and prior to burial so that the need for disinterment is minimized.

Burial↗