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PubMed2000

Level of agreement between opinions of medical examiner investigators and forensic pathologist medical examiners regarding the manner of death.

To evaluate the level of agreement between medical examiner investigators' opinion of the manner of death and what the manner of death was as certified by forensic pathologist medical examiners (MEs), we reviewed the case records stored in a database of all deaths reported to the office of the medical examiner in Fulton County, Georgia. Of 15,771 deaths reported to the office during a 10-year period, a difference exists in 1908 cases. In 900 natural deaths, the investigators recorded 135 accident, 10 homicide, 10 suicide, and 745 undetermined manners of death. In 755 accidental deaths, the investigators recorded 16 natural, 8 homicide, 13 suicide, and 718 undetermined manners of death. In 107 homicides, the investigators recorded 12 natural, 8 accident, 0 suicide, and 87 undetermined manners of death. In 70 suicides, the investigators recorded 9 natural, 9 accident, 3 homicide, and 49 undetermined manners of death. In 61 deaths classified as undetermined, the investigators recorded 25 natural, 13 accident, 17 homicide, and 6 suicide manners of death. In 15 deaths, the discrepancy exists due to an apparent error in the database information. This study confirms a high concordance between investigator and ME opinion regarding manner of death but also documents the need for case review and autopsies by forensic pathologists to confirm the investigators' opinion of the manner of death, determine the manner of death when the investigator selects undetermined, and on occasion, refute the investigators' opinion regarding the manner of death.

Cause of Death↗

PubMed2001

Phonoscopy--a valuable tool for otolaryngologists and speech-language pathologists in the management of dysphonic patients.

OBJECTIVES: To describe the phonoscopic evaluation, present a rationale for its use, and demonstrate its use in identifying laryngeal and vocal pathology. STUDY DESIGN: Retrospective review. METHODS: One hundred consecutive cases of new patients referred to our voice clinic team were reviewed. Findings on laryngeal examination as reported by the referring otolaryngologist were compared with our findings on "phonoscopic" examination. The phonoscopic examination combines the traditional voice evaluation performed by speech-language pathologists with endoscopy, which is relatively new to the voice clinician, to visualize the larynx during a broad sample of phonatory tasks. Patients with spasmodic dysphonia or tremor were excluded from the study. RESULTS: In 26 cases of the 100 reviewed, our observations were consistent with those of the referring otolaryngologist. In 32 cases, we agreed with the referral diagnosis, but found additional factor(s) related to pathology. In 42 cases, our findings differed from those of the referring physician. CONCLUSIONS: Results support our contention that phonoscopic evaluation can be of value to both the otolaryngologist and speech-language pathologist. It is particularly recommended in those patients whose dysphonia is unexplained following diagnostic laryngeal examination by the otolaryngologist, in cases in which voice use is a suspected factor in the pathology, and when voice therapy is a recommended treatment for a dysphonic patient.

Diagnosis, Differential↗

PubMed2006

Mature B-cell lymphoma in children and adolescents: International group pathologist consensus correlates with histology technical quality.

In pediatric mature B-cell non-Hodgkin lymphoma, international pathologist diagnostic agreement was previously evaluated using the Revised European-American Lymphoma Classification. Surgical biopsy histology technical quality (HTQ) is variable and may affect diagnostic accuracy. This study evaluated diagnostic agreement correlated with HTQ. Surgical biopsies obtained from international protocol FAB LMB96 Treatment of Mature B-Cell Lymphoma/Leukemia for Burkitt lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), and high-grade B-cell lymphoma Burkitt-like (BLL), were independently reviewed by hematopathologists from 3 national groups (Children's Cancer Group, Société Française d'Oncologie Pédiatrique, and United Kingdom Children's Cancer Study Group) to determine each national diagnosis and a final diagnosis. HTQ grades for microscopic tissue sections included: good; medium; low; inconclusive. Final diagnoses in 187 cases included: BL 87 (47%); BLL 20 (11%); DLBCL 64 (34%); other 16 (9%). HTQ grades included: good 10 (5%); medium 100 (54%); low 75 (40%); inconclusive 2 (1%). The rate of uniform agreement between the national diagnoses was significantly higher with good or medium HTQ (62%) than with low HTQ (33%) (P = 0.001). In conclusion, in pediatric mature B-cell non-Hodgkin lymphoma, international pathologist diagnostic agreement is significantly higher in surgical biopsies with better HTQ. Poor HTQ may adversely impact diagnostic ability and affect prognosis and therapeutic management when different treatment regimens are employed for DLBCL versus BL/BLL.

Adolescent↗

PubMed2006

Update on the Gleason grading system for prostate cancer: results of an international consensus conference of urologic pathologists.

The Gleason system for prostate cancer was based on a study of 270 patients from the Minneapolis Veterans Administration Hospital in 1966-1967. In 1974, Gleason and the Veterans Administrative Cooperative Urological Research Group expanded this study to 1032 men. These studies formed the basis of the Gleason grading system, which is now endorsed as the primary grading system for prostate cancer by the World Health Organization, the Armed Forces Institute of Pathology Fascicle on prostate cancer, the Association of Directors of Anatomic and Surgical Pathology, and the College of American Pathologists. In the nearly 40 years since its inception, several aspects about prostate cancer and its management have changed, most notably serum prostate-specific antigen, transrectal ultrasonography, 18-gauge needle biopsy sampling, immunohistochemistry for the diagnosis of cancer, and radical prostatectomy and radiation therapy as primary treatment modalities. Several aspects of the disease, and consequently the reporting needs, have changed such as reporting cancer on multiple cases in needle biopsies, multiple nodules in prostatectomy, tertiary patterns, variants and variations in prostate cancer. The application of the Gleason system, therefore, has varied considerably in contemporary surgical pathology practice. An International Consensus Conference attended by 80 urologic pathologists from 20 countries was convened to discuss clarifications and modifications to the Gleason system. This article serves as a brief overview and summary of the proceedings that have been published in detail in recent literature.

Adenocarcinoma↗

PubMed2001

New Zealand pathologists: a case study in occupational control.

This paper examines the progressive exertion of external managerial control over New Zealand pathologists as the country's New Public Management health reforms were implemented during the 1990s. Perspectives on professionalism, and its role in the effective use of resources, are discussed as part of the examination of this shift in decision-making power from pathologists to external management. Our analysis, based on a range of archived and interview data collected over the period 1997-2000, suggests that publicly unacceptable compromises in pathology service quality were risked by the pursuit of tight bureaucratic and free market controls over pathology practice. The paper concludes with suggestions for a health professional control model facilitative of maximal health gain.

Decision Making, Organizational↗

PubMed2007

Barrett's oesophagus--a pathologist's view.

Barrett's oesophagus, a precancerous condition for oesophageal adenocarcinoma, detected on endoscopy and confirmed on histology, shows intestinal metaplasia of the lower oesophagus. The significance of microscopic foci of intestinal metaplasia at the gastro-oesophageal junction, corresponding either to so-called 'ultrashort' segment Barrett's oesophagus, or to carditis with intestinal metaplasia, is still a matter of debate. The surveillance of patients with Barrett's oesophagus is still based on systematic biopsy sampling of Barrett's mucosa on endoscopy, looking for dysplasia. Although well-established classifications of dysplasia are now used by most pathologists, there remain numerous problems with this subjective marker (sampling, diagnostic reproducibility, natural history, etc). Therefore, many alternative biomarkers have been proposed, but only DNA aneuploidy, proliferation markers and p53 loss of heterozygosity/overexpression have been shown to be of some use at the present time. Some endoscopic improvements already allow a better selection of biopsies, and it may be that in future new technologies will allow 'virtual biopsies'. On the other hand, the role of pathologists now extends to the evaluation of new therapeutic modalities of early neoplastic lesions in Barrett's oesophagus, especially endoscopic mucosal resection.

Adenocarcinoma↗

PubMed2004

Perinatal pathology in the context of a clinical trial: attitudes of neonatologists and pathologists.

OBJECTIVE: To describe the attitudes of neonatologists to trial related perinatal postmortem examinations (PMs), in the light of declining perinatal PM rates and poor levels of participation in pathology studies. METHODS: A qualitative study was carried out, using semistructured interviews. Twenty six neonatologists from five UK neonatal units were interviewed; five UK perinatal pathologists also contributed to the study. The professionals involved were all linked to one or both of two neonatal trials. RESULTS: Pathologists expressed concern over the difficulties experienced in UK perinatal pathology and the impact on research of inadequate levels of samples. The interviews with neonatologists reveal discomfort over approaching bereaved parents for PMs, and a widespread concern that parents should not be further distressed or feel under pressure to consent. Although there was support for neonatal trials, the study highlights a view that PMs may be unnecessary if the cause of death seems apparent or when a baby was born prematurely, and a devaluation of PMs among some younger staff. Poor rates of participation in pathology studies may be accounted for by a notable sense of disconnection between trial interventions and pathology studies. CONCLUSIONS: Neonatologists were concerned to protect vulnerable parents and varied in whether they saw this as compatible with inclusion in trial related pathology studies. Dedicated research is needed to document and gain an understanding of the consent process and should examine the usefulness and impact of consent forms. It should assess whether professionals might benefit from training, to help parents to come to their decisions.

Adult↗

PubMed2006

External quality assessment slide schemes: pathologists' experiences and perceptions.

BACKGROUND: External quality assessment schemes (EQAS) in pathology have been established in the United Kingdom for several years with the aim of raising standards. OBJECTIVE: To determine the experiences and perceptions of pathologists undertaking EQAS. METHODS: A questionnaire was distributed to histo/cytopathologists in the south and west of England. RESULTS: A large proportion of pathologists responding felt that the EQAS was educational, and 69% said participation had encouraged them to undertake additional educational activities. Some reservations were expressed about marking schemes. Asked if EQAS using digital images (CD-ROM or web based) rather that glass slides were valid alternatives two thirds responded no, despite 75% claiming to have appropriate IT skills. CONCLUSIONS: EQAS play a valuable role in helping to maintain standards in histopathology and cytopathology. Some reservations were expressed about the marking schemes and further work is needed to establish a robust marking method. Significant barriers need to be overcome if digital EQAS are to be successfully implemented.

Attitude↗

PubMed2006

Why I became a surgical pathologist with interest in breast disease.

Factors that influenced my decision to become a surgical pathologist are presented below. Early childhood experience shaped my interest in epidemiology and public health. Formal education at Johns Hopkins Medical School cemented my decision to become a surgical pathologist and elective time with pioneers in the field of surgical pathology sealed my career choice. As a mentor, I have tried to teach residents and fellows how to practice pathology, not merely how to make a diagnosis.

Breast Diseases↗

PubMed2006

Coeliac disease: an update for pathologists.

Coeliac disease is the manifestation of an immune hypersensitivity reaction towards gluten and related proteins, in genetically predisposed people. Although the precise pathogenesis of this condition remains to be fully elucidated, it is probably multifactorial in origin. The diagnosis of coeliac disease has traditionally depended on intestinal biopsies alone; nowadays, the diagnosis has been expanded to include an array of serological markers. This review is intended to offer pathologists an update of the relevant history and immunopathology pertaining to coeliac disease and also to offer recommendations on the ongoing responsibilities of the pathologist in the diagnosis and reporting of coeliac disease.

Biopsy↗

PubMed1988

The confidential enquiry into maternal deaths: its role and importance for pathologists.

Comparatively few pathologists seem to know of the existence of the confidential enquiry into maternal deaths and fewer still know anything of its aims or its methods of obtaining confidential information. As the success of any such enquiry depends greatly on the accuracy and completeness of necropsy, histological, and other laboratory reports a brief account of the report itself and the role of pathologists in it may not be out of place.

Adolescent↗

PubMed1990

Royal College of Pathologists' United Kingdom pilot study of laboratory accreditation. The College Accreditation Steering Committee.

The Royal College of Pathologists recently commissioned a pilot study to assess the feasibility, desirability, and cost of establishing a national scheme for laboratory accreditation in the United Kingdom. Using a format similar to that designed by the College of American Pathologists, eight inspectors visited 24 laboratories comprising the major disciplines of two district hospitals, two teaching hospitals, a specialised (paediatric) hospital and a private hospital. Nine were considered accreditable without reservation, but 15 had deficiencies identified of differing importance which needed to be corrected before accreditation could be awarded. Problems identified were variable, but none related to technical performance and many did not require extra resources to correct. The exercise was conducted without organisational difficulty at an approximate direct cost of 300 pounds per laboratory. The study shows that the format used could form the basis of a cost effective nationwide strategy. The type of problems identified suggest that such a strategy is more likely to succeed if it is organised from within the pathology professions.

Accreditation↗

PubMed2002

How could pathologists improve the initial diagnosis of colitis? Evidence from an international workshop.

BACKGROUND: The taking of multiple colorectal biopsies is in widespread use although there is little research into their benefit for the pathological diagnosis of inflammatory bowel disease. There is also still debate about appropriate morphological criteria for interpreting these biopsies. AIMS: To determine the effect of single versus multiple biopsies on the accuracy of diagnosis and to study the accuracy and reproducibility of the different criteria used in the diagnosis of multiple biopsies by expert and non-expert pathologists. METHOD: Thirteen expert and 12 non-expert international diagnostic histopathologists attended a workshop. Sixty cases with full follow up were viewed, blinded, in two rounds. Diagnoses were made on rectal biopsies and then full colonoscopic series. RESULTS: Experts correctly identified 24% of Crohn's disease cases (non-experts, 12%) from the rectal biopsies. This improved to 64% (non-experts, 60%) with the full series. The accuracy of the diagnosis of ulcerative colitis also improved slightly with the full series from 64% to 74% overall. Experts had a similar (moderate) level of agreement and accuracy to non-experts. For Crohn's disease, the likelihood ratios (LR) for the most important individual features were 12.4 for granulomas and 3.3 for focal or patchy inflammation. Features favouring ulcerative colitis were diffuse crypt architectural irregularity (LR, 3.4), general crypt epithelial polymorphs (LR, 3.7), and reduced crypt numbers (LR, 2.9). CONCLUSIONS: A full colonoscopic series gave more accurate diagnosis than a rectal biopsy. Accurate pathologists used the same evidence based criteria for multiple biopsies as for single biopsies.

Biopsy↗

PubMed2004

Inter-observer variation between pathologists in diffuse parenchymal lung disease.

BACKGROUND: There have been few inter-observer studies of diffuse parenchymal lung disease (DPLD), but the recent ATS/ERS consensus classification provides a basis for such a study. METHODS: A method for categorising numerically the percentage likelihood of these differential diagnoses was developed, and the diagnostic confidence of pathologists using this classification and the reproducibility of their diagnoses were assessed. RESULTS: The overall kappa coefficient of agreement for the first choice diagnosis was 0.38 (n = 133 biopsies), increasing to 0.43 for patients (n = 83) with multiple biopsies. Weighted kappa coefficients of agreement, quantifying the level of probability of individual diagnoses, were moderate to good (mean 0.58, range 0.40-0.75). However, in 18% of biopsy specimens the diagnosis was given with low confidence. Over 50% of inter-observer variation related to the diagnosis of non-specific interstitial pneumonia and, in particular, its distinction from usual interstitial pneumonia. CONCLUSION: These results show that the ATS/ERS classification can be applied reproducibly by pathologists who evaluate DPLD routinely, and support the practice of taking multiple biopsy specimens.

Biopsy↗

PubMed2006

The education of speech-language pathologists in the United States of America.

The education of speech-language pathologists and audiologists is provided by over 250 colleges and universities at the master's and doctoral level. The educational programs for speech-language pathologists and audiologists consist of academic coursework, clinical education, and supervised experience. Coursework and clinical education include study in liberal arts and science and human communication in addition to study in all aspects of communication sciences and disorders, including cultural and linguistic diversity. The programs may take 2 to 3 years beyond the bachelor's degree. Audiologists will require a doctoral degree beginning in 2012. Educational programs are accredited by the Council on Academic Accreditation of the American Speech-Language Hearing Association. Individuals who wish so earn the Certificate of Clinical Competence from the American Speech-Language Hearing Association.

Adolescent↗

PubMedDate not supplied

The pathologist and toxicologist in pharmaceutical product discovery.

Significant change is occurring in the drug discovery paradigm; many companies are utilizing dedicated groups from the toxicology/ pathology disciplines to support early stage activities. The goal is to improve the efficiency of the discovery process for selecting a successful clinical candidate. Toxicity can be predicted by leveraging molecular techniques via rapid high-throughput, low-resource in vitro and in vivo test systems. Several important activities help create a platform to support rapid development of a new molecular entity. The proceedings of this symposium provide excellent examples of these applied concepts in pharmaceutical research and development. Leading biopharmaceutical companies recognize that a competitive advantage can be maintained via rapid characterization of animal models, the cellular identification of therapeutic targets, and improved sensitivity of efficacy assessment. The participation of the molecular pathologist in this quest is evolving rapidly, as evidenced by the growing number of pathologists that interact with drug discovery organizations.

Animals↗

PubMedDate not supplied

The role of the toxicologic pathologist in the preclinical safety evaluation of biotechnology-derived pharmaceuticals.

Biotechnology-derived pharmaceuticals, or biopharmaceuticals, represent a special class of complex, high molecular weight products, such as monoclonal antibodies, recombinant proteins, and nucleic acids. With these compounds, it is not appropriate to follow conventional safety testing programs, and the preclinical "package" for each biopharmaceutical needs to be individually designed. In addition to standard histopathology, the use of molecular pathology techniques is often required either in conventional animal studies or in in vitro tests. In this review, the safety evaluation of biopharmaceuticals is discussed from the perspective of the toxicologic pathologist, and appropriate examples are given of the use of molecular pathology procedures. Examples include the use of in situ hybridization to localize gene therapy vectors, the assessment of vector integration into genomic DNA by the polymerase chain reaction (PCR), and the use of immunohistochemistry to evaluate the potential cross-reactivity of monoclonal antibodies. In situ PCR techniques may allow for confirmation of the germ cell localization of nucleic acids and may therefore facilitate the risk assessment of germline transmission. Increased involvement with biopharmaceuticals will present challenging opportunities for the toxicologic pathologist and will allow for much greater use of molecular techniques, which have a critical role in the preclinical development of these compounds.

Animals↗

PubMed1976

Influence of coroners' officers and pathologists on suicide verdicts.

Three-hundred-and-thirty cases of unnatural death, leading to 110 open verdicts, 110 verdicts of suicide and 110 of accident, from the Inner West London Coroner's District have been examined to see if particular coroner's officers or pathologists were associated with disproportionate numbers of suicide verdicts. No significant deviations from the expected numbers were found. Coroner's officers probably share common ideas about the features defining suicide, and so do pathologists.

Accidents↗