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PubMed2005

Analytic bias of thyroid function tests: analysis of a College of American Pathologists fresh frozen serum pool by 3900 clinical laboratories.

CONTEXT: In proficiency testing surveys, there are differences in the values reported by users of various analytic methods. Two contributors to this variation are calibrator bias and matrix effects of proficiency testing materials. OBJECTIVES: (1) To quantify the biases of the analytic methods used to measure thyroid-stimulating hormone, thyroxine, triiodothyronine, free thyroxine, and free triiodothyronine levels; (2) to determine if these biases are within allowable limits; and (3) to ascertain if proficiency testing materials correctly identify these biases. DESIGN: A fresh frozen serum specimen was mailed as part of the 2003 College of American Pathologists Ligand and Chemistry surveys. The means and SDs for each analytic method were determined for this sample as well as for a proficiency testing sample from both surveys. In the fresh frozen serum sample, target values for thyroxine and triiodothyronine were determined by isotope dilution/liquid chromatography/tandem mass spectrometry. All other target values in the study were the median of the means obtained for the various analytic methods. MAIN OUTCOME MEASURES: Calibration biases were calculated by comparing the mean of each analytic method with the appropriate target values. These biases were evaluated against limits based on intra- and interindividual biological variation. Matrix effects of proficiency testing materials were assessed by comparing the rank of highest to lowest analytic method means (Spearman rank test) for each analyte. PARTICIPANTS: Approximately 3900 clinical laboratories were enrolled in the College of American Pathologists Chemistry and Ligand surveys. RESULTS: The number of methods in the Ligand Survey that failed to meet the goals for bias was 7 of 17 for thyroid-stimulating hormone and 11 of 13 for free thyroxine. The failure rates were 12 of 16 methods for thyroxine, 8 of 11 for triiodothyronine, and 9 of 11 for free triiodothyronine. The means of the analytic method for the proficiency testing material correlated significantly (P < .05) only with the fresh frozen serum means for thyroxine and thyroid-stimulating hormone in the Chemistry Survey and free triiodothyronine in the Ligand Survey. CONCLUSIONS: A majority of the methods used in thyroid function testing have biases that limit their clinical utility. Traditional proficiency testing materials do not adequately reflect these biases.

Calibration↗

PubMed2005

Total long-term within-laboratory precision of cortisol, ferritin, thyroxine, free thyroxine, and thyroid-stimulating hormone assays based on a College of American Pathologists fresh frozen serum study: do available methods meet medical needs for precision?

CONTEXT: It is important that the total long-term precision of laboratory methods meet the medical needs of the patients being served. OBJECTIVES: To determine the long-term within- and between-laboratory variation of cortisol, ferritin, thyroxine, free thyroxine, and thyroid-stimulating hormone measurements using commonly available methods and to determine if these variations are within accepted medical needs. DESIGN: Two vials of pooled frozen serum were mailed 6 months apart to laboratories participating in 2 separate College of American Pathologists surveys. The data from those laboratories that analyzed an analyte in both surveys were used to determine for each method the total variance and the within- and between-laboratory components. SETTING: The study included the A mailing of the 2003 College of American Pathologists Ligand Survey and the C mailing of the Chemistry Survey. MAIN OUTCOME MEASURES: For each analyte, total variance was partitioned into within- and between-laboratory components for each analytic method. The within-laboratory variations were then compared with imprecision criteria based on biological variation. PARTICIPANTS: The laboratories that reported results on the same analyte using the same method in both surveys. RESULTS: For each analyte, the median of the long-term within-laboratory variances of each peer group was 78% to 95% of its total-survey variance, and the median long-term within-laboratory coefficients of variation varied from 5.1% to 7.6%. The number of methods that met within-laboratory imprecision goals based on biological criteria were 5 of 5 for cortisol; 5 of 7 for ferritin; 0 of 7 for thyroxine and free thyroxine; and 8 of 8 for thyroid-stimulating hormone. CONCLUSIONS: For all analytes tested, the total within-laboratory component of variance was the major source of variability in this study. In addition, there are several methods, especially for thyroxine and free thyroxine, that may not meet analytic goals in terms of their imprecision.

Clinical Laboratory Techniques↗

PubMed2006

Cytologic features of adenocarcinoma, not otherwise specified, in conventional smears: comparison of cases that performed poorly with those that performed well in the College of American Pathologists Interlaboratory Comparison Program in cervicovaginal cytology.

CONTEXT: Characteristic cytologic features have been identified that distinguish cases that are consistently identified from those that are sometimes missed in the College of American Pathologists Gynecologic Cytology Program for a variety of different lesions and preparations. OBJECTIVES: To compare the cytologic features of cases of adenocarcinoma, not otherwise specified (NOS), in conventional smears that perform poorly and well. DESIGN: The cytologic features of 21 conventional smear cases of adenocarcinoma, NOS, that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 17 cases that performed extremely well. RESULTS: Cases that performed well were significantly more likely to have greater than 1000 abnormal cells (P = .006), greater than 100 large abnormal cells (P = .006), large nuclei (P < .001), marked nuclear atypia (P = .02), and hyperchromasia (P = .02). Repair-like features were rare in both groups and were not significant (P = .71). CONCLUSION: Conventional smears with a diagnosis of adenocarcinoma that were consistently identified were significantly more likely to have more abnormal cells, larger abnormal cells, larger nuclei, marked atypia, and hyperchromasia than cases that performed poorly.

Adenocarcinoma↗

PubMed1997

Basic rules for the security of frozen section diagnosis through image transmission between anatomo-pathologists.

Telemedicine can provide an alternative solution to the lack of medical resources in areas where the population is no longer dense enough to justify the temporary or permanent presence of certain specialists such as anatomo-pathologists. In the long run certain pre-operational frozen section examinations cannot be carried out without putting the quality of healthcare at stake. The telematic transmission of macro and microscopic images of lesions, under the supervision of a surgeon, to an anatomo-pathologist consultant located off premises allows for the maintenance of equitable care of acceptable quality.

Computer Security↗

PubMed1983

View of the young pathologist: a wavering future.

What will be the fate of future generations of hospital-based pathologists? In the next few years, the author of this article foresees a new breed of MD emerging from the laboratory. This up-and-coming pathologist must be a skilled practitioner of medicine, yet one who wears many hats. He must have earned the respect of his clinical colleagues, kept abreast of the rapidly changing technology at his disposal, and discovered a balance for the role pathology must play for the patient and society.

Hospital Departments↗

PubMed1986

The prognosis for the hospital-based pathologist--Part 2.

Last month the authors diagnosed the condition of the hospital-based pathologist and prescribed a large dose of competitive activities to improve security and financial well-being. In this concluding article the complications of this treatment are examined, highlighting the issues that pathologists must resolve as they venture forth into a new practice environment.

Hospital Departments↗

PubMed1980

A pathologist's delight.

In this article, the author describes how classification, "a distinctively human activity," is integral to the practice of pathology and a source from which pathologists often derive much pleasure. Dr. Henson is pathologist, National Cancer Institute, Bethesda, Maryland.

Classification↗

PubMed1999

Predictive factors in prostate cancer: current concepts from the 1999 College of American Pathologists Conference on Solid Tumor Prognostic Factors and the 1999 World Health Organization Second International Consultation on Prostate Cancer.

Many clinically important predictive factors in prostate cancer are derived from light microscopic examination of tissue specimens by the pathologist. Two separate international consensus conferences held in 1999 addressed the contemporary status of such prognostic factors, sponsored by the College of American Pathologists (CAP) and the World Health Organization (WHO). Both conferences concluded that the following factors are recommended for routine use based on evidence from multiple published trials: TNM stage, histological grade using the Gleason system, surgical margin status, and serum prostate-specific antigen concentration. The WHO conference additionally recommended use of WHO nuclear grade, location of cancer within the prostate, and pathological effects of treatment. Other factors were categorized as promising or of unproven utility, including a wide variety of histopathologic and genetic markers. Standards are needed for analysis and quantitation of methods of tissue analysis, particularly for immunohistochemical studies and genotypic studies. This report describes the recommendations and conclusions of these two conferences.

Apoptosis↗

PubMed2000

The pathologist in breast cancer: contemporary issues in the interdisciplinary approach.

The pathologist's contribution to the interdisciplinary team approach in breast cancer management is a cornerstone for decision-making. Continuous communication with the radiologist, surgeon, oncologist, and radiation oncologist is essential. Preoperative diagnosis, surgical specimen work-up with size determination, sentinel lymph node examination, processing forms to facilitate the work-up, and diagnostic templates are some of the items covered in this review of the pathologist's contribution to the interdisciplinary team in breast cancer. Use of diagnostic templates or synoptic reports routinely provide the complete diagnostic information required for treatment decisions.

Biopsy, Needle↗

PubMed1979

[Medical secrecy and the pathologist's obligation of notification (author's transl)].

The pathologist, like every other doctor, is pledged to secrecy. The pledge of secrecy also extends to what he has found in the body of the deceased be they secrets of the patient or of a third party. Third party secrets are not protected by the obligation of secrecy if safequarding them would be against the "projected interests of the patient". The present obligation to notify according to the burial laws of some states applies to pathologists even when possible medical contributary faults are established, but he faces a dilemma which cannot be solved juridically at present. Alteration of the law should take this into account.

Accidents, Home↗

PubMed2001

[Role of the pathologist in management of familial cancers].

Pathologists have long been in charge of the morphological analysis of human cancers, and have been used to be at the end of a chain in the diagnostic procedure. With the search for somatic mutations and new prognostic markers, the pathologists have become key-members in oncogenetics. New modalities for tissue fixation, microdissection of tumors, and forwarding of specimens to the molecular biologists are therefore requested. Two examples are presented to illustrate the need for tumor DNA, with the diagnostic utility of a microsatellite testing as a prescreening test in HNPCC tumors, and the search for new prognostic markers in some inherited predispositions to breast cancers.

Acetic Acid↗

PubMed1999

[Einar Sjövall - a forensic pathologist in Lund with a social pathos].

The Swedish forensic pathologist Einar Sjovall (1879-1964) lived and worked mainly in Lund, southern Sweden, in the early decades of this century. He became famous, not only for particular broad medical knowledge and skills, but also for his devotion to social questions. It was obvious to Sjovall, in the same way as to the German pathologist Rudolf Virchow, that medicine is a prism for many aspects of society and the way people live and work. In other words, Sjovall was convinced that public health measures and prevention of alcohol abuse were very important to improve the health of the Swedish people. Therefore he wrote several papers and books, not only on strictly academic matters, but also on the need of public health reforms and structural changes within the health care sector, eg. building primary health care. This seemed radical at his time, but the development in later years has proved Sjovall to be right in many ways. He was also a respected teacher at the Medical Faculty, University of Lund, and wrote textbooks on forensic medicine. During the Second World War Sjovall had to face and cope with several political problems in the academic world, being one of the leading academics of the university. He always tried to defend positions of humanism and opposition to nazi rule in occupied Denmark and Norway. A current political debate in Sweden has focused on abortion laws from the 1930's and 1940's. Sjovall was involved in this process, as member of a national committee, and advocated abortion for women with certain conditions, but always in a restricted way and after full consent had been obtained. In this delicate matter he was obviously guided by his background in social medicine. This highlights the crucial questions raised by medical decision-making in the border-areas between societal needs and professional thinking in academic medicine.

Forensic Medicine↗

PubMed2001

[Communication between urologist and pathologist. Proposal for the standardization of histological tests requests for neoplasms].

The aim of this work is to propose a new clinical data system which should accompany the histological sample for the histologic diagnosis made by the pathologist. Six different schedules on the most important urological tumours are presented: prostate (needle biopsies and surgical approach), bladder (endoscopic procedure and open surgery), kidney and ureter, testis. In each schedule the urologist provides, in a scheme, the clinical report needed for the pathologist's final diagnosis. A clear explanation of the clinical data and a faster method of filling in the form are the qualifying elements of these schedules.

Forms and Records Control↗

PubMed1999

Primary adenocarcinoma of the urinary bladder: a study of 6 cases from the pathologist's point of view.

OBJECTIVE: The clinical presentation of adenocarcinoma is not different from the usual transitional cell carcinoma, hence the histological diagnosis plays an important role in the interpretation of cystoscopic biopsies. Six cases of primary adenocarcinoma of the urinary bladder are described from the pathologist's point of view. The diagnostic problems encountered in these cases are highlighted. METHODS: 6 cases of primary adenocarcinoma of the urinary bladder were encountered from 1983 to 1997. Relevant clinical data were analyzed. Multiple sections from the tumor and adjoining areas of the bladder were studied. Five patients were aged 50 to 75 years and the youngest patient was 22 years old. RESULTS: Hematuria and retention of urine were common presenting symptoms. Histologically, the diagnostic problems faced were mucinous metaplasia vs mucinous carcinoma, clear cell adenocarcinoma of the urinary bladder vs clear cell carcinoma of the pelvic kidney. We had one case of urachal and 5 cases of non-urachal carcinoma. CONCLUSIONS: Primary adenocarcinoma of the urinary bladder is an unusual tumor accounting for 0.5 to 2% of all bladder malignancies. They are commonly seen in endemic areas like schistosomiasis. By origin they are grouped into urachal and non-urachal carcinoma and histologically grouped as enteric, mucinous, clear cell and adenocarcinoma not otherwise specified. Direct consultation with the urologist, clinical findings, investigations and careful screening of histological material will help the pathologist to arrive at a correct diagnosis.

Adenocarcinoma↗

PubMed1975

[Pathology in the U.S.A. A glut of pathologists, the role of the autopsy and the future of the "clinical pathology"].

This analysis deals with selected questions regarding the status of pathology in the United States. For a long time, the number of pathologists, both in practice and in training, had been deemed inadequate, but present trends indicate the existence of a considerable surplus of specialists in this discipline. The autopsy is still an important field of endeavor for the American pathologist even tbhough autopsy rates have drastically declined everywhere and the exact role of this procedure is being reevaluated. The concept of "clinical pathology" which seeks to encompass a whole conglomerate of heterogeneous disciplines and still dominates the practice of pathology in North America has come under attack; some observers plead for the total separation of laboratory medicine from pathology as well as for the systematic and intensive development of subspecialties within the field of pathology.

Autopsy↗

PubMed1965

THE BATTERED CHILD SYNDROME. RESPONSIBILITIES OF THE PATHOLOGIST.

A pathologist working in a medical examiner's or coroner's office dealing with the syndrome of the battered child is responsible for performing a complete external examination of the body with careful detailed description of all injuries, supplemented by roentgenograms of the entire skeleton, taken before the autopsy, to determine the existence of old or recent bone injury. The complete autopsy with microscopic studies must include the dissection and microscopic study of the osseous lesions.All findings possibly related to trauma are recorded in diagrams and photographs in color. The pathologist's findings and police reports dealing with the circumstances of the injuries and death must be evaluated with utmost care to determine whether inconsistencies exist in their statements as to the time and the nature of the events associated with the injuries. When confronted with the findings, suspects frequently confess.

Autopsy↗

PubMed2003

Pathologist and HIV--are safe autopsies possible?

Pathologists are at particularly high risk for blood contamination and skin injuries, so they are vulnerable to blood borne pathogens, like HIV. This article describes the first and the only one documented case of occupational HIV transmission in the world concerning American pathologist. The factors increasing the risk of contracting infection during the autopsy on the patient who has died of AIDS are considered. World-known recommendations to follow in such autopsy are described. The importance of compliance with universal precautions and the necessity of knowledge of the post-exposure prophylaxis are pointed as a way to avoid HIV infection.

Autopsy↗

PubMed2003

[Biopsy of breast microcalcifications using an 11-Gauge vacuum-assisted device: roles and challenges for the pathologist].

Stereotactic 11-Gauge vacuum-assisted biopsy provides a valuable tool in the diagnosis of mammographically detected breast microcalcifications. However, this new diagnostic technology presents some limitations and requires a close collaboration between radiologists, pathologists and physicians. The aim of this work is to propose a practical approach in the management of large core biopsies and to summarize the different difficulties faced by the pathologist in the management and histological interpretation of specimens issuing from this device.

Biopsy, Needle↗