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The Association of Directors of Anatomic and Surgical Pathology have developed recommendations for the surgical pathology report for common malignant tumors. The recommendations for carcinomas of the urinary bladder are reported herein.
The Association of Directors of Anatomic and Surgical Pathology have developed recommendations for the surgical pathology report for common malignant tumors. The recommendations for cutaneous melanoma are reported herein.
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OBJECTIVE: To compare the differences between clinical (FIGO 1971) and surgical-pathological (FIGO 1989) stagings of endometrial carcinoma and to investigate the advantage and the feasibility of the surgical-pathological staging. METHODS: Clinical and pathological data of 290 patients with endometrial carcinoma surgically treated from 1989 to 1995 were retrospectively reviewed. The clinical and surgical-pathologic staging of these patients were compared. The stagings were analyzed with regards to the prognostic factors of endometrial cancer. RESULTS: The differences between clinical and surgical-pathologic staging in stage I and II were 19.7% and 80.5% respectively. 4.2% with metastases to the lymph node, 10.6% with positive peritoneal cytology and 60.5% with myometrial invasion were found in clinical stage I. 51.4% with metastases to the lymph nodes, 46.9% with positive peritoneal cytology and 100.0% of myometrial invasion were observed in clinical stage II. The causes of the differences between these two staging systems are: (1) it was impossible before operation to accurately detect metastases of the lymph nodes and malignant cells in the pelvic-peritoneal cavity; (2) when the dilation and curettage was done before operation, the lesions of an involved cervix might be missed or an uninvolved cervix misdiagnosed as metastatic lesion; (3) there were already cancer cells disseminated in the peritoneal cavity. CONCLUSIONS: The surgical-pathologic staging defines the real extent of endometrial carcinoma. It is advised that at the initial operation attention should be paid to areas beyond the extent of the intended surgery itself. During the initial operation, peritoneal cytology and pelvic and para-aortic lymph node samplings should be done for the purpose of surgical-pathologic staging of the selection of postoperative adjuvant therapy and of providing a clinico-pathological basis for the prediction of prognosis. Since there is a high percentage of misdiagnosis in clinical stage II endometrial carcinoma, special attention is needed in diagnosing and treating such patients.
OBJECTIVE: To explore the practical value of surgical-pathological staging for endometrial carcinoma. METHODS: Ninety-six patients with endometrial carcinoma accepted primary surgical treatment from January 1995 to December 1999 were analyzed retrospectively in our hospital. The clinical and surgical pathologic staging of these patients were compared. RESULTS: The total differences between clinical and surgical-pathologic staging were 44 cases (45.8%), in stage I 24.0%, stage II 76.9%, in stage III 2 of 5 cases. The metastasis rate of pelvic lymph nodes was 10.3%, in stage I 1 of 16 cases, stage II 14.7%. Fourteen patients (14.6%) with extrauterine pelvic metastasis were found, of which 2 of 19 cases in stage I b, 23.1% in stage II. 9.4% with ovarian metastasis, in stage I a 9.7%, stage II 10.3%. 7.9% with positive peritoneal cytology, in stage I 4.0%, stage II 10.3%. 5.2% with omentum metastasis. 2.1% with appendix metastasis. Clinical stages, depth of myometrial invasions, pathological grades and histological types were related to the extent of pelvic and abdominal cavity by univariate analysis (P < 0.01, 0.05). The first three factors were significantly correlated to dissemination by multivariate (P < 0.05). CONCLUSIONS: The surgical-pathological staging is more accurate than the clinical staging, especial in stage II clinical stage depth of myoinvasion, patho-histological grades were closely related to the dissemination in pelvic-abdominal cavity. The surgical-pathological staging is able to assess prognosis objectively and guide therapy for endometrial carcinoma.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
CONTEXT: Because of its complex nature, surgical pathology practice is inherently error prone. Currently, there is pressure to reduce errors in medicine, including pathology. OBJECTIVE: To review factors that contribute to errors and to discuss error-reduction strategies. DESIGN: Literature review. RESULTS: Multiple factors contribute to errors in medicine, including variable input, complexity, inconsistency, tight coupling, human intervention, time constraints, and a hierarchical culture. Strategies that may reduce errors include reducing reliance on memory, improving information access, error-proofing processes, decreasing reliance on vigilance, standardizing tasks and language, reducing the number of handoffs, simplifying processes, adjusting work schedules and environment, providing adequate training, and placing the correct people in the correct jobs. CONCLUSIONS: Surgical pathology is a complex system with ample opportunity for error. Significant error reduction is unlikely to occur without a sustained comprehensive program of quality control and quality assurance. Incremental adoption of information technology and automation along with improved training in patient safety and quality management can help reduce errors.
A mechanism for quality assurance in surgical pathology based on a review of the surgical pathology reports is described. The setting up of performance standards by the participating pathologists before the institution in quality assurance helped in acceptance of the critique of the reviewer. Suggestions are made to improve the quality of the surgical pathology report by incorporating the needs of th surgeons and oncologists, in the hope that the quality assurance process becomes oriented to patients care.
The potential role of morphometry in surgical pathology is discussed. Specific areas in which morphometry could be helpful are in (1) identifying malignant cells in lesions that are largely composed of benign-appearing cells (e.g., follicular thyroid neoplasms), (2) defining reference points in apparent continua (e.g., in the progression from normal colon to adenoma to adenocarcinoma), (3) distinguishing between benign and malignant lesions with similar appearances (e.g., fibromatosis and fibrosarcoma of the soft tissue) and (4) distinguishing between similar-appearing types of malignant neoplasms (e.g., between small-cell carcinoma of the lung and small-cell lymphoma). Morphometric techniques are already being used in DNA ploidy determinations, which frequently bear prognostic information. The measurement of other nuclear and cellular parameters has been used for both diagnostic and prognostic ends; one example is the relation of nuclear roundness to metastatic potential in prostatic carcinomas. Morphometry is now being increasingly applied to histologic sections, as in the prognostic study of lesion thickness in malignant melanoma and the diagnostic study of glandular architecture in colonic adenoma. The use of morphometry can enhance the observation and interpretation of morphologic features, which, combined with the clinical data and the experience of the pathologist, can lead to greater accuracy and precision in surgical pathology diagnoses.
Recent developments in the surgical pathology of the vulva include updated classifications of non-neoplastic epithelial disorders and vulvar intraepithelial neoplasias. Several histologic variants of vulvar squamous cell carcinoma (SCC) with distinct clinicopathologic features have been described. The concept of superficially invasive vulvar SCC continues to be a complex issue. The use of standardized surgical pathology reports and checklists are recent developments in surgical pathology.
The Association of Directors of Anatomic and Surgical Pathology (ADASP) has named several committees to develop recommendations regarding the content of the surgical pathology report for common malignant tumors. A committee of individuals with special interest and expertise write the recommendations, and they are reviewed and approved by the council of ADASP and subsequently by the entire membership. The recommendations have been divided into four major areas: (1) items that provide an informative gross description; (2) additional diagnostic features that are recommended to be included in every report if possible; (3) optional features that may be included in the final report; (4) A checklist (see Appendix). The purpose of these recommendations is to provide an informative report for the clinician. The recommendations are intended as suggestions and adherence to them is completely voluntary. In special clinical circumstances, the recommendations may not be applicable. The recommendations are intended as an educational resource rather than a mandate.
The Association of Directors of Anatomic and Surgical Pathology (ADASP) has named several committees to develop recommendations regarding the content of the surgical pathology report for common malignant tumors. A committee of individuals with special interest and expertise write the recommendations, and they are reviewed and approved by the council of ADASP and subsequently by the entire membership. The recommendations have been divided into four major areas: (1) Items that provide an informative gross description; (2) Additional diagnostic features that are recommended to be included in every report if possible; (3) Optional features that may be included in the final report; and (4) A checklist. The purpose of these recommendations is to provide an informative report for the clinician. The recommendations are intended as suggestions and adherence to them is completely voluntary. In special clinical circumstances, the original recommendations may not be applicable. The recommendations are intended as an educational resource rather than a mandate.