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At least 721 records · Page 40Linked to original sources
PubMed2005

[Recent data on lobular neoplasia of the breast: the pathologist's opinion].

Lobular neoplasia is the new WHO terminology that encompasses the so-called lobular carcinoma in situ and atypical lobular hyperplasia. Besides the classical forms, particular variants have been described, which are mammographically detectable with distinct histologic patterns and behaviour. These variants are characterized by pleomorphic cells, necrosis with calcifications and may be associated to an invasive lobular carcinoma. Their clinical issue looks more like a preinvasive lesion than a marker of increased risk. Thus, their identification on biopsy requires a surgical reexcision. Hybrid forms, sharing a mixed lobular and ductal morphology and phenotype, have also been mentionned. Despite a lack of prognostic evaluation, it seems logical to recommend a subsequent surgical investigation when they are observed. Classical forms are usually managed by simple follow-up, although this attitude does not make a consensus among pathologists. Lobular neoplasia are not all indolent lesions and belong to an heterogeneous group that percutaneous guided biopsies have emphasized. They should be managed in a pluridisciplinar way and correctly diagnosed on percutaneous biopsies as well as surgical specimens.

Biopsy↗
PubMed1991

Influence of laboratory test volume and geographic location on maternal alpha-fetoprotein results. Information from the College of American Pathologists Maternal alpha-fetoprotein Survey.

Using 1989 College of American Pathologists Maternal alpha-fetoprotein (AFP) Survey data, we found virtually no association between a laboratory's AFP test volume and the reliability of reported multiples of the median uncorrected for maternal weight, race, or diabetes. We also found no differences in AFP gestational age-specific medians across geographic regions of the United States. We did find that clinically important adjustments for maternal weight, race, and diabetes were made more frequently by laboratories with higher clinical AFP test volumes. Consequently, we believe that a minimum AFP test volume for satisfactory performance of AFP testing, as proposed by several professional organizations, cannot be justified on inability of laboratories with low AFP test volumes to quantify AFP in clinical specimens or calculated uncorrected multiples of the medians accurately. However, high-volume laboratories enhance clinical utility of the reported AFP results by making clinically important adjustments of their reported multiples of the medians, and they tend to provide more accurate clinical interpretations. Therefore, we recommend that efforts to improve the quality of AFP testing nationally should focus on improving the ability of laboratories to provide appropriate adjustments to and clinical interpretation of their AFP results, in addition to more traditional efforts directed toward quality control of the analytical aspects of the AFP assay.

Clinical Laboratory Techniques↗
PubMed2006

Laboratory benchmarking: the College of American Pathologists' experience.

Benchmarking is an important part of performance evaluation in the clinical laboratory. When used effectively, benchmarking can lead to significant changes and performance improvement. This article reviews the experience of the College of American Pathologists (CAP) with benchmarking clinical laboratory expenses and presents data that summarizes recent laboratory trends identified through CAP's benchmark data.

Benchmarking↗
PubMedDate not supplied

Superficial oeso-gastric cancer and endoscopic mucosal resection: the pathologist's approach.

Dysplasia is the earliest phase in cancer development that can be recognized by routine morphology. High grade dysplasia, intraepithelial carcinoma and in situ carcinoma are synonymous terms identifying a non invasive lesion whereas superficial (early) carcinoma is defined as a lesion confined to the mucosa or to the mucosa and sub-mucosa with or without lymph node metastasis. In the Vienna classification, proposed by a panel of Western and Japanese experts in 2000, the term "dysplasia" was replaced by the term "intraepithelial neoplasia" because this term defines more clearly the nature and the extent of the lesion, allowing recommendations for further diagnostic and therapeutic measures. Intraepithelial neoplasia is divided into two groups: low grade and high grade. Superficial oeso-gastric cancer can be treated by endoscopic mucosal resection (EMR). EMR provides specimens that must be handled and reported as surgical specimens by the pathologist.

Carcinoma in Situ↗
PubMed1992

Emergency department stat test turnaround times. A College of American Pathologists' Q-Probes study for potassium and hemoglobin.

We report aggregate turnaround times (TATs) from phlebotomy to result reporting of emergency department patients' hemoglobin and potassium results for 722 subscribers to the College of American Pathologists Q-Probes program. Approximately 40,000 specimens were obtained for each analyte. Median interinstitutional TAT time of 25 minutes for hemoglobin and 36 minutes for potassium varied little by shift, weekdays, or weekends. The type of personnel collecting the specimen and the method of specimen transport were the most important factors affecting TATs. Specimen transit times accounted for approximately one third of the total TATs, but when couriers transported hemoglobin specimens, the median transit time was equivalent to the median intralaboratory test TAT. The influence of various measures used to improve test transit and TATs is presented.

Bloodletting↗
PubMed1991

Cocaine, fetal loss, and the role of the forensic pathologist.

Adverse obstetrical outcomes are often associated with maternal cocaine use. These have included intrauterine growth retardation, abruptio placentae, and an increased incidence of spontaneous abortion and pre-term labor. This report details the case of an 18-week-gestation fetus recovered from a sewage treatment plant. A brain specimen was positive for cocaine. With the present epidemic of cocaine abuse, it is important for the forensic pathologist to seek toxicologic evidence of cocaine in all suspicious fetal and neonatal deaths.

Brain Chemistry↗
PubMed1991

Intralaboratory performance and laboratorians' expectations for stat turnaround times. A College of American Pathologists Q-Probes study of four cerebrospinal fluid determinations.

More than 400 laboratories participated in the module of the College of American Pathologists' quality assurance program, Q-Probes, which measured intralaboratory turnaround time (TAT) of stat cerebrospinal fluid tests. Four determinations encompassing more than 14,000 specimens were monitored and intralaboratory TATs were compared with participants' TAT goals. The median TATs were as follows: cell count, 32 minutes; glucose, 34 minutes; protein, 37 minutes; and Gram's stain, 45 minutes. Between 14% and 21% of participants (test dependent) met their goals 100% of the time, with 72% of the determinations completed within the time laboratorians required. Standard statistical stepwise regression analysis was used to model influence of up to eight factors on TAT. Correlations were test and bed-size dependent, but ranged from a high of .23 to a low of .02. Only computerized reporting and instrumentation measuring protein and glucose had a consistent effect, delaying TAT, whereas use of a stat laboratory, one workstation, automation, computerized order entry, and centralized processing gave variable results. We conclude that laboratorian goals for cerebrospinal fluid test TAT are met most of the time, and that a stepwise regression analysis poorly explains factors that statistically influence TAT.

Cerebrospinal Fluid↗
PubMed1991

Effect of lupus anticoagulants on the activated partial thromboplastin time. Results of the College of American Pathologists survey program.

Lupus anticoagulants are antibodies that interfere with in vitro phospholipid-dependent coagulation reactions. In vivo, they have been associated with a variety of thromboembolic problems. Samples from patients with lupus anticoagulants were included in the 1986 and 1987 College of American Pathologists proficiency survey program. Participant performance on these samples demonstrated significant variation in the responsiveness of different activated partial thromboplastin reagents to lupus anticoagulants. The level of factor VIII in these samples reported by the participants also varied with the reagent used. Follow-up studies demonstrated striking reagent-dependent differences in the dilutional effect on apparent factor VIII, IX, XI, and XII activity. These results point out the importance of selecting sensitive and responsive reagents for appropriate identification of lupus inhibitors. In addition, the results indicate that the choice of reagent used for factor assays can affect the apparent factor activity as well as whether a dilutional effect is noted when a lupus anticoagulant is present in the test sample, an important consideration when trying to distinguish a lupus anticoagulant from a specific factor inhibitor.

Autoantibodies↗
PubMed1991

[Use of personal protective equipment by pathologists and legal physicians working with particularly dangerous infectious diseases].

The possibility of pneumosuit use constructed in the Institute to protect the pathology department staff at the hospitals for infectious diseases from HIV virus was studied. The suit is a hose-type suit for protection of respiratory organs and skin using the ventilated underhood space and autonomic air supply. Both the detailed description of this suit and its disinfection scheme developed and tested by authors are presented. The comparative physio-hygienic assessment of pneumosuit and standard antiplaque suit demonstrated a number of advantages of the former during 2 hours work at pathology department. The authors recommend the pneumosuit as an equipment for the protection of skin and respiratory organs of pathologists and legal physicians working with particularly dangerous infections.

Forensic Medicine↗
PubMed1991

Interlaboratory comparison of glycohemoglobin results: College of American Pathologists Survey data.

We describe recent changes in the College of American Pathologists Glycohemoglobin (gHb) Survey, made to improve the assessment of interlaboratory variability and the accuracy of results reported. The questionnaire portion of the survey was revised to include an updated list of current methods, and results for survey specimens were grouped according to the component measured (Hb A1, Hb A1c, or total gHb). The survey specimen material was changed to a material thought to give more reliable results with all available methods. After these changes, instituted in 1989, between-laboratory CVs decreased for some methods. Furthermore, gHb values between method types were more consistent with results obtained from fresh blood samples under very controlled laboratory conditions. However, these recent data also show that the interlaboratory variability is still quite high for some methods and that the variability within and between method types is still very great. We describe a pilot standardization program for gHb measurement.

Chromatography, Affinity↗
PubMed1991

Laboratory phlebotomy. College of American Pathologists Q-Probe study of patient satisfaction and complications in 23,783 patients.

Outpatients from 630 institutions participated in a phlebotomy module of Q-Probes, a quality assurance program of the College of American Pathologists, Northfield, Ill. This module assessed patient outcome measurements of complications, discomfort, and satisfaction with the phlebotomy procedure. Of the 29,700 ostensibly healthy individuals registered, 80.1% returned postcards containing measurements and assessments they made about the procedure and information recorded by the phlebotomist. The median time required for phlebotomy was 6 minutes, with 25% of patients requiring less than 5 minutes and 10% more than 21 minutes for completion of the procedure. The average number of phlebotomy attempts per patient was 1.03, with 95 patients (0.4%) experiencing three to 11 attempts. Ecchymoses occurred in 4048 (16.6%) attempts, with the median size of ecchymosis being 15.1 mm. On the average, an outstanding employee was identified by patients 46.6% of the time. The discomfort caused by the needle puncture was more than expected by 35.3% of patients. Although 98.6% of the patients were satisfied, 336 patients were dissatisfied with the procedure. We conclude that the technical skills of phlebotomists and patient satisfaction with phlebotomy are outstanding, but that patient discomfort from the procedure needs to be minimized.

Bloodletting↗
PubMed1991

The surgical pathologist's role in liver transplantation.

Liver transplantation has become an option in treating a wide variety of diseases. The surgical pathologist, as a member of the transplantation team, is increasingly involved in the evaluation of allograft dysfunction. Interpretation of the liver allograft biopsy specimen requires integration of clinical history, biochemical data, and histologic patterns of a wide variety of lesions, including harvesting injury, vascular thrombosis, rejection, infection, and recurrent disease. This article reviews the varied histologic appearances of the more common forms of liver allograft injury, the contexts in which they arise, and their distinction from one another.

Acute Disease↗
PubMed1991

Pathologists and the autopsy.

Autopsy practice today remains rooted in the fabric of medicine as it developed through the 18th and 19th centuries. Recent developments in medicine and society have left autopsy practice behind and have led to the decline of the autopsy. Potential new values of autopsies point strongly to the need for revitalized modern autopsy services, services focused on objectives and problems related to patients, their physicians, and the attendant societal issues. There are real values for pathology and pathologists, but only if major realignments in purposes and outcomes are forthcoming.

Autopsy↗
PubMed1990

Understanding pathologists (an exercise in communication): 2. Understanding biopsy techniques.

For the best possible report to be made, it is necessary for the appropriate specimen to be taken and transported in the appropriate manner, and then correctly processed. In the second of a four-part series aiming to 'demystify' the subject of pathology, the author critically evaluates biopsy techniques. The next two articles in this series will look in some detail at the pathologist's report and special laboratory investigations.

Biopsy↗
PubMed1990

The cytogenetics and molecular genetics of lung cancer. Implications for pathologists.

The interactions of cytogenetic and molecular genetic changes in the pathogenesis and progression of lung cancer are complex. To the practicing pathologist, certain of these changes may prove useful as diagnostic or prognostic markers and may help in selecting patients for particular types of therapy. Changes such as 3p14-23 deletions, c-myc amplification, and L-myc RFLPs have already been reported to predict aggressive behavior in lung cancer. Future studies will clarify the application of these changes to the clinical care and treatment of patients with carcinoma of the lung.

Cytogenetics↗
PubMed1990

College of American Pathologists-Centers for Disease Control collaborative study for evaluating reference materials for total serum cholesterol measurements.

Several recent studies to evaluate the performance of laboratory instruments have shown that with some instrument systems processed (lyophilized, frozen, and stabilized) materials exhibit matrix effects that cause the assay for cholesterol to respond differently for them than for patient specimens. To understand this phenomenon better the College of American Pathologists, Northfield, III, and the Centers for Disease Control, Atlanta, Ga, have conducted a collaborative study with 44 laboratories where 16 instruments manufactured by nine companies are evaluated. The purposes were to assess measurement variation on several reference materials used for standardizing total cholesterol measurements and to evaluate a new stabilized liquid serum as a potential reference material. Lypophilized, frozen, fresh-frozen, and stabilized materials at three concentrations were measured for total cholesterol. The results show that the average coefficient of variation of measured total cholesterol for all instruments, laboratories, vials, and replicates is 3.6% to 4.1% for each of the materials measured (excluding the results for one instrument). For one instrument, however, significant bias was found on the stabilized liquid serum material. Results from the fresh-frozen materials indicate that the instrument systems evaluated allow laboratories to attain the National Cholesterol Education Program analytical performance goals.

Analysis of Variance↗