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PubMed1990

The College of American Pathologists Laboratory Accreditation Programme.

The Laboratory Accreditation Programme (LAP) offered by the College of American Pathologists (CAP) was begun in 1961. It is a voluntary peer review programme with the goal of laboratory improvement to excellence. It presently accredits more than 4300 laboratories throughout the world, although the majority are in the United States and Canada. Accreditation is contingent upon continuing successful performance in the CAP proficiency testing programmes, as well as passing biennial on-site laboratory inspections. These on-site inspections are done by practising laboratorians who use checklists appropriate for the various laboratory disciplines. Several governmental regulatory agencies (e.g. the Health Care Financing Agency) as well as private agencies (e.g. the Joint Commission on Accreditation of Healthcare Organizations) accept the LAP in place of their own programmes for laboratory accreditation.

Accreditation↗
PubMed1990

New technology in laboratory medicine. A call for pathologists to lead the march.

Several new technologies are impacting the practice of pathology. Appropriate clinical uses must be defined and standards established. It is vitally important that pathologists play the leadership role in incorporating new diagnostic techniques in the clinical laboratory. To do so may require new knowledge and skills. Pathology associations must support the needs of their members by providing avenues for education and training in new technologies applicable to pathology practice.

Education, Medical, Continuing↗
PubMed1990

Transplantation of the small intestine: the pathologist's perspective.

Small-bowel transplantation is now ready for clinical trials. The surgical techniques and methods for immunosuppression and monitoring bowel status have been developed in animal models over the past 30 years. Several attempts at small-bowel transplantation in humans have already been reported. In the course of future trials, pathologists will be involved in the monitoring of the posttransplant course by mucosal biopsies and functional studies, including maltose and xylose absorption tests. The morphology of rejection has been studied in canine and rat models. Activated lymphocytes and plasma cells infiltrate the lamina propria and invade crypt epithelium, causing "cryptitis." Villous blunting ensues, resulting eventually in necrosis. Graft survival without immunosuppression is about 10 days. Under Cyclosporine immunosuppression, a lymphoplasmacytic infiltrate has been noted around nerves and vessels in the submucosa. The overlying mucosa may be relatively normal. End-stage bowel is characterized by a contracted, scarred mass. Due to the large amount of lymphoid tissue in the allograft, graft-versus-host disease is a significant problem in small-bowel transplantation.

Graft Rejection↗
PubMed1990

Evaluation of APTT reagent sensitivity to factor IX and factor IX assay performance. Results from the College of American Pathologists Survey Program.

Hereditary factor IX deficiency (hemophilia B) is among the more common hereditary bleeding disorders and factor IX assays are among the more common specific factor assays performed by coagulation laboratories. To assess the sensitivity of various reagents used for performance of activated partial thromboplastin times and factor IX assays, a series of samples with varying levels of factor IX were included in the 1988 College of American Pathologists Survey Program. We found significant differences in the sensitivity of reagents to factor IX deficiency. Surprisingly, the least sensitive reagents were among the most commonly used reagents. Significant differences in the classification of activated partial thromboplastin times as abnormal were noted between H1 and H2 survey participants. As with factor VIII assays, significant differences in the dose-response curves for factor IX deficiency were noted between reagents, with more responsive reagents giving more precise results for factor IX assays. Comparison of factor IX assay performance in 1988 with 1980 performance indicates a substantial improvement in assay precision. However, a further improvement in assay performance could be expected if current recommendations were followed.

Blood Coagulation Tests↗
PubMed1990

Human immunodeficiency virus type 1 proficiency testing. The American Association of Blood Banks/College of American Pathologists Program.

The American Association of Blood Banks/College of American Pathologists Viral Marker Survey program added samples to evaluate participant performance with test systems for the detection of antibodies to human immunodeficiency virus type 1 in 1985. On the 80 challenges sent through April 1989, the major problem observed with enzyme immunoassay testing was unexpected reactivity on samples that did not contain anti-human immunodeficiency virus type 1. One manufacturer's testing system accounted for most of the specificity problems. The sensitivity of the enzyme immunoassay for anti-human immunodeficiency virus type 1 is close to 99%, based on the multiple reactive samples used on the 16 panels. Between 1985 and 1989, there was a 14-fold increase in participants reporting Western blot results. The introduction of a licensed system for Western blots increased the number of samples that contained antibody to human immunodeficiency virus type 1 interpreted as indeterminate. Answers to supplementary questions showed that the rate of repeatably reactive and confirmed positives on blood donors dropped to less than 0.1%.

AIDS Serodiagnosis↗
PubMed1985

The surgical pathologist examines the placenta.

In this chapter, placental development, morphology, and indications for its examination have been reviewed. Techniques for placental examination with practical suggestions applicable to the surgical pathology laboratory have been pointed out. Several specific examples of clinical conditions in which morphologic alterations within the placenta assist with or establish a diagnosis have been presented. It is hoped that this information will encourage pathologists to use this important organ more fully as a resource in diagnoses and patient care.

Abortion, Spontaneous↗
PubMed1989

Interlaboratory variability of immunohistochemical stains. Results of the cell markers survey of the College of American Pathologists.

Immunohistochemical techniques have become commonplace adjunctive aids in anatomic pathology. Although much has been written describing modifications of the basic techniques, sensitivity, and specificity of reagents, little has been published regarding the interlaboratory variability in immunostain results on a given test sample. The Cell Markers Survey of the College of American Pathologists was organized to address this question of interlaboratory variability and to disseminate information on the techniques and reagents currently available.

Biomarkers↗
PubMed1989

[The anatomo-pathologist as a necroscopy physician in the field: a balance-sheet of 4 years' experience].

The quality of the certificates of death for 2429 cases, all the residents died at home in the USL 70 during the period 1.8.83-31.12.87, was evaluated thanks to the necroscopic activity of the Legnano's Hospital pathologist. All the information, oral or written, available about each case was used to check the family doctor's certificate. Any correction to the certificate was discussed with the certifier. During the period a gradual and progressive reduction of error in the statement of the underlying cause of death was shown. The improvement comes out using different quality indicators.

Autopsy↗
PubMedDate not supplied

AIDS/HIV: implications for speech-language pathologists and audiologists.

Although research is underway to answer the many unknown questions about AIDS/HIV, there are many myths that continue to plague the public as well as health care and education workers. In this report, the ASHA Committee on Quality Assurance provides factual information about what is known about AIDS/HIV and delineates a list of suggested precautions which speech-language pathologists and audiologists can utilize when providing speech-language-hearing service. Practice and legal issues will continue to be addressed as our knowledge about the provision of services to AIDS/HIV patients/clients expands. Consequently, practitioners will need to update their knowledge through continuing education programs and/or products. Similarly, graduate training programs will have to continually update their curriculum and clinical practicum training to meet these changing needs.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Construction of the diagnostic encyclopedia workstation. Computerizing pathology for the pathologist.

The combination of a personal computer and a laser-vision disc player is an adroit tool for storing and retrieving textual information in combination with pictorial information. This paper describes such a system (a "diagnostic encyclopedia workstation"), which provides information to the pathologist engaged in daily diagnostic practice. The system contains a considerable amount of descriptive textual information that might be useful in making diagnoses in histopathology, along with many illustrations; the text is presented in a natural language (English). The descriptive information is divided into 18 categories, including such topics as histology, macroscopy, immunopathology and clinical data; each topic has a separate display in the system. Also present are two types of "decision rules" for making diagnoses (confirmative criteria for a diagnosis under consideration and exclusive criteria for many other diagnoses) and a classifying structure. The present version of this system contains information on about 100 diagnoses in ovarian pathology, illustrated with about 3,000 color slides from about 140 cases. The information and pictures are immediately available. Further characteristics of this system are its flexibility, accessibility and user friendliness; it has been structured so that components of artificial intelligence may be added later.

Artificial Intelligence↗
PubMed1989

[The role of autopsy from the viewpoint of pathologists at medical schools].

The results of a questionnaire dealing with the role of pathological anatomy in cancer clinics were reported. The questionnaire was distributed among pathological departments (168) and clinicopathological sections (29) of all medical schools in Japan. The response rate was 69%, and 136 reports were divided into three categories (experimental, human pathological field and a combination of both). There were no clear differences among the pathologists as to the three categories in the recognition of the role of autopsy. The study looked at pathological anatomy in an attempt to put into proper perspective the systems, including clinicopathological conferences, issuance of final reports, manpower, dissatisfaction and other problems of pathological anatomy. The most important matter was increasing the staff in the pathological section due to specialization in each field and the increase in materials examined. The authors also reported our data on autopsied lung cancer with multiple primary cancer as one of the organ pathologies considered in the workshop.

Autopsy↗
PubMed1989

[Comments from a clinician and pathologist on the terminology, diagnosis and treatment of precancerous conditions of the larynx].

Only comprehensive treatment comprising active screening of risk groups, treatment proper, primary and secondary prevention and permanent collaboration of the clinician and pathologist can improve significantly the prognosis (morbidity and mortality) of patients with precanceroses of the larynx. Subsequent dispensary care then improves by cca 10% the five-year survival of patients with confirmed malignancies, as compared with the therapeutic results of all treated carcinomas of the larynx during the corresponding period.

Humans↗
PubMedDate not supplied

Quality assurance activities of the College of American Pathologists.

Since its inception, the College of American Pathologists (CAP) has played a fundamental and pivotal role in the development and execution of quality assurance programs for laboratories. Within the realm of anatomic pathology, operational programs include those in surgical pathology, immunohistochemistry and cytopathology. The emphasis of prior cytopathology programs on cervical cytology has now been expanded to include body fluids and fine needle aspiration material. CAP's role in the expansion of quality assurance programs in cytology may be enhanced in the future by intersociety cooperation with established cytology organizations and will also be influenced by and closely linked to the expansion of its quality assurance programs in surgical pathology. As for the Papanicolaou smear, it can no longer be regarded as the "Cinderella of cytology"; it is in fact the present-day cynosure in the laboratory. In recognition of this, CAP has undertaken efforts to help heighten public awareness about the value of Papanicolaou smear testing and is encouraging women to become more informed about the process involved in the examination of their smears.

Clinical Laboratory Techniques↗
PubMedDate not supplied

An overview of the College of American Pathologists' programs in surgical pathology and cytopathology. Data summary of diagnostic performance in cervical cytopathology.

The survey programs in surgical pathology and cytopathology of the College of American Pathologists are described, along with a summary of the data produced on diagnostic performance in cytopathology. The levels of agreement between individual diagnoses and consensus diagnoses were highest for slides in the "negative" and "positive" categories and somewhat less for slides in the "suspicious" categories. Submission of slides with 70% or less agreement and slides on which a consensus had not been reached to a new group of observers yielded similar levels of agreement, indicating that there is a fairly small percentage of cervical smears that are diagnostic problems. Agreement levels, especially in relation to false negatives and false positives, represent a commendable achievement, especially considering that cervical cytology is a screening procedure and that "suspicious" smears result in further investigations. It is also important to recognize that additional clinical data and studies are often taken into consideration before definitive treatment is begun or additional follow-up smears are taken.

Cytodiagnosis↗
PubMed1989

Interdisciplinary activity between occupational therapists and speech language pathologists.

The interdisciplinary activities between occupational therapists (OTs) and speech language pathologists (SLPs) were studied by conducting a national mail survey. Analysis of data gathered from 344 OTs and 262 SLPs (n = 1250 and n = 1130, respectively), indicated strikingly similar responses. Results showed that OTs and SLPs in the medical setting had frequent informal contacts, but interdisciplinary activity was not typical of formal job descriptions. According to 84% of OTs and 91% of SLPs, the most common activity involved exchange of diagnostic information, while 66.6% of both groups identified cooperative planning as typical of their interactions. Only 33.3% of each professional group responded that team treatment characterized interactions. Approximately 50% of the respondents felt that interactions were self-motivated and that the amount of interdisciplinary activity was satisfactory. The data suggested improvement needs are primarily qualitative rather than quantitative, and the primary limiting factors reported by both groups included staff shortages, financial constraints, and physical locations.

Adult↗
PubMed1989

[The computer at the pathologist's laboratory].

Computers are coming into practical use by pathologists. The computer hardware and software are briefly outlined. The software is discussed while drawing up protocols on the examination of biopsies, operative materials and autopsies. A special attention is given to the SNOP and SNOMED coding of diagnoses. How to operate on a computer is described in the paper. The latter provides evidence for applying the computer to the formulation of laboratory documents.

Clinical Laboratory Techniques↗
PubMed1988

Natural history of hepatocellular carcinoma as viewed by the pathologist.

The classical morphological criteria in the diagnosis of hepatocellular carcinoma (HCC) include: (a) the similarity of tumor cells to hepatic cord cells; (b) the trabecular nature of the growth with capillary and canaliculi formation, and (c) the intravascular growth of trabecular carcinoma. These criteria apply to the most common variants of HCC but they do not suffice in all cases. That makes additional criteria and certain refinements necessary. A promising approach to the diagnosis of HCC is that based upon consideration by the pathologist of some relevant aspects of the natural history of this tumor. A panel of tests exploring the various functions and properties of liver cells should be set up. Tests for bile and fibrinogen synthesis are most important because they reflect specific and exclusive properties of the original cell line. Bile synthesis in tumor tissue is reflected by the finding of cholecholatestasis, namely bilirubinostasis and retention of copper and copper-binding proteins. The positive immunostaining for fibrinogen may appear in the form of cytoplasmic granules occurring in 50% of HCC, or in the form of fibrinogen-ground-glass (G-G) inclusions, representing a specific feature of HCC. During neoplastic transformation oncofetal proteins may reappear, alpha-fetoprotein (AFP) being very common. Despite sensitivity of AFP, this test, similar to alpha-1-antitrypsin (AAT), has very low specificity, because of the widespread occurrence of these proteins in a variety of tumors. The selection of special 'clones' such as Mallory bodies and fibrinogen-G-G is of particular value, because of the specificity of these peculiar cytoplasmic changes. Although rare, the presence of HBV antigens in tumor tissue is virtually pathognomonic for HCC. The availability of nonneoplastic liver tissue for morphological examination is of great help, because it may carry key information or markers of the development stages of HCC: cirrhosis, liver cell dysplasia, HBV antigens, congenital metabolic disorders, such as hemochromatosis and AAT deficiency. The two latter conditions represent the link with the last working hypothesis of the present study, i.e. that during neoplastic transformation hepatocytes may 'switch' their 'phenotype' thus escaping the storage phenomena, which continue to occur in nonneoplastic hepatocytes. This study provides a guideline to a dynamic approach to the diagnosis of HCC. The rationale is listed in 5 points; among them, bile production, fibrinogen synthesis, Mallory body and fibrinogen-G-G selection, HBV antigen expression can be considered at present as confident markers for the morphological diagnosis of HCC.

Bile Canaliculi↗