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PubMed1995

College of American Pathologists Conference XXVI on clinical relevance of prognostic markers in solid tumors. Report of the Prostate Cancer Working Group.

Critical analysis of the evidence supporting the use of prognostic markers is needed for these to be used most appropriately in patient management. The College of American Pathologists recently sponsored a national conference to review the status of tumor markers for carcinomas of the breast, colon, and prostate gland. The conclusions of the Prostate Cancer Working Group are presented in this report. Currently, the TNM (Tumor, Lymph Node, Metastasis) staging system, histologic grading (Gleason system), and serum prostate-specific antigen are recommended for general use as prognostic markers in prostate cancer. Data support the use of DNA ploidy analysis in specific clinical settings, although general use is not currently recommended. The Working Group concluded that other markers do not have sufficient support in the literature to recommend routine use at the present time.

Biomarkers, Tumor↗

PubMed1994

Detection of Chlamydia trachomatis by direct fluorescent antibody staining. Results of the College of American Pathologists Proficiency Testing Program, 1986-1992.

Since 1986 the College of American Pathologists has provided a proficiency testing program for laboratories that use the direct fluorescent antibody test for direct detection of Chlamydia trachomatis in clinical specimens. The number of survey participants increased from about 200 in 1986 to about 800 in 1992, and in all years the majority used reagents produced by Syva Co (Palo Alto, Calif), although the percentage decreased from 82% in 1986 to 68% in 1992. Performance on positive specimens varied based on specimen fixation method, number of elementary bodies present, serotype, and specific product used, and declined when the specimen was fixed with acetone prior to shipping or contained fewer than 50 elementary bodies, particularly when the elementary bodies were of serotype L2. Performance with negative specimens was also variable, with 79% to 96% of all participants, and over 90% since 1991, responding correctly. In the last 1992 survey, an ungraded specimen (a five-well slide containing latex beads incorporated with fluorescein isothiocyanate) and a questionnaire were included to assess the potential influence of laboratory operations on performance. Responses to the questionnaire and the ungraded specimen suggested that the level of experience of testing personnel affected performance. A test for trend in error rate across the number of years that a laboratory had offered the Chlamydia direct fluorescent antibody test indicated that error rate declined as degree of experience with the test increased.

Chlamydia trachomatis↗

PubMed1995

Interinstitutional comparison of bladder carcinoma surgical pathology report adequacy. A College of American Pathologists Q-Probes Study of 7234 bladder biopsies and curettings in 268 institutions.

Participants in the 1992 College of American Pathologists' Q-Probes Study of bladder carcinoma surgical report adequacy evaluated 7234 bladder biopsies and curettings from 268 institutions. In over 98% of the cases evaluated, the histologic type was stated. In over 95%, the histologic grade was stated where appropriate. Of the 7234 cases studied, 2149 (29.7%) were invasive, 4498 (62.2%) were noninvasive, and invasiveness (presence or absence of invasion) was not stated for 587 (8.1%). For invasive carcinomas, there was definitive assessment for the presence or absence of muscularis propria in 1145 (53.3%) of 2149 cases, and in 67 (3.1%) of 2149 cases no muscle or muscularis was present. For noninvasive carcinomas, there was a definitive evaluation of the muscularis propria (presence or absence) in 1349 (30%) of 4498 cases.

Biopsy↗

PubMed1995

The laboratory diagnosis of pneumonia. The role of the community hospital pathologist.

Pneumonia is one of the most serious infections seen in community hospital practice, with virulent bacteria and viruses producing infections in the healthy host and a variety of opportunistic organisms capable of causing disease in the immunocompromised patient. Accurate laboratory diagnosis is extremely important for correct clinical management of pneumonia, and the community hospital pathologist can take an active role in daily review of respiratory tract specimens to optimize and coordinate this important laboratory testing. This article discusses strategies for improving sputum Gram stain interpretation and for the use of both routine and supplementary cultures in community-acquired pneumonias and outlines a comprehensive consultative approach for rapid and reliable pneumonia diagnosis in the compromised patient.

Biopsy↗

PubMed1995

Proficiency test performance and experience with College of American Pathologists' programs.

We examined rates of unacceptable results in a large interlaboratory proficiency test program, which is designed for small hospitals, clinics, and physician offices. The objective was to see whether rates of unacceptable results decrease as laboratories gain experience in interlaboratory comparison programs. We examined data from the College of American Pathologists' Excel Surveys, 1987 through 1993, in the areas of chemistry, hematology, immunology, and blood bank. The data for laboratories with consistent participation show consistent and statistically significant improvement in performance for the first 3 to 4 years of proficiency testing. The data for all participants also suggest that laboratories with more experience with proficiency testing have lower rates of unacceptable results, and that these rates tend to decrease with each year of experience. These conclusions support the findings of other researchers who have documented the benefits of interlaboratory comparison programs and proficiency testing.

Pathology↗

PubMed1995

Clinicians and pathologists in the management of breast disease. An evolving relationship.

The breast is host to a spectrum of benign and malignant diseases. Medical advances during the last few decades have changed and refined the diagnosis of breast diseases considerably, and their treatment has become increasingly sophisticated. These changes have changed the relationship between pathologists and clinicians: Close collaboration has become even more essential for optimal patient care.

Adult↗

PubMed1995

Communication between the pathologist and urologist. Focus on prostate cancer.

Open communication between the pathologist and surgeon is crucial for optimum patient care and job satisfaction. Communication must occur in both directions and should include a free exchange of clinical information and explanation of the thought processes used by both physicians. Various means can improve communication, and the authors focus on the special clinical problems posed by prostate cancer diagnosis and treatment.

Aged↗

PubMed1976

Results of the College of American Pathologists mycobacterial surveys, 1973.

Results of the College of American Pathologists Surveys showed a significant improvement of participant performances between 1972 and 1973. Participants in the Special Mycobacterial Survey did much better in speciating mycobacteria than did those in the Comprehensive Microbiology Survey. It is likely that many of the participants in the Comprehensive Microbiology Survey were unaware of their option to select the extent to which they offer service and were evaluated.

Bacteriological Techniques↗

PubMed1995

College of American Pathologists Mycobacteriology E Proficiency Testing Survey. Summary of participant performance, 1979-1992.

The College of American Pathologists first offered a program of proficiency testing in mycobacteriology in 1969 to laboratories that offered any extent of diagnostic service. This program was intended to provide a mechanism for evaluation of methods of staining, culture, identification, and susceptibility testing. From 1979 to 1992, the period covered by this review, participation in the Mycobacteriology E Survey increased almost sixfold. On graded smears to be stained for detection of acid-fast bacilli, more than 85% of Extent 4 and Extent 3 laboratories and more than 80% of Extent 2 laboratories responded correctly to all specimens except one. Performance on specimens that contained Mycobacterium tuberculosis was similar for Extent 4 and Extent 3 laboratories. For all specimens containing M tuberculosis, a mean of more than 90% of Extent 4 and Extent 3 laboratories provided a correct identification each year except 1979, when a mean of 83% of Extent 3 laboratories responded correctly. Only Extent 4 laboratories were required to identify isolates other than M tuberculosis to the species level. For specimens that contained nontuberculous mycobacteria, the means of the yearly averages of correct responses for Extent 4 laboratories were 90% or greater for M kansasii, M marinum, M avium complex, and M fortuitum-chelonae complex and less than 85% for M bovis, M simiae, M scrofulaceum, M szulgai, M flavescens, M xenopi, M terrae complex, and M gastri. In general, on these same specimens, a slightly higher percentage of Extent 3 laboratories (which were required to identify only M tuberculosis to the species or complex level) gave correct or acceptable responses, and the performance of Extent 2 laboratories (which were only required to report whether or not a mycobacterium was present) was the best of all extents. The data suggest that laboratory performance improved somewhat after initial experience with uncommonly encountered organisms. For the most part, however, performance with a given species changed minimally from year to year.

Antibiotics, Antitubercular↗

PubMed1994

[Non-seminomatous germ cell tumors of the testis. Role of the pathologist in the assessment of prognostic factors based on the specimen of orchiectomy. Proposal of an anatomopathological examination report defined by the Study Group of the Committee of Cancerology of the French Association of Urology].

Non-seminomatous germ cell tumors of the testis. Role of the pathologist in the definition of the prognostic factors based on examination of the orchidectomy specimen. Proposal of a pathological examination report form defined by the study Group of the Oncology Committee of the French Urological Association.

Carcinoma, Embryonal↗

PubMed1994

Perspectives on the male speech-language pathologist.

Although many professions are reporting greater gender neutrality, the opposite appears to be the case in speech-language pathology and audiology. The number of men in speech-language pathology and audiology has always been small. In 1925, 40% of the original members of the American Academy of Speech Correction were male (Bender, 1989). Each subsequent decade has seen the gender gap between male and female professionals widen (see chart illustrating the steady decline of male ASHA members between the years 1968 and 1992). When one considers only speech-language pathology, the gap between numbers of males and of females is even greater. According to ASHA's membership database, in December 1993 only 6.0% of ASHA-certified speech-language pathologists were men (ASHA, 1993).

Audiology↗

PubMedDate not supplied

The pathologist's role in multidisciplinary management of bladder cancer.

The pathologist plays an important role in management of bladder cancer, as a member of the multidisciplinary team of urologists, radiation therapists, and medical oncologists. The therapeutic goal is saving the bladder function as long as possible. The pathologic determinants utilized for selection of therapeutic modalities are described in 172 consecutively treated patients with transitional cell carcinoma and 20 patients with other forms of bladder tumors during a five year period. Based on histologic type, pathologic stage, and status of the urothelium, 100 patients were treated by resection and intravesical instillation of cytostatic drugs or bacille Calmette-Guérvin (BCG). Seventy patients underwent radical cystectomy and bladder substitution by continent urinary diversion. Serial transurethral resection (TUR) biopsies and cytologic evaluations were found adequate in evaluating pathologic determinants for progression and for survival except in cases of Grade 2 papillary transitional carcinomas where additional experimental studies need to be further developed, such as nuclear ploidy and molecular genetic studies, to identify patients at high risk for progression. Of the 70 patients with radical cystectomy and 5 with partial cystectomy, 49 are living, a median of 36.8 months since surgery. There was one intraoperative death and one post-operative death within 30 days post-operatively.

Adult↗

PubMed1995

Ordering accuracy. A College of American Pathologists Q-Probes study of 577 institutions.

Five hundred seventy-seven institutions examined how accurately physicians' test orders on inpatients were transmitted to the laboratory. Written orders could be found on laboratory requisitions or the medical record for 97.5% of 224,431 completed tests (median institution = 99.3%). Participants indicated that entry of extra tests into a hospital computer was the most common reason for completing unordered tests. In a multivariate analysis, factors associated with completing unordered tests were the lack of a policy requiring nursing staff to recheck computer orders against the medical record, average census of 301-450 patients, College of American Pathologists accreditation, and the use of preprinted "checkoff" order forms. Overall, 97.1% of 225,457 test orders were completed by the laboratories (median institution = 98.1%). Factors associated with not completing ordered tests were the lack of a policy requiring staff to check computer orders, teaching hospital status, and urban hospital location. Several interventions commonly thought to improve communication of orders were not found to affect performance. These results indicate that many institutions have a problem accurately transmitting test orders to their clinical laboratories.

Data Collection↗

PubMed1994

A pathologist-designed imaging system for anatomic pathology signout, teaching, and research.

Pathology images are derived from gross surgical specimens, light microscopy, immunofluorescence, electron microscopy, molecular diagnostic gels, flow cytometry, image analysis data, and clinical laboratory data in graphic form. We have implemented a network of desktop personal computers (PCs) that allow us to easily capture, store, and retrieve gross and microscopic, anatomic, and research pathology images. System architecture involves multiple image acquisition and retrieval sites and a central file server for storage. The digitized images are conveyed via a local area network to and from image capture or display stations. Acquisition sites consist of a high-resolution camera connected to a frame grabber card in a 486-type personal computer, equipped with 16 MB (Table 1) RAM, a 1.05-gigabyte hard drive, and a 32-bit ethernet card for access to our anatomic pathology reporting system. We have designed a push-button workstation for acquiring and indexing images that does not significantly interfere with surgical pathology sign-out. Advantages of the system include the following: (1) Improving patient care: the availability of gross images at time of microscopic sign-out, verification of recurrence of malignancy from archived images, monitoring of bone marrow engraftment and immunosuppressive intervention after bone marrow/solid organ transplantation on repeat biopsies, and ability to seek instantaneous consultation with any pathologist on the network; (2) enhancing the teaching environment: building a digital surgical pathology atlas, improving the availability of images for conference support, and sharing cases across the network; (3) enhancing research: case study compilation, metastudy analysis, and availability of digitized images for quantitative analysis and permanent/reusable image records for archival study; and (4) other practical and economic considerations: storing case requisition images and hand-drawn diagrams deters the spread of gross room contaminants and results in considerable cost savings in photographic media for conferences, improved quality assurance by porting control stains across the network, and a multiplicity of other advantages that enhance image and information management in pathology.

Computer Systems↗

PubMed1995

Complete blood count specimen acceptability. A College of American Pathologists Q-Probes study of 703 laboratories.

OBJECTIVE: to determine the frequency and reasons for rejection of specimens submitted to the laboratory for complete blood count studies. DESIGN AND SETTING: College of American Pathologists' Q-Probes laboratory quality improvement study prospective recording of rejected complete blood count specimens and associated factors in 703 laboratories. MAIN OUTCOME MEASURE: Percentage of submitted specimens rejected for testing. RESULTS: Of 7,894,882 complete blood count specimens submitted for testing to the participating laboratories during the data collection period, 35,347 (0.45%) were rejected. The most frequent reason for rejection was a clotted specimen, which occurred about six times more frequently than the second most cited reason, insufficient specimen quantity. Compared with their respective frequency of use for specimen collection, significantly more rejected specimens were collected in microtubes than in other containers. Compared with the respective frequency with which they collect specimens, laboratory personnel had significantly fewer rejected specimens than the other personnel groups. The poorest performance was exhibited by other in-hospital nonlaboratory personnel. Hospital bedsize was also a significant performance factor; smaller hospitals demonstrated lower rejection percentages. CONCLUSIONS: Specimen rejection should be monitored on a regular basis, identifying institution-specific factors that are associated with rejection. Monitoring of sufficient significant variables will help narrow the focus of corrective action. Action thresholds should be set sufficiently low to assure ongoing efforts toward improvement.

Blood Cell Count↗

PubMed1994

[Gastritis. Current point of view of the anatomo-pathologist].

Acute, granulomatous and chronic are the three main forms of gastritis. The discovery of Helicobacter pylori has stimulated a new detailed classification of gastritis. Having set out the various conventional histopathological classifications, the authors describe two newly recognized types of gastritis, lymphocytic gastritis and reactive gastritis. The authors also recall the earlier pathogenic classifications of gastritis, first initiated by Strickland and Mackay. Because of the problems related to these earlier classifications, the "Sydney system" has been developed. This system allows to simply pathologists' reports, by incorporating the morphological, topographical and etiological parameters of gastritis. Some of the advantages and disadvantages of the "Sydney system" are briefly discussed.

Acute Disease↗

PubMed1994

Phlebotomists' safety practices. A College of American Pathologists Q-Probes study of 683 institutions.

We report on phlebotomists' safety practices in 683 institutions participating in the College of American Pathologists Q-Probes program. Participants inspected 38,357 phlebotomy tourniquets and 31,952 blood collection tube holders in use and found 2098 tourniquets and 2966 holders visibly contaminated with blood. In 67.8% of the institutions, at least one tourniquet or collection tube holder was contaminated. Needlestick injuries reported by phlebotomists during 1990 through 1992 were analyzed from approximately 11 million inpatient venipuncture procedures. These injuries ranged between 9.2 and 9.8 needlesticks per 100,000 venipunctures per year. Over 99% of the participants had a policy preventing recapping of needles, 45% discarded tourniquets when contaminated with blood, and 3.3% routinely assigned tourniquets to specific patients. Between 1990 and 1992, increasing frequencies of phlebotomists using gloves, replacing gloves between each inpatient phlebotomy, and handwashing after degloving were found. We cite the lack of compliance of handwashing between glove changes as suggesting need for regulatory rereview.

Bloodletting↗

PubMed1993

Endocrine tumors of the pancreas: the pathologist's approach.

The introduction of modern cytological techniques has provided the pathologist of tools that considerably improved his analysis of pancreatic endocrine tumors and that are discussed in this review. Hormonal characterization of the tumors by immunohistochemistry significantly contributed to the definition of the current functional classification of the tumors and proved that ectopic tumors (producing extrapancreatic hormones) are as common as entopic tumors synthesizing pancreatic hormones. The identification of neuroendocrine markers and of other active non-hormonal substances extended our knowledge on the functional properties of tumor cells often with significant fall out on the biology of the corresponding normal cells. Current studies are mostly oriented toward the analysis of cell proliferation and appear to open promising perspectives for the prognostic evaluation of the tumor course.

Adenoma, Islet Cell↗