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Moore M, Chen X, Sadigh S, Seifert R, Mindiola Romero AE, Pozdnyakova O, Courville EL. Evaluating pathologist practices in peripheral blood smear review: A comprehensive practice survey. Am J Clin Pathol 2024:aqae091. [PMID: 39037433 DOI: 10.1093/ajcp/aqae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVES Widely accepted standardized criteria for peripheral blood (PB) smear review do not exist. The aim of this study was to collect data regarding PB smear review practices across multiple institutions, with a focus on pathologist review. METHODS A 23-question survey was developed by members of the Society for Hematopathology (SH) Education Committee and distributed to SH members. The survey included questions on practice environment and PB smear review practices, including trainee involvement. RESULTS Of 725 members contacted, 137 (19%) completed the entire survey. Over half of practices examined 5 to 20 smears a day. All respondents reported using complete blood count/differential leukocyte count data and clinical history as part of smear review. The reported proportion of laboratory-initiated vs clinician-requested reviews varied across respondents. Clinician-requested smear reviews were more likely to be billed and issued as a separate pathology report. Glass slide review (as opposed to digital microscopy) was used by most respondents. All respondents affirmed that PB smear review is an essential component of pathology training programs. Numerous free-text comments were submitted by respondents regarding their own experiences with PB smear review and suggested improvements. CONCLUSIONS This survey elucidated the spectrum of practice patterns for pathologist review of blood smears and identified potential areas for process improvement.
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Affiliation(s)
- Margaret Moore
- University of Virginia Health, University of Virginia School of Medicine, Charlottesville, VA, US
| | - Xueyan Chen
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, US
| | - Sam Sadigh
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US
| | - Robert Seifert
- Department of Pathology, Immunology and Lab Medicine, University of Florida College of Medicine, Gainesville, FL, US
| | | | - Olga Pozdnyakova
- The Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Elizabeth L Courville
- University of Virginia Health, University of Virginia School of Medicine, Charlottesville, VA, US
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Schmidt RL, White SK, Timme KH, McFarland MM, Lomo LC. Graduate Medical Education in Pathology: A Scoping Review. Arch Pathol Lab Med 2024; 148:117-127. [PMID: 37014974 DOI: 10.5858/arpa.2022-0365-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 04/06/2023]
Abstract
CONTEXT.— Pathologists have produced a substantial body of literature on graduate medical education (GME). However, this body of literature is diverse and has not yet been characterized. OBJECTIVE.— To chart the concepts, research methods, and publication patterns of studies on GME in pathology. DATA SOURCES.— This was a systematic scoping review covering all literature produced since 1980 in the PubMed and Embase databases. CONCLUSIONS.— Research on GME in pathology is evenly dispersed across educational topics. This body of literature would benefit from research based on theory, stronger study designs, and studies that can provide evidence to support decisions on educational policies.
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Affiliation(s)
- Robert L Schmidt
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
| | - Sandra K White
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
| | - Kathleen H Timme
- the Department of Endocrinology, Eccles Primary Children's Hospital, Salt Lake City, Utah (Timme)
| | - Mary M McFarland
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
| | - Lesley C Lomo
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
- ARUP Laboratories, Salt Lake City, Utah (Schmidt, Lomo)
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Cipriani NA, Johnson DN, Sarne DH, Angelos P, Reeves W, Antic T. The Significance of RAS-Like Mutations and MicroRNA Profiling in Predicting Malignancy in Thyroid Biopsy Specimens. Endocr Pathol 2022; 33:446-456. [PMID: 36227454 DOI: 10.1007/s12022-022-09734-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
In cytologically indeterminate thyroid nodules undergoing molecular testing, estimated risk of malignancy is variable. Identification of a non-cancer-specific mutation (RAS-like) confirms a neoplastic process but does not differentiate between benign, malignant, and low-risk neoplasms. This study aims to retrospectively evaluate institutional experience of Interpace (ThyGeNEXT® and ThyraMIR®; Pittsburgh, PA) testing and to determine the rate of malignancy in resected nodules, stratified by mutational analysis and microRNA profile. Of 1917 fine need aspirations, 140 (7.3%) underwent Interpace testing: 47 (33.6%) were molecular-not-benign (harbored mutation, fusion, and/or positive miRNA) and 93 (66.4%) were molecular-benign (no mutations or fusions and negative microRNA). Surgery was spared in 79.6% of molecular-benign and 61.4% of all tested patients. Fifty-four (38.6%) underwent resection. Seventeen (89.5%) of the resected molecular-benign were benign and 2 were malignant. Thirteen (37.1%) of the resected molecular-not-benign were benign, 7 (20%) were noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and 15 (42.9%) were malignant (p < 0.05, negative predictive value (NPV) 89.4-95.6%, positive predictive value (PPV) 22.3-42.8%). Most molecular-not-benign (72.3%) had RAS-like mutation. Twenty-three were resected: 3 were malignant and 7 were NIFTP. Nodules with non-RAS-like mutations (BRAF V600E-like, others) were more likely to be malignant than RAS-like (H/N/KRAS, BRAF K601E) (p < 0.05, NPV 86.9-96.5%, PPV 100%). Most nodules had RAS-like mutations and most were benign or low-risk neoplasms (NIFTP). This study supports the role of histologic examination in the distinction of malignancy in RAS-like thyroid neoplasms and underscores the role of molecular testing in risk stratification, patient counseling, and operative management.
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Affiliation(s)
- Nicole A Cipriani
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave., MC 6101, Chicago, IL, 60637, USA.
| | | | - David H Sarne
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA
| | - Peter Angelos
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago, Chicago, IL, USA
| | - Ward Reeves
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave., MC 6101, Chicago, IL, 60637, USA
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave., MC 6101, Chicago, IL, 60637, USA
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Tashkandi H, Verdoni A, West M, Yatsenko S, Swerdlow SH, Aggarwal N. Enhancing Molecular and Cytogenetic Fellow Education With an Integrative Hematopathology/Molecular Genetic Pathology Joint Conference. Am J Clin Pathol 2022; 158:112-121. [PMID: 35142790 DOI: 10.1093/ajcp/aqac011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/24/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To overcome the challenges associated with molecular and cytogenetic (MG) education in hematopathology (HP), a monthly joint HP/MG conference with specific curricular goals was established and evaluated by the participants. METHODS All cases from the HP/MG conference over 56 months were reviewed. To assess the educational impact, a survey was distributed to current/former HP/molecular genetic pathology fellows and faculty. RESULTS During the study period, a total of 252 cases covering MG testing considered important for HP fellowship training were presented. The 100 most recent cases since 2018 discussed findings of diagnostic (85%), prognostic (40%), or therapeutic (10%) importance. A broad range of technologies were discussed such as karyotyping, cytogenetic fluorescence in situ hybridization studies, microarrays, polymerase chain reaction-based tests, next-generation sequencing, and Sanger sequencing. Twenty-three (95.8%) of 24 survey respondents agreed that the conference achieved all of its goals, and all agreed it was worth implementing. CONCLUSIONS This educationally based HP/MG conference supplements existing rotations, didactic presentations, and consensus case conferences and enhances MG education in HP without excessive time commitment or need for extensive in-house MG testing. It also contributes to enhancing HP knowledge among the MG faculty and fellows.
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Affiliation(s)
- Hammad Tashkandi
- Division of Molecular and Genomics Pathology, Pittsburgh, PA, USA
| | | | - MaryAnn West
- Pittsburgh Cytogenetics Laboratory, Pittsburgh, PA, USA
| | | | - Steven H Swerdlow
- Division of Hematopathology, Department of Pathology, Pittsburgh, PA, USA
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nidhi Aggarwal
- Division of Molecular and Genomics Pathology, Pittsburgh, PA, USA
- Division of Hematopathology, Department of Pathology, Pittsburgh, PA, USA
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Nayar R, Chute D, Douglas A, Sandersfeld T, Johnson R. Harmonization of training, training program requirements, board certification, and the practice of cytopathology: data from the American Board of Pathology surveys. J Am Soc Cytopathol 2021; 10:447-458. [PMID: 34454871 DOI: 10.1016/j.jasc.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The American Board of Pathology (ABPath) has ongoing efforts to better align certification with graduate medical education, training program requirements, and pathology practice. The present study focused on the subspecialty of cytopathology. We evaluated the current content and scope of fellowship programs, practice patterns and needs of diplomates, and program director (PD) and diplomate perceptions of the ABPath certification examination to identify gaps and provide an evidence base to guide harmonization in these areas. METHODS Two surveys were administered: one directed to PDs of all 93 Accreditation Council for Graduate Medical Education (ACGME) cytopathology fellowship programs and the other to cytopathology diplomates submitting continuing certification reporting to the ABPath. RESULTS Most (86%) cytopathology diplomates work in smaller groups. Only 11% do >50% cytopathology in practice. Diplomates' cytopathology-related practice tasks varied, as did their perception of the content of fellowship training aligning with practice needs. In fellowship training programs, the specimen types, volumes, techniques of specimen acquisition, and graduated responsibility varied significantly. We identified areas in which current training and certification requirements are challenging for some programs. Diplomates and PDs had differing perceptions of the cytopathology examination; diplomates regarded image-based and microscopic glass slide questions as the best assessment of their knowledge. CONCLUSIONS First, fellowship training programs could benefit from shared resources and should provide more graduated responsibility for fellows. Second, the ACGME Review Committee could consider this data in future program requirement revisions. Finally, information from these surveys will be useful as the ABPath adjusts certification examination content and delivery.
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Affiliation(s)
- Ritu Nayar
- Professor and Vice Chair, Departments of Pathology and Medical Education, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
| | - Deborah Chute
- Associate Professor and Residency Program Director, Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Aaron Douglas
- Former Psychometrician, American Board of Pathology, Tampa, Florida
| | - Tyler Sandersfeld
- Current Psychometrician, American Board of Pathology, Tampa, Florida
| | - Rebecca Johnson
- Chief Executive Officer, American Board of Pathology, Tampa, Florida
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White K, Qualtieri J, Courville EL, Beck RC, Alobeid B, Czuchlewski DR, Teruya-Feldstein J, Soma LA, Prakash S, Gratzinger D. Entrustable Professional Activities in Hematopathology Pathology Fellowship Training: Consensus Design and Proposal. Acad Pathol 2021; 8:2374289521990823. [PMID: 33644302 PMCID: PMC7894592 DOI: 10.1177/2374289521990823] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/24/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022] Open
Abstract
Hematopathology fellowship education has grown in complexity as patient-centered treatment plans have come to depend on integration of clinical, morphologic, immunophenotypic, molecular, and cytogenetic variables. This complexity is in competition with the need for timely hematopathology care with stewardship of patient, laboratory, and societal resources. Accreditation Council for Graduate Medical Education Milestones provide a guidance document for hematopathology training, but fellows and their educators are in need of a simple framework that allows assessment and feedback of growth toward independent hematopathology practice. Entrustable professional activities provide one such framework, and herein, we provide proposed Hematopathology Fellowship Entrustable Professional Activities based on review of pertinent guidelines and literature, with multiple rounds of expert and stakeholder input utilizing a modified mini-Delphi approach. Ten core entrustable professional activities deemed essential for graduating hematopathology fellows were developed together with skills and knowledge statements, example scenarios, and corresponding Accreditation Council for Graduate Medical Education Milestones. Application of these entrustable professional activities in program design, fellow evaluation, and decisions regarding level of supervision is discussed with consideration of benefits and barriers to implementation. These entrustable professional activities may be used by hematopathology fellowship directors and faculty to provide fellows with timely constructive feedback, determine entrustment decisions, provide the Clinical Competency Committee with granular data to support Milestone evaluations, and provide insight into areas of potential improvement in fellowship training. Fellows will benefit from a clear roadmap to independent hematopathology practice with concrete and timely feedback.
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Affiliation(s)
- Kristie White
- Department of Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Julianne Qualtieri
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Elizabeth L. Courville
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rose C. Beck
- Department of Pathology, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bachir Alobeid
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - David R. Czuchlewski
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Julie Teruya-Feldstein
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Lorinda A. Soma
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sonam Prakash
- Department of Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Dita Gratzinger
- Stanford University School of Medicine, Stanford, CA, USA
- Dita Gratzinger, Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA 94305, USA.
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