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Soleimani N, Zare Sheibani A, Khajeh S, Mohammadzadeh S, Taheri N, Mokhtari M, Farhadi M, Hajizade Z, Khaleghpanah S, Dehghani S. Critical value in surgical pathology: evaluating the current status in a multicenter study. Diagn Pathol 2023; 18:55. [PMID: 37106381 PMCID: PMC10134675 DOI: 10.1186/s13000-023-01342-8] [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: 10/29/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The concept of critical value is not evident in surgical pathology, and there is no established protocol for determining, reporting, and documenting these results. MATERIALS AND METHODS A questionnaire was designed regarding critical value in surgical pathology, and all pathologists and some clinicians from five laboratories were asked to participate through an invitation link. The most important items were selected, and all pathologists were instructed to follow a standard operating procedure to deal with critical results for a year. RESULTS A total of 43 pathologists and 44 non-pathologists participated in the study. Some critical or unexpected items were selected. Most participants agreed that the optimal time to announce critical reports is within 24 h of establishing the final diagnosis, and a phone call was the most dependable communication option. In addition, the most qualified recipients were the attending physicians. Therefore, a written policy was implemented for a year. One hundred seventy-seven critical or unexpected cases (0.5%) were detected. Mucormycosis and cytomegalovirus (CMV) were the most frequent critical cases. CONCLUSION There are no set criteria for critical items or the reporting process in surgical pathology. It is possible to establish more uniform norms for reporting these cases by boosting pertinent research efforts and recruiting more pathologists and physicians. Additionally, it is advised that each medical facility compile its own unique critical or unexpected diagnosis list.
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Affiliation(s)
- Neda Soleimani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefe Zare Sheibani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samira Khajeh
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahand Mohammadzadeh
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Negar Taheri
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Mokhtari
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Farhadi
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Hajizade
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeideh Khaleghpanah
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sima Dehghani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Mlika M, Laatar E, Braham E, Chebbi C, Hamzaoui A, Mezni F. The place of the bronchoalveolar lavage in the diagnosis of interstitial lung disease: a descriptive and qualitative study. LA TUNISIE MEDICALE 2022; 99:869-876. [PMID: 35261013 PMCID: PMC9003584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Interstitial lung disease represents a challenge and consists in more than 200 entities. Their diagnoses are assessed through a multidisciplinary approach including pulmonologists, radiologists, pathologists and biologists. BAL analysis is useful mainly when clinical and radiological findings aren't suggestive of an etiology. Even if, the indication of BAL is consensual, its real place as a diagnostic mean remains non consensual. AIM To describe the BAL findings and to analyse the perceptions of the pulmonologists, anaesthesiologists and pathologists implicated in the interpretation of the BAL data, that are related to the presentation and the validity of the results. METHODS the authors performed a descriptive study about BAL results during an 8-year-period (2010-2018) and a qualitative study assessing the pulmonologists, anaesthesiologists and pathologists' opinions concerning the different results performed in the same institution. Two questionnaires were conceived with participation of different experts and satisfaction scores were calculated. RESULTS 2508 BAL were recorded including 1320 women (53%) and 1188 men (47%) with a sex-ratio (H/F) of 0,9. The mean age of the patients was 51 years. The mean response delay was 3.25 days. An accurate diagnosis was retained in 24.3%. It consisted in infection evoked in 13.89% cases. Eosinophilic pneumonia was evoked in 0.35% cases. 15.01% cases presented erythrophagocytosis with a golde score>100 favouring active alveolar haemorrhage with occult alveolar haemorrhage. Lipoproteinosis was diagnosed in 2 cases. Adenocarcinoma was retained in 1.04% cases and lymphoma in 0.16% cases. Langerhans cell histiocytosis was confirmed in 1.51% cases. In the other cases, cellular profile was not specific evoking tuberculosis or sarcoidosis in 316 cases with a CD4/CD8 ratio superior to 1,6 and the diagnoses of tuberculosis or hypersensitivity pneumonia in 202 cases with a CD4/CD8 ratio inferior to 1,2. Concerning the questionnaire-based study, 50 pulmonologists and anaesthesiologists attributed a mean score of 7.96/10 (DS=0.55) concerning the presentation of the results and 9.28/15 (DS=0.77) concerning the quality and validity of the results. On the other hand, the mean satisfaction score rated by pathologists reached 24/40. CONCLUSION BAL results could be helpful for the management of interstitial lung disease depending on the experience of pathologists and a good communication between pulmonologists, anaesthesiologists and pathologists.
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Affiliation(s)
- Mona Mlika
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Emna Laatar
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Emna Braham
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Chokri Chebbi
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Agnès Hamzaoui
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Faouzi Mezni
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
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ISSİN G, GAMSIZKAN M, TURAL E, ÇAĞATAY D, KESKİN ÇİMEN F. An Examination of the factors which may affect the duration of admission to the hospital of panic diagnosed patients during and pre-COVID-19 pandemic. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.918394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Onken AM, VanderLaan PA, Rosenbaum MW. Critical values in cytology. J Am Soc Cytopathol 2021; 10:341-348. [PMID: 34034996 DOI: 10.1016/j.jasc.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
The timely reporting of critical values, or values that may be life-threatening if immediate action is not taken, is essential to patient care and safety. Although some guidelines exist for critical diagnoses in cytology, not all laboratories have a specific list of diagnoses that should be considered critical, and the very existence of cytology "critical values" has been called into question. Here we propose a pragmatic system for determining cytology critical values and report our laboratory's critical value list, formulated based on a review of the medical literature regarding clinical urgency and other institutions' cytology critical value lists.
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Affiliation(s)
- Allison M Onken
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matthew W Rosenbaum
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Staats PN, Parkash V, Otis CN, Sharma P, Ioffe O, Bracamonte ER. The Current State of Communication of Urgent and Significant, Unexpected Diagnoses in Anatomic Pathology. Arch Pathol Lab Med 2020; 144:1067-1074. [PMID: 32023089 DOI: 10.5858/arpa.2019-0436-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The concept of critical diagnoses in anatomic pathology is relatively recent and rigorous study of the issue is quite limited. The College of American Pathologists and Association of Directors of Anatomic and Surgical Pathology issued a consensus statement in 2012. There has been no multi-institutional study of communication policies since then. OBJECTIVE.— To survey the policies of anatomic pathology laboratories regarding communication of critical values. DESIGN.— A survey of the Association of Directors of Anatomic and Surgical Pathology membership was performed using a 14-question electronic survey tool. RESULTS.— Responses were received from 38 institutions. Thirty-five of 38 (92%) had a policy on anatomic pathology critical values. Twenty-five of 38 (66%) respondents had read the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology consensus statement. Twelve of 38 (32%) institutions divided critical values into 2 categories, of which 9 used the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology terminology; 24 used only a single term, of which 11 used critical value. There was substantial variation in the diagnoses that were considered critical. A direct phone call to the responsible provider was uniformly considered an acceptable means of communication; all other methods had mixed or low support. The most common time frame was same day; many laboratories did not specify a timeframe. Most laboratories document date, time, and person to whom the result was communicated in the final report or an addendum report. Eighteen of 38 (47%) laboratories report an auditing mechanism for communication. CONCLUSIONS.— Policies for communication of critical/urgent/significant, unexpected results in anatomic pathology are the norm. However, there remains significant variation between institutions in the details of these policies.
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Affiliation(s)
- Paul N Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore (Staats, Ioffe)
| | - Vinita Parkash
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Parkash)
| | - Christopher N Otis
- Department of Pathology, University of Massachusetts Medical School - Baystate, Springfield (Otis)
| | - Poonam Sharma
- Department of Pathology, Creighton University School of Medicine, Omaha, Nebraska (Sharma)
| | - Olga Ioffe
- Department of Pathology, University of Maryland School of Medicine, Baltimore (Staats, Ioffe)
| | - Erika R Bracamonte
- Department of Pathology, University of Arizona College of Medicine, Tucson (Bracamonte)
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Zhang X, Furth EE, Tondon R. Vasculitis Involving the Gastrointestinal System Is Often Incidental but Critically Important. Am J Clin Pathol 2020; 154:536-552. [PMID: 32789454 DOI: 10.1093/ajcp/aqaa083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study was aimed to investigate the significance of unexpected vasculitis identified in gastrointestinal (GI) specimens by determining its prevalence and correlation with clinical outcomes. METHODS GI specimens with histologic evidence of vasculitis were identified in our pathology database over a 10-year period (January 2008 to August 2018). Clinical history, treatment, and follow-up were reviewed. RESULTS Of the 131,367 GI pathology cases received over the 10-year study period, 29 (0.02%) cases showed histologic evidence of GI vasculitis. The majority (69%, 20/29) were not clinically suspected. Of these, 20% (4/20) of patients were subsequently diagnosed with systemic vasculitis. During the mean follow-up period of 34.0 months, 24% (4/17) of the patients with this unexpected diagnosis died as the result of direct complications of GI vasculitis. We also found that 95% of cases with unexpected vasculitis in their GI pathology specimens were communicated in a timely manner to the ordering physicians, which necessitated the immediate initiation of additional workups in 85% of these patients. CONCLUSIONS The GI involvement of vasculitis is rarely encountered by pathologists, but its diagnosis carries tremendous clinical significance with a high mortality rate. Therefore, timely communication is highly recommended for the early diagnosis and treatment of this disease.
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Affiliation(s)
- Xiaoming Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Emma Elizabeth Furth
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Rashmi Tondon
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
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Margo CE. Critical Diagnoses in Ophthalmic Pathology: Suspected Important Unanticipated Diagnoses in Surgically Removed Eyes. Ocul Oncol Pathol 2019; 6:44-49. [PMID: 32002405 DOI: 10.1159/000500640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/29/2019] [Indexed: 11/19/2022] Open
Abstract
Aim To describe the 5-year profile of anatomic critical diagnoses from an ophthalmic pathology laboratory and raise awareness of the challenges of establishing guidelines for these diagnoses. Methods Medical records of patients who had consecutively submitted surgically removed globes or eviscerated eyes from 1 October 2009 to 31 October 2014 were examined for a critical diagnosis, as defined by a verbal communication for a serious, unanticipated diagnosis.Important discordant anatomic and clinical diagnoses were reviewed to determine whether the anatomic finding was truly unanticipated. Results During the study period, 313 eyes were submitted to the laboratory as primary specimens. Twenty (6.4%) had critical (alert) diagnoses. Six of the 20 anatomic diagnoses (30%) were known or suspected prior to surgery but were not communicated on the pathology request form. Five diagnoses (25%) were not clinically suspect before surgery. In 9 cases (45%) medical-care providers were alerted to the critical findings but insufficient clinical information was provided about preoperative conditions. Conclusions The proportion of critical diagnoses among surgically removed eyes is small, but not inconsequential. Some "critical alerts" would be unnecessary if relevant clinical information was provided when the tissue is submitted to the laboratory. Laboratory guidelines for critical values in surgical pathology should be flexible since they need to anticipate the vicissitudes of clinical practice. Surgeons need to appreciate that relevant clinical information must be provided to pathologists because it can play a role in formulating anatomic diagnoses.
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Affiliation(s)
- Curtis E Margo
- Morsani College of Medicine, University of South Florida, Department of Ophthalmology, Pathology and Cell Biology, Tampa, Florida, USA
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Müller S, Boy SC, Day TA, Magliocca KR, Richardson MS, Sloan P, Tilakaratne WM, Zain RB, Thompson LDR. Data Set for the Reporting of Oral Cavity Carcinomas: Explanations and Recommendations of the Guidelines From the International Collaboration of Cancer Reporting. Arch Pathol Lab Med 2018; 143:439-446. [PMID: 30500296 DOI: 10.5858/arpa.2018-0411-sa] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The International Collaboration on Cancer Reporting is a nonprofit organization whose goal is to develop evidence-based, internationally agreed-upon standardized data sets for each cancer site for use throughout the world. Providing global standardization of pathology tumor classification, staging, and other reporting elements will lead to the objective of improved patient management and enhanced epidemiologic research. Carcinomas of the oral cavity continue to represent a significant oncologic management burden, especially as changes in alcohol and tobacco use on a global scale contribute to tumor development. Separation of oral cavity carcinomas from oropharyngeal tumors is also important, as management and outcome are quite different when human papillomavirus association is taken into consideration. Topics such as tumor thickness versus depth of invasion, pattern of invasive front, extent and size of perineural invasion, and margin assessment all contribute to accurate classification and staging of tumors. This review focuses on the data set developed for Carcinomas of the Oral Cavity Histopathology Reporting Guide, with discussion of the key elements developed for inclusion.
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Affiliation(s)
- Susan Müller
- From Atlanta Oral Pathology, Decatur, Georgia (Dr Müller); Lancet Laboratories, Pretoria, South Africa (Dr Boy); the Departments of Otolaryngology-Head and Neck Surgery (Dr Day) and Pathology and Laboratory Medicine (Dr Richardson), Medical University of South Carolina, Charleston; the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Magliocca); the Department of Cellular Pathology, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Sloan); the Department of Oral Pathology, University of Peradeniya, Sri Lanka (Dr Tilakaratne); the Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Jalan, Malaysia (Dr Zain); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California (Dr Thompson)
| | - Sonja C Boy
- From Atlanta Oral Pathology, Decatur, Georgia (Dr Müller); Lancet Laboratories, Pretoria, South Africa (Dr Boy); the Departments of Otolaryngology-Head and Neck Surgery (Dr Day) and Pathology and Laboratory Medicine (Dr Richardson), Medical University of South Carolina, Charleston; the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Magliocca); the Department of Cellular Pathology, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Sloan); the Department of Oral Pathology, University of Peradeniya, Sri Lanka (Dr Tilakaratne); the Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Jalan, Malaysia (Dr Zain); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California (Dr Thompson)
| | - Terrence A Day
- From Atlanta Oral Pathology, Decatur, Georgia (Dr Müller); Lancet Laboratories, Pretoria, South Africa (Dr Boy); the Departments of Otolaryngology-Head and Neck Surgery (Dr Day) and Pathology and Laboratory Medicine (Dr Richardson), Medical University of South Carolina, Charleston; the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Magliocca); the Department of Cellular Pathology, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Sloan); the Department of Oral Pathology, University of Peradeniya, Sri Lanka (Dr Tilakaratne); the Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Jalan, Malaysia (Dr Zain); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California (Dr Thompson)
| | - Kelly R Magliocca
- From Atlanta Oral Pathology, Decatur, Georgia (Dr Müller); Lancet Laboratories, Pretoria, South Africa (Dr Boy); the Departments of Otolaryngology-Head and Neck Surgery (Dr Day) and Pathology and Laboratory Medicine (Dr Richardson), Medical University of South Carolina, Charleston; the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Magliocca); the Department of Cellular Pathology, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Sloan); the Department of Oral Pathology, University of Peradeniya, Sri Lanka (Dr Tilakaratne); the Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Jalan, Malaysia (Dr Zain); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California (Dr Thompson)
| | - Mary S Richardson
- From Atlanta Oral Pathology, Decatur, Georgia (Dr Müller); Lancet Laboratories, Pretoria, South Africa (Dr Boy); the Departments of Otolaryngology-Head and Neck Surgery (Dr Day) and Pathology and Laboratory Medicine (Dr Richardson), Medical University of South Carolina, Charleston; the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Magliocca); the Department of Cellular Pathology, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Sloan); the Department of Oral Pathology, University of Peradeniya, Sri Lanka (Dr Tilakaratne); the Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Jalan, Malaysia (Dr Zain); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California (Dr Thompson)
| | - Philip Sloan
- From Atlanta Oral Pathology, Decatur, Georgia (Dr Müller); Lancet Laboratories, Pretoria, South Africa (Dr Boy); the Departments of Otolaryngology-Head and Neck Surgery (Dr Day) and Pathology and Laboratory Medicine (Dr Richardson), Medical University of South Carolina, Charleston; the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Magliocca); the Department of Cellular Pathology, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Sloan); the Department of Oral Pathology, University of Peradeniya, Sri Lanka (Dr Tilakaratne); the Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Jalan, Malaysia (Dr Zain); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California (Dr Thompson)
| | - Wanninayake M Tilakaratne
- From Atlanta Oral Pathology, Decatur, Georgia (Dr Müller); Lancet Laboratories, Pretoria, South Africa (Dr Boy); the Departments of Otolaryngology-Head and Neck Surgery (Dr Day) and Pathology and Laboratory Medicine (Dr Richardson), Medical University of South Carolina, Charleston; the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Magliocca); the Department of Cellular Pathology, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Sloan); the Department of Oral Pathology, University of Peradeniya, Sri Lanka (Dr Tilakaratne); the Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Jalan, Malaysia (Dr Zain); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California (Dr Thompson)
| | - Rosnah B Zain
- From Atlanta Oral Pathology, Decatur, Georgia (Dr Müller); Lancet Laboratories, Pretoria, South Africa (Dr Boy); the Departments of Otolaryngology-Head and Neck Surgery (Dr Day) and Pathology and Laboratory Medicine (Dr Richardson), Medical University of South Carolina, Charleston; the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Magliocca); the Department of Cellular Pathology, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Sloan); the Department of Oral Pathology, University of Peradeniya, Sri Lanka (Dr Tilakaratne); the Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Jalan, Malaysia (Dr Zain); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California (Dr Thompson)
| | - Lester D R Thompson
- From Atlanta Oral Pathology, Decatur, Georgia (Dr Müller); Lancet Laboratories, Pretoria, South Africa (Dr Boy); the Departments of Otolaryngology-Head and Neck Surgery (Dr Day) and Pathology and Laboratory Medicine (Dr Richardson), Medical University of South Carolina, Charleston; the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Magliocca); the Department of Cellular Pathology, Newcastle University, Newcastle upon Tyne, United Kingdom (Dr Sloan); the Department of Oral Pathology, University of Peradeniya, Sri Lanka (Dr Tilakaratne); the Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Jalan, Malaysia (Dr Zain); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California (Dr Thompson)
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Cretara AD, Otis CN. Perspectives and perceptions of urgent and alert values in surgical pathology and cytopathology: A survey of clinical practitioners and pathologists. Cancer Cytopathol 2018; 126:970-979. [PMID: 30291817 DOI: 10.1002/cncy.22067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 11/07/2022]
Abstract
In previous editorials, Chapman and Otis in 2011 and Layfield in 2014 have summarized much of the work responsible for establishing the concept of critical diagnoses in surgical pathology and cytopathology. Both editorials end with a list of 8 key policy points needed for an effective strategy of handling and communicating critical diagnoses. We have developed and distributed a Web-based survey to elicit clinicians' attitudes regarding many of those key policy points, such as how, when, and to whom critical diagnoses should be reported; we have allowed some level of collaboration with the clinical staff when developing our communication policies as the Association of Directors of Anatomic and Surgical Pathology (ADASP) consensus statement recommends. We have identified important areas of disagreement between pathologists and clinicians regarding what entities should be considered critical and who should be responsible for correlating histologic findings with the larger clinical context. Identifying these discordant points of view and fostering interdepartmental agreement on the best practices in the communication of critical diagnoses is an important patient care and safety issue. Chapman and Otis have also suggested the importance of increased access to accurate patient information and the clinical history, including the level of clinical suspicion of malignancy, and of forming a periodic review and quality assurance process. Here we explore methods of increasing the ability of pathologists and cytopathologists to identify unexpected diagnoses, including optimization of their workstations for better access to the electronic medical record, and we examine the progress of quality assurance methods in surgical pathology and cytopathology since the ADASP consensus statement in 2012.
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Affiliation(s)
- Anthony D Cretara
- Department of Pathology, Baystate Medical Center, Springfield, Massachusetts
| | - Christopher N Otis
- Department of Pathology, Baystate Medical Center, Springfield, Massachusetts.,University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
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Nakhleh R, Fitzgibbons PL, Nowak JA, Najarian RM, Keren DF, Colgan TJ, Colasacco C, Fatheree LA. The Lifecycle of an Evidence-Based Laboratory Practice Guideline: Origin, Update, Affirmation, and Impact! Arch Pathol Lab Med 2018; 142:438-440. [DOI: 10.5858/arpa.2017-0401-ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Raouf Nakhleh
- From the Department of Pathology, Mayo Clinic Florida, Jacksonville (Dr Nakhleh); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Najarian); the D
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11
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Korbl JD, Wood BA, Harvey NT. 'Why don't they ever call?' Expectations of clinicians and pathologists regarding the communication of critical diagnoses in dermatopathology. Pathology 2018; 50:305-312. [PMID: 29496200 DOI: 10.1016/j.pathol.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/14/2017] [Accepted: 10/15/2017] [Indexed: 10/17/2022]
Abstract
Certain diagnoses in dermatopathology have significant implications for patient management and on occasion appropriate clinical care may be facilitated by a phone call from the reporting dermatopathologist to the referring doctor. Whether this is appropriate depends on a number of factors. The concept of 'critical diagnoses' is now well established in surgical pathology, having evolved from critical value policies in clinical pathology and haematology. However, only limited attempts have been made to assess perceptions among different clinical groups. We designed a survey to assess the attitudes of pathologists, dermatologists, surgeons and general practitioners as to what circumstances warrant telephone contact in addition to a standard written report, as well as their approaches to routine histology follow-up. The survey was distributed Australia-wide via a combination of specialist colleges, medical forums and collegiate contacts. A total of 262 responses were received, encompassing representations from all of the targeted specialties. Approximately 20% of respondents were aware of adverse outcomes or 'near misses' which they felt had been due in some part to inadequate communication of histopathology results. While most practitioners have formal systems in place to review histopathology reports, this practice is not universal. There were a number clinical situations where there was a discrepancy between the expectations of clinicians and those of pathologists, in particular with regard to a diagnosis of cutaneous melanoma as well as cutaneous lesions which might be associated with inherited cancer syndromes. It is our hope that the results of this study will facilitate discussion between pathologists and referring clinicians at a local level to minimise the potential for miscommunication.
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Affiliation(s)
| | - Benjamin Andrew Wood
- Dermatopathology Group, Department of Anatomical Pathology, PathWest, Perth, WA, Australia; Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Nathan Tobias Harvey
- Dermatopathology Group, Department of Anatomical Pathology, PathWest, Perth, WA, Australia; Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, WA, Australia.
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12
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Xing J, Seigh L, Monaco SE, Ohori NP, Yousem SA, Amin R, Pantanowitz L. Critical diagnoses in cytopathology: Experience at a large medical center. Cancer Cytopathol 2017; 125:726-730. [PMID: 28704594 DOI: 10.1002/cncy.21896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/17/2017] [Accepted: 06/06/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Critical values have been well established and accepted in laboratory medicine, but to the authors' knowledge are less well accepted in anatomic pathology. Herein, the authors used a reporting process whereby reports with critical diagnoses were coded to ensure that the patient's clinical team was promptly notified electronically of this finding. The aim of the current study was to determine whether this coding mechanism was used appropriately for critical cytopathology diagnoses in the study health care system. METHODS A retrospective review of the University of Pittsburgh Medical Center anatomic pathology laboratory information system was performed to identify cytopathology reports in which a critical diagnosis code (MedTrak notification/CoPath Tissue Code TC66; TC66) was used from 2011 through 2016. TC66-coded cytopathology reports between 2015 and 2016 were reviewed further to determine whether this code was used appropriately. RESULTS A total of 1687 TC66-coded cytopathology reports were identified. Between 2015 and 2016, a total of 30 of 46 reports (65%) from academic hospitals and 46 of 441 reports (10%) from community hospitals met the critical diagnoses criteria outlined by institutional policy. The remaining TC66-coded cases were predominantly for new diagnoses of malignancy in patients clinically suspected of having cancer. CONCLUSIONS Use of a code for critical cytopathology diagnoses was found to be occurring increasingly at the study health care system. Pathologists at the academic and community hospitals in the study institution used this code somewhat differently, reflecting the need to satisfy communication with clinicians in different practice settings. Nevertheless, the authors' experiences with using a code for critical diagnoses not only ensured timely patient care but also proposed a model that could be used by other medical specialties to enhance communication and improve quality of care. Cancer Cytopathol 2017;125:726-30. © 2017 American Cancer Society.
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Affiliation(s)
- Juan Xing
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lindsey Seigh
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samuel A Yousem
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rajnikant Amin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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13
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Smith SM, Yearsley M. Constructing Comments in a Pathology Report: Advice for the Pathology Resident. Arch Pathol Lab Med 2016; 140:1023-4. [DOI: 10.5858/arpa.2016-0220-ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Stephen M. Smith
- From the Department of Pathology & Laboratory Medicine, Wexner Medical Center at The Ohio State University, Columbus, Ohio
| | - Martha Yearsley
- From the Department of Pathology & Laboratory Medicine, Wexner Medical Center at The Ohio State University, Columbus, Ohio
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14
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Abstract
Quality assurance encompasses monitoring daily processes for accurate, timely, and complete reports in surgical pathology. Quality assurance also includes implementation of policies and procedures that prevent or detect errors in a timely manner. This article presents uses of informatics in quality assurance. Three main foci are critical to the general improvement of diagnostic surgical pathology. First is the application of informatics to specimen identification with lean methods for real-time statistical control of specimen receipt and processing. Second is the development of case reviews before sign-out. Third is the development of information technology in communication of results to assure treatment in a timely manner.
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Affiliation(s)
- Raouf E Nakhleh
- Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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15
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Thrall MJ, Janssen BL, Mody DR. The clinical impact of including pictures in Papanicolaou test reports. J Am Soc Cytopathol 2015; 4:122-127. [PMID: 31051692 DOI: 10.1016/j.jasc.2014.11.004] [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: 09/16/2014] [Revised: 11/06/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Although the inclusion of representative photomicrographic images in pathology reports remains uncommon, the frequency has increased in recent years. The impact of the inclusion of pictures has not previously been examined in peer-reviewed literature. MATERIALS AND METHODS We compared the Papanicolaou (Pap) test interpretations produced by our laboratory before and after the introduction of a requirement to include pictures in reports with interpretations of low-grade squamous intraepithelial lesion (LSIL); atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion; high-grade squamous intraepithelial lesion; atypical glandular cells; or carcinoma. Atypical squamous cells of undetermined significance (ASC-US) did not require a picture, creating an incentive to interpret borderline cases as ASC-US instead of LSIL. We compared 1810 Pap tests from before the picture requirement to 1807 after. RESULTS The number of cases upgraded by the pathologists from a cytotechnologist interpretation of negative or ASC-US to one of the positive interpretations requiring a picture decreased from 99 in the prepicture era to 80 in the picture era (P = 0.19). Conversely, the number of cases downgraded by the pathologists increased from 65 to 98 (P = 0.015). The ASC-US to LSIL (ASC-SIL) ratio for the laboratory went from 0.92 to 1.45. CONCLUSIONS The introduction of a picture requirement in Pap test reports significantly affected the practice of pathologists in our laboratory. The ASC-SIL ratio of the laboratory shifted toward the national mean in association with this change.
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Affiliation(s)
- Michael J Thrall
- Houston Methodist Hospital, Department of Pathology and Genomic Medicine, 6565 Fannin M227, Houston, Texas.
| | | | - Dina R Mody
- Houston Methodist Hospital, Department of Pathology and Genomic Medicine, 6565 Fannin M227, Houston, Texas
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16
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Affiliation(s)
- Elizabeth A. Wagar
- From the Department of Laboratory Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas
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17
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Layfield LJ. Critical values: Has their time arrived for cytopathology? Cancer Cytopathol 2014; 122:163-6. [DOI: 10.1002/cncy.21378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Lester J. Layfield
- Department of Pathology and Anatomical Sciences; University of Missouri; Columbia Missouri
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18
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Renshaw AA, Birdsong GG. Issues in reporting cytology: From headers and critical values to categorical data and natural language parsers. J Am Soc Cytopathol 2014; 3:37-41. [PMID: 31051728 DOI: 10.1016/j.jasc.2013.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/16/2013] [Accepted: 05/21/2013] [Indexed: 06/09/2023]
Abstract
The standards for reporting cytology, including critical values in cytology, are rapidly evolving. The issues and standards for the use of headers, reporting critical values, and the switch to categorical data elements are reviewed. The way in which cytology is reported is evolving, and the amount of information that is routinely generated from that report is increasing.
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19
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Blessing MM, Reichard RR. Critical Diagnoses in Forensic Pathology: Ethics of Disclosure. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A complex set of systems exists in the United States to manage and regulate the practice of medicine, and forensic pathologists (FPs) are bound by the associated ethical guidelines and associated statutory obligations. Individual FPs, for example, are required to have and maintain a state medical license that requires continuing medical education and provides oversight of many aspects of the practice of medicine. The laboratories in which forensic pathology is practiced, however, generally do not have to be accredited. In contrast, the College of American Pathologists (CAP) is the recognized accrediting body that “regulates” the majority of anatomic pathology and laboratory medicine, including hospital (consented) autopsies. Unlike hospital-based pathology practices, few incentives are present that encourage or require forensic pathology practices to pursue accreditation. Since the preponderance of forensic pathology practices do not fall under the purview of CAP, this relatively small subset of pathologists are left to determine their own set of professional and ethical standards. The National Association of Medical Examiners (NAME) laboratory accreditation and published autopsy guidelines provides a foundation for development of a quality management program, but does not specifically address disclosure of test results. Defining “critical diagnoses” in forensic pathology is challenging, and communicating these important findings to the proper individual(s) or organizations may not fall under statutory or accrediting requirements, and thus may become an ethical issue for the medical examiner/coroner.
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Affiliation(s)
- Melissa M. Blessing
- Mayo Clinic, Rochester, MN
- Mayo Clinic - Anatomic Pathology, Rochester, MN (RR)
| | - R. Ross Reichard
- Mayo Clinic, Rochester, MN
- Mayo Clinic - Anatomic Pathology, Rochester, MN (RR)
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