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Andrew A Renshaw

Publications and source records attributed to Andrew A Renshaw.

At least 19 recordsLinked to original sources
PubMed2007

Measuring errors in surgical pathology in real-life practice: defining what does and does not matter.

This review summarizes our experience using blinded review as a method to measure quality in surgical pathology. It details the specifics about how the review is performed, the weaknesses in the method, and then summarizes our results so far. These results suggest that error rates correlate with the individual pathologist, the type of specimen, the type of diagnosis, subspecialization, and the number of pathologists who review a case. Errors do not correlate with workload. This method is relatively unbiased and effective at identifying significant errors in real life clinical practice. The drawback to this method is the amount of work involved. Blinded review, performed so that errors can be corrected in a timely manner, and eventually integrated into an interlaboratory review process, represents a realistic and fair method to provide quantitative quality assurance information.

Bias↗
PubMed2007

The value of inking breast cores to reduce specimen mix-up.

Accidental switching of tissue specimens in the histology laboratory can result in significant medical error. We sought to evaluate inking breast core needle specimens as a method to reduce the chance of specimen mix-up. We sequentially inked 1,000 consecutive breast core specimens with 6 different colors. Review of the color of the ink revealed 3 discrepancies: 1 related to blocks being switched, 1 related to incorrect labeling, and 1 was a typographical error. Inking of breast core specimens is a simple, inexpensive, and effective way to help reduce the chance of specimen mix-up.

Biopsy, Needle↗
PubMed2006

Prostate-specific antigen recurrence and mortality after conventional dose radiation therapy in select men with low-risk prostate cancer.

BACKGROUND: Prostate-specific antigen (PSA) recurrence, prostate cancer-specific mortality (PCSM), and all-cause mortality (ACM) were evaluated for men age >70 years receiving conventional dose external beam radiation therapy (RT). METHODS: Between January 1, 1989, and December 1, 2002, 358 men were treated with RT for localized prostate cancer at a Harvard Medical School Affiliate in Fall River, MA. Median age was 71.2 (range, 43.2-83.5) years and patients were followed for a median of 4.0 (range, 0.2-13.5) years. RESULTS: Univariable analysis demonstrated that increasing pretreatment PSA velocity was significantly associated with increasing pretreatment PSA (P < .0001), Gleason score (P = .0002), and shorter post-RT PSA doubling time (P = .0007) but not with clinical T-category (P = .09) or percent positive biopsies (P = .08). For the select cohort of men age >70 years with low-risk disease and a pretreatment PSA velocity < or =1.0 ng/mL per year, all deaths observed to date have been from nonprostate cancer etiologies. Whereas PSA recurrence in this group reached 43.3% by 7 years, due to the advanced age of the cohort and less aggressive biology, competing causes of mortality predominated as the cause of death despite PSA failure. CONCLUSIONS: In men age >70 years with low-risk prostate cancer and pretreatment PSA velocity < or =1.0 ng/mL/year, prostate cancer death was not observed despite a modest PSA recurrence rate.

Adult↗
PubMed2006

Six-month androgen suppression plus radiation therapy compared with radiation therapy alone for men with prostate cancer and a rapidly increasing pretreatment prostate-specific antigen level.

PURPOSE: We evaluated whether treatment with 6 months of androgen-suppression therapy (AST) and radiation therapy (RT) compared with RT was associated with the time to prostate-specific antigen (PSA) recurrence, prostate cancer-specific mortality (PCSM), and all-cause mortality (ACM) in men with a pretreatment PSA velocity more than 2 ng/mL/yr. PATIENTS AND METHODS: The study cohort comprised 241 men with clinically localized or locally advanced prostate cancer treated with RT and AST or RT from 1989 to 2002. Cox regression and Gray's formulation were used to assess whether treatment was associated significantly with the time to PSA recurrence or ACM and PCSM, respectively, adjusting for known prognostic factors. RESULTS: Despite the significantly longer median follow-up, younger age at diagnosis, higher proportion of Gleason score 7 to 10, and advanced T-category cancers, significantly lower estimates of PSA recurrence (P < .001), PCSM (P = .007), and ACM (P < .001) were observed in men who were treated using RT and AST compared with RT. Treatment with RT and AST compared with RT was associated with a longer time to PSA recurrence (adjusted hazard ratio [HR], 0.22; 95% CI, 0.14 to 0.35; P < .001), PCSM (HR, 0.23, 95% CI, 0.09 to 0.64; P = .005), and ACM (HR, 0.30; 95% CI, 0.16 to 0.58; P < .001). CONCLUSION: Treatment using 6 months of AST and RT compared with RT in men with a pretreatment PSA velocity greater than 2 ng/mL/yr was associated with a longer time to PSA recurrence, PCSM, and ACM.

Aged↗
PubMed2006

Perineural invasion associated with increased cancer-specific mortality after external beam radiation therapy for men with low- and intermediate-risk prostate cancer.

PURPOSE: To identify an association between perineural invasion (PNI) and cancer-specific survival in patients with prostate cancer after standard-dose external beam radiation therapy (RT). METHODS AND MATERIALS: A total of 517 consecutive patients who underwent RT (median dose, 70.5 Gy) between 1989 and 2003 for low-risk or intermediate-risk prostate cancer were studied. A genitourinary pathologist (AAR) scored presence or absence of PNI on all prostate needle-biopsy specimens. A Cox regression multivariable analysis was performed to assess whether the presence of PNI was associated with risk of prostate cancer-specific mortality after RT when the recognized risk-group variables were factored into the model. Estimates of cancer-specific mortality were made using a cumulative incidence method. Comparisons of survival were made using a two-tailed log-rank test. RESULTS: At a median follow-up of 4.5 years, 84 patients (16%) have died, 15 of 84 (18%) from prostate cancer. PNI was the only significant predictor of prostate cancer-specific mortality after RT (p=0.012). The estimated prostate cancer-specific mortality was 14% at 8 years for PNI+ patients vs. 5% for PNI- patients (p=0.0008). CONCLUSIONS: Patients with low- or intermediate-risk prostate cancer who have PNI on prostate needle biopsy have a significantly higher rate of prostate cancer-specific mortality after standard-dose radiation therapy than patients without PNI. Although this analysis is retrospective, this association argues for consideration of the use of more aggressive therapy, such as hormonal therapy with RT or dose escalation, in these select patients.

Biopsy, Needle↗
PubMed2006

Predictors of mortality after prostate-specific antigen failure.

PURPOSE: We identified factors associated with the length of survival after prostate-specific antigen (PSA) failure. METHODS AND MATERIALS: The study cohort comprised 81 of 206 men enrolled on a randomized trial evaluating external-beam radiation therapy (RT) with or without androgen suppression therapy (AST) and who experienced PSA failure. Salvage AST was administered at a PSA level of approximately 10 ng/mL as per protocol. Cox regression was used to determine factors associated with length of survival after PSA failure. RESULTS: A PSA DT (doubling time) <6 months (p = 0.04) and age at the time of PSA failure (p = 0.009) were significantly associated with length of survival. By 5 years, 35% and 65% of all-cause mortality was from prostate cancer in men whose age at PSA failure was 75 or higher vs. <75, respectively. Across all ages, 0%, 4%, as compared with 63% of men, were estimated to die of prostate cancer within 5 years after PSA failure if their PSA DT was >12, 6-12, or <6 months, respectively. CONCLUSIONS: Advanced age and a PSA DT <6 months at the time of PSA failure are associated with a significantly shorter survival.

Aged↗
PubMed2006

Comparison of ureteral washing and biopsy specimens in the community setting.

BACKGROUND: Ureteral lesions can be difficult to diagnose. The value of ureteral biopsy in addition to ureteral washings has not been defined clearly. METHODS: All ureteral washings and biopsies with follow-up that were performed at a single institution were reviewed. RESULTS: In total, 39 patients underwent ureteral washing, ureteral biopsy, or both and had follow-up: Eighteen patients had urothelial tumors at follow-up (14 high-grade carcinomas, 3 low-grade carcinomas, and 1 papillary urothelial neoplasm of low malignant potential). The sensitivity was 79% for washings and 71% for biopsies (P = 1.0), for a combined sensitivity of 100%. Biopsies often were scant, and cell blocks from biopsies and washings often were of value. CONCLUSIONS: Ureteral washings and biopsies had similar sensitivity and appeared to be complementary. Cell blocks often are useful for both specimen types.

Biopsy↗
PubMed2006

Identifying men diagnosed with clinically localized prostate cancer who are at high risk for death from prostate cancer.

PURPOSE: We identified factors at diagnosis that are significantly associated with time to prostate cancer specific mortality following radical prostatectomy or external beam radiation therapy. MATERIALS AND METHODS: The study cohort included 1,453 men treated with radical prostatectomy (1,095) or external beam radiation therapy (358) for localized prostate cancer between 1989 and 2002. Cox regression multivariate analysis was used to evaluate whether prostate specific antigen, prostate specific antigen velocity, biopsy Gleason score and clinical tumor category at diagnosis were significantly associated with time to prostate cancer specific mortality following radical prostatectomy or external beam radiation therapy. RESULTS: In addition to increasing prostate specific antigen (p < or =0.04) and biopsy Gleason score 8 to 10 disease (p < or =0.02), prostate specific antigen velocity more than 2 ng/ml yearly was significantly associated with shorter time to prostate cancer specific mortality in patients treated with radical prostatectomy (adjusted HR 12, 95% CI 3 to 54) and external beam radiation therapy (adjusted HR 12, 95% CI 3 to 54) compared with that in men with prostate specific antigen velocity 2 ng/ml yearly or less (p < or =0.001). Despite low risk disease 7-year estimates of prostate cancer specific mortality were 5% to 19% in patients in whom prostate specific antigen increased by more than 2 ng/ml during the year before diagnosis compared with less than 1% in those with a prostate specific antigen increase of 2 ng/ml or less. CONCLUSIONS: Despite prostate specific antigen level less than 10 ng/ml and Gleason score 6 cancer a prostate specific antigen increase of more than 2 ng/ml during the year before diagnosis places a man at high risk for prostate cancer death following radical prostatectomy or external beam radiation therapy.

Aged↗
PubMed2006

Correlation of workload with disagreement and amendment rates in surgical pathology and nongynecologic cytology.

In gynecologic cytology, workload limits are imposed as a surrogate to limit error rates. Whether workload correlates with error rates in surgical pathology and nongynecologic cytology is not known. We reviewed and compared the disagreement and amendment rates based on blinded review for 5 pathologists with the number of cases reviewed during that same period. A total of 2,659 general surgical pathology and nongynecologic cytology cases underwent blinded review. There were 105 disagreements identified and 28 amendments issued. Workload varied from 455 to 649 cases per month. Neither the disagreement nor the amendment rate correlated with total workload during the period of the study (Pearson rank correlation r = 0.58 and 0.12, respectively). There is no correlation between workload and disagreement or amendment rates. Workload seems to be a poor surrogate for error rates in the range of workload examined in this study. Such data suggest that workload limits would have no effect at limiting or reducing error rates in surgical pathology or nongynecologic cytology.

Cytodiagnosis↗
PubMed2006

Measuring the value of review of pathology material by a second pathologist.

In many departments, some cases are reviewed routinely by a second pathologist within the same department before sign out. The value of this practice is not known. We reviewed and compared the disagreement and amendment rates for cases reviewed by 1 or more pathologists based on the results of blinded review. A total of 8,363 cases underwent blinded review, and of these, 1,087 (13.0%) were reviewed by more than 1 pathologist before sign out. The disagreement rate for cases reviewed by more than 1 pathologist (4.8%) was significantly lower than for cases reviewed by only 1 pathologist (6.9%; P = .004). The amendment rate decreased to 0.0% from 0.5%, but this decrease was not statistically significant (P = .12). Review of material by a second pathologist before sign out is associated with a lower disagreement rate. These results suggest second review of surgical pathology is of value, but the best selection of cases to be reviewed remains to be defined.

Diagnostic Errors↗
PubMed2006

Sessile serrated adenoma is associated with acute appendicitis in patients 30 years or older.

Sessile serrated adenoma is a relatively recently described entity that can occur in the appendix. The incidence of this finding is unknown. We entirely submitted 100 consecutive appendices sent for acute appendicitis and correlated the histologic findings with clinical parameters and the findings in 100 routinely (partially) submitted cases. In cases submitted routinely, only 1 sessile serrated adenoma was found. In contrast, in cases entirely submitted, 11 adenomas were found, all in patients 30 years or older. All sessile serrated adenomas were present in 3 cross-sections or fewer of the appendix. The incidence of sessile serrated adenoma in patients with acute appendicitis is significantly increased in patients 30 years or older (P = .001), and detection is dependent on thorough tissue sampling.

Acute Disease↗
PubMed2006

Comparison of disagreement and amendment rates by tissue type and diagnosis: identifying cases for directed blinded review.

We sought to determine whether a group of cases that was relatively high in disagreements and subsequent amendments could be identified and targeted for blinded review. During a 4-year period, 8,916 surgical pathology and nongynecologic cytology cases were subjected to blinded review; of these, there were 616 disagreements (6.9%), 69 (0.8%) had subsequent amendments issued, and 33 (0.4%) represented false-negative errors of blinded review. Tissues with the highest amendment rates were breast (4.4%), endocrine (4%), gynecologic (1.8%), and cytology (1.3%). Specimen types with highest amendment rates for specimens with more than 20 cases were breast core biopsies (4.0%) and endometrial currettings (2.1%). Diagnoses were divided into negative (64.7%), malignant (21.4%), nondiagnostic (1%), defined precursor lesions (ie, atypical ductal hyperplasia, tubular adenoma) (9.8%), and atypical or "suspicious" (3.1%). Amendment rates were highest for nondiagnostic material (5%) and atypical/suspicious (2.2%). Reviewing only nondiagnostic and atypical cases would have involved reviewing only 4.0% of cases and detected 14% of amendments. Reviewing all breast, gynecologic, nongynecologic cytology, and endocrine material would have involved reviewing 26.9% of cases and detected 88% of amendments. These data can be used to define material for directed blinded review that is relatively high in potential errors.

Biopsy, Needle↗
PubMed2006

Lobular neoplasia in breast core needle biopsy specimens is associated with a low risk of ductal carcinoma in situ or invasive carcinoma on subsequent excision.

To address the significance of lobular neoplasia (LN) in breast core needle biopsy specimens, we prospectively obtained LN cases and correlated results of subsequent tissue sampling. LN was diagnosed by core needle biopsy in 467 women; in 101 (21.6%), invasive carcinoma (IC) or ductal carcinoma in situ (DCIS) was diagnosed concurrently. Two patients (0.4%) had previous diagnoses of IC or DCIS, and 17 (3.6%) had a concurrent diagnosis of contralateral IC or DCIS. Of 366 patients without a concurrent diagnosis of IC or DCIS, subsequent tissue diagnoses were available for 156 cases (42.6%). Of 60 cases of LN and atypical ductal hyperplasia on the biopsy, 5 had IC and 10 had DCIS on the excision (total, 25%). Of 4 women with LN and a mucocele-like lesion on the biopsy, none had IC or DCIS on excision. Of 92 with LN alone on the biopsy, 7 had IC (6) or DCIS (1) on excision. Two cases were in sites away from the biopsy site, 3 in subsequent excisions of the biopsy site, and 2 after previous excision of the biopsy site without finding IC or DCIS. Although LN is associated with a high overall rate of IC and DCIS (30%), excision of the biopsy site for women with LN alone on core needle biopsy has a very low rate of IC and DCIS in our center. Women in whom biopsy sites are excised are still at risk for subsequent DCIS and IC.

Biopsy, Needle↗
PubMed2006

Robustness of validation criteria in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.

CONTEXT: Field validation of slides used in gynecologic cytology proficiency testing has surfaced as an important issue. Although the precision of diagnoses in peer-reviewed educational programs has been examined, the robustness of the validation criteria for specific types of interpretations used in proficiency testing has not been previously studied. OBJECTIVE: To evaluate the robustness of validation criteria for slides entering an educational slide program. DESIGN: We reviewed the results of the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology and compared the robustness of validation criteria for different reference diagnoses, using a total of 16,948 circulating slides. RESULTS: Validation criteria could be divided into 2 significantly different groups. The criteria for herpes, Trichomonas, squamous cell carcinoma, and adenocarcinoma were significantly more robust than the diagnoses of unsatisfactory; negative for intraepithelial lesion and malignancy, not otherwise specified; low-grade squamous intraepithelial lesion; and high-grade squamous intraepithelial lesion (P < .001). CONCLUSIONS: The validation criteria used in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology show 2 different levels of robustness or redundancy. These results have implications for the design of fair proficiency tests. Proficiency testing can be designed with the necessary number of reviews needed for slide validation.

Clinical Competence↗
PubMed2006

The significance of certification in liquid-based cytology and performance in the college of american pathologists interlaboratory comparison program in cervicovaginal cytopathology.

CONTEXT: Morphology training and certification provided by the manufacturer is required before laboratories are allowed to prepare and interpret liquid-based cytology (LBC) gynecologic slides. Whether this certification is associated with improved LBC interpretation performance is not known. OBJECTIVE: To determine whether LBC certification correlates with performance. DESIGN: The results of the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytopathology for the year 2004 were reviewed. During this year a question on the answer form asked participants whether they were certified in LBC preparations. Participant responses were analyzed at 2 levels of agreement with the reference diagnosis of unknown glass slides mailed quarterly. RESULTS: For cytotechnologists and pathologists, participants who were LBC certified had a significantly lower total discordant rate to series than participants who were not certified for validated LBC ThinPrep (Cytyc Corp, Marlborough, Mass) preparations (P < .001 for both groups). The results were similar for validated conventional preparations for pathologists but not for cytotechnologists. The differences were present across most individual diagnostic series. Differences were most striking for low-grade squamous intraepithelial lesions. In addition, cytotechnologists and pathologists who were certified had a significantly lower total discordant rate to the exact diagnosis for validated LBC ThinPrep slides than those who were not certified (discordant rates for cytotechnologists, 14.14% and 23.36%, respectively, P < .001; for pathologists, 15.99% and 24.07%, respectively, P < .001). CONCLUSION: Although not all confounding factors were excluded in this study, LBC certification is associated with a significantly lower discordant rate to both series and exact diagnosis for validated LBC ThinPrep preparations.

Allied Health Personnel↗
PubMed2006

Interobserver agreement on microfollicles in thyroid fine-needle aspirates.

CONTEXT: Although microfollicles are a well-known feature of follicular neoplasms in fine-needle aspirates of the thyroid, the level of agreement about classifying groups as microfollicles is not known. OBJECTIVE: To determine what features are present in groups that are consistently classified as microfollicles. DESIGN: We showed 45 small groups of follicular cells each composed of fewer than 50 cells from fine-needle aspirates of the thyroid to 12 members of the College of American Pathologists Cytopathology Committee, who then classified the groups into microfollicles, macrofollicles, and indeterminate groups. RESULTS: Twenty groups were consistently classified as microfollicles, 7 groups as macrofollicles, and 18 groups as indeterminate. Cases that were consistently classified as microfollicles were composed of fewer than 15 cells (19/20 cases), were arranged in a circle with a lumen (13/20 cases) that was at least two-thirds complete (12/20 cases), and were flat (18/20 cases). Cases that were classified as macrofollicular had between 8 and 35 cells, were arranged in sheets composed of at least 15 cells (5/7 cases) or rows of 8 cells (2/7 cases), and were flat (7/7 cases). In contrast, cases that were indeterminate were composed of either 3-dimensional groups (5/18 cases), flat groups of fewer than 10 cells (11/18 cases), or single cells (1/18 cases). CONCLUSION: Not all small groups of follicular cells are consistently classified as microfollicles, and some are more often classified as macrofollicles. The criteria described here for reproducible microfollicles (<15 cells, arranged in a circle that is at least two-thirds complete, and flat) may help improve the agreement in classification of microfollicles and lead to more consistent classification of thyroid fine-needle aspirates.

Adenocarcinoma, Follicular↗