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PubMed2001

[Colorectal cancer--experiences with the use of standardized forms for reporting pathologic-anatomic data].

BACKGROUND: Colorectal cancer is the second most common cancer among both men and women in Norway. The quality of the information given in the histopathological report is crucial for staging and treatment, and standardised reports are recommended. Such standardised schemes for histopathological reporting and surgical specimen handling were introduced from 1 July 1996 and 1 January 1998, respectively. The present study was undertaken in order to evaluate these schemes and to investigate to what extent the procedures complied with international recommendations. MATERIAL AND METHODS: An evaluation of all histopathological reports from 390 patients operated for colorectal carcinomas and registered at the Department of Pathology of the Central Hospital of Rogaland 1 July 1996 to 30 June 1999. RESULTS: The standardised schemes were used in 184 of 193 cases of surgical specimen handling (95%) and in 381 of 390 cases of histopathological reporting (98%). The quality of the histopathological reports, was in good agreement with international recommendations with respect to most data items. However, the average number of 9.0 lymph nodes sampled was below the minimum of 12 recommended by the International Union Against Cancer. In 29% of the cases, less than six lymph nodes were found. INTERPRETATION: Although the standardised schemes were used almost uniformly, the schemes did not ensure by themselves that all data items were in accordance with international recommendations. The fact that too few lymph nodes were sampled, was only detected during the present evaluation. Thus, any introduction of standardised schemes should include a regular follow-up to ensure that predefined goals are attained.

Carcinoma↗
PubMed1997

Changes in emergency department turnaround time performance from 1990 to 1993. A comparison of two College of American Pathologists Q-probes studies.

OBJECTIVE: To compare the results of a 1990 College of American Pathologists Q-Probes Emergency Department (ED) turnaround time (TAT) study with a similar study done in 1993 and to identify factors associated with TAT improvement. DESIGN: Participants gathered data over a 4-week period on the various times of day associated with the ordering, specimen-collection, laboratory-receipt, and result-reporting stages of stat tests for potassium and hemoglobin levels, using a mail-in questionnaire that also included practice parameter questions. PARTICIPANTS: Laboratories enrolled in the 1990 College of American Pathologists Q-Probes study on ED TAT and laboratories enrolled in the 1993 program ED TAT study. MAIN OUTCOME MEASURES: Components associated with shorter ED TAT and, for those participating in both the 1990 and 1993 studies, comparison with previous results. RESULTS: Six hundred fifteen hospital laboratories returned data on up to 43,521 hemoglobin and 41,989 potassium specimens. Half of these laboratories collected and reported 90% of their ED potassium results in 53 minutes or less, compared to 61 minutes or less in 1990, and reduced the corresponding median collection-to-reporting TAT for 90% of hemoglobin results from 46 minutes or less to 39 minutes or less. The fastest 10% of laboratories showed interlaboratory median order-to-report TATs of 36 and 50 minutes for potassium and hemoglobin tests, respectively. Comparisons of TATs from 277 laboratories with 1990 and 1993 data were possible. Components found to contribute statistically to improvement of ED TAT between 1990 and 1993 were laboratory control of specimen handling, rapid transport time, and monitoring. Active monitoring was particularly important when the laboratory did not control the specimen-handling process. CONCLUSIONS: Laboratories improved their control of ED TAT from 1990 to 1993 and reduced the number of TAT events exceeding 70 minutes. Internally set TAT goals, however, were not met most of the time.

Diagnostic Tests, Routine↗
PubMed1999

Prostate. Practice parameters, pathologic staging, and handling radical prostatectomy specimens.

This article addresses the handling, processing, and reporting of radical prostatectomy specimens with the goal of providing general guidelines and practical suggestions for the surgical pathologist. During the last decade, pathologists in academic and community institutions have witnessed a surge in the number of radical prostatectomy specimens evaluated in their departments. Unlike the relative familiarity most pathologists have with other major oncologic resections, radical prostatectomy specimens present an interesting and occasionally frustrating challenge with respect to gross evaluation, sampling, and reporting.

Humans↗
PubMed2000

Increase in information content in histopathology reports: a concealed workload for histopathologists.

INTRODUCTION: The workload of histopathologists is traditionally assessed by the total number of specimens handled annually (TSA). Development in medical science has resulted in an increased demand by clinicians for more information in histopathology reports. Inclusion of this information requires more work. Annual information output (AIO) is the total number of specimens handled annually multiplied by the average number of items of information per histopathology report (AIR). An item of information is any pathological feature of prognostic or therapeutic relevance. OBJECTIVE: This study aims to determine whether there has been an increase in annual information output (AIO) during a 17-year period. METHOD: This is a retrospective study in a University Department of Pathology. 200 histopathology reports per year at 4 yearly intervals from 1982 to 1998 were examined. TSA, AIR and AIO were calculated. RESULTS: TSA increased from 2912 in 1982 to 3919 in 1998 (34.6% increase). AIR increased from 1.11 to 3.12 (181.1% increase). AIO increased from 3232.3 to 12227.3 (278.3% increase). CONCLUSION: The increase in AIO was greater than the increase in TSA. Thus the use of TSA alone will not reflect the increase in workload accurately. We recommend the use of AIO rather than TSA to quantify workload and staffing requirements of histopathologists.

Forms and Records Control↗
PubMed1993

Usefulness of the mean platelet volume.

The mean platelet volume measurement can reflect changes in either the level of platelet stimulation or rate of platelet production. The controversy related to whether platelets change volume or density in the circulation is still not clearly resolved, and although the relationship between platelet number and size and megakaryocyte number, size, and ploidy have been well described, the factors that regulate this interaction are still poorly understood. Platelet volumes are frequently measured after being collected in EDTA and stored at room temperature in spite of the known artifacts that are induced by this type of specimen handling. Still, the MPV can be useful in selected clinical conditions. If platelet consumption in vascular disorders is associated with stimulated platelet production, however, then there is a need for further optimization of this technique. Proper method standardization and the development of more stable specimen handling conditions may allow the MPV to have broader clinical application in detecting and monitoring vascular disorders. Development of improved technique may currently be impeded by the ease with which highly artifactual measures can be now be obtained.

Animals↗
PubMed1999

The diagnosis and incidence of allergic fungal sinusitis.

OBJECTIVE: To reevaluate the current criteria for diagnosing allergic fungal sinusitis (AFS) and determine the incidence of AFS in patients with chronic rhinosinusitis (CRS). METHODS: This prospective study evaluated the incidence of AFS in 210 consecutive patients with CRS with or without polyposis, of whom 101 were treated surgically. Collecting and culturing fungi from nasal mucus require special handling, and novel methods are described. Surgical specimen handling emphasizes histologic examination to visualize fungi and eosinophils in the mucin. The value of allergy testing in the diagnosis of AFS is examined. RESULTS: Fungal cultures of nasal secretions were positive in 202 (96%) of 210 consecutive CRS patients. Allergic mucin was found in 97 (96%) of 101 consecutive surgical cases of CRS. Allergic fungal sinusitis was diagnosed in 94 (93%) of 101 consecutive surgical cases with CRS, based on histopathologic findings and culture results. Immunoglobulin E-mediated hypersensitivity to fungal allergens was not evident in the majority of AFS patients. CONCLUSION: The data presented indicate that the diagnostic criteria for AFS are present in the majority of patients with CRS with or without polyposis. Since the presence of eosinophils in the allergic mucin, and not a type I hypersensitivity, is likely the common denominator in the pathophysiology of AFS, we propose a change in terminology from AFS to eosinophilic fungal rhinosinusitis.

Diagnosis, Differential↗
PubMedDate not supplied

Bedside hemoglobinometry in hemodialysis patients: lessons from point-of-care testing.

The HemoCue B-hemoglobin test system (HemoCue, Inc., Mission Viejo, CA) is a photometric method for rapid bedside determination of hemoglobin (Hb). We compared the performance of HemoCue measured Hb against Coulter STK-S (CSTK) measured Hb in chronic hemodialysis (HD) patients in two different settings. In the first setting, Hemocue analysis was performed by multiple HD technicians (n = 132). In the second setting, a nurse trained in proper specimen handling performed the HemoCue analysis (n = 74). Simultaneous measurement of Hb by the CSTK method was performed. First setting: Hb was 11.1+/-1.66 (SD) g/dl by CSTK and 11.7+/-2.29 g/dl by HemoCue. The HemoCue method consistently overestimated Hb by an average (SD) of 0.63 (1.267) g/dl (95% CI = 0.42 to 0.85). Hb was overestimated in 25.7% and underestimated in 2.3% of the patients by 1 g/dl or more. Thus, the HemoCue system was accurate within 1 g/dl only 72% of the time. Second setting: HemoCue overestimated Hb by an average (SD) of 0.29 (0.52) g/dl (95% CI, 0.17 to 0.41). Only 4% of all patients had errors in estimation of 1 g/dl or more. Thus, HemoCue was accurate in 96% of the patients within 1 g/dl. After reviewing the two protocols, the primary difference in the two studies was the technique used to obtain the specimens. When performed properly, Hb testing using the HemoCue testing system had a high level of agreement with CSTK. Appropriate training in specimen handling, as well as test performance, will increase accuracy and reliability of bedside hemoglobinometry.

Adult↗
PubMed2001

Laboratory-acquired parasitic infections from accidental exposures.

Parasitic diseases are receiving increasing attention in developed countries in part because of their importance in travelers, immigrants, and immunocompromised persons. The main purpose of this review is to educate laboratorians, the primary readership, and health care workers, the secondary readership, about the potential hazards of handling specimens that contain viable parasites and about the diseases that can result. This is accomplished partly through discussion of the occupationally acquired cases of parasitic infections that have been reported, focusing for each case on the type of accident that resulted in infection, the length of the incubation period, the clinical manifestations that developed, and the means by which infection was detected. The article focuses on the cases of infection with the protozoa that cause leishmaniasis, malaria, toxoplasmosis, Chagas' disease (American trypanosomiasis), and African trypanosomiasis. Data about 164 such cases are discussed, as are data about cases caused by intestinal protozoa and by helminths. Of the 105 case-patients infected with blood and tissue protozoa who either recalled an accident or for whom the likely route of transmission could be presumed, 47 (44.8%) had percutaneous exposure via a contaminated needle or other sharp object. Some accidents were directly linked to poor laboratory practices (e.g., recapping a needle or working barehanded). To decrease the likelihood of accidental exposures, persons who could be exposed to pathogenic parasites must be thoroughly instructed in safety precautions before they begin to work and through ongoing training programs. Protocols should be provided for handling specimens that could contain viable organisms, using protective clothing and equipment, dealing with spills of infectious organisms, and responding to accidents. Special care should be exercised when using needles and other sharp objects.

Accidents, Occupational↗
PubMed2002

Laboratory diagnosis and biosafety issues of biological warfare agents.

Bioterrorism events have been rare until recently. Many clinical laboratories may not be familiar with handling specimens from a possible bioterrorism attack. Therefore, they should be aware of their own responsibilities and limitations in the handling and treatment of such specimens, and what to do if they are requested to process clinical samples. The Centers for Disease Control and Prevention has developed the Laboratory Response Network to provide an organized response system for the detection and diagnosis of biological warfare agents based on laboratory testing abilities and facilities. There are potentially many biological warfare agents, but probably a limited number of agents would be encountered in case of an attack, and their identification and laboratory safety will be discussed.

Biological Warfare↗
PubMed2002

Short-term stability of the molecular forms of prostate-specific antigen and effect on percent complexed prostate-specific antigen and percent free prostate-specific antigen.

Differences in stability of the free and complexed molecular forms of prostate-specific antigen (PSA) may influence the clinical utility of assays for these forms, as well as the calculated ratios to total PSA (tPSA), such as percent free PSA (fPSA) and percent complexed PSA (cPSA). The objective of this study was to directly compare the short-term stability of fPSA and cPSA under different storage conditions. Specimens (3 with prostate cancer, 3 biopsy-negative without cancer, 2 normal) from 8 men were analyzed at baseline within 2 hours of collection, and at 4 hours, 8 hours, 24 hours, 48 hours, and 1 week after storage at room temperature, 4 degrees C, or -20 degrees C. Serum specimens were analyzed in duplicate on the Bayer Immuno 1 analyzer (tPSA, cPSA) and on the Beckman Coulter Access analyzer (tPSA, fPSA Tandem assays). Baseline tPSA values ranged from 0.7 to 62.0 ng/mL, with a median of 7.9 ng/mL (Immuno 1). Overall, all forms of PSA were stable up to 24 hours at the 3 temperatures, with the exception of fPSA and percent fPSA, which decreased when stored at 4 degrees C. After 1 week, tPSA levels decreased when stored at room temperature and at 4 degrees C, as did cPSA stored at room temperature. Over the 7 days, percent cPSA was stable at room temperature, but increased at 4 degrees C. There were no significant changes in any PSA form or calculated ratio with storage at -20 degrees C for up to 1 week. In summary, in the short term (<1 week), fPSA is less stable with storage than tPSA or cPSA in a time- and temperature-dependent fashion. Thus, specimen handling should be considered when interpreting PSA results. It is recommended that specimens not analyzed the same day (within 8 hours of collection) be stored frozen at -20 degrees C.

Cryopreservation↗
PubMed2002

Evaluation of an automated preanalytical robotic workstation at two academic health centers.

BACKGROUND: Purchase of automated systems in today's clinical laboratory needs justification based on demonstrable improvements in efficiency and a sound payback model. Few studies provide information on laboratory automation that focuses on the preanalytical portion of specimen processing. METHODS: We recently evaluated an automated preanalytical processing unit (GENESIS FE500) at two academic health centers. This preanalytical unit processes blood specimens through automated specimen sorting, centrifugation, decapping, labeling, aliquoting, and placement of the processed specimen in the analytical rack. We quantified the output of the FE500 by processing >3000 barcode-labeled specimens according to a protocol designed to test all of the features of this automated specimen-processing unit. RESULTS: Depending on the batch size, aliquot number requested, and percentage of tubes that required centrifugation, the mean system output performance varied between 93 and 502 total tubes/h. Throughput increased when the batch size expanded from 40 or 100 samples (mean = 211 total tubes processed/h) to batch sizes of 200 and 300 tubes (mean = 474 total tube processed/h). The GENESIS FE500 processed specimen tubes differing in size from 13 x 65 mm (width x height) to 16 x 100. At one site, the FE500 was operated by one person, compared with the three individuals required to perform the same tasks manually. Finally, the specimen-processing error rate determined at one of the institutions was significantly reduced. CONCLUSIONS: We conclude that the GENESIS FE500 effectively reduces the labor associated with specimen processing; decreases the number of laboratory errors that occur with specimen sorting, labeling, and aliquoting; and improves the integrity of specimen handling throughout the steps of specimen processing.

Autoanalysis↗
PubMed1984

Obtaining samples for the laboratory.

Mislabeling, incomplete or incorrect requisition forms, and in-vitro hemolysis are the most common problems related to specimen handling. Postprandial lipemia, administration of corticosteroids, and use of excess EDTA in the collecting tube may interfere with test results. Specimens for coagulation profiles should be collected in tubes containing EDTA or citrate. Most urinalysis errors result from improper sample collection, inappropriate storage, and delayed analysis.

Animals↗
PubMed2005

Impact of preanalytical variables on granulocytic surface antigen expression: a review.

BACKGROUND: There is a gradual but steady increase in the use of granulocytic surface marker studies to diagnose several inherited and acquired blood and bone marrow disorders. Diagnosis and follow-up of patients with inflammation and infection are other areas of quantitative flow cytometric application. Despite the increased use of flow cytometry to study granulocytes, there seems to be no well-established standards regarding specimen handling for these studies. METHODS: This review summarizes the effect of preanalytical variables on granulocytic surface markers. RESULTS AND CONCLUSIONS: Storing specimens in sodium heparin at room temperature for up to 72 h seems satisfactory. Other anticoagulants, although acceptable, may have a shorter storage time. Storage time could be prolonged further with the use of some preservation media. Lysed whole blood is the preferred technique. Techniques should avoid major temperature change and excessive manipulation and should maintain storage and methodologic temperature with minimal fluctuation. Fixation before staining with the antibody may result in decreased expression of some surface antigens.

Animals↗
PubMed1976

Proper biopsy technique for immunofluorescence tests on skin.

Successful use of direct immunofluorescence tests on skin depends on selection of the appropriate biopsy site, careful preparation of the specimen, and prompt transportation to a reliable laboratory. Recommendations for selection of biopsy sites in various dermatoses and methods available for handling specimens are discussed.

Biopsy↗