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PubMed1997

[The comparison of clinical and surgical-pathological staging for endometrial carcinoma].

OBJECTIVE: To compare the differences between clinical (FIGO 1971) and surgical-pathological (FIGO 1989) stagings of endometrial carcinoma and to investigate the advantage and the feasibility of the surgical-pathological staging. METHODS: Clinical and pathological data of 290 patients with endometrial carcinoma surgically treated from 1989 to 1995 were retrospectively reviewed. The clinical and surgical-pathologic staging of these patients were compared. The stagings were analyzed with regards to the prognostic factors of endometrial cancer. RESULTS: The differences between clinical and surgical-pathologic staging in stage I and II were 19.7% and 80.5% respectively. 4.2% with metastases to the lymph node, 10.6% with positive peritoneal cytology and 60.5% with myometrial invasion were found in clinical stage I. 51.4% with metastases to the lymph nodes, 46.9% with positive peritoneal cytology and 100.0% of myometrial invasion were observed in clinical stage II. The causes of the differences between these two staging systems are: (1) it was impossible before operation to accurately detect metastases of the lymph nodes and malignant cells in the pelvic-peritoneal cavity; (2) when the dilation and curettage was done before operation, the lesions of an involved cervix might be missed or an uninvolved cervix misdiagnosed as metastatic lesion; (3) there were already cancer cells disseminated in the peritoneal cavity. CONCLUSIONS: The surgical-pathologic staging defines the real extent of endometrial carcinoma. It is advised that at the initial operation attention should be paid to areas beyond the extent of the intended surgery itself. During the initial operation, peritoneal cytology and pelvic and para-aortic lymph node samplings should be done for the purpose of surgical-pathologic staging of the selection of postoperative adjuvant therapy and of providing a clinico-pathological basis for the prediction of prognosis. Since there is a high percentage of misdiagnosis in clinical stage II endometrial carcinoma, special attention is needed in diagnosing and treating such patients.

Adenocarcinoma↗
PubMedDate not supplied

Pathologic tumor response in the breast following neoadjuvant chemotherapy predicts axillary lymph node status.

PURPOSE: Neoadjuvant chemotherapy is becoming the standard of care for locally advanced breast cancer. This study was performed to determine whether pathologic primary tumor response to neoadjuvant chemotherapy might predict axillary lymph node status and so be used to identify patients in whom surgery could be effectively limited to biopsy of the previous primary tumor site without axillary dissection. PATIENTS AND METHODS: Between 1992 and 1996, 170 consecutive patients with locally advanced breast cancer were treated in a prospective trial with four preoperative cycles of 5-fluorouracil, doxorubicin, and cyclophosphamide. Disease was staged before initiation of preoperative chemotherapy and before surgery. Segmental resection with axillary lymph node dissection or modified radical mastectomy was performed first, followed by postoperative chemotherapy and radiation therapy of the breast (or chest wall) and regional lymphatics. Patient and tumor characteristics associated with complete versus incomplete pathologic primary tumor response to neoadjuvant chemotherapy and correlation between primary breast tumor pathologic response and axillary lymph node status found at surgery were analyzed. RESULTS: Of 156 evaluable patients, 30 patients (19%) had primary breast tumors that were completely eliminated after induction chemotherapy based on histologic assessment. Nineteen of those 30 patients (63%) had negative axillary lymph nodes at dissection, compared with 13 patients (33%) of the 40 who had a near-complete pathologic primary tumor response (< or = 1 cm3 remaining) and only 15 patients (17%) of the 86 who had > 1 cm3 tumor remaining in the pathology specimen of the breast primary. Of the 22 patients with a complete pathologic response in the breast and a clinically negative axilla after induction chemotherapy, axillary dissection revealed positive lymph nodes in four. These four patients had only one or two positive lymph nodes. DISCUSSION: Because initial clinical regression of primary tumor with neoadjuvant chemotherapy is considered an excellent prognostic indicator and because patients with locally advanced breast cancer routinely receive local and regional radiation treatment followed by additional chemotherapy, the role of breast and axillary surgery has been questioned. In this study, a complete pathologic response of the primary tumor to induction chemotherapy is highly predictive of negative axillary lymph node status. Therefore, axillary lymph node dissection may be omitted in certain subsets of patients who have a biopsy-proven complete pathologic response in the primary tumor and a clinical negative axillary examination. Further prospective, randomized investigation is needed to confirm this finding.

Adult↗
PubMed2006

Critical diagnoses (critical values) in anatomic pathology.

Similar to critical values in clinical pathology, occasional diagnoses in surgical pathology and cytology may require urgent contact of the physician to facilitate rapid intervention or treatment. However, there are no established critical value (critical diagnosis) guidelines in anatomic pathology. As discussed herein, the Association of Directors of Anatomic and Surgical Pathology (ADASP) believes that establishing anatomic pathology critical diagnosis guidelines represents a practice improvement and patient safety initiative. The ADASP also recognizes that a generic anatomic pathology critical diagnosis guideline such as this should only be used as a template because the list needs to be customized at each individual hospital after consultation with relevant clinical services. Based on surveys of the membership of the ADASP, this document provides examples of possible critical diagnoses in anatomic pathology.

Diagnostic Errors↗
PubMed2006

Critical diagnoses (critical values) in anatomic pathology.

Similar to critical values in clinical pathology, occasional diagnoses in surgical pathology and cytology may require urgent contact of the physician to facilitate rapid intervention or treatment. However, there are no established critical value (critical diagnosis) guidelines in anatomic pathology. As discussed herein, the Association of Directors of Anatomic and Surgical Pathology (ADASP) believes that establishing anatomic pathology critical diagnosis guidelines represents a practice improvement and patient safety initiative. ADASP also recognizes that a generic anatomic pathology critical diagnosis guideline such as this should only be used as a template, because the list needs to be customized at each individual hospital after consultation with relevant clinical services. Based on surveys of the membership of the ADASP, this document provides examples of possible critical diagnoses in anatomic pathology.

Diagnostic Errors↗
PubMed2006

Critical diagnoses (critical values) in anatomic pathology.

Similar to critical values in clinical pathology, occasional diagnoses in surgical pathology and cytology may require urgent contact of the physician to facilitate rapid intervention or treatment. However, there are no established critical value (critical diagnosis) guidelines in anatomic pathology. As discussed herein, the Association of Directors of Anatomic and Surgical Pathology (ADASP) believes that establishing anatomic pathology critical diagnosis guidelines represents a practice improvement and patient safety initiative. ADASP also recognizes that a generic anatomic pathology critical diagnosis guideline such as this should be used only as a template because the list needs to be customized at each individual hospital following consultation with relevant clinical services. Based on surveys of the membership of the ADASP, this document provides examples of possible critical diagnoses in anatomic pathology.

Female↗
PubMed1986

The future of biomedical research and its impact on pathology.

Biomedical research is an enterprise that is generally active today. The future of biomedical research will be determined by the directions given it by the individual research investigators, development of new equipment and facilities, availability of money to fund research, societal attitudes about the goals and uses of research, and the character of research investigators' training. The future of biomedical research seems to be substantial because it leads to strategies and techniques for preventing or curing disease, and, thereby, results of research can enable health care to be both improved and made less costly. The condition of research in pathology seems to be less healthy than does that of biomedical research in general. Faculty members of academic pathology departments do not seem to compete well for research support from federal sources, and this lack may signal a further decline in pathology research in the future. The reasons for the perceived erosion of research in pathology are complex, but they must be addressed and reversed. Since the practice of diagnostic pathology is an applied technology that depends on research for new scientific insights and techniques to sustain it, continued erosion of the research base of pathology will adversely affect the future utility and relevance of diagnostic pathology as a clinical medical specialty.

Financing, Government↗
PubMed2004

Quality of colon carcinoma pathology reporting: a process of care study.

BACKGROUND: In 1996, the Association of Directors of Anatomic and Surgical Pathology (ADASP) published recommendations for colon carcinoma reporting. Since this publication, no study has evaluated physician practice in relation to these recommendations. The objectives of the current study were to describe pathology reporting for colon carcinoma, evaluate potential variations in reporting, and identify areas for improvement. METHODS: Data were obtained from a population-based study of incident colon carcinoma in 33 counties in North Carolina between 1997 and 2000. All subjects with surgically resected colon carcinoma of tumor stage T2-T4 with available surgical pathology reports were eligible for inclusion in the current analysis. The authors reviewed pathology reports for adherence to recommendations of the ADASP. RESULTS: Four hundred thirty-eight pathology reports were included for analysis. Adherence to ADASP recommendations was < 90% for descriptions of how specimen was received (68%), how specimen was identified (71%), macroscopic depth of penetration (82%), appearance of serosa adjacent to tumor (50%), and status of residual bowel (73%). All other criteria were reported in > 90% of patients. Teaching hospital and contract pathology laboratories had greater adherence to recommendations, compared with community hospital laboratories. Hospitals with the highest colon carcinoma case volume demonstrated greater adherence to recommendations, compared with low-volume hospitals. CONCLUSIONS: Pathology reports were effective in communicating most pertinent findings from surgically resected colon carcinoma specimens. Omissions of some critical characteristics did occur, however, and significant variability in reporting existed based on laboratory affiliation and hospital case volume.

Colonic Neoplasms↗
PubMed1989

General pathology teaching at the University of Washington.

I have provided a brief overview of our experience teaching undergraduate general pathology at the University of Washington School of Medicine. Our course is part of a pathology curriculum that is somewhat unusual in light of the amount of time we devote to general, as opposed to organ system pathology. We think this makes sense in relation to the way medical teaching and practice are changing. Resources and curriculum time needed to teach an extensive, morphology-based organ system pathology curriculum are no longer available. In addition, experimental biology and medicine are beginning to improve the way human diseases are diagnosed and treated. Many of these advances are the result of new information on disease aetiology and pathogenesis. Students and practitioners of medicine need an understanding of disease processes that will allow them to rapidly assimilate and rationally apply this new information. The particular strengths of our course, as we view them, are an opportunity to discuss the small number of processes that underlie most human disease in some depth, and thus to emphasize general pathology as a conceptual and practical foundation for the practice of medicine; our laboratory sessions, which in a sense illustrate and summarize the course; and early placement of the course in the curriculum, which allows us to capitalize on concurrent basic science courses and a high level of interest among students in applying basic science knowledge to understanding human disease. Problems we face include the need for more 'active' learning exercises in the lecture and laboratory format we are bound to; the need, given the scope of general pathology, to present more 'take home messages' and fewer systematic reviews of evidence than we would like; the limited clinical knowledge of first year students, which restricts the scope of our laboratory and disease example presentations; and an inability to consistently challenge the abilities of the best students in each class. Organizing and teaching the course described above has been in large part satisfying and stimulating. I hope this overview has provided useful ideas for others teaching or contemplating courses in general pathology.

Education, Medical, Undergraduate↗
PubMed2005

Surgical pathological second opinion in thyroid malignancy: impact on patients' management and prognosis.

OBJECTIVES: To evaluate the effect of inter-institutional surgical pathology review of thyroid cancer on patients' treatment and prognosis. METHODS: All cases referred to the Institute of Pathology at Leeds for thyroid pathology review between January 2001 and March 2003 were included. The referring pathologists reports were compared to those produced in the MDT meeting by the expert pathologist. Whenever there was disagreement a third expert opinion was sought who was blinded for both diagnoses. Effects on management and prognosis were evaluated if there was disagreement. RESULTS: Of the 66 patients reviewed, 12 (18%) had a different pathological diagnosis (kappa=0.33). Two had their diagnosis changed from malignant to benign and a further two from benign to malignant. Eight patients had their prognosis downgraded and four upgraded after histopathological review. Five patients had their management affected by the new pathological diagnosis. CONCLUSION: A second opinion of surgical pathology for thyroid tumours can result in major therapeutic and prognostic modifications. All cases of suspected thyroid cancers should be reviewed in a multidisciplinary meeting supported by pathologist with experience in thyroid pathology.

Diagnostic Errors↗
PubMed2004

Variable oxygen and retinal VEGF levels: correlation with incidence and severity of pathology in a rat model of oxygen-induced retinopathy.

Retinal capillary quiescence is regulated by a delicate balance between proangiogenic and anti-angiogenic factors. Pathological angiogenesis is the result of a shift in this balance towards proangiogenic influences. Pathological angiogenesis is produced in a rat model of oxygen-induced retinopathy (OIR) by exposing newborn rat pups to alternating periods of hyperoxia and hypoxia. Based upon previous work, two similar exposure paradigms were investigated and compared, exposure of rat pups to alternating periods of 45 and 12.5% oxygen, and to alternating periods of 40 and 15% oxygen. The resulting retinal pathology was assessed by measurement of retinal clock hours with pathological blood vessel growth and the percentage of the retina that is avascular. The 45 and 12.5% exposure produced significantly greater incidence and severity of pathology than the 40 and 15% protocol. To explain the difference in pathology between these two very similar exposure protocols, retinal levels of proangiogenic vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGFR2) and anti-angiogenic pigment epithelium-derived factor (PEDF) were measured by ELISA and western blot analysis at 0, 2, and 6 days post-exposure. In whole retinal lysates, there were no significant differences in VEGFR2 and PEDF levels. However, VEGF levels were approximately 48 and 78% higher on post-oxygen exposure day 0 and 2, respectively, in the group treated with alternating periods of 45 and 12.5% oxygen compared to the group treated with alternating periods of 40 and 15% oxygen. There was no significant difference in VEGF levels between these two groups on day 6 post-exposure. Therefore, the difference in pathology observed between these two experimental paradigms is associated with differences in whole retinal VEGF levels, but not changes in whole retinal VEGFR2 or PEDF levels. The results of this study suggest the existence of a threshold in the rat model of OIR, such that a small change in blood oxygen profile triggers a disproportionate increase in subsequent neovascularization, which is accompanied by more dramatic changes of retinal VEGF level than VEGFR2 or PEDF level. If a similar threshold exists for humans, it could explain why some oxygen-treated premature infants develop retinopathy and others do not, despite similar gestational ages, birth weights and clinical courses.

Animals↗
PubMed2005

Strategies for teaching pathology to graduate students and allied health professionals.

Pathology is an essential course for many students in the biomedical sciences and allied health professions. These students learn the language of pathology and medicine, develop an appreciation for mechanisms of disease, and understand the close relationship between basic research and clinical medicine. We have developed 3 pathology courses to meet the needs of our undergraduates, graduate students, and allied health professionals. Through experience, we have settled on an approach to teaching pathology that takes into account the diverse educational backgrounds of these students. Educational resources such as assigned reading, online homework, lectures, and review sessions are carefully balanced to adjust course difficulty. Common features of our pathology curricula include a web-based computer laboratory and review sessions on the basis of selected pathology images and open-ended study questions. Lectures, computer-guided homework, and review sessions provide the core educational content for undergraduates. Graduate students, using the same computer program and review material, rely more heavily on assigned reading for core educational content. Our experience adapting a pathology curriculum to the needs of divergent groups of students suggests a general strategy for monitoring course difficulty. We hypothesize that course difficulty is proportional to the information density of specific learning resources (eg, lecture or textbook) multiplied by the weight of those learning resources placed on examinations. This formula allows educators to match the difficulty of a course with the educational needs of students, and provides a useful tool for longitudinal studies of curriculum reform.

Allied Health Personnel↗
PubMed2005

Influence of a problem-based learning curriculum on the selection of pathology as a career: evidence from the Canadian match of 1993-2004.

Since the introduction of problem-based learning (PBL) to North American medical education more than 30 years ago, there have been a number of analyses of its educational outcomes. Several authors have suggested that PBL may influence medical students' career choices. The balance of opinion in the pathology literature appears to assume that PBL curricula limit students' contact with pathologists and hypothesizes that PBL may impair recruitment into pathology residency programs. To evaluate this latter hypothesis, evidence from the 1993-2004 Canadian residency match was considered. During this period, 8 of 13 English-language medical schools in Canada changed from a non-PBL to a PBL curriculum; 1 had been using a PBL curriculum even before the 1993 start point and 4 remained using a non-PBL curriculum throughout the period under consideration. The proportion of medical school graduates ranking pathology first in their residency application match is compared between PBL and non-PBL medical schools. On average, 1.1% of non-PBL graduates and 1.2% of PBL graduates ranked a pathology residency program first. In general, there were proportionately slightly more pathology recruits from non-PBL schools at the beginning of the 1993-2004 period and slightly more pathology recruits from PBL schools toward the end of the period. In the absence of a nationally or internationally recognized standard for what constitutes a PBL school, this analysis must remain somewhat subjective. However, it does indicate that graduates from PBL schools are approximately as likely as those from non-PBL schools to rank pathology first in residency applications.

Canada↗
PubMed2006

The impact of computerised physician order entry systems on pathology services: a systematic review.

PURPOSE: Computerised physician order entry (CPOE) systems hold the promise of significant improvements to health care delivery and patient care. The implementation of such systems is costly and complex. The purpose of this paper is to review current evidence of the impact of CPOE on hospital pathology services. METHODS: This paper presents a review of the literature (1990-August 2004) about CPOE systems and identifies indicators for measuring the impact of CPOE on pathology services. RESULTS: Nineteen studies which contained some form of 'control' group, were identified. They featured a variety of designs including randomised controlled trials, quasi-experimental and before and after studies. We categorised these into three groups: studies comparing pathology CPOE systems (with no decision support) to paper systems; pathology CPOE systems (with decision support) to paper systems; and pathology CPOE systems with specific pathology features compared to systems without those features. We identified 10 areas of impact assessment and 39 indicators used to measure the impact of CPOE on different stages of the pathology test ordering and reporting process. CONCLUSION: We conclude that while some data suggest that CPOE systems are beneficial for clinical and laboratory work processes, these data are limited, and further research is needed. Few data are available regarding the impact of CPOE on patient outcomes.

Diffusion of Innovation↗
PubMed2005

Confounders in interpreting pathology for safety and risk assessment.

The contribution of pathology to toxicity assessment is invaluable but often not clearly understood. Pathology endpoints are the central response around which human health risk assessment is frequently determined; therefore, it is important that the general toxicology community understand current concepts and nomenclature of toxicologic pathology. Toxicologic pathology encompasses the study of changes in tissue morphology that help define the risk of exposure to xenobiotics. Toxicologic pathology is a discipline that has changed and adapted over time including methods of analysis and nomenclature of lesions. As risk assessments are updated for chemicals in commerce, frequently the older literature must be reviewed and reevaluated. When interpreting pathology data from animal studies, it is important to consider the biological significance of a lesion as well as its relationship to the ultimate adverse health effect. Assessing the potential for a chemical to cause harm to humans must include the examination of the entire pathology database in context of the study design, the mode of action of the chemical of concern, and using the most current interpretation of a lesion to determine the significance for human health effects of a particular tissue response.

Animals↗
PubMed2004

Influence of breast cancer histology on the relationship between ultrasound and pathology tumor size measurements.

Establishing an accurate primary invasive breast cancer size is crucial for patient management. Although ultrasonographic measurement is reported to correlate reliably with the gold standard pathology measurement, few authors have examined the influence of histologic subtype on ultrasound measurement. The common subtypes of invasive breast carcinoma, ductal and lobular, have different growth patterns, which may influence the ability of ultrasound to predict pathologic size. For this analysis, ultrasound and pathology reports were retrospectively reviewed for 204 women with 210 invasive breast cancers, including 129 ductal, 41 lobular, and 40 mixed pattern ductal and lobular carcinomas. For each tumor, the largest pathology and ultrasound dimensions were compared using Pearson's correlations, linear regression, paired t-tests and Wilcoxon signed ranks tests, stratified by histologic subtype. The Hodges-Lehmann approach was used to obtain 95% confidence intervals (CI) for median difference of the sizes. Ultrasonography consistently underestimated pathologic tumor size; the overall median difference was 3.5 mm (CI: 2.5-4.0 mm) and for subtypes: 2.5 mm (CI: 1.5-3.5 mm) for ductal pattern; 3.0 mm (CI: 1.5-4.5 mm) for mixed pattern; and in contrast, 7.5 mm (CI: 5.0-13.5 mm) for lobular pattern tumors. Significant correlations of similar magnitude, were observed between size measurements for ductal, lobular, and mixed subtypes (r=0.816, 0.811 and 0.672, respectively; all P<0.001); however, linear regression models differed between subtypes. Although practical and widely available, ultrasonography tends to underestimate pathologic tumor size. The size difference may be large for lobular carcinomas, potentially influencing stage; differences are less pronounced for ductal and mixed subtypes. Pathologic tumor size can be estimated from the ultrasonographic measurement, particularly if the histologic tumor subtype is known. The results of this study underscore the continued benefit of pretreatment tumor histology.

Breast Neoplasms↗
PubMed2002

A brief history of head and neck pathology.

Surgical pathology had its beginnings in the late 1800s. A biopsy that gained much attention was from the larynx of Crown Prince Frederick in 1887. The tissue was seen by Rudolph Virchow and the clinical management of the Prince eventuated in a highly publicized furor. During the first half of the twentieth century, numerous entities in the head and neck were described by dozens of pathologists worldwide. The information was scattered in clinical journals for radiotherapists, general surgeons, and otolaryngologists. The first book on ear, nose, and throat pathology did not appear until 1947 and by 1956 two atlases were available. The book was "Histopathology of the Ear, Nose and Throat" by Eggston and Wolff (1947), and the atlases were the first Armed Forces Institute of Pathology (AFIP) fascicle on salivary gland tumors by Foote and Frazell (1954) and "An Atlas of Otolaryngic Pathology" by Ash and Raum (1956). Clinicopathologic studies accelerated in the 1960s as laryngeal conservation therapy evolved and radiation therapy became more sophisticated. The years 1968 and 1974 mark major events for the emergence of Head and Neck Pathology into a clear-cut discipline. In 1968, Vincent J. Hyams was appointed Director of Otolaryngic Pathology at the AFIP, and 1974 was the publication date of "Tumors of the Head and Neck" by John G. Batsakis. The past 25 years have been filled with hundreds of articles on new entities and the application of fresh technology to old entities. Specialized therapeutic approaches have demanded greater diagnostic precision. This paper touches on a few representative aspects in the history of Head and Neck Pathology during the past 130 years.

Head and Neck Neoplasms↗
PubMed2003

The clinical impact of expert pathological review on lymphoma management: a regional experience.

The All Wales Lymphoma Panel (AWLP) was established in January 1998 to provide a central expert pathological review service for district general hospital pathologists. A discordance rate of 20% between the submitted and reviewed diagnosis has previously been identified. It has not been known whether this change in diagnosis affects clinical management. Ninety-nine patients whose diagnosis was changed as a result of central pathological review are presented. Between January 1998 and August 2000, 125 of 745 (17%) specimens submitted for AWLP review had a consequent change in pathological diagnosis. Of these 125 specimens, 99 (79%) complete case notes were recovered. In all 99 cases, a hypothetical management plan was generated using collected data, clinical protocols and the submitted pathological diagnosis. These plans were compared with the actual management patients received based on the reviewed diagnosis proffered by the AWLP. Forty-six of 99 (46%) cases had a change in management as a result of central pathological review. Overall, management was changed in 8% of cases referred for central pathological review. In conclusion, expert central pathological review has a direct effect on patient management.

Adult↗
PubMed1998

Paediatricians: referral rates and speech pathology waiting lists.

OBJECTIVE: This study aimed to examine paediatricians' training in and understanding of communication development and disabilities and their attitudes to speech pathology waiting lists and management practices. The relationship between these factors and referral rates was also investigated. METHODOLOGY: A total of 229 paediatricians registered with the Australian College of Paediatrics participated in the study in November 1996. They answered 15 multiple-choice questions designed to collect demographic information and data pertaining to their training and understanding of communication development and disabilities. The survey also obtained data on referral rates to public and private speech pathology services and on paediatricians' perceptions of speech pathology waiting lists and possible management strategies. RESULTS: Referral rate to public and private speech pathology services was found to be associated with the quality of paediatricians' training in and knowledge of communication development and disabilities. Paediatricians who had regular contact with speech pathologists were also more likely to make more referrals. Waiting lists had a negative influence on referral rate. Treatment rather than assessment waiting lists were preferred. Paediatricians believed the best solution to speech pathology waiting lists was an increase in staffing levels particularly in community health centres. Respondents reported that 1-4 months was an acceptable time to wait for speech pathology care and indicated the order of importance of factors for prioritising children. CONCLUSIONS: The results have important implications for developing best practice models for improving referral processes and access to speech pathology services for children with communication disabilities.

Australia↗