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PubMed1995

Pathologic response to induction chemotherapy in locally advanced carcinoma of the breast: a determinant of outcome.

BACKGROUND: The prognosis for patients with locally advanced carcinoma of the breast remains poor. This study examines the pathologic evidence of response of the mammary tumor and axillary nodes after preoperative chemotherapy. We sought to determine if there was a relationship between the histologic response and clinical outcome. STUDY DESIGN: Between 1987 and 1992, 36 patients with locally advanced carcinoma of the breast received three cycles of chemotherapy after incisional biopsy. Modified radical mastectomy was then performed. The breast and axillary nodes were examined pathologically for therapeutic effect and a grading scale was assigned. Postoperatively, patients received completion chemotherapy with the same agents used preoperatively followed by radiation therapy to the chest wall. RESULTS: Fourteen tumors (39 percent) showed near total therapeutic effect, five (14 percent) showed greater than 50 percent but less than total effect, 12 (33 percent) showed less than 50 percent effect, and five (14 percent) showed no effect. Nodal positivity was seen in 61 percent of the patients. Overall clinical response to induction chemotherapy was seen in 86 percent of the patients. There was poor correlation between clinical and pathologic response. Only 50 percent of the patients with complete clinical response were pathologically free of disease. Patients with excellent pathologic therapeutic response had a 79 percent overall five-year survival rate compared with 34 percent for tumors with a lesser response. This was irrespective of nodal status. While pathologic response was critical in determining outcome, clinical response was not. CONCLUSIONS: These results indicate that patients whose tumors have the best pathologic response to induction chemotherapy experience the best outcome.

Adult↗
PubMed1994

Pediatric surgical pathology of the head and neck.

Anatomically, the head and neck region is composed of a greater variety of structures than any other part of the body. Practically all the anatomic structures can be the site of the various pathological processes. Multiplying the anatomic structures by the various pathological processes produces an infinite number of pathological diagnoses that may be encountered in the head and neck region. The large number of pathological possibilities provides a challenge for the pathologist working in surgical pathology of the head and neck region in children. Whenever a specimen is submitted to the laboratory, it is necessary to have at one's disposal a list of differential diagnoses. Clinical information is of importance in interpreting specimens if excellence in patient management is to be achieved. Therefore, it is imperative that open communication exist between the clinician and the pathologist. Thus, a combination of knowledge of the pathological possibilities, the range of differential diagnoses, the ability to use newer technologies, such as cell marker determinations by flow cytometry and immunoperoxidase, and dialogue with clinical physicians will provide some assurance of the ultimate in patient care. Herein the authors discuss some of the more common and important neoplasms encountered in pediatric head and neck surgical pathology.

Branchioma↗
PubMed1994

Pathological gamblers--will they use a new telephone hotline?

AIMS: This paper reports on the preparedness of pathological gamblers to seek help through a new national toll-free telephone hotline and compares these callers, on some key dimensions, with a representative sample of pathological gamblers living in the community. METHODS: Callers were assessed using standard diagnostic screens. Sociodemographic data and reported symptoms of stress and depression were also recorded. Callers identified as pathological gamblers were compared with their counterparts in a recent nationwide epidemiological survey. RESULTS: During the first 3 months of operation, 1506 calls were received from 329 callers. Of these 167 were pathological gamblers, 117 were partners or family members and 45 were from various agencies. Pathological gamblers contacting the hotline resembled those from the community survey with respect to gender and age. Maori and Pacific Islanders were underrepresented. Suicidal ideation was reported by over 90% of pathological gambler callers. CONCLUSIONS: The new service provides a means to reach people with serious gambling-related problems and provides information to family members and helping agencies. High reported suicidal ideation was consistent with previous studies showing elevated rates of stress and depression among pathological gamblers. Underutilization by Maori, Pacific Islanders and people with less severe gambling disorders indicates the need to find better ways to engage these groups.

Gambling↗
PubMed1994

Comparison of fallopian tube intraluminal pathology as assessed by salpingoscopy with pelvic adhesions.

OBJECTIVE: To correlate the severity and extent of pelvic adhesions, as noted at laparotomy for microsurgery, with the presence and extent of fallopian tube intraluminal pathology, as noted using salpingoscopy. DESIGN: Prospective clinical study. SETTING: A university teaching hospital. PATIENTS: Twenty patients presenting for pelvic microsurgery between July 1992 and January 1993. INTERVENTIONS: Salpingoscopy was performed at the time of microsurgery and intraluminal pathology was scored. An objective assessment of the extent of pelvic adhesions was made using standardized adhesion score systems. RESULTS: There was a strong correlation between the degree of intratubal damage and the extent of pelvic adhesions when the etiology was previous pelvic inflammatory disease (PID) but not when the underlying etiology was endometriosis. However, in the endometriosis subgroup, intraluminal ampullary pathology was noted in 27% of tubes assessed, and intraluminal fimbrial pathology was noted in 36% of tubes assessed. Intraluminal tubal pathology also was noted in a number of cases where the underlying etiology was previous surgery for benign disease. CONCLUSIONS: This study confirms previous reports that, in cases of PID leading to adhesions, there is a high incidence of intraluminal pathology. However, this study also demonstrates that intraluminal pathology is often associated with adhesions arising from other etiologic groups, suggesting that intraluminal assessment is required for all patients in whom adhesiolysis for fertility is considered.

Endometriosis↗
PubMedDate not supplied

Prognostic significance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy for locally advanced breast carcinoma.

PURPOSE: The prognostic significance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy was assessed in patients with noninflammatory locally advanced breast carcinoma. PATIENTS AND METHODS: Between January 1989 and April 1995, 148 consecutive patients with locally advanced breast carcinoma participated in the study. Of these, 140 fully evaluable patients (67, stage IIIA; 73, stage IIIB) were treated with three courses of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC), followed by modified radical mastectomy when technically feasible or definitive radiation therapy. The median age was 53 years (range, 26 to 75 years); 55% of patients were postmenopausal. RESULTS: Objective response was recorded in 99 of 140 patients (71%; 95% confidence interval, 63% to 79%). Complete response occurred in 11 patients (8%), and partial response occurred in 88 patients (63%). No change was recorded in 37 patients (26%), and progressive disease occurred in 4 patients (3%). One hundred and thirty-six patients underwent the planned surgery. Maximal pathological response of the primary tumor (in situ carcinoma or minimal microscopic residual tumor) was observed in 24 (18%); 112 patients (82%) presented minimal pathological response of the primary tumor (gross residual tumor). The number of metastatic axillary nodes after neoadjuvant chemotherapy was as follows: N0, 39 patients (29%); N1-N3, 35 patients (26%); > N3, 62 patients (45%). Considering the initial TNM status, 75% of the patients had decreases in tumor compartment after neoadjuvant chemotherapy. Also, 31% and 23% of patients with clinical N1 and N2, respectively, showed uninvolved axillary lymph nodes. A significant correlation was noted between pathological response of primary tumor and the number of metastatic axillary lymph nodes. Median disease-free survival was 34 months, whereas median overall survival was 66 months. Pathological responses of both primary tumor and metastatic axillary lymph nodes were strongly correlated with disease-free survival and overall survival in univariate analyses. Additionally, in a proportional hazard regression model and in an accelerated failure time model, metastatic axillary lymph nodes significantly influenced both disease-free survival and overall survival, whereas pathological response of primary tumor did so on disease-free survival only. CONCLUSION: After neoadjuvant chemotherapy, pathological responses of both primary tumor and metastatic axillary lymph nodes had a marked prognostic significance and influenced outcome for patients with locally advanced breast carcinoma. Our results suggest that maximal tumor shrinkage and sterilization of potentially involved axillary nodes may represent a major goal of neoadjuvant chemotherapy. Further studies are warranted to clarify whether these results reflect the therapeutic effect or intrinsic biologic factors of the tumor.

Adenocarcinoma↗
PubMedDate not supplied

The expanding role of pathologists in the diagnosis and management of breast cancer: Worldwide Excellence in Breast Pathology Program.

Pathology is the study of human illness and it involves the morphologic and biologic recognition of abnormalities that are associated with a disease. Breast pathology represents an excellent example of this discipline. By providing diagnostic information and by characterizing the biologic behavior of a breast lesion, a pathologist plays a critical role in a patient's life. Any mistake in this exercise is associated with serious consequences. In addition, there are many unresolved issues in breast pathology, which contribute to our limited understanding of the biology of breast cancer, variability in diagnostic criteria, and significant diversity in breast cancer management and therapy. Furthermore, breast pathology has remained an underrecognized discipline, and its importance in diagnosis and disease management is not fully realized. In order to better serve our patients, particularly medically underserved women and those living in countries with limited resources, we must place emphasis on effectively using the talent and expertise of pathologists around the globe. For example, to provide a cost-effective way to diagnose breast cancer, particularly at advanced stages, pathologists can sample lesions by fine-needle aspiration biopsy (FNAB), stain the resulting smears, and provide an immediate bedside diagnosis. This is a valid contribution; however, this exercise requires the availability of a pathologist with experience in breast cytopathology. Alternatively the pathologist may seek consultations from more experienced pathologists. Developing strategies to better recognize the importance of high-quality breast pathology services and to train qualified and innovative breast pathologists is an ambitious task. The proposed Worldwide Excellence in Breast Pathology Program may provide such an opportunity.

Breast↗
PubMed1998

Evaluation of turnaround times as a component of quality assurance in surgical pathology.

OBJECTIVE: As a part of a quality assurance program in anatomic pathology, a study was conducted to determine intralaboratory components of turnaround time according to specimen type, and to compare the present data with results obtained 2 years after implementing the program. DESIGN: Assessment of intralaboratory turnaround times for surgical pathology reports in a sample of 501 biopsies and surgical specimens during 1992. Comparison between the basal data obtained in 1992 and the final determination in 1994 after the implementation of an improvement action. SETTING: Surgical specimens and biopsies accessioned at the Department of Anatomic Pathology of a 913-bed acute-care teaching hospital in the city of Barcelona, Spain. STUDY SAMPLES AND PARTICIPANTS: The sample was selected from the total number of biopsies and surgical specimens accessioned on specific days by applying a table of random numbers. Data were collected from the request forms, final report copies, and laboratory registries of turnaround time-points by two resident physicians. INTERVENTIONS: All relevant information concerning turnaround times was recorded following a standardized questionnaire developed specifically for the study. MAIN OUTCOME MEASURES: The basal determination for turnaround time for pathologic diagnosis in 1992 was 5.7 days. RESULTS: The mean turnaround time for the 501 specimens was 6.24 (SD = 3.16; range = 2-27 days). Turnaround times varied substantially according to specimen type. Endoscopic biopsy samples were completed by 5.19 days (SD = 2.18). Bone biopsies were finalized within a mean of 8.11 days of receipt (SD = 3.18). For the diagnosis of lymphoproliferative disorders, most lymph node specimens required special histochemical or immunohistochemical stains. The mean turnaround time for results reporting/results transmittal to the ordering physician varied between 1.14 and 1.66 days. The 1992 annual mean turnaround time for a total of 14,862 surgical pathology specimens was 5.7 days as compared with 4.2 days for a total of 17,931 surgical pathology specimens in 1994.

Hospitals, Teaching↗
PubMed2004

Effects of clinical service reorganisation on cellular pathology workload.

AIMS: To assess changes in volume and complexity of cellular pathology workload after clinical service reorganisation and alterations in pathology reporting practices, and to identify objective measures of change applicable to all cellular pathology departments. The ear, nose, and throat (ENT), head and neck (HN) specialty was chosen for assessment. METHODS: Cellular pathology workload from the ENT-HN surgical specialty was assessed numerically and the complexity in examination of cancer resection specimens was evaluated. Medical and technical time inputs in the reporting of ENT-HN cancer resections were measured prospectively, and the histological and cytological workload arising from the management of such cases was obtained. RESULTS: The 88.83% increase in ENT-HN specimens contrasted with a 13.53% increase in total surgical workload. Substantial increases in work complexity were found when measured as blocks/slides for each case and number of histochemical/immunohistochemical requests. On average, examination of one ENT-HN cancer case consumed 55% of one pathologist's work session and over one 10th of a technician's working week. On average, each cancer generated 3.3 histological and 1.06 cytological specimens. CONCLUSIONS: Evidence is provided of the increase in cellular pathology workload and in its complexity. This study lists objective measures of complexity applicable to all pathology subspecialties. Given the workforce crisis and expanding clinical needs, realistic workload calculations should include measurement of complexity and not just volumes.

England↗
PubMed1994

[Role of pathology as clinical medicine: experience at Kawasaki Medical School].

The department of Pathology at Kawasaki Medical School was destined, from the outset of its foundation, to be one of clinical departments. To discuss the role of pathology as clinical medicine, the actual state of our department is described here with reference to its organization, principles, and quality assurance program in both surgical pathology service and hospital practice. The department at School also functions as a hospital pathology department and handles 10,000 surgical and 18,000 cytology materials as well as about 180 autopsies per year. Examination of the tissues and organs removed from the patients is wholly entrusted to our department in its full responsibility. All the tissue sections are examined by multiple certified pathologists and reports are returned by the third day. Case reviews are regularly done by peer reviewers and through the conferences held between pathology and relevant clinical departments. The latter conferences serve as a medical audit in the hospital as well. The pathologists sometimes participate in the performance of aspiration cytology, and muscle and nerve biopsy. It is hoped that the description of our experience in surgical pathology will provide some insights on the improvement of the system to concerned readers and cause lively discussion on this matter.

Humans↗
PubMed1993

An image analysis workstation for the pathology laboratory.

Computer-based image analysis (IA) is a technology gaining importance in diagnostic pathology. Applications of IA in pathology include DNA ploidy analysis, quantitative immunohistochemistry, three-dimensional reconstruction of tissue sections, motility studies, and chromosomal analysis. Morphometry, the quantitative measurement of size, shape, and textural features of cells and tissues, is another rapidly developing area of IA in pathology. Morphometric IA allows the objective evaluation of subtle histologic and cytologic features to yield useful diagnostic and prognostic information. Research is currently underway to develop diagnostically useful applications of morphometric IA. Several image analysis workstations designed for the pathology laboratory are currently available. However, the high cost and software inflexibility of these instruments are prohibitive to many potential users limiting the practicality of IA and hindering research. We present a relatively inexpensive pathology IA workstation assembled from commercially available hardware and software components. System features and basic image processing methods are described. A variety of practical applications for the surgical pathology laboratory are illustrated, including spatial measurements of tumors, nerve and muscle biopsy evaluation, and nuclear morphometry for classification of lymphoid effusions and hepatocellular carcinoma.

Biopsy↗
PubMed1997

[100 years of the German Society of Pathology (1897-1997)].

The German Society of Pathology emerged from the Society of German Scientists and Physicians. Founded in Braunschweig in 1897, the first scientific meeting was held in Düsseldorf in 1898. Rudolf Virchow was the first chairman up to this death in 1902. From the beginning the Society with its former name of German Pathological Society till the 2nd world war, was an association of German-speaking countries including Austrian and Swiss pathologists who also regularly presided at the meetings. Alternately the meetings were held in Germany, Austria, or Switzerland. The 100-year-history of the Society has been documented in 80 volumes of the meetings so far. Since 1903 these are published by Gustav Fischer, Jena-Stuttgart. The scientific results of the annual meetings show not only the growth and development of Pathology, but also the lectures and papers to the main subjects contribute considerably to the history of medical basic research in the 20th century. The chairmen's speeches combine to a history of problems in the subject of Pathology. Rudolf Virchow began it with his opening address in 1898. A special chapter covers the period of national socialism and German partition after the 2nd world war. The German Pathological Society suffered great losses by dismissal and emigration after 1933. Institutes rich in tradition got lost in East Germany. The partition of Germany, especially after construction of the wall, excluded the East German colleagues for Society life. An attempt has been made to record the losses in numbers by evaluation of the member lists of the meeting volumes. At the end of the century and after overcoming of the German partition, the German Society of Pathology has got a chance for revival.

Germany↗
PubMed2003

Multidisciplinary pediatric pathology rotations in a residency training program.

The pediatric pathology residency rotations described herein represent an innovative multidisciplinary approach to residency education that combines concepts from anatomic pathology and laboratory medicine, and utilizes faculty members from pathology, pediatrics, and obstetrics/gynecology to teach pathology residents the clinicopathological highlights of antenatal, perinatal, and postnatal pathology. Training is provided through a combination of didactic interactions, laboratory experiences, and current clinical cases. As such, it can be a model for other multidisciplinary residency rotations that could span graduate medical education in pathology to permit a more thorough, informative, and stimulating residency experience.

Education, Medical, Graduate↗
PubMed1992

A 35-year experience with the post-sophomore fellowship in pathology: analysis of its effectiveness as a recruitment resource.

Recent reports have indicated a shortage of pathologists coming out of training programs over the next few years. This is due, in part, to a decrease in the number of medical students entering pathology and an overall decline in the popularity of the field as a specialty choice. Medical students electing to spend a year in a post-sophomore fellowship in pathology would be expected to enter the field at a higher than average rate. In this study, the specialty choices of 140 former student fellows were analyzed. The students included in the study were enrolled in a year-long University of California, Los Angeles post-sophomore fellowship in pathology between 1953 and 1988. Twenty-seven of the 140 students (19.3%) ultimately chose pathology as a career. This represents a 9- to 10-fold increase over the average percentage of medical students entering pathology through the match (less than 2%) for any given year. Of all students from the University of California, Los Angeles who entered pathology, 75% did not elect to spend a year in fellowship. Eighty percent of the former fellows chose some other field, medicine and surgery being the most popular choices.

Cohort Studies↗
PubMed2004

Improving patient safety by examining pathology errors.

A considerable void exists in the information available regarding anatomic pathology diagnostic errors and their impact on clinical outcomes. To fill this void and improve patient safety, four institutional pathology departments (University of Pittsburgh, Western Pennsylvania Hospital, University of Iowa Hospitals and Clinics, and Henry Ford Hospital System) have proposed the development of a voluntary, Web-based, multi-institutional database for the collection and analysis of diagnostic errors. These institutions intend to use these data proactively to implement internal changes in pathology practice and to measure the effect of such changes on errors and clinical outcomes. They believe that the successful implementation of this project will result in the study of other types of diagnostic pathology error and the expansion to national participation. The project will involve the collection of multi-institutional anatomic pathology diagnostic errors in a large database that will facilitate a more detailed analysis of these errors, including their effect on patient outcomes. Participating institutions will perform root cause analysis for diagnostic errors and plan and execute appropriate process changes aimed at error reduction. The success of these interventions will be tracked through analysis of postintervention error data collected in the database. Based on their preliminary studies, these institutions proposed the following specific aims: Specific aim #1: To use a Web-based database to collect diagnostic errors detected by cytologic histologic correlation and by second-pathologist review of conference cases. Specific aim #2: To analyze the collected error data quantitatively and generate quality performance reports that are useful for institutional quality improvement programs. Specific aim #3: To plan and implement interventions to reduce errors and improve clinical outcomes, based on information derived from root cause analysis of diagnostic errors. Specific aim #4: To assess the success of implemented interventions by quantitative measure of postinterventional errors and clinical outcomes and by qualitative assessment by project participants. Funding for this project was approved by the Agency for Health Care Research and Quality in September 2002, and data collection and analysis are ongoing. Over 5000 errors have been collected in the database, and the clinical outcomes of these errors have been tracked. At a national meeting in November 2003, root cause analysis was performed to determine causes of errors. The findings of these root cause analyses have been presented at national pathology meetings and are currently being published.

Diagnostic Errors↗
PubMed2005

The pathology student fellowship program at the University of Vermont: 1956-2005.

Student fellowship programs in pathology offer a unique educational experience for selected medical students. In this report, the specialty preferences of former student fellows graduating from the University of Vermont were analyzed. Since 1956, 110 students have participated in this program, of whom 33 chose pathology as a career. These individuals represented 32.6% of all Vermont graduates who entered pathology between 1958 and 2005. In addition, former student fellows were more likely to become academic pathologists and to obtain subspecialty certification. Furthermore, based on comments received from former student fellows, the program had a positive impact on the medical education and career of pathologists and nonpathologists alike. It is concluded that student fellowship programs represent a powerful recruitment tool for pathology generally and for academic pathology in particular. The development of a database to track these programs and their graduates is essential to fully assess the educational impact of pathology student fellowship programs nationally.

Education, Medical, Graduate↗
PubMed2001

Pathological evaluation of intervertebral disc tissue specimens after routine cervical and lumbar decompression. A cost-benefit analysis retrospective study.

BACKGROUND: After decompression of cervical and lumbar nerve roots for radicular pain, pathological evaluation of the extracted disc material is commonly performed. Although histological examination rarely detects clinically significant unsuspected disease, it remains a common practice in most hospitals in the United States. To determine the cost-effectiveness of this routine practice, we conducted a retrospective study. The results are contained within this report. METHODS: Using the University Neurosurgery database, we retrospectively identified 1,387 patients who had spinal decompression surgery (laminectomy and/or discectomy). These cases were broadly classified into routine and non-routine cases depending on the preoperative diagnosis. Benign and noninfectious cases were classified as routine; malignant and all other cases were classified as nonroutine. We reviewed the medical records and pathology reports of these routine and nonroutine cases in an attempt to study the efficacy of the pathological evaluation of the disc material. The cost-benefit value of histopathology in these cases was analyzed, retrospectively. RESULTS: In all routine cases, the histopathology was consistent with benign disc disease and yielded no additional information that could have altered the treatment plan. In the nonroutine cases, however, histopathology was significant in the management of the patient. The cost factor for pathological study was the same for both case groups. CONCLUSIONS: Pathological study of intervertebral disc specimens is cost beneficial only in cases with significant preoperative clinical diagnoses. Pathological evaluation of routine herniated nucleus pulposus extracted during decompressive surgeries is not warranted.

Cervical Vertebrae↗
PubMed1986

The teaching of general pathology in European undergraduate education programs in medicine.

The need for a common platform of the teaching of pathology in Europe was agreed upon at the IXth European Congress of Pathology in Hamburg. We undertook to formulate the educational objectives of pathology for undergraduates, and outline the subject content necessary to achieve these objectives. It was decided to determine how much time is required to teach general pathology and when during the medical course the teaching should take place. In this symposium in Athens we concentrated on the teaching of general pathology as a subject of its own, apart from special or organ pathology.

Curriculum↗
PubMed1998

The cost-effectiveness of routine pathology consultation in knee arthroscopy.

Regulations in Ontario, Canada, as in most provinces and states in North America, require human tissues (with few exceptions) removed at surgery to be sent to a pathology laboratory for examination and report. We hypothesized that this practice is inconsistently followed and that routine pathological consultation is costly and rarely results in a change in treatment for patients undergoing knee arthroscopy. Chiefs of pathology, orthopaedic surgeons, and orthopaedic operating room nurse managers in Ontario hospitals that perform arthroscopic knee surgery were surveyed for compliance. We determined cost using pathology department procedure codes and evaluated effectiveness as the correlation between the postoperative diagnoses of orthopaedic surgeons and pathologists for 1,036 consecutive knee arthroscopy cases. In only one case (0.1%) was it felt that pathology consultation had the potential to significantly alter patient care. The total cost of pathology consultation for the 1,036 cases reviewed was $234,147.00 (mean cost per case, $226.00). Ninety percent of hospitals do not comply with the regulations regarding the processing of these tissues. Poor compliance is justified by the lack of diagnostic value and the need to contain health care costs.

Arthroscopy↗