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PubMed1998

The role of the pathologist in the diagnosis of melanoma.

The pathologist plays a vital role in patients with malignant melanoma. Dermatologists, surgeons, and oncologists must rely on the pathologist for accurate and complete diagnoses. Although most melanomas can be easily recognized with routine histopathology, special stains, including immunohistochemistry, may be necessary to differentiate melanoma from other cutaneous malignancies. Likewise, there are benign entities that can mimic melanoma microscopically, including Spitz nevi, pigmented spindle cell nevi, deep-penetrating nevi, and Monsel's reaction. Recognition of these entities is important to avoid unnecessary surgery, testing, adjuvant therapy, and unnecessary concern by the patients and their families. In addition to making an accurate diagnosis, the pathologist should report prognostic histologic attributes that may influence therapy and follow-up care for these patients. These histologic features should be recorded in the pathology report. This chapter provides a brief review of the most important histologic attributes that should be identified and reported by the pathologist.

Humans↗

PubMed2003

Visualising scanning patterns of pathologists in the grading of cervical intraepithelial neoplasia.

AIM: To investigate how effectively eye tracking devices can visualise the scanning patterns of pathologists, for application in studies on diagnostic decision making. METHODS: EyeCatcher, an eye tracking device, was used to visualise and compare the scanning patterns of five pathologists while they graded two projections of cervical intraepithelial neoplasia. Density cloud images were created from the scanning patterns. A questionnaire and interview provided information on the following steps in the diagnostic process. RESULTS: EyeCatcher successfully registered the scanning patterns of the pathologists. A "scanning style" and a "selective style" of visual search were distinguished. The scanning patterns, in addition to the interpretation and combination of the information ultimately leading to a diagnosis, varied between the various observers, resulting in a broad range of final diagnoses. CONCLUSIONS: Eye gaze tracking devices provide an excellent basis for further discussion on the interpretation and grading criteria of lesions. As such, they may play an important role in studies on diagnostic decision making in pathology and in the development of training and quality control programmes for pathologists.

Decision Making↗

PubMed2000

C.L. Shear: Gifted Mycologist, Plant Pathologist, and APS Founder.

Cornelius Lott Shear was one of the most influential plant pathologists of the early twentieth century. He was first and foremost an excellent mycologist who did pioneering research on pathogenic fungi and, as a senior pathologist with the USDA's Bureau of Plant Industry, studied important crop diseases and offered useful control measures. Shear's successful research enhanced his reputation among his fellow pathologists and allowed him to embark on what was perhaps his most significant contribution to plant pathology, his pivotal role in the creation of the American Phytopathological Society in 1908. Shear felt that an independent society dedicated to the unique needs of plant pathologists would facilitate communication and cooperation among practitioners. Between his scientific research and his role in the creation of APS, Shear stands out for the enormous impact he had on his science.

American Phytopathological Society↗

PubMedDate not supplied

Positive economic and diagnostic accuracy impacts of on-site evaluation of fine needle aspiration biopsies by pathologists.

OBJECTIVE: To investigate the impact of pathologists' immediate evaluation of fine needle aspiration biopsy (FNAB) on increasing diagnostic yield and decreasing related expenses. STUDY DESIGN: All FNABs performed at our 420-bed hospital between January 1992 and December 1994 were reviewed. The 1992-1993 FNABs were all performed without pathologist attendance. Smears were wet fixed in 95% alcohol and later stained by the Papanicolaou or hematoxylin and eosin methods. The remaining aspirated material was collected in Saccomano's preservative, and a cell block was made. Nearly all the 1994 FNABs were performed with the pathologist present; he examined air-dried, Diff-Quik-stained smears for preliminary evaluation of the aspirate. An average of three passes were done. The rest of the procedure was as usual. RESULTS: The total number of 1992-1993 FNABs was 227 (108 + 119); of them, 104 (46%) were inadequate for diagnosis. In contrast, the 1994 FNABs totaled 169, with only 40 (24%) inadequate for diagnosis. The vast majority of the aspirates were done on deep-seated lesions under computed tomography (CT) guidance. CONCLUSION: The results of our experience indicate that on-site evaluation by a pathologist greatly increases the diagnostic yield. Another advantage is the significant financial savings as compared to excisional tissue biopsy. In general, the expenses of a CT-guided FNAB (e.g., pancreas) average around $1,400, while charges for excisional biopsy under general anesthesia with a subsequent two- to three-day hospitalization average about $7,720.

Biopsy↗

PubMedDate not supplied

Legal responsibilities of the pathologist.

Pharmaceutical companies exist today in a hostile legal and regulatory environment. The threat of product liability in the pharmaceutical industry has risen to the point where it stifles research and development, especially for contraceptive and psychotropic drugs. Regulatory sanctions against the industry are more likely now than in the past since the Food and Drug Administration (FDA) has placed significant emphasis on regulatory inspection and enforcement. Industrial pathologists play a critical role in defending their company in product liability litigation and from regulatory sanctions. In-house and contract pathologists should be prepared to give expert testimony in court and ensure that an effective document retention policy is implemented. Pathologists should know the limits of the FDA's inspection authority and be aware of the "pitfalls" of the FDA's new Fraud Policy. In addition to keeping abreast of science, industrial pathologists today can best serve the pharmaceutical industry if they maintain an awareness of legal issues that pose a threat to the future success of the industry.

Drug Industry↗

PubMed2002

Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control.

PURPOSE: Quality assessment and assurance are important issues in modern health care. For the evaluation of surgical procedures, there are indirect parameters such as complication, recurrence, and survival rates. These parameters are of limited value for the individual surgeon, and there is an obvious need for direct parameters. We have evaluated criteria by which pathologists can judge the quality or completeness of the resection specimen in a randomized trial for rectal cancer. PATIENTS AND METHODS: The pathology reports of all patients entered onto a Dutch multicenter randomized trial were reviewed. All participating pathologists had been instructed by workshops and videos in order to obtain standardized pathology work-up. A three-tiered classification was applied to assess completeness of the total mesorectal excision (TME). Prognostic value of this classification was tested using log-rank analysis of Kaplan-Meier survival curves using the data of all patients who did not receive any adjuvant treatment. RESULTS: Included were 180 patients. In 24% (n = 43), the mesorectum was incomplete. Patients in this group had an increased risk for local and distant recurrence, 36.1% v. 20.3% recurrence in the group with a complete mesorectum (P =.02). Follow-up is too short to observe an effect on survival rates. CONCLUSION: A patient's prognosis is predicted by applying a classification of macroscopic completeness on a rectal resection specimen. We conclude that pathologists are able to judge the quality of TME for rectal cancer. With this direct interdisciplinary assessment instrument, we establish a new role of the pathologist in quality control.

Adult↗

PubMed2002

Papanicolaou tests diagnosed as atypical by a cytotechnologist and downgraded to benign by a pathologist: a measure of laboratory quality.

Follow-up of Papanicolaou (Pap) tests diagnosed as atypical squamous cells of undetermined significance (ASCUS) or atypical glandular cells of undetermined significance (AGUS) by a cytotechnologist and downgraded to benign by a pathologist has not been measured. Squamous intraepithelial lesion (SIL) follow-up rates were obtained for Pap tests diagnosed as ASCUS (288) or AGUS (94) and downgraded to benign and for Pap tests diagnosed as repair (231). Statistically significant associations were seen between 7 cytotechnologists and between 7 pathologists and ASCUS, AGUS, downgraded ASCUS, and downgraded AGUS rates. The percentage of downgraded ASCUS cases compared with all ASCUS cases per pathologist ranged from 4.8% to 43.7%. Statistically significant associations between pathologists and SIL follow-up rates for downgraded ASCUS diagnoses were seen. The SIL follow-up rate for repair (7.9%) was similar to that for a downgraded ASCUS (11.0%) or AGUS (7.3%). The parameters of downgraded ASCU and AGUS Pap test interpretations are good quality indicators of individual performance and overall laboratory quality.

Cell Biology↗

PubMed2001

Histologic diagnosis of primary hyperparathyroidism: a concordance analysis between three pathologists.

Primary hyperparathyroidism (HPT) is caused by a parathyroid adenoma, hyperplasia or carcinoma. Difficulties for the histologic diagnosis of abnormal parathyroid tissue are widely recognized. The aim of the study was to evaluate the reproducibility of the morphologic criteria through a concordance study among three pathologists. Representative slides of 40 patients with biochemically primary HPT stained with hematoxylin and eosin were blindly reviewed by three pathologists. Each pathologist established the diagnosis of adenoma or hyperplasia and assessed the presence of fat cells, a rim of normal tissue, a fibrous capsule, the number of cellular types, the lobular pattern, and the characteristics of the blood vessel's wall. A concordance analysis was then performed. Mean age of the group was 55 +/- 14 yr, 7 were males and 33 females. The concordance analysis among the three pathologists for the differential diagnosis between adenoma and hyperplasia, showed a Kappa index of 0.5. Kappa index for the presence of fat cells was 0.56, for the presence of a rim of normal tissue 0.47, and for the number of cellular types 0.29. The concordance for the differential diagnosis between parathyroid adenoma and hyperplasia in this study was low.

Adenoma↗

PubMedDate not supplied

[Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists].

BACKGROUND: This work presents the results of an epidemiological survey about the professional experience of Speech-Language Pathologists and Audiologists of Rio de Janeiro (Brazil) with children and adolescents who are victims of domestic violence. AIM: To understand the occurrence of child abuse and neglect of children and adolescents treated by speech-language pathologists, characterizing the victims according to: most affected age group, gender, form of violence, aggressor, most frequent speech-language complaint, how the abuse was identified and follow-up. METHOD: 500 self-administered mail surveys were sent to a random sample of professional living in Rio de Janeiro. The survey forms were identified only by numbers to assure anonymity. RESULTS: 224 completed surveys were mailed back. 54 respondents indicated exposure to at least one incident of abuse. The majority of victims were children, the main abuser was the mother, and physical violence was the most frequent form of abuse. The main speech disorder was late language development. In most cases, the victim himself told the therapist about the abuse--through verbal expression or other means of expression such as drawings, story telling, dramatizing or playing. As the majority of the victims abandoned speech-language therapy, it was not possible to follow-up the cases. CONCLUSION: Due to the importance if this issue and the limited Brazilian literature about Speech-Language and Hearing Sciences and child abuse, it is paramount to invest in the training of speech-language pathologists. It is the duty of speech-language pathologists to expose this complex problem and to give voice to children who are victims of violence, understanding that behind a speech-language complaint there might be a cry for help.

Adolescent↗

PubMed1991

Team acceptance of specific recommendations for the treatment of VPI as provided by speech pathologists.

This retrospective study describes the frequency of one team's acceptance of speech pathologists' recommendations for specific secondary treatment procedures for the correction of VPI for 100 consecutive patients. In addition, assessment was made of the level of success in eliminating VPI relative to treatments utilized that were recommended by speech pathologists versus level of success when treatment other than that recommended by speech pathologists were used. For the 78 patients who received the treatment procedure recommended by speech pathologists, only 10 percent continued to demonstrate any clinically significant residual speech problem associated with VPI. However, for the 22 patients who received treatment other than that which had been recommended, 32 percent continued to demonstrate clinically significant speech problems associated with VPI. Data is presented on the success rate for correcting VPI relative to specific treatment recommendations including pharyngeal flap, palatal pushback, pharyngeal wall implant, tonsillectomy, prosthetic palatal lifts, and speech therapy.

Clinical Protocols↗

PubMed1980

International pathologists congruence survey on quantitation of malignant melanoma.

A congruence survey of pathologists in Brisbane, Adelaide, Oslo and Paris on classifying and grading histological features such as dermal invasion, cross-sectional profile, mitotic activity and lymphocytic infiltrate was done on 147 cutaneous melanomas. The overall agreement was about 70%, about one pathologist in three or four disagreeing on each feature. Taking into acount also the considerable number of slides in which agreement was less, the results are considered unsatisfactory. Agreement was highest in cross-sectional profile and least in level of invasion. It is evident that the gradings are subjective and indicate the need for detailed histological description in making the criteria and the necessity of collaboration between pathologists to study slides and clarify problems. Experience is important and the slides must be of high technical excellence. Comparisons of results between different pathologists on the histological quantitations of malignant melanoma should take note of the degree of congruence achievable.

Humans↗

PubMed1993

PEIRS: a pathologist-maintained expert system for the interpretation of chemical pathology reports.

Provision of a comprehensive interpretative service is an important challenge facing chemical pathologists. Attempts to automate report interpretation using expert systems have been limited in the past by the difficulties of rule base maintenance. We have applied a novel knowledge acquisition technique, ripple down rules, in the development of PEIRS (Pathology Expert Interpretative Reporting System), a user-maintained expert system for automating chemical pathology report interpretation. We created over 950 rules for thyroid function tests, arterial blood gases and other test sub-groups in 9 mths of operation. A staff pathologist performed all maintenance tasks as part of his routine duties without any need for computer programming skills. No clerical staff involvement was required. Duplication of rule addition for reports requiring multiple comments was the only limitation to coverage of other high volume test groups. PEIRS is the first expert system for the automated interpretation of a range of chemical pathology reports which operates in routine use without extra staffing requirements. PEIRS does not require "knowledge engineering" expertise. Thus, the knowledge base is flexible and can be easily maintained and updated by the pathologist. Expert systems based on ripple down rules should enable pathologists to provide a comprehensive automated interpretative service within the context of the total testing process.

Chemistry, Clinical↗

PubMed2001

National practice characteristics and utilization of pathologists' assistants.

OBJECTIVE: To obtain descriptive information regarding the practice characteristics and utilization of US pathologists' assistants. DESIGN: A self-administered, mailed, voluntary, anonymous questionnaire was distributed to a cross-sectional sample of 515 US pathologists' assistants registered as members of the American Association of Pathologists' Assistants. The questionnaire contained items relating to subject demographics, practice characteristics, specific task performance, and amount of time spent per day on the performance of specific tasks. Descriptive statistics were used to describe the data in terms of measures of central tendency and dispersion. RESULTS: The response rate was 66.8%. The majority of questionnaires sent and received were from East Coast regions. Of all respondents, 46.6% were women, 57.6% were less than 40 years old, and 60.0% had been practicing 10 years or less. Over half (54.0%) had a master's degree. Almost the entire sample reported working 30 or more hours per week, with 43.4% reporting working more than 40 hours per week. The majority reported earning annual salaries between $56 000 and $75 000. Although task analysis of responses revealed a wide range of responses, the majority of the sample reported spending most of their daily time performing surgical specimen gross examinations (median 300 min/d). Approximately half of respondents also reported spending up to 90 minutes per day on nonspecific tasks such as logging specimens and answering the phone. Most respondents reported spending more daily time on such nonspecific tasks than on autopsy prosection or research. CONCLUSIONS: To our knowledge, this national survey provides the first description of pathologists' assistants across the United States. These data provide a useful tool for tracking changes in the profession.

Cross-Sectional Studies↗

PubMed2002

Misinterpretation of normal cellular elements in fine-needle aspiration biopsy specimens: observations from the College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytopathology.

CONTEXT: The College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytopathology is a popular educational program for nongynecologic cytology, with 1018 participating laboratories by the end of 2000. Data generated from this program allow tracking pathologist performance in a wide variety of laboratory practices. OBJECTIVE: To review performance of participating pathologists in making patient diagnoses with fine-needle aspiration biopsy specimens, with particular interest in the false neoplastic diagnoses (both benign and malignant neoplasms) that were submitted for benign aspirates containing only normal cellular components. DESIGN: We reviewed the diagnoses made from 1998 through 2000 by participating pathologists through the use of glass slides containing benign fine-needle aspiration biopsy specimens of the liver, kidney, pancreas, and salivary gland that contained only normal cellular components. RESULTS: The false neoplastic rate for kidney (60%) was the highest, followed by liver (37%), pancreas (10%), and salivary gland (6%). These rates are much higher than what has previously been reported in the literature. CONCLUSIONS: This study illustrates that normal cellular elements are a significant pitfall for overinterpretation of fine-needle aspiration biopsy specimens.

Biopsy, Needle↗

PubMed2003

Electronic medical devices: a primer for pathologists.

CONTEXT: Electronic medical devices (EMDs) with downloadable memories, such as implantable cardiac pacemakers, defibrillators, drug pumps, insulin pumps, and glucose monitors, are now an integral part of routine medical practice in the United States, and functional organ replacements, such as the artificial heart, pancreas, and retina, will most likely become commonplace in the near future. Often, EMDs end up in the hands of the pathologist as a surgical specimen or at autopsy. No established guidelines for systematic examination and reporting or comprehensive reviews of EMDs currently exist for the pathologist. OBJECTIVE: To provide pathologists with a general overview of EMDs, including a brief history; epidemiology; essential technical aspects, indications, contraindications, and complications of selected devices; potential applications in pathology; relevant government regulations; and suggested examination and reporting guidelines. DATA SOURCES: Articles indexed on PubMed of the National Library of Medicine, various medical and history of medicine textbooks, US Food and Drug Administration publications and product information, and specifications provided by device manufacturers. STUDY SELECTION: Studies were selected on the basis of relevance to the study objectives. DATA EXTRACTION: Descriptive data were selected by the author. DATA SYNTHESIS: Suggested examination and reporting guidelines for EMDs received as surgical specimens and retrieved at autopsy. CONCLUSIONS: Electronic medical devices received as surgical specimens and retrieved at autopsy are increasing in number and level of sophistication. They should be systematically examined and reported, should have electronic memories downloaded when indicated, will help pathologists answer more questions with greater certainty, and should become an integral part of the formal knowledge base, research focus, training, and practice of pathology.

Defibrillators, Implantable↗

PubMed1983

Can the laboratory director find the pathologists he needs?

Is the pathologist seeking a job the kind of pathologist the laboratory director wants to hire? The author of this article emphasizes that all pathologists, not just residency training program directors, must be aware of changing needs if new pathologists are to possess the necessary qualifications for practice in the 1980s and 1990s.

Hospital Departments↗

PubMed2000

A study on task-analysis of clinical pathologists as medical consultants in Nihon University Hospital--a Japanese perspective by comparison with current status in the USA.

To identify our role and the customers' satisfaction, the on-call consultation service records of the Department of Clinical Pathology, Nihon University School of Medicine, Itabashi Hospital (NUIH), were analyzed. Between 1995 and 1998, 1,789 consultation services were recorded, and approximately 40% were from physicians, and 50% were from medical technologists. During office hours, many physicians made contact with us at the office of clinical pathology, the clinical laboratory and other places in the hospital by various means. They asked us to interpret multidisciplinary laboratory data, and to provide the specific information that might affect clinical management. Medical technologists asked for clinical information of patients with extreme measured values and requested that we contact with physicians. In contrast, on weekends/holidays or after routine working hours, physicians sometimes requested non-automated laboratory tests such as peripheral blood smears/bone marrow smears or Gram stains. The major contents of our responses to medical technologists were concerned with blood banking and handling of instruments not to be operated in routine work. These results reconfirm that we are still required to have clinical competence for common laboratory procedures and to have the capability of interpretation of multidisciplinary laboratory data in the university hospital. Traditionally, most Japanese clinical pathologists have been focused their attention on bench work in research laboratories. However, the present study shows that the clinical pathologists need to bridge the real gap between laboratory technology and patient care. Our on-call service system can enhance the education of clinical pathologists, and improve not only laboratory quality assurance but also patient care. In addition, in response to a need for customer access to this service with a shortage of clinical pathologists, a more effective method would be to set up a proactive systemic approach in a more rigorous academic environment adopting advances in medical informatics.

Consultants↗

PubMed2001

Histological classification of gastric adenocarcinoma for epidemiological research: concordance between pathologists.

Epidemiology of gastric adenocarcinoma suggests that intestinal-type and diffuse-type cancers develop through distinct causal pathways. To examine the differences in risk factors and molecular changes between the histological types, reliable data on histological typing are essential. We evaluated the concordance between two pathologists in assessment of 95 gastric adenocarcinomas for Laurén classification and tumor grade. Two pathologists, each blinded to the other's assessment, reviewed H&E-stained slides of gastric tumor. The responses of the two pathologists for histological type were considered as concordant if they fell on one of the three categories (intestinal type, diffuse type, or other). Tumor grade was classified into three categories (well, moderately, or poorly differentiated). The pathologists agreed on the classification of histological type for 71 of 92 (77%) tumors. Kappa coefficient was 0.59 (95% confidence interval, 0.44-0.73). Concordance for tumor grade was 87%, with a kappa coefficient of 0.72 (95% confidence interval, 0.57-0.87). Both observed concordance and kappa coefficient for histological type and tumor grade were similar across three calendar periods of study. Interobserver agreement was virtually identical between tumors with biopsy specimens only and those with surgical specimens. Although the level of disagreement for histological type observed in this study is comparable with that in other studies, the resulting misclassification would lead to the reduction in observed differences in prevalence and odds ratio estimates between two histological types.

Adenocarcinoma↗