Diagnoses In Anatomic Pathology Research Articles

The Concept and Application of Critical Diagnoses (Critical Values) in Anatomic Pathology

Occasional diagnoses in surgical pathology and cytology require immediate notification of the physician to potentially initiate rapid treatment or change management of the patient, similar to critical values (CVs) in clinical pathology. However, while CVs in clinical pathology are well established, the concept of CVs in anatomic pathology has not been presented until recently. Based on our recent studies determining the prevalence of CVs in surgical pathology and cytology, and the perceptions of pathologists and clinicians concerning the concept of CVs in anatomic pathology, the Association of Directors of Anatomic and Surgical Pathology conducted a survey of its membership. Based on the response, an Association of Directors of Anatomic and Surgical Pathology Committee developed national guidelines for critical diagnoses (CVs) in anatomic pathology that included diagnoses that can have immediate clinical consequences, unexpected or discrepant findings, and a variety of infections in immunocompromised and immunocompetent patients. These guidelines are meant to serve as a template, which can be customized at individual hospitals. It is now apparent that the concept of critical diagnoses in anatomic pathology is becoming established in the pathology community and is in fact included in the College of American Pathologists laboratory accreditation checklist. Following the Institute of Medicine’s report on medical errors, there have been an increasing number of initiatives to improve patient safety. We believe that similar to CVs in clinical pathology, having guidelines for anatomic pathology CVs will enhance patient safety and represent a practice improvement in anatomic pathology.

Researches Concerning The Health Of Maramures Horses

By studying many archive papers, summaries, and yearbook one finds out that along the years the number of horses depended on diseases, some of them under the form of epizooties, and on natural disasters, hunger, wars, accidents. This way at the beginning of XVIII century and until the end of the XIX century, a number of anthrax cases, rabies, glanders, and mange among the Maramures horses are reported. The papers make references to a number of measures that need to be taken in order to fight the epizooties (the necessity of perfectly burying all dead animals- skin included-; the intensification of security through passing point and many others) The sketch of the first anatomical-pathologically register card (necropsy file) in old Maramures was drafted for the county by veterinarian Gyoller Gyorgy, in May 1898 in Budapest, taking into consideration the fact that the autopsy bill was drawn up 110 years ago, it did not refer to the confirmation of the anatomical-pathological diagnosis through laboratory examinations.(3) Many documents of the same period have been found these documents specify the compulsoriness of the horse corpse necropsy and of notifying the authorities on the dead of the horse. In the studied area the most frequent internal diseases for horses are: colics syndrome (more frequent in autumn), bronchopneumonia, pulmonary emphysema, paralytic myoglobinuria myopathy. With the internal diseases I did not notice any correlation between the scenery of the researched area and the illnesses, but I have noticed a higher frequency of bronchopneumonias in winter and at the end of spring. 3-4% of horses catch obstructive respiratory disease out of which 1% contract pulmonary emphysema. The most frequent surgical conditions of the limbs in the investigated area are: track of the hoof, pododermatitis circumscripta, pododermatitis aseptica difusa, crack of the horn box, callosities, lymphagit, avulsion of the horn box. Due to the work in the forest many horses catch synovitis, tenosynovitis, luxations, arthritis, and sprains.

Aspectos clínico-patológicos e laboratoriais do envenenamento experimental por Bothrops alternatus em bovinos

Esse estudo teve como objetivo determinar as alterações clínico-patológicas e os achados laboratoriais em bovinos inoculados com a peçonha de Bothrops alternatus, no intuito de fornecer subsídios para o estabelecimento do diagnóstico e do diagnóstico diferencial, bem como esclarecer pontos obscuros da literatura pertinente. O veneno liofilizado foi diluído em 1 ml de solução fisiológica e administrado a cinco bovinos, por via subcutânea, nas doses de 0,0625, 0,125 e 0,25 mg/kg e a dois outros, por via intramuscular, nas doses de 0,25 e 0,45 mg/kg. Seis bovinos foram a óbito e um que recebeu a dose de 0,0625mg/kg, por via subcutânea, recuperou-se. Os sinais clínicos tiveram início entre 25 minutos a 5 horas 30 minutos após a inoculação. O período de evolução variou de 7 horas 18 minutos a 66 horas 12 minutos. Um animal recuperou-se após 92 horas. O quadro clínico, independentemente das doses, caracterizou-se por aumento de volume (hemorragia/hematoma) no local da inoculação, tempo de sangramento aumentado, mucosas hipocoradas e apatia. O exame laboratorial revelou progressiva anemia normocítica normocrômica, trombocitopenia, redução de fibrinogênio e proteínas plasmáticas totais, hematócrito e hemoglobina diminuídos, além de leve aumento dos níveis de creatinaquinase e desidrogenase lática. Á necropsia, havia, a partir do local da inoculação, extensos hematomas e áreas de hemorragia no tecido celular subcutâneo dos animais que receberam o veneno por via subcutânea; nos animais inoculados por via intramuscular, adicionalmente, havia hemorragia intramuscular. O endocárdio esquerdo apresentava extensas hemorragias e verificaram-se petéquias na serosa do rúmen e do omaso e na mucosa do abomaso e da vesícula biliar. Em cinco animais, o cólon, reto e região perirrenal estavam envoltos por coágulos de sangue. Ao exame histológico observou-se, além do quadro hemorragíparo, necrose muscular coagulativa, acompanhada de hemorragia, no entorno do local da inoculação nos animais que receberam o veneno por via intramuscular; essa lesão era discreta nos músculos próximos ao local de inoculação subcutânea. Nos bovinos deste estudo, o aumento de volume observado no local de inoculação e adjacências era constituído por sangue e não edema. Não foram observadas mioglobinúria, nem lesões macro ou microscópicas significativas nos rins. Este estudo indica que exemplares de B. alternatus, caso inoculem todo seu veneno, poderiam levar bovinos adultos à morte. Por outro lado, pelo fato de ofídios serem capazes de regular a quantidade de veneno inoculada e, possivelmente, não considerarem bovinos como presa potencial, é provável que o número de acidentes nessa espécie seja pequeno, o que está de acordo com o observado na maioria dos centros diagnóstico anátomo-patológico no país.

Quantification of diverse subcellular immunohistochemical markers with clinicobiological relevancies: validation of a new computer‐assisted image analysis procedure

Tissue microarray technology and immunohistochemical techniques have become a routine and indispensable tool for current anatomical pathology diagnosis. However, manual quantification by eye is relatively slow and subjective, and the use of digital image analysis software to extract information of immunostained specimens is an area of ongoing research, especially when the immunohistochemical signals have different localization in the cells (nuclear, membrane, cytoplasm). To minimize critical aspects of manual quantitative data acquisition, we generated semi-automated image-processing steps for the quantification of individual stained cells with immunohistochemical staining of different subcellular location. The precision of these macros was evaluated in 196 digital colour images of different Hodgkin lymphoma biopsies stained for different nuclear (Ki67, p53), cytoplasmic (TIA-1, CD68) and membrane markers (CD4, CD8, CD56, HLA-Dr). Semi-automated counts were compared to those obtained manually by three separate observers. Paired t-tests demonstrated significant differences between intra- and inter-observer measurements, with more substantial variability when the cellular density of the digital images was > 100 positive cells/image. Overall, variability was more pronounced for intra-observer than for inter-observer comparisons, especially for cytoplasmic and membrane staining patterns (P < 0.0001 and P = 0.050). The comparison between the semi-automated and manual microscopic measurement methods indicates significantly lower variability in the results yielded by the former method. Our semi-automated computerized method eliminates the major causes of observer variability and may be considered a valid alternative to manual microscopic quantification for diagnostic, prognostic and therapeutic purposes.

Diagnostic ‘errors’ in anatomical pathology: relevance to Australian laboratories

Failure to recognise that anatomical pathology diagnosis is a process of cognitive interpretation of the morphological features present in a small tissue sample has led to the public misperception that the process is infallible. The absence of a universally accepted definition of diagnostic error makes comparison of error rates impossible and one large study of laboratories in the United States shows a significant error rate of about 5%, most of which have no major impact on patient management. A recent review of the work of one pathologist in New South Wales confirms a lack of appreciation in medical administration that variable diagnostic thresholds result in an inherent fallibility of anatomical pathology diagnoses. The outcome of the review emphasises the need to educate both public and non-pathology colleagues of the nature of our work and brings into consideration the requirement to establish baseline error rates for Australian laboratories and the role of the Royal College of Pathologists of Australasia (RCPA) in developing fair and unbiased protocols for review of diagnostic errors. The responsibility of ensuring that diagnostic error rates are kept to the minimum is a shared one. Area health services must play their part by seeking to ensure that pathologists in any laboratory are not overworked and have adequate support and back-up from pathologists with expertise in specialised areas. It has been clearly enunciated by the Royal College of Pathologists in the United Kingdom that it is not safe for any histopathology service to be operated single-handedly by one histopathologist. Service managers and clinicians have to understand that country pathologists cannot provide the full range and depth of pathology expertise in the many clinical subspecialty areas that are often practised in non-metropolitan areas. Attending clinicians share the responsibility of accepting proffered pathology diagnoses only if it conforms to the clinical context. Pathology laboratories must continue to develop and maintain best-practice protocols and conduct periodic reviews of diagnosis, cytology-histology concordance, frozen section/permanent section correlations, conference reviews, intra and interdepartmental consultations, participate in external quality assurance programs and maintain ongoing education for all laboratory staff.

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.

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.

Clinical impact and frequency of anatomic pathology errors in cancer diagnoses

To the authors' knowledge, the frequency and clinical impact of errors in the anatomic pathology diagnosis of cancer have been poorly characterized to date. The authors examined errors in patients who underwent anatomic pathology tests to determine the presence or absence of cancer or precancerous lesions in four hospitals. They analyzed 1 year of retrospective errors detected through a standardized cytologic-histologic correlation process (in which patient same-site cytologic and histologic specimens were compared). Medical record reviews were performed to determine patient outcomes. The authors also measured the institutional frequency, cause (i.e., pathologist interpretation or sampling), and clinical impact of diagnostic cancer errors. The frequency of errors in cancer diagnosis was found to be dependent on the institution (P < 0.001) and ranged from 1.79-9.42% and from 4.87-11.8% of all correlated gynecologic and nongynecologic cases, respectively. A statistically significant association was found between institution and error cause (P < 0.001); the cause of errors resulting from pathologic misinterpretation ranged from 5.0-50.7% (the remainder were due to clinical sampling). A statistically significant association was found between institution and assignment of the clinical impact of error (P < 0.001); the aggregated data demonstrated that for gynecologic and nongynecologic errors, 45% and 39%, respectively, were associated with harm. The pairwise kappa statistic for interobserver agreement on cause of error ranged from 0.118-0.737. Errors in cancer diagnosis are reported to occur in up to 11.8% of all reviewed cytologic-histologic specimen pairs. To the authors' knowledge, little agreement exists regarding whether pathology errors are secondary to misinterpretation or poor clinical sampling of tissues and whether pathology errors result in serious harm.

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.

Estudio de concordancia entre el diagnóstico clínico y el diagnóstico anatomopatológico de lesiones dermatológicas en Atención Primaria

We try to study the concordance between clinical diagnosis and anatomical pathology diagnosis in cutaneous lesions in patients who come from five Primary Health Care centres of the Area 11. It is a descriptive study in which we examine all cutaneous lesions from five centers and then we send this examination to the Pathology Service of the 12 de Octubre Hospital, between August 1997 and February 2002. There were studied 203 cutaneous lesions obtained from 199 patients (79 male and 120 female), aged between 13 and 88 years (mean age 48.4 years old). Essentially, presurgical diagnosis were fibroepithelial papiloma (67 events), nevocellular nevi (45) and viral wart (33). There was 64% global agreement between clinical diagnosis and histopathological diagnosis. There were found 4 skin cancer (1.97%). We believe that there is a satisfactory concordance and this allow us to practice minor surgery in Primary Health Care centres as it is established in the Primary Health Care protocol.

Spontaneous conception in the presence of stage IIIC endometrioid ovarian cancer

Objective: To describe a rare case of spontaneous conception in a patient with a preexisting metastatic ovarian cancer. Design: Case report. Setting: University hospital. Patient(s): A 39-year-old Asian woman who conceived while undergoing an evaluation for primary infertility and newly detected bilateral adnexal masses. Intervention(s): Staging laparotomy and total abdominal hysterectomy and bilateral salpingooophorectomy. Main Outcome Measure(s): Anatomic pathology diagnosis. Result(s): Blighted ovum and stage IIIC endometrioid adenocarcinoma of ovary. Conclusion(s): Metastatic ovarian cancer does not prevent either spontaneous ovulation or spontaneous conception.

Correlación clinicopatológica de 370 casos de cirugía menor dermatológica realizada por médicos de familia

To analyse the concordance between presurgical diagnosis and anatomical pathology diagnosis in 370 cutaneous lesions in primary care centres. Descriptive study.Setting. Primary care centres and hospital pathology service, Medina del Campo. The prior diagnosis was compared with the anatomical pathology for simple agreement. There were 370 lesions. Complete date were obtained for 345 lesions of 298 patients (156 male and 142 female, aged between 6 and 98). Most problems diagnosed were nevocellular nevi (99 cases), fibroepithelial papiloma (72 cases), epidermoid cyst and viral wart (44). There was 63.1% global agreement between the laboratory report and doctor's diagnosis. Concordance and misdiagnosis were described in each type of lesion, mostly in skin cancer. Performing minor surgery in primary care is feasible and effective. There is a high concordance between clinical diagnosis and anatomical pathology diagnosis.

Cirugía menor en atención primaria: la satisfacción de los usuarios

To find the satisfaction of patients undergoing minor surgery at health centres and describe the processes.Retrospective study of population seeking the service.Health district.160 people who had minor surgery during a year.Descriptive variables of everyone who had minor surgery were analysed: age, sex, type of intervention, pre-surgical diagnosis, anatomical-pathological diagnosis and informed consent. Over three weeks the patients were interviewed by phone with use of a satisfaction questionnaire. 160 interventions took place, 80% of which were then studied histologically, with an 83.16% concordance index. 65% of patients were interviewed. 15% had no telephone, 20% were not found, 95.56% considered they were well attended and 3.17% badly attended. 92.06% would choose the health centre again for procedures of a similar nature. 89.9% thought that the explanations they had received were sufficient. 4.4% thought that the room's hygiene was poor.Minor surgery in primary care was favourably received by users. Activity at our centre had good anatomical-pathological concordance.

A computerised diagnostic index for medical and neuro-ophthalmology.

We have developed a classification that meets the requirements of the Medical Eye Unit and computerised it. The classification uses three categories: anatomical site of lesion, pathological process, and clinical diagnosis. Each patient is identified by standard data and up to three entries in each of anatomical localisation, pathological diagnosis, and clinical diagnosis. This system allows the formation of groups of patients which can be either very specific or very broad by appropriate combination of selection criteria in the different categories. No codes are used but computer validation ensures consistent nomenclature. Computerisation allows rapid searching of records even with multiple selection criteria. The program is simple to use and validates data entries. An additional benefit is that it facilitates medical audit of the department's work.