College Of Pathologists Research Articles

Determining HER2 Status by Artificial Intelligence: An Investigation of Primary, Metastatic, and HER2 Low Breast Tumors

The expression of human epidermal growth factor receptor 2 (HER2) protein or gene transcripts is critical for therapeutic decision making in breast cancer. We examined the performance of a digitalized and artificial intelligence (AI)-assisted workflow for HER2 status determination in accordance with the American Society of Clinical Oncology (ASCO)/College of Pathologists (CAP) guidelines. Our preliminary cohort consisted of 495 primary breast carcinomas, and our study cohort included 67 primary breast carcinomas and 30 metastatic deposits, which were evaluated for HER2 status by immunohistochemistry (IHC) and in situ hybridization (ISH). Three practicing breast pathologists independently assessed and scored slides, building the ground truth. Following a washout period, pathologists were provided with the results of the AI digital image analysis (DIA) and asked to reassess the slides. Both rounds of assessment from the pathologists were compared to the AI results and ground truth for each slide. We observed an overall HER2 positivity rate of 15% in our study cohort. Moderate agreement (Cohen's κ 0.59) was observed between the ground truth and AI on IHC, with most discrepancies occurring between 0 and 1+ scores. Inter-observer agreement amongst pathologists was substantial (Fleiss´ κ 0.77) and pathologists' agreement with AI scores was 80.6%. Substantial agreement of the AI with the ground truth (Cohen´s κ 0.80) was detected on ISH-stained slides, and the accuracy of AI was similar for the primary and metastatic tumors. We demonstrated the feasibility of a combined HER2 IHC and ISH AI workflow, with a Cohen's κ of 0.94 when assessed in accordance with the ASCO/CAP recommendations.

Female Presidents of the "Royal College of Pathologists": Their Achievements and Contributions.

The Royal College of Pathologists (RCPath) celebrates its Diamond Jubilee in 2022 since its opening by Her Majesty Queen Elizabeth II in 1962. One of the main remits of RCPath is the overseeing of the training of pathologists and scientists working in pathology’s 17 different specialties within the United Kingdom and across the globe. During its 60 years, three female Presidents have been elected: Dame Barbara Clayton (1984–1987), Dr. Suzannah (Suzy) Lishman CBE (2014–2017), and Prof. Joanne (Jo) Martin (2017–2020). Whilst Clayton specialised in Chemical Pathology and its relevance to public health, both Lishman and Martin are diagnostic cellular histopathologists with differing areas of expertise. This article reviews the contributions of these three distinguished and inspirational female pathologists to Pathology (“the science behind the cure”), to healthcare, public health and education, medical research, and to teaching. It highlights their qualities as leaders and mentors for those not only in medicine but in other career settings.

Correlation between MRI morphological response patterns and histopathological tumor regression after neoadjuvant endocrine therapy in locally advanced breast cancer: a randomized phase II trial

PurposeTo correlate MRI morphological response patterns with histopathological tumor regression grading system based on tumor cellularity in locally advanced breast cancer (LABC)-treated neoadjuvant with third-generation aromatase inhibitors.MethodsFifty postmenopausal patients with ER-positive/HER-2-negative LABC treated with neoadjuvant letrozole and exemestane given sequentially in an intra-patient cross-over regimen for at least 4 months with MRI response monitoring at baseline as well as after at least 2 and 4 months on treatment. The MRI morphological response pattern was classified into 6 categories: 0/complete imaging response; I/concentric shrinkage; II/fragmentation; III/diffuse; IV/stable; and V/progressive. Histopathological tumor regression was assessed based on the recommendations from The Royal College of Pathologists regarding tumor cellularity.ResultsFollowing 2 and 4 months with therapy, the most common MRI pattern was pattern II (24/50 and 21/50, respectively). After 4 months on therapy, the most common histopathological tumor regression grade was grade 3 (21/50). After 4 months an increasing correlation is observed between MRI patterns and histopathology. The overall correlation, between the largest tumor diameter obtained from MRI and histopathology, was moderate and positive (r = 0.50, P-value = 2e-04). Among them, the correlation was highest in type IV (r = 0.53).ConclusionThe type II MRI pattern “fragmentation” was more frequent in the histopathological responder group; and types I and IV in the non-responder group. Type II pattern showed the best endocrine responsiveness and a relatively moderate correlation between sizes obtained from MRI and histology, whereas type IV pattern indicated endocrine resistance but the strongest correlation between MRI and histology.

Creation of a novel simple heat mapping method for curriculum mapping, using pathology teaching as the exemplar

BackgroundThe undergraduate five-year MBChB programme at the University of Glasgow has a high volume of pathology teaching integrated into the course. The ability to better understand what pathology is taught and when, so as to build a picture of the types and depth of pathology topics covered across the programme stages is crucial, especially in a spiral curriculum. A novel method of curriculum mapping, known as curriculum heat mapping, was developed as a way to visualise where and when topics are taught, in an easier to understand format.MethodsThis method involved comparing the Glasgow curriculum to a pre-determined standard of what should be taught. In this case, The Royal College of Pathologists’ ‘Pathology Undergraduate Curriculum’ was used as a comparison of what a graduating doctor should know about pathology.ResultsFollowing the developed template, heat maps showcasing the range of pathology topics covered, and where they are covered, were developed for local use.These heat maps provided a clear visual representation of where and when topics are taught, and how they cluster.ConclusionsHeat mapping is a novel low-cost, high-input method of curriculum mapping. It requires a person to input the data which can take a long time for large curricula. There are no other upfront financial costs. It can be used in any area with a curriculum and an external or internal comparator. Examples of gold standard external comparators include validated national or international curricula.Heat mapping can help integrated, spiral curriculum programmes to identify where core topics are taught throughout their course. The heat maps themselves successfully demonstrate the required information and are easy to interpret. The process of mapping, as well as the final heat map, can yield important information. This includes information about trends within the curriculum, areas for potential improvement in sessional design and a clearer understanding of the depth to which each topic is covered in each lecture.Overall, it is a viable novel method, which has been successful locally and is easily transferable to other areas such as pharmacology.

Abstract 51: Breast Biopsy Report Abstraction Process From A Community And Hospital Based Screening And Treatment Programme In A Lmic (Kenya) Between January 2017 – December 2019

Abstract Purpose: There is no standardized way of reporting the pathological lab results therefore there is inadequate reporting in Low- and Middle-Income Countries like Kenya. Proper documentation of the lab results is key in providing appropriate care to breast cancer patients, policymaking, designing, implementing, and evaluating cancer control activities. There is need to standardize reporting of the pathological breast cancer lab results. Methods: The biopsy results for all the Africa Breast and Cervical Cancer Program (ABCCP) in Kenya patients seen between the year 2017 to 2019 were received, photocopied, and filed in box files. Biopsy reporting was done by various pathologists within the country. To standardize the reporting, a data abstraction questionnaire was developed from Protocol for the Examination of Resection Specimens From Patients With Invasive Carcinoma of the Breast (7th Edition, 2012) adapted from the American College of Pathologists programmed into an Open Data Kit. Raw abstracted data was verified against corresponding images to identify misclassifications by the consultant. Sensitivity and specificity for correct classification by the clinical and non-clinical research assistants was calculated and evaluated. Results: A total of 1490 records were abstracted in 3 weeks, out of which 529 records were breast biopsy results. On average, the research assistants abstracted 83 (42 - 195) records. The research assistants were able to correctly classify 284 cases as malignant and 202 cases as benign with a Sensitivity of 92% and Specificity of 92%. Upon review of the data by the consultant, the total misclassified records were 18 benign classified as malignant and 25 malignant cases classified as benign. There was no statistically significant difference (p = 0.1125) in the classifications between the clinical and non-clinical abstraction staff. Conclusion: There was high sensitivity and specificity on correctly classifying the biopsy results for both well trained clinical and non-clinical staff. Citation Format: Stephen Karuru Maina, Emmah Achieng, Hussein Elias, Kibet Kibor, Chite Asirwa. Breast Biopsy Report Abstraction Process From A Community And Hospital Based Screening And Treatment Programme In A Lmic (Kenya) Between January 2017 – December 2019 [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 51.

Minimally invasive total adventitial resection of the cardia for tumours of the oesophagogastric junction.

A cohort study analysing phases and outcomes of the learning curve required to master minimally invasive total adventitial resection of the cardia. Data from 198 consecutive oesophagectomies performed by a single surgeon was collected prospectively. Patients' stratification reflected chronologically and technically the four main phases of the learning curve: open surgery (open total adventitial resection of the cardia (TARC), n = 45), hybrid Ivor Lewis oesophagectomy (HILO, n = 50), laparoscopic-thoracoscopic assisted (LTA, n = 56) and totally minimally invasive TARC (TMI TARC, n = 47). Operating time, hospital stay, specimen lymph nodes and resection margins were analysed. Five-year survival was the main long-term outcome measured. Overall 5-year survival was 45%. Perioperative mortality was 1.5% (n = 3). Hospital stay was 22 ± 23 days. Specimen lymph node median was 20 (range: 15-26). Resection margins were negative (R = 0, American College of Pathologists) in 193 cases (97.4%). Five-year survival in the four phases was 37.8%, 44.9%, 42.9% and 55.3%, showing a positive trend towards the end of the learning curve (p = 0.024). Median specimen lymph nodes was 20 (range: 15-22) for open TARC, 18.5 (13-25) for HILO, 19.5 (15-25) for LTA and 23 (18-30) for TMI TARC (p = 0.006). TMI TARC, adenocarcinoma, R >0, T >2, N >0 and LyRa (ratio positive/total specimen nodes) were associated with survival on univariate analysis. T >2 and LyRa independently predicted worse survival on multivariate analysis. CUSUM analysis showed surgical proficiency gain since laparoscopy was introduced. Mastering minimally invasive TARC requires a long learning curve. TMI TARC is safe and oncologically appropriate and may benefit long-term survival: it should be validated by randomised trials as a standardised anatomical resection for tumours of the oesophagogastric junction.

Gamma-Glutamyl Transferase (GGT) Is the Leading External Quality Assurance Predictor of ISO15189 Compliance for Pathology Laboratories.

Pathology results are central to modern medical practice, informing diagnosis and patient management. To ensure high standards from pathology laboratories, regulators require compliance with international and local standards. In Australia, the monitoring and regulation of medical laboratories are achieved by conformance to ISO15189-National Pathology Accreditation Advisory Council standards, as assessed by the National Association of Testing Authorities (NATA), and an external quality assurance (EQA) assessment via the Royal College of Pathologists of Australasia Quality Assurance Program (RCPAQAP). While effective individually, integration of data collected by NATA and EQA testing promises advantages for the early detection of technical or management problems in the laboratory, and enhanced ongoing quality assessment. Random forest (RF) machine learning (ML) previously identified gamma-glutamyl transferase (GGT) as a leading predictor of NATA compliance condition reporting. In addition to further RF investigations, this study also deployed single decision trees and support vector machines (SVM) models that included creatinine, electrolytes and liver function test (LFT) EQA results. Across all analyses, GGT was consistently the top-ranked predictor variable, validating previous observations from Australian laboratories. SVM revealed broad patterns of predictive EQA marker interactions with NATA outcomes, and the distribution of GGT relative deviation suggested patterns by which to identify other strong EQA predictors of NATA outcomes. An integrated model of pathology quality assessment was successfully developed, via the prediction of NATA outcomes by EQA results. GGT consistently ranked as the best predictor variable, identified by combining recursive partitioning and SVM ML strategies.

Serological testing for COVID-19

The objectives of this study are to identify the rapid, appropriate, screening, definite and novel methods of diagnosis of SARS-CoV-2 (COVID-19) infection, including SARS-CoV-2 (COVID-19) variants among various degree of COVID-19 severity for rapid prevention and control of SARS-CoV-2 (COVID-19) transmission. Methods of The Study: A comprehensive search was carried out in mainstream bibliographic databases or Medical Subject Headings, including ScienDirect, PubMed, Scopus, and ISI Web of Science. The search was applied to the articles that were published between 1971 and early March 2021. Results: With strict literature search and screening processes, it yielded 40 articles from 78 articles of initial literature database. Characteristically, after infection, antibodies are detected in the blood of individuals, particularly individuals with few or mild symptoms. In patients with varying symptoms of COVID-19 and negative results of reverse-transcriptase-polymerase-chain reaction (RT-PCR) tests, the testing has a significantly clinical role when nasopharyngeal swabs are taken more than 5 days after symptom onset. The Royal College of Pathologists (RCPath) developed seven principles for production of a COVID-19 testing strategy. Testing being carried out for a purpose is one of these RCPath’s principles. Nevertheless, denial of requesting SARS-CoV-2 (COVID-19) antibody tests for reassurance should be cautioned. With a lower antibody levels, whether the protective immunity will be sustained is questionable. Several immune-based assays were developed against different SARS-CoV-2 (COVID-19) viral proteins as the followings: 1) Entire Spike (S) protein, IgG antibody from patient serum can cross-react with SARS-CoV and MERS-CoV, 2) S1 subunit of Spike (S) protein, IgA, IgG antibodies from patient serum can cross-react with SARS-CoV only, 3) Receptor-binding domain (RBD), IgG antibody from patient serum can cross-react with SARS-CoV only, and 4) Nucleocapsid (N), IgG antibody from patient serum can cross-react with SARS-CoV only. Long et al demonstrated in their study that IgG antibody and neutralizing antibody levels initiate decreasing within 2-3 months after infection in the majority of persons with recovery from SARS-CoV-2 (COVID-19) infection. An analytical study of the dynamics of neutralizing antibody titers demonstrated reduced neutralizing antibodies around 6-7 weeks after illness onset. In conclusion, the nucleic acid amplification tests may be poorly timed specimen collection, poor-quality specimen collection, long wait times for generating the results, and requirement of trained laboratory technicians. Serological data greatly supplement the laboratory results from the quantitative reverse-transcriptase-polymerase-chain reaction (qRT-PCR), the design of virus elimination programs (seroepidemiology), discovery of the monoclonal antibodies, and development of SARS-CoV-2 (COVID-19) vaccines.

The diversity of education in pathology worldwide and perspectives of the international academy of pathology

The article, based on the personal experience of the President of the International Academy of Pathology (IAP), presents the features of three main training programs for pathologists: European, Anglo-Saxon and North-American, applied in accordance with the guidelines of the European Union of Medical Professionals (UEMS), the Royal College of Pathologists (RCPath) and the American Board of Pathology (ABPath), respectively. Differences in the training of pathologists in different countries are associated with the structure and time of training, the possibilities of financing it, the sub-specialties of pathologists and their accreditation by the commissions for pathology. The minimum training time for pathologists varies in different countries of the world and is: six years (in Sri Lanka), five and a half years (in the countries of the British Commonwealth), four years (in the USA, North American countries, EU countries, Norway, Switzerland, Turkey, Australia, New Zealand), three to five years (in South Africa), two years (in Russia, Armenia, Mongolia, Vietnam, Cambodia), one year (in Ukraine). The structure of training for resident pathologists is also different. For example, the European system of training pathologists covers such compulsory subjects as clinical and surgical pathology, autopsy, cytopathology, as well as additional (for some sub-specialties) educational disciplines: neuropathology, dermatopathology, pediatric pathology. The Anglo-Saxon system, in addition to clinical and surgical pathology, includes chemical pathology (metabolic medicine), virology, infectious diseases, and optional subjects: hematopathology and biochemistry. Medical microbiology and chemical pathology are also being studied in Arab countries. The North American resident pathologist training system includes surgical pathology, autopsy, forensic medical examination, chemistry, cytopathology, cytogenetics, molecular diagnostics, hematopathology, dermatopathology, neuropathology, virology, infectious diseases, liver pathology, transplant pathology, transfusion medicine. The financial support provided by the Education Committee of the IAP encourages the development of educational programs and the creation of schools in pathology in developing countries, the organization of international Congresses, teleconferences and webinars, and the development of the international program “Goodwill / Visiting / Ambassador”. In conclusion, Albert Einstein's statement is given: “Education is not the learning of facts, but the training of the mind to think”.Conclusion. The time has come for an educational revolution. It is necessary to give strength to everyone in order to open channels everywhere to improve education and achieve harmonization of Pathology globally.

Importance of Circumferential Resection Margin in Management of Esophageal Cancer

Esophagectomy (R0) remains the gold standard for the management of esophageal cancer. But due to close vicinity of esophagus with the major structures like heart, aorta, vertebral column, tracheobronchial tree and lungs, a wider circumferential resection is generally not possible and a R1/ R2 resection might occur. Therefore, locoregional recurrence rates of esophageal cancer are reported to be as high as 52%. The Royal College of Pathologists (RCP) and The College of American Pathologists (CAP) define circumferential resection margin (CRM) differently. A mean overall CRM involvement was found to be 40.7% (RCP criteria) and 11.8% (CAP criteria). Twometa-analyses have shown poor survival in CRM positive cases. CRM positivity in T1/ T2 lesions should not occur unless there is a surgical fault. For T3 lesions, a higher rate of CRM positivity has been documented. Therefore, a wider CRM using transthoracic approach appears mandatory, especially for T3 lesions.

Prof Mervyn Shear ... a towering presence in Oral Pathology

Professor Mervyn Shear made immense contributions to the discipline of Oral Pathology and indeed was the founder of the speciality in South Africa, holding the first Chair of Oral Pathology in the country. He graduated BDS from Wits in 1964, Neil to MDS (Oral Pathology) in 1961 and to the FRC (Pathology) from the Royal College of Pathologists in 1965. His passion for the discipline motivated his determination that Oral Pathology should be affiliated to Anatomical Pathology, a relationship which has ensured maximum exposure for South African registrars in Oral Pathology.

Recommendation for the pathological examination of the placenta: practical aspects and indications. Methodological recommendation

Introduction: According to the Hungarian law, placental examination is not mandatory, although it is known from the international practice that it can give valuable information in cases of stillbirth or in conditions, where the neonate has difficulty in the postnatal adaptation. Aim: It can be useful in the early detection of diseases, which otherwise would have gone undetected until late in life. This article is unique in Hungary, as no similar guideline exists in Hungarian language. Method: The recommendation of the Royal College of Pathologists (United Kingdom) determines those conditions where essential information can be obtained from the placental examination in not normal pregnancies. It serves as a useful guide in the medical practice. The journal titled "Placenta", first published in 1980 with impact factor above two, just underlines this statement. Results: In this article, the authors present the recent guideline of the RCPath and finish with the presentation of established clinicopathological association that might help clinicians to get the most valuable information from placental examination. Conclusion: The present article aims to summarise updated recommendations and present clinicopathological correlations. Orv Hetil. 2019; 160(48): 1894-1903.

P43 IS THERE AN OPTIMAL DEFINITION FOR POSITIVE CIRCUMFERENTIAL RESECTION MARGIN IN LOCALLY ADVANCED OESOPHAGEAL CANCER?

Abstract Aim The utility of Circumferential Resection Margin (CRM) status in predicting prognosis in oesophageal cancer remains controversial, with two different definitions of a positive CRM, one from the College of American Pathologists (CAP) (tumour at margin) and the other from the Royal College of Pathologists (RCP) (tumour within 1 mm)1-3. This study aimed to analyze the validity of these definitions in oesophageal tumours and explore the optimal cutoff value for CRM to predict survival. Background & Methods Patients who underwent curative radical oesophageal resection for locally advanced (>pT2) adenocarcinoma or squamous cell carcinoma of the oesophagus were selected from 2007 to 2016. Patients with positive longitudinal resection margins were excluded. CRM was histologically reassessed using an ocular micrometer. Overall survival (OS) and disease-free survival (DFS) were estimated with uni and multivariate analyses. Results From 860 resected patients, 283 fulfilling the inclusion criteria were selected. CRM was measured as follows: CRM=0mm (n=48), 0<CRM ≤1mm (n=123) and CRM>1mm (n=112). In univariate (figure 1) and multivariate analysis R1 resection, according to both definitions was significantly associated with poor OS (CAP: HR=2.26,p<0.001; RCP: HR=1.42,p=0.035). However only CAP definition accurately predicted DFS (CAP: HR=2.25,p<0.001; RCP: HR=1.28,p=0.094). When comparing the 3 CRM groups and taking 0 < CRM ≤1mm as reference, only CRM=0 predicted OS and DFS (p<0.001). A CRM cutoff at 0.1 mm was the best to predict OS and differed according to histology. Conclusion Among existing definitions of CRM, CAP definition was more accurate to predict prognosis and recurrence. New cutoffs are promising.

Interobserver Variability in Assessing Pathologic Response to Preoperative Treatment in Rectal Cancer: Standardization of an Evaluation Method and Comparisons Between Published Scales.

Evaluating tumor response of rectal cancer to preoperative chemoradiotherapy (NCRT)has a prognostic value on overall survival; however, grading tumor response is a controversial issue due to lack of reproducibility and the lack of information about the standardization of the evaluation. We performed this studyto examine the variability between observers' assessment of the pathological responses to NCRT using a systematic quantitative grading system based on a percentage of tumor response against the proportion of residual tumor burden. As a secondary aim, we classified the tumor response according to six published systems to determine the correlation between the observers into each grading system. From 70 cases, the mean age was 60.6 ± 11.78years, 36 (51.47%) patients were female, the pathological T stage was pT3 in 48.6% of cases, pT2 in 32.9%, pT1 in 11.4% and 7.1% in pT4, whereas 40% had lymph node metastasis. The median lymph node count was ten lymph nodes (range 6-43). Our method of tumor regression evaluation has a good intraclass correlation (ICC) value. From the scales compared regarding interobserver agreement, the Ryan's and Royal College of Pathologists showed fair agreement (but good ICC); the scales from Dworak, Becker, and Rizk showed substantial agreement (and good to excellent ICC values); and the scale from Rödel showed almost-perfect agreement. All the evaluated systems showed good interobserver agreement, but the best interobserver agreement was reached with the Rödel's scale.

Paola Domizio: gifted pathology teacher and science communicator

Paola Domizio, the pathologist and professor who has died from breast cancer, may be the only person to have incorporated card tricks into her inaugural professorial lecture. It was typical of the flair she brought to her teaching role at Barts and the London School of Medicine and Dentistry at Queen Mary University of London and to her ambassadorial and leadership positions with the Royal College of Pathologists. Having served as assistant registrar and then registrar for a total of nine years from 2001, Domizio deployed her communication skills and zest for the specialty as director of public engagement at the college from 2011. Concerned that the public’s view of pathology was shaped by TV crime solving sleuths in pristine white coats, running between antiseptic laboratory and faintly exotic murder scenes, she wrote articles and took to television and radio herself to redress the balance. It was during this period that the college adopted the strapline “Pathology: the science behind the cure.” This was in the 1990s, and Domizio was among those to take on the discredited former doctor and antivaccine activist Andrew Wakefield, writing two articles challenging his research methods and conclusions around links between the measles, mumps, and rubella vaccine and autism. Domizio may also have been the first clinician to offer children who had undergone colectomies for bowel disease the opportunity to view and learn about the bowel resection tissue that had caused their distressing symptoms. She …

Sri Lankan clinical practice guidelines: A methodological quality assessment utilizing the AGREE II instrument.

Clinical practice guidelines (CPG) play a major role in patient care in Sri Lanka. This study evaluates the methodological quality of the Sri Lankan CPGs developed in 2007. A total of 94 CPGs developed by several professional colleges in Sri Lanka in the year 2007 were evaluated by 2 independent reviewers using AGREE II instrument for their methodological quality. Item score being ≤3 points was defined as "poor quality". Each domain score was calculated according to AGREE II. A guideline was labelled as "strongly recommended" if 4 or more domains scored above 60%, "recommended for use with certain modification" if only 3 domain scores were above 60% or if 4 or more domain scores were between 30% and 60%, and "not recommended" if 4 or more domains scored less than 30%. Most (22.3%) guidelines were developed by the College of Pathologists. Most of the guidelines (>55%) poorly reported on all the items, except for items 1, 2, and 22 of AGREE II. Median domain scores [range] and the proportion of the guidelines with domain score of <30% were as follows: domain on scope and purpose (33.3% [2.8%-83.3%]; 42.6%), stakeholder involvement (14.9% [0.0%-61.1%]; 81.9%), rigour of development (6.1% [0.0%-49%]; 98.9%), clarity and presentation (30.5% [8.3%-61.1%]; 46.8%), and applicability (8.3% [4.2%-14.6%]; 100%). All CPGs scored 50% for "editorial independence". Reviewers reported the overall quality was poor in 86 (91.5%). Based on the definitions used in the study, of 94 CPGs, 8 (8.5%) could be recommended to be used with modifications, while 86 (91.5%) could not be recommended for clinical practice. The methodological quality of the CPGs was poor irrespective of the source of development. Major efforts are essential to update the CPGs according to the principles of evidence based medicine.

Presidential address: annual academic sessions of college of pathologists of Sri Lanka 2017

Presidential address: annual academic sessions of college of pathologists of Sri Lanka 2017

An audit of lymph node retrieval and histopathology reporting of pancreaticoduodenctomy specimens undertaken at a tertiary care referral center

Pancreaticoduodenectomy (PD) is currently the main surgical option for malignancies in the ampullary region, which includes ampulla of Vater tumours (AVT), distal bile duct tumours (DBDT), periampullary duodenal tumours (DT) and tumours of the head of the pancreas (PT). Nodal status and many other important pathological features have a significant impact on tumour prognosis and therapy. The aim of this study was to determine the total number of lymph nodes (LNs) retrieved from PD specimens, whether grouping of LNs improves the total yield and to assess the level completeness of histopathology reporting of PD specimens. Forty two PD requests and histopathology reports were assessed to determine the total number of LNs retrieved and whether the LN were grouped (G)or non-grouped (NG). The significance of difference in the number of LNs in the two groups were assessed using the Wilcoxon signed rank test. The tumours were subcategorized as AVT, DBDT, DT and PT and the reports were audited against the respective minimum data sets of the Royal College of Pathologists of United Kingdom to determine the overall completeness and the parameters poorly reported in the reports. The overall median LN yield was 14.5 and the median LN yield was 15 and 10 in G and NG respectively which was statistically significant. The completeness of the histopathology reporting was 63.6%- 77.3% in AVT (n-18), 73.9% - 95.6% in DBDT (n-5), 68.1% - 90.1% in DT (n-8), 70.8% - 83.3% in PT (n-11). The lengths of the bile duct, lesser and greater curvature of the stomach, tumour differentiation, involvement of resection margins and named blood vessels were poorly reported. In conclusion, the total LN retrieval improved by grouping according to the Union of International Cancer Control (UICC) protocol. Histopathology reporting of some of the data items requires improvement. Hence adoption of a pro forma for synoptic reporting and establishment of national guidelines on reporting and handling of specimens is recommended.

Massively Parallel Sequencing of Genes Implicated in Heritable Cardiac Disorders: A Strategy for a Small Diagnostic Laboratory.

Sudden cardiac death (SCD) in people before the age of 35 years is a devastating event for any family. The causes of SCD in the young can be broadly divided into two groups: heritable cardiac disorders that affect the heart structure (cardiomyopathies) and primary electrical disorders (cardiac ion channelopathies). Genetic testing is vital as those suffering from cardiac ion channelopathies have structurally normal hearts, and those with cardiomyopathies may only show subtle abnormalities in the heart and these signs may not be detected during an autopsy. Post-mortem genetic testing of SCD victims is important to identify the underlying genetic cause. This is important as family cascade screening may be undertaken to identify those who may be at risk and provide vital information about risk stratification and clinical management. The development of massively parallel sequencing (MPS) has made it possible for the simultaneous screening of multiple patients for hundreds of genes. In light of this, we opted to develop an MPS approach for SCD analysis that would allow us to screen for mutations in genes implicated in cardiomyopathies and cardiac ion channelopathies. The rationale behind this panel was to limit it to genes carrying the greatest mutation load. If no likely pathogenic gene variant were found then testing could cascade to whole exome/genome sequencing as a gene-discovery exercise. The overarching aim was to design and validate a custom-cardiac panel that satisfies the diagnostic requirements of LabPLUS (Auckland City Hospital, Auckland, NZ) and the guidelines provided by the Royal College of Pathologists of Australasia and the Association for Clinical Genetic Science.

PTH-098 Audit of Current Liver Biopsy Practice at A Single Tertiary Centre

Introduction In an era of increasing availability and access to well validated non-invasive laboratory diagnostic screens and measures of liver fibrosis, the role of liver biopsy for diagnosis and staging of liver disease has diminished. Liver biopsies are subject to sampling error which is made worse by inadequate sample sizes. There is no data on the adequacy of liver biopsy specimens when obtained percutaneously as opposed to the transjugular route.We aimed to assess the adequacy of liver biopsy samples as defined by the minimum standards suggested by the Royal College of Pathologists’(RCP),1 UK (minimum of 6 portal tracts and sample length of 15 mm). Where available we wished to compare the results of biopsy fibrosis staging with transient elastography data. Methods A retrospective study was designed to review all liver biopsy requests made in our tertiary liver unit between 31 st October 2012 and 24 June 2013. Results 114 patients(59.6% male) with a median age of 48.7(interquartile range 19.8) had a liver biopsy. The commonest indications for biopsy were deranged liver function tests and queries regarding aetiology. Out of 114 reports 82 (71.9%) included the number of portal tracts and length of the biopsy and of these 52 (63.4%) were adequate samples as per RCP standards.1The number of transjugular liver biopsy reports were 16 (14.0%) and of these only 5 (31.3%) mentioned the size and number of portal tracts. Of these only 1 (20%) sample was adequate as per RCP standards.1 Of the 98 (86.0%) percutaneous samples 77 (78.6%) reported the length and number of portal tracts and only 51 (66.2%) were adequate. Of the 114 patients, 54 (47.3%) had transient elastography within 12 months of the liver biopsy with 47 (87.0%) having a score above 7 kPa suggestive of abnormal liver stiffness. The 26 (48.1%) with a score above 12.2 kPa which is indicative of cirrhosis only 9 (34.6%) had a histological diagnosis of cirrhosis. Of the 13 (24.1%) patients who had a normal liver stiffness picture on transient elastography with a score below 7 kPa none had a histological diagnosis of cirrhosis. Conclusion Assessment of sample adequacy was compromised because only two-thirds of the reports contained the recommended information to confirm adequacy. Of those where this information was present 36.6% of samples did not meet minimum standards set by the RCP1 which may impact on histopathological diagnosis. The audit showed that patients with a low transient elastography were unlikely to have a histological diagnosis of cirrhosis. Patients with a raised transient elastography only a third were identified as being cirrhotic on biopsy suggesting further clinical correlation is required. Reference 1 Wyatt J, et al. Tissue pathways for liver biopsies for the investigation of medical disease and for focal lesions Royal College of Pathologists’ Guidelines. 2014. Disclosure of Interest None Declared