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April 2018

TB testing: new approaches to old scourge

April 2018—Scratch the surface of TB testing, and things quickly get interesting. The standard skin reaction test, widely adopted by the early 1940s, is still in use today. The goal has remained steady as well: break the transmission cycle. “From the clinician perspective and the laboratory perspective, because of its infectious nature, we want to identify people with latent tuberculosis,” says Elitza Theel, PhD, lab director for the infectious disease serology laboratory, Mayo Clinic and Mayo Medical Laboratories. “The ultimate goal is to treat them, so they don’t progress to active TB.”

HBsAg tests, mutation in public health spotlight

April 2018—If you were asked to pick a place on the map where problems with detecting a mutant strain of an infectious disease would likely come to light, the capital of Nebraska might not be your first guess. But in Lincoln, in 2017, a hemodialysis patient who was vaccinated against hepatitis B virus in 2010 and had repeatedly tested negative for HBV surface antigen was found to have had undiagnosed chronic hepatitis B. The case led state and local public health officials to investigate and find evidence that some hepatitis B surface antigen (HBsAg) assays were not picking up particular HBV mutant strains.

Digital pathology: A 1st anniversary report card

April 2018—Nearly one year after the FDA cleared the Philips IntelliSite Pathology Solution for primary diagnosis, Philips is reporting worldwide momentum for the adoption of digital pathology. Last year, it helped two labs in Austria—Pathology Institute in Hall and Pathology Institute at Tirol Kliniken—fully digitize their workflows. In North America, “adoption is accelerating as the U.S. catches up with the rest of the industrialized world in terms of digital pathology,” says Marlon Thompson, PhD, MBA.

Fewer false-positive pregnancy results with intact hCG

April 2018—When women of childbearing age check in at a cancer center where they might be undergoing medical or surgical treatment, the screening protocol is often to test them for pregnancy, primarily by quantifying serum β-hCG. But because a form of the β-hCG subunit can also be produced by several epithelial cancers, false-positive pregnancy results are more common in patients who have cancer.

From the President’s Desk: Pathologists as medicine’s first responders, 4/18

April 2018—The National Institute on Drug Abuse estimates that 100 million Americans suffer from chronic pain. The majority of drug overdose deaths involve an opioid, and nearly half of drug overdoses caused by opioids involve prescription drugs. The American Medical Association has formed a task force to combat the opioid crisis and has supported state-based prescription drug monitoring programs through which registered physicians can access information about their patients’ current medications before prescribing a new one.

LCIS variants and DCIS: tips on telling them apart

April 2018—DCIS or LCIS? Making the distinction can be difficult in some cases. Stuart J. Schnitt, MD, in a session at CAP17 on ancillary testing in breast pathology, delineated the reasons and provided tips, including the role of E-cadherin immunostains to help in this distinction. The cells of DCIS typically show strong membrane staining for E-cadherin while the cells of LCIS are typically E-cadherin negative. But among the tips: If an in situ lesion is E-cadherin positive, it doesn’t automatically mean it’s ductal carcinoma in situ. As he demonstrated in several cases, the lesion could be lobular carcinoma in situ with aberrant E-cadherin immunostaining.

Turnover in phlebotomy: looking deeper than pay

April 2018—Laboratory managers struggling to reduce turnover among phlebotomists should look beyond the pay and examine their hiring and management practices and the dysfunction that could be creating walls between analytical and preanalytical staff. “It’s an enormous problem,” Dennis J. Ernst, MT(ASCP), NCPT(NCCT), director of the Center for Phlebotomy Education, says of phlebotomist turnover. “There’s no silver bullet because there are so many things that lead phlebotomists to give up hope where they work and in the profession. It’s critical that managers are tuned in to the needs of this specialized workforce because they’re varied and many.”

POC glucose: views on volume, critical care, ACOs

April 2018—Test volume, limitations on devices used in critical care, consolidation, and population health is what CAP TODAY asked about when it spoke in March with the makers of three bedside glucose testing systems. Their systems and those of two other companies are profiled on pages 44-49. “The customers are more aware than ever of the limitations that are in the package inserts from the glucose manufacturers,” says Corrine Fantz, PhD, director of medical and scientific affairs for point-of-care testing, Roche Diagnostics. But she and Kevin Peacock, clinical marketing manager, HemoCue America, say there is still confusion. Here is more of what they and others told senior editor Amy Carpenter Aquino.

In cervical disease dx, agreement rises with p16 IHC use

April 2018—In analyzing cervical tissue, adjunctive use of p16 IHC with H&E-stained slides improves accuracy and sensitivity, according to the results of the Cervical Tissue Adjunctive Analysis study presented by Thomas C. Wright Jr., MD, in a webinar hosted by CAP TODAY and made possible by an educational grant from Roche Diagnostics.

Clinical Pathology Abstracts, 4/18

April 2018—Potential contributors to error in oxygen saturation calculation using a POC assay: Oxygen saturation is important for measuring respiratory status and calculating cardiac output for patients. The gold standard for oxygen saturation (sO2) is CO-oximetry, but other methods, which involve calculations rather than measurement of sO2, are widely used because they enable point-of-care (POC) testing. The calculations use mathematical models based on average physiologic parameters to relate blood parameters, such as pH, pCO2, and pO2, to sO2.