IN THIS MONTH’S ISSUE

April 2024—The rise in fungal infections in recent years troubles Sean Zhang, MD, PhD, for reasons near and far. It’s readily apparent in the patient populations at Johns Hopkins Hospital, where he is director of the mycology laboratory. Especially concerning is the increase in Candida auris following the height of the COVID-19 pandemic, both in terms of colonization and infection cases, says Dr. Zhang, who is also associate professor of pathology, Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine. “Since 2022, we suddenly saw an uptick in Candida auris cases across the Johns Hopkins Health System.” But the situation isn’t unique to Johns Hopkins. Pointing to CDC figures, he notes that the tide is rising more broadly as well. The agency reports that in 2020, there were 757 clinical cases and 1,310 screening cases of C. auris in the United States. In 2022, there were 2,377 clinical cases and 5,754 screening cases.

April 2024—With the technology now available, could and should remote diagnos-tic pathology, or at least a hybrid model, become more the norm in the future? Timothy Craig Allen, MD, JD, and Casey P. Schukow, DO, of Corewell Health in Michigan, in an editorial published recently, say the time for one or the other or both has come.

April 2024—As the call for fast turnaround of genetic testing results in tumor profiling grows louder, the need for rapid, reliable test methods becomes more pressing. Meanwhile, with new genetic biomarkers emerging at a rapid pace, “everything has tipped the balance toward comprehensive next-generation sequencing analysis,” said Maria E. Arcila, MD.

April 2024—The Food and Drug Administration in February cleared Proscia’s Concentriq AP-Dx digital pathology software for the purpose of primary diagnosis.

April 2024—In billing for pathology and laboratory services, the hurdles are only getting higher. Narrow networks, prior authorizations, claims denials. Payers “have deeper pockets and figure they can outlast us,” said Joe Saad, MD, chair of the CAP Council on Government and Professional Affairs, in a Feb. 14 roundtable led online by CAP TODAY publisher Bob McGonnagle. He and others talked about AI, digital pathology codes and molecular Z-Codes, biomarker testing, and unity within the laboratory community.

April 2024—Too few people, too much to do. In that, Duke Health’s molecular diagnostics laboratory is no different from any other laboratory. But competing for staff on the basis of money alone is out. “The reality is that in today’s labor market, any molecular technologist can always find a job that pays more,” says Barbara Anderson, PhD, MB(ASCP)^CM, analytical specialist in Duke’s molecular diagnostics laboratory, Division of Molecular Pathology, Genetics, and Genomics.

April 2024—Primary cutaneous marginal zone lymphoma (PCMZL) is a newly recognized, distinctive subtype of non-Hodgkin’s lymphoma. This low-grade lymphoma predominantly presents as papules or nodules within the skin of middle-aged adults. Formerly grouped under the extranodal marginal zone lymphoma (EMZL) category, the World Health Organization’s fifth edition classification of hematolymphoid tumors now recognizes PCMZL as a distinct entity.

CAP Publications released this month its newest book, Quality Management in Clinical Laboratories: Optimizing Patient Care Through Continuous Quality Improvement. It is a second edition; the first was published in 2005. Twenty-one contributors cover everything from laboratory staff and informatics to all phases of testing and the laboratory quality management plan.

April 2024—When Tip O’Neill, former speaker of the U.S. House of Representatives, said many years ago that all politics is local, he was talking about how elections, legislation, and all of politics affect people where they live. I believe the concept applies just as much to pathology advocacy. When it comes to the issues we care about for our profession and for our patients, our efforts in advocacy, lobbying, educating, and persuading all need to happen at the local level just as much as at the national level.

April 2024—Neonatal anemia is a common comorbidity of premature infants and may result from certain obstetric conditions or diseases, or, in the case of iatrogenic anemia, from multiple phlebotomies in the first days of life. Once infants enter the neonatal intensive care unit (NICU), they undergo a series of laboratory tests at baseline and then as needed for treatment or monitoring. These tests commonly include blood cultures, CBCs, coagulation profiles, metabolic screens, blood gases, blood glucose, and chemistry profiles. Phlebotomy-associated blood loss is more clinically relevant in lower birth-weight neonates since they have lower total circulating blood volumes. When blood is drawn from an indwelling umbilical catheter, even more blood is removed due to the need to flush residual intravenous fluid from the line.

April 2024—Fumarate hydratase-deficient renal cell carcinoma is a rare and distinct subtype of renal cancer caused by FH gene mutations. FH negativity and s-2-succinocysteine (2SC) positivity on IHC can be used to screen for FH-deficient renal cell carcinoma (RCC), but their sensitivity and specificity are imperfect. The expression of AKR1B10, an aldo-keto reductase that catalyzes cofactor-dependent oxidation-reduction reactions, in RCC is unclear. The authors compared AKR1B10, 2SC, and FH as diagnostic biomarkers for FH-deficient RCC. They included genetically confirmed FH-deficient RCCs (n=58), genetically confirmed TFE3 translocation RCCs (TFE3-tRCC; n=83), clear cell RCCs (n=188), chromophobe RCCs (n=128), and papillary RCCs (pRCC; n=97).

April 2024—Personalized medicine is revolutionizing cancer therapy, with targeted treatments customized to a person’s cancer-specific mutational profile leading to substantially improved health outcomes. Personalized medicine can also be applied to cancer prevention for high-risk groups based on genetic predisposition or lifestyle factors. However, there is a significant gap in cancer research resulting from a lack of equitable representation of racial and ethnic groups in cancer databases. Most research data are derived from white patients in the United States and Europe, creating racial disparities in understanding cancer development and therapies. The underrepresentation of patients of African, Asian, and Native American descent in observational, translational, and clinical cancer studies is particularly notable.

April 2024—Transitioning to digital pathology can seem complex and costly. And for some, but not all, laboratories, cost in particular can be a barrier to adoption. So how do you determine which camp your lab falls into? You calculate, according to Orly Ardon, PhD, director of digital pathology operations at Memorial Sloan Kettering Cancer Center.

April 2024 Q. Ordering clinicians are requesting that our laboratory flag abnormally high absolute neutrophil counts (ANC) on peritoneal fluids. We cannot find sources for reference ranges, but there is literature that states that a polymorphonuclear cell count greater than 250/μL is a reliable discriminatory test for bacterial peritonitis. We would like to use this as our reference and flag results with an ANC greater than 250 cells/μL as abnormally high. Is this acceptable? Read answer. Q. How do you code fallopian tubes submitted for sterilization with a finding of a paratubal cyst? Read answer.

April 2024—The article “Test adds twists to lung disease diagnosis” (November 2023, page 1) virtually ignores the major problem of clinicians in the hospital thinking that it is perfectly okay to take specimens from patients in the hospital and send them directly to whatever laboratory they choose without input from the hospital’s laboratory administration or medical director. The laboratory medical director is legally responsible for approving the menu of laboratory tests to be performed in-house and all of the reference laboratories to be used.

April 2024—Member organizations of the Enduring Consensus Cervical Cancer Screening and Management Guidelines effort released in March their recommendations for the use of p16/Ki-67 dual stain for managing individuals who test positive for HPV.