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THIS MONTH’S ISSUE

Making it personal: transgender medicine

August 2017—Talk about personalized medicine. While the national discussion about transgender women and men often pivots on civil rights legislation (exhibit A: so-called bathroom bills), the medical community has quietly begun to ask questions about how to provide care for transgender patients. In the process, assumptions are being turned sideways. And as laboratory professionals are realizing, the impact can affect everything from start (patient identification, test ordering) to finish (test results, billing), seemingly one patient at a time.

A slimmer molecular micro section among changes to checklists

August 2017—There was no trip to the spa. But some sections of the 2017 edition of the CAP Laboratory Accreditation Program checklist are looking trimmed and toned compared with last year’s checklists. A microbiology section that is shorter by eight pages, fewer Individualized Quality Control Plan reporting requirements, and a new section addressing chain of custody once again reflect the hard work of the Checklists Committee and scientific resource committees to achieve conciseness and clarity.

In digital age, new focus on specimen, slide prep

August 2017—The age of FDA-approved whole slide imaging for primary diagnosis has dawned with opportunity for every level of professional who works in the digital pathology environment. It includes not only an expanded professional cachet but also great potential born of collaborative and remote capabilities, and perhaps better patient outcomes as a result.

From the President’s Desk: Staying close to our knitting, 8/17

August 2017—Nearly two years ago, I mentioned that I wanted to start a conversation about how we as pathologists and the CAP as our professional society must evolve in order to meet our emerging needs as individuals and as a specialty. Now, as my time in the perch is coming to a close, I’d like to explore what we have come to realize—and sometimes reinforced—about building and maintaining a complex infrastructure that reflects and serves our core purposes.

Ownership remix as hospitals, national labs jockey for position

August 2017—In the game of Risk, dominating the board hinges not only on clever strategy but also on rolls of the dice. In the real-world game that is the enormous laboratory market, there is a parallel: Rationally calculating the profitability and risk of mergers or acquisitions is crucial, but many such business moves involve a gamble. Right now, the main thing the laboratory industry appears to be betting on is upheaval.

NGS panel aids in diagnosis of rare collision tumor

August 2017—CAP TODAY and the Association for Molecular Pathology have teamed up to bring molecular case reports to CAP TODAY readers. AMP members write the reports using clinical cases from their own practices that show molecular testing’s important role in diagnosis, prognosis, and treatment. The following report comes from Columbia University Medical Center. If you would like to submit a case report, please send an email to the AMP at amp@amp.org. For more information about the AMP and all previously published case reports, visit www.amp.org.

Laboratory director duties clarified in 2017 checklist

August 2017—Quantum theory is often interpreted to mean an object can be in two places simultaneously. Unfortunately, quantum theory doesn’t apply to laboratory directors, at least not on a scheduling level. Like the rest of us, directors can be in only one place at a time, no matter how many laboratories they oversee. Now a change to the CAP Laboratory Accreditation Program’s checklists will clarify expectations for directors who are in charge of more than one laboratory. The 2017 edition of the checklists, released this month, has eliminated the specific requirements for laboratory directors who are not on site full time and has clarified responsibilities for all directors, on site or remote.

Cytopathology in focus: CELL BLOCKS—Getting the most from the least invasive method

August 2017—Adequate and high-quality cell block preparations can be a useful adjunct to cytologic smear preparations and touch imprint cytology. Adequate cell blocks allow for additional studies and can provide a specific diagnosis and information essential for targeted treatment plans. Cell blocks can be prepared from most cytology specimens such as fine needle aspirations, body cavity fluids, washings, brushings, and gynecologic and nongynecologic liquid-based specimens.

Cytopathology in focus: Closing cytopathology, cytotechnology practice gaps —three years later

August 2017—The CAP has focused during the past 10 years on facilitating the transformation of pathology practices from the instrumentation age to the information age, with a concentration on personalized medical care and laboratorians as integral members of the health care team. Hand-in-hand with that effort, the CAP Cytopathology Committee has advocated for the expanded use of cytology specimens in molecular diagnostics and the evolution of the cytotechnology workforce to meet the emerging practice gaps as pathologists become engaged in ever more complex diagnostic processes.

Molecular Pathology Abstracts, 8/17

August 2017—Mismatch repair-deficient tumors and immune checkpoint inhibitors: Immune checkpoint inhibitors have yielded highly effective therapeutic responses in a subset of tumors by eliciting an endogenous adaptive immune response. The determinants that define this subset of tumors are still unclear, but several markers, including PD-L1 expression and mutational burden, have been evaluated in various tumor types.

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