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July 2003
Criteria for identifying serrated adenomas of the colon and rectum
The authors evaluated the histological characteristics ascribed
in the literature to serrated adenomas and developed a practical
working model for identifying the adenomas. They documented the
frequency and location of serrated adenomas identified in an unselected
series of individuals undergoing colonoscopic evaluation and the
clinical characteristics of those individuals. They identified 140
consecutive individuals (prospective polyp data set; 97 male, 43
female; age mean, 63.3 years; age range, 29 to 98 years) with 255
polyps from 919 individuals undergoing colonoscopy. Additional polyps
previously removed from these individuals were included for histological
assessment (extended polyp data set, n=380). All polyps were assessed
for eight selected architectural and cytological features. In the
prospective polyp data set, 56 patients had 72 hyperplastic polyps,
seven had nine serrated adenomas, three had four admixed polyps,
and 98 had 170 conventional adenomas. No difference was found in
the age, gender, or cancer association of the seven patients with
serrated adenomas when compared with the other individuals with
polyps. The prevalence of serrated adenomas was nine of 919 (one
percent), with an average size of 5.8 mm. When assessing serrated
adenomas histologically, the combination of nuclear dysplasia and
serration of 20 percent or more of crypts provided the most accurate
model for detecting these lesions (sensitivity, 100 percent; specificity,
97 percent). Other criteria provided supportive evidence but did
not increase the diagnostic yield. The optimum model for the histological
identification of serrated adenoma includes the presence of a serrated
architecture in 20 percent or more of crypts in association with
surface epithelial dysplasia.
Bariol C, Hawkins NJ, Turner JJ, et al. Histopathological
and clinical evaluation of serrated adenomas of the colon and rectum.
Mod Pathol. 2003;16(5):417-423.
Reprints: Dr. Robyn L. Ward, Dept. of Medical Oncology, St. Vincent’s
Hospital, Victoria St., Darlinghurst, 2010, Australia; r.ward@garvan.org.au.
Comparing voice-automated transcription to human transcription for generating pathology reports
Continuous speech systems were developed in 1994, with the latest
commercially available editions claiming accuracy of up to 98 percent
of speech recognition at natural speech rates. The authors evaluated
the efficacy of one commercially available voice-recognition software
system with pathology vocabulary in generating pathology reports,
and they compared this with human transcription and drew cost-analysis
conclusions regarding human versus computer-based transcription.
To reach their goal, they simultaneously generated 206 routine pathology
reports from the surgical pathology material handled at St. Joseph’s
Healthcare, Hamilton, Ontario, using computer-based transcription
and human transcription. They used a desktop 450-MHz Intel Pentium
III processor with 192 MB of RAM, speech-quality sound card (Sound
Blaster), noise-canceling headset microphone, and IBM Via-Voice
Pro version 8 with pathology vocabulary support (Voice Automated,
Huntington Beach, Calif.). The cost of the hardware and software
was approximately $2,250 (Canadian). A total of 23,458 words were
transcribed using both methods, with a mean of 114 words per report.
The mean accuracy rate was 93.6 percent (range, 87.4 to 96 percent)
using the computer software, compared with a mean accuracy rate
of 99.6 percent (range, 99.4 to 99.8 percent) for human transcription
(P<.001). Time needed to edit documents by the primary evaluator
(M.A.) using the computer was an average of twice that needed for
editing the documents produced by human transcriptionists (range,
1.4 to 3.5 times). The extra time needed to edit documents was 67
minutes per week (13 minutes per day). The authors concluded that
computer-based continuous speech-recognition systems in pathology
can be used successfully in pathology practice, even during the
handling of gross pathology specimens. However, the relatively low
accuracy rate of this voice-recognition software, with the resultant
increased editing burden on pathologists, may not encourage its
application on a wide scale in pathology departments with sufficient
human transcription services, despite the potential for significant
financial savings. Computer-based transcription represents an attractive
and relatively inexpensive alternative to human transcription in
departments where there is a shortage of transcription services
and is likely to be more commonly used in pathology departments
in the future.
Al-Aynati MM, Chorneyko KA. Comparison of voice-automated transcription and human transcription in generating pathology reports.
Arch Pathol Lab Med. 2003;127: 721-725.
Reprints: Dr. Katherine A. Chorneyko, St. Joseph’s Healthcare, 50 Charleton Ave. East, Hamilton, Ontario, L8N 3Z5, Canada; chorneyk@mcmaster.ca.
Intraparenchymal nevus cell aggregates in lymph nodes— a possible diagnostic pitfall
The authors conducted a study to draw attention to the finding of
nevus cells in the parenchyma of lymph nodes and to alert pathologists
to this as a potential diagnostic pitfall, especially in patients
with concurrent melanoma or carcinoma. It is well-documented that
nevus cells can be found within the fibrous capsule and trabeculae
of lymph nodes, but it is less well-known that nevus cells can be
found in the lymph node parenchyma. The authors reported the findings
in 13 cases of nevus cell aggregates located in the cortical or
medullary parenchyma of lymph nodes, or both. Seven of the 13 patients
had a primary diagnosis of melanoma, three had no known malignancy,
one had breast carcinoma, one had adnexal carcinoma of the skin,
and one had squamous cell carcinoma of the tonsil. Of the seven
patients with melanoma, four had axillary lymph node dissections
and three had inguinal lymph node dissections. The patient with
adnexal carcinoma had metastatic carcinoma in 14 of 20 lymph nodes
that had been dissected; one of them also had intraparenchymal nevus
cells. The patient with squamous cell carcinoma of the tonsil had
an intraparenchymal nevus cell aggregate in one of the 21 dissected
lymph nodes; all 21 were negative for carcinoma. Nests of intraparenchymal
nevus cells ranged from clusters of only a few cells to 2.1-mm aggregates.
Mitotic figures, prominent nucleoli, and lymphatic-vascular invasion
were not detected in any of the melanocytic aggregates. The melanocytic
cells of the nevus cells aggregates expressed S-100 protein or MART-1,
or both, but not gp100 protein (HMB-45). Less than one percent of
the nevus cells expressed Ki-67. Awareness that nevus cells can
be present in nodal parenchyma, analysis of their morphologic features,
including comparison with any previous or existing melanoma or carcinoma,
and immunophenotyping will help pathologists establish the correct
diagnosis in most instances.
Shah VI, Raju U, Chitale D, et al. False-negative
core needle biopsies of the breast: an analysis of clinical, radiologic,
and pathologic findings in 27 consecutive cases of missed breast
cancer. Cancer. 2003;97: 1824-1831.
Biddle DA, Evans HL, Kemp BL, et al. Intraparenchymal
nevus cell aggregates in lymph nodes: a possible diagnostic pitfall
with malignant melanoma and carcinoma. Am J Surg Pathol. 2003;27(5):673-681.
Reprints: Dr. Victor G. Prieto, Dept. of Pathology, University of Texas M.D.
Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030; vprieto@mail.mdanderson.org.
Anatomic pathology abstracts editors
Michael Cibull, MD, professor of pathology and laboratory medicine
and director of surgical pathology, University of Kentucky Medical
Center, Lexington.
Subodh Lele, MD,
assistant professor of pathology and laboratory medicine, University
of Kentucky Medical Center.
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