Anatomic Pathology Selected Abstracts, 1/15

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Editors: Michael Cibull, MD, professor emeritus, University of Kentucky College of Medicine, Lexington; Rouzan Karabakhtsian, MD, attending pathologist, Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Thomas Cibull, MD, dermatopathologist, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill.; and Rachel Stewart, DO, resident physician, Department of Pathology and Laboratory Medicine, University of Kentucky.

Are amended surgical pathology reports reaching the correct care provider?

Amended reports need to follow patients to treating physicians to avoid erroneous management based on an original diagnosis. The authors undertook a study to determine if amended reports followed patients appropriately. They tracked amended reports with diagnostic changes and discrepancies between ordering and treating physicians. Chart reviews, electronic medical report reviews, and interviews were conducted to establish that the correct physician received the amended report. The authors found that seven of 60 amended reports, all with malignant diagnoses, had discrepancies between the ordering and treating physicians. The amended report was present in the treating physician’s chart in only one case. Ordering physicians indicated that amended reports were not forwarded to treating physicians when corrected results arrived after patient referral, under the assumption that the new physician was automatically forwarded pathology updates. No harm was documented in any of the study cases. In one case with a significant amendment, the correct information was entered in the patient chart based on a tumor board discussion. A review of two electronic health record systems uncovered significant shortcomings in each delivery system. The authors concluded that amended reports fail to follow the patient’s chain of referrals to the correct care provider, and EHR systems lack the functionality to address this failure and alert clinical teams of amendments.

Parkash V, Domfeh A, Cohen P, et al. Are amended surgical pathology reports getting to the correct responsible care provider? Am J Clin Pathol. 2014;142:58–63.

Correspondence: Dr. Vanita Parkash, Bridgeport Hospital, Department of Pathology, 267 Grant St., Bridgeport, CT 06610

Evaluation of histological staging systems for primary biliary cirrhosis

A new Japanese histological staging system for primary biliary cirrhosis has been proposed. The authors undertook an evaluation of the efficacies of the Scheuer, Ludwig, and Japanese staging systems, emphasizing their clinical and biochemical correlations and prognostic significance. They conducted a retrospective review of a cohort of 58 Chinese subjects with primary biliary cirrhosis, with follow-up of up to 16.9 years. All three systems correlated well with prognostically significant parameters, namely serum bilirubin, Mayo scores, and model for end-stage liver disease score. Only the Japanese staging system was associated with Child–Pugh score, which was the single independent prognostic factor for liver-related events (log-rank, P<0.001; Cox proportional hazard ratio [HR], 6.723; P<0.001). The Japanese system (log-rank, P=0.007; Cox proportional HR, 10.400; P=0.025) predicted liver-related events, while the Scheuer (log-rank, P=0.112) and Ludwig (log-rank, P=0.147) systems did not. The copper-associated protein deposition score, a component of the Japanese system, was the most powerful prognostic histological parameter (log-rank, P<0.001; Cox proportional HR, 99.534; P=0.049) and provided extra prognostic values in addition to serum albumin, serum bilirubin, Child–Pugh score, Mayo scores, and MELD score. The authors concluded that the Japanese staging system is more effective than classical systems. The degree of copper-associated protein deposition is an essential prognostic histological parameter.

Chan AW, Chan RC, Wong GL, et al. Evaluation of histological staging systems for primary biliary cirrhosis: correlation with clinical and biochemical factors and significance of pathological parameters in prognostication. Histopathology. 2014;65:174–186.

Correspondence: K. F. To at kfto@cuhk.edu.hk