Anatomic pathology selected abstracts

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McDonald TM, Epstein JI. Aberrant GATA3 staining in prostatic adenocarcinoma: a potential diagnostic pitfall. Am J Surg Pathol. 2021;45(3):341–346.

Correspondence: Dr. Jonathan I. Epstein at jepstein@jhmi.edu

Adequacy of breast carcinoma margins in radioactive seed and wire-guided localization lumpectomies

Image-guided preoperative localization helps surgeons resect nonpalpable breast cancers. The authors conducted a study to compare the adequacy of specimen margins for invasive breast cancer (IBC) and ductal carcinoma in situ (DCIS) after radioactive seed localization (RSL) versus wire-guided localization (WGL). They retrospectively reviewed 600 cases at a Canadian academic center from January 2014 to September 2017. The authors compared surgical margins, re-excisions and re-operations, localization accuracy, major complications (migration, accidental deployment, and vasovagal reaction), and operative duration between RSL and WGL cases. Invasive breast cancer margins were positive in seven percent of RSL and six percent of WGL cases (P = 0.57). Tumor size (P = 0.039) and association with DCIS (P = 0.036) predicted positive margins in invasive carcinoma. DCIS margins were positive in six percent and eight percent and close (2 mm or less) in 37 percent and 36 percent (P = 0.45) of RSL and WGL cases, respectively. Extensive intraductal component predicted positive DCIS margins (P < 0.0001). No significant differences in intraoperative re-excisions (P = 0.54), localization accuracy (P = 0.34), and operation duration (P = 0.81) were found. Re-operation for lumpectomies and mastectomies was marginally higher for WGL than RSL (P = 0.049). The authors reported 11 (four percent) WGL and no RSL complications (P = 0.03). Overall, positive margins for IBC, close or positive margins for DCIS, intraoperative re-excision, localization accuracy, and operation duration in RSL and WGL were similar. The fact that the re-operation rate was higher in WGL than RSL may reflect practice changes over time. RSL was safer than WGL and had lower complication rates.

Law W, Cao X, Wright FC, et al. Adequacy of invasive and in situ breast carcinoma margins in radioactive seed and wire-guided localization lumpectomies. Breast J. 2021;27(2):134–140.

Correspondence: Dr. Wyanne Law at wyanne.law@gmail.com

Use of timestamp data to assess voice recognition for grossing biopsies

Studies on the adoption of voice recognition in health care have primarily focused on turnaround time and error rate and less on the impact of voice recognition on provider efficiency. The authors conducted a study to assess the impact of voice recognition on the efficiency of grossing biopsy specimens. They retrieved timestamps corresponding to barcode scanning for biopsy specimen bottles and cassettes from their pathology information system database. The time elapsed between scanning a specimen bottle and the corresponding first cassette was the length of time spent on the gross processing of that specimen and was designated as the specimen time. For the first specimen of a case, the specimen time also included the time spent dictating the clinical information. Therefore, the specimen times were divided into first-specimen time and subsequent-specimen time. Univariate and multivariate analyses were used to study the impact of voice recognition on specimen times. The major determinants of specimen times were specimen complexity, prosector variability, length of clinical information text, and the number of biopsies the prosector grossed that day. The authors found that adopting voice recognition had a negligible impact on specimen times. They concluded that using voice recognition in the gross room removes the need to hire transcriptionists without negatively impacting the efficiency of the prosectors, resulting in cost savings. Using computer scripting to automatically enter clinical information (received through the electronic order interface) into report templates potentially may increase grossing efficiency in the future.

Ye JJ, Tan MR, Shum CH. Using timestamp data to assess the impact of voice recognition on the efficiency of grossing biopsies. Arch Pathol Lab Med. 2021;145(5):599–606.

Correspondence: Dr. Jay J. Ye at jye@dahlchase.com