April 2019

April 2019—For years, laboratories have chafed against testing being, literally and figuratively, an out-of-sight, out-of-mind transaction. Now a new, highly visible era in genetics may be pushing testing the other way, into the hands of consumers who value entertainment as well as medical information. Anyone who wants to write a book about this shift has a ready-made title: From Basement to Big Top. It’s not that clinical testing is becoming an actual circus. But ever since the first consumer genetic tests entered the market in 2007—in a nonphysician-ordered, SNP array technology way—labs, physicians, and regulatory agencies have had plenty to juggle.

April 2019—When pathologist Sandra Ewaskow, MD, was asked at a recent medical conference what topic she would choose if she were to write a book in her field, she thought of her own experience with musculoskeletal pain and of her mother, who had recently been hospitalized for occupational therapy after a hip fracture.

April 2019—Genotypic testing for ciprofloxacin susceptibility in Neisseria gonorrhoeae has been proved to be effective in guiding physician treatment in a single-center study at UCLA Health.

April 2019—The tight supply of technologists to fill open positions is pushing laboratories to be creative in finding answers. Memorial Sloan Kettering Cancer Center and TriCore Reference Laboratories found their answers by looking not just outward but also—and largely—inward.

April 2019—With the release in January of a new guideline for quantitative image analysis of HER2 immunohistochemistry for breast cancer, the CAP believes it is filling a gap and blazing a trail for the profession. In setting evidence-based standards, the guideline provides background and details about the quantitative image analysis (QIA) process and the data and metadata it generates. The guideline will help facilitate pathology’s increasing use of not only digital pathology but also artificial intelligence, says Marilyn Bui, MD, PhD, chair of the CAP expert panel for QIA of HER2 IHC. “This is not just another guideline. It is a milestone for pathologists.”

April 2019—Harold E. Bowman, MD, a member of the CAP Board of Governors from 1979 to 1985, died on Feb. 1 at age 93. Dr. Bowman retired in 1994 as director of laboratories at St. Lawrence Hospital, now Sparrow Hospital, in Lansing, Mich., and as associate chair, Department of Pathology, Michigan State University College of Human Medicine.

April 2019—Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) in which promyelocytes predominate. APL accounts for about 10 percent of AML cases, and although APL can be diagnosed at any age, it is most common among young adults with a slight male predominance. APL is defined by the balanced reciprocal translocation (15;17)(q22;q21) between PML and RARA, although variant translocations involving RARA and other partner genes can occur.

April 2019—Diagnoses of essential thrombocythemia and chronic myelomonocytic leukemia were among those covered in four cases in a CAP18 session on practical challenges in peripheral blood evaluation.

Shield launches test 
for antibiotic susceptibility 
in N. gonorrhoeae April 2019—Shield Diagnostics launched Target-NG, a rapid molecular test for antibiotic susceptibility in Neisseria gonorrhoeae. “Rapid molecular testing for ciprofloxacin resistance allows for smarter medicine,” Jeffrey D. Klausner, MD, MPH, a professor of infectious disease medicine at the University of California, Los Angeles, said in a Shield statement. “Right now we’re treating gonorrhea with a sledgehammer; we’re treating everything with the same exact regimen. And it’s not a surprise that the organism will become resistant to what we’re currently using.” Ciprofloxacin can be used to treat 80 percent of infections and is 99.8 percent effective when susceptibility has been determined. Because it is administered as a single oral dose, rather than the current injectable treatment, clinicians can prescribe antibiotics for the patient to give to their partners. “Shield has launched Target-NG to help clinicians adopt a precision medicine approach to gonorrhea treatment,” said Nidhi Gupta, PhD, lead scientist on the project.

Q. Can you describe the contemporary significance and use of osmolality testing in the clinical laboratory? Read answer. Q. Is it necessary to include a comment on the patient report indicating that a test result was obtained after dilution? Read answer.

April 2019—The R&B classic “Time Is on My Side” may be an anthem for rejected lovers, but a new virtual reality teaching tool that allows students to “visit” the pathology lab without leaving the classroom may soon have NYU medical students humming the song’s refrain.

April 2019—As Dr. Seuss famously wrote, “It is fun to have fun, but you have to know how.” CAP Council on Education chair Jennifer Hunt, MD, MEd, agrees. Learning styles evolve as we mature, she says; grownups are not just tall children. We know what we want to do and are drawn to knowledge we can use. Most pathologists are born educators; we can’t help ourselves. We like to think about how we learn. I think that’s why the CAP Learning team does such an outstanding job—they know what to ask, how to listen, and when to act. Participant evaluations are scrutinized and what we learn from them is applied quickly.

April 2019—Trauma resuscitation considerations: gender as a biological variable: Sex dimorphisms in coagulation are well established, with females manifesting a more hypercoagulable profile, but the relationship between sex dimorphism in coagulation and trauma outcomes has not been investigated. Trauma-induced hemorrhage remains a leading cause of early post-injury death.

April 2019—Frequent GNAQ and GNA14 mutations in hepatic small vessel neoplasm: April 2019—Hepatic small vessel neoplasm is a recently described infiltrative vascular neoplasm of the liver composed of small vessels. Although its infiltrative nature can mimic angiosarcoma, hepatic small vessel neoplasms (HSVNs) are thought to be benign or low-grade neoplasms because they lack cytologic atypia and increased proliferation.

April 2019—Variants in NUDT15: association with thiopurine–induced myelosuppression: The thiopurines mercaptopurine, thioguanine, and azathioprine are purine antimetabolites widely used as anticancer and immunosuppressive agents. Commonly prescribed in patients with inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, they are valuable steroid-sparing treatment options.