August 2019

August 2019—Even though he practices in Houston, James Versalovic, MD, PhD, swears he can see the coastline. As he and colleagues at Texas Children’s Hospital delve into research related to the human microbiome, several diagnostic and treatment possibilities are starting to appear tantalizingly close. Comparing their endeavors to ocean explorers of yore, he says, “We’re not quite sure exactly what is in front of us. We can see land—but we’re not quite there.” But unlike Captain Cook and company, Dr. Versalovic and others in the field have access to next-generation sequencing (though Dr. Versalovic jokes, “It’s been around long enough to be called this-generation sequencing”).

August 2019—Antibiotic treatment of sepsis patients often has to rely on clinical observation and educated guesswork as clinicians wait for a culture to determine whether the infection is bacterial, viral, or possibly fungal.

August 2019—For HIV testing, a three-step algorithm that differs from the one recommended since 2014 can potentially reduce the number of tests performed and speed up the availability of viral load results, according to a CDC analysis presented at the HIV Diagnostics Conference in March.

August 2019—In the blood bank, all platelets in bags appear to be the same, whether resting or activated, and because they look the same, they may be used as if they’re equal. But they are not.

August 2019—Having an enterprisewide health care platform can put laboratories in a stronger decision-making position for enterprisewide IT, whereas in most other circumstances, “we are relatively isolated,” said Raj C. Dash, MD, in a talk he gave at this year’s Executive War College. Dr. Dash, vice chair of pathology IT at Duke University Medical Center, shared what he called the blessings and curses of his department’s move in 2014 to a lab information system that’s fully integrated with the electronic medical record. His focus was Beaker’s AP-LIS module.

August 2019–Newly discovered pathogenic variants in BCR-ABL1-negative myeloproliferative neoplasms (i.e. polycythemia vera, essential thrombocythemia, primary myelofibrosis) led to recent revisions of the World Health Organization diagnostic criteria. Initially JAK2 V617F, MPL (MPL W515K/L), and calreticulin (CALR) exon 9 gene pathogenic variants were deemed mutually exclusive in patients with essential thrombocythemia and primary myelofibrosis. However, coexisting somatic variants in both JAK2 V617F and CALR have been reported with variable frequency, ranging from less than one percent and up to 6.8 percent depending on the employed molecular technique.

August 2019—A practical guide that can help labs standardize the handling of a patient’s surgical specimen from harvest to diagnosis is available but too little known, and one of its authors aims to change its hidden treasure status. The 52-page “Practical Guide to Specimen Hand-ling in Surgical Pathology” is on the CAP/NSH Histotechnology Committee page on the CAP website. “Our main objective was to standardize specimen collection handling. Nothing had ever been done like it before,” says Elizabeth Sheppard, MBA, HT(ASCP), past president of the National Society for Histotechnology and head of global market access at Roche Tissue Diagnostics, Tucson, Ariz. She and M. Elizabeth H. Hammond, MD, first chair of the CAP Center Guideline Committee, submitted the topic for an evidence-based guideline; however, it was determined to be better suited as a practical guide for labs to be developed by the CAP/NSH Histotechnology Committee.

August 2019—The CAP has a long-standing commitment to education in cytopathology, with a number of organized educational offerings in gynecologic and nongynecologic cytopathology. The Interlaboratory Comparison Program in nongynecologic cytopathology (NGC Education) was started in 1997 and the Interlaboratory Comparison Program in fine-needle aspiration glass slide education (FNAG) in 2010. These programs are strictly educational and not graded or used for proficiency testing. Semiannual (FNAG) and quarterly (NGC) mailings include four or five cases. For each case, glass slides generally stained with a Diff-Quik and/or Pap stain are provided.

August 2019—The BD Onclarity HPV assay is a human papillomavirus test approved by the Food and Drug Administration on Feb. 12, 2018. The assay is a qualitative test for detection of HPV in cervical specimens collected either with a broom or endocervical brush/spatula combination and placed in a BD SurePath liquid-based cytology vial. The assay is not approved for use with ThinPrep collection media (PreservCyt).

August 2019—Cytology practice is shifting from fewer gynecologic screening tests to a greater focus on diagnostic testing in nongynecologic cytology including fine-needle aspiration. Roles of cytotechnologists have been changing in the workplace to help laboratories meet new demands and act as pathologist extenders.

A heads-up on hybrid lab models of genetic testing
August 2019—Little attention has been paid to the emergence and effect of hybrid laboratories—those that fall in the middle ground between the direct-to-consumer and traditional models, say the authors of an opinion piece published in the June 25 issue of JAMA. Kathryn Phillips, PhD, Julia Trosman, PhD, and Michael Douglas, MS, of the Center for Translational and Policy Research on Personalized Medicine, University of California, San Francisco, say the emergence of the hybrid model, in which a clinician orders the test and returns results, “has significant implications for everyone involved in genetic testing,” providing potential benefits and risks.Greater access and convenience and lower cost for the consumer are among the potential benefits they list. Among the concerns: reduced continuity of care, profit motivation, and insufficiently extensive guidance and counseling. But there are other challenges with hybrid laboratories, they say.

Q. I have heard that in the United States there is a shortage of tuberculin skin test antigen used for detecting Mycobacterium tuberculosis infection. Is there an alternative that can be used? Read answer. Q. What is the value of doing incubated mixing studies on prolonged prothrombin times? Read answer.

Editor: Deborah Sesok-Pizzini, MD, MBA, professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and chief, Division of Transfusion Medicine, Children’s Hospital of Philadelphia. Financial impact of approaches to reduce bacterial contamination of platelet transfusions August 2019—The leading infection risk from blood transfusion is bacterial contamination, which is most likely due to the ...

Evaluation of pan-TRK IHC in infantile fibrosarcoma, lipofibromatosis-like neural tumor, and histological mimics.
August 2019—Infantile fibrosarcoma is characterized by intersecting fascicles of spindle cells and ETV6-NTRK3 gene fusion in most cases. Given histological overlap with other spindle-cell tumors, the diagnosis can be challenging and often requires molecular confirmation. A recently developed pan-TRK antibody shows promise for identifying tumors with NTRK fusions.

August 2019—From concept to curriculum: PIER going strong five years later: In the five years since its launch, Pathology Informatics Essentials for Residents, or PIER, has continued to serve as a much-needed guide for pathology residents and program directors who otherwise would be navigating the waters of informatics training without a compass.

August 2019—I am always interested in learning what is new in CAP laboratory improvement. My first inspection was some 40 years ago and our work in that realm has grown faster and gone further than I could have imagined back then.The CAP accredited its first laboratory in 1964 and published the first checklist several years later. I’m told that when Dennis B. Dorsey, MD (a then-future CAP president), submitted the first draft at 10 pages, his fellow LAP commissioners asked that he try to make it shorter.

Editors: Donna E. Hansel, MD, PhD, chair of pathology, Oregon Health and Science University, Portland; Richard D. Press, MD, PhD, professor and director of molecular pathology, OHSU; James Solomon, MD, PhD, assistant professor, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York; Sounak Gupta, MBBS, PhD, senior associate consultant, Mayo Clinic, Rochester, Minn.; Tauangtham Anekpuritanang, MD, molecular pathology ...