May 2020

May 2020—Along with SARS-CoV-2, clinical laboratory testing has been hiding in plain sight far longer than many people realize. But it took the novel coronavirus (which, frankly, hardly feels novel anymore) to make that clear to the rest of the world. As the COVID-19 pandemic spread across the globe, laboratory testing crashed the news cycle. National leaders sought to reassure citizens by promising millions of test kits.

May 2020—When tick-borne infections are the topic of discussion, talk of Lyme disease, caused by Borrelia burgdorferi, has tended to predominate. But as the prevalence of tick-borne infections in the United States rises steadily and widens geographically, the number of novel pathogens carried by ticks has been climbing as well.

May 2020—To combat the spread of COVID-19, Louisiana’s governor in late March issued an order directing state residents to limit their excursions outside.

Michael Becich, MD, PhD, of the University of Pittsburgh School of Medicine, and five others spoke with CAP TODAY publisher Bob McGonnagle in March about the hype versus reality of artificial intelligence and the tension around it. Here is what they had to say.

May 2020—But as the prevalence of tick-borne infections in the United States rises steadily and widens geographically, the number of novel pathogens carried by ticks—including non-Lyme bacteria, protozoa, and viruses—has been climbing as well.

May 2020—William B. Zeiler, MD, CAP president from 1987 to 1989, died March 24 at age 99. Dr. Zeiler was CAP vice president from 1985 to 1987 and a member of the Board of Governors from 1981 to 1985. He led and was a member of several CAP councils, committees, and commissions. He was named CAP Pathologist of the Year in 1990, and winner of the Gold Headed Cane Award from the World Association of Societies of Pathology and Laboratory Medicine in 2001.

May 2020—Christine C. Ginocchio, PhD, MT(ASCP), in an April 8 CAP TODAY webinar, reported findings on the analytical efficiencies and sensitivities of four of the original and most common of the SARS-CoV-2 assays. Read more.

May 2020—Traditionally, histopathologic diagnosis has been regarded as the gold standard for most disease processes including cancer. However, in certain circumstances, a final histopathologic diagnosis cannot be rendered despite extensive conventional ancillary testing such as immunohistochemistry. In recent years, molecular testing has revealed specific variant signatures for many tumors, which can be used to determine a final diagnosis.

May 2020—Like a top 40 radio hit, test utilization is a topic that can sometimes seem to be overplayed. But the COVID-19 pandemic brings into sharp relief its importance. “What we’ve seen is organizations that have more mature test utilization efforts in place may be better able to handle these crises,” says Peter L. Perrotta, MD, professor and chair of pathology, anatomy, and laboratory medicine at West Virginia University School of Medicine and director of pathology services, West Virginia University Health System.

May 2020—According to a Centers for Disease Control and Prevention study from 2008 to 2012, there are about 16,000 cases of HPV-positive oropharyngeal squamous cell carcinoma per year in the United States. These carcinomas tend to present with small primary lesion and early nodal metastases as an initial manifestation of the disease. Furthermore, carcinoma of unknown primary presenting as a cystic metastasis in the head and neck has been linked frequently to oropharyngeal squamous cell carcinomas, mainly of palatine tonsils and base of the tongue.

May 2020—The CAP implemented proficiency testing for cervical cytology in 2006 as mandated by federal legislation. The performance of participants and granting of appeals on glass slides in the first year of the CAP Pap PT program was reported in detail by Crothers, et al. Once a participant initiates an appeal, the slide in question is pulled from the program for a blinded review by three board-certified anatomic pathologists who are members of the CAP Cytopathology Committee. In the first year, 155 participants failed the PT examination and appealed their testing results on 86 individual slides. After review, appeals were granted for 21 slides, resulting in 45 exam failure reversals. The overall appeal rate was 13/1,000 slides in the program.

May 2020—The CAP relies on the generous submission of slide-based cases from laboratories to maintain the excellent quality of its Cytopathology Educational Programs in Gynecologic Cytopathology (Pap Education), Non-Gynecologic Cytopathology (NGC), Fine Needle Aspiration Cytopathology (FNA), and Proficiency Testing Program in Gynecologic Cytopathology (Pap PT). The CAP Cytopathology Committee, composed of 26 pathologists, two junior members, and two cytotechnologist members, meets quarterly and members submit glass slides to these varied programs.

May 2020—Hazard. Harm. Risk. Benefit. Performing any activity poses risks. The laboratory deals with hazards known and understood, or unknown and unanticipated, that can lead to harm. Laboratorians attempt to minimize these risks to the point where benefit exceeds residual risk that cannot be further minimized. We understand these concepts and terms and deal with them in everything we do. For optimal patient care and for the safety of our employees, a formal approach to risk assessment is desirable to identify pertinent risks, assess those risks, determine if and when the risk has been sufficiently minimized or if mitigation measures are worth the benefit we expect to see, and document each step.

Clinical research registry aims to answer crucial COVID-19 questions May 2020—A Healthcare Worker Exposure Response and Outcomes Registry was launched April 13 to unite health care workers in the U.S. for rapid-cycle research. The goals of the so-called HERO registry are to engage workers in a research community, understand their experiences, and track outcomes associated with caring for patients with ...

May 2020—The most pressing topic in pathology today is the COVID-19 pandemic. Because this column must be written a few weeks before it is printed and delivered to readers, anything I write in April will be out of date by the time you see it. Numbers will be wrong, and comments on testing methodology will be obsolete. Instead, I’ll focus on the bigger picture. As we watch the world’s response to the pandemic, I am proud to be a physician and a pathologist. I am honored to work with phenomenal laboratory personnel, and this is by no means unique to me. Across the medical community, we have seen people come together for a shared mission in ways we have never experienced before. The demands on our laboratories are tremendous, and we are rising to the challenges of producing tests and directing therapies under conditions we have not seen before.

May 2020—Imagine the potential educational benefits of pathology residents being able to see the precise path that the eyes of experienced pathologists take as they scan a whole slide image. Preliminary research has suggested that showing residents visual representations of a pathologist’s eye-tracking movement overlaid over a whole slide image can impact how they learn, says Sharon E. Fox, MD, PhD, a pathologist at the Southeast Louisiana Veterans Healthcare System and associate director of research and development, Department of Pathology, Louisiana State University Health Sciences Center.

May 2020—Laboratory costs represent approximately three to four percent of overall health care expenses but drive 70 to 80 percent of decisions made by physicians. One way to control laboratory testing expenditures is through appropriate utilization. For example, thyroid and antinuclear antibody (ANA) testing have reliable initial screening tests, yet specialized testing is overutilized for both. In 2000 guidelines, the College of American Pathologists and American College of Rheumatology established that the ANA screen by immunofluorescence in the setting of a negative result is sufficiently sensitive not to perform further testing with subserologies and that thyroid-stimulating hormone (TSH) is a sensitive marker of thyroid function and can often be used without further testing with a normal TSH.

Q. Can you provide a current reference for the various modifications of transfused red blood cells — for example, irradiation and white cell depletion — and their indications? Read answer. Q. In the context of allowable error relative to the immature platelet fraction test, is the analytical measurement range applicable to the IPF? Read answer. Q. What is the normal random plasma glucose value? Read answer.

May 2020—Flat epithelial atypia is an alteration of terminal duct lobular units by a proliferation of ductal epithelium with low-grade atypia. No consensus exists regarding whether the diagnosis of flat epithelial atypia in core needle biopsy necessitates excision. The authors retrospectively identified all in-house core needle biopsies with flat epithelial atypia obtained at their institution between January 2012 and July 2018. They reviewed all core needle biopsy slides and assessed radiologic-pathologic concordance. An upgrade was defined as invasive carcinoma or ductal carcinoma in situ in the excision, or both. The excision slides of all upgraded cases were re-reviewed.

May 2020—Each year a growing number of novel viruses are discovered in the wild animal kingdom with the use of next-generation sequencing technology. However, the current method of functionally assessing the zoonotic potential—that is, the potential to be transmitted to humans—of novel viruses involves synthesis of viral genomes (tens of thousands of bases) and reverse genetic engineering to produce a recombinant virus. This is expensive and time-consuming, and it is not practical due to the scale of new viral strains being discovered. To overcome this hurdle, Letko, et al., developed a rapid and cost-effective method that could functionally assess a number of related viruses for zoonotic potential. The essential component of viral cross-species transmission is cell entry, which is a multi-step process involving attachment of the virus to the host cell surface, receptor engagement, processing of host proteases, and downstream membrane fusion.