July 2021

July 2021—The pandemic’s reach has often been portrayed in shades of red, signaling surging COVID-19 cases across states and countries. Vaccination maps, on the other hand, tend to render progress in more soothing tones, typically in the green family. But in coagulation laboratories, one small portent is colored blue—specifically, blue-top sodium citrate tubes. In recent months, laboratories began voicing concerns about tightening supplies. They’ve spoken with their vendors; some have reached out to new ones. And though no one wants to think about limiting testing if supplies truly become scarce, it wouldn’t be the first time labs have had to steer through these waters. The tubes are a functional symbol of the continued complexities of COVID-19-related coagulopathy, as physicians try to understand and respond to the pathophysiology of infection that leads to a thrombotic event. As the pandemic has churned on, much has started coming into sharper focus. Prepublication persists, but physicians have begun to sort through the past 18 months and, as many have put it, to “do the science.”

July 2021—From takeout margaritas to the embrace of remote work, the pandemic upended convention, leaving behind permanent changes that were nowhere on the radar in 2019. In the world of pathology informatics, the new online COVID-19 data dashboards at the Cleveland Clinic illustrate how much the pandemic has raised the profile of data analytics in managing the laboratory.

July 2021—Proficiency testing is the bedrock of good laboratory performance, but Accuracy-Based Programs are equally important, which is why members of a CAP committee are hoping for 10 labs from each peer group to participate.

July 2021—Liquid biopsy has entered a more confident era, with two FDA-approved next-generation sequencing assays for comprehensive tumor mutation profiling, evidence of its clinical utility, and broadened patient access.

July 2021—For SARS-CoV-2, there has to be a plan to sequence locally and collaborate globally, and public health must recognize that hospital-based laboratories have a part to play, says Glen Hansen, PhD, D(ABMM), medical director of microbiology and molecular diagnostics at Hennepin County Medical Center, Minneapolis.

July 2021—Revenue and growth, cybersecurity, and labor and wage pressures were on minds June 1 when Compass Group members met virtually with CAP TODAY publisher Bob McGonnagle. But perhaps no problem felt heavier than the labor shortage.

July 2021—Identifying severe disorders of primary hemostasis is relatively straightforward for most coagulation laboratories, but the more prevalent disorders with less severe bleeding and less overt diagnostic abnormalities are trickier, and platelet function testing using platelet-rich plasma remains the gold standard. Geoffrey Wool, MD, PhD, in an AACC virtual session last year, presented some of his laboratory’s cases to illustrate the use of light transmission aggregometry and a modification called lumi-aggregation.

July 2021—The advent of genomically targeted therapy and immunotherapy has greatly altered the clinical management of advanced non-small cell lung cancer (NSCLC). Molecular testing is recommended for sensitizing EGFR mutations, ALK fusions, ROS1 fusions, BRAF V600E, NTRK fusions, RET fusions, and MET exon 14 skipping alterations.

July 2021—Laboratory instrumentation from an IT perspective and as one solution to the labor shortage were the topics explored April 27 in a virtual roundtable of instrument vendors and laboratory medical directors, led by CAP TODAY publisher Bob McGonnagle. Part one of their conversation about core labs was published in the June 2021 issue; part two follows.

July 2021—CAP Publications released this month Grossing, Staging, and Reporting—An Integrated Manual of Modern Surgical Pathology, edited by Qihui “Jim” Zhai, MD, professor of laboratory medicine and pathology, consultant pathologist, and director of the FISH laboratory, Mayo Clinic Florida. The manual consists of 12 sections—from breast to thorax—and 54 chapters, organized by organ. CAP TODAY asked Dr. Zhai to tell us about the new book.

July 2021—It has been a long time since the American public has been so terribly divided by politics. So many topics seem polarizing in our country right now. As pathologists, we should not allow these forces to fragment us. I fear that if we are not careful, we could find our community pulled apart, and that would be detrimental to those we should most protect—our patients. I’ve been thinking a lot lately about the phrase, “United we stand, divided we fall.” It is well worn but still meaningful. It’s the official motto of the Commonwealth of Kentucky, where I was born. Within the CAP and each state’s pathology society—in my view, the two groups every pathologist should belong to—it is imperative that we stick to the topics that unite us to keep our organizations strong and inclusive. We are all pathologists or soon-to-be pathologists, and we are all physicians. We are united on measures that allow us to better serve our patients and protect our practices. We should not be divided by politics, and there is no room for that in the CAP or state-level pathology societies. I am not saying that we should not individually be politically active or work peacefully in other politically active groups.

July 2021—Pathologists play a key role in molecular and genomics testing, so pathologists-in-training should demonstrate an understanding of genetics concepts and the utility of molecular and genomic testing in patient care. A list of published competencies for training includes determining sample adequacy, ensuring that appropriate molecular tests are ordered, and effectively communicating genomic testing results through pathology reports and interdisciplinary teams.

July 2021—Microscopic colitis is characterized by chronic watery diarrhea, endoscopically normal findings, and abnormal histology. The disorder is most prevalent in adults. Pediatric cases are rare and may vary in presentation.

July 2021—Despite growing awareness of whole slide imaging, few pathology laboratories have implemented and validated such a digital pathology system for primary diagnosis. Among the barriers to adopting whole slide imaging (WSI) for routine clinical work is the difficulty of justifying the expense, time and effort, and change management involved in deploying this disruptive technology.

July 2021—The accurate diagnosis of malignant pleural mesothelioma is important because of its association with asbestos inhalation and because it is an aggressive tumor with poor outcome despite multimodal treatment. Unfortunately, however, diagnosing malignant pleural mesothelioma is not straightforward. Initial diagnosis often occurs on small biopsies, and the disease has morphologic overlap not only with other neoplasms that affect the lungs and pleura, such as solitary fibrous tumor or synovial sarcoma, but also with reactive conditions, such as reactive mesothelial hyperplasia or sclerosing fibrous pleuritis. While immunohistochemical markers can provide ancillary information, many of them are nonspecific and can lead to diagnostic dilemmas. Sequencing of cancer genes can help in some situations but cannot provide a definitive diagnosis.

July 2021
Q. Our lab does not have reference ranges established for body fluid manual differentials. Is it acceptable to use ranges from a reference material and include a disclaimer citing the source of the ranges? Read answer.
Q. In our lab, we perform semen analysis and make slides to send out for sperm morphology using Kruger’s strict criteria. We get quite a few results back as swollen sperm head for probable contamination. The reference lab insisted that liquefying agent was added, but when we reviewed the results, the sample was normal, so liquefying agent wasn’t used. What can cause a sperm head to swell, other than liquefying agent? Read answer.

July 2021—As the role of informatics in the practice of medicine continues to grow, so does the need to move formalized informatics education from the category of luxury to necessity, says Bruce Levy, MD, associate chief medical informatics officer at Geisinger Health System, Danville, Pa., and professor and program director of the clinical informatics fellowship at Geisinger Commonwealth School of Medicine.

July 2021—The article about eGFR (“A transparent lens on estimated GFR,” June 2021) reinforces my initial attitude about eGFR: that it is an inaccurate contrived calculation. Testing for the status of a patient’s renal function is information too crucial to be done as a shortcut even though the National Kidney Foundation claims that eGFR is the most accurate way of determining renal function.

July 2021—The FDA in May approved two new targeted therapies for non-small cell lung cancer.