February 2022

February 2022—Like growing old gracefully, moving to high-sensitivity cardiac troponin is both easier and more complex than it often appears. Stacy Beal, MD, thought clinical colleagues might be intimidated by switching assays. Dr. Beal was fully prepared to field worries about increased admissions, more consults, and other disaster scenarios. Instead, what surprised Dr. Beal, a member of the CAP Quality Practices Committee, was the ease with which some thought change could occur. “We heard people saying, ‘Just move the decimal point over two spots,’” she recalls. “I think we started hearing that from the day we started talking about it.” Could simply moving the decimal work? As Dr. Beal notes, “It’s hard to argue with that method, but we truly tried to tell them not to—that they needed to interpret this in a totally different way, and to view the different units as a new assay that’s very different from our previous assay.” “Maybe it’s our own fault,” Dr. Beal concedes. When the lab presented its correlation data, the new units were presented on one axis, while the old ones appeared on another.

February 2022—It was Isaac Asimov who surmised: “The most exciting phrase to hear in science is not ‘Eureka!’ but ‘That’s funny . . .’” And it was coagulation processing in the clinical laboratory that, in a small way, illustrated Asimov’s axiom for Dorothy Adcock, MD, former chief medical officer, Labcorp Diagnostics.

February 2022—In a survey of the international pathology community on the integration of artificial intelligence into diagnostic pathology practice, 80 percent of the 487 respondents predicted integration within the next five or 10 years.

February 2022—How to classify gastric intestinal metaplasia, when to classify it, and the implications of a GIM diagnosis were the focus of a CAP21 presentation in a session on advances in gastric neoplasms. The big question, said presenter Namrata Setia, MD, is, “Why are we suddenly talking about classifying intestinal metaplasia in the stomach?

February 2022—New year, new variant. For Compass Group lab leaders on a call with CAP TODAY publisher Bob McGonnagle on Jan. 4, omicron was new but the struggles were similar. They spoke of staffing and supplies but also of the CDC’s day-five guidance, crisis planning, instrument downtimes and hard-to-get parts, and doing such things as limiting routine phlebotomy draw times for COVID-positive inpatients.

February 2022—Up first in a CAP21 molecular oncology tumor board session was an unusual case of head and neck cancer, one that raises questions about what salivary duct carcinoma is and the role of next-generation sequencing. Justin Bishop, MD, the Jane B. and Edwin P. Jenevein, MD, distinguished chair in pathology and professor and chief of anatomic pathology, UT Southwestern, along with Saad Khan, MD, assistant professor of medicine (oncology) at Stanford, teamed up to present the case, along with a second case that will be reported in the March issue. (Dr. Khan practiced at one time at UT Southwestern, so this wasn’t their first tumor board together.)

February 2022—Myeloproliferative neoplasms (MPNs) are a group of clonal hematopoietic stem cell disorders characterized by increased proliferation of myeloid cells of one or more lineage. The most common MPNs include chronic myeloid leukemia (CML), polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). CML is defined by the BCR-ABL1 fusion, which typically results from the t(9;22)(q34;q11.2) rearrangement.

February 2022—Oracle’s purchase of Cerner, cloud computing, and integrated reporting were up for discussion when CAP TODAY publisher Bob McGonnagle convened a virtual roundtable Jan. 6 on anatomic pathology computer systems. Hematopathologist Monica E. de Baca, MD, said on the call she was encouraged by what she heard about integrated reporting from the AP LIS vendor reps on the call. But she said: “We should also be thinking about what is next; we don’t want to be talking about things 10 years after they were needed.” She and seven others answered McGonnagle’s questions, among them: Are the resources in pathology adequate to make progress toward and enable the necessary IT outcomes?

The time for courage
February 2022—We pathologists tend to share traits common among physicians: We are often type A overachievers, driven by perfectionism, our own unrealistic expectations, and a deep fear of failure. Normally, these characteristics help us to achieve our goals, in life and in caring for patients. But these are not normal times. In the COVID-19 pandemic, it is almost impossible to feel like we’re doing a good job. Like so many of you, I am working significantly long­er hours than usual. At the end of each day I am often left with a sense of despondency that there’s not enough time to get everything done, or to do it all as well as I would like.To get through this crisis, we have to let go of our perfectionism and embrace doing what we can. We need to accept that if we’re doing what we can, it’s enough. Even if our individual efforts seem inadequate in dealing with this pandemic nightmare, the collective effort is adequate. Each day in my hospital I feel like I’m taking a bath in COVID-19. But I go home, rest up, and do it again the next day.

• Association of preanalytical error with use of outdoor courier lockboxes in summer • Enhancing diversity, equity, and inclusion in pathology training programs

• Use of subtyping to predict behavior of papillary thyroid microcarcinomas • Gastrointestinal pathology in samples from COVID-19–positive patients • Assessment of an artificial intelligence system for prostate cancer detection • Expression patterns for Bcl-2, EMA, β-catenin, E-cadherin, PAX8, and MIB-1 in thymomas • Analysis of intraoperative frozen section biopsy of uterine smooth muscle tumors

• Use of a 21-gene assay to inform chemotherapy benefit in node-positive breast cancer • Benefits of gene therapy to treat beta-thalassemia

February 2022 Q. Are there established benchmarks for such transfusion services quality monitors as C:T ratio, blood product waste, and cancellation of suboptimal specimens? Read answer. Q. If we collect only enough blood to inoculate one blood culture bottle, should we inoculate the aerobic or anaerobic bottle? Read answer.

February 2022—Ask TRUU-Lab founder Ila Singh, MD, PhD, what’s in a name and she will provide an answer that differs greatly from that of Shakespeare’s Juliet Capulet. According to Dr. Singh, the answer can be too much information, not enough information, or ambiguous terminology—when referring to lab test names, that is.

February 2022—Siemens Healthineers’ Enhanced Liver Fibrosis test is available in the United States, exclusively through collaboration with Labcorp and Quest Diagnostics. This commercial availability in the U.S. follows de novo marketing authorization from the FDA in August 2021.

February 2022—The CDC published on Nov. 5, 2021 a report indicating that immunocompromised persons receiving SARS-CoV-2 mRNA vaccines should receive three doses and a booster (MMWR Morb Mortal Wkly Rep. 2021;70[44]:1553–1559). The following n-of-1 observational study suggests that an immunocompromised nonresponder to mRNA vaccine may indeed respond to a second series of SARS-CoV-2 mRNA vaccine.