January 2022

January 2022—“Workflow” evokes a process that moves smoothly, like water, that doesn’t break down or grind to a halt, a sequence of steps that can be completed in a seamless manner. Genomic workflows in information systems, however, have an especially poor fit with the concept of “flow.” As genomic data migrate from the laboratory to an electronic health record or from one EHR to another, significant gaps can result between generation, interoperability, and utilization that may lead the data to miscommunicate or mislead. “The technology behind next-generation sequencing and genetic testing in general has advanced by leaps and bounds over the last 10 to 15 years,” says Alexis Carter, MD, physician informaticist, pathology and laboratory medicine, Children’s Healthcare of Atlanta. While the use of genomic testing has expanded rapidly, “information systems and electronic health records have really not been able to keep up.”

January 2022—Laboratories don’t have to monitor direct oral anticoagulants, but they might want to measure DOAC drug levels in some situations in some patients, said Karen A. Moser, MD, in a CAP21 session.

January 2022—“Still a pressure cooker and hotter now” and “grim.” Two comments that describe where some states were on Dec. 7 when Compass Group members met for their monthly call on COVID-19 and more—and this was before omicron spread in the United States.

January 2022—The United States and the rest of the world can expect to see an uptick in active tuberculosis cases brought about by impaired access to care and delays in diagnosis and treatment during the pandemic, says Wendy Thanassi, MD, MA.

January 2022—It’s not curriculum. It’s visibility. That’s the upshot of two companion studies on what influences U.S. medical students to choose pathology as a specialty, say Cindy B. McCloskey, MD, chair of the CAP’s Graduate Medical Education Committee, and Melissa R. George, DO, a member of the committee. Their study of allopathic medical students was published in 2020, and their latest study, of osteopathic medical students, has been submitted for publication.

January 2022—A 33-year-old male with progressive hoarseness and shortness of breath was given a purported diagnosis of laryngeal papillomatosis and referred to our institution in November 2020 for a higher level of care. On presentation, the patient reported no recent upper respiratory infection-like systemic symptoms but had cough, nasal congestion, throat discomfort, dysphonia, and worsening dyspnea.

January 2022—A consistent virtue of the cytopathology laboratory is that it combines two qualities essential to patient care: It provides an accurate and timely diagnosis. The ability to make a prompt diagnosis is particularly important in immunosuppressed or otherwise vulnerable patient populations for whom a timely diagnosis can result in early treatment initiation and potentially better outcomes.

January 2022—Cytopathologists are often the first pathologists to diagnose HPV-related head and neck squamous cell carcinomas (HNSCC). These head and neck cancers can present as superficial masses amenable to fine-needle aspiration, where p16 immunostaining is used as a surrogate marker for HPV in situ hybridization in a subset of squamous cell carcinomas.

January 2022—The CAP has a robust Laboratory Accreditation Program with a commitment to continually improving the programs and providing appropriate resources needed for compliance. As a deemed status organization, validation surveys are performed annually through the Centers for Medicare and Medicaid Services and the feedback obtained provides direction for education.

January 2022—A diverse and copious inventory of Pap and nongynecologic glass slides is the backbone of the CAP glass slide educational programs. Each year tens of thousands of cytopathology slides are packaged and mailed to laboratories enrolled in CAP educational glass slide programs throughout the world. Prior to mailing, numerous cytotechnologists and cytopathologists screen these slides and companion web enhancement images to ensure quality and diagnostic accuracy.

The CAP for the next generation January 2022—Happy New Year! Most of us start each year with resolutions, fresh budgets, or perhaps yearlong plans. This is often the time we think about the future and the choices we need to make now to achieve those long-term goals. In that spirit, I’ve been thinking about how important it is for the CAP to continually engage with and mentor the newest members of our pathology community. Residents and early-career pathologists bring vibrant energy to our ranks, and many of them will eventually contribute to the leadership of the CAP. While we always value the experience and wisdom of our more seasoned fellows, it is essential that we also make space to train up-and-coming leaders.

January 2022—Cancer rates have decreased consistently during the last several years, but not all populations have experienced similar rates of decline.

January 2022—Ki67, a nuclear proliferation-related protein, is used extensively in anatomic pathology but has not become a companion diagnostic or a standard-of-care biomarker because of analytic variability in assay protocols and interpretation.

January 2022—With modern HIV testing incorporating p24 antigen detection, fourth- and fifth-generation HIV screening tests have halved the time between acquiring and detecting the infection.

January 2022—Irritable bowel syndrome is the most common gastrointestinal disorder, affecting 10 to 15 percent of the world population, yet its etiology is unknown. Patients experience a spectrum of gastrointestinal symptoms, including diarrhea, constipation, abdominal cramping, and pain.

January 2022 Q. When reporting reference ranges for absolute differential counts, should the ranges be age specific or is a single reference range acceptable? Read answer. Q. Is it acceptable to use polystyrene tubes for aliquotting plasma for coagulation tests, such as platelet aggregation, and factor-related studies requiring serial dilutions of plasma? I recall seeing recommendations for using nonpolystyrene tubes for frozen plasma aliquots but did not see a reason for the recommendation. Read answer.

One pathologist’s foray into 3D printing
January 2022—The use of three-dimensional printing in the pathology lab may still be in its infancy, but pathologist Danielle Lameirinhas Vieira Maracaja, MD, and her anesthesiologist husband have been affirming its value to pathologists, and the medical community in general, for years. Dr. Danielle Maracaja, a pathologist at Atrium Health Wake Forest Baptist, Winston-Salem, NC, and assistant professor of pathology at Wake Forest School of Medicine, has been working alongside her husband, Luiz Maracaja, MD, associate professor of anesthesiology at the same hospital and medical school, in designing and producing medical tools using 3D-printing technology for more than five years. They took on one of their largest projects in early 2020, when Dr. Danielle Maracaja was a pathology fellow at Yale University School of Medicine and COVID-19 cases were spiking.

January 2022—The Food and Drug Administration granted 510(k) clearance for SeptiCyte Rapid, which runs on Biocartis’ molecular diagnostics Idylla platform. It’s a fully automated, rapid host-response test that distinguishes sepsis from infection-negative systemic inflammation in patients suspected of sepsis.