February 2023

February 2023—Like a thriving expat, Deborah Dillon, MD, is comfortable moving within worlds both old and new. Specifically, as a breast and molecular pathologist at Brigham and Women’s Hospital, she appreciates the biomarkers she and her colleagues grew up with, so to speak, as well as those that are part of a more recently arrived-at scenery. Not everyone finds both worlds equally riveting. “A lot of people are much more interested in, and excited by, new markers,” she says. “When I talk to people from pharma, this is what they want to hear about.” So do many pathologists, oncologists, and patients—new markers and new therapies have a way of updating hopes. Dr. Dillon understands the persistent thrill of the new, why people want her to talk the language of PIK3CA, PARP inhibitors, MMR, NTRK fusions, ESR1, and the like. But as an in-demand speaker as well as in a recent interview with CAP TODAY, she also advocates for making the old—the longstanding trinity of ER, PR, and HER2—seem new again.

February 2023—Traditional algorithm? Or reverse? Elitza Theel, PhD, D(ABMM), of Mayo Clinic, in an AACC session last year walked through the two primary diagnostic algorithms for syphilis, explaining where the complexities lie and how her laboratory uncovered inappropriate testing for neurosyphilis.

February 2023—Consensus on the best ways to stem unnecessary laboratory testing, and spare health care systems and patients its negative effects, is still elusive.

February 2023—Point of care or core lab? An old question but a new conversation, this one on Jan. 12 between Stan Schofield, Brian Durkin, and CAP TODAY publisher Bob McGonnagle (asking the questions). Here’s what they said about that and health care economics, autoimmune testing, tube supplies—and, of course, the labor shortage because it affects nearly everything in health care.

February 2023—Workspace design seldom supports the tasks workers perform, and pain and productivity loss can be the outcomes. Eliminating the risks at the design stage is therefore the best approach. When that’s not possible, retrofitting to reduce or eliminate some (but not all) of the hazards is an option, though it’s difficult and can be costly, says Marissa Pentico, MS, OT/L, CPE, ergonomics coordinator in the Duke University Occupational and Environmental Safety Office.

February 2023—Sex hormones, rather than sex assigned at birth, may be a stronger driver of the observed concentration differences between healthy men and women for biomarkers of cardiac disease, say the authors of a study published in JAMA Cardiology (Greene DN, et al. JAMA Cardiol. 2022;7[11]:1170–1174).

February 2023—As this year’s guide to anatomic pathology computer systems was taking shape, CAP TODAY publisher Bob McGonnagle met online with representatives of five companies and with John Sinard, MD, PhD, of Yale University School of Medicine. They talked about the cloud, CPT codes, training of pathology informaticians, and artificial intelligence, for which the time frame in pathology is far longer than it’s been portrayed, in Dr. Sinard’s view. “It will start to impact the careers of some of our trainees, but it’s probably a 10- to 20-year time frame before it plays a major role,” he said. The view of Joe Nollar of Xifin: “Speculation that AI will someday replace pathologists is completely overblown,” though it will help to triage cases and mitigate risk. Their full conversation, which took place Dec. 20, 2022, follows.  

February 2023—I was fortunate last summer to be part of a team established to build a histology laboratory in rural Ghana. Despite our many challenges, we succeeded in building a laboratory where specimens can now be processed for pathological interpretation. Although many obstacles remain, this laboratory offers great potential to improve the pathology services provided to a large portion of rural Ghana.

  March 2023—Whether you watched Quincy, M.E., like I did as a kid, or something more recent like CSI, many of us encountered pathology for the first time through a TV show. Watching Jack Klugman’s weekly adventures as the L.A. county medical examiner, Dr. Quincy, certainly had me intrigued about the specialty of pathology. While most of us work in clinical or anatomic pathology instead of subspecializing in forensic pathology, it’s the forensics field—and how it’s portrayed in TV and movies—that gives most of the general public the only insight into pathology they get in their daily lives. When people outside the medical field hear about a pathologist, they typically picture someone performing an autopsy and trying to figure out the mystery behind a person’s demise.

February 2023—Fetal and neonatal alloimmune thrombocytopenia is the most common cause of intracranial hemorrhage in term infants with thrombocytopenia. It often presents as severe thrombocytopenia in the newborn or a spontaneous intracranial hemorrhage in a fetus in an uncomplicated pregnancy. Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by maternal antibodies against paternal platelet antigens, which cross the placenta and destroy fetal platelets. Studies have shown that FNAIT is underdiagnosed in pregnancies. However, primigravida screening for FNAIT is not performed in the United States.

February 2023—Atypical mitosis is considered a feature of malignancy, but its significance in breast cancer remains elusive. The authors conducted a study to assess the clinical value of atypical mitoses in breast cancer and explore their underlying molecular features. They quantified and correlated atypical and typical mitotic figures with clinicopathological variables in a large cohort of primary breast cancer tissue sections (n=846) using digitalized H&E whole slide images. They also used RNA sequencing data from The Cancer Genome Atlas (TCGA) breast cancer data set (n=1,032) to link atypical mitoses to the underlying genetic alterations and pathways.

February 2023—Systemic lupus erythematosus is an autoimmune disease that affects multiple organ systems and is most prevalent in women of Asian, Hispanic, and African ancestries. People with the heterogeneous disease experience major organ damage, which primarily affects the kidneys, skin, heart, and joints. Transcriptomic studies of systemic lupus erythematosus (SLE) have implicated increased type 1 interferon signaling, dysregulated lymphocyte activation, and failure of apoptotic clearance as hallmarks of the disease. Many genes are near the approximately 100 loci associated with SLE. Despite the use of flow cytometry and transcriptome profiling to characterize the role of circulating immune cells in SLE, there is not a complete census of circulating immune cells in the disease, and characterizing the genetic associations has been challenging.

February 2023—Magic, joy, wisdom, and goats. Words seldom—if ever—used together in describing a pathology-focused website. Until now.

February 2023 Q. What is the most specific serologic test for diagnosing IgG4-related disease? Read answer. Q. Our new endocrine clinic is monitoring estradiol levels in transgender male patients (female to male) and asked if our standard estradiol immunoassay is appropriate to use in this setting. What do you recommend? Read answer.

February 2023—The CAP and three other organizations told the FDA in a Jan. 6 letter they are increasingly concerned that it is not recognizing updated antimicrobial susceptibility interpretive criteria, or breakpoints, in a sufficiently timely manner.