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May 2013

From the President’s Desk: Next-generation communication

May 2013—Eric Topol, MD, director of the Scripps Translational Science Institute, chief academic officer for Scripps Health, and editor-in-chief of Medscape, will present at the CAP ’13 Spotlight Reception in October. We (CAP CEO Charles Roussel; Nazneen Aziz, PhD, director of molecular medicine and staff lead for the CAP Next Generation Sequencing Working Group; and I) invited Dr. Topol to speak after we met with him to talk about our interest in genomic medicine and the steps we have taken—through the Transformation Program Office, CAP Learning, and the Laboratory Accreditation Program—to spearhead efforts to fully integrate cutting-edge genomics into pathology practice.

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Cytopathology and more: Interrater agreement of anal cytology

May 2013—Anal-rectal cytology has been used to evaluate HPV-related lesions of the anal canal, particularly in high-risk populations. Because anal cancer is uncommon in the general population, there is no utility in surveillance cytologic assessment on a population-wide scale (as with the Pap test for cervical disease). However, in certain populations, such as men who have sex with men (MSM) and HIV-positive men and women, the risk for anal cancer is higher and approaches the risk of cervical cancer reported in unscreened populations of women. Thus, given that anal cancer shares an HPV-related etiology with cervical cancer and involves a similar squamous mucosal site, anal cytology has been recommended as a method of screening for the prevention of anal cancer through the detection of precancerous lesions (anal intraepithelial neoplasia, AIN). Although the Bethesda terminology, criteria, and guidelines for anal cytology specimens parallel those for cervical cytology, degenerative cellular changes, extensive keratinization, and contaminating fecal material frequently make it more difficult to evaluate these specimens than to evaluate cervical specimens. Because there are limited data on the interobserver agreement of anal cytology (as compared with cervical cytology), Teresa M. Darragh, MD, et al., investigate interrater agreement of anal cytology as well as the relationship between biomarkers and anal cytologic interpretations (Cancer Cytopathol. 2013;121[2]:72–78).

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Cytopathology and more: Know where the deficiencies and dust hide

May 2013—Accreditation inspections are inevitably stressful events. Having a colleague you’ve never met walk through your lab with a checklist looking for how you’ve slipped up reminds me a bit of my mother’s first visit to my apartment when I was a newlywed. I had cleaned everything, including every nook and cranny that weren’t part of my usual routine. I even bought a new shower curtain to ensure no possible hint of mildew. I thought the place looked terrific and that my high level of preparation would surely be sufficient to meet my mom’s white glove standards. Little did I expect that she would peer down the shade of my living room lamp shortly after arriving and remark that I really should dust my light bulbs. It is hard to ever be fully prepared for a June Cleaver mom or to read the mind of a CAP inspector. Fortunately, deficiencies in cytopathology are relatively infrequent and don’t involve eliminating dust on light bulbs. Nonetheless, being aware of the top three checklist items that are most often cited as phase one and two deficiencies can be helpful in your inspection preparation and will assist you in avoiding pitfalls.

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Standard of care hits close to home

May 2013—Town versus gown: It’s a long-standing source of tension in medicine. In November 1963, JAMA published a piece on the pathology of this so-called syndrome. The disease was characterized as both chronic and acute, with the author blaming social forces, the structure of medical practice, philosophical differences in medical education, and the rise of specialization, as well as a host of secondary etiologic factors. After much hand wringing, the author called for a renewal of spirit to end this classic divide.

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Put it On the Board, 5/13

May 2013—Omnyx digital pathology OK’d for routine use in Canada, Europe; PCR platform, kit cleared for H7N9; CollabRx forms Pan Cancer molecular oncology editorial board; ‘Time for omic ancillary systems’; Thermo Fisher to acquire Life Tech; First next-generation sequencing assay for GE Healthcare; FDA clears BD Diagnostics’ C. diff assay; Foundation Medicine, Sloan-Kettering to co-develop test for hematologic cancers

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Clinical Pathology Selected Abstracts, 5/13

May 2013—Although allogeneic bone marrow transplantation can cure sickle cell disease, human leukocyte antigen-matched donors are difficult to find, and the toxicities of myeloablative conditioning prior to transplants are a major risk factor for morbidity and mortality in most adults. The authors developed for patients with sickle cell disease newer bone marrow transplant regimens using nonmyeloablative conditioning regimens and human leukocyte antigen (HLA)-haploidentical donors.

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Anatomic Pathology Selected Abstracts, 5/13

May 2013—Pseudomyxoma peritonei originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The authors conducted a study to evaluate outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an international registry study. A retrospective multi-institutional registry was established through the collaborative efforts of units affiliated with the Peritoneal Surface Oncology Group International.

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Q & A, 5/13

May 2013—We are relocating to a new laboratory on a different floor in our hospital. There is little guidance from regulatory agencies on revalidating analyzers after the move. Decisions are left to the discretion of our pathologist. What kind of precision/accuracy/ normal range/patient sample/control testing do you recommend?

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Newsbytes, 5/13

May 2013—How software sent to the ocean floor is aiding cancer cell detection; Lab interoperability white paper addresses interface issues; NovoPath launches batch sign-out module for AP software; Atlas Medical releases functionality designed to boost lab revenue; Thermo Fisher Scientific introduces tool for cloud-based communication; PathCentral forges alliances via new digital pathology network; Data Innovations marketing enhanced version of Instrument Manager

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