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October 2013

No worries with new cancer biomarker templates

October 2013—For anyone worried about the new CAP reporting templates for cancer biomarkers, Patrick L. Fitzgibbons, MD, has an important message: Don’t panic. “These are nothing new,” says Dr. Fitzgibbons, a pathologist at St. Jude Medical Center, Fullerton, Calif., and chair of the CAP Cancer Biomarker Reporting Committee. “We’re not adding anything. The templates will look very familiar to users of the CAP cancer protocols. They shouldn’t be considered a significant burden.”

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Put It on the Board, 10/13

November 2013—LifeTech names TriCore an NGS Center of Excellence: TriCore Reference Laboratories and Life Technologies have signed an agreement to establish TriCore as a regional Next-Generation Sequencing Center of Excellence. The partnership is part of Life’s initiative to establish a global alliance composed of centers capable of running the most advanced NGS-based oncology panels for clinical research.

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Ways to move quickly on bloodstream infection

October 2013—Since 1942, when penicillin was first used to treat infections caused by gram-positive bacteria, many improved and potent beta-lactam antimicrobials have been developed. Yet today, if a patient in an intensive care unit develops a bloodstream infection with Staphylococcus aureus, that person has a one in three chance of dying. High mortality rates apply to many other pathogens that cause bloodstream infections in ICU patients—from one in five for coagulase-negative staphylococci and Escherichia coli to almost 40 percent for Pseudomonas aeruginosa and Candida spp. Enterobacter spp and Enterococcus spp have intermediate mortality rates: one in four and one in three, respectively. Even among patients on a non-ICU ward, bloodstream infections are associated with mortality rates between 20 percent and 30 percent.

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On cuts and consequences, pathologists make their case

October 2013—James Richard, DO, directs CAP-Lab, an independent laboratory in Lansing, Mich., where he manages the business and does everything from signing off on pathology reports to paying the mortgage on the building. But among the many issues he tackles running his practice and in the midst of a shift in health care in the U.S., a single rule proposed by the Centers for Medicare and Medicaid Services is what’s keeping him awake at night.

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‘Extra’ genetic info—too much, too quickly?

October 2013—In the 1997 film “Gattaca,” the movie-going public was introduced to a world in which biology was quite literally destiny. A world in which the probabilities encoded in one’s genome dictated virtually every aspect of one’s existence and where those found genetically wanting were relegated to society’s margins. Fortunately, genomics has so far yielded nothing so nefarious nor is it ever likely to, thanks in part to the vigorous debate that accompanies advances in genetic and genomic technologies. An example of this is the debate underway, and making medical news, among physicians, ethicists, and laboratory directors over the American College of Medical Genetics and Genomics’ recommendations on the reporting of incidental findings.

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New guideline takes on tough HER2 cases

October 2013—In HER2 testing for breast cancer, the term “equivocal” verges on being a four-letter word. If the patient has a clearly positive test result, therapies targeting HER2 become a treatment option, and a highly successful one at that. If the result is clearly negative, HER2-targeting drugs are off the table; the patient isn’t expected to benefit from the drugs, which are expensive and can be cardio- toxic.

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Newsbytes, 10/13

October 2013—Microchip at core of Silicon BioDevices’ prototype product to test for troponin; FDA releases guide on wireless medical devices; Ventana and EMC partner on digital pathology endeavor; HIMSS launches Web site focused on health IT value; Pathologist group joins Xifin’s digital pathology network

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Clinical Pathology Selected Abstracts, 10/13

October 2013—Performance of assays used in the U.S. to diagnose Lyme borreliosis acquired in Europe: The most common tick-borne infection reported in the United States is Lyme disease, which can be acquired in the United States or while traveling in Europe. Evaluation of Lyme disease acquired in Europe, by doctors in the United States, is challenging because assays used in the United States use lysates of the original Borrelia burgdorferi sensu stricto isolate (B31 strain).

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Anatomic Pathology Selected Abstracts, 10/13

October 2013—Acellular mucin in rectal cancer patients showing pathologic complete response to preoperative chemoradiotherapy; Association between p16 expression and human papillomavirus in urinary bladder squamous cell carcinoma; Immunohistochemical signature comprising PTEN, MYC, and Ki-67 and disease progression in prostate cancer; Preoperative BRAF(V600E) mutation screening: likelihood of altering initial surgery for indeterminate thyroid nodules; Claudin expression in high-grade invasive ductal carcinoma of the breast; Interobserver agreement in assessing lung cancer: H&E diagnostic reproducibility for non-small cell lung carcinoma

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Molecular testing platforms a land of plenty

October 2013—If you’ve ever seen what happens when someone accidentally puts regular liquid soap in a dishwasher, you’ll have a good mental image of just how vigorously the automated molecular testing market is bubbling over with new assays. HCV genotyping, rifampin resistance, group A Streptococcus—vendors are pouring these and many other tests into a market that, by all accounts, is more than eager for them.

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Letters, 10/13

October 2013—A CAP-accredited, multi-department laboratory, with 25 well-trained employees. A full-time staff of four American Board of Pathology-certified pathologists, including one with cytopathology boards. A rigorous quality assurance program involving clinicians and pathologists. An integrated electronic medical record system. Constant communication between administrative, technical, and clinical staff.

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An uneasy dance with POC glucose in the ICU

October 2013—Too much of a good thing can be wonderful,” Mae West famously said. And some feel our culture of excess reflects that value. Perhaps as a reaction there has been a surge of interest recently in the embrace of “enough” as a worthwhile goal. But when it comes to precise measurement of glucose values in the intensive care unit, the often-warring needs for speed and accuracy make the issue a critical matter of patient care. For point-of-care glucose testing in the ICU, how much precision is “enough”?

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