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February 2017

In cancer sequencing, a new lingua franca

February 2017—NGS has taken its NBS, or next big step: a newly published joint consensus guideline on how to interpret and report sequence variants in cancer. With these 20 pages of best practices for making next-generation sequencing a regular part of cancer diagnostics, the field is moving, essentially, from frontier town to gated community.

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One bug or prix fixe? Respiratory pathogen testers weigh in

February 2017—With the number of rapid, accurate molecular assays for respiratory pathogens growing, microbiology laboratories have more options than ever. They include, among others, Meridian Bioscience’s Illumigene assays for group A Streptococcus and pertussis and its newest assay, Mycoplasma Direct, as well as Alere’s assays for influenza A/B, respiratory syncytial virus, and Streptococcus on its i molecular platform. No longer are laboratories limited to inaccurate rapid antigen tests, weeks-long culture, or multi-pathogen panels.

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From the President’s Desk: The deep roots of tall trees, 2/17

February 2017—One of my mentors, Richard E. Horowitz, MD, is thoughtful, perceptive, persuasive, and calmly persistent. He is a pathologist to the core, the physician inseparable from the scientist. When he wants to know something, he asks—and there’s plenty he wants to know. He is an emeritus professor of pathology with a long string of leadership credits, so he knows where to look for answers to deep questions. And his seemingly irrepressible inclination to mentor younger pathologists nurtures pragmatic leaders who can move our specialty forward.

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AMP case report: An unusual BRAF mutation in a patient with melanoma, February 2017

February 2017—An activating BRAF mutation is found in 40 to 60 percent of melanoma patients. BRAF (B-Raf proto-oncogene) encodes a protein-kinase that activates the MAP kinase/ERK signaling pathway, a pathway that regulates cell differentiation, growth, and survival. Another protein, NRAS, normally activates BRAF. A mutated BRAF, however, can act independently of NRAS and skew cell activity toward growth and survival and away from differentiation.

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‘A marriage of virtual and real bronchoscopy’

February 2017—The molecular testing guidelines have been having a significant impact on surgical practices since they were issued, said thoracic surgeon Min Kim, MD, another webinar panelist. As practice at his institution, Houston Methodist Hospital, has evolved, Dr. Kim said, there has been an increasing need for minimally invasive ways of obtaining tissue from lung cancer patients.

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Molecular Pathology Selected Abstracts, 2/17

February 2017—Concordance between liquid biopsy and patient-matched tumor molecular testing: The use of sequence analyses of extended panels of genes to identify therapeutic targets in cancer is becoming commonplace. These assays typically rely on the availability of tissue biopsies as a source of genomic material, which can become a limitation in situations where insufficient tissue is available or an invasive procedure to collect tissue is impractical. A potential solution to this dilemma is the use of a blood-based, or liquid biopsy, approach, in which a peripheral blood sample is used as a source of tumor-derived genomic material, either in the form of cell-free DNA (cfDNA) or via circulating tumor cells (ctcDNA).

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Anatomic Pathology Abstracts, 2/17

February 2017—Findings in hysterectomy specimens of women with Lynch syndrome; Percentages and architectural types of Gleason pattern 4 cancer in radical prostatectomy; PTEN loss and chromosome 8 alterations in Gleason grade 3 prostate cancer cores; Lymph node count from neck dissection predicts mortality in head and neck cancer; Assessing the adequacy of lymph node yield for papillary thyroid cancer; Addressing perceived versus actual agreement in breast pathology interpretation; Cost-effectiveness of Oncotype DX DCIS score for guiding treatment of DCIS

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Q&A column, 2/17

February 2017—I have an oncology patient with a diagnosis of immune thrombocytopenia. The patient’s sample has been drawn in sodium citrate, EDTA K2, sodium heparin, and warm saline replacements, and a true platelet count cannot be obtained. Platelets clump in all tubes, and multiple platelet clumps are observed under the microscope. The patient doesn’t have thrombocytopenia. What else can I do?

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Newsbytes, 2/17

February 2017—In virtual informatics conference series, students teach and learn: In the television drama “The Paper Chase,” law professor Charles W. Kingsfield strikes fear and terror in the hearts of his students by “cold-calling” on them in class. Douglas Bell, MD, PhD, professor of medicine at the University of California, Los Angeles, and the program director of UCLA’s clinical informatics fellowship program, doesn’t want his own classes to be as stressful. But part of the pedagogical challenge for Dr. Bell and Bruce Levy, MD, who together run a virtual conference series for clinical informatics fellows, is finding a way to use active learning techniques, like calling on students, when the students are remote.

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