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July 2017

Volume, value, technology steering 2017 instrument buys

July 2017—For at least some laboratories, economic conditions and capital flows are calling for a cautious approach to purchasing new laboratory instruments. As one analyst of the clinical laboratory services industry was heard to say recently: “Because of tight capital, nobody is buying anything unless it breaks.” But laboratory executives and medical directors at some of the nation’s largest health systems in the Northeast, West, and Midwest take a different view.

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Hepatic neoplasms—cases, challenges, cautions

July 2017—Kisha Mitchell Richards, MBBS, once took a picture of the ocean as she went around a bend in the road traveling from Negril to Montego Bay in Jamaica. She showed that photo in the second half of a CAP16 session to prepare the audience to shift gears, as she put it, from the first speaker’s talk on medical liver disease (see “Liver injury patterns: pitfalls and pointers,” March 2017) to hers on hepatic neoplasms. “So for me, we are about to go around a bend to things of sheer beauty,” she said, referring to immunohistochemistry stains in the neoplastic liver. “Unfortunately, that which is beautiful to the pathologist is not often great for the patient. That’s our usual practice,” said Dr. Richards, a pathologist at Greenwich Hospital, Yale New Haven Health, Greenwich, Conn.

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Hepatocellular adenoma subtypes—Which is it?

July 2017—Kisha Mitchell Richards, MBBS, a pathologist at Greenwich Hospital, Yale New Haven Health, Greenwich, Conn., recalls that when she was a resident, adenoma was just adenoma. “Nowadays it’s not quite where breast is, where it’s a two-page report, but there are now subtypes of hepatocellular adenomas,” she said in a CAP16 presentation on liver neoplasms. The subtypes are the HNF1 alpha or TCF1 inactivated adenoma, inflammatory adenoma, beta-catenin mutated adenoma, and the unclassified adenoma, which she notes is basically adenoma NOS (not otherwise specified).

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Integrative consults remove referral inefficiencies

July 2017—Inappropriate referrals to rheumatologists and months-long wait times led pathologists to start a service at Harris Health in Houston of consultative-algorithmic workups for rheumatologic disease. “Everyone liked it. Rheumatologists were happy to get patients they could treat and who were already worked up,” Robert L. Hunter, MD, PhD, says of the service that gave primary care providers the option of selecting algorithmic testing with pathologist consultation rather than order individual tests when signs and symptoms suggested rheumatologic disease.

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New pathology patient consult program takes off

July 2017—Ten weeks in, 10 patients seen. The pathology patient consult program at Lowell General Hospital is already giving a boost to pathology’s visibility and patients a better understanding of their disease. Lija Joseph, MD, chief of pathology and medical director of pathology and laboratory medicine at Lowell General Hospital in Lowell, Mass., says a colleague’s presentation about social media and medicine led her to launch the patient pathology consult program in March.

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15th phlebotomy edition holds ‘latest, greatest’

July 2017—After overseeing 10 editions of So You’re Going to Collect a Blood Specimen: An Introduction to Phlebotomy, Frederick L. Kiechle, MD, PhD, can authoritatively say that the 15th edition is the best. Released in March, this edition provides new information on ultrasound-guided peripheral intravenous cannulation, comprehensive instructions on proper hand hygiene, and a deeper dive into quality assurance.

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Clinical Pathology Abstracts, 7/17

July 2017—Effects of early tranexamic acid administration on women with postpartum hemorrhage: The leading cause of maternal death is postpartum hemorrhage, which is defined as blood loss of more than 500 mL within 24 hours of giving birth. The majority of such deaths occur in low-income and middle-income countries.

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Anatomic Pathology Abstracts, 7/17

July 2017—Potential quality indicators for lymph node staging of colon cancer: Evaluation of 12 or more lymph nodes is used as a quality indicator for adequacy of pathologic examination of colon cancer resections. The authors conducted a study to evaluate the utility of a focused lymph node search in the immediate vicinity of the tumor and a “second-look” protocol for improving lymph node staging in colon cancer.

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Molecular Pathology Abstracts, 7/17

July 2017—Immune checkpoint inhibition therapy, such as blockage of PD-1/PD-L1 interaction, has proven effective in many types of cancers. The mechanism underlying this therapy is postulated to involve “disinhibition” of tumor-infiltrating lymphocytes that respond to neoantigens expressed by tumor cells. In theory, the larger the number of neoantigens expressed, the greater the immune response resulting from disinhibition.

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Newsbytes, 7/17

July 2017—Machine learning: What will it do for pathology? If finance, online retail, and other industries are “embracing” machine learning, then the medical field is still in the polite handshake phase, despite the potential of this form of artificial intelligence to revolutionize health care. Recent research endeavors highlight just a few examples of what machine learning, which allows computers to analyze data, detect patterns, and build algorithms to guide decision-making, can contribute to the field of pathology alone.

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Q&A column, 7/17

July 2017—A laboratory is considering the implementation of a laboratory test for the diagnosis of Zika virus infection. This test is currently labeled as a test under the issuance of an Emergency Use Authorization. What specific regulations regarding the use of this test, quality control, and proficiency testing apply when performing this test on patient specimens?

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Put It on the Board, 7/17

July 2017—Putting pathology at the center of precision medicine: Michael H. Roehrl, MD, PhD, pathologist and director of the Precision Pathology Biobanking Center at Memorial Sloan Kettering Cancer Center, would like to see more joint development of companion diagnostics—pathologists and industry working together. It would lead, in his view, to better companion diagnostics.

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