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September 2018

Molecular ‘bucket list’ for renal cancer

September 2018—Leo Tolstoy is not listed as a coauthor on the most recent iteration of The Cancer Genome Atlas on renal cell carcinoma, which focuses on molecular characterization of RCC. But the topic is as rich and complex as a Russian novel, and the authors’ approach is so comprehensive, it’s tempting to picture them at least holding forth at a certain soirée in Saint Petersburg (minus the after-party drunkenness and the bit with a bear, of course). The project may not be as sprawling as War and Peace, which marches 559 characters, speaking two languages, over four volumes, 15 parts, and 333 chapters. It’s a heroic effort nonetheless. There is much to keep track of in renal cell carcinoma, both generally and in this latest document, which evaluates 843 RCCs from three major histologic subtypes, including 488 clear cell RCC, 274 papillary RCC, and 81 chromophobe RCC.

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From the President’s Desk: Policies to protect and preserve

September 2018—CAP leadership presents a gamut of responsibilities, including the enforcement of policies adopted to protect members and staff. What I am about to discuss is relevant to all organizations and work settings. As you read on, I hope you will reflect on how tolerance for inappropriate behavior could have an impact on your own workplace and what steps you can take to protect yourself, your colleagues, and by extension your patients.

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‘We wanted to be the best we could possibly be’: CAP ISO 15189-accredited labs on the difference it makes

September 2018—Ten years ago, Richard J. Zarbo, MD, was feeling pretty proud of his laboratory. As system chairman of pathology and laboratory medicine at Detroit-based Henry Ford Health System, over the previous few years he’d seen his team rigorously implement Lean practices, practices that had paid off in greater safety and efficiency. “Setting the bar higher was important because that’s the culture here,” he says. “This is what we do.”

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Next step? The switch from stool culture to PCR

September 2018—The advantages of moving from stool culture to a molecular platform are many: faster time to results, more accurate pathogen identification, a savings of space and staff time. For Jose Alexander, MD, D(ABMM), SM, MB(ASCP), and colleagues at Florida Hospital Orlando, another plus is being able to adhere to the Infectious Diseases Society of America guideline suggestion that labs use a diagnostic approach that can distinguish O157 from non-O157 E. coli and Shiga toxin 1 from Shiga toxin 2 E. coli.

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Put It on the Board

Broad-based molecular testing for NSCLC September 2018—A recently published study on broad-based genomic sequencing and survival among patients with advanced non-small cell lung cancer in the community oncology setting should not lead to the conclusion that such sequencing should be avoided in nonsquamous NSCLC, say Paul A. Bunn Jr., MD, and Dara L. Aisner, MD, PhD, of the University of Colorado Denver, Aurora. Dr. Bunn, of the Department of Medical Oncology, and Dr. Aisner, of the Department of Pathology, in an editorial published Aug. 7 in JAMA, caution readers about the study published in the same issue, which found that broad-based sequencing (more than 30 cancer genes) directly informed treatment in a minority of patients and was not independently associated with better survival. The study of 5,688 patients with advanced NSCLC was based on data acquired through abstraction and aggregation of information from the electronic medical record from 191 U.S. community oncology practices.

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