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In Every Issue

Newsbytes

June 2018—Electronic device shows promise for identifying pathology specimens: While barcodes and radio-frequency identification are considered the workhorses of pathology specimen identification, a new technology, nearly two decades in the making, may soon get a piece of the action.

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Put It on the Board

June 2018—FDA clears T2Bacteria panel for detecting sepsis-causing pathogens: T2 Biosystems received market clearance from the Food and Drug Administration for the T2Bacteria panel for the direct detection of bacterial species in human whole blood specimens from patients with suspected bloodstream infections.

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Letters

June 2018—LCIS variants and DCIS: We write in response to the article by Karen Lusky regarding tips to distinguish DCIS from variant forms of LCIS (April 2018). A different question might be: Is it actually important to distinguish these two in situ proliferations?

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From the President's Desk: What we learn from member surveys

May 2018—As a professional society, we want to know what our members need so we can provide services and programs to help them excel. We know that pathology practices are diverse because they have to be—science is never static. We also know that practice settings vary widely. In short, CAP members’ interests and concerns are uncommonly diverse because our field is uncommonly diverse.

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Clinical Pathology Abstracts, 5/18

May 2018—Use of a smartphone app to assess neonatal jaundice: Neonates are screened for hyperbilirubinemia before hospital discharge using a transcutaneous or total serum bilirubin measurement. However, levels peak at approximately 96 hours of life, which is after most healthy infants have left the hospital. Outpatient follow-up is often performed by visual inspection, but this can be highly variable and have poor interobserver agreement.

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Anatomic Pathology Abstracts, 5/18

May 2018—Outcomes related to use of hygroscopic sonographically detectable clips: The use of hygroscopic sonographically detectable clips (HSDCs) has dramatically increased in recent years, especially for breast cancer patients who undergo neoadjuvant chemotherapy. The authors conducted a study to define the appearance of HSDC sites in histopathological specimens and allow pathologists to recognize these sites and differentiate them from other lesions.

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Molecular Pathology Abstracts, 5/18

May 2018—DNA methylation-based testing to classify central nervous system tumors: Despite being the mainstay of pathology tissue diagnostics, microscope-based histological review has limitations. Among them is that pathologists may have differing opinions about a case. This interobserver variability may result in over- or undertreatment of the patient and lack of agreement about which diagnosis is correct.

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Newsbytes, 5/18

May 2018—Vendor neutral archives: A fit for the pathology lab? Whether the initialism VNA will become as recognizable as the acronym PACS in the pathology field remains to be seen, but pathologists and vendors alike are considering how vendor neutral archives may benefit the pathology lab.

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Put It on the Board, 5/18

May 2018—FDA approves osimertinib for NSCLC, nivolumab + ipilimumab for RCC: The FDA on April 18 approved osimertinib (Tagrisso, AstraZeneca) for the first-line treatment of patients with metastatic non-small cell lung cancer whose tumors have EGFR exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test.

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Q&A column

April 2018—A semen analysis for viability was collected at 9:30 AM and not received in the laboratory until 1:40 PM. Our standard operating procedure says this test must be analyzed one hour after collection, with no disclaimers stated for late receivables. Therefore, it is my understanding that a specimen received five hours after collection would be considered unacceptable because the viability of the semen is compromised and the collection delivery does not follow our SOP.

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Molecular Pathology Abstracts

April 2018—Effect of inherited TP53 mutations on children with B-cell ALL: TP53 has been referred to as the “guardian of the genome” because it plays a central role in regulation of the cell cycle, DNA repair, and apoptosis, and because somatic mutations in TP53 are frequently identified in many tumor types.

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Newsbytes, 4/18

April 2018—Data-extraction system demonstrates potential for pathology laboratories: Just as parents instill in their children a desire to improve themselves, in part through interactions with others, some software developers are “teaching” their tools to interact and adjust accordingly.

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Put It on the Board, 4/18

April 2018—CMS changes proposed policy on NGS for cancer patients: The CAP and the Association for Molecular Pathology, in separate statements in March, lauded the Centers for Medicare and Medicaid Services for revising its national coverage determination on next-generation sequencing.

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Letters, 4/18

April 2018—Let us bring back breast FNAB: The article “Standardized reporting for breast FNAB cytology” (January 2018) is a welcome account of some of the challenges associated with breast fine needle aspiration biopsy compared with core needle biopsy. The author expertly outlines the significance of a standardized approach to performance, interpretation, and reporting of the breast FNAB procedure. The article was a pleasant surprise because the topic of breast FNAB has not been the subject of much interest in our pathology community during the past several years.

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Anatomic Pathology Abstracts, 3/18

March 2018—Magee equation 3 for predicting response to chemotherapy in some breast tumors: Magee equations were derived as an inexpensive, rapid alternative to the Oncotype DX commercial assay. Magee equation 3 uses immunohistochemical and FISH data for estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 for its calculation: 24.30812+ERIHC×​(–.02177)+PRIHC×(−0.02884)+(0 for HER2 negative, 1.46495 for equivocal, 12.75525 for HER2 positive)+Ki-67×0.18649.

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Molecular Pathology Abstracts, 3/18

March 2018—Nonendoscopic detection of Barrett’s esophagus using DNA methylation biomarkers: Esophageal adenocarcinoma is an aggressive disease, with a less than 20 percent five-year survival rate, and its incidence is rapidly increasing. Early detection of esophageal adenocarcinoma or its precursor lesion, Barrett’s esophagus, would enable more effective treatment strategies and a greater chance of cure.

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Newsbytes, 3/18

March 2018—How hospitals use savvy and software as a phishing net: We all know we shouldn’t click on suspicious emails, but suppose you see an email from your department of human resources with an attached document about a new dress code. You open it, thinking “What new dress code?” And now you’ve infected the hospital’s computer system with a virus.

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Q&A column, 3/18

March 2018—Our pathology group has an unusual case of residual squamous cell carcinoma of the lung in a lobectomy specimen after chemotherapy. The lung shows a hilar scar (1.7 cm) involving the lung parenchyma and the peribronchial adipose tissue. In the scar there is residual carcinoma (0.4 cm) that focally is involving the peribronchiolar adipose tissue around the lobar bronchus. The focus is located at 0.3 cm of the final surgical resection margin of the bronchus. Because the tumor involves peribronchiolar adipose tissue, is it considered outside the lung (extension outside the lung)? Since the tumor is in the mediastinal fat around the bronchi and had to invade the viscera pleura to invade the peribronchial adipose tissue, would the tumor stage be ypT2a? Or T3 since it is invading part of the mediastinal fat? Or should it be pT1?

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Put It on the Board, 3/18

March 2018—AMP issues recommendations for clinical CYP2C19 genotyping allele selection: To promote standardized testing across laboratories, the Association for Molecular Pathology published on Feb. 27 consensus, evidence-based recommendations for designing and validating clinical CYP2C19 assays.

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Clinical Pathology Abstracts, 2/18

February 2018—Restrictive or liberal approach to red blood cell transfusion for cardiac surgery: Among the largest group of recipients of red blood cell transfusions are patients undergoing cardiac surgery. Whether a restrictive approach to intraoperative and postoperative transfusion in cardiac surgery is superior to a more liberal approach with regard to patient outcomes is unclear.

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Anatomic Pathology Abstracts, 2/18

February 2018—ARTEMIS trial: quantifying pathological response to neoadjuvant chemotherapy: The Affordability and Real-World Antiplatelet Treatment Effectiveness after Myocardial Infarction Study, also known as the ARTEMIS trial, tested standard neoadjuvant chemotherapy with or without bevacizumab in the treatment of HER2-negative early breast cancer.

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Molecular Pathology Abstracts, 2/18

February 2018—Gene expression and risk of leukemic transformation in myelodysplasia: The myelodysplastic syndromes represent a group of clonal hematopoietic disorders with varying prognoses, with survival ranging from a few months to more than 10 years. Multiple laboratory measurements have been used in attempts to provide reliable prognostic assessments, including bone marrow blast counts, severity of peripheral cytopenia, cytogenetic findings, and, most recently, gene-mutation profiling.

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Newsbytes, 2/18

February 2018—The many facets of a laboratory IT budget: Creating an information technology budget for the laboratory may seem like a fairly straightforward, if painstaking, exercise. But a number of factors that can affect the laboratory’s bottom line are frequently overlooked during the budgeting process, according to two health care consultants who spoke with cap today.

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Q&A column, 2/18

February 2018—I come from a core (hematology/chemistry) background, and I would like practical, how-to guidance in developing an effective QC strategy for HIV viral load testing. What performance characteristics do you verify? How many and what type of samples do you use? What are the chosen acceptable thresholds? Do you use L-J charts? If so, what do you plot, what control rules do you select, and how do you select them?

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Anatomic Pathology Abstracts, 1/18

January 2018—Analysis of desmoplastic pattern at the tumor front in colorectal cancer subtypes: Although recent findings of cancer biology research indicate that prognostic power arises from genes expressed by stromal cells rather than epithelial cells, desmoplastic reaction has not been completely examined as a prognostic marker for colorectal cancer. The authors conducted a pathologic review of 821 stage II and III patients who underwent R0 resection for colorectal cancer at four independent institutions.

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Clinical Pathology Abstracts, 1/18

January 2018—Drone transport of chemistry and hematology samples over long distances: Interest in using unmanned aerial vehicles, or drones, to transport laboratory specimens is based on the need to move specimens from satellite facilities to a central hub for testing. Earlier studies of biological specimens transported by drones were performed in ambient or cold temperatures for a maximum flight length of 40 minutes.

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Molecular Pathology Abstracts, 1/18

January 2018—Importance of interstitial genes that exist between gene fusion partners in prostate cancer: Prostate cancer is one of the most common cancers affecting men, yet understanding of the disease’s development and progression is limited. One of the most effective ways to stratify treatment and outcomes is based on pathology review of prostate biopsies, though the application of molecular testing to these samples is increasing.

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Newsbytes, 1/18

January 2018—Why pathologists shouldn’t ‘pass the baton’ with IT: It may be tempting to stay in your comfort zone and leave the technology decisions to the information technology experts. But pathologists who abdicate oversight of IT projects within their departments are setting up those projects for failure, says John H. Sinard, MD, PhD, professor of pathology and medical director of pathology informatics at Yale University School of Medicine.

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Q&A column, 1/18

January 2018—We are in the process of validating the Stago STA Compact Max and Stago STA R Max with cap piercing. The company is stating that the open and closed modes follow the same testing pathway and therefore validation between modes is not necessary. Is this correct? Is PHI (phosphohexose isomerase), also known as GPI (glucose phosphate isomerase), mainly responsible for metastasis and circulating tumor cells?

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Put It on the Board, 1/18

January 2018—Some safety issues more gray than black and white: Most laboratory safety rules are free from ambiguity. Anyone who handles specimens must wear personal protective equipment, for example. Some issues are less clearly defined, though, and require a deeper dive into the guidelines. That is where Dan Scungio, MT (ASCP), SLS, CQA(ASQ), comes in.

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From the President’s Desk: Family matters, 12/17

December 2017—Most of us look forward to the holidays. We are excited about renewing old connections or making new ones, getting together with family and friends, having special meals, attending comforting services, gathering together to exchange gifts or just talk. We look forward to the comforts of predictability. The corny Dad jokes that must be retold. Family stories, those true and nearly true, are relived together and, for the younger members of the family, may be heard for the first time. Familiar, treasured television shows are seen for the umpteenth time. Beautiful lights, shows, pageants, and parades dazzle all, young and old.

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Anatomic Pathology Abstracts, 12/17

December 2017—Gene mutations in HPV-negative penile squamous cell carcinoma: The majority of penile squamous cell carcinomas are caused by transforming human papillomavirus infection. The etiology of HPV-negative cancers is unclear, but TP53 mutations have been implicated. Archival tissue from 108 invasive squamous cell carcinomas from a single pathology institution in a low-incidence area were analyzed for HPV-DNA and p16INK4A overexpression and for TP53 mutations by Ion Torrent next-generation sequencing.

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Clinical Pathology Abstracts, 12/17

December 2017—Chimeric antigen receptor T-cell therapy assessment and management of toxicities: In August, the FDA approved the gene therapy Kymriah (tisagenlecleucel) for pediatric and young adult patients with a form of acute lymphoblastic leukemia. Chimeric antigen receptor (CAR) T-cell therapy is a breakthrough in the treatment of leukemia and lymphoma, but it is associated with unique acute toxicities, such as cytokine-release syndrome and CAR-T-cell-related encephalopathy syndrome.

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Molecular Pathology Abstracts, 12/17

December 2017—Refining subgroups of pediatric gliomas using molecular markers: Pediatric high-grade and diffuse intrinsic pontine gliomas are a rare and heterogeneous group of tumors that show diverse histology, location, and prognosis. Although little was known regarding the development of these tumors, recent genomic studies have begun to elucidate their biological underpinnings. The authors conducted a study to further understanding of such gliomas by breaking them into subgroups.

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Newsbytes, 12/17

December 2017—Hospital cyberattack a brief setback with lasting gain: A cyberattack that paralyzed the computer systems at a rural West Virginia hospital last summer could have brought the laboratory’s work to a screeching halt. But that didn’t happen, thanks, in part, to the downtime procedures in place throughout the laboratory and the low-tech nature of the lab’s pathology operations.

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Put It on the Board, 12/17

December 2017—FDA announces IMPACT authorization and path for authorization of other tumor profiling tests: The FDA on Nov. 15 authorized Memorial Sloan Kettering Cancer Center’s IMPACT (Integrated Mutation Profiling of Actionable Cancer Targets) tumor profiling test. The IMPACT test uses next-generation sequencing to identify the presence of mutations in 468 unique genes, as well as other molecular changes in the genomic makeup of a tumor.

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From the President’s Desk: CAP17—No match for being there, 11/17

November 2017—My sister Jean had a Chatty Cathy doll; you pulled a cord in the back of her neck and she would say one of a handful of things (“Would you like some tea?”). Chatty Cathy was Jean’s favorite for a while, supplanting her much-loved Raggedy Ann. The coup lasted just long enough to make it plain that the new kid on the block didn’t have much to say for herself. She was kind of stiff and controlling, really. Raggedy Ann was a much better listener. Making up stories with her was a lot more fun.

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Clinical Pathology Abstracts, 11/17

November 2017—Performance of virological testing for early infant diagnosis: a systematic review: The World Health Organization recommends that HIV-exposed infants receive virological testing for HIV infection between four and six weeks of age and treatment with antiretroviral (ARV) therapy as soon as the diagnosis is made. Despite efforts to expand mother-to-child transmission prevention programs, only an estimated 50 percent of HIV-exposed infants are tested within the first two months of life.

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Newsbytes, 11/17

November 2017—Software-validation products: finding a glitch before it’s a hitch: The idiom “time is of the essence” isn’t lost on Lisa Adams, senior information technology systems analyst at Banner Health and a believer in the need for speed when identifying software glitches and errors.

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Q&A column, 11/17

November 2017—A laboratory owns chemistry analyzers from company X. Company X recommends that its customers use company X’s calibration material to perform their linearity studies, starting with the highest concentration and using the chemistry analyzer’s autodilution feature to provide a total of four measurable concentrations and a final zero point. Does this protocol fulfill CAP checklist requirements?

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Put It on the Board, 11/17

November 2017—Study finds biotin interference; FDA clears Flu A/B/RSV assay on Hologic’s Panther Fusion; FDA clears Abbott’s Alinity ci-series; Sysmex introduces CyFlow Antibodies for flow cytometry; Test approved for screening Zika in blood donations; New insights into female reproductive tract development

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Letters, 11/17

Biotin pharmacokinetic study results: In Anne Paxton’s September 2016 article, “Beauty fad’s ugly downside: test interference,” I stated a commitment from Roche to reduce possible interferences, including biotin, and provide clear test labeling to ensure that physicians and laboratories can mitigate risk.

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Clinical Pathology Abstracts, 10/17

October 2017—Association between age at natural menopause and risk of type 2 diabetes: Menopause in women marks the loss of ovarian follicle development and the timing of the final menstrual period. The timing of menopause differs significantly among women and is seen as a marker of aging and cardiovascular health. Studies have shown a link between early onset of menopause and an increased risk of cardiovascular disease (CVD) and overall mortality, whereas menopause at age 50 to 54 years is linked to a decrease in CVD risk and mortality.

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Anatomic Pathology Abstracts, 10/17

October 2017—Lymph node yield is an independent predictor of survival in rectal cancer: Lymph node yield is used as a marker of adequate oncological resection. The American Joint Committee on Cancer recommends at least 12 nodes to confirm node-negative disease for rectal cancer. However, it is not always possible to achieve a lymph node yield of 12, particularly in patients who have undergone neoadjuvant treatment.

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Molecular Pathology Abstracts, 10/17

Editors: Donna E. Hansel, MD, PhD, chief, Division of Anatomic Pathology, and professor, Department of Pathology, University of California, San Diego; John A. Thorson, MD, PhD, associate professor of pathology, director of the Clinical Genomics Laboratory, Center for Advanced Laboratory Medicine, UCSD; Sarah S. Murray, PhD, associate professor, Department of Pathology, and director of genomic technologies, Center for Advanced Laboratory ...

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Q&A column, 10/17

October 2017—Our doctors request strep group A culture on throat specimens that are negative for rapid strep group A. On culture workup, if we have beta-hemolytic strep, we perform latex grouping only for group A strep; we report negative for GAS if latex is negative and positive if latex is positive. I think we should confirm all GAS with pyrrolidonyl arylamidase (PYR), and group and report other non-GAS. What do you think?

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Newsbytes, 10/17

October 2017—Clinical analytics: from benefits attained to software available: While LIS and laboratory billing software vendors tout the power of their business analytics tools to boost the laboratory’s bottom line, a newer application of information technology—clinical analytics—is elevating the role of the laboratory in personalized medicine.

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Put It on the Board, 10/17

October 2017—Houston labs learn: know the back roads: The disaster plan of the laboratories at Memorial Hermann Health System in Houston held up well in Hurricane Harvey, thanks to lessons learned in years past, but the labs have something new to add: Know in advance the back-road access routes to the various hospitals.

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Letters, 10/17

CAP TODAY provides valuable information that is important to guide the practice for many pathologists. However, an article published in the August 2017 issue, “Laboratory director duties clarified in 2017 checklist” by Anne Ford, has raised serious concerns among many pathologists, particularly members of the Chinese American Pathologists Association (CAPA).

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From the President’s Desk: Entrustable professional activities, 9/17

September 2017—Academic Pathology recently published the results of a two-year project by the CAP Graduate Medical Education Committee to build a framework for teaching specific entrustable professional activities (EPAs) in pathology. Their scheme structures a competency-based approach to training mapped to the ACGME Milestones for pathology resident evaluation. Competency-based curricula are well suited to impart the breadth and depth of necessary fundamental knowledge to future pathologists.

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Clinical Pathology Abstracts, 9/17

September 2017—Hemoccult testing before therapeutic anticoagulation in venous thromboembolism: Gastrointestinal bleeding is a major adverse event associated with therapeutic anticoagulation. Surveys of physicians have shown that concern for this event is one of the most common reasons to withhold anticoagulation in patients who have atrial fibrillation, acute coronary syndromes, or venous thromboembolism (VTE).

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Anatomic Pathology Abstracts, 9/17

Editors: Michael Cibull, MD, professor emeritus, University of Kentucky College of Medicine, Lexington; Rouzan Karabakhtsian, MD, PhD, associate professor of pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Thomas Cibull, MD, dermatopathologist, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill.; and Rachel Stewart, DO, resident physician, Department of Pathology and Laboratory Medicine, University of Kentucky. Detection of HPV ...

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Molecular Pathology Abstracts, 9/17

September 2017—Ability of cell-free circulating tumor DNA to reflect genomic changes in cancer deposits: Analysis of cell-free circulating tumor DNA is an emerging precision medicine technology that may be used to assess molecular alterations in cancer-derived DNA present in the blood, as well as to monitor cancer genomic changes over time and assess genomic changes and resistance following cancer therapy.

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Letters, 9/17

September 2017—I write this after reading “Total joints in view: to tilt at or to toss” (July 2017). I just completed my 42nd year as a general pathologist in an acute care community hospital that had 100 beds in 1971 and now has close to 500. From about 1980 (before we went to “separate billing”) through 2014, I fought relentlessly to have and keep the policy that all tissue get a pathology exam. These exams are needed:

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Q&A column, 9/17

September 2017— I received a sample with very high hemoglobin grossly. When I ran the sample on the Cell-Dyn Ruby, it was unable to calculate the parameters related to Hgb. I diluted the EDTA blood and ran the test again. In this scenario, should I multiply all the indices and Hgb-related parameters with the dilution factor? Which parameters should I multiply with the dilution factor?

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Newsbytes, 9/17

September 2017—Why so few women in pathology informatics? Alexis Carter, MD, did not realize she was a rare bird when, as a resident more than a decade ago, she acted on her penchant for health informatics. Dr. Carter had become interested in the field while working under a clinical chemist who developed computer programs that notified him when instruments weren’t performing as expected or when a lab result required further investigation.

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Put It on the Board, 9/17

September 2017—Eliminating CK-MB testing in suspected ACS: Health care leaders and clinicians should design and implement hospital-wide educational campaigns and partner with information technology and/or laboratory medicine staff at their institutions to remove CK-MB from standardized acute coronary syndrome routine order sets, say authors of a blueprint that could be a “first step to finally putting the CK-MB laboratory test to rest.”

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From the President’s Desk: Staying close to our knitting, 8/17

August 2017—Nearly two years ago, I mentioned that I wanted to start a conversation about how we as pathologists and the CAP as our professional society must evolve in order to meet our emerging needs as individuals and as a specialty. Now, as my time in the perch is coming to a close, I’d like to explore what we have come to realize—and sometimes reinforced—about building and maintaining a complex infrastructure that reflects and serves our core purposes.

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Molecular Pathology Abstracts, 8/17

August 2017—Mismatch repair-deficient tumors and immune checkpoint inhibitors: Immune checkpoint inhibitors have yielded highly effective therapeutic responses in a subset of tumors by eliciting an endogenous adaptive immune response. The determinants that define this subset of tumors are still unclear, but several markers, including PD-L1 expression and mutational burden, have been evaluated in various tumor types.

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Anatomic Pathology Abstracts, 8/17

August 2017—Analysis of microglandular adenosis and acinic cell carcinoma of the breast: Acinic cell carcinoma is an indolent form of invasive breast cancer, whereas microglandular adenosis has been shown to be a neoplastic proliferation. Both entities display a triple-negative phenotype and may give rise to, as well as display, somatic genomic alterations typical of high-grade triple-negative breast cancers. The authors compared previously published data on eight carcinoma-associated microglandular adenoses and eight acinic cell carcinomas subjected to massively parallel sequencing targeting all exons of 236 genes recurrently mutated in breast cancer or DNA repair related, or both.

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Clinical Pathology Abstracts, 8/17

August 2017—Etiology and clinical presentation of birth defects: a population-based study: Birth defects are inborn errors of development and include any structural or functional anomaly that impacts physical, intellectual, or social well-being. They are a considerable and growing clinical and public health challenge. Major birth defects are common and costly. Collectively, they are estimated to occur in one in 33 births, which translates into approximately 7.9 million babies affected worldwide. In the United States alone, the cost of care during a single year (2004) was estimated to be $2.6 billion.

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Q&A column, 8/17

August 2017—Due to an ever-changing workforce, many new and inexperienced technologists are working in the microbiology lab and appear to be having difficulty interpreting cultures and troubleshooting when an organism in question may not be significant. As an example, a scant growth of Micrococcus was isolated and reported from a cerebrospinal fluid culture; it was not seen in the Gram stain and was negative for leukocytes. Contaminants had been noted on some of the media plates at this time as well, but many of these inexperienced technologists do not have the confidence to ignore obvious contaminants or suggest the possibility of contamination. Is there some guidance or troubleshooting tools for these situations?

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Newsbytes, 8/17

August 2017—Health record security at root of personal grid architecture: Imagine the risks credit reporting agencies would face if they did not maintain databases of consumer transactions but instead requested information from various creditors and assembled credit reports from that information in real time. Yet that’s how health information exchanges typically work. And that, says William Yasnoff, MD, PhD, a consultant, physician, and computer scientist, is not a safe or effective approach.

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Put It on the Board, 8/17

August 2017—AML drug approved with companion diagnostic: The Food and Drug Administration approved Idhifa (enasidenib) for the treatment of adult patients with relapsed or refractory acute myeloid leukemia who have a specific genetic mutation. The drug is approved for use with the RealTime IDH2 Assay, which is used to detect specific mutations in the IDH2 gene in patients with AML.

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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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Anatomic Pathology Abstracts, 6/17

June 2017—Fallopian tube involvement in uterine serous carcinomas: The authors investigated the frequency and histopathologic and immunohistochemical characteristics of tubal involvement in uterine serous carcinoma to clarify the relationship between serous tubal intraepithelial carcinoma (STIC) and uterine serous carcinoma. They prospectively collected and reviewed, for the presence of tubal involvement, cases of the latter with complete tubal examination.

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Clinical Pathology Abstracts, 6/17

June 2017—Stem cell divisions, somatic mutations, cancer etiology, and cancer prevention: Cancers are caused by mutations that may be inherited or induced by environmental factors or that may result from DNA replication errors. The mutations due to random mistakes made during normal DNA replication may explain why cancers occur much more commonly in some tissues than others. Approximately three mutations occur every time a normal human stem cell divides.

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Molecular Pathology Abstracts, 6/17

June 2017—Whole genome single-cell copy number profiling on FFPE tissue samples Single-cell genomic methods take the concept of analyzing intratumor genetic heterogeneity to its logical conclusion. Traditionally, however, single-cell methods can only be used to analyze fresh or rapidly frozen tissue because formalin fixation and paraffin embedding degrades tumor DNA and cross-links proteins.

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Q&A column, 6/17

June 2017—Our analyzer reported nucleated red blood cells of six, with no cellular interference flag. The technologist missed that the automated NRBC was six. When he performed the manual differential, he noted more than five NRBCs and performed a corrected count and certified it. Is it acceptable to report out the automated white blood cell value as well as the corrected WBC?

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Newsbytes, 6/17

June 2017—Making the most of classroom technologies to train residents: Google the phrase “millennials killed” and you’ll discover a genre of Internet clickbait claiming the generation in question has rejected a lengthy assortment of previously popular items, from “the suit” to “napkins” to the “hangout sitcom.”

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Put It on the Board, 6/17

June 2016—CMS grants Qualified Clinical Data Registry status to Pathologists Quality Registry: The Centers for Medicare and Medicaid Services has approved the CAP’s Pathologists Quality Registry as a Qualified Clinical Data Registry, or QCDR. This makes it a reporting option for pathologists in fulfilling reporting requirements under Medicare’s Quality Payment Program.

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From the President’s Desk: Soup’s ready, ketchup plopped, 5/17

May 2017—When we were growing up, my sisters would often ask, “Is it soup yet?” mimicking a popular TV commercial. The catch phrase caught on with the kids as a way to express eagerness for anything, lunch related or not. Another commercial popular back then showed an inverted ketchup bottle slowly yielding its contents to the force of gravity while Carly Simon belted out “Anticipation.” Part of me always wanted to tell my friends that because ketchup was thixotropic, a good shake would help the ketchup flow faster. I never did, probably because that wasn’t how the cool kids talked and partly because it seemed necessary to wait for the ketchup to plop.

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Anatomic Pathology Abstracts, 5/17

May 2017—Value of Ki-67 proliferative index in WHO-classified pulmonary carcinoids; Chromosomal abnormalities and genetic changes in uterine smooth muscle tumors; Expression of divergent endodermal lineage markers in yolk sac tumors; Interobserver reproducibility of percent GP4 in prostatic adenocarcinoma on biopsies; MELF pattern invasion: a report of FIGO grade 1 endometrial endometrioid adenocarcinomas; Cost-effectiveness of identifying H. pylori  in gastric biopsies without ancillary stains

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Q&A column, 5/17

May 2017—Is there any medical reason why a physician would ask the lab to run a complete blood count on cord blood? Does CAP checklist requirement HEM.23050 treat automated and manual differentials equally? That is, does the recommendation to report absolute counts apply also to manual differentials or only to automated differentials? What is the next step in resolving platelet clumping when it occurs in a citrate tube also?

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Put It on the Board, 5/17

May 2017—First here, then there—FISH testing in Kenya; FDA OKs PD-L1 biomarker test for urothelial carcinoma; FDA clears Roche Cobas e 801 immunoassay module; DiaSorin granted EUA for fully automated Zika IgM test; Advia Centaur XPT has comprehensive ID menu; Roche CINtec Histology test receives FDA clearance

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From the President’s Desk: If you can’t find your niche, build it, 4/17

April 2017—Our ubiquitous access to (and increasing reliance on) search engines such as Google, Siri, Cortana, and others has resurfaced much of the intellectual landscape. The historical “Guardians of the Truth” no longer sit comfortably in ivory towers waxing poetic while issuing definitive determinations of “fact.” Today, when we want to know something, we reach for our phones. The answers, devoid of context and authoritative citations, seem to be so simple there.

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Clinical Pathology Abstracts, 4/17

April 2017—Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women: Chlamydia trachomatis is the most common bacterial sexually transmitted infection in the United States. In 2010, more than 1.3 million such infections in the United States were reported to the Centers for Disease Control and Prevention. In 2013, the estimated direct lifetime cost of treatment for chlamydia and its complications was more than $500 million.

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Anatomic Pathology Abstracts, 4/17

April 2017—Proposing prognostic thresholds for lymph node yield in oral cavity cancers: Prognostic lymph node yield thresholds have been identified and incorporated into treatment guidelines for multiple cancer sites, but not for oral cancer. The authors conducted a study to identify optimal thresholds in elective and therapeutic neck dissection for oral cavity cancers.

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Molecular Pathology Abstracts, 4/17

April 2017—Molecular profiling in MDS to predict clinical outcomes after transplantation: In recent years, several insights have been gleaned regarding the role of molecular markers for prognosis in myeloproliferative disease. This study expanded the use of molecular markers for prognosis in myelodysplastic syndrome (MDS) to predicting clinical outcomes after allogeneic hematopoietic stem-cell transplants.

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Q&A column, 4/17

April 2017—Our laboratory receives requests for breast predictive marker testing (estrogen receptor, progesterone receptor, HER2, Ki-67) on biopsies of bone metastases. Is it appropriate to perform this testing on decalcified tissue? Is there a regulatory speed limit—whether a per day or a per hour “at the microscope” workload limit—on surgical pathology slide interpretations, similar to workload limits for cytology screening?

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Newsbytes, 4/17

April 2017—New open-access website offers a treasure trove of digital slides; HL7 collaborates with Google; Health Catalyst and Regenstrief to advance text analytics technology; Corista teams with Elsevier to augment digital platform; Seacoast enhances system for document management

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Put It on the Board, 4/17

April 2017—At OSU, Inspirata completes deployment of WSI scanners, launches Consultation Portal: Inspirata has completed what it describes as the largest single-site deployment of whole slide image scanners at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (The James) and the Department of Pathology, both located at Ohio State University Wexner Medical Center, Columbus.

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From the President’s Desk: We all need a safe place, 3/17

March 2017—Students of history tell us that a durable paradigm shift most often involves a long gestation, typically under the radar and recognized by a precious few. What they frequently fail to tell us is that the vast majority of prognosticators often turn out to be both flat-out wrong and invisible when the “future” arrives. Either way, however, the prevailing narrative points to uncertainty in the greater health care environment.

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Clinical Pathology Abstracts, 3/17

February 2017—Preventing genetic testing order errors via a lab utilization management program: Diagnostic errors, or failure to provide an accurate and timely diagnosis, impact an estimated 12 million outpatient care visits annually in the United States. These errors can often be attributed to the testing process, including test selection, ordering, retrieval, and interpretation. Literature about diagnostic errors has primarily focused on the outpatient setting; study of diagnostic error in the inpatient setting has been limited.

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Anatomic Pathology Abstracts, 3/17

March 2017—An immunohistochemical algorithm for ovarian carcinoma typing: Five major histotypes of ovarian carcinoma exist. Diagnostic typing criteria have evolved over time, and past cohorts may be misclassified by current standards. The authors undertook an endeavor to reclassify the recently assembled Canadian Ovarian Experimental Unified Resource and Alberta Ovarian Tumor Type cohorts using immunohistochemical (IHC) biomarkers and to develop an IHC algorithm for ovarian carcinoma histotyping.

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Molecular Pathology Abstracts, 3/17

March 2017—Effects of ovarian cancer cells manipulating mesothelial cells that line the peritoneal cavity: spread within the peritoneal cavity, resulting in cell implantation and metastasis at many secondary sites. The peritoneal cavity and associated organs are lined by a single layer of mesothelial cells that it has been suggested not only provides a physical barrier to prevent implantation and invasion but also plays a more complex interactive role in regulating cancer spread.

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Newsbytes, 3/17

March 2017—Pathologist to ‘name names’ in support of interoperability: Desperate times call for desperate measures. And while desperation may be a bit of an overstatement, a leader in pathology informatics says extreme frustration with LIS vendors, whose closed architecture, in effect, holds client data hostage, drove him to rally his colleagues to call out the offenders in a public forum.

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Q&A column, 3/17

March 2017—Our hospital system is implementing Sysmex instruments with a focus on the accuracy of the absolute white blood cell values—use of the absolute neutrophil count and immature granulocytes with the WBC as markers for septicemia. I then became aware that the hospital purchased the St. John Sepsis v14 protocol, which lists 10 percent bands as one of the markers for septicemia. The Rumke for 10 percent is 4–16. Using bands is not consistent with reducing manual differentials and is not an accurate parameter to use. Are there other protocols using WBC/ANC?

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Put It on the Board, 3/17

March 2017—LabCorp to acquire PAML: LabCorp, Providence Health & Services, and Catholic Health Initiatives announced Feb. 23 they have entered into a definitive agreement for LabCorp to acquire all of the ownership interest in Pathology Associates Medical Laboratories, LLC, which is owned by Providence and CHI.

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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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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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Anatomic Pathology Abstracts, 1/17

January 2017—Drawbacks of reflex ER and PR analysis of DCIS in breast needle core biopsies; Analysis of eosinophils and mast cells of gastrointestinal tract in healthy children; Classifying gastric cancer into molecular subgroups; Clinicopathologic significance of mismatch repair defects in endometrial cancer; Use of immunostains to distinguish hepatic adenoma from hepatocellular carcinoma; Prognostic effect of PD-L1 expression patterns in cervical cancers; Variation in pattern-based classification of invasive endocervical adenocarcinoma

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Clinical Pathology Abstracts, 1/17

January 2017—Impact of laboratory cost display on resident attitudes and knowledge of costs: The Institute of Medicine report on health care quality recommends providing better care at lower costs. However, the United States has consistently seen rising health care costs instead of cost reductions. An approach to reducing unnecessary health care spending is to make physicians more aware of the cost of diagnostic tests.

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Q&A column, 1/17

January 2017—I have a technologist who is a recent graduate from a medical technology school. She has her BA but the school she attended did not offer an internship program. We are offering her one year of on-the-job training so she will be able to sit for her ASCP certification exam after completing the one year of training.

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Put It on the Board, 1/17

January 2017—Experts collaborate on evidence-based somatic variant classification system; FDA clears next-generation test for MRSA colonization; PMA approval granted for Aptima HIV-1 Quant; Henry Ford announces automation partnership; ArcherDX launches immune repertoire sequencing assays

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Clinical Pathology Abstracts, 12/16

December 2016—Process optimization to improve immunosuppressant drug testing turnaround time: The routine use of immunosuppressant medications is critical for patients receiving solid organ transplants. Monitoring immunosuppressant (ISP) drug concentrations helps guide safe and effective dosing. ISP drug monitoring is performed using mass spectrometry or immunoassay methods.

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Molecular Pathology Selected Abstracts, 12/16

December 2016—ANXA1 as a predictive biomarker for resistance to trastuzumab in breast cancer: Treatment with the HER2-targeting antibody trastuzumab (Herceptin) is a key component of therapy for women with HER2-positive breast cancer. However, a subset of women with advanced disease shows initial or acquired resistance to therapy, although the mechanisms that control this resistance are largely unknown. Some studies have suggested that activation of the PI3K/mTOR signaling pathway may be responsible for trastuzumab resistance.

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Anatomic Pathology Abstracts, 12/16

December 2016—Reproducibility of NEPTUNE descriptor-based scoring system with various types of images: The multicenter Nephrotic Syndrome Study Network, or NEPTUNE, digital pathology scoring system uses a novel and comprehensive methodology to document pathologic features from whole-slide images, immunofluorescence, and ultrastructural digital images.

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Q&A column, 12/16

Q. Are there guidelines on microsatellite instability analysis by immunohistochemistry on colorectal adenocarcinomas? Specifically, should immunohistochemical stains for the mismatch repair enzymes be performed on all colorectal adenocarcinomas regardless of the clinical or pathological findings? A medical group recently requested these studies on all colorectal adenocarcinomas.

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Newsbytes, 12/16

December 2016—The benefits of building a dedicated LIS support team: Too many cooks in the kitchen may be a problem, for which building more than one “kitchen” may be a solution. That’s the message Kathy Davis, manager of pathology informatics at the University of Michigan Medical Center, conveyed in an LIS management presentation at the 2016 Pathology Informatics Summit.

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From the President’s Desk: Where we direct our gaze

December 2016—I gave a talk for the CAP16 House of Delegates in September that opened with a three-minute video showing how perspective can change along a continuum of distance. The clip depicts a logarithmic journey across space from a grassy field in downtown Chicago to the farthest reaches of outer space, then retraces and extends its path to the deepest interior (“inner space”?) of human cells. That would be mesmerizing even without the stirring—almost danceable—orchestral accompaniment. The overall effect is visually stunning and intellectually provocative. I have watched the video a number of times. It never fails to remind me that where we stand and how we focus our attention really do shape what we see and how we see it.

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Anatomic Pathology Abstracts, 11/16

November 2016—Relevance of papillary growth patterns of pulmonary adenocarcinoma, HPV involvement in head and neck cancers: assessment of biomarkers, Distinctive immunoregulatory microenvironment of medullary carcinoma of the colon, Diagnostic challenges caused by endoscopic biopsy of colonic polyps, MicroRNA expression profiling and expression of miR-205 in inflammatory breast cancer

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Clinical Pathology Abstracts, 11/16

November 2016—Neonatal ICU quality initiative: identifying preanalytical variables that contribute to specimen hemolysis: Hemolysis is a major cause of sample rejection and the need to recollect a specimen from a patient. In the neonatal intensive care unit, this may be of particular concern because of limited venous access and the risk of causing iatrogenic anemia.

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Molecular Pathology Selected Abstracts, 11/16

November 2016—Misclassification of genetic variants associated with hypertrophic cardiomyopathy: Hypertrophic cardiomyopathy has a variable clinical presentation and may lead to sudden cardiac death. In many cases, it is associated with pathogenic genetic variants, enabling screening of relatives and, possibly, the ability to individualize treatment strategies through lifestyle modification or invasive procedures.

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Q&A column, 11/16

November 2016—As originally described, there are technically five Gleason patterns: 1, 2, 3, 4, 5. However, since patterns 1 and 2 are never used, there are no Gleason scores 1 + 1 = 2, 1 + 2 = 3, 2 + 1 = 3, 2 + 2 = 4, 2 + 3 = 5, and 3 + 2 = 5. Why is this? Isn’t this an alteration of Gleason’s original classification concept? Furthermore, there are cases in which a biopsy may contain a few glands that are diagnostic of carcinoma but insufficient to assign an accurate Gleason score. Would it simply be best to make a descriptive comment to that effect?

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Newsbytes, 11/16

November 2016—How a pathology website can help build pathology websites: What if one could Google “biopsy orientation processing cassette” and receive detailed methodological instruction in surgical pathology as easily as finding a recipe for pound cake? Izak B. Dimenstein, MD, PhD, HT(ASCP), a grossing technologist retired from Loyola University Chicago Medical Center, believes highly specific information about laboratory methodologies should be easily accessible on the Web.

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The President’s Desk: How clarity can bridge our silos, 10/16

October 2016—I had been looking forward to Cancer Biomarkers Conference II at Houston Methodist Hospital, even though early September wasn’t the best time to travel. Work was busy and CAP16 was only two weeks away. During the weekend meeting, I rediscovered the value of stepping back from business as usual. The program was fast-paced and stimulating, and I learned a lot. Even the nonpathologists I met clearly appreciated what I shared about how much pathologists do to facilitate the adoption of these new diagnostic tools.

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Anatomic Pathology Abstracts, 10/16

October 2016—Features of columnar-lined esophagus in gastroesophageal junction biopsies; Significance of Paneth cells in histologically unremarkable rectal mucosa; MicroRNA expression profile related to lymph node status in endometrial cancer; Plasma cells in melanoma: prognostic significance and possible role of IgA; Human epidermal growth factor receptor 2 testing in invasive breast cancer

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Clinical Pathology Abstracts, 10/16

October 2016—Risk factors for transfusion in cesarean section deliveries at a tertiary hospital: Obstetrical hemorrhage is a major cause of morbidity and mortality in young women and may be difficult to predict. In some regions of the world, postpartum hemorrhage (PPH) may account for up to 25 percent of maternal deaths. Many studies have focused on the predictors of PPH before delivery.

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Q&A column, 10/16

October 2016—What are the guidelines for proper handling and processing of blood specimens collected in serum separator tubes? Are there regulations guiding the practice of taking additional blood samples from a patient even though there are no orders for the blood samples? These “just in case” specimens are sent to our laboratory by the emergency department when a port or catheter is placed in the patient. The ED’s reasoning is that it prevents a patient from being stuck twice if there is an order for blood tests later. Our lab has to either store the samples or process them (centrifuge or separate RBCs from serum) so they are ready in case an order is entered later. Should this practice be banned? Should we refuse to accept these samples?

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Newsbytes, 10/16

October 2016—Process improvement software more than online suggestion box; Viewics launches analytics tool for diabetes management; Hc1.com joins forces with Experian Health; OptraScan introduces whole slide imaging scanner; Contracts and installations

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Put It on the Board

October 2016—Cancer Moonshot has diagnostic thrust: Vice president Joe Biden’s Cancer Moonshot now has a flight plan, drafted by a blue-ribbon panel and published in September. Coming as it does in the final year of president Obama’s term in office, there are doubts about whether the ambitious $1 billion program—aimed at achieving 10 years’ progress in cancer research and treatment in a five-year period—will ever get off the launching pad.

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From the President’s Desk: In the eye of the brainstorm, 9/16

September 2016—Radiolab is a radio show and podcast about (mostly) scientific curiosities co-hosted by a perpetually interested guy who majored in music. You might describe it as a talk show for science geeks. These are people who know how to ask the right questions and put the answers in context. A recent installment (“Colors”) questions whether color is a concrete characteristic of the physical world or simply a mental overlay we apply to our perception. Early on, you learn that a young Isaac Newton pursued the mechanism of color perception by piercing his own eye with a knife. I was hooked.

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Anatomic Pathology Abstracts, 9/16

September 2016—Digital image analysis versus manual biomarker assessment in breast cancer; Clinical and cost impact of EGFR and ALK testing in early stage NSCLC; Switch/sucrose nonfermenting complex protein expression in an aggressive endometrial cancer; Immune microenvironment of breast ductal carcinoma in situ; Adverse histological features in malignant colorectal polyps; Use of ancillary molecular analysis for diagnosis of soft tissue tumors

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Molecular Pathology Selected Abstracts, 9/16

September 2016—Mutations causing acquired resistance to PD-1 blockade in melanoma: Immunotherapy in metastatic cancer has achieved durable responses in a wide variety of cancer types. Antibodies that block programmed cell death protein-1 (PD-1) are particularly effective in metastatic melanoma, but a recent study showed that approximately 25 percent of patients that achieved a durable response ultimately had disease progression at a median follow-up of 21 months.

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Q&A column, 9/16

September 2016—We know we can count fewer than 100 cells for a manual differential if there is a very low white cell count. But if the white cell count is very high, should we count more than 100 cells? Some references state that >30,000 WBC/µL require a 200 cell differential, others >50,000 WBC/µL, and many do not mention at all the need to increase above 100 cells counted.

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Newsbytes, 9/16

September 2016—Graph database technology: what it can do given the chance; Group seeks participants to help foreign labs meet needs; ONC tool grades C-CDA documents for interoperability; BBCS releases new version of ABO Express; Prototype device provides fast bacterial infection diagnosis; Voicebrook announces software installation

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Put It on the Board, 9/16

September 2016—AMP lays out clinical utility standard for molecular Dx: The Association for Molecular Pathology has published a 14-page report its leaders hope will reset the conversation payers, policymakers, and medical guideline panels have when assessing the clinical utility of molecular diagnostics in oncology and inherited diseases. The key to AMP’s approach is to broaden the standard for what is considered a clinically useful molecular diagnostic test.

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From the President’s Desk: Let’s close the knowledge gap, 8/16

August 2016—Most of us have heard the laboratory described as a black box where specimens are exchanged for information and diagnoses. This tells me that we work beside some highly skilled people who don’t know what we do and that the knowledge gap makes them uncomfortable enough to joke about it. This incomplete understanding of what takes place within the laboratory has meaningful consequences in multiple contexts.

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Clinical Pathology Abstracts, 8/16

August 2016—Cold antibodies may be detected with routine pretransfusion testing and may obscure the identification of clinically significant red blood cell antibodies. They may be detected in healthy people or may be transient in appearance after a mycoplasma or mononucleosis infection. In most cases, cold antibodies are benign, and pretransfusion laboratory testing is designed to avoid detecting these antibodies by eliminating testing at room temperature.

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Anatomic Pathology Abstracts, 8/16

August 2016—Use of HSP70 and glutamine synthetase to diagnose hepatocellular carcinoma; Recurrence of benign and low-grade fibroepithelial neoplasms of the breast; Lobular neoplasia detected in MRI-guided core biopsy: a high risk for upgrade; Use of microsatellite instability, MLH1 methylation analysis, IHC to identify Lynch syndrome; Differential diagnosis of bladder versus colorectal adenocarcinoma; Enhanced expression of PD L1 in CIN and cervical cancers

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Molecular Pathology Selected Abstracts, 8/16

August 2016—Germline mutations in men with metastatic prostate cancer: Prostate cancer displays great diversity in clinical behavior, ranging from essentially silent, organ-confined disease to rapid and aggressive metastatic spread. The authors know of no clear-cut screening method that can reliably identify those patients whose tumors are likely to behave aggressively and, therefore, may benefit from a more active treatment strategy. Prostate cancer has also been shown to have a significant component of heritability.

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Q&A column, 8/16

August 2016—If you obtain a platelet count from a blood sample collected in a sodium citrate tube, the result is multiplied by 1.1 to correct for the volumetric difference in anticoagulant compared with EDTA. When you result the platelet count from the sodium citrate tube, is it a CAP requirement to attach a comment such as: “_#__ Results reported from blue top tube. The reference range and other method performance specifications have not been established or approved by FDA. Use results with caution.”

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Put It on the Board, 8/16

August 2016—LabCorp will acquire Sequenom; New York ends state PT services; St. Jude lands CAP ISO 15189 accreditation; Epigenomics’ DNA test included in CRC guideline; OSU to deploy Inspirata digital pathology solution; Mindray’s clinical chemistry analyzer cleared; Successful Keytruda trial stopped early; Top court clarifies autopsy’s place in Texas law; EUA for Siemens Zika assay

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Shorts on Standards: Update on the frontier of NGS, 7/16

July 2016—Next-generation sequencing has continued to deliver on its promises and potential in the diagnostic arena. However, as with any emerging and evolving technology, the medical and scientific community faces the challenge of assessing the implications and demonstrating definitive clinical uses of its expanding capabilities, especially in the context of medical efficacy, clinical utility, and cost efficiency.

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Clinical Pathology Abstracts, 7/16

July 2016—Utilization management to reduce unnecessary lab testing at a VA hospital: It is estimated that laboratory and pathology testing account for four percent of annual health care costs. A laboratory utilization management system, or laboratory expert system (LES), can be employed to reduce such costs. A variety of functionality, including passive and active alerts, in the computerized physician order entry (CPOE) system provide decision-making support for physicians ordering tests.

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Molecular Pathology Selected Abstracts, 7/16

July 2016—Using single nucleotide polymorphism arrays in acute lymphoblastic leukemia: In patients with acute lymphoblastic leukemia/lymphoma, the identification of chromosomal abnormalities at the time of diagnosis is important for risk classification. The current standard of care includes karyotype and FISH analysis to identify recurrent cytogenetic abnormalities.

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Newsbytes, 7/16

July 2016—How to minimize cybersecurity risks from business associates: Like parents, through the decades, telling their teenagers, “It isn’t all about you,” cybersecurity firms are sending health care organizations a similar message: It isn’t all about you—it’s about your business associates too.

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Q&A column, 7/16

July 2016—What are the steps to validating maximum dilution for certain analytes when the stated manufacturer dilution is not enough? What is considered best practice for verifying platelet-poor plasma for coagulation? Is it necessary to measure platelet counts from 2.7 mL and 1.8 mL tubes? Is annual verification consistent with best practice?

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Put It on the Board, 7/16

July 2016—Michel: The good, bad, and ugly that labs need to know: Robert Michel’s opening remarks at the Executive War College, which can be seen as a kind of state of the union address for laboratory medicine, focused on the trends in the industry and the opportunities and dangers they create. “Fraud and abuse. That’s the ugly,” Michel began. “Folks who are doing lab medicine the right way aren’t really aware of what’s been happening outside the walls of their laboratories.”

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From the President’s Desk: CAP16: All in one place, 6/16

June 2016—Even though I had a good idea of what would be in the CAP16 program, my heart raced when the final curriculum arrived. Perhaps because of my role as CAP president, I found myself taking a slightly different perspective than in the past and thinking about just how ambitious an undertaking it is. A program this complex involves serious choreography. Those who construct it must be thoughtful, forward-looking, and sensitive to many compelling needs and interests competing for limited time and space. It’s a big job.

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In memoriam: Raymond C. Zastrow, MD | 1930–2016

June 2016—Raymond C. Zastrow, MD, the 24th president of the CAP, died April 28 at age 85 following complications of surgery. A member of the CAP Board of Governors from 1985 to 1988, Dr. Zastrow also served as CAP secretary-treasurer from 1988 to 1993, president-elect from 1993 to 1995, and president from 1995 to 1997. In 1998, the CAP recognized him as Pathologist of the Year.

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Clinical Pathology Abstracts, 6/16

June 2016—Fasting or nonfasting lipid measurements: The joint American College of Cardiology and American Heart Association “2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults” replaces low-density lipoprotein cholesterol treatment thresholds with a more global measurement of risk.

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Q&A column, 6/16

June 2016—Can you offer feedback on the growing trend of using type A fresh frozen plasma in emergencies instead of type AB? Is this being used mainly in trauma hospitals and military sites or is the trend becoming more popular in smaller hospitals too?

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Put It on the Board, 6/16

June 2016—Guidance seen as sign of FDA openness to digital pathology, Eco effort cuts biohazard waste, saves money, EGFR mutation liquid biopsy OK’d as companion Dx, Qiagen adds Horizon QC to next-generation system, Siemens enters molecular oncology services market, Roche PD-L1 tabbed as complementary test

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Clinical Pathology Abstracts, 5/16

May 2016—Platelet transfusion: a clinical practice guideline from the AABB: The AABB recently developed guidelines on the appropriate use of platelet transfusions in adults. The guidelines are based on a systematic review of randomized clinical trials and observational studies from 1900 to September 2014 that reported clinical outcomes on patients who received either prophylactic or therapeutic platelet transfusions.

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Anatomic Pathology Abstracts, 5/16

May 2016—Noninfectious aortitis of the ascending aorta: a histological and clinical correlation of cases; Stratifying HPV-induced cervical pathology using E4 with p16 or MCM; Limited resection versus lobectomy for older patients with early-stage lung cancer; L1CAM expression and its association with mutant p53 expression in endometrial cancer; Value of p16 staining for predicting outcome of LSIL/CIN1

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Q&A column, 5/16

May 2016—What laboratory test should be used to monitor the effect of the heart failure medication Entresto (sacubitril/valsartan)? After getting a consultation report, I usually issue an addendum without changing my own diagnosis. Some of my colleagues use an amended report with their own diagnosis changed. They say this will help clinicians with patient management. I do not feel confident about many of these difficult cases, so I do not want to change my diagnosis. We would like to establish a department policy to address this. Can you provide guidance?

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Newsbytes, 5/16

May 2016—Sunquest acquires GeneInsight; Technidata launches lab system; HHS seeks feedback on measuring growth of interoperability in health IT; Xifin upgrades collaboration and clinical data-management platform; Kalorama Information releases report on global LIS market; Aspyra announces LIS installation

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From the President’s Desk: Our role in population health, 4/16

April 2016—In late January, I represented the CAP at MEDLAB, the medical laboratory conference and exhibition held each year in Dubai, United Arab Emirates. MEDLAB was held in conjunction with Arab Health, a multidisciplinary conference attended by more than 130,000 people from 163 countries. I was asked to present six separate talks in Dubai; the one on precision medicine in pathology drew more than 1,200 attendees.

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Anatomic Pathology Abstracts, 4/16

April 2016—Comparison of methods for analyzing gene amplification in gastric cancers; Uterine smooth muscle tumor analysis by comparative genomic hybridization; Role of TAZ in aggressive types of endometrial cancer; Reclassification of resected lung carcinomas diagnosed as squamous cell carcinoma; Sequencing of cancer genes in ampullary carcinoma shows trends in histologic subtypes; Prognostic significance of the 2014 ISUP grading system for prostate cancer

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Q&A column, 4/16

April 2016—We review peripheral blood smears and sometimes provide recommendations. For microcytic anemia with high red blood cell count, iron study and hemoglobin electrophoresis are suggested to rule out hemoglobinopathy. But for cases of microcytosis with high RBC count but without anemia, should we give the same recommendation as for an anemic patient?

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Newsbytes, 4/16

April 2016—Finding, fixing, and foiling shadow IT problems: The unsanctioned use of mobile devices and cloud-based software in the workplace, often referred to as shadow IT, is a pervasive problem. Yet, through education and enforcement of policies, it’s a problem that can be minimized.

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Put It on the Board, 4/16

April 2016—Logistics hurdles overcome for single Pap-HPV report: Is one test better than two? That question—primary HPV versus the Pap-HPV cotesting option—has roiled the world of cervical cancer screening since the Food and Drug Administration approved a primary HPV screening test in April 2014. However clinicians decide to answer that question, this much is clear: A single report is better than two separate results.

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Anatomic Pathology Abstracts, 3/16

March 2016—Reproducibility of residual cancer burden for assessing breast cancer after neoadjuvant chemotherapy: The residual cancer burden index was developed to quantify residual disease ranging from pathological complete response to extensive residual disease. The authors conducted a study to evaluate inter-pathologist reproducibility in the residual cancer burden index score and category and in their long-term prognostic utility.

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Molecular Pathology Selected Abstracts, 3/16

March 2016—Enhancing tumor selectivity of a picornavirus virotherapy: Oncolytic viruses that selectively target tumor cells are a promising cancer therapy and are thought to work not only via direct lysis and destruction of tumor cells but also through recruitment and activation of the host’s anti-tumor immune response. While there are a number of naturally occurring viruses that preferentially replicate in cancer cells and have otherwise limited effects in human tissue, the real therapeutic promise lies in genetically engineered viruses.

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Clinical Pathology Abstracts, 3/16

March 2016—Impact of add-on laboratory testing at an academic medical center: Clinical laboratories are often asked to perform additional laboratory tests after the original sample is received and testing per the original order is complete. It is well known that this significantly increases laboratory workload and impacts turnaround time.

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Q&A column, 3/16

March 2016—I have a question regarding auto-verification delta checks, not for a single patient but between all patients tested during a given period. Are there labs that use postanalytic comparisons of clinical lab results during the testing interval between quality assurance checks to ascertain if the autoverified results being released are reasonable?

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Newsbytes, 3/16

March 2016—Digital consults: options for getting from here to there: The U.S. digital pathology consultation marketplace is steadily gaining ground, largely owing to increased demand for international consultations. And those delving into digital consults are making a three-pronged decision: build your own system, install an off-the-shelf software solution, or sign up with a Web-based digital consultation network.

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Put It on the Board, 3/16

March 2016—Case raises uncertainty on autopsy’s legal status: Should a hospital-provided autopsy be considered health care? It’s a question the Supreme Court of Texas will decide this spring, and its answer to that question will make a big difference—in the millions of dollars—to the claimants, Christus Health Gulf Coast v. Carswell. It could also have an impact on the medical liability coverage available to pathologists who perform autopsies in the Lone Star State.

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Clinical Pathology Abstracts, 2/16

February 2016—Link between a liberal transfusion strategy and patient survival: Guidelines support using a restrictive strategy for blood transfusion management in various clinical settings. However, randomized controlled trials in cardiac surgery, oncology, and hip fracture surgery suggest that a more liberal transfusion strategy may benefit survival.

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Anatomic Pathology Abstracts, 2/16

February 2016—Subtype classification of lung adenocarcinoma in patients undergoing complete resection: The classification for invasive lung adenocarcinoma by the International Association for the Study of Lung Cancer, American Thoracic Society, European Respiratory Society, and World Health Organization is based on the predominant histologic pattern—lepidic, papillary, acinar, micropapillary, or solid—present in the tumor.

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Newsbytes, 2/16

February 2016—IT staffing considerations for the NGS laboratory: For the past five years, the University of Washington Department of Laboratory Medicine has been expanding its next-generation sequencing capabilities, adding the latest technologies and offering new tests in genetics, cancer, and infectious disease—and honing its information technology staffing skills along the way.

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Q&A column, 2/16

February 2016— I am a practicing board-certified pathologist and I have one cytotechnologist to screen Pap tests. She is moving to another city, and I must decide whether to send all Paps to a reference laboratory or to another lab just for screening and then returned to me for sign-out of normal and abnormal Paps.

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Put It on the Board, 1/16

January 2016—2016 may be year of action on laboratory-developed tests: During a session at the Association for Molecular Pathology’s annual meeting in November, Rep. Michael Burgess, MD (R-Tex.), said he expects the Food and Drug Administration to issue its long-awaited final guidance on laboratory-developed tests during the first quarter of 2016.

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From the President’s Desk: Flexibility matters, 1/16

January 2016—Pathology is becoming more vital, complex, variable, integrated, and interactive. Once upon a time, we trained to enter practice. Today, we must train to be continually trained. Our ability to stay current with science and explain its potential is a critical variable in the quality of care our patients receive. As a department chair and laboratory medical director, I encourage each member of our group to embrace a coordinated approach.

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Molecular Pathology Selected Abstracts, 1/16

January 2016—Genomic sequencing of tumors can be used clinically to identify acquired somatic mutations in cancer-related genes. In an era of personalized medicine, tumor-specific mutational status can be used to acquire prognostic information and guide molecular targeted therapies. However, many patients also have germline variants in these genes, which not only can make it difficult to identify the tumor-specific somatic mutations, but may also affect the biological mechanism of tumorigenesis.

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Anatomic Pathology Abstracts, 1/16

January 2016—Uterine leiomyosarcomas are rare malignant tumors with a poor prognosis, while leiomyomas are common benign tumors unrelated to their malignant counterparts. Diagnostic features commonly present in leiomyosarcoma include cytologic atypia, high mitotic index, and a sarcoma-specific geographic cell death designated as tumor cell necrosis (TCN).

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Newsbytes, 1/16

January 2015—As the trend in cloud computing continues, in part as a way to reduce capital investment costs, laboratory decision-makers must learn the nuances of how to vet this type of vendor and negotiate software-as-a-service agreements. Without this knowledge, they risk entering into a less-than-satisfactory contractual arrangement that can cost them money, industry experts say.

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Clinical Pathology Abstracts, 1/16

January 2016—A logical delta check for identifying erroneous blood cell count results: Regulations require that hospitals have a quality management plan that benchmarks key indicators of quality performance. One such indicator is a delta check, which is a broad quality control for preanalytic and analytic errors that identifies significant variation in a patient’s present lab result when compared with the patient’s previous result for the same test.

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Q&A column, 1/16

January 2016—The current recommendation of the Centers for Disease Control and Prevention to screen baby boomers for hepatitis C virus may cause stress on laboratory resources. Is this the most prudent way to capture those individuals who will progress to liver cancer? Current data/literature suggest that 80 percent of those who may screen positive will not progress to cancer but will eliminate the virus on their own.

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Clinical Pathology Abstracts, 12/15

December 2015—Optimizing transfusion ratios in massive transfusion protocols: The 1:1:1 ratio of packed red blood cells to plasma to platelet use for massive transfusion emerged out of data on mortality in military personnel wounded in combat. Many studies have investigated the optimal ratio for use in massive transfusion. The literature is controversial, and studies continue to support and refute the 1:1:1 ratio.

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Anatomic Pathology Abstracts, 12/15

December 2015—Reappraisal of etiologic field effect in cancer predisposition and progression: The term field effect, which is also known as field defect, field cancerization, and field carcinogenesis, has been used to describe a field of cellular and molecular alteration that predisposes to the development of neoplasms within that territory.

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Newsbytes, 12/15

December 2015—Fellowship blends clinical informatics and pathology: Ask Rebecca Johnson, MD, and her colleague Bruce Levy, MD, about a newly approved fellowship program that allows fellows to train concurrently in clinical informatics and any other of the pathology subspecialties, and they’ll give you a similar answer: This has been in the works for a long time.

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Molecular Pathology Selected Abstracts, 11/15

November 2015—Off-label use of molecularly targeted therapy: Advances in technology allow for genetic and molecular profiling of tumors, findings that are useful for guiding molecularly targeted therapy. Molecularly targeted agents are usually tested and developed on groups of tumors based on histologic type and primary location, but many genetic abnormalities overlap across tumor types.

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Anatomic Pathology Abstracts, 11/15

November 2015—Variation in reporting extraprostatic extension after radical prostatectomy: Extraprostatic extension of prostate cancer in radical prostatectomy specimens significantly affects patient management. The authors evaluated the degree of interobserver variation between uropathologists at a tertiary referral teaching hospital in assessing the extraprostatic extension of prostate cancer in radical prostatectomy specimens.

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Put It on the Board, 11/15

November 2015—Approvals mark ‘tip of the iceberg’ for PD-L1 testing: What the FDA giveth, the FDA may taketh away. On Oct. 2, the agency approved the use of Merck’s immunotherapy drug Keytruda (pembrolizumab) to treat patients with metastatic non-small cell lung cancer whose disease has progressed after chemotherapy and whose tumors express the PD-L1 protein. Dako’s IHC 22C3 pharmDx test kit was approved as a companion diagnostic for use with the drug.

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Newsbytes, 11/15

November 2015—Collaborative prepares pilot on managing genomic data in EHRs: As genetic testing travels the path from rare to routine, it simultaneously provides answers and poses problems. One such problem is rooted in the question, How can electronic health record systems organize and display genomic information in a standardized, interoperable format that best supports clinical decision-making?

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Q&A column, 11/15

November 2015—Is there a recommended procedure for or reference article about checking APTT reagent sensitivities (for the identification of factors VIII and IX) when changing lot numbers and reference range? The activated partial thromboplastin time (APTT) clot-based assay is a global test used to detect factor deficiencies in patients with a bleeding diathesis or as a preoperative screen to ensure normal coagulation laboratory parameters before an invasive procedure.

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Clinical Pathology Abstracts, 11/15

Editor: Deborah Sesok-Pizzini, MD, MBA, professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and chief, Division of Transfusion Medicine, Children’s Hospital of Philadelphia. Altered lysosomal proteins in neural-derived plasma exosomes in preclinical Alzheimer disease It is necessary to identify biomarkers to detect patients at risk for Alzheimer disease well before neurological signs ...

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Put It on the Board, 10/15

Neuropathologist Dr. Omalu in spotlight at CAP ’15: Bennet Omalu, MD, MBA, MPH, who gave the spotlight event speech at CAP ’15 earlier this month, says he met retired Pittsburgh Steeler Mike Webster before conducting the 2002 autopsy that would lead to the first diagnosis of chronic traumatic encephalopathy in a National Football League player.

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From the President’s Desk: First things first, 10/15

October 2015—As I mulled over the best way to begin my first column, two classes I had taken long ago came to mind. The first was part of an intensive undergraduate philosophy program at Stanford in 1978. The second, on organizational behavior, was part of a master’s program in health care management at Harvard 20 years later. In each case, I expected little more than a series of fuzzy discussions. Instead, the components I thought would be the lightest were the deepest.

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Newsbytes, 10/15

October 2015—A decade later, online laboratory handbook gets makeover: Ten years ago, when Massachusetts General Hospital created an online laboratory handbook, the event crowned many hours of programming and coding by a team of pathologists, who were convinced their labors would dramatically streamline access to information.

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Clinical Pathology Abstracts, 10/15

October 2015—Impact of a rapid respiratory panel test on patient outcomes: Studies have examined the impact of polymerase chain reaction tests on patient outcomes. Rapid detection in microbiology and virology allows more appropriate treatment sooner. This, in turn, can reduce hospital length of stay for patients with respiratory pathogens and may generate hospital savings.

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Anatomic Pathology Abstracts, 10/15

October 2015—CD117 expression in phyllodes tumors: correlation with adverse pathologic parameters. CD117 (c-Kit) is a type III receptor tyrosine kinase encoded by the KIT gene. Deregulation of expression and mutations in the gene are implicated in various tumors. Reports of CD117 expression in phyllodes tumors have generated controversy.

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Molecular Pathology Selected Abstracts, 10/15

October 2015—Mutation clearance after induction therapy in acute myeloid leukemia: After initial induction chemotherapy for acute myeloid leukemia, approximately 20 percent of patients fail to achieve complete remission, and approximately 50 percent experience relapse within one year. Therefore, it would be clinically useful to identify patients at higher risk of induction therapy failure or relapse.

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Q&A column, 9/15

September 2015—In the article on novel oral anticoagulants in the May 2015 issue of Archives of Pathology & Laboratory Medicine (139:687–692), a few blood products that are mentioned are not described. What is the composition of 3-factor PCC, 4-factor PCC, and FEIBA, and how are they prepared commercially?

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Molecular Pathology Selected Abstracts, 9/15

September 2015—Molecular profile of diffuse lower-grade gliomas: Diffuse low- and intermediate-grade gliomas include World Health Organization grade II and III astrocytomas, oligodendrogliomas, and oligoastrocytomas. These lower-grade gliomas usually arise in the cerebral hemispheres of adults, and they are highly infiltrative and, therefore, cannot be completely resected.

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Clinical Pathology Abstracts, 9/15

September 2015—Costs and outcomes after cardiac surgery in patients refusing transfusion: Numerous randomized, controlled trials have shown no benefit of a liberal blood transfusion strategy compared with a more restrictive strategy in surgical patients. Furthermore, concerns exist regarding the association of transfusion with postoperative morbidity and mortality.

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Newsbytes, 9/15

September 2015—How site visits led to an LIS selection at Stanford: Seven gets all the attention, but five turned out to be the lucky number for a Stanford University Medical Center team charged with selecting a new laboratory information system. Visiting five installation sites in five cities in five days was “probably the most important aspect of the whole process,” says Brent Tan, MD, PhD, director of clinical laboratory informatics at Stanford.

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Put It on the Board, 9/15

September 2015—Roche buys ‘sample in, susceptibility out’ technology: Roche has signed a definitive agreement to acquire Los Gatos, Calif.-based GeneWeave BioSciences, a privately held company focused on molecular clinical microbiology diagnostic solutions. The acquisition provides Roche with GeneWeave’s Smarticles technology, which quickly identifies multidrug-resistant organisms and assesses antimicrobial susceptibility directly from clinical samples without the need for traditional enrichment, culture, or sample preparation processes.

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Anatomic Pathology Abstracts, 9/15

September 2015—Tumor-infiltrating lymphocytes and response to neoadjuvant chemotherapy in select breast cancers: Modulation of immunologic interactions in cancer tissue is a promising therapeutic strategy. To investigate the immunogenicity of HER2-positive and triple-negative breast cancers, the authors evaluated tumor-infiltrating lymphocytes and immunologically relevant genes in the neoadjuvant GeparSixto trial.

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From the President’s Desk: Partnerships for patients

September 2015—This is my last column, so the bad news is that it’s time to go. But the good news is that by the time you read this, we’ll be heading into CAP ’15, where many of us will continue this conversation in person. If you cannot come this year, I hope you will at least plan lunch afterward with someone who did. We always return to work infused with energy and optimism. At least you can tap into that.

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Q&A, 8/15

August 2015—Our laboratory is adding urine total protein to its Siemens Dimension EXL test menu. The test is being performed now at our reference lab on the Siemens Advia 1800. Our Dimension EXL method validation studies have revealed an average 40 percent positive bias over the Advia method. This bias is also evident in peer group evaluations for the quality control product we are using.

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Letters, 08/15

August 2015—Breast pathology study: I read the letter by Diane Schecter, MD (July 2015), and I respect her right to remind readers that the findings from the breast pathology study published in JAMA (Elmore JG, et al. 2015;313:1122–1132) are similar to results published nearly 25 years ago.

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From the President’s Desk: Showing what is in our hearts

August 2015—The CAP Foundation See, Test & Treat program is one of the best things we do. I like that it is patient centric and volunteer driven. I like that it is multidisciplinary, collaborative, and community based. I like that it is quietly disrupting how underserved populations experience the health care system and how we relate to our clinical partners. And I like knowing that something that does so much good for everyone it touches is pathologist led—which means we are forever examining, growing, and improving it as only we can do.

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Clinical Pathology Abstracts, 8/15

August 2015—Characteristics and antibiotic use associated with short-term risk of C. difficile infection in hospital patients: Clostridium difficile infection is recognized as the leading cause of infectious nosocomial diarrhea. Since molecular testing has improved the sensitivity and specificity of C. difficile infection (CDI) diagnosis, most hospitals discourage repeating a negative test within seven days. However, there is a rare possibility that a patient may have repeat CDI testing that is positive within 14 days after an initial negative finding.

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Anatomic Pathology Selected Abstracts, 8/15

August 2015—Quality of diagnostic staging in patients with bladder cancer: a process-outcomes link: Muscle sampling is often used as a surrogate for staging quality in patients with bladder cancer. The association of staging quality at diagnosis and survival was examined among patients with bladder cancer. The clinical records of all individuals within the Los Angeles Surveillance, Epidemiology, and End Results registry with an incident diagnosis of nonmuscle-invasive bladder cancer in 2004–2005 were reviewed.

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Molecular Pathology Selected Abstracts, 8/15

August 2015—Studying clonal dynamics in response to cancer therapy using barcoding: The emergence of resistance to targeted cancer therapeutics is a significant problem clinically and is generally believed to result from genetic alterations in tumor cells. Whether resistance exists within a subpopulation of a tumor prior to treatment or develops de novo during treatment is a fundamental question that may significantly impact therapy.

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Put It on the Board, 8/15

August 2015—To meet TAT goals, Vanderbilt builds ED lab: In a move expected to help meet accreditation standards on testing turnaround times for stroke and chest pain patients, Vanderbilt University Medical Center’s emergency department will gets its own satellite laboratory this month.

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Newsbytes, 8/15

August 2015—How one pathologist made use of artificial intelligence: Like many pathologists, Jay J. Ye, MD, PhD, longed to spend less time preparing reports and more time interpreting slides and rendering diagnoses. Rather than dedicating half of his workday to what he considers secretarial tasks, the dermatopathologist wanted to devote the lion’s share of his hours in the lab toward applying the knowledge and skills he developed during his years of medical training and practice.

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Put it on the Board, 7/15

July 2015—Amid excitement about the groundbreaking work of unlocking the human genome’s secrets to speed diagnosis and target oncologic treatment comes the unpleasant reality that much of this labor now goes unpaid. Getting the American Medical Association’s editorial panel to publish nearly two dozen new genomics-related CPT codes for molecular pathology was a vital step, as was having those codes accepted in the Medicare clinical laboratory fee schedule.

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Anatomic Pathology Selected Abstracts, 7/15

July 2015—Expanding the morphologic spectrum of differentiated VIN by mapping p53 loss; Mitotic count by PHH3 immunohistochemical staining in pancreatic WDNETs; Comparison of prostate cancer markers in lymph node and distant metastases; Evaluation of a new grading system for laryngeal squamous intraepithelial lesions; Breast cancer assessment based on levels of estrogen receptor expression ...

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Newsbytes, 7/15

July 2015—Why Sonora Quest gave itself high marks for LIS conversion; Pathologists share homegrown software for infant autopsies; CMS promotes innovation by offering data to private sector; Agilent purchases Cartagenia; Database provides information from next-gen sequencing

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From the President’s Desk: Our role in shared decision-making, 7/15

July 2015—Responsibilities as medical director for transfusion and coagulation services at Nebraska Methodist Hospital in Omaha occupy about 15 percent of my time. We have an excellent staff, the work is satisfying, and I enjoy the patient contact. In 2007, we became one of what are now three hospitals in Nebraska with recognized blood conservation programs and one of about 150 nationally that accommodate patients who refuse or restrict blood use for personal or religious reasons. Many of these patients travel a significant distance to reach us.

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Q&A column, 7/15

July 2015—Q. We recently reorganized the workflow in our blood bank in hopes of improving process control and reducing distractions. In doing so, we increased the potential for workplace injuries. The ergonomic issues are a major concern for a lot of workers. Employees on all three shifts are developing back and knee issues. We are an 800-plus-bed hospital lab with more than 30 people working in our department. The following issues have arisen:

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Anatomic Pathology Selected Abstracts, 6/15

June 2015—Safety and diagnostic accuracy of tumor biopsies in children with cancer; Napsin A as a specific marker for ovarian clear cell adenocarcinoma; Long-term follow-up of an active surveillance cohort of patients with prostate cancer; Primary sources of pelvic serous cancer in patients with endometrial intraepithelial carcinoma; Re-evaluating the role of sentinel lymph node biopsy in microinvasive breast carcinoma; Molecular analyses of six types of uterine smooth muscle tumors

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Clinical Pathology Selected Abstracts, 6/15

June 2015—Effects of red cell storage duration on patients undergoing cardiac surgery: Patients who undergo cardiac surgery often receive multiple units of red blood cells and may be at risk for end-organ injury because of compromised cardiac output or a proinflammatory state that follows cardiopulmonary bypass. At least one large study has shown an increase in adverse outcomes in patients receiving RBCs stored longer than 14 days compared with those receiving RBCs stored less than 14 days.

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Newsbytes, 6/15

June 2015—Consortium gaining ground in quest for interoperability; Xifin purchases VisualShare; CDC releases update on electronic lab result reporting to public health agencies; Enzo Life Sciences releases ELISA plate reader app; Orchard Software features white papers on website; Imprivata expands reach with acquisition of HT Systems; Sampleminded teams up with Exact Sciences

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Letters, 5/15

May 2015—Speech recognition: I found the article on speech recognition to be well reported and interesting (“Hear me now? Another audition for speech recognition,” March 2015). We implemented speech recognition at NorthShore University HealthSystem (as your writer reported) before I retired as director of the clinical pathology division. What William Watkin, MD, said in the article about our smooth implementation was so true.

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Q&A column, 5/15

May 2015—Q. I am a pathologist practicing in a small community hospital. I was involved with a patient who was declared brain-dead and subsequently designated a donor of multiple organs. The organ procurement agency ordered additional testing during the two days before the organ harvest, including a CT scan of the chest. The latter revealed a solitary pulmonary nodule.

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Anatomic Pathology Selected Abstracts, 5/15

Editors: Michael Cibull, MD, professor emeritus, University of Kentucky College of Medicine, Lexington; Rouzan Karabakhtsian, MD, attending pathologist, Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Thomas Cibull, MD, dermatopathologist, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill.; and Rachel Stewart, DO, resident physician, Department of Pathology and Laboratory Medicine, University of Kentucky. Molecular detection of ...

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Clinical Pathology Selected Abstracts, 5/15

May 2015—Use of hemoglobin content of reticulocytes to evaluate anemia in cancer patients: Evaluating iron-deficiency anemia in patients with cancer is difficult. Malignancy is frequently associated with anemia of chronic disease. However, it is important to distinguish iron-deficiency anemia due to inadequate iron stores from anemia of chronic disease due to decreased iron availability with abundant stores. Advanced reticulocyte indices, such as the cellular hemoglobin content of reticulocytes, named CHr and RET-He, are reportable parameters on newer automated hematology analyzers.

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Molecular Pathology Selected Abstracts, 5/15

May 2015—Clinical and molecular effects of order of acquired mutations in myeloproliferative neoplasms: Cancers arise and evolve from the accumulation of somatic mutations. With the addition of each mutation, tumor subclones are selected for biologic attributes that increase growth and proliferation potential. However, the authors hypothesized that it may not only be the presence of the mutations that affects these attributes but also the order in which the mutations arise, since their interactions and resulting environment likely play a key role in the development of subsequent genetic events and the tumor’s neoplastic behavior.

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Newsbytes, 5/15

May 2015—A lab IT strategic plan: from guidance to lessons learned: For those with even the slightest bit of health care business acumen, it should come as no surprise that when health systems expand quickly through mergers and acquisitions, hospital labs often struggle to communicate and cooperate with their counterparts at far-flung sister sites. Faced with such a challenge, the lab at the rapidly growing Geisinger Health System embraced a solution.

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Put It on the Board, 4/15

April 2015—Door opens on direct access to genetic tests: The FDA’s recent move to give 23and­Me permission to market this country’s first direct-to-consumer genetic test, for Bloom syndrome, goes beyond the one in 107 Jews of Ashkenazi descent who are carriers of the rare disorder.

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Anatomic Pathology Selected Abstracts, 4/15

April 2015—Uterine smooth muscle tumors with features suggesting fumarate hydratase aberration; Histologic and immunohistochemical assessment of penile carcinomas in a North American population; Predictive value of IASLC/ATS/ERS classification of lung adenocarcinoma in tumor recurrence and patient survival; Histomorphology of Lynch syndrome-associated ovarian carcinomas with regard to a screening strategy

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Molecular Pathology Selected Abstracts, 4/15

April 2015—Interpreting pathogenic variants in TTN for dilated cardiomyopathy: In this era of expanding gene panels and whole-exome and whole-genome sequencing for rare disease molecular diagnostics, it remains a challenge to filter numerous resulting variants from these sequencing assays, assign functional consequences of a variant in the resulting protein, and then determine potential pathogenicity.

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Newsbytes, 4/15

April 2015—How a best practice alert cut unneeded transfusions: Embedding a decision support tool in an EMR to nudge physicians toward an evidence-based practice—without ruffling feathers—can be a delicate process. But two physicians at Dartmouth-Hitchcock Medical Center did just that when they launched a best practice alert that encourages adherence to new guidelines for ordering blood.

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Q&A column, 4/15

April 2015—Why is the number 12 for lymph node retrieval in colon cancer protocol reporting not specific to the kind of resected specimens and whether a total colectomy was performed? We are establishing a list of maximum allowable dilutions for our clinical chemistry analytes. Are you aware of any reference that would list absurd or invalid values for such analytes, i.e. the endpoint that would determine the most dilutions we would have to do for the highest possible value for that analyte?

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From the President’s Desk: Together, we gain more than we give, 4/15

April 2015—Before I could become your president, my partners had to agree to cover for me. I would be away a lot and it would be more work for everyone. We talked about it, weighed the impact on our practice, considered what it would mean for them, and came to a consensus. I would be the person whose picture appeared on this page. They would have a decisive role in making it possible.

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From the President’s Desk: Transitions in training and practice

March 2015—Turning points emerge in retrospect, but I’m ready to put a red pushpin at December 2013 on the evolutionary timeline for pathology graduate medical education. Twenty-four pathology education organizations came together that month for a workforce summit sponsored by the CAP, the American Society for Clinical Pathology, the Association of Pathology Chairs, and the United States and Canadian Academy of Pathology that would refine consensus on how to best shape the future of our specialty.

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Q&A column, 3/15

Are red blood cell parameters (Hb, MCV, MCH, MCHC, and RDW), especially a normal MCV, a reliable screening tool for ruling out beta thalassemia trait? Is the sickle solubility test reliable in ruling out sickle cell disorder? The absence of coagulation of seminal fluid has been attributed to bilateral congenital absence of the vas deferens and seminal vesicles due to the absence of the coagulation substrate (fibrinogen-like precursor).

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Newsbytes, 3/15

March 2015—CMS to alter reporting period for meaningful use: The Centers for Medicare and Medicaid Services has announced that it intends to engage in rulemaking to shorten the reporting period for stage two meaningful use attestation this year from 365 to 90 days under the EHR incentive programs.

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Anatomic Pathology Selected Abstracts, 3/15

March 2015—Histopathologic spectrum of thecoma of the ovary: a report of 70 cases: The authors evaluated 70 cases of thecoma of the ovary to ascertain their histopathologic spectrum. The tumors occurred over a wide age range (average, 49.6 years). Presentation in the form of pelvic or abdominal pain was uncommon, but postmenopausal bleeding was relatively frequent.

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Clinical Pathology Selected Abstracts, 3/15

March 2015—Chimeric antigen receptor T cells for sustained remissions in leukemia: Relapsed and refractory acute lymphoblastic leukemia is associated with a poor prognosis. T cells genetically modified to express chimeric antigen receptors targeted to cells expressing CD19 (CTL019) are a promising treatment strategy, with complete responses previously reported in two patients who had relapsed and refractory acute lymphoblastic leukemia (ALL).

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Put It on the Board, 3/15

AMP outlines laboratory view on incidental findings: The American College of Medical Genetics and Genomics’ controversial 2013 recommendations on the reporting of incidental findings on select genes was the first attempt to address the matter in the clinical setting. But the ACMG’s recommendations pose significant challenges that labs undertaking next-generation sequencing must be prepared to address, said a special report written by an Association for Molecular Pathology working group.

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Put It on the Board

February 2015—Two medical organizations said that using an HPV test alone for cervical cancer screening is an effective alternative to the current recommendation for screening with either cytology alone or cotesting with cytology and HPV testing. Pathology leaders said the multispecialty-developed guidance leaves the Pap test standing as a first-line screening option.

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Anatomic Pathology Selected Abstracts, 2/15

February 2015—Alteration of ARID1A gene, PI3K-Akt pathway, and ZNF217 gene in ovarian clear cell carcinoma: AT-rich interactive domain 1A (ARID1A) is a subunit of switch/sucrose nonfermentable (SWI/SNF) complex. Recently, alterations of the ARID1A gene, phosphatidylinositol 3-kinase-protein kinase B (PI3K-Akt) pathway, and zinc-finger protein 217 (ZNF217) gene have been identified as frequent molecular genetic changes in ovarian clear cell carcinoma.

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Clinical Pathology Selected Abstracts, 2/15

February 2015—Alcohol consumption relative to type of breast cancer risk in postmenopausal women: Alcohol consumption is a known risk factor for breast cancer, but it is not known which subtypes of breast cancer, if any, are more likely associated with alcohol consumption. The authors conducted a large study using the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial cohort to test for heterogeneity in alcohol-related risk by breast cancer subtypes defined by estrogen receptor (ER) and progesterone receptor (PR) status and histological type.

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Newsbytes, 2/15

February 2015—Simplifying the search for units of uncommon blood: For blood banks, obtaining red blood cell units with uncommon blood types can be a time-consuming and daunting task in which delays can hinder patient care. So two blood bank professionals, frustrated by the challenge, set out to change that. The American Rare Donor Program fields requests for rare blood types, which are blood types found in fewer than one in 1,000 donors, but it is “not set up to serve those requesting uncommon units—defined as blood with combinations of antigens that occur in fewer than one in 100 people,” says Connie Westhoff, PhD, director of immunohematology and genomics at New York Blood Center.

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Q&A column, 2/15

February 2015—Can our laboratory use ALK immunohistochemistry in lung adenocarcinoma to select patients for targeted therapy? ALK gene rearrangements (the most common of which results in expression of the EML4-ALK fusion protein) are found in approximately five percent of lung adenocarcinomas, and these ALK-rearranged tumors show marked clinical response to the tyrosine kinase inhibitor crizotinib.

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From the President’s Desk: Making disaster readiness routine, 1/15

January 2015—Ebola virus disease had taken 6,900 lives in West Africa and exactly one in the United States as of Dec. 18, 2014. The World Health Organization in August had declared the West African crisis to be a public health emergency of international concern. Yet EVD received little attention in the U.S. until a patient who had traveled from Liberia was diagnosed at Texas Presbyterian Hospital in Dallas on Sept. 30 and died eight days later.

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Molecular Pathology Selected Abstracts, 1/15

January 2015—Age-related mutations linked to clonal hematopoietic expansion and malignancies: A common practice in molecular profiling of tumors is to subtract mutations detected in DNA derived from blood (representing germline or inherited polymorphisms) from mutations detected in DNA derived from the paired tumor to assess the tumor’s somatic molecular profile.

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Anatomic Pathology Selected Abstracts, 1/15

January 2015—Are amended surgical pathology reports reaching the correct care provider? Amended reports need to follow patients to treating physicians to avoid erroneous management based on an original diagnosis. The authors undertook a study to determine if amended reports followed patients appropriately. They tracked amended reports with diagnostic changes and discrepancies between ordering and treating physicians.

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Put It on the Board, 1/15

January 2015—Digitized slides spur patient engagement, ‘allow for democratized medicine’. Regulatory and reimbursement hurdles are key factors blocking broader adoption of digital pathology. But the technology is already having an impact, enabling patients to grasp a firmer hold of the wheel in directing their care, said Keith J. Kaplan, MD, a pathologist and laboratory medical director in Charlotte, NC.

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Newsbytes, 1/15

January 2015—Desire to stem lab test overuse leads to free software: For Zia Uddin, PhD, enough was enough. After reading time and again about the proliferation of redundant and otherwise medically unnecessary laboratory testing in the U.S. health care system, the clinical chemist and computer scientist decided to take matters into his own hands—quite literally.

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From the President’s Desk: Are we there yet?, 12/14

December 2014—At this time of year, when we are inclined to reminisce, I often recall holiday travel with small children. I mention this to explain my headline—an existential question also relevant to our work at the CAP. When those around the table begin to debate a point (say, for example, during a CAP Board of Governors meeting), I sometimes recall voices. I suspect that’s true for many of us.

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Molecular Pathology Selected Abstracts, 12/14

December 2014—Overcoming limitations in the sequencing of whole viral genomes: The identification and analysis of pathogenic viruses, especially the Ebola virus, has recently received significant attention. The sequencing of newly identified viral genomes has presented historical challenges as existing technology fails to capture the 3’ and 5’ terminal ends of the viral genome.

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Newsbytes, 12/14

December 2014—Why lab report formatting remains a work in progress: As a guiding principle, “form follows function” may be as appropriate for pathology reports as it was for 20th century architecture and industrial design. So, if the primary function of a lab report is to communicate diagnostic information, it should be designed and formatted to make it easy for the reader to assimilate data that will impact patient care. But achieving this result may require due diligence, say two pathologists who have embraced the cause of better-looking, more effective reports.

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Q&A column, 12/14

December 2014—What are the legal ramifications for medical technologists or medical laboratory technicians if they release results on suboptimal specimens on the insistence of physicians? What are the consensus recommendations for the diagnosis of eosinophilic esophagitis, eosinophilic gastroenteritis, and eosinophilic colitis? What is the clinical significance of increased lymphocytes in esophageal biopsy? Has there been a significant increase in diagnosed eosinophilic disorders over the past 10 or so years?

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Put It on the Board, 12/14

December 2014—Crizotinib shrinks tumors in ROS1-positive NSCLC: A recently published New England Journal of Medicine study that shows promise for the treatment of ROS1-positive lung cancer patients also demonstrates the value of advanced diagnostics, says John Iafrate, MD, PhD, the article’s senior author. Thirty-six of 50 study participants whose non-small cell lung cancer was driven by a rearrangement of the ROS1 gene saw their tumors shrink significantly when they received treatment with the drug crizotinib (Xalkori). The drug suppressed tumor growth in another nine ROS1-positive patients in the study, a phase one trial.

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Clinical Pathology Selected Abstracts, 12/14

December 2014—Prevalence of antimicrobial use in U.S. acute care hospitals: Inappropriate antimicrobial drug use is associated with adverse events in hospitalized patients as well as the emergence of resistant pathogens. Targeting effective interventions to improve antimicrobial use in the acute care setting may help guide safe and effective therapy while reducing the risks and complications of resistant and difficult-to-treat pathogens.

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Anatomic Pathology Selected Abstracts, 12/14

December 2014—Value of autopsies in the era of high-tech medicine: Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have declined to less than 10 percent. The authors conducted a study to investigate the value of autopsies in the era of high-tech medicine by determining the frequency of discrepancies between clinical and autopsy diagnoses. The authors classified all adult autopsy cases (n=460) performed at the Symbiant Pathology Expert Centre in Holland, in 2007 and from 2012 to 2013, as having major or minor discrepancy or total concordance.

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Anatomic Pathology Selected Abstracts, 1/13

January 2013—Relationship between PAX2-null secretory cell outgrowths in the oviduct and pelvic serous cancer: With the exception of germ-line mutations in ovarian cancer susceptibility genes, genetic predictors for women destined for ovarian serous cancer cannot be identified in advance of malignancy. The authors recently showed that benign secretory cell outgrowths (SCOUTs) in the oviduct increase in frequency with concurrent serous cancer and typically lack PAX2 expression (PAX2-null).

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Clinical Pathology Selected Abstracts, 1/13

January 2013—Chocolate consumption, cognitive function, and Nobel laureates: Dietary flavonoids are associated with health benefits, including improved cognitive function and reduced risks associated with aging, such as the risk of dementia. Flavonoids, or the subclass flavanols, are present in green tea, red wine, cocoa, and some fruits. Evidence has also shown that flavanols are linked to lower blood pressure due to vasodilation in the peripheral vasculature and brain.

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Put It on the Board, 11/14

November 2014—Amid initial confusion over Ebola-related safety protocols for health professionals providing direct patient care, laboratory professionals report hearing a consistent message from the CDC on proper specimen handling. The pressing question for laboratories is how best to approach testing with potential Ebola patients given the dual imperatives of preventing exposure and offering faster diagnostic answers.

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Molecular Pathology Selected Abstracts, 11/14

November 2014—Whole exome sequencing of Merkel cell carcinoma demonstrates conserved retinoblastoma pathway dysregulation: Merkel cell carcinoma is a rare aggressive neuroendocrine malignancy of the skin that is associated with infection by Merkel cell polyomavirus. Viral integration into the human genome and subsequent expression of the large T antigen is thought to cause cell cycle dysregulation via binding and inactivation of the retinoblastoma tumor suppressor protein and is a key step in the development of Merkel cell carcinoma.

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Newsbytes, 11/14

November 2014—Software expands on ‘what you see is what you get’; ONC unveils tool for sharing health information with patients; Portal gives patients direct access to lab test results; Xifin partners with SyTrue; GenoSpace awarded grant for developing biorepositories; NovoPath interfaces to Athenahealth EHR

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Anatomic Pathology Selected Abstracts, 11/14

November 2014—Final trial report of sentinel-node biopsy versus nodal observation in melanoma: Sentinel-node biopsy, a minimally invasive procedure for regional melanoma staging, was evaluated in a phase three trial. The authors evaluated outcomes in 2,001 patients with primary cutaneous melanomas who were randomly assigned to undergo wide excision and nodal observation, with lymphadenectomy for nodal relapse (observational group), or wide excision and sentinel-node biopsy, with immediate lymphadenectomy for nodal metastases detected on biopsy (biopsy group).

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From the President’s Desk: How we tell our story, 11/14

November 2014—We do what we do because we know it’s important, we find it engaging, and we like to keep things interesting. We are committed to our work and precise by nature. So we spend hours with one patient’s specimens. We build systems-based safety nets to protect quality. We investigate, verify, document. We juggle a bit of everything and work with everyone. No wonder no one knows what we do.

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Q & A column, 11/14

November 2014—When performing a platelet count from a blood sample collected in a sodium citrate tube, the result is multiplied by 1.1 to correct for the volumetric difference in anticoagulant compared to EDTA. Which other CBC parameters, if any, should be similarly corrected?

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From the President’s Desk: Building a quality tradition, 10/14

October 2014—Laboratory medicine is a human endeavor with zero tolerance for error. “Human endeavor” and “zero error” make for an awkward pairing, but those are the rules and they’re good ones. So we create systems to protect quality, sustain excellence, and provide education. We are vigilant. CAP quality assurance programs are instruments of that vigilance and of our member-driven commitment to patient safety.

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Q & A Column, 10/14

October 2014—My laboratory reports the color of a body fluid after it’s spun down. So bloody fluid may be reported as “color: yellow, appearance = bloody.” Is this common practice? We have had phone calls from a neurologist who questioned the color and pointed out that it doesn’t make sense, except for spinal fluid when it’s important to record xanthochromia versus a bad tap.

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Clinical Pathology Selected Abstracts, 10/14

October 2014—Benefits of green tea extract to brain connectivity during working memory processing: Green tea extract or its main ingredient has been shown to have a beneficial impact on cognitive functioning and prevention of cognitive decline. The benefit to cognition could be related to altered brain activity in regions engaged during higher order cognitive functioning. Some recent studies demonstrated increased brain activation in the fronto-parietal regions during working memory processing.

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Put It on the Board, 10/14

October 2014—Leading pathologists and the CAP are encouraging laboratory professionals to use the social media website Twitter as a way to amplify lab medicine’s voice among clinicians, policymakers, news organizations, patients, and the public. It is advice that at least one prominent social media expert and nonpathology physician says lab professionals ought to heed. “Pathologists have a problem being recognized by society because we don’t see patients directly. This is an opportunity for us to get out there in society and to contribute value in that regard,” says Timothy Craig Allen, MD, JD, a newly elected member of the CAP’s Board of Governors and director of anatomic pathology at the University of Texas Medical Branch, Galveston.

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Anatomic Pathology Selected Abstracts, 10/14

October 2014—Role of STAT6 immunohistochemistry in diagnosis of solitary fibrous tumors: Solitary fibrous tumor is an uncommon fibroblastic neoplasm. Although histologic characteristics and frequent CD34 expression allow for an accurate diagnosis in the majority of solitary fibrous tumor (SFT) cases, a wide histologic spectrum and occasional unexpected immunophenotype may pose diagnostic challenges. Molecular analyses have shown that almost all SFTs harbor a NAB2-STAT6 fusion gene, which is considered specific to this tumor type.

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Newsbytes, 10/14

October 2014—A conundrum: teaching pathology informatics to residents: Just as high schoolers are prone to protest, “We’re never going to need to use quadratic equations/literary theory/the periodic table in real life,” pathology residents have been known to question the value of subjects for which they don’t envision a practical application—such as pathology informatics.

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Molecular Pathology Selected Abstracts, 10/14

October 2014—A gene panel to examine mosaic somatic mutations in cerebral malformations: Somatic mutations are widely recognized in cancer, often affecting prognosis and determining candidacy for use of molecular targeted treatments. These somatic mutations may lead to a mosaic population of cells. Recent advances in technology involving deep next-generation sequencing have allowed for detection and quantification of these mosaic variants.

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Put It on the Board, 9/14

September 2014—Simple blood tests, colossal contrasts on price: California hospitals have a pricing range for common blood tests so wide that it brings to mind the vast span of that state’s world wonder, the Golden Gate Bridge. Among the 150 hospitals whose blood test charges were examined in a recent study, the price for a basic metabolic test ranged from $35 to $7,303, depending on the hospital, with a median charge of $214. The biggest price difference was in charges for a lipid panel.

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Q & A Column, 9/14

September 2014—Occasionally on certain patients, when we draw for a CBC in the early morning, we get a low Hgb of 6 or 7 g/dL. We draw the same patient for a CBC in the afternoon and we get a higher Hgb by at least 1–1.5 g/dL. Can you explain the reason for this difference? We would like to standardize reference ranges throughout our system of regional facilities, using our main laboratory to establish the ranges. How does the CAP view using the transference process as described in CLSI document C28-A3C, Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Guideline? Is this an approved method for establishing reference ranges? Is it an acceptable process once the laboratory director approves it?

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Newsbytes, 9/14

September 2014—Why LIS limitations shouldn’t inhibit genomic testing: Many community-based hospitals don’t have the resources to perform complex genomic testing, but they shouldn’t let that deter them. By being creative in overcoming the limitations of their lab information systems, pathology departments can ensure that clinicians and their patients benefit from the latest advances in next-generation sequencing, says Lynn Bry, MD, PhD.

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Anatomic Pathology Selected Abstracts, 9/14

September 2014—Cytokeratin 17: an adjunctive marker of invasion in anal squamous neoplastic lesions: Diagnosing anal squamous cell carcinoma, which is often preceded by anal intraepithelial neoplasia, may be challenging in small biopsies. Cytokeratin 17 (CK17) is a basal/myoepithelial cell keratin induced in activated keratinocytes and associated with disease progression in squamous cell carcinoma (SCC) of the uterine cervix, esophagus, and oral cavity.

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Clinical Pathology Selected Abstracts, 9/14

September 2014—Potential link between vitamin D and subclinical cerebrovascular disease: Vitamin D deficiency has been associated with several diseases, including hypertension, diabetes mellitus, and stroke. A recent prospective population-based study of cardiovascular disease showed that subclinical infarcts and white matter hyperintensities (WMHs) are commonly seen on brain magnetic resonance image scans of older adults and are associated with cardiovascular disease risk factors and prior stroke. The lesions are also associated with reduced functioning on cognitive tests.

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From the President’s Desk: Premium PT—and more to come in 2015, 9/14

September 2014—Even as a newly minted pathologist, I knew that the CAP Surveys were critical tools to ensure patient safety and test validity. Still, I didn’t give them much thought. There was already a lot to learn; something already so well established just wasn’t on my radar. But over time and with experience, I learned that our Surveys program of proficiency testing, which had its roots in a demonstrated need for interlaboratory comparison 60 years ago, had evolved organically into an engine of scientific advancement in our specialty.

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Molecular Pathology Selected Abstracts, 8/14

August 2014—The dystrophin gene is the largest known human gene, comprising 2.2 Mb of the genome and 79 coding exons: Through the use of multiple tissue-specific promoters and alternative splicing of RNA, several isoforms of the protein dystrophin are encoded by the dystrophin (DMD) gene. The primary 427-kDA dystrophin isoform (Dp427) is found in the cytoplasm of skeletal and cardiac muscle cells, where it is involved in physically linking the cytoskeleton to protein structures outside the cell and, therefore, strengthens and protects muscle fibers during contraction and relaxation.

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From the President’s Desk: From representation to RUC, reasons to join AMA

August 2014—It was my good fortune to be introduced to practice by a group of pathologists with a tradition of robust professional engagement. In residency or shortly thereafter, all of us joined the CAP, our state pathology society, state medical society, and the AMA because we were brought to understand it was the right thing to do. Explicitly and by example, mentors and partners have taught me a lot.

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Q & A Column, 8/14

August 2014—Is there a trough and crest occurrence with blood testosterone levels, or is it like thyroid testing, where one’s result is the total of the previous several days? What is the relationship between the presence of moderate to many spherocytes and the MCHC parameter? We always thought cases that show spherocytes on the blood smear are usually associated with high MCHC. We had a case of autoimmune hemolytic anemia with moderate spherocytes, but the MCHC was normal.

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Newsbytes, 8/14

August 2014—Smartphone use in AP ‘immature’ but advancing: It may never be as famous as Snapchat or Instagram, but another method of photo sharing is gaining favor with some anatomic pathologists by allowing them to use their smartphones to send images from glass slides quickly and inexpensively. “The use of smartphones is still at an immature stage for pathology, but I think the emerging area is utilizing the camera functions in the phones to manage decisionmaking,” says Douglas J. Hartman, MD, assistant professor, Department of Anatomic Pathology, University of Pittsburgh Medical Center.

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Anatomic Pathology Selected Abstracts, 8/14

August 2014—GATA3: a multispecific but potentially useful marker in surgical pathology: The transcription factor GATA3 is important for differentiating breast epithelia, urothelia, and subsets of T lymphocytes. It has been suggested that it may be useful in evaluating carcinomas of mammary or urothelial origin or metastatic carcinomas, but its distribution in normal and neoplastic tissues is incompletely mapped. The authors conducted a study in which they examined normal developing and adult tissues and 2,040 epithelial and 460 mesenchymal or neuroectodermal neoplasms for GATA3 expression to explore its diagnostic value in surgical pathology.

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Clinical Pathology Selected Abstracts, 8/14

August 2014—Anti-D alloimmunization after D-incompatible platelet transfusions: Because a small but immunogenic dose of red blood cells may be contained in apheresis platelets, transfusion services establish protocols to provide D– recipients with D– platelets to prevent anti-D alloimmunization. This is of particular concern for young females as there is potential for hemolytic disease of the newborn. In cases where D+ platelets are given to D– recipients, Rh immune globulin (RhIG) may be used to help prevent sensitization. The authors retrospectively analyzed during a 14-year period the anti-D formation in D– recipients who received D+ platelets without the use of RhIG.

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Clinical Pathology Selected Abstracts, 7/14

July 2014—Effects of fish oil in recent-onset rheumatoid arthritis: a patient study: The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaneonic acid (DHA), which are found in fish oil, can suppress synthesis of the omega-6 proinflammatory eicosanoids prostaglandin E2 and leukotriene B4. The effects of fish oil as a dietary supplement in rheumatoid arthritis have been studied in randomized, controlled trials for patient-assessed pain, morning stiffness, number of painful or tender joints, and non-steroidal anti-inflammatory drug consumption.

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Anatomic Pathology Selected Abstracts, 7/14

July 2014—Assessing IHC biomarkers for basal-like breast cancer against a gene-expression profile gold standard: Gene-expression profiling of breast cancer delineates a particularly aggressive subtype referred to as basal-like. This subtype comprises approximately 15 percent of all breast cancers and afflicts younger women. It is refractory to endocrine and anti-HER2 therapies.

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Put It on the Board, 7/14

July 2014—Ethics of laboratory billing at stake in AMA’s code: Proposed revisions to the American Medical Association’s Code of Medical Ethics would remove language that supports direct billing and condemns clinicians who charge markups for laboratory or pathology services. The changes could weaken efforts to rein in billing practices that CAP leaders argue are not in the best interest of the patient and that the AMA currently defines as unethical.

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Newsbytes, 7/14

July 2014—The benefits of building versus buying lab software: Like many in the field of pathology informatics, John Sinard, MD, PhD, does not believe that one-size-fits-all when it comes to laboratory software systems. But unlike many of his peers, he does not choose to live with the discrepancies or purchase a new product.

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Put it on the Board, 6/14

June 2014—For trainees, information ‘gaps are closing’: With the dismissal of residents from training programs having led to well-known tragedies, the most recent in pathology just a year ago, attention is being paid to the importance of ensuring residents’ well-being and properly handling remediation, probation, and dismissal.

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Anatomic Pathology Selected Abstracts, 6/14

June 2014—Utility of triple antibody cocktail intraurothelial neoplasm-3 and AMACR in urothelial CIS and reactive urothelial atypia: Urothelial carcinoma in situ (CIS) is a prognostically and therapeutically significant lesion with considerable morphologic overlap with reactive conditions, especially in the setting of prior therapy. Various markers, including CK20, CD44s, and p53, have been used as an adjunct in making this distinction.

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Clinical Pathology Selected Abstracts, 6/14

June 2014—How a single patient influenced HIV research: 15-year followup: The hope of a cure for human immunodeficiency virus infection is raised by recent reports of people in whom viral replication spontaneously reduced despite the absence of antiretroviral treatment (ART). A “Berlin patient” described in 1999 was immediately treated with ART and hydroxyurea after an acute HIV infection but chose to discontinue treatment.

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Newsbytes, 6/14

June 2014—Making the most of big data no easy task: A trillion base pairs of sequence here, a trillion there. Pretty soon, you’re talking about a lot of information—and it all needs to be managed. That’s the dilemma facing Mayo Clinic and other health care organizations leading the personalized medicine revolution that relies on compiling and analyzing patients’ genetic code to better diagnose, predict, and treat disease.

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Q & A Column, 6/14

June 2014—Treatment with rasburicase seems to affect the uric acid analysis. Drawing the specimen in a pre-chilled lithium heparin tube appears to eliminate the falsely low uric acid results we see. Are there current studies regarding uric acid test analysis on patients receiving rasburicase?

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Put It on the Board, 5/14

May 2014—FDA clears FilmArray GI Panel: BioMérieux affiliate BioFire received Food and Drug Administration 510(k) clearance for the FilmArray Gastrointestinal Panel. The 22-target panel allows a syndromic approach to the diagnosis of infectious diarrhea, the company says, as it includes bacteria, viruses, and parasites in one test.

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Q & A Column, 5/14

May 2014—Checklist requirement HEM.23050 regarding reference intervals includes a note that if absolute cell counts are reported with their reference ranges, then percent cell count reference ranges should not be reported because they can lead to misinterpretation of CBC data. I understand that many laboratories, like ours, have been reporting reference ranges for both absolute and percent cell counts, and I would like to clarify whether this is permissible.

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Newsbytes, 5/14

May 2014—How to avoid becoming a ‘legacy system junkyard: The constant churn of information technology applications is creating new security and financial risks that health care organizations—including laboratories—must systematically address, IT experts say.

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Clinical Pathology Selected Abstracts, 5/14

May 2014—Real-time clinical decision support systems for platelet and cryoprecipitate orders: Platelet and cryoprecipitate transfusions are often used to treat patients who are bleeding. However, many clinicians use non-evidence–based approaches to ordering and transfusing these products. Cost and such adverse effects as transfusion-transmitted diseases and transfusion reactions make it desirable to reduce the unnecessary transfusion of these products.

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Anatomic Pathology Selected Abstracts, 5/14

May 2014—Impact of operator techniques and specimen-preparation checklist on bone marrow assessment: Successful bone marrow assessment is essential to the diagnosis and staging of hematologic malignancies. The authors conducted a study to determine whether specific operator techniques or use of a specimen-preparation checklist, or both, could impact the quality of bone marrow assessment by reducing the frequency of obtaining nonspicular aspirates, small cores, and nondiagnostic samples.

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Letters, 4/14

April 2014—HER2 testing guideline update: Karen Titus’ article “New guideline takes on tough HER2 cases” (October 2013) nicely captures the deliberations behind the new HER2 testing guideline, issued by the American Society of Clinical Oncology and the CAP last October. But as her article makes clear, the new guideline leaves open a question—and I would like to suggest an answer. That answer is based on new studies of molecular diagnostics, to which my institution and several others are contributors, and my own experience as a practicing medical oncologist.

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Put It on the Board

April 2014—Clinical trial data and a Food and Drug Administration panel’s full-throated endorsement stand to reshape cervical cancer screening practice recommendations in the U.S. The FDA’s Microbiology Devices Advisory Committee in March voted 13-0 in favor of a new indication for Roche’s Cobas human papillomavirus test that would allow the assay to be used as a primary screen for cervical cancer in women 25 and older.

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From the President’s Desk: Member survey meets our need to know, 4/14

April 2014—Soon CAP members will receive the online Practice Characteristics Survey, designed to provide evidence of the value we contribute to health care and the many ways we serve our patients. This is the ninth time since 1994 that we have conducted this survey, which informs our policy, advocacy, and planning for member services. If every CAP member makes a commitment to complete and return the survey, the results will greatly refine and enlighten our work to serve, promote, and represent your best interests. But every is the key word. Each member has a role in building a robust response rate that will give our findings the depth and level of credibility that inform and educate.

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Q & A Column, 4/14

April 2014—I have a question about the meaning of the word “guideline” versus “procedure.” Checklist requirement ANP. 11670 Specimen—Gross Examination says the following: “Documented instructions or guidelines are readily available in the laboratory for the proper dissection, description, and histologic sampling of various specimen types (e.g. mastectomy, colectomy, hysterectomy, renal biopsy, etc.).” This leads me to question whether the word guideline means the same as procedure. Procedures need to be signed bi­ennially. Does the same apply to guidelines? The formatting is different for procedures. Could guidelines also mean references?

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Newsbytes, 4/14

April 2014—CommonWell executing pilot phase of interoperability project: Competition is considered a positive force in business, but when patients are the consumers, cooperation sometimes trumps competition. For the founding members of the CommonWell Health Alliance, all major players in the competitive arena of health information technology, enabling clients to share patient data across disparate care settings and competing electronic health record systems is viewed as a common-sense move that boosts cost-effectiveness and benefits patients.

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Clinical Pathology Selected Abstracts, 4/14

April 2014—Intervention to improve timing of vancomycin levels: Samples drawn for therapeutic drug monitoring are sometimes drawn too early, which can cause inaccurate results that lead to a potential dosing error. One approach to reducing such errors is to create an information technology tool to assist clinicians in determining the best timing for a sample draw. The authors conducted a study at Brigham and Women’s Hospital, Boston, in which the investigators used both an educational and electronic intervention to reduce the number of vancomycin collection timing errors. The information technology-based intervention provided educational instructions to nurses.

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Anatomic Pathology Selected Abstracts, 4/14

April 2014—Clear cell papillary renal cell carcinoma: diagnosis and immunohistochemical profile: Clear cell papillary renal cell carcinoma is a recently recognized renal neoplasm composed of cells with clear cytoplasm lining cystic, tubular, and papillary structures. These tumors have immunohistochemical and genetic profiles distinct from clear cell renal cell carcinoma and papillary renal cell carcinoma. The authors studied morphologic and immunohistochemical features (cytokeratin 7 [CK7], carbonic anhydrase IX [CAIX], CD10, alpha-methylacyl-CoA racemase [AMACR], smooth muscle actin, desmin, and estrogen and progesterone receptors) in 55 tumors from 34 patients, eight of whom had end-stage renal disease.

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Newsbytes, 3/14

March 2014—Digital imaging going strong but weaknesses persist: In his CAP ’13 presentation on digital imaging last fall, John H. Sinard, MD, PhD, asked attendees if they use digital still photography in anatomic pathology. “Most of the people in the room raised their hands,” says Dr. Sinard, who is professor of pathology, director of pathology informatics, and associate director of anatomic pathology at the Yale School of Medicine. In contrast, “very few hands went up” in response to a similar query regarding whole slide imaging.

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Clinical Pathology Selected Abstracts, 3/14

March 2014—Transfusion-associated hyperkalemic cardiac arrest in pediatric patients: Hyperkalemic cardiac arrest is a potential complication in pediatric patients undergoing rapid massive transfusion. Identifying patients at particular risk for this reaction is critical for determining the best strategies to prevent transfusion-associated hyperkalemic cardiac arrest (TAHCA). Concerns arise over the use of older blood in at-risk pediatric patients. The authors examined the case reports and studies related to transfusion-associated cardiac arrest in a pediatric population.

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Anatomic Pathology Selected Abstracts, 3/14

March 2014—Use of morphological parameters of LN in stereotactic 11-gauge vacuum-assisted needle core biopsy: Management of lobular in situ neoplasia when diagnosed on core biopsy remains controversial. The authors conducted a study to investigate the association between morphological parameters of lobular in situ neoplasia (LN) on vacuum-assisted needle core biopsy (VANCB) and the presence of malignancy (ductal carcinoma in situ, pleomorphic lobular carcinoma in situ, or invasive carcinoma) at surgical excision. The study included 14 pathology departments in Italy.

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Put It on the Board, 3/14

March 2014—Patient-access rule creates opportunities, costs for labs: A long-awaited Department of Health and Human Services rule that requires laboratories to provide completed test reports to patients upon request may strengthen the relationship patients have with their pathologists, but also will pose another compliance burden for labs in many states.

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Clinical Pathology Selected Abstracts, 2/14

February 2014—Comorbidity-adjusted life expectancy: a new tool to aid cancer screening strategies: Controversy surrounds how best to use cancer screening tests in the elderly and at what age to stop screening. The benefits of early cancer diagnosis and treatment decline with age because many elderly people are more likely to die of a comorbid condition or other cause than of cancer. This impacts the survival benefits of early cancer detection. One must also consider the harms of screening, including complications of further testing and treatment for a disease that may not be symptomatic in a patient’s lifetime.

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Anatomic Pathology Selected Abstracts, 2/14

February 2014—Early stage triple-negative breast cancer treated with mastectomy without adjuvant radiotherapy; Predicting recurrence after limited resection versus lobectomy for small lung adenocarcinoma; HER2 amplification in gastric cancer: a rare event restricted to intestinal phenotype; Gleason score undergrading on biopsy sample of prostate cancer; Fallopian tube intraluminal tumor spread from noninvasive precursor lesions; Factors that influence histopathological diagnosis of differentiated vulvar intraepithelial neoplasia; Impact of molecular analysis on final sarcoma diagnosis; Distinguishing primary bladder adenocarcinoma from secondary involvement by colorectal adenocarcinoma; Determining if close margins warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma; Three methodological approaches for defining basal-like lesions in triple-negative breast carcinoma

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Newsbytes, 2/14

February 2014—Orchard Software collaborates with Memorial Sloan-Kettering: Orchard Software has entered into a long-term agreement with Memorial Sloan-Kettering Cancer Center under which Orchard will supply the cancer center with its Orchard Harvest lab information system while working with Memorial Sloan-Kettering to enhance and further develop its lab informatics products.

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Q & A Column, 2/14

February 2014—We are thinking about using a reference laboratory for HER2 FISH testing of breast carcinomas with an arrangement in which that lab performs the technical component and we perform the interpretation. A “frequently asked question” from 2011 on the CAP Web site seems to say that we must perform bright-field ISH proficiency testing to be in compliance, since we are not performing the hybridization and cannot refer PT to another laboratory. Can you clarify the PT requirement, if any, for this situation? The vendor we are dealing with has offered to establish its own FISH PT program.

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Put It on the Board, 2/14

February 2014—When are genomic tests useful? IOM seeks answers: Collaboration among key stakeholders to set clear evidentiary standards is needed to determine the clinical utility of genome-based testing in cancer care, according to a wide variety of experts participating in an Institute of Medicine workshop. Between 1969 and 1989, genomic biomarkers were mentioned in fewer than 50,000 National Library of Medicine publications. But between 2000 and 2010, more than 250,000 articles mentioned biomarkers, said a December 2013 IOM report, “Genome-Based Diagnostics: Demonstrating Clinical Utility in Oncology: Workshop Summary.”

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Clinical Pathology Selected Abstracts, 1/14

January 2014—Predictive factors for blood transfusion in living donor pediatric liver transplantation: Patients undergoing liver transplantation, in particular pediatric liver transplantation, may receive massive transfusion. However, technical surgical improvements over the years have made it possible for many patients undergoing pediatric living donor liver transplantation (LDLT) to avoid transfusion.

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Anatomic Pathology Selected Abstracts, 1/14

January 2014—Flat pattern of nephrogenic adenoma unveiled using PAX2 and PAX8 immunohistochemistry; Managing borderline atypical ductal hyperplasia/ductal carcinoma in situ on breast needle core biopsy; Classic lobular neoplasia on core biopsy: a clinical and radiopathologic study with followup excision biopsy; Intestinal-type endocervical adenocarcinoma in situ: a subset of AIS affecting older women; Oncotype DX recurrence score: use of pathology-generated equations from linear regression analysis; Neuroendocrine carcinoma of the stomach: characteristics and prognosis; Interobserver reproducibility in diagnosis of high-grade endometrial carcinoma; Features associated with metastatic potential in invasive adenocarcinomas of the lung

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From the President’s Desk: In policy matters, no pause in the cause, 1/14

January 2014—The landscape for physician payment is changing and all of medicine is feeling a persistent downward pressure on reimbursement, so this month’s column is a reality check and a call to arms. The reality check piece is that we’re not just talking about the shift from volume to value, the growing influence of coordinated care, or a new approach to Medicare physician payment updates.

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Q & A Column , 1/14

January 2014—I read a question and answer in the April 2001 CAP TODAY about platelet clumping on EDTA and whether vortexing is an acceptable procedure. A common solution suggested was to redraw the specimen into sodium citrate or acid citrate dextrose (ACD). How do you calculate the correction factor for blood drawn in an ACD tube? Our lab has an old procedure for ACD correction, and it is to divide the RBC of the EDTA tube by the RBC count of the ACD tube. I don’t have any reference for this and would appreciate information.

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Newsbytes, 1/14

January 2014—Why one pathologist champions social media—In an era when one angry tweet or provocative selfie can crash a career, the potential pitfalls of social media might be more obvious than their professional benefits. But one Arkansas dermatopathologist, an enthusiastic user of Facebook, Twitter, and YouTube, urges pathologists to consider the many opportunities social media offer, particularly for networking and education.

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Q&A Column, 12/13

December 2013—Our hematology standardization committee has asked us for input on performing cell counts on tubes No. 1 and No. 4 for cerebrospinal fluid. Each site in our system has a different protocol set up with its emergency department with regard to when a count is performed on tube No. 1 after counting tube No. 4. Some sites use RBC greater than five to automatically count tube No. 1 with or without an order to not delay patient care, whereas other sites use greater than 50 or greater than 200. Is there an established guideline recommendation for the number of RBCs seen on CSF tube No. 4 before doing an additional count on tube No. 1?

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From the President’s Desk: All systems go, and those who make it so, 12/13

December 2013—Some nonpathologists attribute our ability to negotiate the cutting edge of science and medicine to the tools we use. I’m not saying that tools aren’t important, but we know better. Our ability to navigate today’s volatile waters is the product of an affinity for quality and an inclination for systems-based thinking. First we get it right. Then we get it out.

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Clinical Pathology Selected Abstracts, 12/13

December 2013—Impact of blood product ratios in massively transfused pediatric trauma patients

Few studies have included pediatric patients when analyzing the impact of plasma/packed red blood cell (PRBC) ratios during massive transfusions. The implications of changing to a 1:1 plasma/PRBC ratio are significant and relate to additional product exposure, transfusion reaction-related risk, and product wastage.

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Newsbytes, 12/13

December 2013—How software issues enhanced a vendor’s relationship with its client; Abbott releases new version of LIMS; Viewics introduces payer-focused solution; Syapse debuts clinical ‘omics’ reporting software; Telcor software receives certification as EHR module

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Anatomic Pathology Selected Abstracts, 12/13

December 2013— Human papillomavirus-related carcinomas of the sinonasal tract; Localized and metastatic myxoid/round cell liposarcoma; Urothelial carcinoma with prominent squamous differentiation in neurogenic bladder: role of HPV infection; Atypical leiomyomas of the uterus: a clinicopathologic study of 51 cases; Clinicopathological significance of HER2/neu genetic heterogeneity in various breast carcinomas; EIN with secretory differentiation: features and underlying mechanisms; Glypican 3 and arginase in diagnosing scirrhous hepatocellular carcinoma

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Put It on the Board, 12/13

December 2013—Illumina in November received premarket clearance from the FDA for the MiSeqDx system, the first high-throughput DNA sequencing analyzer to receive FDA clearance. Illumina also received FDA premarket clearance for the MiSeqDx Cystic Fibrosis 139-Variant Assay, MiSeqDx Cystic Fibrosis Clinical Sequencing Assay, and MiSeqDx Universal Kit.

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Put It on the Board, 11/13

November 2013—Myriad Genetics presented last month new clinical data from a study with myRisk Hereditary Cancer, a 25-gene hereditary cancer panel, that showed a 60 percent increase in mutations detected in cancer predisposition genes in patients with a prior history of colon cancer, polyps, or both. Myriad presented this study and data from four others at the Collaborative Group of the Americas on Inherited Colorectal Cancer Annual Meeting in Anaheim, Calif.

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Anatomic Pathology Selected Abstracts, 11/13

November 2013—Diagnostic and prognostic morphometric features in WHO 2003 invasive endometrial stromal tumors; Association of tumor staging with adverse clinical outcome in neuroendocrine tumors of appendix; Detection of HPV capsid proteins L1 and L2 in squamous intraepithelial lesions; Feasibility and safety of sequential research-related tumor core biopsies in clinical trials; Evaluation of breast amyloidosis finds AL type most prevalent; Outside case review of surgical pathology for referred patients: impact on patient care; Reporting trends for right-sided hyperplastic and sessile serrated polyps; Atypical leiomyomas of the uterus: a clinicopathologic study of 51 cases; Pathological diagnostic criterion of blood and lymphatic vessel invasion in colorectal cancer

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Newsbytes, 11/13

November 2013—New connectivity standards nearly ready to roll; CAP and mTuitive create application for care of cancer patients; European firm purchases Centricity LIS from GE; NovoPath offers Citrix platform for AP system; AHRQ tool focuses on lab test processes in medical offices; Brazilian hospital selects Cerner system

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From the President’s Desk: PT for the passionate and the savvy, 11/13

November 2013—PT for the passionate and the savvy I believe that most pathologists and laboratory professionals enjoy refining systems and processes to further promote quality practices in their laboratories. We may not think about discipline and precision when somebody mentions passion, but passion is what those inclinations represent. While passionate pathology can manifest in a host of ways, this month I’d like to talk about how it drives excellence in CAP Surveys or proficiency testing (PT) programs.

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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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Q & A, 10/13

October 2013—We are standardizing procedures across our system. In thrombocytopenic patients with low platelet counts, some sites perform manual platelet counts using the Unopette system; others perform slide estimates to confirm an automated count. The need for improved turnaround times and greater accuracy and precision is clear. Are there studies that have evaluated the true accuracy of a low platelet count via a manual dilution technique versus the many automated techniques, and is there a true value in performing the time-consuming manual platelet count?

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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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From the President’s Desk: It’s our teammates who matter most

September 2013—Cross-country runners train for terrain and endurance. Downhill routes require biomechanical adaptations because the runners must anticipate and adjust for sudden rocks in the road or lack of traction. While there is time to plan around threats on an uphill route, threats to safety or stability in a downhill race may manifest too late for avoidance strategies. Agility matters.

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Put It on the Board, 9/13

September 2013—FDA clears Vitek MS: BioMérieux has been granted FDA 510(k) de novo clearance for Vitek MS, the first clinical mass spectrometry MALDI-TOF-based system available in the U.S. for rapid identification of disease-causing bacteria and yeast. To gain FDA clearance, BioMérieux submitted data from a multi-center study consisting of 7,068 clinical isolates.

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From the President’s Desk: Workforce advocacy: everyone’s job

August 2013—Many people don’t know what we pathologists do. This is concerning, especially when some of the same people are responsible for determining levels and allocation of funding for graduate medical education, keeping our training programs open, or encouraging careers in pathology. I hope this column ignites a sense of urgency around funding for pathology training and recruiting a strong workforce, for without both our patients will suffer an indefensible loss.

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Anatomic Pathology Selected Abstracts, 8/13

August 2013—Endometrium as a primary site of origin of pelvic high-grade serous carcinoma in BRCA1 or BRCA2 mutation carriers; Criteria and pitfalls in diagnosis of lymphovascular invasion in prostatectomy specimens; An interobserver study of reproducibility in subtyping pulmonary adenocarcinomas; Value of PAX8, PAX2, claudin-4, and h-caldesmon in identifying peritoneal epithelioid mesotheliomas; Clinicopathologic study of cutaneous digital papillary adenocarcinoma;

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Newsbytes, 8/13

August 2013—From pathologist to IT professional: a telling of five tales: Many people wear more than one hat in life, but rarely are they employed as both a hospital’s pathologist and information technology professional—consecutively or simultaneously. Only a select group has donned both chapeaux.

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Put it On the Board, 7/13

July 2013—The FDA approved Abbott’s hepatitis C virus genotyping test for use in the United States. The RealTime HCV Genotype II test differentiates genotypes 1, 1a, 1b, 2, 3, 4, and 5 and is run on the automated m2000 platform. Gavin Cloherty, PhD, Abbott Molecular’s director of scientific affairs, told CAP TODAY the test has a 99.5 percent accuracy relative to sequencing and a greater than 99 percent discrimination of HCV genotype 1 subtype 1a versus 1b. Time to result for 22 samples and two controls, he said, is 5.25 hours, with 30 minutes hands-on time.

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Anatomic Pathology Selected Abstracts, 7/13

July 2013—Intraoperative pathologic examination in the era of molecular testing for differentiated thyroid cancer: Diagnostic thyroidectomy is typically indicated for indeterminate thyroid cytology results. Traditionally, intraoperative pathologic examination (IOPE) helped guide the extent of initial surgery. Preoperative molecular testing of fine-needle aspiration cytology has emerged as another diagnostic adjunct, is highly specific for thyroid cancer, and can lead to appropriate initial total thyroidectomy.

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Clinical Pathology Selected Abstracts, 7/13

July 2013—Risk factors for first venous thromboembolism around pregnancy: Venous thromboembolism is a serious maternal complication occurring at a rate of one to two per 1,000 maternities during pregnancy and the puerperium. Venous thromboembolism (VTE) is a leading cause of maternal mortality in developed countries and an important source of morbidity in the form of post-thrombotic syndrome.

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From the President’s Desk: Now and Future Policy Agenda

June 2013—My father and his brother were teenagers when they found steerage on a ship to the United States in 1910. They arrived with neither English nor assets but with a firm belief that this democracy would provide opportunity. My father completed high school, college, and medical school under difficult circumstances; the long effort gave shape to his hopes. He became a physician who loved his work. We absorbed by osmosis the satisfactions of a life devoted to thoroughly unreasonable goals. I still believe what we learned then: In this country, effort that is intentional and persistent will be respected and rewarded.

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Newsbytes, 6/13

June 2013—Clinical IT help desks bring service to new level; PathCentral introduces plug-and-play AP system; ONC guideline addresses transition of care under meaningful use criteria; Laboratory systems certified as electronic health record modules

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Anatomic Pathology Selected Abstracts, 6/13

June 2013—Prolonged cold ischemia time and ER immunohistochemistry in breast cancer: To aid detection of estrogen receptor expression in breast tumors, the American Society of Clinical Oncology and College of American Pathologists recommend that cold ischemia time be kept under one hour. However, data to address the upper threshold of cold ischemia time are limited.

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Clinical Pathology Selected Abstracts, 6/13

June 2013—Ehrlichiosis is a tick-borne disease that may be asymptomatic or result in fatal sepsis. Ehrlichiosis transmitted from transfusion of blood products has not been documented. A case report of a 9-year-old Georgia boy with a history of acute lymphoblastic leukemia is the first report of Ehrlichia ewingii infection transmitted by a platelet transfusion. The authors first describe the patient as presenting to the hospital with complaints of fever, fatigue, malaise, vomiting, diarrhea, and petechial rash.

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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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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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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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Put it On the Board, 4/13

April 2013—ACMG issues guidance on incidental findings: The American College of Medical Genetics and Genomics released last month its recommendations for reporting incidental findings in clinical exome and genome sequencing. An ACMG working group, working with 15 experts who served as external reviewers, specifies a set of disorders, the relevant associated genes, and certain categories of variants that should be reported, based on a consensus-driven assessment of clinical validity and utility.

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Newsbytes, 4/13

April 2013—Computing for Good project proving great for African labs; Cerner purchases Labotix Automation, PureWellness; Six health IT companies forge interoperability organization; Liaison Technologies acquires Ignis Systems; Psyche Systems offers new LIS and updates another; AP-Visions marketing LIS to small hospitals and POLs; HL7 releases intellectual property as free offering

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Anatomic Pathology Selected Abstracts, 4/13

April 2013—Preoperative diagnosis of benign thyroid nodules with indeterminate cytology: Approximately 15 percent to 30 percent of thyroid nodules evaluated by fine-needle aspiration are not clearly benign or malignant. Patients with cytologically indeterminate nodules are often referred for diagnostic surgery, though most of these nodules prove to be benign.

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Clinical Pathology Selected Abstracts, 4/13

April 2013—Variant of TREM2 associated with risk of Alzheimer’s disease: Alzheimer’s disease is the most common form of dementia in the elderly. The disease is characterized by the formation of extracellular amyloid plaques, intracellular neurofibrillary tangles, and loss of neurons, which results in brain atrophy and progressive loss of cognitive function.

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Put it On The Board, 3/13

March 2013—FDA clears ALK automated gene scanner; precision medicine center at Weill Cornell, NY-Presbyterian; sequence-based system cleared for HLA typing; Abbott to collaborate on companion CLL test; Cepheid, OHSU to develop oncology assays for Xpert; Clarient adopts Qiagen KRAS; test could reduce number of repeat biopsies; and Ventana, Biocare sign p63 license agreement.

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Anatomic Pathology Selected Abstracts, 3/13

March 2013—Immunohistochemical assay versus Oncotype DX qRT-PCR assay for estrogen and progesterone receptors; accuracy and precision of endometrial intraepithelial neoplasia diagnosis; histologic patterns and molecular characteristics of lung adenocarcinoma; MicroRNA expression profiling as a diagnostic tool for thyroid cancer; inflammation and preneoplastic lesions in benign prostate as risk factors for prostate cancer; and reclassification of serous ovarian carcinoma using a two-tier system.

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From the President’s Desk: Transformational practice—2 in spotlight

February 2013—A National Football League playoff game was on the ceiling monitor in the airport lounge where I was trying to work on this column, and the announcer was talking about how well they were moving the ball. My first reaction was that he sounded awfully excited for a guy with only one ball to move. Maybe he should come to work at the CAP and see what real excitement is.

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Clinical Pathology Selected Abstracts, 2/13

February 2013—Outcome of patients who refuse transfusion after cardiac surgery: Jehovah’s Witness patients may refuse blood transfusion, due to religious beliefs, following cardiac surgery. Strategies to conserve blood for such patients may include the preoperative use of erythropoietin, iron, and B-complex vitamins, as well as hemoconcentration; intraoperative use of antifibrinolytics and cell-saver and smaller cardiopulmonary bypass circuits; and tolerance of low hematocrit levels postoperatively.

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Anatomic Pathology Selected Abstracts, 2/13

February 2013—BRCA1 and BRCA2 mutations, TP53 abnormalities, and immune cell infiltrates in ovarian carcinoma; Significance of loss of ARID1A/BAF250a expression in endometriosis; Relationship between pathologic complete response and prognosis after chemotherapy in breast cancer subtypes; Determining HER2 status on breast core-needle biopsies; Use of MiTF in differentiating cellular neurothekeoma from plexiform fibrohistiocytic tumor; A study of genetic heterogeneity in HER2/neu testing by FISH

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Newsbytes, 2/13

February 2013—Subspecialty no more—integrating informatics; PathCentral sells diagnostic laboratory business; ONC asks labs about health information exchange; EMR module from Psyche addresses meaningful use; NetLims to release new version of lab system; Online database addresses meaningful use measures

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Put It on the Board, 2/13

February 2013—An estimate of specimen identification error; Cepheid CT/NG test classified as moderate complexity; ARUP to offer Oncimmune early-stage lung cancer test; Hologic test cleared for detecting GI pathogens; IntelligentMDx to develop tests for Qiagen platform; Latest lab vacancy data in

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Newsbytes, 1/13

January 2013—Obtaining buy-in for an information systems buy; 2012 Best in KLAS Awards: Siemens laboratory system a winner once again; Apollo and ClearData team up on cloud-based offering; Alternative meaningful use criterion for reporting laboratory results; HHS posts information on mobile device security

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