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August 2013

Risk, compliance, pay—a juggling act for labs

August 2013—Theatergoers don’t want to see theunderstudy. Passengers don’t want to encounter a series of “flight delayed” messages on the departures board. And while it may not be every laboratory’s worst nightmare, no pathologist wants to open a letter from a government agency or payer that starts out, “It has come to our attention,” followed with words like “violation” and “false claim.”

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Toolkit lets labs make the case for the right LIS

August 2013—In ancient Rome, the legions might gird for combat with a muscled cuirass, helmet, and greaves, and carry a pilum. But none of them ever had to confront a hospital system C-suite, with high-level executives whose titles start with “chief” deciding between a single, enterprisewide information system or a “best-of-breed” laboratory information system.

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AMP case report: A 48-year-old woman with endometrial cancer. Importance of screening for Lynch syndrome in patients with EC

August 2013—Lynch syndrome (LS) is an autosomal dominant syndrome that predisposes patients to multiple malignancies. LS has traditionally been thought of as a colorectal-cancer-dominated syndrome; however, the incidence of endometrial cancer in women with LS actually exceeds that of colorectal cancer. Here we report a case of a woman with metachronous colorectal cancer and endometrial cancer, with the goal of increasing awareness of the need to screen endometrial cancer patients for LS. Identifying these patients is important not only for the patient but also for other family members who would benefit from genetic counseling and surveillance for LS-associated malignancies.

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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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Checklists 2013: newborn screening and MALDI-TOF

August 2013—At CAP ’11, then president-elect Stanley Robboy, MD, sat at a table in a conference room. He didn’t know those seated with him but he and they started to chat. The conversation turned to Dr. Robboy’s goals for his upcoming presidential term, and a member from Saudi Arabia, Amal Saadallah, MD, PhD, proposed that newborn screening requirements be created for accreditation.

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Cytopathology and More | Cytologic-histologic correlation: And the answer is…

August 2013—You have a great gynecologic cytology case, a patient with atypical endometrial cells on Pap test that you believe might represent a low-grade endometrial adenocarcinoma, but it has been four weeks and you have had no feedback about the patient’s outcome. It seems as if there have been a lot of atypical endometrial cells on Pap tests lately. Could it be due to the implementation of a new liquid-based technology for Pap tests in your laboratory? Fortunately, your laboratory performs cytologic-histologic correlation monthly, so you ask the medical director if she has noticed any trends in the rate of atypical glandular cells, and what the corresponding biopsies have shown. To your relief, the patient had a biopsy showing low-grade endometrial carcinoma, and the laboratory statistics have shown only a slight increase in atypical glandular cells since the new technology was implemented. The medical director informs you that she has been recording these data as a special QA project to determine if the increase is due to over-interpretation of reactive glandular cells, because the technology enhances nuclear and cytologic details of glandular cells.

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Cytopathology and More | Managing abnormal screening results: highlights of new guidelines

August 2013—The field of cervical cancer screening saw many developments in 2012. In April last year, the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology published new guidelines for cervical cancer screening, most notably raising the age at which screening should begin, extending the interval between screening tests, and giving preference to simultaneous Pap and human papillomavirus co-testing in women ages 30 to 65.1 Almost simultaneously, the U.S. Preventive Services Task Force published similar screening guidelines.2 Then, in July, the CAP and ASCCP published the results of a joint project recommending a uniform Lower Anogenital Squamous Terminology (LAST).3 Finally, in September the ASCCP led a consensus conference of 23 participating organizations to update guidelines for managing abnormal cervical cancer screening test results. In April of this year, these updated guidelines were published simultaneously in the Journal of Lower Genital Tract Disease and Obstetrics and Gynecology.4,5

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Microbiology QA, measure for measure

August 2013—In the May 20, 2013 issue of the New Yorker, Google co-founder Sergey Brin is quoted as saying of Internet security: “In big corporations people don’t understand what security people do, for the most part, and no one pays attention to them unless something goes wrong. Frankly, a lot of companies aren’t that interested in security.”

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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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Q & A, 08/13

August 2013—What are considered best practices for tracking re-sult trending in the lab? We use hemoglobin running mean in our hematology department because it is built into the analyzer software. The chemistry department will have a difficult time applying moving averages without purchasing middleware.

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