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September 2013

Q & A, 9/13

September 2013—Our clinicians are asking about testing for IgG4-related disease. What role does IgG4 immunohistochemical staining play? IgG4-related disease is a recently recognized fibroinflammatory condition that may affect a wide variety of organ systems, producing mass lesions and generally responding to immunosuppressive therapy. The pancreas, salivary/lacrimal glands, and kidney are frequently affected, but almost any tissue may be involved, including aorta, pleura, retroperitoneum, and lymph nodes.

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Anatomic Pathology Selected Abstracts, 9/13

September 2013—Quantification of the Ki67 proliferative index in neuroendocrine tumors of the gastroenteropancreatic system; Clinicopathologic and immunohistochemical study of intrapulmonary SFTs; Papillary mucinous metaplasia of the endometrium as a precursor of endometrial mucinous adenocarcinoma; Expression of miRNAs and PTEN in endometrial specimens; Molecular investigation of lymph nodes in colon cancer patients using OSNA; Thymidylate synthase expression and molecular alterations in adenosquamous carcinoma of the lung; Microdensitometry of osteopontin as a prognostic biomarker in colorectal carcinoma tissue microarrays; Evaluation of pathological and molecular features in clinically aggressive dermatofibromas; Interobserver agreement in the reporting of colorectal polyp pathology by bowel cancer screening pathologists

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Cancelled lab tests—study analyzes why

September 2013—A handful, a fraction of a percent, a tiny portion. In most institutions, that’s about how many tests are cancelled after they’ve been ordered and a specimen has been sent to the laboratory. But even that small number can have significant quality implications. The authors of the Q-Probes study, ”Reasons for Test Cancellation,” looked at more than a million specimen accessions at several dozen institutions, to get a fix on why tests are being cancelled and to gain insight into how laboratories can bring that number down. As the study makes clear, there is definitely room for improvement.

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With molecular testing, better infection control

September 2013—Rapid and accurate molecular assays have gradually infiltrated the field of bacterial diagnosis. For several potentially lethal nosocomial pathogens—Clostridium difficile, vancomycin-resistant enterococcus, Mycobacterium tuberculosis, and methicillin-resistant Staphylococcus aureus—FDA-approved molecular assays are making a difference. Not only have they improved the accuracy of diagnosis, benefiting patients and clinicians, they have also been a boon to infection control practitioners.

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AMP case report: aCGH as a diagnostic aid in a childhood Spitzoid melanoma

September 2013—CAP TODAY and the Association for Molecular Pathology have teamed up to bring molecular case reports to CAP TODAY readers. Here, this month, is the third such case. (See the February 2013 issue for the first, on multilocus sequencing for rapid identification of molds, and last month’s issue for the second, on the importance of screening for Lynch syndrome in patients with endometrial cancer.) 

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Letters, 9/13

We read with interest your article in the June issue, “To reduce UTIs, one lab takes a long, wide look.” We strongly agree that there is inappropriate prescribing of antibiotics for patients whose urine cultures are reported with organism identification and antibiotic susceptibilities but who do not have urinary tract infection. This is because many physicians send urine for culture inappropriately and then equate a positive result with infection; they believe that these laboratory tests are diagnostic for UTI.

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A pathologist’s observations about in-office AP labs

September 2013—With the GAO reporting that self-referral of anatomic pathology and other services costs Medicare millions, and with legislation introduced Aug. 1 that would prohibit such self-referrals, physician groups are fighting back, arguing that the exemptions allow for more integrated care. Not so, says pathologist Matthew Foster, MD, who shared what he’s observed about in-office AP labs in an Aug. 8 CAP online panel discussion. He is with Pathology Consultants of Central Virginia, an independent lab that provides services to Centra Health, a nonprofit hospital system serving a community of about 350,000. He is also associate medical director of the Alan B. Pearson Regional Cancer Center in Lynchburg. Dr. Foster’s edited remarks follow.

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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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MOC:PQRS incentive: what it is, how to earn it

September 2013—The Centers for Medicare and Medicaid Services has approved the American Board of Pathology for participation in the MOC:PQRS Additional Incentive Program. This approval allows ABP diplomates who are participating successfully in the PQRS incentive program to earn an additional 0.5 percent incentive payment on the total Medicare part B allowed charges for participating in MOC:PQRS in 2013.

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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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