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February 2014

Breast cancer answers, short and long

February 2014—When it comes to breast cancer, medical oncologists have two “wish lists” for their pathologist colleagues. Here’s the short list of test results they need when they sit down with a patient, courtesy of Melody Cobleigh, MD. “ER, PR, HER2,” says Dr. Cobleigh, professor of medicine and the Brian Piccolo Chair for Cancer Research, Rush University Medical Center, Chicago. It’s a direct, unassailable answer. But so, too, is saying that the assassination of the Archduke Ferdinand caused World War I.

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Diabetes debate: HbA1c or glucose?

February 2014—If it were a boxing match, the debate over whether hemoglobin should be used to diagnose diabetes would place the odds-on favorite in the “Yes” corner. In the “No” corner would be the underdog. At least based on the mainstream consensus since 2010, HbA1c for diagnosis is well established as an alternative to measuring glucose.

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Powering down on excessive test use

February 2014—Utility companies can generate electricity in many ways—fossil fuel, nuclear reaction, solar panel, wind turbine. Which power source is preferable depends on the circumstances and the work that needs to be done. Generating optimal laboratory utilization is much the same. Providing an efficient and effective combination of tests for diagnosing hematologic neoplasms requires a different approach from achieving appropriate repeat ordering of chemistry tests in ICU patients. Delivering only the necessary blood components to cardiovascular surgery patients may take different tactics from curbing orders of expensive molecular genetic send-out tests.

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Handling a reagent recall, step by strenuous step

February 2014—Recalling a reagent is about more than just removing a product from laboratory shelves. It’s about retracting test results and thus affecting diagnoses and treatment plans. It’s about questioning patient outcomes and revisiting past decisions. “So much of what laboratories do is central to making a diagnosis and determining treatment,” says John Harbour, MD, regional medical director of HealthPartners Laboratories, medical director of the Bon Secours St. Mary’s Hospital Laboratory, and president of Monument Pathologists Inc., Richmond, Va.

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IT drives clinical, financial gains in hospital labs

February 2014—For “quants”—people who love all things numeric or algorithmic—information technology is its own reason for being. But for those with responsibility for clinical outcomes and the bottom line in the clinical laboratory, IT is much, much more. Innovative uses of IT are providing myriad new solutions with measurable paybacks in quality improvement and cost reduction.

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2013 statement on human papillomavirus DNA test utilization

February 2014—The Cytopathology Education and Technology Consortium in 2009 issued a statement on human papillomavirus DNA test utilization that was published in multiple journals. This statement was a concise summary of the clinical indications for high-risk or oncogenic HPV testing based on guidelines of the American Society for Colposcopy and Cervical Pathology and the American Cancer Society published from 2002 through 2007. These organizations have since published newer consensus guidelines addressing HPV testing, and the previous summary no longer reflects current screening and management guidelines.

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Testing the test—ABP administers pilot part 3 MOC exam

February 2014—All primary and subspecialty certificates that the American Board of Pathology issues are now time limited, and diplomates must successfully participate in the ABP’s Maintenance of Certification, or MOC, program to maintain certification. Part three of the four-part MOC program is the evaluation of cognitive expertise, which consists of a secure examination that assesses a diplomate’s pathology-specific knowledge, judgment, and skills.

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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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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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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, 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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