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August 2017

Making it personal: transgender medicine

August 2017—Talk about personalized medicine. While the national discussion about transgender women and men often pivots on civil rights legislation (exhibit A: so-called bathroom bills), the medical community has quietly begun to ask questions about how to provide care for transgender patients. In the process, assumptions are being turned sideways. And as laboratory professionals are realizing, the impact can affect everything from start (patient identification, test ordering) to finish (test results, billing), seemingly one patient at a time.

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A slimmer molecular micro section among changes to checklists

August 2017—There was no trip to the spa. But some sections of the 2017 edition of the CAP Laboratory Accreditation Program checklist are looking trimmed and toned compared with last year’s checklists. A microbiology section that is shorter by eight pages, fewer Individualized Quality Control Plan reporting requirements, and a new section addressing chain of custody once again reflect the hard work of the Checklists Committee and scientific resource committees to achieve conciseness and clarity.

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In digital age, new focus on specimen, slide prep

August 2017—The age of FDA-approved whole slide imaging for primary diagnosis has dawned with opportunity for every level of professional who works in the digital pathology environment. It includes not only an expanded professional cachet but also great potential born of collaborative and remote capabilities, and perhaps better patient outcomes as a result.

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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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Ownership remix as hospitals, national labs jockey for position

August 2017—In the game of Risk, dominating the board hinges not only on clever strategy but also on rolls of the dice. In the real-world game that is the enormous laboratory market, there is a parallel: Rationally calculating the profitability and risk of mergers or acquisitions is crucial, but many such business moves involve a gamble. Right now, the main thing the laboratory industry appears to be betting on is upheaval.

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AMP case report: NGS panel aids in diagnosis of rare collision tumor, August 2017

August 2017—CAP TODAY and the Association for Molecular Pathology have teamed up to bring molecular case reports to CAP TODAY readers. AMP members write the reports using clinical cases from their own practices that show molecular testing’s important role in diagnosis, prognosis, and treatment. The following report comes from Columbia University Medical Center. If you would like to submit a case report, please send an email to the AMP at amp@amp.org. For more information about the AMP and all previously published case reports, visit www.amp.org.

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Laboratory director duties clarified in 2017 checklist

August 2017—Quantum theory is often interpreted to mean an object can be in two places simultaneously. Unfortunately, quantum theory doesn’t apply to laboratory directors, at least not on a scheduling level. Like the rest of us, directors can be in only one place at a time, no matter how many laboratories they oversee. Now a change to the CAP Laboratory Accreditation Program’s checklists will clarify expectations for directors who are in charge of more than one laboratory. The 2017 edition of the checklists, released this month, has eliminated the specific requirements for laboratory directors who are not on site full time and has clarified responsibilities for all directors, on site or remote.

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Cytopathology in Focus: Cell Blocks: Getting the most from the least invasive method

August 2017—Adequate and high-quality cell block preparations can be a useful adjunct to cytologic smear preparations and touch imprint cytology. Adequate cell blocks allow for additional studies and can provide a specific diagnosis and information essential for targeted treatment plans. Cell blocks can be prepared from most cytology specimens such as fine needle aspirations, body cavity fluids, washings, brushings, and gynecologic and nongynecologic liquid-based specimens.

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Cytopathology in Focus: Closing cytopathology, cytotechnology practice gaps—three years later

August 2017—The CAP has focused during the past 10 years on facilitating the transformation of pathology practices from the instrumentation age to the information age, with a concentration on personalized medical care and laboratorians as integral members of the health care team. Hand-in-hand with that effort, the CAP Cytopathology Committee has advocated for the expanded use of cytology specimens in molecular diagnostics and the evolution of the cytotechnology workforce to meet the emerging practice gaps as pathologists become engaged in ever more complex diagnostic processes.

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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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