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May 2017

Acute leukemia workups, from top to bottom

May 2017—Plenty can happen in five years. Just ask Cubs fans who watched their team leap from a 101-loss season in 2012 to a 103-win season in 2016 and a World Series title as the cherry on top. Or ask Daniel Arber, MD, who co-chaired a hefty new guideline—a half decade in the making—on diagnostic workup of acute leukemia. At the start of the project, “I think everyone going into it realized it was going to be a time-consuming, long process. But I don’t think anyone realized how long,” says Dr. Arber, professor and chair of pathology, University of Chicago, and the CAP co-chair for the guideline group.

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TLA in, volume up—micro labs take stock

May 2017—Rise of the Robots. Disruption. Humans Need Not Apply. “The Future of Work.” A flood of books and articles in the past several months make the argument that service industries in the U.S. hover on the brink of total automation and humans will have to figure out how to adapt. Forty-five years ago, when Michael R. Jacobs, MD, PhD, started in microbiology, people fantasized about microbiology reaching this stage.

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Whole slide imaging for primary diagnosis: ‘Now it is happening’

May 2017—When the Food and Drug Administration granted permission to Philips to market its whole slide imaging system for primary diagnosis last month, it was a “big deal” of the highest order. “Yes, this is a very big deal,” says Liron Pantanowitz, MD, a professor of pathology and biomedical informatics at the University of Pittsburgh Medical Center. “This event will provide the impetus to drive digital pathology forward for clinical use in the U.S., and allow us to catch up with our colleagues around the world who are ahead of us in their digital transformation journey.”

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Study ‘opens the door’ to troponin, diabetes link

May 2017—Clinicians and laboratories have only begun to wade into the depths of the FDA’s long-awaited clearance of a new-generation, high-sensitivity cardiac troponin T (hs-cTnT) assay for rapid diagnosis of acute myocardial infarction. Roche’s Elecsys TnT Gen 5 STAT assay received just such clearance in January. Yet researchers are already deep into investigations that may float new opportunities for high-sensitivity troponin T testing to the surface of medical diagnostics.

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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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In memoriam: Richard E. Horowitz, MD | 1931–2017

May 2017—Richard E. Horowitz, MD, a member of the CAP Board of Governors from 1997 to 2000, died March 15 at age 85 of complications from lung cancer. Dr. Horowitz is a past member of the CAP’s House of Delegates and the CAP’s Practice and Education, Government Affairs, and Public Affairs councils. He was chair of the Outcomes and Performance Measures committees and a longtime member of the Committee on Computerized Laboratory Systems. He was a member, vice president, and president of the CAP Foundation Board of Directors.

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In flu season management, POC molecular to the fore

May 2017—Stacked against some of the nation’s previous bouts with influenza—such as the 2014–15 season—the 2016–17 flu season didn’t break records for drama. To be sure, every flu season is different, and regional variation was prominent. In Central Texas, some outbreaks appeared to start later than usual, but the dominant viruses were the same as last year’s—H1N1, H3N2, and influenza B—says Bob Fader, PhD, chief of the virology and microbiology laboratory at Baylor Scott & White Health, Temple, Tex. The strains identified were a good match with this year’s trivalent and quadrivalent vaccine. Testing volume was up, as were positive PCRs.

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How billing systems profit from analytics and automation

May 2017—The laboratory financial systems of yesteryear were built to deliver on a prime directive: achieve optimal, timely payment. Fast-forward to today and the overriding goal remains largely the same, but the means to the end has become more sophisticated, with billing/accounts receivable/revenue cycle management systems providing capabilities to recover outstanding payments, pinpoint reimbursement bottlenecks, and deliver a diverse range of data.

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For C. difficile, lab assessment alone is not enough

May 2017—Toxigenic Clostridium difficile can be isolated in about one-third of hospital rooms in which there is no patient with C. diff infection, and the same is seen in the community. A study published in 2014 found that 32 percent of the samples obtained from 30 houses in Houston were culture-positive for toxigenic C. diff. And C. diff was isolated from 83 percent of the houses.

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No perfect approach to detecting C. diff infection

May 2017—With Clostridium difficile causing a wide range of infectious manifestations, the dilemma for clinical laboratories is how to balance the different diagnostic options. “Because if you’re treating someone who is only colonized, you’re not going to benefit them—and very likely you may harm them,” said Ferric C. Fang, MD, professor of laboratory medicine, Department of Microbiology and Medicine, University of Washington School of Medicine, Seattle, in a recent webinar hosted by CAP TODAY and sponsored by BioFire. And having a negative toxin assay is no assurance, he said, that C. difficile is not causing disease.

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Cytopathology in Focus: More aggressive follow-up for patients with AGC?

May 2017—The most recent edition of the Bethesda System for Reporting Cervical Cytology classifies glandular cell abnormalities into the following broad categories: atypical (specify favored site of origin), atypical (favor neoplastic), endocervical adenocarcinoma in situ (AIS), and adenocarcinoma.1 Generic terminology of “atypical glandular cells (AGC)” may be used if the origin of the cells cannot be determined with certainty. Nevertheless, the Bethesda System encourages pathologists and cytotechnologists to report the favored site of origin (endometrial versus endocervical) whenever possible.

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Cytopathology in Focus: Integrating cytology samples into molecular testing of tumors

May 2017—Use of cytology specimens for molecular testing can spare patients from repeated or more invasive procedures. A two-part special section in recent issues of Archives of Pathology & Laboratory Medicine highlights a variety of applications of molecular techniques in cytopathology specimens. The articles in this section cover laboratory workflow issues, considerations for the preparation of cell blocks, application of immunoperoxidase staining and FISH to cytology specimens, and specific applications of molecular testing in thyroid and lung specimens.

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Cytopathology in Focus: Paris System for urinary cytology: why and where now

May 2017—It is well known that examination of urine dates back to antiquity, but it wasn’t until the 19th century that cancer cells were microscopically documented in urine, by Hermann Lebert in 1845 and Vilem D. Lambl in 1856. Over many decades, countless talented and noteworthy authors have contributed valuable observations and conceptual mechanisms to the study of urinary cytology, but a systematic, universally accepted, internationally recognized system with clear goals was missing.

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New autopsy book ‘a complete learning experience’

May 2017—Autopsy Performance & Reporting is a new book from CAP Press, released in April. The editor, Kim A. Collins, MD, and her 43 contributors wrote 40 chapters on facility design, safety, high-risk cases, the oral cavity, the placenta, the pediatric autopsy, special studies of the heart and lungs, postmortem microbiologic testing, photomicrography, and much more. “I know of no other autopsy book like this on the market,” Dr. Collins tells CAP TODAY.

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Pregnancy-related death: Hepatic System

The chapter in Autopsy Performance & Reporting titled “Pregnancy-Related Death and the Autopsy Examination” is written by Cynthia Schandl, MD, PhD, of Medical University of South Carolina. Here from that chapter is an excerpt (published without references) on the hepatic system. Dr. Schandl’s chapter also covers the cardiovascular, respiratory, hematopoietic, urogenital, and endocrine systems, as well as the gastrointestinal tract and skin and connective tissue.

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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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