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The American Journal of Surgical... Aug 2022Direct pathologist-patient encounters are infrequent, but there has been a modest movement toward such interactions in the past 2 decades. The present article places...
Direct pathologist-patient encounters are infrequent, but there has been a modest movement toward such interactions in the past 2 decades. The present article places that movement in perspective. It includes a discussion of diverse factors-including congressional laws, the views of department chairs, and progress in artificial intelligence-that could promote pathologist-patient interactions and also reviews factors that might deter such encounters.
Topics: Artificial Intelligence; Humans; Pathologists
PubMed: 35220353
DOI: 10.1097/PAS.0000000000001877 -
Abdominal Radiology (New York) Nov 2019Evaluation of primary rectal cancer specimens places the pathologist in a unique position relative to peers, as it is one of the few specimens where the report... (Review)
Review
Evaluation of primary rectal cancer specimens places the pathologist in a unique position relative to peers, as it is one of the few specimens where the report influences not just patient outcomes but also the quality of the surgical technique itself. With ever-increasing data indicating that the completeness of the mesorectal excision and adequate resection margins are critical for reduced local recurrence rates and improved clinical outcome, the pathologist is faced with the challenge of implementing methods to optimize the evaluation of primary rectal cancers.
Topics: Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Pathologists; Rectal Neoplasms
PubMed: 31327042
DOI: 10.1007/s00261-019-02134-9 -
Endocrine Pathology Mar 2023The effects of many pharmacological agents on thyroid function are well known. Direct influences on measurements of thyroid function tests are also described. However,... (Review)
Review
The effects of many pharmacological agents on thyroid function are well known. Direct influences on measurements of thyroid function tests are also described. However, certain classes of drugs produce morphological changes in the gland. This review focuses on the significance of the following drug classes for the thyroid pathologist: iodine, antithyroid drugs, psychotropic drugs, antibiotics, cardiotropic drugs, antidiabetic drugs, and immunomodulatory agents. Radioactive iodine initially induces mild histologic changes; however, the long-term effects include marked follicular atrophy, fibrosis, and nuclear atypia-changes that vary depending on the pre-therapy condition of the gland. Some psychotropic drugs have been associated with a spectrum of inflammatory changes throughout the gland. The tetracycline class of antibiotics, namely minocycline, can lead to a grossly black thyroid gland with pigment seen in both colloid and follicular epithelial cells while variably present within thyroid nodules. The surgical pathologist most commonly sees an amiodarone-affected gland removed for hyperthyroidism, and the histologic findings again depend on the pre-therapy condition of the gland. While GLP-1 receptor agonists carry an FDA black box warning for patients with a personal or family history of multiple endocrine neoplasia or medullary thyroid carcinoma, the C cell hyperplasia originally noted in rats has not borne out in human studies. Finally, thyroiditis and hypothyroidism are well known complications of checkpoint inhibitor therapy, and rare cases of severe thyroiditis requiring urgent thyroidectomy have been reported with unique histologic findings. In this review, we describe the histologic findings for these drugs and more, in many cases including their functional consequences.
Topics: Humans; Animals; Rats; Iodine Radioisotopes; Pathologists; Thyroid Neoplasms; Thyroiditis; Anti-Bacterial Agents; Iodine
PubMed: 36723855
DOI: 10.1007/s12022-023-09749-1 -
Pathologica Feb 2022Children are not simply miniature adults. The evaluation of their gastrointestinal disorders is therefore different from that in full-grown adults and requires a... (Review)
Review
Children are not simply miniature adults. The evaluation of their gastrointestinal disorders is therefore different from that in full-grown adults and requires a particular clinical/pathologic approach. Different studies have tried to assess the normal eosinophil distribution in the gastrointestinal tract in adults while very few studies have investigated the paediatric population, consequently complicating the pathologist's ability in identifying an abnormal number of eosinophils in this setting of patients. When evaluating gastrointestinal tract biopsies with eosinophilia, eosinophilic count must be considered along with other histological features like eosinophil distribution in the gastrointestinal wall, their degranulation, cryptitis and crypt abscesses, other accompanying inflammatory cells, apoptotic bodies, foreign material or microorganisms; these findings, although rarely specific, may be a useful aid for diagnosis. Reports should not include a diagnosis of primary eosinophilic gastrointestinal disorders (EoGID) if clinical data and test results do not rule out other forms of gastrointestinal eosinophilia. A more descriptive definition like "with eosinophilic pattern" should be favoured over a specific diagnosis of "eosinophilic disorder" in order to avoid potential confusion between different entities.
Topics: Child; Enteritis; Eosinophilia; Eosinophils; Gastritis; Humans; Pathologists
PubMed: 35212318
DOI: 10.32074/1591-951X-734 -
Archives of Pathology & Laboratory... Feb 2019
Topics: Humans; Pathologists
PubMed: 30673307
DOI: 10.5858/arpa.2018-0365-ED -
Archives of Pathology & Laboratory... Aug 2023With the adoption of Epic/Beaker at our institution, surgical pathology specimens are assigned a Current Procedural Terminology (CPT) charge code at the time of... (Review)
Review
CONTEXT.—
With the adoption of Epic/Beaker at our institution, surgical pathology specimens are assigned a Current Procedural Terminology (CPT) charge code at the time of accessioning, and pathologists have been made responsible for verifying the accuracy of the code before signing out the case.
OBJECTIVE.—
To determine with what frequency attending pathologists reassigned the correct charge code to a specimen when the code assigned at accessioning was incorrect, as well as to estimate the potential financial impact of missed changes.
DESIGN.—
We reviewed all specimens received for frozen section during a 7-month period, identified specimens where the default charge code that our departmental protocol assigns at frozen section (88305) was incorrect, and assessed the rate of successful code change by pathologists and the potential financial cost of each missed change.
RESULTS.—
Three hundred fifty-two of 2191 frozen section specimens (16%) required a change in the 88305 charge code. The codes for 195 specimens (55%) were correctly changed by the attending pathologist, while 157 (45%) were not changed (149) or were changed to an incorrect charge code (8). Individual pathologist change rates ranged from 0% to 100%, with a mean and median change rate of 43% and 24%, respectively. Using average code reimbursements at our institution, the loss in revenue from the 157 missed and incorrect frozen section changes was estimated at $13 788 ($1970 per month).
CONCLUSIONS.—
Pathologists showed highly variable rates of correcting CPT charge codes when the incorrect code had been previously assigned to a case, with associated loss of revenue from missed and incorrect code changes.
Topics: Humans; Frozen Sections; Pathologists; Pathology, Surgical
PubMed: 36287188
DOI: 10.5858/arpa.2022-0158-OA -
Archives of Pathology & Laboratory... May 2019As part of its value-based care initiative, the College of American Pathologists has pursued research to better understand the role pathologists can have in population... (Review)
Review
CONTEXT.—
As part of its value-based care initiative, the College of American Pathologists has pursued research to better understand the role pathologists can have in population health.
OBJECTIVES.—
To answer the following questions: (1) what is the impact of population health and population health management on pathologists; (2) what roles are pathologists playing in population health management; (3) is population health something that pathologists in both larger and smaller settings can engage in; (4) are pathologists in a position to analyze laboratory data for population health, and, if so, what are the key information sources those pathologists must access; and (5) what steps can a pathologist take to become involved in population health?
DESIGN.—
We conducted 10 semistructured interviews with pathologists and other medical laboratory leaders who have been active in population health. These interviews were supplemented with a review of the medical literature.
RESULTS.—
Pathologists have demonstrated that laboratory data can provide unique value-added contributions to improving the health of populations. These contributions are not limited to pathologists in large, integrated settings. However, pathologists need to be proactive to contribute to health systems' population health efforts and may need to both enhance their own skills and the quality of their data to maximize the value of their contributions.
CONCLUSIONS.—
Although not necessarily a definitive summary of the roles that pathologists are playing in population health, this article identifies some of the promising and innovative activities occurring among pathologists and laboratorians.
Topics: Humans; Pathologists; Pathology, Clinical; Population Health
PubMed: 30398912
DOI: 10.5858/arpa.2018-0223-CP -
American Journal of Clinical Pathology Nov 2021
Topics: Humans; Pathologists; Physicians
PubMed: 34549266
DOI: 10.1093/ajcp/aqab040 -
Laboratory Investigation; a Journal of... Oct 2017Induced pluripotent stem cell (iPSC) technology was originally developed in 2006. Essentially, it converts somatic cells into pluripotent stem cells by transiently... (Review)
Review
Induced pluripotent stem cell (iPSC) technology was originally developed in 2006. Essentially, it converts somatic cells into pluripotent stem cells by transiently expressing a few transcriptional factors. Once generated, these iPSCs can differentiate into all the cell types of our body, theoretically, which has attracted great attention for clinical research including disease pathobiology studies. Could this technology then become an additional research or diagnostic tool widely available to practicing pathologists? Here we summarize progress in iPSC research toward disease pathobiology studies, its future potential, and remaining problems from a pathologist's perspective. A particular focus will be on introducing the effort to recapitulate disease-related morphological changes through three-dimensional culture of stem cells such as organoid differentiation.
Topics: Humans; Induced Pluripotent Stem Cells; Pathologists; Pathology, Clinical; Stem Cell Research
PubMed: 28759008
DOI: 10.1038/labinvest.2017.81 -
Clinical and Molecular Hepatology Feb 2023Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases characterized by fatty accumulation in hepatocytes, ranging from steatosis, non-alcoholic... (Review)
Review
Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases characterized by fatty accumulation in hepatocytes, ranging from steatosis, non-alcoholic steatohepatitis, to cirrhosis. While histopathological evaluation of liver biopsies plays a central role in the diagnosis of NAFLD, limitations such as the problem of interobserver variability still exist and active research is underway to improve the diagnostic utility of liver biopsies. In this article, we provide a comprehensive overview of the histopathological features of NAFLD, the current grading and staging systems, and discuss the present and future roles of liver biopsies in the diagnosis and prognostication of NAFLD.
Topics: Humans; Non-alcoholic Fatty Liver Disease; Liver; Pathologists; Liver Cirrhosis; Hepatocytes; Biopsy
PubMed: 36384146
DOI: 10.3350/cmh.2022.0329