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Archives of Pathology & Laboratory... Oct 2010Interest in pathologist-performed ultrasound-guided fine-needle aspiration is increasing. Educational courses discuss clinical ultrasound and biopsy techniques but not... (Review)
Review
CONTEXT
Interest in pathologist-performed ultrasound-guided fine-needle aspiration is increasing. Educational courses discuss clinical ultrasound and biopsy techniques but not ultrasound physics and instrumentation.
OBJECTIVE
To review modern ultrasound physics and instrumentation to help pathologists understand the basis of modern ultrasound.
DATA SOURCES
A review of recent literature and textbooks was performed.
CONCLUSIONS
Ultrasound physics and instrumentation are the foundations of clinical ultrasound. The key physical principle is the piezoelectric effect. When stimulated by an electric current, certain crystals vibrate and produce ultrasound. A hand-held transducer converts electricity into ultrasound, transmits it into tissue, and listens for reflected ultrasound to return. The returning echoes are converted into electrical signals and used to create a 2-dimensional gray-scale image. Scanning at a high frequency improves axial resolution but has low tissue penetration. Electronic focusing moves the long-axis focus to depth of the object of interest and improves lateral resolution. The short-axis focus in 1-dimensional transducers is fixed, which results in poor elevational resolution away from the focal zone. Using multiple foci improves lateral resolution but degrades temporal resolution. The sonographer can adjust the dynamic range to change contrast and bring out subtle masses. Contrast resolution is limited by processing speed, monitor resolution, and gray-scale perception of the human eye. Ultrasound is an evolving field. New technologies include miniaturization, spatial compound imaging, tissue harmonics, and multidimensional transducers. Clinical cytopathologists who understand ultrasound physics, instrumentation, and clinical ultrasound are ready for the challenges of cytopathologist-performed ultrasound-guided fine-needle aspiration and core-needle biopsy in the 21st century.
Topics: Artifacts; Biopsy; Biopsy, Needle; Electricity; Fibroadenoma; Humans; Neoplasms; Pathology; Periodicity; Physics; Sound; Ultrasonography
PubMed: 20923312
DOI: 10.5858/2009-0730-RA.1 -
Forensic Science, Medicine, and... Sep 2023The autopsy is considered the gold standard in death investigation. Performing an autopsy requires human and material resources that must be programmed in order to meet...
INTRODUCTION AND OBJECTIVES
The autopsy is considered the gold standard in death investigation. Performing an autopsy requires human and material resources that must be programmed in order to meet the demands of the judicial system. However, as far as we know, the cost of forensic autopsy in Spain has not been determined. Thus, the aim of this study was to estimate the cost of a standard autopsy in order to organise Forensic Pathology Services more efficiently.
MATERIAL AND METHODS
A micro-cost analysis was carried out. The nominal group technique was applied using a panel of 10 forensic experts in order to identify and quantify the resources associated with a forensic autopsy.
RESULTS
The results showed that analysis and studies are the most important item in the total cost (54.7%), followed by staff (20.5%), preservation of body (14%), single-use products (7%), equipment and stock (1.6%), cleaning and disinfection (1.5%), facilities maintenance (0.5%) and IT (0.2%).
CONCLUSIONS
The total cost of a standard autopsy was €1501.45, which is lower than the European average. This study is the first in Spain to calculate the unit price of a forensic autopsy by means of micro-cost analysis. This may help to address the way forensic pathology centres are organised at different levels of complexity.
Topics: Humans; Autopsy; Spain; Cause of Death; Forensic Medicine; Forensic Pathology
PubMed: 36342626
DOI: 10.1007/s12024-022-00534-w -
Journal of Clinical Pathology Nov 2015For several decades, immunohistochemistry (IHC), more specifically diagnostic IHC (dIHC), has been considered an art rather than a laboratory test. There was no clarity... (Review)
Review
For several decades, immunohistochemistry (IHC), more specifically diagnostic IHC (dIHC), has been considered an art rather than a laboratory test. There was no clarity about what test performance characteristics are relevant to dIHC, test performance characteristics were not fully defined for dIHC and partly as a consequence of that, there were no standardised controls or reference standards. Herein, we discuss the role of standardisation of external controls for test performance characteristics and the role of standardised controls and reference standards for overall standardisation of IHC.
Topics: Humans; Immunohistochemistry; Pathology, Clinical; Reference Standards
PubMed: 26286753
DOI: 10.1136/jclinpath-2014-202705 -
Diagnostic Microbiology and Infectious... Oct 2020Robust clinical specimen nucleic acid extraction instrumentation and methods are critical to the performance of downstream molecular diagnostics for the diagnosis of... (Review)
Review
Robust clinical specimen nucleic acid extraction instrumentation and methods are critical to the performance of downstream molecular diagnostics for the diagnosis of drug-resistant tuberculosis (DR-TB). Currently, there is a high level of interest in sequencing-based solutions for rapid and comprehensive DR-TB testing from primary specimens (i.e., sputum). However, there is no standardized or fully automated sputum extraction system that has been widely implemented for use with Mycobacterium tuberculosis complex-containing sputum specimens. For sequencing-based technologies to be widely adopted in clinical laboratory settings in low- and middle-income countries, automated extraction technologies will be important to enhance scalability and reliability and to standardize performance of the downstream assays. Additionally, the ease of automatic technologies allows for faster uptake in laboratories currently without the expertise or infrastructure to perform manual extractions at the same automated throughput. This work is intended to provide an initial specification comparison of available automated DNA extraction systems that could serve as front-end components for existing and future sequencing approaches and provide the framework for future evaluations.
Topics: Automation, Laboratory; DNA, Bacterial; Humans; Mycobacterium tuberculosis; Pathology, Molecular; Reproducibility of Results; Sequence Analysis, DNA; Sputum; Tuberculosis, Multidrug-Resistant
PubMed: 32623232
DOI: 10.1016/j.diagmicrobio.2020.115096 -
Indian Journal of Pathology &... May 2022Over the last three decades, skin punch biopsy has become the gold standard for diagnosis of small fiber neuropathies, including autonomic neuropathies commonly seen in... (Review)
Review
Over the last three decades, skin punch biopsy has become the gold standard for diagnosis of small fiber neuropathies, including autonomic neuropathies commonly seen in diabetics, patients with HIV, and children with hereditary sensory autonomic neuropathies and toxin-induced neuropathy. Clinical, biochemical, electrophysiological tests are inconclusive, making it difficult to diagnose and initiate treatment. A skin punch biopsy is easy to perform in the outpatient clinic, is highly sensitive, and provides an objective diagnosis. Importantly, it helps avoid performing invasive nerve biopsy in patients with small fiber neuropathy, thereby preventing complications such as non-healing of the biopsy site, which is common in these patients. Secondly, the greatest advantage of skin punch biopsies is that they can be repeated any number of times, unlike a nerve biopsy, and are useful to evaluate disease progression and therapeutic response. More recently, its use has been expanded to the diagnosis of large fiber neuropathies, inherited demyelinating neuropathies, etc., obviating the need for a nerve biopsy. The European Federation of Neurological Societies has published guidelines for evaluation to ensure uniformity with regard to the site of biopsy, processing, and quantification. The evaluation of the skin biopsy involves morphometric assessment of the intraepidermal nerve fiber density using PGP 9.5 immunostained sections by bright-field microscopy. This review focuses on the practical aspects of skin punch biopsy and its utility for the practicing pathologist.
Topics: Biopsy; Child; Humans; Nerve Fibers; Neuropathology; Peripheral Nervous System Diseases; Skin; Small Fiber Neuropathy
PubMed: 35562165
DOI: 10.4103/ijpm.ijpm_92_22 -
Biochemia Medica Feb 2017The complete blood count (CBC) is one of the most frequently requested tests in laboratory medicine, performed in a range of healthcare situations. The provision of an... (Review)
Review
The complete blood count (CBC) is one of the most frequently requested tests in laboratory medicine, performed in a range of healthcare situations. The provision of an ideal assay material for external quality assessment is confounded by the fragility of the cellular components of blood, the lack of commutability of stabilised whole blood material and the lack of certified reference materials and methods to which CBC results can be traced. The choice of assay material between fresh blood, extended life assay material and fully stabilised, commercially prepared, whole blood material depends upon the scope and objectives of the EQA scheme. The introduction of new technologies in blood counting and the wider clinical application of parameters from the extended CBC will bring additional challenges for the EQA provider.
Topics: Clinical Laboratory Techniques; Hematology; Humans; Medical Laboratory Science; Pathology, Clinical; Quality Assurance, Health Care; Quality Control; Surveys and Questionnaires
PubMed: 28392727
DOI: 10.11613/BM.2017.008 -
Romanian Journal of Morphology and... 2020In the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, healthcare workers are at high risk to be infected with this new coronavirus, particularly... (Review)
Review
In the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, healthcare workers are at high risk to be infected with this new coronavirus, particularly when they handle not only patients, but also their body fluids. In Romania, even though the protective measures to be used by medical staff in emergency departments, clinical departments, radiology departments, clinical laboratories and morgues services are well known, there is little information about the protection of medical staff in the laboratories of cytopathology and histopathology. In this article, we will discuss the transmission routes of the new coronavirus, the surfaces it could contaminate in a hospital, as well as the modalities of its inactivation. We will present some guidelines for preparing the pathology departments to face the pandemic situation like the present one. Also, we will point out some possible recommendations/suggestions for protective measures to be taken by laboratory staff during the cytological and histopathological procedures when they manipulate body fluids or surgical samples of patients with suspected or confirmed coronavirus disease 2019 (COVID-19). Laboratory personnel should be aware that any body fluid or surgical specimen that arrives in the laboratory may contain SARS-CoV-2 and, as such, they should act after new working procedures. We recommend restraint from performing extemporaneous examination (smear and frozen section) and cytopathological examination in laboratories that do not have adequate condition for handling and processing Hazard Group 3 (HG3) pathogens, as SARS-CoV-2. Also, laboratory personnel should pay attention to instruments, technical equipment, or environmental surfaces as these also can be contaminated with the new coronavirus.
Topics: COVID-19; Guidelines as Topic; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Laboratory Personnel; Pandemics; Pathology; Romania; SARS-CoV-2
PubMed: 34171056
DOI: 10.47162/RJME.61.4.09 -
Human Pathology Jan 1990We present an overview of our 6-year experience in the design of expert systems for anatomic pathology. Our practical goal is to help practicing pathologists with... (Review)
Review
We present an overview of our 6-year experience in the design of expert systems for anatomic pathology. Our practical goal is to help practicing pathologists with learning, teaching, and the task of diagnosis by providing them with dynamic expert knowledge by means of a personal computer. This project could only be undertaken by first addressing a scientific goal: to characterize the problem-solving strategies that expert pathologists use in making a diagnosis and to state them in the logical terms of computer science. Our approach has been to build systems first for experimentation and then for use. The result of our work is an integrated computer-based approach that handles expert knowledge as formal relationships and morphologic images and that uses a number of logical strategies to provide multiple perspectives on diagnostic tasks. Configured as a pathologist's workstation, this approach can be expected to enhance the performance of trained general pathologists and pathologists in training. Lymph node pathology has been used as the prototype domain for this research, but care has been taken to seek a generalized authoring and inference structure that can be applied to other areas of pathology by changing the contents but not the structure itself. Excursions into various surgical pathology specialties suggest that the ways the system is constructed and exercised is fundamentally robust. Such computer-based expert systems can be expected to generate a new standard in the practice of pathology--based on the "gold standard" of classical morphology, but including the coordinated use of new methods from immunology and molecular biology in a multidisciplinary approach to diagnosis when these techniques are relevant. The benefits from this technology can be expected to be widespread with the evolution, refinement, and diffusion of these systems.
Topics: Artificial Intelligence; Diagnosis, Computer-Assisted; Expert Systems; Humans; Pathology, Surgical; Software; Video Recording; Videodisc Recording
PubMed: 2403974
DOI: 10.1016/0046-8177(90)90071-c -
Journal of Cancer Research and... 2020Pathologists have been using their tool of trade, "the microscope," since the early 17 century, but now diagnostic pathology or tissue-based diagnosis is characterized... (Review)
Review
Pathologists have been using their tool of trade, "the microscope," since the early 17 century, but now diagnostic pathology or tissue-based diagnosis is characterized by its high specificity and sensitivity. Technological telecommunication advances have revolutionized the face of medicine, and in pursuit of better health-care delivery, telepathology has emerged. Telepathology is the practice of diagnostic pathology performed at a distance, with images viewed on a video monitor rather than directly through the (light) microscope. This article aims to provide an overview of the field, including specific applications, practice, benefits, limitations, regulatory issues, latest advances, and a perspective on the current status of telepathology in Indian scenario based on literature review.
Topics: Computer Systems; Education, Medical, Continuing; Humans; India; Microscopy, Video; Remote Consultation; Telepathology
PubMed: 32930106
DOI: 10.4103/jcrt.JCRT_477_17 -
Analytical Cellular Pathology... 2012In pathology, histological examination of the "gold standard" to diagnose various diseases. It has contributed significantly toward identifying the abnormalities in... (Review)
Review
In pathology, histological examination of the "gold standard" to diagnose various diseases. It has contributed significantly toward identifying the abnormalities in tissues and cells, but has inherent drawbacks when used for fast and accurate diagnosis. These limitations include the lack of in vivo observation in real time and sampling errors due to limited number and area coverage of tissue sections. Its diagnostic yield also varies depending on the ability of the physician and the effectiveness of any image guidance technique that may be used for tissue screening during excisional biopsy. In order to overcome these current limitations of histology-based diagnostics, there are significant needs for either complementary or alternative imaging techniques which perform non-destructive, high resolution, and rapid tissue screening. Optical coherence tomography (OCT) is an emerging imaging modality which allows real-time cross-sectional imaging with high resolutions that approach those of histology. OCT could be a very promising technique which has the potential to be used as an adjunct to histological tissue observation when it is not practical to take specimens for histological processing, when large areas of tissue need investigating, or when rapid microscopic imaging is needed. This review will describe the use of OCT as an image guidance tool for fast tissue screening and directed histological tissue sectioning in pathology.
Topics: Animals; Biopsy; Diagnostic Imaging; Humans; Pathology; Tomography, Optical Coherence
PubMed: 22133731
DOI: 10.3233/ACP-2011-0047