Histologic review of melanomas by pathologists trained in melanocytic lesions may change therapeutic approach in up to 41 9% of cases

Abstract: Melanoma Guidelines of the Brazilian Dermatology Society recommend histologic review by pathologists trained in melanocytic lesions whenever possible. Out of 145 melanoma cases identified at a private clinic in São Paulo/Brazil, 31 that had been submited to histologic review were studied to evaluate whether revision had led to change in therapeutic approach.. Differences in original/reviewed reports were found in 58.1% (n=18) of the reports, leading to changes in therapeutic approach in 41.9% (n=13). Change in diagnosis was observed in 6 out of 31 (19,3%) cases. These findings suggest that second opinion by pathologists trained in melanocytic lesions is likely to show significant differences from the original report.

Completeness of low anterior resection pathology report: A hospital-based audit with recommendations on improving reporting.

Aims: To audit the information content of the pathology report on Low Anterior Resection (LAR) specimens and to provide recommendations in order to improve the existing standard of reporting. Materials and Methods : All the reports of LAR specimens during 2004 - 2005 were collected from the Hospital Information System (HIS). Individual items of information were compared with the minimum data sets provided by the Royal College of Pathologists (RCP). Results : Fifty-nine reports were audited. Nineteen percent of the reports were classified as satisfactory. Although many items were well reported, only 30.5% (18/59) of the reports contained a statement on the completeness of excision at the circumferential resected margin and only 25.4% of all reports mentioned the relation of tumors to the peritoneal reflection. Conclusion : The information content of the reports on colorectal cancer resection specimens is inadequate. The use of the standard proforma (template) for reporting rectal cancer is therefore recommended, along with improved education, review of laboratory practices in the light of current knowledge, and further motivation of pathologists through their involvement in multidisciplinary cancer management.

Quality control in the histopathology laboratory: an overview with stress on the need for a structured national external quality assessment scheme.

The concept of quality control in histopathology is relatively young and less well understood. Like in other disciplines of laboratory medicine, the concept of quality and its control is applicable to pre analytical, analytical and post analytical activities. Assessment of both precision and accuracy performances is possible by appropriate internal and external quality control and assessment schemes. This article is a review of all processes that achieve quality reporting in histopathology. There is a special focus on external quality assessment - a scheme that lacks organization on a national level in our country. Statistical data derived from a small scale external quality assurance program is also analyzed along with recommendations to organize an effective national scheme with the participation of authorized zonal centers.

The Implementation and Effects of a Clinical Laboratory Accreditation Program in Korea from 1999 to 2006 / 대한진단검사의학회지

BACKGROUND: The Korean Laboratory Accreditation Program (KLAP) by the Korean Society of Laboratory Medicine (KSLM) was started in 1999. We summarized history and achievement of KLAP for the last 8 yr. METHODS: We analyzed 8 yr data (1999-2006) of historical events, trends of participating laboratories, and scores according to the impact of the question to the outcome of the tests. Inspection check lists are for 'laboratory management', 'clinical chemistry', 'diagnostic hematology', 'clinical microbiology', 'diagnostic immunology', 'transfusion medicine', 'cytogenetics', 'molecular genetics', 'histocompatibility', 'flow cytometry', and 'comprehensive laboratory test verification report'. The laboratories with score 90 or higher got 2-yr certificate and laboratories with score between 60 and 89 got 1-yr certificate. The laboratories with score below 60 failed accreditation. RESULTS: The number of accredited laboratories was 2.4 times higher in 2006 (n=227) than in 1999 (n=96). Inspection check lists have been revised 5 times till 2006. The average accreditation rate was 99.6% during these periods and the 2-yr accreditation rate was 32.4% in 2000, 45.6% in 2001, 53.3% in 2002, 47.3% in 2003, 68.5% in 2004, 37.7% in 2005, and 47.7% in 2006. Number of participants in inspector training workshops increased from 89 in 2000 to 766 in 2006. CONCLUSIONS: The KLAP has been in place successfully and stabilized over the past 8 yr. It seemed to enhance the laboratory quality. Efforts for improvement of quality control and inspector training workshops appeared to be in the main contributing factors.

Gleason scoring of prostatic carcinoma: impact of a web-based tutorial on inter- and intra-observer variability.

A total of 40 cases of prostatic adenocarcinomas were scored independently by four pathologists using the Gleason scoring system. After attending a web-based tutorial, the scoring was repeated by all. Consensus scores were obtained by simultaneous viewing of each case in a multihead microscope by all four pathologists. The scores were then compared. The pretutorial kappa (kappa) values ranged from 0.36 to 0.64 with an average of 0.459. After the tutorial, the kappa values ranged from 0.44 to 0.678 with the average kappa value increasing to 0.538, thus indicating an improvement in the agreement. The intraobserver agreement ranged from 0.435 to 0.788. We conclude that web-based tutorials with emphasis on images developed by experts serve to achieve an uniformity in reporting.

Aptitud para la correlación anatomoclínica de neumopatología en alumnos de pregrado / Clinical-pathologyc correlation aptitude of pneumopathology in undergraduate medical students

Objective. 1) To develop and validate an instrument to evaluate the clinical pathology correlation aptitude in pneumopathology (CPCAP). 2) Compare two groups of students: those who had already taken the respiratory pathology course and students that hadn 't. Methods. An instrument with real anatomopathology respiratory cases was developed. The measurement instrument was validated through expert rounds. It included 116 items of the "true", "false", or "don't know" type, with an agreement of 80 % or more in the answerers between the judges. The internal consistency was determined with Spearman Brown proficiency, reaching a value of 0.78. The sample studied was all the groups of each hospital of an organic pathology undergraduate universitary course. Two sampled were taken, students who had already been through respiratory pathology (Group A), and students who hadn't (Group B) Results.The sample studied was of 485 applicants, from 64 different universitary groups. These were divided in two groups, with 245 (A) and 240 (B) students each. Its global medians were 51 and 36 for groups A and B respectively (p < 0.001). In the 55 % of the subgroups when compared individually taking into account each one of the hospital where they study the test results were significantly better in group A. Discussion.In a general way, students in group A show a major development into CPCAP than students in B. However, development is not enough to reach the expected by the educative program. The results suggest that the teachers put greater effort in the correlation between anatomopathological changes and the clinical and paraclinical manifestations of the patients.

Objetivos. 1) Construir y validar un instrumento de medición de la aptitud para la correlación anatomoclínica en neumopatología (ACACN). 2) Comparar la ACACN de alumnos que ya tomaron el curso de patología y quiénes no. Métodos. Se elaboró un cuestionario con base en nueve casos anatomopatológicos con sus correspondientes estudios clínicos. Se estimó su validez conceptual por un grupo de expertos y la confiabilidad mediante correlación de mitades equivalentes. El instrumento quedó conformado por 116 ítems, que obtuvieron un porcentaje de acuerdo con 80 o mayor en las respuestas de los jueces y un coeficiente de .78 de confiabilidad (Spearman-Brown). Se aplicó un diseño ex post facto y las unidades de análisis fueron los grupos de cada hospital sede de un curso universitario de patología orgánica. Mediante un muestreo por cuota se seleccionaron dos muestras de alumnos de pregrado de la carrera de medicina para realizar las mediciones: quienes ya habían cursado la asignatura de patología (A) y quienes no (B). Resultados. Se incluyeron 485 alumnos, 245 de la muestra A y 240 de la muestra B, correspondientes a 64 grupos universitarios. Las medianas globales de ambas muestras fueron 51 y 36, respectivamente (p < 0.001). En la comparación entre muestras de una misma sede hubo diferencia significativa a favor de A en 39% de los grupos. Discusión. Los resultados muestran que la ACACN fue mayor en los alumnos que ya habían cursado la materia, en comparación con los que aún no lo habían hecho, sin embargo, el grado de desarrollo de la misma está lejos de las expectativas del programa educativo y refleja la necesidad de implementar modificaciones en la manera de cómo se imparte la materia.

Search and identification of spermatozoa and spermatids in the ejaculate of non-obstructive azoospermic patients

OBJECTIVE: To search and to identify spermatozoa and spermatids, present in the ejaculate of non-obstructive azoospermic patients. MATERIALS AND METHODS: 27 patients, aged between 18 and 48 years, with initial diagnosis compatible with non-obstructive azoospermia, underwent up to 3 seminal samples, with assessment of macroscopic and microscopic parameters differentiated for each sample. In the first sample, 5 æL of semen were analyzed in a Horwell chamber in order to assess the presence or absence of spermatozoa. The procedure was repeated with 2 other aliquots. In the absence of spermatozoa, the entire sample was transferred to a conic tube and following centrifugation the sediment was freshly analyzed. The second seminal sample was collected only when no spermatozoa were found in the first sample and the research was performed in the same way. In cases where spermatozoa were not seen, the sample was centrifuged and the obtained sediment was stained by the panoptic method and observed under common light microscopy (1250X). The third seminal sample was collected only in cases when patients had not shown spermatozoa in the first and second seminal samples. RESULTS: 4/27 (14.8 percent) patients presented spermatozoa in the first seminal sample and 6/23 (26.1 percent), in the second seminal sample. No spermatozoa were seen in the third sample, however, 11/17 (64.7 percent) presented spermatids. CONCLUSION: In clinical situations where the initial diagnosis is non-obstructive azoospermia, one single routine seminal analysis is not enough to confirm this diagnosis and the analysis of the centrifuged sediment can have relevant clinical consequences. Among patients considered non-obstructive azoospermic, when duly assessed, 37 percent presented spermatozoa and 64.7 percent, spermatids.

Quality assessment program in histopathology: a pilot study from Maharashtra.

Histopathology reports are important quality assurance tools and evaluation of pathological diagnoses described in them is an integral part of total quality control and quality improvement program. We describe a program based on slide circulation which was aimed at both continuing education to upgrade knowledge and proficiency testing of histopathologists. The performance of the participating pathologists was analyzed and the degree of agreement was also studied. The results showed improvement indicated by rising level of performance in 35.3% of consistent participants and increasing trend in the average score. The degree of agreement was comparatively low (65.29%). The practicability of this program and its acceptability as an EQAS was also investigated.

Mucoproteína versus alfa-1-glicoproteína ácida: o que quantificar? / Mucoprotein versus alpha-1-acid glycoprotein: what should be measured?

A quantificaçäo sérica da alfað1ðglicoproteína (GPA) ácida é útil no diagnóstico e no acompanhamento dos processos agudos resultantes de múltiplas causas. Esta proteína também pode ser estimada pela quantificaçäo da mucoproteína (Muco), ensaio que reflete as glicoproteínas com elevado teor de açúcar, entre as quais a GPA é majoritária. O objetivo deste trabalho é verificar a correlaçäo e a performance analítica das determinações de mucoproteína (Muco) e alfað1ðglicoproteína ácida (GPA), propondo uma equaçäo de regressäo linear. Amostras de soros e 540 pacientes, com idades entre 10 e 79 anos (média de 34,6), predominando mulheres (71,3 por cento), foram analisadas simultaneamente para Muco (Winzler, manual com reagentes próprios) e GPA (imunoturbidimetria automatizada, Roche; Cobas mira). A análise de regressäo, fixando a Muco como variável dependente, apresentou Muco (mg/dl em tirosina) = 0,031 x GPA (mg/dl) + 0,8 (r = 0,91); e, fixando o intercepto em zero, Muco = 0,039 x GPA (r = 0,98). A imprecisäo interensaio foi de 23,4 por cento e 5,2 por cento (coeficiente de variaçäo), respectivamente, para Muco e GPA. Conclusäo: a elevada variabilidade analítica da quantificaçäo da mucoproteína pelo método de Winzler recomenda que este ensaio seja substituído pela dosagem da alfað1ðglicoproteína ácida. Quanto necessário, recomendamos estimar a mucoproteína, quantificando a alfað1ðglicoproteína ácida com ensaios de mesmo desempenho que o do utilizado neste trabalho, e usar a equaçäo de regressäo AGP (mg/dl) x 0,039 = Muco (mg/dl em tirosina)

Overview of the laboratory accreditation programme of the College of American Pathologists

Although Saudi medical laboratories have developed enormously over the past 25 years, the absence of a national body for medical laboratory accreditation has meant the number of accredited laboratories [seven] remains low. Of these, five are accredited by the College of American Pathologists' Laboratory Accreditation Program [LAP]-the 'gold standard' of laboratory accreditation. It requires successful performance in the College of American Pathologists' proficiency testing programme as well as passing on-site inspections carried out by practising laboratory technicians, after which the laboratory is accredited for a 2-year period. This article gives an insight into the current situation of laboratory accreditation in Saudi Arabia and an updated overview of the process involved in obtaining laboratory accreditation from the College of American Pathologists

Recomendaçöes para o execício da medicina laboratorial / Recomendations for the laboratorial medicine practice

A preocupaçäo de médicos especialistas em patologia clínica que, no exercício de suas atividades, têm se deparado com vários aspectos aqui apontados. Näo há como questionar a pertinência de tal preocupaçäo nos tempos atuais, e esse grupo de Belo Horizonte pretende contribuir para que a medicina continue a ser exercida segundo preceitos éticos consolidados, mesmo em um momento cultural adverso a essa postura a que favorece prioridades financeiras

Manual de acreditación de hospitales / Manual for hospital accreditation

Contiene: Marco conceptual; Estándares de acreditación; Dirección; Administración; Epidemiología; Consulta externa; Emergencia; Hospitalización; Centro quirúrgico; Esterilización central; Centro obstétrico; Neonatología; Cuidados intensivos; Rehabilitación; Patología clínica; Banco de sangre; Anatomía patológica; Imágenes; Radioterapia; Medicina nuclear; Enfermería; Farmacia; Trabajo social; Nutrición y dietética; Registros médicos y estadística; Lavandería; Mantenimiento; Limpieza; Seguridad