Implementation of a required 3rd-year medical student surgical pathology clinical experience.

Few medical schools have required experience â€‹in surgical pathology during the clinical years. After introducing a pilot and preliminary surgical pathology clinical experience into the curriculum, we initiated a required 3rd-year medical student surgical pathology clinical experience that consisted of a one hour introductory lecture; one hour gross room, histology, and immunohistochemistry laboratory introduction; and one hour of one-on-one case sign-out preceptorship with a subspecialty surgical pathologist within the surgery and obstetrics/gynecology block. Concepts that were covered included specimen processing, intraoperative frozen section consultation, completing specimen requisitions, interpreting synoptic reports, and pTNM staging. Students evaluated the surgical pathologist from 1 to 5 (1 "poor/unhelpful," 2 "marginal," 3 "neutral," 4 "good," 5 "excellent/useful"). Ten multiple-choice questions (included as part of a perioperative services exam) and attendance were incorporated into students' perioperative services rotation grade. From 2014 to 2018, 757 students participated in the required 3rd-year surgical pathology clinical experience. Thirty academic subspecialty pathologists acted as preceptors with an average of nine sessions per preceptor per year. Evaluation data from 316 students from 2015 to 2018 showed a mean preceptor rating of 4.8/5 (range 4.0-5.0). Students scored an average of 81% on the surgical pathology portion of the exam (range 21-99% for each question). We successfully implemented a required medical student surgical pathology clinical experience. At the clerkship's conclusion, students demonstrated understanding of key concepts and rated their preceptorship experience highly.

Clinical Utility of Fluorescence In Situ Hybridization (FISH) for Deletion of Chromosome 3p in the Work-up of Renal Masses.

Chromosome 3p deletion is a well-established genetic aberration in clear cell renal cell carcinoma (RCC). We aimed to evaluate the clinical utility of 3p fluorescence in situ hybridization (FISH) on formalin-fixed paraffin-embedded tissue in surgical pathology specimens. 3p:3q <0.8 was established as the cut-off for 3p loss. The 2015 Medicare allowable billing rates were used to estimate the cost. Over 2.5 years (2013 to 2015), 3p FISH was performed on 18 cases per year. Among tested cases, 70% (30/43) were nephrectomies and 30% (14/43) metastases. 3p loss was detected in 44% (19/43) of cases, with a higher rate of loss in radical compared with partial nephrectomies (71% vs. 15%; P=0.003). A definitive RCC subtype was assigned in 65% (28/43) of cases. More partial nephrectomies had a definitive subtype assigned, compared with radical nephrectomies (92% vs. 59%; P=0.04), possibly related to more high-grade, high-stage tumors in submitted radical nephrectomies. Tested nephrectomies were most commonly diagnosed as clear cell (41%) or clear cell papillary RCC (32%). Half of unclassifiable RCCs had 3p loss (53%, 8/15). Annual 3p FISH costs were $3446.64, with 79% of costs from ancillary studies attributable to immunostains. 3p FISH was performed infrequently in nephrectomy specimens and was not cost prohibitive. RCC cases that are unclassifiable by morphology and other ancillary tests, but which have 3p FISH deletion may merit a comment in the pathology report, raising the possibility of clear cell RCC, as the oncologic approach may be altered despite the lack of a definitive RCC subtype.