RESUMO
CONTEXT.: Electronic synoptic pathology reporting using xPert from mTuitive is available to all pathologists in British Columbia, Canada. Comparative feedback reports for pathologists and surgeons were created by using the synoptic reporting software. OBJECTIVE.: To use data stored in a single central data repository to provide nonpunitive confidential comparative feedback reports (dashboards) to individual pathologists and surgeons for reflection on their practice and to use aggregate data for quality improvement initiatives. DESIGN.: Integration of mTuitive middleware in 5 different laboratory information systems to have 1 software solution (xPert) sending discrete data elements to the central data repository was performed. Microsoft Office products were used to build comparative feedback reports and made the infrastructure sustainable. Two different types of reports were developed: individual confidential feedback reports (dashboards) and aggregated data reports. RESULTS.: Pathologists have access to an individual confidential live feedback report for the 5 major cancer sites. Surgeons get an annual confidential emailed PDF report. Several quality improvement initiatives were identified from the aggregate data. CONCLUSIONS.: We present 2 novel dashboards: a live pathologist dashboard and a static surgeon dashboard. Individual confidential dashboards incentivize use of nonmandated electronic synoptic pathology reporting tools and have increased adoption rates. Use of dashboards has also led to discussions about how patient care may be improved.
Assuntos
Patologistas , Cirurgiões , Humanos , Melhoria de Qualidade , Colúmbia BritânicaRESUMO
BACKGROUND: Gestational choriocarcinoma is a rare malignancy believed to arise from the trophoblast cells of the placenta. Despite the frequently aggressive clinical nature, choriocarcinoma has been routinely curable with cytotoxic chemotherapy for over 50 years. To date little is known regarding the route to oncogenesis in this malignancy. METHODS: In a case of intraplacental choriocarcinoma, we have performed detailed genetic studies including microsatellite analysis, whole genome sequencing (WGS) and methylation analysis of the tumour and surrounding mature placenta. RESULTS: The results of the WGS sequencing indicated a very low level of mutation and the absence of any driver mutations or oncogene activity in the tumour. The methylation analysis identified a distinctly different profile in the tumour from that of the mature placenta. Comparison with a panel of reference methylation profiles from different stages of placental development indicated that the tumour segregated with the first trimester samples. CONCLUSIONS: These findings suggest that gestational choriocarcinoma is likely to arise as a result of aberrations of methylation during development, rather than from DNA mutations. The results support the hypothesis that gestational choriocarcinoma arises from a normally transient early trophoblast cell. At this point in development this cell naturally has a phenotype of rapid division, tissue invasion and sensitivity to DNA damaging chemotherapy that is very similar to that of the mature choriocarcinoma cell.
Assuntos
Coriocarcinoma/genética , Metilação de DNA/genética , Doença Trofoblástica Gestacional/genética , Mutação/genética , Placenta/patologia , Neoplasias Uterinas/genética , Adulto , Ilhas de CpG/genética , Epigênese Genética/genética , Feminino , Seguimentos , Humanos , Repetições de Microssatélites/genética , Fenótipo , Gravidez , Trofoblastos/patologia , Sequenciamento Completo do GenomaRESUMO
BACKGROUND: This study was performed to determine if surgeons' performance of sentinel lymph node biopsy (SLNB) for breast cancer varied with time and to devise a method to continuously evaluate that performance. METHODS: We retrospectively examined the SLNB experience of 13 community surgeons performing 765 SLNBs and 579 concomitant axillary dissections. False-negative rates (FNRs) were assessed for individuals and cohorts defined by caseload. Performance with time was assessed using cumulative sum (CUSUM) analysis. RESULTS: Overall, the SLN identification rate was 94.3%, and FNR was 5.3%. Each surgeon demonstrated variation in identification rate and/or FNR with time. CUSUM analysis provided an effective means to demonstrate when surgeon variation breached performance standards. CONCLUSIONS: Surgeon performance of SLNB varied with time, independent of case load. CUSUM may prove to be a useful statistical tool to evaluate performance before adopting stand-alone SLNB.
