SURGICAL PATHOLOGY

Subspecialty of anatomical pathology concerned with the study and the diagnosis of disease, based on observable cellular and tissue changes in specimens removed from living patients.

Doctors practicing this specialty: 4

N. Peter Libbey, MD - ADMINISTRATIVE OFFICE: Roger Williams Medical Center, Department of Pathology, 825 Chalkstone Avenue, RI Providence, RI 02908; Phone: 401-456-2162, Fax: 401-456-2131
Paul Ferbend, DO - CLINICAL PRACTICE: Roger Williams Medical Center, Department of Pathology, 825 Chalkstone Avenue, Providence, RI 02908; Phone: 401-456-2162, Fax: 401-456-2131
Jila Khorsand, MD - CLINICAL PRACTICE: Roger Williams Medical Center, Department of Pathology, 825 Chalkstone Avenue, Providence, RI 02908; Phone: 401-456-2162, Fax: 401-456-2131

SATELLITE PRACTICE LOCATION: 25 Wells Street, Westerly, RI 02891; Phone: 401-596-6000, Fax: 401-348-3714 - ADMINISTRATIVE OFFICE: Roger Williams Medical Center, Department of Pathology, 825 Chalkstone Avenue, Providence, RI 02908; Phone: 401-456-2162, Fax: 401-456-2131
Nicola Kouttab, PhD - ADMINISTRATIVE OFFICE: Roger Williams Medical Center, Department of Pathology, 825 Chalkstone Avenue, Providence, RI 02908; Phone: 401-456-2162, Fax: 401-456-2131

MOST RECENT PUBLICATIONS RELATED TO THIS SPECIALTY

1: Am J Clin Pathol. 2010 Jan;133(1):156-9. 

Experience with voice recognition in surgical pathology at a large academic
multi-institutional center.

Kang HP, Sirintrapun SJ, Nestler RJ, Parwani AV.

Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute,
Buffalo, NY, USA.

There are few reports of institutional use of voice recognition technology in
clinical practice. We describe our experience with voice recognition-integrated
synoptic-like dictation, associating templates with key spoken phrases, that we
have used in gross examination of common specimens and as a major component of
our workflow since 2001. The primary application is VoiceOver Enterprise
(Voicebrook, Lake Success, NY), which uses Dragon NaturallySpeaking Medical
Edition (Nuance Communications, Burlington, MA) as its speech engine. This
integrates with the anatomic pathology laboratory information system (APLIS) and
other applications, such as Microsoft Office (Microsoft, Redmond, WA). The
largest user group, pathology assistants, mainly dictates biopsy reports,
numbering approximately 210,000 specimens since 2001. The technology has been
useful in our anatomic pathology workflow and provided a good return on
investment, including marked improvements in turnaround time, results
standardization, error reduction, and cost savings. The most helpful features of
the software are templating, the seamless integration with APLIS, and the voice
command creation tools.

PMID: 20023272 [PubMed - indexed for MEDLINE]

2: Arch Pathol Lab Med. 2009 Dec;133(12):1949-53. 

Whole-slide imaging digital pathology as a platform for teleconsultation: a
pilot study using paired subspecialist correlations.

Wilbur DC, Madi K, Colvin RB, Duncan LM, Faquin WC, Ferry JA, Frosch MP, Houser
SL, Kradin RL, Lauwers GY, Louis DN, Mark EJ, Mino-Kenudson M, Misdraji J,
Nielsen GP, Pitman MB, Rosenberg AE, Smith RN, Sohani AR, Stone JR, Tambouret
RH, Wu CL, Young RH, Zembowicz A, Klietmann W.

Department of Pathology, James Homer Wright Pathology Laboratories,
Massachusetts General Hospital, and the Department of Pathology, Harvard Medical
School, Boston, MA 02114, USA. dwilbur@partners.org

CONTEXT: -Whole-slide imaging technology offers promise for rapid,
Internet-based telepathology consultations between institutions. Before
implementation, technical issues, pathologist adaptability, and morphologic
pitfalls must be well characterized. OBJECTIVE: -To determine whether
interpretation of whole-slide images differed from glass-slide interpretation in
difficult surgical pathology cases. DESIGN: -Diagnostically challenging
pathology slides from a variety of anatomic sites from an outside laboratory
were scanned into whole digital format. Digital and glass slides were
independently diagnosed by 2 subspecialty pathologists. Reference, digital, and
glass-slide interpretations were compared. Operator comments on technical issues
were gathered. RESULTS: -Fifty-three case pairs were analyzed. There was
agreement among digital, glass, and reference diagnoses in 45 cases (85%) and
between digital and glass diagnoses in 48 (91%) cases. There were 5 digital
cases (9%) discordant with both reference and glass diagnoses. Further review of
each of these cases indicated an incorrect digital whole-slide interpretation.
Neoplastic cases showed better correlation (93%) than did cases of nonneoplastic
disease (88%). Comments on discordant cases related to digital whole technology
focused on issues such as fine resolution and navigating ability at high
magnification. CONCLUSIONS: -Overall concordance between digital whole-slide and
standard glass-slide interpretations was good at 91%. Adjustments in technology,
case selection, and technology familiarization should improve performance,
making digital whole-slide review feasible for broader telepathology
subspecialty consultation applications.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 19961250 [PubMed - indexed for MEDLINE]

3: Arch Pathol Lab Med. 2009 Nov;133(11):1841-9. 

Standards to support information systems integration in anatomic pathology.

Daniel C, Garcia Rojo M, Bourquard K, Henin D, Schrader T, Della Mea V,
Gilbertson J, Beckwith BA.

ADICAP; INSERM, UMR_S 872 eq20 and Universite Paris Descartes, Paris, France.
christel.daniel@spim.jussieu.fr

CONTEXT: Integrating anatomic pathology information- text and images-into
electronic health care records is a key challenge for enhancing clinical
information exchange between anatomic pathologists and clinicians. The aim of
the Integrating the Healthcare Enterprise (IHE) international initiative is
precisely to ensure interoperability of clinical information systems by using
existing widespread industry standards such as Digital Imaging and Communication
in Medicine (DICOM) and Health Level Seven (HL7). OBJECTIVE: To define
standard-based informatics transactions to integrate anatomic pathology
information to the Healthcare Enterprise. DESIGN: We used the methodology of the
IHE initiative. Working groups from IHE, HL7, and DICOM, with special interest
in anatomic pathology, defined consensual technical solutions to provide
end-users with improved access to consistent information across multiple
information systems. RESULTS: The IHE anatomic pathology technical framework
describes a first integration profile, "Anatomic Pathology Workflow," dedicated
to the diagnostic process including basic image acquisition and reporting
solutions. This integration profile relies on 10 transactions based on HL7 or
DICOM standards. A common specimen model was defined to consistently identify
and describe specimens in both HL7 and DICOM transactions. CONCLUSION: The IHE
anatomic pathology working group has defined standard-based informatics
transactions to support the basic diagnostic workflow in anatomic pathology
laboratories. In further stages, the technical framework will be completed to
manage whole-slide images and semantically rich structured reports in the
diagnostic workflow and to integrate systems used for patient care and those
used for research activities (such as tissue bank databases or tissue
microarrayers).

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 19886721 [PubMed - indexed for MEDLINE]

4: Adv Anat Pathol. 2009 Nov;16(6):418-23. 

Core components of a comprehensive quality assurance program in anatomic
pathology.

Nakhleh RE.

Department of Pathology, Mayo Clinic Florida, Jacksonville, 32224, USA.
Nakhleh.raouf@mayo.edu

In this article the core components of a comprehensive quality assurance and
improvement plan are outlined. Quality anatomic pathology work comes with focus
on accurate, timely, and complete reports. A commitment to continuous quality
improvement and a systems approach with a persistent effort helps to achieve
this end. Departments should have a quality assurance and improvement plan that
includes a risk assessment of real and potential problems facing the laboratory.
The plan should also list the individuals responsible for carrying out the
program with adequate resources, a defined timetable, and annual assessment for
progress and future directions. Quality assurance monitors should address
regulatory requirements and be organized by laboratory division (surgical
pathology, cytology, etc) as well as 5 segments (preanalytic, analytic,
postanalytic phases of the test cycle, turn-around-time, and customer
satisfaction). Quality assurance data can also be used to evaluate individual
pathologists using multiple parameters with peer group comparison.

PMID: 19851132 [PubMed - indexed for MEDLINE]

5: Am J Clin Pathol. 2009 Nov;132(5):658-65. 

The Bethesda System For Reporting Thyroid Cytopathology.

Cibas ES, Ali SZ; NCI Thyroid FNA State of the Science Conference.

Dept of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA.

To address terminology and other issues related to thyroid fine-needle
aspiration (FNA), the National Cancer Institute (NCI) hosted the NCI Thyroid FNA
State of the Science Conference. The conclusions regarding terminology and
morphologic criteria from the NCI meeting led to the Bethesda Thyroid Atlas
Project and form the framework for The Bethesda System for Reporting Thyroid
Cytopathology (TBSRTC). For clarity of communication, TBSRTC recommends that
each report begin with 1 of 6 general diagnostic categories. The project
participants hope that the adoption of this flexible framework will facilitate
communication among cytopathologists, endocrinologists, surgeons, radiologists,
and other health care providers; facilitate cytologic-histologic correlation for
thyroid diseases; facilitate research into the epidemiology, molecular biology,
pathology, and diagnosis of thyroid diseases; and allow easy and reliable
sharing of data from different laboratories for national and international
collaborative studies.

Publication Types:
    Consensus Development Conference, NIH
    Review

PMID: 19846805 [PubMed - indexed for MEDLINE]

6: Ugeskr Laeger. 2009 Aug 24;171(35):2453-8. 

[Lymph node identification in colorectal cancer specimens cases]

[Article in Danish]

Schmidt MB, Engel UH, Mogensen AM, Bulow S, Petersen LN, Holck S; Danish
Colorectal Cancer Group.

Patologiafdelingen, Hvidovre Hospital, DK-2650 Hvidovre.

Colorectal carcinoma is one of the most prevalent malignancies in Western
countries. Lymph node status is a significant prognosticator. The chance of
identifying node-positivity is positively correlated with the number of lymph
nodes (LN) identified. The present paper discusses various variables that may
influence the detection of LNs, including patient- as well as surgeon- and
pathologist-related issues. The pathologist-related variable most probably
shapes the yield the most. Introduction of guidelines focusing on the most
appropriate technique may secure better and more consistent results, and the
pathologist's commitment is crucial in this respect.

Publication Types:
    English Abstract
    Review

PMID: 19732529 [PubMed - indexed for MEDLINE]

7: Histopathology. 2009 Sep;55(3):294-300. 

Virtual reality Powerwall versus conventional microscope for viewing pathology
slides: an experimental comparison.

Treanor D, Jordan-Owers N, Hodrien J, Wood J, Quirke P, Ruddle RA.

Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University
of Leeds, Leeds LS9 7TF, UK. darrentreanor@nhs.net

AIMS: Virtual slides could replace the conventional microscope. However, it can
take 60% longer to make a diagnosis with a virtual slide, due to the small
display size and inadequate user interface of current systems. The aim was to
create and test a virtual reality (VR) microscope using a Powerwall (a
high-resolution array of 28 computer screens) for viewing virtual slides more
efficiently. METHODS AND RESULTS: A controlled user experiment was performed to
compare the Powerwall with the microscope for four types of task: (i) a simple
diagnosis, (ii) a decision about a lymph node, (iii) finding small objects, (iv)
scoring a tissue microarray. User behaviour was recorded by video and
questionnaire. Time taken to perform all four tasks and diagnostic confidence
were similar using the Powerwall and conventional microscope. CONCLUSIONS: After
just a few minutes' familiarization, a VR Powerwall allowed tasks to be
performed as quickly and confidently as a microscope. Behavioural data indicated
how histopathologists should be trained to make the best use of the large
display provided by the VR microscope. Together with the potential for further
improvements in the design of the VR microscope, future virtual slide systems
could out-perform conventional microscopes in histopathological diagnosis.

Publication Types:
    Comparative Study
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 19723144 [PubMed - indexed for MEDLINE]

8: Arch Pathol Lab Med. 2009 Sep;133(9):1468-71. 

Circulating tumor cells from well-differentiated lung adenocarcinoma retain
cytomorphologic features of primary tumor type.

Marrinucci D, Bethel K, Luttgen M, Bruce RH, Nieva J, Kuhn P.

Department of Cell Biology, The Scripps Research Institute, La Jolla, CA 92037,
USA.

The detailed cytomorphologic appearance of circulating tumor cells (CTCs) in
cancer patients is not well described, despite publication of multiple methods
for enumerating these cells. In this case study, we present the cytomorphology
of CTCs obtained from the blood of a woman with stage IIIB well-differentiated
lung adenocarcinoma. Four years after she was diagnosed with her disease, 67
CTCs were identified in a blood sample using an immunofluorescent staining
protocol and then subsequently stained with Wright-Giemsa. The cytomorphology of
the CTCs was compared with the original tissue biopsy from 4 years prior. We
found that CTCs and cells from the original biopsy had strikingly similar
morphologic features, including large size in comparison to white blood cells
and low nuclear to cytoplasmic ratios with voluminous cytoplasm. Careful
cytomorphologic evaluation of CTCs will provide insights about the metastatic
significance of these cells, which could yield widespread implications for the
diagnosis, treatment, and management of cancer.

Publication Types:
    Case Reports
    Research Support, N.I.H., Extramural

PMID: 19722757 [PubMed - indexed for MEDLINE]

9: Arch Pathol Lab Med. 2009 Sep;133(9):1375-8. 

Significant and unexpected, and critical diagnoses in surgical pathology: a
College of American Pathologists' survey of 1130 laboratories.

Nakhleh RE, Souers R, Brown RW.

Department of Pathology, Mayo Clinic Florida, Jacksonville, FL 32224, USA.
Nakhleh.roauf@mayo.edu

CONTEXT: The Joint Commission and the College of American Pathologists have
emphasized improved communication as a strategy to improve patient safety and
reduce errors. OBJECTIVE: To determine current policies and practices concerning
critical and/or significant and unexpected results in anatomic pathology.
DESIGN: A survey was distributed with the 2007 D mailing of the Performance
Improvement Program slides. The survey included questions that determined
laboratory size, practice setting, and anatomic pathology critical and/or
significant and unexpected result policies and practices. RESULTS: Surveys from
1130 laboratories were received. A total of 75% had a written policy regarding
anatomic pathology critical and/or significant and unexpected results; 25% did
not. A total of 30% of laboratories with written policies stated that their
policies included guidelines but did not include specific examples. A total of
33% listed 5 or fewer specific examples, 18% listed more than 5 examples, and
19% stated that they had a specifically defined list of significant and
unexpected and/or critical diagnoses. The conditions that were listed included
malignancies (48% of all laboratories), findings not expected by the clinical
history (45%), life-threatening infections (45%), no chorionic villi in products
of conception (37%), inflammatory or immunologic processes (19%), and organ
rejection (14%). Laboratories with a higher median number of accessioned
surgical and cytology cases and independent laboratories tended to have policies
with more than 5 specific examples or precise lists of must-call diagnoses (P <
.001). CONCLUSIONS: This survey illustrates current anatomic pathology policies
and practices with respect to critical and significant and unexpected results.

PMID: 19722742 [PubMed - indexed for MEDLINE]

10: Malays J Pathol. 2009 Jun;31(1):11-6. 

Historical development of the renal histopathology services in Malaysia.

Looi LM, Cheah PL.

Department of Pathology, Faculty of Medicine, University of Malaya, Kuala
Lumpur, Malaysia. looilm@ummc.edu.my

Western-style medicine was introduced to Malaya by the Portuguese, Dutch and
British between the 1500s and 1800s. Although the earliest pathology
laboratories were developed within hospitals towards the end of the 19th
Century, histopathology emerged much later than the biochemistry and
bacteriology services. The University Departments of Pathology were the pioneers
of the renal histopathology diagnostic services. The Department of Pathology,
University of Malaya (UM) received its first renal biopsy on 19 May 1968.
Hospital Universiti Kebangsaan Malaysia (HUKM) and Hospital Universiti Sains
Malaysia (HUSM) started their services in 1979 and 1987 respectively. It is
notable that the early services in these University centres caterred for both
the university hospitals and the Ministry of Health (MOH) until the mid-1990s
when MOH began to develop its own services, pivoted on renal pathologists
trained through Fellowship programmes. Currently, key centres in the MOH are
Kuala Lumpur Hospital, Sultanah Aminah Hospital Johor Bahru and Malacca
Hospital. With the inclusion of renal biopsy interpretation in the Master of
Pathology programmes, basic renal histopathology services became widely
available throughout the country from 2000. This subsequently filtered out to
the private sector as more histopathologists embraced private practice. There is
now active continuing professional development in renal histopathology through
clinicopathological dicussions, seminars and workshops. Renal research on
amyloid nephropathy, minimal change disease, IgA nephropathy, fibrillary
glomerulonephritis, lupus nephritis and microwave technology have provided an
insight into the patterns of renal pathology and changing criteria for biopsy.
More recently, there has been increasing involvement of renal teams in clinical
trials, particularly for lupus nephritis and renal transplant modulation.

Publication Types:
    Historical Article

PMID: 19694308 [PubMed - indexed for MEDLINE]

11: Arch Pathol Lab Med. 2009 Aug;133(8):1256-61. 

Introduction of the 7th edition eyelid carcinoma classification system from the
American Joint Committee on Cancer-International Union Against Cancer staging
manual.

Ainbinder DJ, Esmaeli B, Groo SC, Finger PT, Brooks JP.

Department of Ophthalmology, Madigan Army Medical Center, MCHJ-SOU, Tacoma, WA
98431, USA. darryl.ainbinder@amedd.army.mil

CONTEXT: The American Joint Committee on Cancer (AJCC) and the International
Union Against Cancer commissioned the Ophthalmic Oncology Task Force to modify
and update the ophthalmic chapters of the 7th edition of the AJCC Cancer Staging
Manual. OBJECTIVE: To review the existing eyelid carcinoma chapter in the 6th
edition of the AJCC Cancer Staging Manual for its clinical and research utility
and to seek evidence-based revisions with the strongest medical foundation to
use in updating the anatomically based TNM cancer staging system manual. DATA
SOURCES: The 4-year Ophthalmic Oncology Task Force consisted of 45 tumor
specialists from 10 countries and an extensive internal and external peer review
process. The 10-member Carcinoma of the Eyelid team included a diverse group of
international authors. The group included extensive representation by
clinicians, pathologists, surgeons, radiation therapists, and cancer registrars,
all with advanced, ophthalmic cancer-related areas of subspecialty. Data sources
included the above expertise applying a worldwide medical literature search,
with no discrimination based on language, country of origin, discipline source,
specialty source, or surgical practice. CONCLUSIONS: Revisions were made to the
TNM classification in areas with the strongest basis in evidence and practical
effect. Lymph node staging data were expanded markedly to reflect its
significant prognostic value. T3 and T4 were redefined and stage groupings were
added that applied current understanding in tumor biology, respected
site-specific risk factors, and provided greater correlation with the common
language of the overall AJCC Cancer Staging Manual. Evidence-based biomarkers
and data-field modifiers were included to capture additional pathologically and
clinically substantiated prognostic factors.

PMID: 19653721 [PubMed - indexed for MEDLINE]

12: Arch Pathol Lab Med. 2009 Jul;133(7):1135-8. 

Frozen section and the surgical pathologist: a point of view.

Taxy JB.

Section of Surgical Pathology, Department of Pathology, University of Chicago,
Chicago, Illinois 60637, USA. Jerome.taxy@uchospitals.edu

Frozen section is a prominent point of intersection between surgeons and
pathologists. It is regarded as the most definitive--but not the sole--form of
intraoperative consultation. Its role in tissue triage, diagnosis, and
intraoperative management should not be misconstrued as a shortcut to a
definitive diagnosis. Although the pathologist remains in control of the tissue
disposition, frozen sections are ideally requested and executed as a
collaborative effort. Frivolous requests with no direct consequences for the
conduct of a given procedure should not be honored. Frozen section plays a
material role in resident education and may be the last vestige of general
surgical pathology in an era of organ system specialization. Frozen section will
retain its relevance only in the context of broad clinical knowledge by the
pathologist and judicious utilization by the surgeon, both in the ultimate
service of the patient.

PMID: 19642740 [PubMed - indexed for MEDLINE]

13: Arch Pathol Lab Med. 2009 Jul;133(7):1026-32. 

Recent developments in the pathology of renal tumors: morphology and molecular
characteristics of select entities.

Yan BC, Mackinnon AC, Al-Ahmadie HA.

Department of Pathology, University of Chicago, Chicago, Illinois, USA.

CONTEXT: Renal cell carcinoma is a heterogeneous group of tumors with distinct
histopathologic features, molecular characteristics, and clinical outcome. These
tumors can be sporadic as well as familial or associated with syndromes. The
genetic abnormalities underlying these syndromes have been identified and were
subsequently found in corresponding sporadic renal tumors. OBJECTIVE: To review
the recent molecular and genetic advancements relating to sporadic and familial
renal carcinomas as well as those related to Xp11.2 translocation-associated
renal cell carcinoma and renal medullary carcinoma. DATA SOURCES: Literature
review, personal experience, and material from the University of Chicago.
CONCLUSIONS: Molecular genetic diagnostic techniques will continue to introduce
new biomarkers that will aid in the differential diagnosis of difficult cases.
The identification of specific signaling pathways that are defective in certain
renal tumors also makes possible the development of new therapies that
selectively target the aberrant activity of the defective proteins.

Publication Types:
    Review

PMID: 19642729 [PubMed - indexed for MEDLINE]

14: Vet Clin Pathol. 2009 Sep;38(3):281-7. Epub 2009 Jul 9. 

Guidelines for resident training in veterinary clinical pathology. III:
cytopathology and surgical pathology.

Kidney BA, Dial SM, Christopher MM.

Department of Veterinary Pathology, Western College of Veterinary Medicine,
University of Saskatchewan, Saskatoon, SK, Canada. beverly.kidney@usask.ca

The Education Committee of the American Society for Veterinary Clinical
Pathology has identified a need for improved structure and guidance of training
residents in clinical pathology. This article is the third in a series of
articles that address this need. The goals of this article are to describe
learning objectives and competencies in knowledge, abilities, and skills in
cytopathology and surgical pathology (CSP); provide options and ideas for
training activities; and identify resources in veterinary CSP for faculty,
training program coordinators, and residents. Guidelines were developed in
consultation with Education Committee members and peer experts and with
evaluation of the literature. The primary objectives of training in CSP are: (1)
to develop a thorough, extensive, and relevant knowledge base of biomedical and
clinical sciences applicable to the practice of CSP in domestic animals,
laboratory animals, and other nondomestic animal species; (2) to be able to
reason, think critically, investigate, use scientific evidence, and communicate
effectively when making diagnoses and consulting and to improve and advance the
practice of pathology; and (3) to acquire selected technical skills used in CSP
and pathology laboratory management. These guidelines define expected
competencies that will help ensure proficiency, leadership, and the advancement
of knowledge in veterinary CSP and will provide a useful framework for didactic
and clinical activities in resident-training programs.

PMID: 19619150 [PubMed - indexed for MEDLINE]

15: Hum Pathol. 2009 Aug;40(8):1082-91. Epub 2009 Jun 23. 

Virtual slide telepathology enables an innovative telehealth rapid breast care
clinic.

Lopez AM, Graham AR, Barker GP, Richter LC, Krupinski EA, Lian F, Grasso LL,
Miller A, Kreykes LN, Henderson JT, Bhattacharyya AK, Weinstein RS.

Department of Pathology, The University of Arizona College of Medicine, Tucson,
AZ 85724, USA.

An innovative telemedicine-enabled rapid breast care service is described that
bundles telemammography, telepathology, and teleoncology services into a single
day process. The service is called the UltraClinics Process. Because the core
services are at 4 different physical locations, a challenge has been to obtain
stat second opinion readouts on newly diagnosed breast cancer cases. To provide
same day quality assurance rereview of breast surgical pathology cases, a
DMetrix DX-40 ultrarapid virtual slide scanner (DMetrix Inc, Tucson, AZ) was
installed at the participating laboratory. Glass slides of breast cancer and
breast hyperplasia cases were scanned the same day the slides were produced by
the University Physicians Healthcare Hospital histology laboratory. Virtual
slide telepathology was used for stat quality assurance readouts at University
Medical Center, 6 miles away. There was complete concurrence with the primary
diagnosis in 139 (90.3%) of cases. There were 4 (2.3%) major discrepancies,
which would have resulted in a different therapy and 3 (1.9%) minor
discrepancies. Three cases (1.9%) were deferred for immunohistochemistry. In 2
cases (1.3%), the case was deferred for examination of the glass slides by the
reviewing pathologists at University Medical Center. We conclude that the
virtual slide telepathology quality assurance program found a small number of
significant diagnostic discrepancies. The virtual slide telepathology program
service increased the job satisfaction of subspecialty pathologists without
special training in breast pathology, assigned to cover the general surgical
pathology service at a small satellite university hospital.

PMID: 19552938 [PubMed - indexed for MEDLINE]

16: Hum Pathol. 2009 Aug;40(8):1057-69. Epub 2009 Jun 24. 

Overview of telepathology, virtual microscopy, and whole slide imaging:
prospects for the future.

Weinstein RS, Graham AR, Richter LC, Barker GP, Krupinski EA, Lopez AM, Erps KA,
Bhattacharyya AK, Yagi Y, Gilbertson JR.

Arizona Telemedicine Program, University of Arizona College of Medicine, Tucson,
AZ 85724, USA. ronaldw@u.arizona.edu

Telepathology, the practice of pathology at a long distance, has advanced
continuously since 1986. Today, fourth-generation telepathology systems,
so-called virtual slide telepathology systems, are being used for education
applications. Both conventional and innovative surgical pathology diagnostic
services are being designed and implemented as well. The technology has been
commercialized by more than 30 companies in Asia, the United States, and Europe.
Early adopters of telepathology have been laboratories with special challenges
in providing anatomic pathology services, ranging from the need to provide
anatomic pathology services at great distances to the use of the technology to
increase efficiency of services between hospitals less than a mile apart. As to
what often happens in medicine, early adopters of new technologies are
professionals who create model programs that are successful and then stimulate
the creation of infrastructure (ie, reimbursement, telecommunications,
information technologies, and so on) that forms the platforms for entry of
later, mainstream, adopters. The trend at medical schools, in the United States,
is to go entirely digital for their pathology courses, discarding their student
light microscopes, and building virtual slide laboratories. This may create a
generation of pathology trainees who prefer digital pathology imaging over the
traditional hands-on light microscopy. The creation of standards for virtual
slide telepathology is early in its development but accelerating. The field of
telepathology has now reached a tipping point at which major corporations now
investing in the technology will insist that standards be created for pathology
digital imaging as a value added business proposition. A key to success in
teleradiology, already a growth industry, has been the implementation of
standards for digital radiology imaging. Telepathology is already the enabling
technology for new, innovative laboratory services. Examples include STAT QA
surgical pathology second opinions at a distance and a telehealth-enabled rapid
breast care service. The innovative bundling of telemammography, telepathology,
and teleoncology services may represent a new paradigm in breast care that helps
address the serious issue of fragmentation of breast cancer care in the United
States and elsewhere. Legal and regulatory issues in telepathology are being
addressed and are regarded as a potential catalyst for the next wave of
telepathology advances, applications, and implementations.

Publication Types:
    Introductory Journal Article

PMID: 19552937 [PubMed - indexed for MEDLINE]

17: Hum Pathol. 2009 Aug;40(8):1122-8. Epub 2009 Jun 24. 

Competency assessment of residents in surgical pathology using virtual
microscopy.

Bruch LA, De Young BR, Kreiter CD, Haugen TH, Leaven TC, Dee FR.

Department of Pathology, Carver College of Medicine, The University of Iowa,
Iowa City, IA, USA.

Our goal was to develop an efficient and reliable performance-based virtual
slide competency examination in general surgical pathology that objectively
measures pathology resident's morphologic diagnostic skill. A Perl scripted
MySQL database was used to develop the test editor and test interface. Virtual
slides were created with the Aperio ScanScope. The examination consisted of 20
questions using 20 virtual slides. Slides were chosen to represent general
surgical pathology specimens from a variety of organ systems. The examination
was administered in a secure environment and was completed in 1 to 1 1/2 hours.
Examination reliability, as an indicator of the test's ability to discriminate
between trainee ability levels, was excellent (r = 0.84). The linear correlation
coefficient of virtual slide competency examination score versus months of
surgical pathology training was 0.83 (P = .0001). The learning curve was much
steeper early in training. Correlation of virtual slide competency examination
performance with resident's performance on the 64 item Resident In-Service
Examination surgical pathology subsection was 0.70. Correlation of virtual slide
competency examination performance with global end of rotation ratings was 0.28.
This pilot implementation demonstrates that it is possible to create a short,
reliable performance-based assessment tool for measuring morphologic diagnostic
skill using a virtual slide competency examination. Furthermore, the examination
as implemented in our program will be a valid measure of an individual
resident's progress in morphologic competency. Virtual slide technology and
computer accessibility have advanced to the point that the virtual slide
competency examination model implemented in our program could have applicability
across multiple residency programs.

Publication Types:
    Research Support, N.I.H., Extramural

PMID: 19552936 [PubMed - indexed for MEDLINE]

18: Hum Pathol. 2009 Aug;40(8):1092-9. Epub 2009 Jun 24. 

Robotic surgical telepathology between the Iron Mountain and Milwaukee
Department of Veterans Affairs Medical Centers: a 12-year experience.

Dunn BE, Choi H, Recla DL, Kerr SE, Wagenman BL.

Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Bruce.Dunn@va.gov

Since mid-1996, we have operated a diagnostic robotic telepathology (TP) system
at the Iron Mountain, MI, Department of Veterans Affairs Medical Center (VAMC)
from the Milwaukee, WI, VAMC, located some 220 miles away. No on-site
pathologist is present in Iron Mountain. Instead, an experienced, well-trained
pathologist assistant, under direction of pathologists located in Milwaukee, is
responsible for tissue grossing and sectioning. The pathologist assistant places
slides onto the stage of the robotic microscope, which is then controlled by
pathologists in Milwaukee. Each case read by TP is subsequently read by light
microscopy (LM) by the same pathologist. Three distinct phases of TP have been
recognized. Our experience during phase I (mid-1996 to early 1999) has been
published previously. During phase II (early 1999 to mid-2004), 1 of the 2
senior telepathologists in phase I retired, and 3 junior pathologists were
hired. During phase III (mid-2004 to June 2008), 2 new junior pathologists were
hired, and ASAP Imaging (Apollo Telemedicine, Inc., Falls Church, VA) was
implemented. The number of TP case opportunities in phases I, II, and III was
2200, 5841, and 3512, respectively, resulting in a total of 11 553. A total of
1834 cases were deferred to LM for a variety of reasons. The number of TP
diagnoses rendered in phases I, II, and III was 2144, 4636, and 2939,
respectively, resulting in a total of 9719. The major discordance rates in
phases I, II, and III were 0.33%, 0.45%, and 0.20%, respectively, with an
overall rate of 0.35%. Pathologist-specific discordance rates were not
significantly different and ranged from a low of 0.12% to a high of 0.77%,
whereas case deferral rates were significantly different (P < .0001) and ranged
from 2.5% to 28.7%. In general, no relationship between deferral rate and
discordance rate was noted. Iron Mountain clinicians have expressed great
satisfaction with the services provided by their off-site pathologist
colleagues.

PMID: 19552935 [PubMed - indexed for MEDLINE]

19: Hum Pathol. 2009 Aug;40(8):1129-36. Epub 2009 Jun 21. 

Virtual slide telepathology for an academic teaching hospital surgical pathology
quality assurance program.

Graham AR, Bhattacharyya AK, Scott KM, Lian F, Grasso LL, Richter LC, Carpenter
JB, Chiang S, Henderson JT, Lopez AM, Barker GP, Weinstein RS.

Department of Pathology, University of Arizona College of Medicine, Tucson, AZ
85724, USA.

Virtual slide telepathology is an important potential tool for providing
re-review of surgical pathology cases as part of a quality assurance program.
The University of Arizona pathology faculty has implemented a quality assurance
program between 2 university hospitals located 6 miles apart. The flagship
hospital, University Medical Center (UMC), in Tucson, AZ, handles approximately
20 000 surgical pathology specimens per year. University Physicians Healthcare
Hospital (UPHH) at Kino Campus has one tenth the volume of surgical pathology
cases. Whereas UMC is staffed by 10 surgical pathologists, UPHH is staffed daily
by a single part-time pathologist on a rotating basis. To provide same-day
quality assurance re-reviews of cases, a DMetrix DX-40 ultrarapid virtual slide
scanner (DMetrix, Inc, Tucson, AZ) was installed at the UPHH in 2005. Since
then, glass slides of new cases of cancer and other difficult cases have been
scanned the same day the slides are produced by the UPHH histology laboratory.
The pathologist at UPHH generates a provisional written report based on light
microscopic examination of the glass slides. At 2:00 pm each day, completed
cases from UPHH are re-reviewed by staff pathologists, pathology residents, and
medical students at the UMC using the DMetrix Iris virtual slide viewer. The
virtual slides are viewed on a 50-in plasma monitor. Results are communicated
with the UPHH laboratory by fax. We have analyzed the results of the first 329
consecutive quality assurance cases. There was complete concordance with the
original UPHH diagnosis in 302 (91.8%) cases. There were 5 (1.5%) major
discrepancies, which would have resulted in different therapy and/or management,
and 10 (3.0%) minor discrepancies. In 6 cases (1.8%), the diagnosis was deferred
for examination of the glass slides by the reviewing pathologists at UMC, and
the diagnosis of another 6 (1.8%) cases were deferred pending additional
testing, usually immunohistochemistry. Thus, the quality assurance program found
a small number of significant diagnostic discrepancies. We also found that
implementation of a virtual slide telepathology quality assurance service
improved the job satisfaction of academic subspecialty pathologists assigned to
cover on-site surgical pathology services at a small, affiliated university
hospital on a rotating part-time basis. These findings should be applicable to
some community hospital group practices as well.

PMID: 19540562 [PubMed - indexed for MEDLINE]

20: Hum Pathol. 2009 Aug;40(8):1070-81. Epub 2009 Jun 21. 

Primary frozen section diagnosis by robotic microscopy and virtual slide
telepathology: the University Health Network experience.

Evans AJ, Chetty R, Clarke BA, Croul S, Ghazarian DM, Kiehl TR, Perez Ordonez B,
Ilaalagan S, Asa SL.

Department of Pathology Laboratory Medicine Program, University Health Network,
Toronto, Ontario, Canada. andrew.evans@uhn.on.ca

Although telepathology (TP) has not been widely implemented for primary frozen
section diagnoses, interest in its use is growing as we move into an age of
increasing subspecialization and centralization of pathology services.
University Health Network is a 3-site academic institution in downtown Toronto.
The pathology department is consolidated at its Toronto General Hospital (TGH)
site. The Toronto Western Hospital (TWH), located 1 mile to west of TGH, has no
on-site pathologist, and generates 5 to 10 frozen section cases per week. More
than 95% of these frozen sections are submitted by neurosurgeons, in most cases
to confirm the presence of lesional tissue and establish a tissue diagnosis. In
2004, we implemented a robotic microscopy (RM) TP system to cover these frozen
sections. In 2006, we changed to a virtual slide (VS) TP system. Between
November 2004 and September 2006, 350 primary frozen section diagnoses were made
by RM. An additional 633 have been reported by VS TP since October 2006, giving
a total of 983 frozen sections from 790 patients. Of these cases, 88% have been
single specimens with total turnaround times averaging 19.98 and 15.68 minutes
per case by RM and VS TP, respectively (P < .0001). Pathologists required an
average of 9.65 minutes to review a slide by RM. This decreased 4-fold to 2.25
minutes after the change to VS TP (P < .00001). Diagnostic accuracy has been 98%
with both modalities, and our overall deferral rate has been 7.7%. Midcase
technical failure has occurred in 3 cases (0.3%) resulting in a delay, where a
pathologist went to TWH to report the frozen section. Discrepant cases have
typically involved minor interpretive errors related to tumor type. None of our
discrepant TP diagnoses has had clinical impact to date. We have found TP to be
reliable and accurate for frozen section diagnoses. In addition to its superior
speed and image quality, the VS approach readily facilitates consultation with
colleagues on difficult cases. As a result, there has been greater overall
pathologist satisfaction with VS TP.

Publication Types:
    Evaluation Studies

PMID: 19540554 [PubMed - indexed for MEDLINE]

21: Hum Pathol. 2009 Aug;40(8):1112-21. Epub 2009 Jun 21. 

Virtual microscopy in pathology education.

Dee FR.

Department of Pathology, Carver College of Medicine, University of Iowa, Iowa
City, IA 52242, USA. fred-dee@uiowa.edu <fred-dee@uiowa.edu>

Technology for acquisition of virtual slides was developed in 1985; however, it
was not until the late 1990s that desktop computers had enough processing speed
to commercialize virtual microscopy and apply the technology to education. By
2000, the progressive decrease in use of traditional microscopy in medical
student education had set the stage for the entry of virtual microscopy into
medical schools. Since that time, it has been successfully implemented into many
pathology courses in the United States and around the world, with surveys
indicating that about 50% of pathology courses already have or expect to
implement virtual microscopy. Over the last decade, in addition to an increasing
ability to emulate traditional microscopy, virtual microscopy has allowed
educators to take advantage of the accessibility, efficiency, and pedagogic
versatility of the computer and the Internet. The cost of virtual microscopy in
education is now quite reasonable after taking into account replacement cost for
microscopes, maintenance of glass slides, and the fact that 1-dimensional
microscope space can be converted to multiuse computer laboratories or research.
Although the current technology for implementation of virtual microscopy in
histopathology education is very good, it could be further improved upon by
better low-power screen resolution and depth of field. Nevertheless, virtual
microscopy is beginning to play an increasing role in continuing education,
house staff education, and evaluation of competency in histopathology. As Z-axis
viewing (focusing) becomes more efficient, virtual microscopy will also become
integrated into education in cytology, hematology, microbiology, and urinalysis.

PMID: 19540551 [PubMed - indexed for MEDLINE]

22: Pathol Res Pract. 2009;205(11):735-41. Epub 2009 Jun 7. 

Digital slides: present status of a tool for consultation, teaching, and quality
control in pathology.

Rocha R, Vassallo J, Soares F, Miller K, Gobbi H.

Department of Pathology Universidade Federal de Minas Gerais, Brazil.
rafael.malagoli@gmail.com

In the last few years, telepathology has benefited from the progress in the
technology of image digitalization and transmission through the world web. The
applications of telepathology and virtual imaging are more current in research
and morphology teaching. In surgical pathology daily practice, this technology
still has limits and is more often used for case consultation. In the present
review, we intend to discuss its applications and challenges for pathologists
and scientists. Much of the limitations of virtual imaging for the surgical
pathologist reside in the capacity of storage of images, which so far has
hindered the more widespread use of this technology. Overcoming this major
drawback may revolutionize the surgical pathologist's activity and slide
storing.

Publication Types:
    Research Support, Non-U.S. Gov't
    Review

PMID: 19501988 [PubMed - indexed for MEDLINE]

23: Lymphology. 2009 Mar;42(1):42-5. 

Emmanuil Kondoleon: pioneer in surgical treatment for lymphedema.

Dimakakos E, Arkadopoulos N, Katsenis K, Toumpis S, Syrigos K.

Vascular Unit of 2nd Surgical Clinic, University of Athens Aretaieion Hospital,
Athens, Greece. edimakakos@yahoo.gr

Our era is characterized by the rapid improvements in treatment in all areas of
medicine. But we should not forget those pioneers who, with their medical
actions and inspiration, changed the course of their era and left their mark on
medical history. One of those is the Greek surgeon Emmanuil Kondoleon
(1879-1940). His brilliant scientific personality, numerous teaching activities,
and his notable publications made him a distinguished Professor of Surgical
Pathology. At the beginning of the 20th century, when very little was known
about lymphedema and especially its treatment, Emmanuil Kondoleon arrived on the
scene with his own original technique that led the surgical treatment of
lymphedema for more than 50 years. Made famous as Kondoleon's procedure, his
technique included wide excision of the fascia and concomitant partial excision
of the hypertrophic tissue. Such important personalities as Kondoleon set great
examples in medical history and inspire future young generations of physicians.

Publication Types:
    Biography
    Historical Article
    Portraits

Personal Name as Subject:
    Kondoleon E

PMID: 19499767 [PubMed - indexed for MEDLINE]

24: Mod Pathol. 2009 Jun;22 Suppl 2:S70-95. 

Staging and reporting of urothelial carcinoma of the urinary bladder.

Cheng L, Montironi R, Davidson DD, Lopez-Beltran A.

Department of Pathology and Laboratory Medicine, Indiana University School of
Medicine, 350 West 11th Street, Clarian Pathology Laboratory Room 4010,
Indianapolis, IN 46202, USA. liang_cheng@yahoo.com

Significant progress has been made in the standardization of bladder neoplasm
classification and reporting. Accurate staging using the American Joint
Committee on Cancer/International Union Against Cancer (AJCC/UICC) TNM system is
essential for patient management, and has been reinforced by clinical evidence
in recent years. It is now recognized that 'superficial' bladder carcinomas are
a heterogenous group of tumors with diverse biological and clinical
manifestations. The term 'superficial,' therefore, is no longer used for bladder
tumor nomenclature. Recognition of diagnostic pitfalls associated with lamina
propria invasion is critical for the evaluation of bladder tumor specimens.
Neither the 1973 nor the 2004 WHO grading system appears to be useful for
predicting the clinical outcome of invasive urothelial carcinoma. This review
will discuss recent progress and controversial issues on the staging and
substaging of bladder carcinomas. Essential elements for handling and reporting
of bladder tumor specimens will also be discussed.

Publication Types:
    Review

PMID: 19494855 [PubMed - indexed for MEDLINE]

25: J Surg Oncol. 2009 Jun 15;99(8):517-24. 

Standardized synoptic cancer pathology reporting: a population-based approach.

Srigley JR, McGowan T, Maclean A, Raby M, Ross J, Kramer S, Sawka C.

Pathology and Laboratory Medicine, Program Cancer Care Ontario, Ontario, Canada.
jsrigley@cvh.on.ca

Cancer pathology reports contain information which is critical for patient
management and for cancer surveillance, resource planning, and quality purposes.
The College of American Pathologists (CAP) has defined scientifically validated
content of checklists that form the basis for synoptic cancer pathology
reporting. We outline how the CAP standards were implemented in a large Canadian
province over a 3-year period resulting in improvements in rates of synoptic
reporting and completeness of cancer pathology reporting.

PMID: 19466743 [PubMed - indexed for MEDLINE]

26: J Gastrointest Surg. 2009 Aug;13(8):1459-63. Epub 2009 May 21. 

Colorectal surgical specimen lymph node harvest: improvement of lymph node yield
with a pathology assistant.

Reese JA, Hall C, Bowles K, Moesinger RC.

Department of Radiology, McKay-Dee Hospital Center, 4403 Harrison Boulevard,
Ogden, UT 84403, USA.

INTRODUCTION: Adequate lymph node harvest from colorectal cancer specimens has
become a standard of care, influencing both staging and survival. To improve
lymph node harvests at our hospital, a pathology assistant was trained to
meticulously harvest lymph nodes from colorectal cancer specimens. An analysis
of trends in lymph node harvests over time is presented. METHODS: The number of
harvested lymph nodes from 391 consecutive colorectal cancer pathology reports
was retrospectively reviewed from a single community hospital over 8 years
(1999-2006). This spanned 4 years prior to the training of the pathology
assistant and 4 years after. RESULTS: From 1999-2002, the mean number of
harvested lymph nodes varied from 12.2 to 14.4. The percentage of specimens
achieving 12 lymph nodes was 50-67%. From 2003-2006, the mean number of
harvested lymph nodes increased to 18.4-20.7, while the percentage of specimens
achieving 12 lymph nodes was 83-87%. Both of these improvements achieved
statistical significance with p values of <0.00001. CONCLUSIONS: Over time,
lymph node harvests at our hospital dramatically improved. The training of a
pathology assistant to harvest the lymph nodes from colorectal cancer specimens
dramatically affected lymph node harvests and can be a crucial component of
pathologic analysis of these specimens.

Publication Types:
    Comparative Study

PMID: 19459019 [PubMed - indexed for MEDLINE]

27: Pathology. 2009;41(4):361-5. 

Histopathology reporting of breast cancer in Queensland: the impact on the
quality of reporting as a result of the introduction of recommendations.

Austin R, Thompson B, Coory M, Walpole E, Francis G, Fritschi L.

Epidemiology Unit, Viertel Centre for Research in Cancer Control, The Cancer
Council Queensland, Spring Hill, Queensland, Australia.
rachelaustin@cancerqld.org.au

AIMS: Recommendations for the pathology reporting of breast cancer were released
in Australia to ensure detailed communication of important prognostic features
and good patient management. An audit of the reporting of invasive breast cancer
in Queensland was conducted to determine how well these guidelines were utilised
in 2004. METHODS: A random sample of reports was audited for inclusion of
recommended criteria. The proportion of reports meeting each of the criteria was
determined and compared across whether the report was in a synoptic report
template or in a free text format. Comparison was made with published data from
prior to the release of the recommendations. RESULTS: Of the 419 reports in the
sample, at least 90% of reports included lesion size, histological type,
histological grade, lymph node involvement, margins of excision, lymphovascular
invasion, and changes in adjacent breast tissue individually, and 74% included
all seven of these essential criteria. Synoptic reports accounted for 76% of the
sample and were significantly more likely to have documented grade (p < 0.001),
quadrant (p = 0.003), calcification (p < 0.001), lymphovascular invasion (p <
0.001), changes in non-neoplastic breast (p < 0.001) and ductal carcinoma in
situ criteria (p < 0.001) compared with free text report format. The most
notable improvements since the implementation of the recommendations were in
documentation of adjacent breast tissue (92% versus 49%) and lymphovascular
invasion (97% versus 54%). CONCLUSION: Breast cancer reporting in Queensland has
improved since the implementation of the recommendations, however further
improvements would likely be seen if there is more widespread utilisation of a
synoptic report format.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 19404849 [PubMed - indexed for MEDLINE]

28: Anal Quant Cytol Histol. 2009 Apr;31(2):90-5. 

The European Network of Uropathology: a novel mechanism for communication
between pathologists.

Egevad L, Algaba F, Berney DM, Boccon-Gibod L, Griffiths DF, Lopez-Beltran A,
Mikuz G, Varma M, Montironi R; European Network of Uropathology.

International Agency for Research on Cancer, Lyon, France. lars.egevad@ki.se

In pathology there is a need to rapidly disseminate professional information to
the appropriate target groups. This is a surprisingly difficult task on an
international level. Therefore, the European Network of Uropathology (ENUP) was
recently organized by the Uropathology Working Group of the European Society of
Pathology. The purposes were to establish a channel for distribution of
information about uropathology, such as guidelines, consensus documents,
meetings and courses; to organize research collaborations; and to set up
mechanisms for survey studies. ENUP has recruited a total of 374 individual
members from 338 pathology laboratories in 15 Western European countries. E-mail
is used for all communication, and studies are carried out through interactive
Web sites. Information e-mails are sent regularly, and 2 Web-based surveys on
handling and reporting of urologic specimens have been conducted. Here we report
on the methods used to organize this novel information network. We think that
ENUP could serve as a model for other fields of pathology and other geographic
regions.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 19402385 [PubMed - indexed for MEDLINE]

29: Virchows Arch. 2009 Jun;454(6):623-8. Epub 2009 Apr 28. 

Activity-based differentiation of pathologists' workload in surgical pathology.

Meijer GA, Oudejans JJ, Koevoets JJ, Meijer CJ.

Department of Pathology, VU University Medical Center, Amsterdam, The
Netherlands. ga.meijer@vumc.nl

Adequate budget control in pathology practice requires accurate allocation of
resources. Any changes in types and numbers of specimens handled or protocols
used will directly affect the pathologists' workload and consequently the
allocation of resources. The aim of the present study was to develop a model for
measuring the pathologists' workload that can take into account the changes
mentioned above. The diagnostic process was analyzed and broken up into separate
activities. The time needed to perform these activities was measured. Based on
linear regression analysis, for each activity, the time needed was calculated as
a function of the number of slides or blocks involved. The total pathologists'
time required for a range of specimens was calculated based on standard
protocols and validated by comparing to actually measured workload. Cutting up,
microscopic procedures and dictating turned out to be highly correlated to
number of blocks and/or slides per specimen. Calculated workload per type of
specimen was significantly correlated to the actually measured workload.
Modeling pathologists' workload based on formulas that calculate workload per
type of specimen as a function of the number of blocks and slides provides a
basis for a comprehensive, yet flexible, activity-based costing system for
pathology.

PMID: 19399515 [PubMed - indexed for MEDLINE]

30: Arch Pathol Lab Med. 2009 Apr;133(4):633-42. 

Pathology of breast carcinomas after neoadjuvant chemotherapy: an overview with
recommendations on specimen processing and reporting.

Sahoo S, Lester SC.

Department of Pathology, University of Louisville, Louisville, KY 40202, USA.
sunati.sahoo@louisville.edu

CONTEXT: Currently, more women are being treated with chemotherapy or hormonal
agents before surgery (neoadjuvant chemoendocrine therapy) for earlier-stage
operable breast carcinoma. The pathologic examination of these specimens can be
quite challenging. OBJECTIVE: To give an overview of (1) pathologic changes that
occur during treatment, (2) systems for evaluating response to treatment, and
(3) recommendations for pathologic examination and reporting of such cases. DATA
SOURCES: The recommendations are based on the review of selected literature on
breast carcinoma after neoadjuvant therapy and the authors' personal experience
with the clinical and pathologic characteristics of cases from each of the
authors' own institutions. CONCLUSIONS: Pathologists play a key role in the
evaluation of pathologic response, which is extremely important as a prognostic
factor for individual patients, as a short-term endpoint for clinical trials,
and as an adjunct for research studies. Therefore, surgical pathologists must be
familiar with the gross examination, sampling, and reporting of breast
carcinomas after neoadjuvant therapy.

Publication Types:
    Review

PMID: 19391665 [PubMed - indexed for MEDLINE]