Experiences from the front-line routine consenting of surplus surgically removed tissue: without investment by the National Health Service fully informed consent for all is not available.
(57/166)
The study investigated the routine introduction of a new surgical consent form containing a tissue consent section to investigate patient attitudes to the use of surplus tissue for research (after the Alder Hey inquiry) and also the differing approaches by consent takers. All surgical consent forms received in histopathology for the same 2-month period in 2 consecutive years were analysed, recording available information about the specimen, the tissue consent section and, for the second year, the consent taker. The findings showed that <5% of patients whose views were recorded disagreed with the use of their tissue for research. They also showed that the number of completed forms sent to histopathology had increased but the pattern of completion had changed very little. A wide variation between departments and also between clinicians was apparent in the levels of completion of the tissue consent section, suggesting wide variability in the quality of the consenting process. When asked, patients rarely object (<5%) but if the highest standards of consent for surgical tissue are to be achieved and the wishes of patients to donate tissue are to be effectively recorded then new resources or approaches will be needed for this process. (+info)
Comparison of human papillomavirus distribution in cytologic subgroups of low-grade squamous intraepithelial lesion.
(58/166)
BACKGROUND: Low-grade squamous intraepithelial lesion (LSIL) subsumes the formerly delineated cytologic categories of human papillomavirus (HPV)-associated cell changes (koilocytotic atypia) and low-grade dysplasia/cervical intraepithelial neoplasia (CIN) Grade 1 (CIN1). In this study, the objective was to determine whether these 2 morphologic subcategories are characterized by differences in risk for CIN3 and/or HPV type distribution. METHODS: Within the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study, all cytologic interpretations of HPV cellular changes and CIN1 rendered by any of the pathology reviewers (community laboratory, clinical center, or Pathology Quality-Control Group) on referral Papanicolaou (Pap) tests or enrollment ThinPrep Pap tests were included for analysis. HPV testing was performed by Hybrid Capture 2 (HC2) and by polymerase chain reaction based reverse-line blot analysis for 27 HPV types. The absolute risks of cumulative detection of CIN3 or cancer (CIN3 +) and CIN2 or worse (CIN2 +) over 2 years of follow-up were calculated for the various cytologic interpretations. RESULTS: For each review group and cytology preparation, most LSIL interpretations (from approximately 2 of 3 interpretations to 3 of 4 interpretations) were subcategorized as CIN1 rather than HPV cellular changes. HPV type 16 (HPV-16) was the most common HPV type and was identified in 21% to 24% of CIN1 and in 14% to 18% of HPV cellular changes. Nononcogenic types were identified alone in from 9% to 11% of CIN1 compared with 17% to 20% of HPV cellular change. The absolute risks of CIN1 and HPV cellular changes for cumulatively detected CIN3 + ranged from 12% to 16% for CIN1 and from 6% to 9% for HPV cellular changes. CONCLUSIONS: Both cytologic subcategories of LSIL were associated predominantly with oncogenic HPV types; however, the proportion of nononcogenic HPV types was lower and the absolute risks for CIN3 + were higher for CIN1 compared with HPV cellular changes. The concordance in subcategorizing LSIL was low, and the authors concluded that the diagnostic distinction is of limited clinical utility for individual patient management. (+info)
Use of a new method in reaching consensus on the cause of cytologic-histologic correlation discrepancy.
(59/166)
Pathologists exhibit very poor agreement in adjudicating the cause of cytologic-histologic correlation discrepancies, which contributes to problems in designing interventions to reduce discrepancy frequency. In this observational study, we developed a visual method of adjudicating discrepancy cause, termed the No-Blame Box method, which consisted of initially assessing specimen interpretability by separately evaluating specimen quality and the presence of tumor. Five pathologists blindly adjudicated the cause of discrepancy in pulmonary specimens from 40 patients. The kappa statistic of all pathologist pairs in adjudicating discrepancy cause using the No-Blame Box method ranged from 0.400 to 0.796, indicating acceptable to excellent agreement. Pathologists ranged in their assessment of specimen interpretability from 13% to 20%, and in no case did all 5 pathologists concur that a specimen was interpretable. Most discrepancies resulted from pathologists diagnosing noninterpretable samples. Pathologists who used the No-Blame Box showed significant agreement in the adjudication of discrepancy cause. (+info)
Measuring errors in surgical pathology in real-life practice: defining what does and does not matter.
(60/166)
This review summarizes our experience using blinded review as a method to measure quality in surgical pathology. It details the specifics about how the review is performed, the weaknesses in the method, and then summarizes our results so far. These results suggest that error rates correlate with the individual pathologist, the type of specimen, the type of diagnosis, subspecialization, and the number of pathologists who review a case. Errors do not correlate with workload. This method is relatively unbiased and effective at identifying significant errors in real life clinical practice. The drawback to this method is the amount of work involved. Blinded review, performed so that errors can be corrected in a timely manner, and eventually integrated into an interlaboratory review process, represents a realistic and fair method to provide quantitative quality assurance information. (+info)
Automated extraction of free-text from pathology reports.
(61/166)
Manually populating a cancer registry from free-text pathology reports is labor intensive and costly. This poster describes a method of automated text extraction to improve the efficiency of this process and reduce cost. FineTooth, a software company, provides an automated service to the Fred Hutchinson Cancer Research Center (FHCRC) to help populate their breast and prostate cancer clinical research database by electronically abstracting over 80 data fields from pathology text reports. (+info)
Developing and evaluating a simple, spreadsheet-based pathology report extraction system for cancer registrars.
(62/166)
Surgical pathology reports are essential for cancer registry. However, cancer registrars in Taiwan still code manually from the pathology reports written in unstructured free-text. The purpose of this study was to develop a cost-effective tool to automatically code the free-text reports with Microsoft-u Excel VBA too. The time and accuracy performances between these two approaches were compared. Results showed that the cost-effectiveness and time-saving of the system and the potentials of using spreadsheet tools for healthcare professionals. (+info)
Why microscopy will remain a cornerstone of surgical pathology.
(63/166)
Recent years have seen increasing predictions of the demise of conventional microscopy in patient care and investigative medicine. However, these predictions fail to recognize the power of morphologic analysis by a skilled observer. The amount of information that can be obtained from a simple H&E slide represents a windfall in terms of data quality, quantity and cost when compared to any other available technique. Moreover, the value of such interpretation is irreplaceable as we develop newer and more sophisticated technologies. Overall, it appears that reports of the death of microscopy have been greatly exaggerated. (+info)
Performance of skin biopsies by general practitioners.
(64/166)
OBJECTIVE: To evaluate and appraise skin biopsies performed by general practitioners and compare their performance with that of hospital doctors. DESIGN: Retrospective analysis of histology records. SETTING: University hospital. SUBJECTS: Records of 292 skin biopsy specimens obtained by general practitioners and 324 specimens obtained by general and plastic surgeons. MAIN OUTCOME MEASURES: Clinical and pathological diagnoses and completeness of excision. RESULTS: The number of specimens received from hospital surgeons and general practitioners increased over the study period; the proportion of specimens from general practitioners rose from 17/1268 (1.3%) in 1984 to 201/2387 (8.7%) in 1990. The range of diagnoses was similar among hospital and general practitioner cases, although malignancy was commoner in hospital cases (63/324 (19%) v 14/292 (5%) in general practitioner cases; chi 2 = 28, p less than 0.00001). Completeness of excision was less common among general practitioners than hospital surgeons (150/233 (3/15 malignant) v 195/232 (57/63); chi 2 = 22, p less than 0.00001). CONCLUSIONS: The increase in minor surgery has implications for the staffing and finance of histopathology departments. General practitioners must be given proper training in performing skin biopsies, and all specimens should be sent for examination. (+info)