December 2021

December 2021—There are success stories. There are overnight success stories. And then there are things that just seem to happen overnight—minus the success. In the midst of chronic discontent over the use of a race coefficient in equations for estimating glomerular filtration rate, one San Francisco hospital sought to make a change. The hope was to help end disparities in health care, such as lower kidney transplantation rates in Black people with chronic kidney disease. The change at Zuckerberg San Francisco General Hospital was pushed by what Neil Powe, MD, MPH, MBA, calls “a very small group of faculty and trainees lobbying the lab, unbeknownst to others.” The lab reported two values, using the eGFR equation with and without the race coefficient, but assigned “high muscle mass” and “low muscle mass” to the two values as a way to step around the troubling race component. Dr. Powe, the hospital’s chief of medicine, doesn’t mince words when he considers how the change was made. “And it stereotyped ethnic groups even more,” he says.

December 2021—No single assay can capture all cancer patients with DNA mismatch repair deficiency, and in determining a patient’s eligibility for immune checkpoint inhibitor therapy, assays for MMR deficiency, microsatellite instability, and tumor mutation burden should not be considered interchangeable.

December 2021—The staffing crisis lives on, despite labs having plans of all kinds in place to alleviate the shortage. “It’s the only thing we’re talking about,” Ochsner Health’s Greg Sossaman, MD, said on Nov. 2 when members of the Compass Group met by Zoom. SARS-CoV-2 testing and test supplies and vaccination are “taking a back seat” to staffing, he said.

December 2021—A cost-effective liquid biopsy focused on analyzing genomewide fragmentation profiles in cell-free DNA has been shown in proof-of-concept studies to detect early-stage lung and other cancers.

December 2021—Pathologists will have a new set of Current Procedural Terminology codes to use for reporting pathology clinical consultation services, beginning Jan. 1, 2022. These codes, which the CAP developed through its advocacy work with the American Medical Association CPT editorial panel, were published in the final 2022 Medicare physician fee schedule on Nov. 2.

December 2021—The CAP has decided to temporarily withdraw the anatomic pathology checklist requirement ANP.10039 (Total Fixation Time) from the 2021 checklist edition, and this requirement will no longer appear in customized checklists provided to laboratories and inspectors using the 2021 edition.

December 2021—Clinical metagenomic next-generation sequencing (mNGS), the comprehensive analysis of microbial and host genetic material (DNA and RNA) in patient samples, is increasingly available in clinical laboratories. At present, for various reasons including test complexity, cost, and turnaround time, this technology is generally limited to difficult-to-diagnose conditions where conventional microbiological testing methods may not lead to a definitive diagnosis in selected patients, such as those with meningoencephalitis of unknown etiology.

December 2021—Four experts met on an Oct. 12 call to talk with CAP TODAY about urinalysis—the newest platforms, what labs need, labor solutions. CAP TODAY publisher Bob McGonnagle asked the questions. Providing their perspectives were Matthew Rhyner, PhD, MBA, Beckman Coulter; Jason Anderson, MPH, MT(ASCP), Sysmex America; Megan Nakashima, MD, Cleveland Clinic; and Keri Donaldson, MD, MSCE, Solvd Health and Penn State. Here’s what they had to say.

December 2021—When I became a pathologist more than 20 years ago, I never imagined I would have the opportunity to serve as chief medical officer at a hospital. But I can see from my new position how a background in pathology has prepared me for hospital leadership. In fact, the very traits that led us to become pathologists are the ones that make so many of us natural leaders. We are nimble thinkers who can simultaneously appreciate the big picture and the tiny details. Likewise, we can think concurrently about population health and individual patients. Our ability to see and understand these perspectives so clearly is a huge advantage. Because our specialty touches many different aspects of medicine, we are comfortable interacting with all segments of the health care system—from operative services and radiology to the emergency department, medical wards, and ambulatory setting.

December 2021—Alzheimer disease is characterized by extracellular amyloid-β deposits, tau tangles, neuronal death, and extensive neuroinflammatory changes. Genetic studies have revealed the importance of gene variants that increase the risk for developing the disease.

December 2021—It is unclear whether HER2+ tumors expressing estrogen receptor and progesterone receptor—that is, triple-positive breast carcinomas—show unique morphologic and clinical features and response to neoadjuvant chemotherapy.

December 2021—Advances in sequencing technologies, such as next-generation sequencing, have yielded many insights into the genomic landscape and clinical import of molecular findings in myelodysplastic syndromes and other myeloid neoplasms with myelodysplasia (MN).

December 2021—Like death and taxes, cyberattacks targeting health care organizations are a certainty, but taking proactive breach mitigation measures and developing a thorough response plan can lessen, or even prevent, a devastating blow.

December 2021 Q. We use the CAP Competency Assessment Program to create quizzes to satisfy the problem-solving element of the CAP’s competency assessment requirements. Is there a requirement to create a new quiz each year or can the same quiz be given every year? Is it OK to use the same quiz for the initial competency and the annual competency? Read answer. Q. Are there red blood cell parameters, such as RBC count or mean corpuscular volume, that can affect a platelet estimate? When determining a platelet estimate, should we always look at the same area of the slide regardless of the patient’s RBC, hematocrit and hemoglobin levels, and indices results? Read answer.

December 2021—In the COVID-19 pandemic and future pandemics, the existing expertise of clinical laboratories should be taken advantage of and labs should be enabled to validate and offer robust clinical assays, say the authors of “The Role of Clinical Laboratories in Emerging Pathogens—Insights from the COVID-19 Pandemic,” published Oct. 29 in JAMA Health Forum (2021;2[10]:​e213154).