October 2021

October 2021—Neither pathologists nor laboratories should panic over the new 21st Century Cures Act rules making laboratory results immediately accessible to patients, pathology leaders agree. Most laboratories already release results to electronic health records and those results are made available in patient portals, and the Cures Act will require little change in how labs send results to EHR systems. But the rules, which took effect April 5, do come with some complexities to navigate. By passing the Cures Act in 2016, Congress aimed broadly to increase interoperability across EHR platforms and to ensure that patients have full, portable, and cost-free access to their health care information. Of most direct relevance to pathology is the Cures Act’s information blocking or open notes rule, mandating that lab report narratives and pathology report narratives, along with six other categories of clinical notes, be available without delay to patients in different electronic formats, including smartphones and secure online portals.

October 2021—It’s not quite six degrees of Kevin Bacon, but the connection between Alzheimer’s disease biomarkers and equity in medicine is real (and far more important). It’s a trail researchers have been following for some time, but which has gained more prominence with the recent approval of a new drug for treating the disease (aducanumab) and the acknowledgment of racial disparities in CSF amyloid and tau biomarkers and their associated cutoffs.

October 2021—By Jan. 1, 2024, laboratories must use current breakpoints to interpret antimicrobial minimum inhibitory concentration and disk diffusion test results, according to a new requirement in the latest edition of the CAP Accreditation Programs microbiology checklist, released Sept. 22.

October 2021—Clonal hematopoiesis is a significant biological phenomenon and denotes presence of mutations in bone marrow stem cells in the absence of a hematologic malignancy.

October 2021—Recent molecular genetic advances have dramatically expanded diagnostic options, thus revolutionizing the diagnosis of many tumor types, especially those of soft tissue and bone. Advances in the discovery of molecular alterations underlying neoplastic pathogenesis have also provided insights into novel therapeutic targets and prognostic biomarkers. These improvements have led to the reclassification of a growing list of previously established tumor types, resulting in significant challenges for practicing pathologists, as exemplified herein.

October 2021—Surge, supplies, staffing. Eighteen months into the pandemic, the story remains similar. Even where laboratory salaries have been bumped up or sign-on bonuses have been in place to strengthen the workforce, Compass Group members report little to no success. And on supplies: “Every week we cross our fingers and toes to see what arrives in the door, how to disperse that through the systems, and how to continually educate the physicians on appropriate use of that limited resource,” says Judy Lyzak, MD, MBA, of Alverno Laboratories. She and other laboratory leaders of the Compass Group met virtually Sept. 6 to share their latest. Of the confluence of problems laboratories face, one said: “I have never seen anything quite like this.”

October 2021—Detecting leukemic cells for post-treatment monitoring in normal karyotype acute myeloid leukemia is challenging, but new approaches to minimal residual disease monitoring may make it increasingly possible in the clinical laboratory, David Wu, MD, PhD, said in an AMP webinar he presented recently on myeloid malignancy minimal residual disease detection.

October 2021—Rules, slide reviews, test ordering, and provider education were part of the conversation when CAP TODAY publisher Bob McGonnagle convened a hematology-focused virtual roundtable in late August. Workforce problems too: “We have a bigger exodus now and our pipeline is smaller,” said Eric D. Hsi, MD, of Wake Forest University.  

October 2021—I was born into the home of medicine. With a father who was an obstetrician/gynecologist and a mother who was a nurse, there was virtually no separation between our home and medical practice. And while I value how much medicine has shaped my life, I should probably note that my health-care–focused upbringing was little consolation to the parents of my third-grade classmates when I brought in a human placenta for show and tell and delivered some unwanted birds-and-bees education in the process. While medicine has always felt like home to me, as a pathologist, the CAP has become my home as well. This organization has given me a sense of belonging and tremendous opportunity. The first CAP committee I served on was the Cytopathology Resource Committee. I had the privilege of attending the historic Bethesda meeting where we determined how Pap tests would be reported going forward. That system is still in place today.

October 2021—Pathologists are well suited to educate patients and their caregivers about laboratory results so these individuals can better understand diseases and make informed treatment decisions. Pathologists from four institutions involved in this study participated in programs focused on patient and family-centered care.

October 2021—Squamous cell carcinoma is the most common malignancy of the anal canal and is strongly associated with human papillomavirus (HPV) infection. Characteristic genomic alterations have been identified in anal squamous cell carcinoma (SqCC), but their clinical significance and correlation with HPV status, pathologic features, and immunohistochemical markers are not well established.

October 2021—Transthyretin amyloidosis, also known as ATTR amyloidosis, occurs secondary to accumulation of misfolded transthyretin (TTR) protein in the form of amyloid fibrils. The acquired form of ATTR amyloidosis is referred to as wild-type ATTR amyloidosis.

October 2021
Q. After naloxone is administered, are opiates still detectable in the body? If so, for how long and in what quantities? Read answer. Q. Why do proficiency testing specimen results for common immunoassay analytes sometimes vary greatly with different instrument manufacturers and their reagents? Does that mean the patient’s results for the same specimen could vary greatly based on the instrument used? If so, is this acceptable? Wouldn’t the variation in results confuse the clinician and patient? Read answer.

October 2021—Given Penn Medicine’s reputation for high operational standards, it’s not surprising that the developers of its new Center for Applied Health Informatics set lofty goals for the center: coordinate the efforts of multiple internal technology-related groups to further improve systems institutionwide and position the health system as a global leader in health informatics.

October 2021—The Food and Drug Administration granted 510(k) clearance for use of the MeMed BV test on the point-of-need platform MeMed Key to help providers distinguish between bacterial and viral infections. The technology has been cleared for children and adults.