August 2022

August 2022—Blood is a precious resource and shouldn’t be treated as a commodity. That’s the consensus in the blood banking community, in line with a longstanding conviction that volunteer donations should remain at the blood system’s core. But as the worst of the pandemic appears to have passed, discussion of blood shortages has increasingly drawn on the vocabulary of commerce, and the warnings about the blood supply have been rife with references to supply chain problems that go beyond the need for more donations. Crises in the blood supply are nothing new, and while the health care system strives to stay prepared, the pandemic threw novel commercial and logistical factors into the mix, in some ways jumbling the expected order of a crisis for blood services. Hospitals scrambled to cope with a surge of COVID-19 patients while the spread of infection caused thousands of blood drives to be canceled, so there was a steep drop in supply of blood products, says Pampee Young, MD, PhD, chief medical officer, biomedical services, American Red Cross.

August 2022—Just as there is scant room in this world for pink “While You Were Out” notepads, paper checks, or the copying skills of Bartleby the Scrivener, laboratories would do well to leave manual result verification in the past.

August 2022—In cases of borderline melanocytic neoplasms, which have overlapping histopathologic features of benign and melanocytic lesions, additional immunohistochemical studies sometimes help to differentiate the two. But a subset of lesions will show overlapping features.

August 2022—Higher wages help to fill open positions, when they can be offered, but in a labor market that’s as tight as ever, they’re often just a start. That’s why many laboratories are casting wider nets, though the hiring solutions tend to be long term.

August 2022—The atypia in Epstein-Barr virus-positive mucocutaneous ulcers can mimic diffuse large B-cell lymphoma or classical Hodgkin lymphoma, a diagnostic pitfall that can result in overtreatment. And esophageal ulcers in immunocompromised patients should trigger cytomegalovirus immunohistochemistry in addition to GMS and herpes simplex virus-1 and -2 stains.

August 2022—HER2 is a known oncogenic driver and emerging biomarker in non-small cell lung cancer, and while the therapeutic implication is not yet fully known in NSCLC, “we need to pay attention to it,” said Fred R. Hirsch, MD, PhD, executive director of the Mount Sinai Center for Thoracic Oncology and associate director, Tisch Cancer Institute, in a CAP TODAY webinar sponsored by Daiichi-Sankyo and AstraZeneca.

August 2022—Running into the reality of staffing. Those are the words of a pathologist who said in the most recent Compass Group roundtable that its health system is making a push to obtain and test specimens “as close to home as possible.” Another Compass Group member said planning is underway for the new hospitals his system is going to build, “but we don’t know where staff will come from.” Here is what they and others told CAP TODAY publisher Bob McGonnagle on July 5.

August 2022—The protocol for the reporting of cervicovaginal cytology, the first in a series of CAP cytopathology protocols, became available for use in a synoptic format on June 22. This protocol is a collaborative effort, based on input from past and present members of the CAP Cytopathology Committee and prepared in conjunction with the CAP Pathology Electronic Reporting Committee. It was presented via webinar to the CAP House of Delegates on March 31. A two-week open comment period followed; all comments were reviewed and appropriate changes were incorporated into the protocol.

August 2022—The ability to make a definitive diagnosis of mesothelioma on pleural fluid cytology has been questioned and debated for a long time. The 2018 American Society of Clinical Oncology clinical guidelines limit the cytological diagnosis of pleural fluid specimens only as an initial screening test for mesothelioma. Monaco, et al., discuss in their article the appropriate use of ancillary studies (immunohistochemistry and fluorescence in situ hybridization studies) to make a definitive diagnosis of mesothelioma in small tissue samples, which are often processed as cell blocks. The authors recommend a stepwise approach starting with immunohistochemistry for BAP1 and, next, MTAP in cases of atypical mesothelial proliferations where the suspicion for malignant mesothelioma is high.

August 2022—The CAP has been advocating for an increase in residency slots that would help give more young physicians the opportunity to embrace careers in pathology. We support the Resident Physician Shortage Reduction Act, bipartisan legislation that is working its way through both chambers of Congress. It would add 14,000 Medicare-supported residency slots over the course of seven years and help ensure an open pipeline for pathologists. Between pandemic burnout and the retirement cliff resulting from an aging population of physicians, we are facing a shortage of all physicians, pathologists included. The CAP projects that the number of pathologists will shrink in the coming years. Unfortunately, when there are not enough pathologists to lead clinical laboratory teams, it creates a gap that has to be filled somehow. Many of us have already seen health care gaps being filled by people with less extensive and intensive training.

August 2022—Prostate cancer is the second leading cause of cancer death in men, following lung cancer. It is necessary to balance efforts to identify prostate cancer in the early stages against complications and harms from overtreatment and overdiagnosis.

August 2022—Mucocele-like lesion of the breast is an uncommon entity. Studies show low rates of upgrade from core needle biopsy to excision. The authors conducted a study to evaluate features associated with upgrade of cases of mucocele-like lesion of the breast (MLL) diagnosed on core needle biopsy.

August 2022—Surgical resection remains the mainstay of treatment for locally advanced (stages II and III) colorectal carcinoma. Patients with node-positive (stage III) cancer receive adjuvant chemotherapy after surgery.

August 2022—Transfusion medicine specialists at Phoenix Children’s Hospital may be used to trending laboratory biomarkers for sickle cell disease patients in their heads, but a dashboard supporting red blood cell exchange procedures for such patients eases the burden on their cerebral cortices.

August 2022 Q. Every month our anatomic pathology laboratory amends patient reports. Does the CAP have a benchmark for amended reports, such as how many are acceptable per month? Read answer. Q. What is the best practice for performing a urine specific gravity test? Which method is preferred—a refractometer or an automated dipstick? Should we correct for elevated glucose and protein or report high specific gravity? Should we correct for x-ray dyes or add a comment and list possible interfering substances? Read answer.

August 2022—The FDA has granted breakthrough device designation to Roche’s Elecsys Amyloid Plasma Panel for detection of early Alzheimer’s disease. It detects and measures AD biomarkers in blood plasma to indicate the need for further confirmatory testing.