May 2024

May 2024—If anything keeps Arturo Casadevall, MD, PhD, lying awake at night, it’s the frogs. And the bats. Also, the patients (relatively few, at least for now) who are affected by invasive fungal diseases. Dr. Casadevall is a microbiologist and infectious diseases expert in the Johns Hopkins Division of Infectious Diseases, Department of Medicine, and the Bloomberg School of Public Health, where he’s a professor of medicine and chairs the Department of Molecular Microbiology and Immunology. In his waking hours, he looks deeply and broadly at the natural world and how the disturbing growth of fungal infections might impact the medical world. Though the arrows haven’t hit the bull’s-eye, they seem to be flying in that direction, says Dr. Casadevall, who has written widely on this topic, including “Immunity to Invasive Fungal Diseases.” In a recent interview with CAP TODAY, Dr. Casadevall spoke about how he and others in the field are thinking about how medicine might respond to this potential threat.

May 2024—In a time of wellness testing and high rates of levothyroxine prescribing for hypothyroidism, it may also be time to rethink TSH test result interpretation.

May 2024—Many laboratories have brought order to chaos in test ordering by launching initiatives to do so, for cost and staff savings and patient care benefits. TriCore is one—it set its sights on orders for monoclonal gammopathies.

May 2024—What is a lupus anticoagulant (LA)? LA is somewhat of a misnomer. Many patients with this condition do not have systemic lupus erythematosus (SLE) and usually do not bleed. However, the in vitro phenomenon was originally described in patients with SLE, as well as other autoimmune disorders—thus use of the term “lupus,” and this does often lead to prolonged in vitro coagulation testing—thus use of the term “anticoagulant.”

May 2024—The number of “champions” who have joined the CAP’s Future Pathologist Champion program grew from 71 in 2022 to 135 in 2023 and now stands at 222, and the goal is to reach 250 by the end of this year.

Four views of artificial intelligence in pathology and laboratory medicine. That’s what panelists provided for attendees at the 7th Clinical Lab 2.0 workshop in late February in Chicago. The University of Michigan’s Ulysses G. J. Balis, MD, spoke of AI’s use in laboratory operations and diagnostics. Tom Neufelder of Beckman Coulter spotlighted its use in instruments and postanalytically. Gaurav Sharma, MD, of Henry Ford Health is the skeptic, and the University of Pittsburgh’s Michael Becich, MD, PhD, is the rabid enthusiast who is working to unite pathology’s reports and calls himself a data plumber.

May 2024—Laboratory-developed testing as it relates to next-generation sequencing was up first in the NGS conversation led online by CAP TODAY publisher Bob McGonnagle on March 19. Other topics: in-house NGS testing, artificial intelligence, and bioinformatics. “There’s a reality now where bioinformatics is solid, stable, and reliable,” said José Luis Costa, PhD, of Thermo Fisher Scientific.

May 2024—Classically, immunohistochemical expression of small cell lung cancer (SCLC) is characterized by strong expression of neuroendocrine markers, notably synaptophysin, chromogranin A, insulinoma-associated protein 1 (INSM1), and CD-56. However, up to 20 percent of SCLCs demonstrate low or no expression of neuroendocrine (NE) markers by IHC and are termed “NE-low/negative.”

May 2024—Breast cancer continues to remain a major global health issue and one of the main leading causes of cancer mortality among women worldwide. The majority of breast cancer mortality is attributed to its ability to metastasize. Bone, lung, liver, pleura, and brain are the most common sites of metastatic lesions, often spreading from invasive breast carcinoma of no special type.

May 2024—Fine-needle aspiration has been an important diagnostic tool for the workup of patients with abnormal enlargement of lymph nodes and related organs, including the spleen and thymus.

May 2024—You may have read my column in the March issue about how the CAP is taking care of the next generation of pathologists by helping and engaging our new-in-practice colleagues. If you’re a more seasoned pathologist, you may be wondering: What about me?

May 2024—Massive hemorrhage is a major cause of death in children, and the mortality rate from life-threatening hemorrhage is estimated to be 20 to 51 percent. To counter this high mortality rate, clinicians have sought to standardize massive transfusion protocols and hemostatic resuscitation, ensuring that protocols support balanced blood-based resuscitation or the use of low titer group O whole blood, or both. These protocols may include using the lysine analogue antifibrinolytics tranexamic acid (TXA) and epsilon aminocaproic acid (EACA) in children with life-threatening hemorrhage (LTH). However, use of these antifibrinolytics is much more common in adult trauma patients. Study data suggest that TXA may increase survival outcomes in adults with traumatic injury, postpartum hemorrhage, nontraumatic intracranial hemorrhage, and all-cause bleeding.

May 2024—The Bethesda System for Reporting Thyroid Cytopathology described four subclasses of atypia within the atypia of undetermined significance category: nuclear (AUS-Nuc), architectural (AUS-A), oncocytic (AUS-Onc), and atypia not otherwise specified (AUS-NOS). Accumulating evidence supports the use of a binary AUS subclassification scheme based primarily on the presence of nuclear atypia only. The authors conducted a study to compare the risk stratification of binary versus four-tier AUS subclassification systems among AUS nodules with molecular or histologic follow-up, or both. The study included thyroid aspirates classified as AUS and tested using Afirma (Veracyte Inc.) between June 2013 and July 2021. Histological classification was considered the final outcome for resected nodules.

May 2024—Immunotherapy has revolutionized cancer treatment by recruiting the patient’s immune system to detect and destroy cancer cells. Immunotherapy often involves immune checkpoint blockade (ICB) agents, which target negative regulators of T-cell activation, such as cytotoxic T lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), or programmed death-ligand 1 (PD-L1). Although ICB is used to treat a variety of cancer types, patients’ response to therapy is often unpredictable, and biomarkers such as tumor mutation burden, mismatch repair deficiency, and IHC for PD-L1 have limitations for assessing ICB response. Consequently, there is great interest in discovering additional biomarkers that will improve the ability to predict clinical response to ICB. Recent studies have explored the hypothesis that there may be a correlation between a person’s gut microbiome and therapeutic response.

May 2024 Q. I know that CLIA is changing and more tests/analytes will become CMS regulated, along with other changes. Can you provide some background and an overview of the changes and when they will become effective? Read answer.

May 2024—The FDA has granted marketing authorization, through the de novo pathway, for Prenosis’ Sepsis ImmunoScore artificial intelligence-enabled software as a medical device, or SaMD, for the rapid diagnosis and prediction of sepsis.

May 2024—Risant Health has completed its acquisition of Geisinger as its first health system dedicated to increasing access to value-based care and coverage. Risant says the organizations together will create a new value-based care platform that includes best practices, tools, technology, and services to support community-based health systems.