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The Significance of Duodenal Mucosal Atrophy in Patients With Common Variable Immunodeficiency: A Clinical and Histopathologic Study
BIAGI, Federico;BIANCHI, Paola I;ZILLI, Alessandra;MARCHESE, Alessandra;LUI...
Academic Journal Academic Journal | American journal of clinical pathology. 138(2):185-189 Please log in to see more details
Gastrointestinal manifestations and villous atrophy can be seen in patients with commo... more
The Significance of Duodenal Mucosal Atrophy in Patients With Common Variable Immunodeficiency: A Clinical and Histopathologic Study
American journal of clinical pathology. 138(2):185-189
Gastrointestinal manifestations and villous atrophy can be seen in patients with common variable immunodeficiency (CVID). In some patients, infectious agents may be responsible, whereas in others, celiac disease (CD) may be the cause. In this study, we investigate the causes and the histopathologic features seen in patients with CVID. Eleven patients with CVID and villous atrophy underwent duodenal biopsies, human leukocyte antigen (HLA) typing, and testing for all celiac antibodies. Fifteen patients with CVID and normal villi and 6 patients with CD but without CVID served as controls. Histologic response to a gluten-free diet (GFD) allowed a diagnosis of CD in 3 of 11 patients. In the remaining 8, the lack of a histologic response to a GFD or HLA typing excluded CD. Celiac antibodies gave conflicting results and were of no help. Polymorphonuclear infiltrates and lesions like graft-versus-host disease are seen more often in flat mucosa unresponsive to a GFD. However, the specificity of these findings remains to be determined and response to a GFD remains the only diagnostic criteria for CD in these patients. Villous atrophy was gluten-sensitive in 3 of 11 patients with CVID. It was not related to gluten-responsive CD in most patients.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Immunopathologie - Immunopathology - Immunodéficits. Immunoglobulinopathies - Immunodeficiencies. Immunoglobulinopathies - Immunodéficits - Immunodeficiencies - Gastroenterologie. Foie. Pancreas. Abdomen - Gastroenterology. Liver. Pancreas. Abdomen - Estomac. Duodénum. Intestin grêle. Côlon. Rectum. Anus - Stomach. Duodenum. Small intestine. Colon. Rectum. Anus - Autres maladies. Sémiologie - Other diseases. Semiology - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Alimentation - Feeding - Alimentación - Appareil digestif - Digestive system - Aparato digestivo - Immunoglobulinopathie - Immunoglobulinopathy - Inmunoglobulinopatía - Immunopathologie - Immunopathology - Inmunopatología - Intestin grêle - Small intestine - Intestino delgado - Malabsorption intestinale - Intestinal malabsorption - Malabsorción intestinal - Pathologie de l'appareil digestif - Digestive diseases - Aparato digestivo patología - Pathologie de l'intestin - Intestinal disease - Intestino patología - Anatomopathologie - Anatomic pathology - Anatomía patológica - Anticorps - Antibody - Anticuerpo - Atrophie - Atrophy - Atrofia - Duodénum - Duodenum - Duodeno - Gluten - Histopathologie - Histopathology - Histopatología - Homme - Human - Hombre - Immunodéficit commun variable - Common variable immunodeficiency - Inmunodefícito común variable - Immunoglobulinopénie - Agammaglobulinemia - Inmunoglobulinopenia - Maladie coeliaque - Coeliac disease - Enfermedad celíaca - Muqueuse - Mucosa - Régime alimentaire dépourvu - Deficient diet - Régimen alimenticio deficiente - Celiac disease - Endomysial antibodies - Gluten-free diet - Hypogammaglobulinemia

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The Clinical Significance of Squamous Intraepithelial Lesion of Indeterminate Grade as a Distinct Cytologic Category
WONG, Dorothy;TESCHENDORF, Crystal;LIN, Grace Y;HASTEH, Farnaz
Academic Journal Academic Journal | American journal of clinical pathology. 137(5):753-760 Please log in to see more details
The histologic and/or cytologic follow-up of 127 cases of cervical lesions termed squa... more
The Clinical Significance of Squamous Intraepithelial Lesion of Indeterminate Grade as a Distinct Cytologic Category
American journal of clinical pathology. 137(5):753-760
The histologic and/or cytologic follow-up of 127 cases of cervical lesions termed squamous intraepithelial lesion of indeterminate grade (SIL) on Papanicolaou (Pap) smears by the 2001 Bethesda System was compared with 150 control cases of low-grade SIL (LSIL), high-grade SIL (HSIL), and atypical squamous cells, cannot exclude HSIL (ASC-H). A follow-up diagnosis of cervical intraepithelial neoplasia (CIN) 2 or higher was identified in 22.8% of SIL cases, which was 2.6 times higher than LSIL, 3 times lower than HSIL, and 1.5 times lower than ASC-H. A follow-up diagnosis of CIN 1 was identified in 31.5% of SIL cases, which was 2 times lower than the LSIL group, 1.5 times higher than the ASC-H cases, and 1.8 times higher than the HSIL group. We found that 22.0% of cases diagnosed as SIL were followed up by Pap smears rather than colposcopy and biopsy, compared with about 1 % ofLSIL and HSIL cases. Because SIL cases have a significant risk of harboring CIN 2 or greater, we recommend follow-up by colposcopy and biopsy.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Gynecologie. Andrologie. Obstetrique - Gynecology. Andrology. Obstetrics - Pathologie de l'appareil génital femelle - Female genital diseases - Tumeurs - Tumors - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Lésion précancéreuse - Premalignant lesion - Lesión precancerosa - Pathologie de l'appareil génital femelle - Female genital diseases - Aparato genital hembra patología - Pathologie du col de l'utérus - Uterine cervix diseases - Cuello útero patología - Anatomopathologie - Anatomic pathology - Anatomía patológica - Atypique - Atypical - Atípico - Bas grade - Low grade - Bajo grado - Cellule - Cell - Célula - Cytologie - Cytology - Citología - Dysplasie du col de l'utérus - Cervical dysplasia - Displasia cuello útero - Frottis - Smear - Frotis - Haut grade - High grade - Alto grado - Haute malignité - High malignancy - Alta malignidad - Lésion épidermoïde intraépithéliale - Squamous intraepithelial lesion - Lesión epidermoide intraepitelial - Système Bethesda - Bethesda system - ASC-H - Atypical squamous cells - Bethesda System - Cervical cytology - High-grade SIL - Low-grade SIL - Papanicolaou smear - SIL of indeterminate grade - cannot exclude high-grade SIL

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Grade Specificity, Association With Protein Expression, and Clinical Relevance
THOTA, Balaram;SHUKLA, Sudhanshu K;SANTOSH, Vani;SRIVIDYA, Mallavarapu R;SH...
Academic Journal Academic Journal | American journal of clinical pathology. 138(2):177-184 Please log in to see more details
IDH1 mutations are frequent genetic alterations in low-grade diffuse gliomas and secon... more
Grade Specificity, Association With Protein Expression, and Clinical Relevance
American journal of clinical pathology. 138(2):177-184
IDH1 mutations are frequent genetic alterations in low-grade diffuse gliomas and secondary glioblastoma (GEM). To validate mutation frequency, IDH1 gene at codon 132 was sequenced in 74 diffusely infiltrating astrocytomas: diffuse astrocytoma (DA; World Health Organization [WHO] grade II), anaplastic astrocytoma (AA; WHO grade III), and GBM (WHO grade IV). All cases were immunostained with IDH1-R132H monoclonal antibody. Mutational status was correlated with mutant protein expression, patient age, duration of symptoms, and prognosis of patients with GBM. We detected 31 (41.9%) heterozygous IDH1 mutations resulting in arginine-to-histidine substitution (R132H;CGT-CAT). All 12 DAs (100%), 13 of 14 AAs (92.9%), and 6 of 48 GBMs (12.5%) (5/6 [83.3%] secondary, and 1/42 [2.4%] primary) harbored IDH1 mutations. The correlation between mutational status and protein expression was significant (P < . 001). IDH1 mutation status, though not associated with prognosis of patients with GBM, showed significant association with younger age and longer duration of symptoms in the whole cohort (P < .001). Our study validates IDH1 mutant protein expression across various grades of astrocytoma, and demonstrates a high incidence of IDH1 mutations in DA, AA, and secondary GBM.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Neurologie - Neurology - Tumeurs du système nerveux. Phacomatoses - Tumors of the nervous system. Phacomatoses - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Enzyme - Enzima - Gliome - Glioma - Oxidoreductases - Pathologie du système nerveux central - Central nervous system disease - Sistema nervosio central patología - Pathologie du système nerveux - Nervous system diseases - Sistema nervioso patología - Tumeur - Tumor - Anatomopathologie - Anatomic pathology - Anatomía patológica - Association - Asociación - Astrocytome - Astrocytoma - Astrocitoma - Immunohistochimie - Immunohistochemistry - Inmunohistoquímica - Isocitrate dehydrogenase (NADP+) - Mutation somatique - Somatic mutation - Mutación somática - Pertinence - Relevance - Pertinencia - Pronostic - Prognosis - Pronóstico - Protéine - Protein - Proteína - Spécificité - Specificity - Especificidad - Survie - Survival - Sobrevivencia - Séquence nucléotide - Nucleotide sequence - Secuencia nucleótido - DNA sequencing - IDH1

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Genotype and Laboratory and Clinical Phenotypes of Protein S Deficiency
DUEBGEN, Sebastian;KAUKE, Teresa;MARSCHALL, Christoph;GIEBL, Andreas;LISON,...
Academic Journal Academic Journal | American journal of clinical pathology. 137(2):178-184 Please log in to see more details
The diagnosis of thrombophilia caused by protein S deficiency remains difficult. From ... more
Genotype and Laboratory and Clinical Phenotypes of Protein S Deficiency
American journal of clinical pathology. 137(2):178-184
The diagnosis of thrombophilia caused by protein S deficiency remains difficult. From 2005 to 2010, we documented 135 patients with suspected hereditary protein S deficiency for whom mutational analysis of the PROS 1 gene had been performed by direct double-stranded sequencing of the amplified 15 exons including splice sites. Multiplex ligation-dependent probe amplification was performed on 12 of 15 exons in cases with no mutation found but a large deletion in the PROS1 gene was suspected. Mutations were identified in 49 patients, 9 by familial screening. Altogether, 17 new and 11 previously described mutations of PROS 1 were identified among the 49 patients. After the exclusion of acquired protein S deficiency due to pregnancy or hormonal contraceptives, there remained only 1 case with protein S activity levels less than 40% that could not be explained by sequence variations or deletions in the examined regions of the PROS 1 gene. After the exclusion of conditions associated with acquired protein S deficiency, persistently low protein S activity levels are highly indicative of a genetic alteration in PROS 1. We observed a clear correlation between the laboratory phenotype and the type of mutation.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Hemopathies - Hematologic and hematopoietic diseases - Maladies des thrombocytes et coagulopathies - Platelet diseases and coagulopathies - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Coagulopathie - Coagulopathy - Coagulopatía - Hémopathie - Hemopathy - Hemopatía - Maladie héréditaire - Genetic disease - Enfermedad hereditaria - Anatomopathologie - Anatomic pathology - Anatomía patológica - Déficit en protéine S - Protein S deficiency - Deficiencia de proteína S - Examen laboratoire - Laboratory investigations - Examen laboratorio - Génotype - Genotype - Genotipo - Hypercoagulabilité - Hypercoagulability - Hipercoagulabilidad - Laboratoire - Laboratory - Laboratorio - Phénotype - Phenotype - Fenotipo - Thrombophilie - Thrombophilia - Trombofilia - Typage - Typing - Tipificación - Laboratory assessment - PROS1

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The incidence of haemorrhagic and thromboembolic events after breast cancer surgery in patients treated with pharmacological thromboprophylaxis
Cosmin A. Andrei;Răzvan V. Scăunașu;Anca A. Simionescu;Traean Burcos;Mircea...
Academic Journal Academic Journal | Journal of Clinical and Investigative Surgery, Vol 4, Iss 1, Pp 10-18 (2019) Please log in to see more details
Background. Hemorrhagic events and venous thromboembolic disease, including pulmonary ... more
The incidence of haemorrhagic and thromboembolic events after breast cancer surgery in patients treated with pharmacological thromboprophylaxis
Journal of Clinical and Investigative Surgery, Vol 4, Iss 1, Pp 10-18 (2019)
Background. Hemorrhagic events and venous thromboembolic disease, including pulmonary embolism and deep venous thrombosis, are the most important complications after breast cancer surgery. Although hemorrhagic complications are not usually severe and do not have a high mortality risk, venous thromboembolic disease is often associated with high morbidity and mortality rates. Under such circumstances, it is highly important to evaluate the need for systemic antithrombotic prophylaxis as opposed to mechanical interventions and the optimal duration of chemoprophylaxis in patients undergoing breast cancer surgery. Methods. Using the database of the General Surgery Department of “Colţea” Clinical Hospital, we analyzed the data from 2015 to 2018. During this period, pharmacological prophylaxis was used in all patients undergoing breast cancer surgery. Mechanical prophylaxis (intermittent pneumatic compression or graduated compression) has also been recommended, but there was no record of patient compliance. The primary outcome was the occurrence of venous thromboembolic or hemorrhagic events within 30 days after surgery. Results. In our institution, the venous thromboembolic disease rate for breast cancer surgery was 4/540 (0.7%; 95% CI: 0.02-1.9%), being similar to that of other studies. Hemorrhagic events occurred in 29 (5.4%; 95% CI 3.6-7.6%) patients, most commonly as hematoma in 3.3% of the patients. The incidence of hematoma requiring operation was 1.1% (95% CI: 0.4-2.4%), while hematoma treated conservatively was 2.2% (95% CI:1.2-3.8%). Other forms of hemorrhagic events include hemorrhagic drainage and bleeding wound, occurring in 2.0% of the cases. Conclusions. The occurrence of venous thromboembolic events is reduced among patients undergoing primary breast cancer surgery. A current issue is decreasing venous thromboembolic disease rates without increasing the hemorrhagic event rate. Standard guidelines on the antithrombotic prophylaxis of these patients are not well established since studies show contradictory data. Further investigations are needed to determine exactly which type of thromboprophylaxis is more effective.

Subject terms:

breast cancer - venous thromboembolism - haemorrhagic complications - risk factors - epidemiology - Medicine

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Comparison of Anti―Estrogen Receptor Antibodies SP1, 6F11, and 1 D5 in Breast Cancer: Lower 1 D5 Sensitivity but Questionable Clinical Implications
BOGINA, G;ZAMBONI, G;VENTURINI, M;SAPINO, A;BORTESI, L;MARCONI, M;LUNARDI, ...
Academic Journal Academic Journal | American journal of clinical pathology. 138(5):697-702 Please log in to see more details
We compared the anti-estrogen receptors (ER) SP1, 6F11, and 1D5 antibodies in breast c... more
Comparison of Anti―Estrogen Receptor Antibodies SP1, 6F11, and 1 D5 in Breast Cancer: Lower 1 D5 Sensitivity but Questionable Clinical Implications
American journal of clinical pathology. 138(5):697-702
We compared the anti-estrogen receptors (ER) SP1, 6F11, and 1D5 antibodies in breast carcinoma cases with different ranges of positive cells to evaluate whether this could generate different therapies for patients. We selected 66 cases of breast cancer, each of which was immunostained with the 3 antibodies. 1D5 was less sensitive than SP1 and 6F11, as seen in 26, 20, and 21 negative cases, respectively. Nine cases showed differences in endocrine-therapy indications, of which 8 1D5-negative cases showed low positivity for SP1 and/ or 6F11. However, these cases were prevalently G3, progesterone receptor―negative or low-positive, with high Ki-67 and positive HER-2 findings, all biological features associated with endocrine resistance. Finally ER values obtained with these 3 antibodies had no implications for chemotherapy.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Gynecologie. Andrologie. Obstetrique - Gynecology. Andrology. Obstetrics - Pathologie de la glande mammaire - Mammary gland diseases - Tumeurs - Tumors - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Cancer - Cáncer - Hormone ovarienne - Ovarian hormone - Hormona ovárica - Hormone stéroïde sexuelle - Sex steroid hormone - Hormona esteroide sexual - Pathologie de la glande mammaire - Mammary gland diseases - Glándula mamaria patología - Pathologie du sein - Breast disease - Seno patología - Tumeur maligne - Malignant tumor - Tumor maligno - Anatomopathologie - Anatomic pathology - Anatomía patológica - Anticorps - Antibody - Anticuerpo - Cancer du sein - Breast cancer - Cáncer del pecho - Etude comparative - Comparative study - Estudio comparativo - Oestrogène - Estrogen - Estrógeno - Récepteur hormonal - Hormonal receptor - Receptor hormonal - Récepteur oestrogène - Estrogen receptor - Receptor estrógeno - Sensibilité - Sensitivity - Sensibilidad - Symptomatologie - Symptomatology - Sintomatología - Traitement - Treatment - Tratamiento - Facteur de transcription Sp1 - Transcription factor Sp1 - 1 D5 antibody - 6F11 antibody - SP1 antibody

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Use of clinical history affects accuracy of interpretive performance of screening mammography
CARNEY, Patricia A;COOK, Andrea J;MIGLIORETTI, Diana L;FEIG, Stephen A;AIEL...
Academic Journal Academic Journal | Journal of clinical epidemiology. 65(2):219-230 Please log in to see more details
Objective: To examine how use of clinical history affects radiologist's interpretation... more
Use of clinical history affects accuracy of interpretive performance of screening mammography
Journal of clinical epidemiology. 65(2):219-230
Objective: To examine how use of clinical history affects radiologist's interpretation of screening mammography. Study Design and Setting: Using a self-administered survey and actual interpretive performance, we examined associations between use of clinical history and sensitivity, false-positive rate, recall rate, and positive predictive value, after adjusting for relevant covariates using conditional logistic regression. Results: Of the 216 radiologists surveyed (63.4%), most radiologists reported usually or always using clinical history when interpreting screening mammography. Compared with radiologists who rarely use clinical history, radiologists who usually or always use it had a higher false-positive rate with younger women (10.7 vs. 9.7), denser breast tissue (10.1 for heterogeneously dense to 10.9 for extremely dense vs. 8.9 for fatty tissue), or longer screening intervals (> prior 5 years) (12.5 vs. 10.5). Effect of current hormone therapy (HT) use on false-positive rate was weaker among radiologists who use clinical history compared with those who did not (P = 0.01), resulting in fewer false-positive examinations and a nonsignificant lower sensitivity (79.2 vs. 85.2) among HT users. Conclusion: Interpretive performance appears to be influenced by patient age, breast density, screening interval, and HT use. This influence does not always result in improved interpretive performance.

Subject terms:

General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Gynecologie. Andrologie. Obstetrique - Gynecology. Andrology. Obstetrics - Pathologie de la glande mammaire - Mammary gland diseases - Tumeurs - Tumors - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Radiodiagnostic. Imagerie rmn. Spectrométrie rmn - Radiodiagnosis. Nmr imagery. Nmr spectrometry - Appareil génital. Glande mammaire - Genital system. Mammary gland - Sante publique. Hygiene-medecine du travail - Public health. Hygiene-occupational medicine - Santé publique. Hygiène - Public health. Hygiene - Mesures de prévention et actions - Prevention and actions - Cancer - Cáncer - Pathologie de la glande mammaire - Mammary gland diseases - Glándula mamaria patología - Pathologie du sein - Breast disease - Seno patología - Radiodiagnostic - Radiodiagnosis - Radiodiagnóstico - Cancer du sein - Breast cancer - Cáncer del pecho - Dépistage - Medical screening - Descubrimiento - Evaluation performance - Performance evaluation - Evaluación prestación - Facteur risque - Risk factor - Factor riesgo - Femelle - Female - Hembra - Femme - Woman - Mujer - Glande mammaire - Mammary gland - Glándula mamaria - Histoire - History - Historia - Historique - Case history - Estudio histórico - Homme - Human - Hombre - Mammographie - Mammography - Mastografía - Performance - Rendimiento - Précision - Accuracy - Precisión - Risque - Risk - Riesgo - Tumeur maligne - Malignant tumor - Tumor maligno - Utilisation - Use - Uso - Breast cancer risk - Interpretive acumen

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Quality varies across clinical practice guidelines for mammography screening in women aged 40—49 years as assessed by AGREE and AMSTAR instruments
BURDA, Brittany U;NORRIS, Susan L;HOLMER, Haley K;OGDEN, Lauren A;SMITH, M....
Academic Journal Academic Journal | Journal of clinical epidemiology. 64(9):968-976 Please log in to see more details
Objective: To assess the quality of clinical practice guidelines providing recommendat... more
Quality varies across clinical practice guidelines for mammography screening in women aged 40—49 years as assessed by AGREE and AMSTAR instruments
Journal of clinical epidemiology. 64(9):968-976
Objective: To assess the quality of clinical practice guidelines providing recommendations on the frequency of mammography screening in asymptomatic, average-risk women 40—49 years of age. Study Design and Setting: We searched the National Guideline Clearinghouse and MEDLINE for guidelines published from 2005 to 2010. Five independent assessors rated the quality of each guideline and its underlying evidence review using the Appraisal of Guidelines for Research and Evaluation (AGREE) and Assessment of Multiple Systematic Reviews (AMSTAR) instruments, respectively. Results: Eleven guidelines were appraised. Ten referenced an underlying evidence review; two referenced the same review. Three reviews were rated good, one was moderate, and five were rated poor quality. On overall assessment of the quality of the guidelines, two were strongly recommended, two were recommended with provisos, and seven were either not recommended or the assessors were unsure whether to recommend it. Most guidelines clearly presented their recommendations, but the rigor of development, applicability, and stake-holder involvement varied. Seven guidelines recommended mammography screening as part of a periodic health examination and four recommended individualized screening in the target population. The latter four guidelines were based on good-quality reviews and three were recommended by the assessors. Conclusion: Guideline users need to be aware of the variability in quality and identify the high-quality guidelines that meet their needs.

Subject terms:

General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Radiodiagnostic. Imagerie rmn. Spectrométrie rmn - Radiodiagnosis. Nmr imagery. Nmr spectrometry - Appareil génital. Glande mammaire - Genital system. Mammary gland - Sante publique. Hygiene-medecine du travail - Public health. Hygiene-occupational medicine - Santé publique. Hygiène - Public health. Hygiene - Mesures de prévention et actions - Prevention and actions - Divers - Miscellaneous - Cancer - Cáncer - Homme - Human - Hombre - Pathologie de la glande mammaire - Mammary gland diseases - Glándula mamaria patología - Pathologie du sein - Breast disease - Seno patología - Radiodiagnostic - Radiodiagnosis - Radiodiagnóstico - Cancer du sein - Breast cancer - Cáncer del pecho - Contrôle qualité - Quality control - Control de calidad - Dépistage - Medical screening - Descubrimiento - Evaluation - Evaluación - Femelle - Female - Hembra - Femme - Woman - Mujer - Glande mammaire - Mammary gland - Glándula mamaria - Mammographie - Mammography - Mastografía - Pratique professionnelle - Professional practice - Práctica profesional - Prévention - Prevention - Prevención - Qualité - Quality - Calidad - Recommandation - Recommendation - Recomendación - Santé publique - Public health - Salud pública - Tumeur maligne - Malignant tumor - Tumor maligno - Clinical practice guidelines - Mass screening - Quality assessment

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Establishing Reference Intervals for Clinical Laboratory Test Results: Is There a Better Way?
KATAYEV, Alex;BALCIZA, Claudiu;SECCOMBE, David W
Academic Journal Academic Journal | American journal of clinical pathology. 133(2):180-186 Please log in to see more details
Reference intervals are essential for clinical laboratory test interpretation and pati... more
Establishing Reference Intervals for Clinical Laboratory Test Results: Is There a Better Way?
American journal of clinical pathology. 133(2):180-186
Reference intervals are essential for clinical laboratory test interpretation and patient care. Methods for estimating them are expensive, difficult to perform, often inaccurate, and nonreproducible. A computerized indirect Hoffmann method was studied for accuracy and reproducibility. The study used data collected retrospectively for 5 analytes without exclusions and filtering from a nationwide chain of clinical reference laboratories in the United States. The accuracy was assessed by the comparability of reference intervals as calculated by the new method with published peer-reviewed studies, and reproducibility was assessed by the comparability of 2 sets of reference intervals derived from 2 different data sets. There was no statistically significant difference between the calculated and published reference intervals or between the 2 sets of intervals that were derived from different data sets. A computerized Hoffmann method for indirect estimation of reference intervals using stored test results is proved to be accurate and reproducible.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Anatomopathologie - Anatomic pathology - Anatomía patológica - Estimation - Estimación - Examen laboratoire - Laboratory investigations - Examen laboratorio - Exploration - Exploración - Interprétation - Interpretation - Interpretación - Intervalle - Interval - Intervalo - Laboratoire - Laboratory - Laboratorio - Référence - Reference - Referencia - Test clinique - Clinical test - Prueba clínica - Valeur référence - Reference value - Valor de referencia - Result - Test

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Differences in Clinical Significance and Morphologic Features of Blastocystis sp Subtype 3
VASSALOS, Constantine M;SPANAKOS, Gregory;VASSALOU, Evdokia;PAPADOPOULOU, C...
Academic Journal Academic Journal | American journal of clinical pathology. 133(2):251-258 Please log in to see more details
Blastocystis is a polymorphic intestinal parasite that is common in humans. A total of... more
Differences in Clinical Significance and Morphologic Features of Blastocystis sp Subtype 3
American journal of clinical pathology. 133(2):251-258
Blastocystis is a polymorphic intestinal parasite that is common in humans. A total of 51 asymptomatic and symptomatic patients positive for Blastocystis only were included in the study. Symptoms were mainly nonspecific gastrointestinal symptoms. Blastocystis isolates were xenically cultured and subtyped. Blastocystis species subtype 3 was the predominant subtype. Intrasubtype differences (vacuolar/amoeboid presence) in subtype 3 morphotypes were observed in 32 asymptomatic and symptomatic subtype 3 cases and could possibly be related to Blastocystis pathogenic potential. Diverse morphologic features (vacuolar transiting to amoeboid), probably reflecting the progression from an asymptomatic to a symptomatic state, were observed in an asymptomatic subtype 3 carrier who later had symptoms. Searching for amoeboid forms might be helpful to presumptively screen symptomatic patients with subtype 3 or to follow up an asymptomatic subtype 3 carrier in case symptoms become evident before antiprotozoal treatment was attempted. Further studies on the roles of morphologic features and variation within Blastocystis species subtypes as predictors of symptoms are encouraged.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Anatomopathologie - Anatomic pathology - Anatomía patológica - Forme clinique - Clinical form - Forma clínica - Morphologie - Morphology - Morfología - Soustype - Subtype - Subtipo - Symptomatologie - Symptomatology - Sintomatología - Amoeboid - Blastocystis sp - Clinical significance - Subtype 3

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Clinical Outcome for Atypia of Undetermined Significance in Thyroid Fine-Needle Aspirations: Should Repeated FNA Be the Preferred Initial Approach?
VANDERLAAN, Paul A;MARQUSEE, Ellen;KRANE, Jeffrey F
Academic Journal Academic Journal | American journal of clinical pathology. 135(5):770-775 Please log in to see more details
In the Bethesda System for reporting thyroid fine-needle aspirations (FNAs), atypia of... more
Clinical Outcome for Atypia of Undetermined Significance in Thyroid Fine-Needle Aspirations: Should Repeated FNA Be the Preferred Initial Approach?
American journal of clinical pathology. 135(5):770-775
In the Bethesda System for reporting thyroid fine-needle aspirations (FNAs), atypia of undetermined significance (A US) is a category with limited reported follow-up and outcome data. We report a retrospective analysis of our institution's experience during nearly 4.5 years with a tiered classification scheme conforming to the Bethesda System in which repeated FNA was recommended for most patients with an initial AUS diagnosis. Of 4,691 thyroid FNAs, 512 (10.9%) had a diagnosis ofAUS. Cytologic or histologic outcome data were available for 331 cases (64.6%), of which 240 (72.5%) were benign and 91 (27.5%) were malignant. Of patients with a surgical diagnosis, there was no statistically significant difference in malignancy rate among patients who went directly to surgery after a single AUS diagnosis (37/90 [41%]), patients having 2 successive A US FNA diagnoses (22/51 [43%]), and patients with a benign aspirate after A US (2/7 [29%]). Although AUS confers an intermediate risk of malignancy, guidelines recommending repeated FNA for most cases should be reevaluated.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Glande endocrine - Endocrine gland - Glándula endocrina - Anatomopathologie - Anatomic pathology - Anatomía patológica - Cytologie - Cytology - Citología - Cytoponction - Fine needle aspiration biopsy - Punción citológica con aguja fina - Evolution - Evolución - Ponction aspiration - Aspiration punction - Punción aspiración - Pronostic - Prognosis - Pronóstico - Thyroïde - Thyroid gland - Tiroides - Atypia of undetermined significance - Fine-needle aspiration - Thyroid

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Clinical Verification of the Performance of the Pathwork Tissue of Origin Test: Utility and Limitations
DUMUR, Catherine I;FULLER, Christine E;BLEVINS, Tana L;SCHAUM, Julia C;WILK...
Academic Journal Academic Journal | American journal of clinical pathology. 136(6):924-933 Please log in to see more details
Gene expression―based assays have been introduced into the clinical arena to assist in... more
Clinical Verification of the Performance of the Pathwork Tissue of Origin Test: Utility and Limitations
American journal of clinical pathology. 136(6):924-933
Gene expression―based assays have been introduced into the clinical arena to assist in the diagnosis of poorly differentiated or undifferentiated tumors. The US Food and Drug Administration has cleared the microarray-based Pathwork Tissue of Origin (TOO) Test (Pathwork Diagnostics, Sunnyvale, CA) for the molecular characterization of such challenging specimens. We aimed at verifying the analytic and clinical performance of this test on 43 poorly differentiated and undifferentiated tumor samples, including 6 off-panel cases and 7 cancers of unknown primary (CUP). Our results showed 97% (95% confidence interval, 80.4%-99.8%) agreement between the Pathwork TOO Test result and the complete diagnosis, which included clinical correlations and immunohistochemical staining, after the original diagnosis. We concluded that for off-panel and CUP samples, the tissue type and the cell type may be confounded by the Pathwork TOO Test and that careful clinicopathologic assessment is needed when interpreting results from this helpful ancillary tool for pathologists.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Cancer - Cáncer - Anatomopathologie - Anatomic pathology - Anatomía patológica - Evaluation performance - Performance evaluation - Evaluación prestación - Exploration - Exploración - Métastase - Metastasis - Metástasis - Origine inconnue - Undetermined primary site - Origen desconocido - Performance - Rendimiento - Tissu - Tissue - Tejido - Tumeur indifférenciée - Undifferentiated tumor - Tumor indiferenciado - Tumeur maligne - Malignant tumor - Tumor maligno - Vérification - Verification - Verificación - Cancer of unknown primary site - Microarray - Tissue of origin

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Current and Future Applications of Mass Spectrometry to the Clinical Laboratory
STRATHMANN, Frederick G;HOOFNAGLE, Andrew N
Academic Journal Academic Journal | American journal of clinical pathology. 136(4):609-616 Please log in to see more details
Mass spectrometry is an analytic technique with high specificity and a growing presenc... more
Current and Future Applications of Mass Spectrometry to the Clinical Laboratory
American journal of clinical pathology. 136(4):609-616
Mass spectrometry is an analytic technique with high specificity and a growing presence in laboratory medicine. Various types of mass spectrometers are being used in an increasing number of clinical laboratories around the world, and, as a result, significant improvements in assay performance are occurring rapidly in areas such as toxicology, endocrinology, and biochemical genetics. This review serves as a basic introduction to mass spectrometry, its uses, and associated challenges in the clinical laboratory and ends with a brief discussion of newer methods with the greatest potential for clinical diagnostics.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Anatomopathologie - Anatomic pathology - Anatomía patológica - Chromatographie phase liquide - Liquid chromatography - Cromatografía fase líquida - Electrospray - Ion - Ions - Ión - Ionisation chimique - Chemical ionization - Ionización química - Laboratoire - Laboratory - Laboratorio - Multiple - Múltiple - Pression atmosphérique - Atmospheric pressure - Presión atmosférica - Spectrométrie masse tandem - Mass spectrometry MS/MS - Espectrometría masa en tándem - Spectrométrie masse - Mass spectrometry - Espectrometría masa - Surveillance - Vigilancia - Atmospheric pressure chemical ionization - Electrospray ionization - Liquid chromatography-tandem mass spectrometry - Multiple reaction monitoring - Selected ion monitoring

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Clinical Laboratory Detection of AmpC β-Lactamase: Does It Affect Patient Outcome?
RAND, Kenneth H;TURNER, Bradley;SEIFERT, Hilary;HANSEN, Christine;JOHNSON, ...
Academic Journal Academic Journal | American journal of clinical pathology. 135(4):572-576 Please log in to see more details
Plasmid-mediated AmpC-producing Escherichia coli and Klebsiella pneumoniae have been a... more
Clinical Laboratory Detection of AmpC β-Lactamase: Does It Affect Patient Outcome?
American journal of clinical pathology. 135(4):572-576
Plasmid-mediated AmpC-producing Escherichia coli and Klebsiella pneumoniae have been associated with poor clinical outcomes, but they are not readily identified in hospital microbiology laboratories. We tested 753 gram-negative bloodstream isolates for AmpC by using the EDTA disk test and the modified Hodge test (n = 172) and the modified Hodge test alone (n = 581). The 30-day mortality for the AmpC group was 9% (2/23) and was 6% (3/51) for the control group. The clinical response was similar: afebrile on day 2 (AmpC group, 16/23 [70%]; control group, 32/45 [71%]) and on day 4 (AmpC group, 19/22 [86%]; control group, 37/44 [84%]). Patients with isolates in the AmpC group were more likely to be in an intensive care unit at the time of the positive blood culture (P = .01) and more likely to be intubated (P = .05) than patients with isolates in the control group. Effective antibiotic treatment within the first 48 hours was given to 47 (92%) of 51 patients with isolates in the control group but to only 14 (61%) of 23 patients with isolates in the AmpC group (P = .001). The modified Hodge test and the EDTA disk test did not identify patients at risk for a poor outcome from AmpC-producing bacterial infections.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Pathologie infectieuse - Infectious diseases - Bactérioses - Bacterial diseases - Bactérioses humaines - Human bacterial diseases - Septicémies bactériennes - Bacterial sepsis - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Bactériose - Bacteriosis - Enzyme - Enzima - Hydrolases - Infection - Infección - Anatomopathologie - Anatomic pathology - Anatomía patológica - Bactériémie - Bacteremia - Bacteriemia - Diagnostic - Diagnosis - Diagnóstico - Disque - Disk - Disco - Détection - Detection - Detección - EDTA - Evolution - Evolución - Exploration - Exploración - Homme - Human - Hombre - Laboratoire - Laboratory - Laboratorio - Pronostic - Prognosis - Pronóstico - β-Lactamase - AmpC (3-lactamase - Bacteremia outcome - EDTA disk test - Modified Hodge test

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Clinical Evaluation of the i-STAT Kaolin Activated Clotting Time (ACT) Test in Different Clinical Settings in a Large Academic Urban Medical Center: Comparison With the Medtronic ACT Plus
LEE LEWANDROWSKI, Elizabeth;VAN COTT, Elizabeth M;GREGORY, Kimberly;JANG, I...
Academic Journal Academic Journal | American journal of clinical pathology. 135(5):741-748 Please log in to see more details
Historically, it has been difficult for hospitals to change methods for activated clot... more
Clinical Evaluation of the i-STAT Kaolin Activated Clotting Time (ACT) Test in Different Clinical Settings in a Large Academic Urban Medical Center: Comparison With the Medtronic ACT Plus
American journal of clinical pathology. 135(5):741-748
Historically, it has been difficult for hospitals to change methods for activated clotting time (ACT) testing because of differences in ACT values obtained with different instruments, wide differences in target ranges used in different procedures, and the difficulty of performing crossover studies at the bedside in critical care situations. There are limited published data comparing the i-STAT (Abbott Point of Care, Princeton, NJ) kaolin ACT with the Medtronic ACT Plus (Medtronic, Minneapolis, MN). The i-STAT system can perform ACT testing in addition to testing of a number of critical care analytes and may offer potential advantages over other ACT analyzers. Comparison of ACT values on 121 simultaneous split-sample tests yielded an R2 of 0.88 with i-STAT = 0.79 Medtronic + 72.0. The Pearson correlation was R = 0.94, indicating statistically significant correlation between the 2 methods. Based on this comparison, we were able to implement the i-STAT ACT throughout our institution without changing target ranges for any individual procedure.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Anatomopathologie - Anatomic pathology - Anatomía patológica - Etude comparative - Comparative study - Estudio comparativo - Evaluation - Evaluación - Facteur transcription STAT - Transduction factor STAT - Factor transcripción STAT - Kaolin - Caolín - Milieu urbain - Urban environment - Medio urbano - Médecine - Medicine - Medicina - Méthode - Method - Método - Temps coagulation - Clotting time - Tiempo coagulación - Test coagulation - Coagulation test - Prueba coagulación - Transduction signal - Signal transduction - Transducción señal - Zone urbaine - Urban area - Zona urbana - ACT - Activated clotting time - Method comparison

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Clinical utility of external immunoscintigraphy with the IMMU-4 technetium-99m Fab' antibody fragment in patients undergoing surgery for carcinoma of the colon and rectum : Results of a pivotal, phase III...
MOFFAT, F. L;PINSKY, C. M;HAMMERSHAIMB, L;PETRELLI, N. J;PATT, Y. Z;WHALEY,...
Academic Journal Academic Journal | Journal of clinical oncology. 14(8):2295-2305 Please log in to see more details
Purpose : To assess the performance and the potential clinical impact of a new antibod... more
Clinical utility of external immunoscintigraphy with the IMMU-4 technetium-99m Fab' antibody fragment in patients undergoing surgery for carcinoma of the colon and rectum : Results of a pivotal, phase III...
Journal of clinical oncology. 14(8):2295-2305
Purpose : To assess the performance and the potential clinical impact of a new antibody imaging agent, CEA-Scan (Immunomedics Inc, Morris Plains, NJ), in 210 presurgical patients with advanced recurrent or metastatic colorectal carcinomas. Methods : CEA-Scan, an anti-carcinoembryonic antigen (CEA) Fab' antibody fragment labeled with technetium-99m-pertechnetate (99mTc), was injected intravenously (IV), and external scintigraphy was performed 2 to 5 and 18 to 24 hours later. Imaging with conventional diagnostic modalities (CDM) was also performed, and findings were confirmed by surgery and histology. Results : The sensitivity of CEA-scan was superior to that of CDM in the extrahepatic abdomen (55% v 32% ; P =.007) and pelvis (69% v 48% ; P =.005), and CEA-Scan findings complemented those of CDM in the liver. Among 122 patients with known disease, the positive predictive value was significantly higher when both modalities were positive (98%) compared with each alone (68% to 70%), potentially obviating the need for histologic confirmation when both tests are positive. Imaging accuracy also was significantly improved by adding CEA-Scan to CDM. In 88 patients with occult cancer, imaging accuracy was enhanced significantly by CEA-Scan combined with CDM (61% v 33%). Potential clinical benefit from CEA-Scan was demonstrated in 89 of 210 patients. Only two patients developed human antimouse antibodies (HAMA) to CEA-Scan after a single injection, and none of 19 assessable patients after two injections. Conclusion : CEA-scan affords high-quality, same-day imaging, uses an inexpensive and readily available radionuclide, adds clinically significant information in assessing extent and location of disease in colorectal cancer patients, and only rarely induces a HAMA response.

Subject terms:

Medical oncology - Cancérologie - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Exploration radioisotopique - Radionuclide investigations - Digestion. Foie. Voies biliaires. Rate. Pancréas - Digestion. Liver. Biliary tract. Spleen. Pancreas - Appareil digestif pathologie - Digestive diseases - Aparato digestivo patología - Côlon pathologie - Colonic disease - Colón patología - Intestin pathologie - Intestinal disease - Intestino patología - Rectum pathologie - Rectal disease - Recto patología - Tumeur maligne - Malignant tumor - Tumor maligno - Anticorps - Antibody - Anticuerpo - Antigène associé tumeur - Tumor associated antigen - Antígeno asociado tumor - Antigène carcinoembryonnaire - Carcinoembryonic antigen - Antígeno carcinoembrionario - Carcinome - Carcinoma - Côlon - Colon - Colón - Diagnostic - Diagnosis - Diagnóstico - Exploration radioisotopique - Radionuclide study - Exploración radioisotópica - Fragment peptidique Fab' - Fab'-Fragment - Fragmento peptídico Fab' - Homme - Human - Hombre - Immunoradiodiagnostic - Immunoradiodiagnosis - Inmunoradiodiagnóstico - Marquage radioisotopique - Radiolabelling - Marcación radioisotópica - Marqueur tumoral - Tumoral marker - Marcador tumoral - Rectum - Recto - Technétium - Technetium - Tecnecio

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The Vanishing Testis: A Histomorphologic and Clinical Assessment
ANTIC, Tatjana;HYJEK, Elizabeth M;TAXY, Jerome B
Academic Journal Academic Journal | American journal of clinical pathology. 136(6):872-880 Please log in to see more details
Of patients with cryptorchidism, 5% have no palpable gonad. Physical examination or sc... more
The Vanishing Testis: A Histomorphologic and Clinical Assessment
American journal of clinical pathology. 136(6):872-880
Of patients with cryptorchidism, 5% have no palpable gonad. Physical examination or scrotal exploration demonstrates tissue nubbins or small nodules that constitute the vanishing testis syndrome. At the University of Chicago Hospitals (Chicago, IL; 2004-2008), 30 surgical pathology specimens from 29 patients with this clinical diagnosis underwent scrotal exploration. Histologic and immunohistochemical comparison was done with 7 fetal testes, 8 surgically removed nonneoplastic testes, and 2 cryptorchid testes. Routine histologic studies showed no seminiferous tubules in 18 cases (60%), fibrosis in all (100%), calcifications in 16 (53%), and hemosiderin deposits in 9 (30%). In 12 cases with seminiferous tubules (40%), there were Sertoli cells only. Scrotal exploration in such cases is clinically driven and results in the removal of any tissue present. Although published studies suggest the risk for future tumor development is low, possibly absent, the definitive removal of a testicle is established by an awareness of the histologic spectrum exhibited by testicular remnants.

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Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Gynecologie. Andrologie. Obstetrique - Gynecology. Andrology. Obstetrics - Pathologie de l'appareil génital mâle - Male genital diseases - Pathologie non tumorale - Non tumoral diseases - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Appareil génital mâle - Male genital system - Aparato genital macho - Maladie congénitale - Congenital disease - Enfermedad congénita - Malformation - Malformación - Pathologie de l'appareil génital mâle - Male genital diseases - Aparato genital macho patología - Pathologie du testicule - Testicular diseases - Testículo patología - Anatomopathologie - Anatomic pathology - Anatomía patológica - Cellule - Cell - Célula - Cryptorchidie - Cryptorchidism - Criptorquidia - Exploration - Exploración - Scrotum - Escroto - Testicule - Testicle - Testículo - Germ cell - Scrotal exploration

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Multivariate Analysis of Clinical, Demographic, and Laboratory Data for Classification of Disorders of Calcium Homeostasis
O'NEILL, Stacey S;GORDON, Christopher J;RUIXIN GUO;HONGTU ZHU;MCCUDDEN, Chr...
Academic Journal Academic Journal | American journal of clinical pathology. 135(1):100-107 Please log in to see more details
Parathyroid hormone (PTH) nomograms combine total calcium and intact PTH (iPTH) measur... more
Multivariate Analysis of Clinical, Demographic, and Laboratory Data for Classification of Disorders of Calcium Homeostasis
American journal of clinical pathology. 135(1):100-107
Parathyroid hormone (PTH) nomograms combine total calcium and intact PTH (iPTH) measurements to classify disorders of calcium homeostasis. Our objective was to determine if using a combination of laboratory, demographic, and clinical parameters improves the accuracy of classification of these disorders. Chart data were collected for 236 patients with physician-ordered iPTH and total calcium tests. Classification was done using 3 approaches: (1) PTH nomogram plotting total calcium and iPTH results against known cases; (2) review of all available chart data (gold standard); and (3) multivariate model (classification and regression tree [CART] or logistic regression) using 24 variables. The CART model was developed using the gold standard patient classification and validated using leave-one-out cross-validation. The CART model was significantly (P = .002) more accurate (80. 6%) than the PTH nomogram (59. 7%) and logistic regression (66.2%) at classifying calcium homeostasis disorders. The CART model used 6 of24 variables (iPTH, calcium, creatinine, renal transplantation, percentage of females, and urea nitrogen) and had a misclassification error rate of 0.194 (27/139). Classification of disorders of calcium homeostasis based on the PTH nomogram can be improved by using the CART model developed in this study.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Endocrinopathies - Parathyroïde. Cellules parafolliculaires. Cholécalciférol. Homéostasie phosphocalcique (pathologie) - Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases) - Pathologie non tumorale. Résistance tissu cible. Tumeurs bénignes - Non tumoral diseases. Target tissue resistance. Benign neoplasms - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Endocrinopathie - Endocrinopathy - Endocrinopatía - Pathologie des parathyroïdes - Parathyroid diseases - Paratiroides patología - Analyse multivariable - Multivariate analysis - Análisis multivariable - Anatomopathologie - Anatomic pathology - Anatomía patológica - Arbre - Tree - Arbol - Calcium - Calcio - Classification - Clasificación - Homéostasie - Homeostasis - Hormone parathyroïde - Parathyroid hormone - Hormona paratiroidea - Hyperparathyroïdie - Hyperparathyroidism - Hiperparatiroidismo - Laboratoire - Laboratory - Laboratorio - Nomogramme - Nomogram - Nomograma - Régression - Regression - Regresión - CART - Classification and regression tree - PTH

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Classical-Type Invasive Lobular Carcinoma With HER2 Overexpression: Clinical, Histologic, and Hormone Receptor Characteristics
JING YU;DABBS, David J;YONGLI SHUAI;NIEMEIER, Leo A;BHARGAVA, Rohit
Academic Journal Academic Journal | American journal of clinical pathology. 136(1):88-97 Please log in to see more details
The majority of invasive lobular carcinomas (ILCs) express estrogen receptor (ER) and ... more
Classical-Type Invasive Lobular Carcinoma With HER2 Overexpression: Clinical, Histologic, and Hormone Receptor Characteristics
American journal of clinical pathology. 136(1):88-97
The majority of invasive lobular carcinomas (ILCs) express estrogen receptor (ER) and progesterone receptor (PR) but lack ERBB2 (HER2) amplification. HER2 overexpression is traditionally considered to occur in the pleomorphic variant of ILCs. We describe 12 cases of classical-type ILCs with HER2 overexpression in a 3-year period. All tumors displayed the characteristic morphologic features of classical ILC with uniform cells and discohesive growth patterns. The lobular phenotype was confirmed by the absence of E-cadherin staining. Multiple variables regarding clinical, histologic, and hormone receptor characteristics of tumors were evaluated and compared with a set of HER2―classical ILCs. The study identified 2 main pathologic features associated with HER2 overexpression in classical type ILC: histiocytoid morphologic features and absence of PR expression. ER is still expressed in HER2+ classical ILCs, although the level of expression is significantly reduced compared with the HER2― cases. The implications of the findings are discussed.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Anatomopathologie - Anatomic pathology - Anatomía patológica - Glande mammaire - Mammary gland - Glándula mamaria - Gène erbB2 - erbB2 Gene - Gen erbB2 - Gène onc cellulaire - C-Onc gene - Gen onc celular - Histologie - Histology - Histología - Protooncogène - Protooncogene - Protooncogen - Récepteur hormonal - Hormonal receptor - Receptor hormonal - Sein - Breast - Seno - Surexpression génique - Gene overexpression - Sobreexpresión genética - Symptomatologie - Symptomatology - Sintomatología - Cancer invasif - Invasive cancer - Cáncer invasivo - Récepteur HER2 - Human Epidermal growth factor Receptor 2 - HER2 - Invasive lobular carcinoma - classical type

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A Comparison of Equivocal Immunohistochemical Results With Anti-HER2/neu Antibodies A0485 and SP3 With Corresponding FISH Results in Routine Clinical Practice
MANION, Elizabeth;HORNICK, Jason L;LESTER, Susan C;BROCK, Jane E
Academic Journal Academic Journal | American journal of clinical pathology. 135(6):845-851 Please log in to see more details
HER2/neu status in breast cancer is determined by immunohistochemical analysis and/or ... more
A Comparison of Equivocal Immunohistochemical Results With Anti-HER2/neu Antibodies A0485 and SP3 With Corresponding FISH Results in Routine Clinical Practice
American journal of clinical pathology. 135(6):845-851
HER2/neu status in breast cancer is determined by immunohistochemical analysis and/or fluorescence in situ hybridization (FISH). Previous studies have found widely varying sensitivities and specificities for anti-HER2/neu antibodies, including recently developed rabbit monoclonal antibodies. The current prospective study compared rabbit monoclonal antibody SP3 and rabbit polyclonal antibody A0485 immunostaining on routinely processed consecutive cases of breast carcinoma. Of 1, 610 cases tested, 261 (16.2%) equivocal (2+) cases were evaluated by FISH. Of 253 cases equivocal with A0485 results, 125 (49.4%) were negative with SP3. In 22 (8.7%) of 253 cases equivocal with A0485, there was amplification by FISH, and 3 of these cases were SP3- (0/1 +). Of the 20 (14.8%) of 135 SP3-equivocal cases amplified by FISH, 1 case was A0485―. The reported false-negative rate with A0485 is 2.8%, and the American Society of Clinical Oncology/ College of American Pathologists guidelines recommend a rate of less than 5%. Compared with A0485, the false-negative rate with SP3 is only 0.3% (3/1,156) higher, but it shows about a 50% reduction in equivocal scores, reducing the need for reflex FISH testing.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Gynecologie. Andrologie. Obstetrique - Gynecology. Andrology. Obstetrics - Pathologie de la glande mammaire - Mammary gland diseases - Tumeurs - Tumors - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Cancer - Cáncer - Pathologie de la glande mammaire - Mammary gland diseases - Glándula mamaria patología - Pathologie du sein - Breast disease - Seno patología - Tumeur maligne - Malignant tumor - Tumor maligno - Analyse coût efficacité - Cost efficiency analysis - Análisis costo eficacia - Analyse routine - Routine analysis - Análisis rutina - Anatomopathologie - Anatomic pathology - Anatomía patológica - Anticorps monoclonal - Monoclonal antibody - Anticuerpo monoclonal - Cancer du sein - Breast cancer - Cáncer del pecho - Carcinome du sein - Breast carcinoma - Carcinoma pecho - Economie santé - Health economy - Economía salud - Etude comparative - Comparative study - Estudio comparativo - Gène erbB2 - erbB2 Gene - Gen erbB2 - Hybridation in situ fluorescence - Fluorescence in situ hybridization - Hibridación in situ fluorescencia - Immunohistochimie - Immunohistochemistry - Inmunohistoquímica - Pratique professionnelle - Professional practice - Práctica profesional - Récepteur biologique - Biological receptor - Receptor biológico - Facteur transcription Sp3 - Transcription factor Sp3 - Poisson - Fish - A0485 - Cost-effectiveness - FISH - HER2/neu receptor - HercepTest - Monoclonal antibodies - SP3

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Influence of Credentials of Clinical Laboratory Professionals on Proficiency Testing Performance
DANNESSA DELOST, Maria;GREG MILLER, W;CHANG, G. Andy;KORZUN, William J;NADD...
Academic Journal Academic Journal | American journal of clinical pathology. 132(4):550-554 Please log in to see more details
The influence of the training, experience, and credentials of testing personnel in the... more
Influence of Credentials of Clinical Laboratory Professionals on Proficiency Testing Performance
American journal of clinical pathology. 132(4):550-554
The influence of the training, experience, and credentials of testing personnel in the increasingly complex laboratory is a significant concern. A retrospective study compared the relationship ofproficiency testing (PT) performance with the credentials of the testing personnel using logistic regression analyses. Predictor variables included the practitioner's college major, degree, certification, and years of laboratory experience. There were 14,326 valid PT results and 359 practitioners of whom 245 (68.2%) had a clinical laboratory science major. Logistic regression analysis revealed that participants without a clinical laboratory science major were more likely (adjusted odds ratio, 1.849; P = .035) to produce unacceptable results compared with participants whose academic history included a clinical laboratory science program. These data suggest that clinical laboratories should be staffed by people who have completed a formal clinical laboratory education program to ensure quality of laboratory testing and to reduce the risk of medical errors.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Anatomopathologie - Anatomic pathology - Anatomía patológica - Certification - Certificación - Dépistage - Medical screening - Descubrimiento - Education - Educación - Erreur - Error - Evaluation performance - Performance evaluation - Evaluación prestación - Laboratoire - Laboratory - Laboratorio - Performance - Rendimiento - Personnel laboratoire - Laboratory staff - Personal laboratorio - Clinical laboratory education - Clinical laboratory personnel - Laboratory errors - Proficiency testing

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2008 ACLPS Panel Discussion on Resident Education in Clinical Pathology
LUNING PRAK, Eline T;YOUNG, Donald S;KAMOUN, Malek;NACHAMKIN, Irving;ALEXAN...
Academic Journal Academic Journal | American journal of clinical pathology. 131(5):618-622 Please log in to see more details
A curriculum in clinical pathology (CP) was developed under the auspices of the Academ... more
2008 ACLPS Panel Discussion on Resident Education in Clinical Pathology
American journal of clinical pathology. 131(5):618-622
A curriculum in clinical pathology (CP) was developed under the auspices of the Academy of Clinical Laboratory Physicians and Scientists (ACLPS) in 2006. At the 2008 ACLPS meeting in Philadelphia, PA, a panel was convened to address the current challenges in resident education and how to overcome them. Current challenges include the heterogeneity of the discipline (which requires analytical, medical, and managerial knowledge), the diverse repertoire of clinical laboratory testing, and the need to better integrate the resident into the work flow of the laboratory, especially with respect to clinical consultation. Recommendations of the panel include the incorporation of active learning, clinical consultation, and competency assessment into CP resident training. A summary of the panel discussion is presented herein.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Anatomopathologie - Anatomic pathology - Anatomía patológica - Consultation - Consulta - Discussion - Discusión - Education - Educación - Homme - Human - Hombre - Interne (étudiant) - Resident (student) - Interno (estudiante) - Résident - Resident - Residente - Clinical pathology - Curriculum - Resident education

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The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) instrument was useful for refining a randomized trial design: Experiences from an investigative team
RIDDLE, Daniel L;JOHNSON, Robert E;JENSEN, Mark P;KEEFE, Francis J;KROENKE,...
Academic Journal Academic Journal | Journal of clinical epidemiology. 63(11):1271-1275 Please log in to see more details
Objective: A recently published instrument (PRECIS) was designed to assist investigati... more
The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) instrument was useful for refining a randomized trial design: Experiences from an investigative team
Journal of clinical epidemiology. 63(11):1271-1275
Objective: A recently published instrument (PRECIS) was designed to assist investigative teams in understanding the various design decisions that need to be made regarding pragmatic vs. explanatory trials. Our team used this instrument during an investigators' meeting to organize our discussion regarding the design of a planned trial and to determine the extent of consensus among the study investigators. Study Design and Setting: The study was descriptive in nature and occurred during an investigator meeting. After reading and reviewing the 10 PRECIS criteria, the team made quantitative judgments of the planned study regarding each PRECIS criteria to reflect initial, ideal, and final study design perceptions. Results: Data indicated that the final study design was more explanatory in nature than the preliminary plan. Evidence of consensus was obtained. Conclusion: The investigative team found that applying PRECIS principles were useful for (1) detailing points of discussion related to trial design, (2) making revisions to the design to be consistent with the project goals, and (3) achieving consensus. We believe our experiences with PRECIS may prove valuable for trial researchers in much the same way that case reports can provide valuable insights for clinicians.

Subject terms:

General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Chirurgie (generalites). Transplantations, greffes d'organes et de tissus. Pathologie des greffons - Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases - Chirurgie orthopédique - Orthopedic surgery - Aptitude professionnelle - Vocational aptitude - Aptitud profesional - But - Goal - Fin - Coping - Coronación - Douleur - Pain - Dolor - Essai clinique - Clinical trial - Ensayo clínico - Genou - Knee - Rodilla - Indicateur - Indicator - Indicador - Prothèse - Prosthesis - Prótesis - Randomisation - Randomization - Aleatorización - Recherche scientifique - Scientific research - Investigación científica - Prothèse de genou - Knee arthroplasty - Arthroplasty - Coping skills - Research design

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The Becton Dickinson FocalPoint GS Imaging System: Clinical Trials Demonstrate Significantly Improved Sensitivity for the Detection of Important Cervical Lesions
WILBUR, David C;BLACK-SCHAFFER, W. Stephen;LUFF, Ronald D;ABRAHAM, Kurian P...
Academic Journal Academic Journal | American journal of clinical pathology. 132(5):767-775 Please log in to see more details
Location-guided screening in cervical cytology offers a potentially significant advanc... more
The Becton Dickinson FocalPoint GS Imaging System: Clinical Trials Demonstrate Significantly Improved Sensitivity for the Detection of Important Cervical Lesions
American journal of clinical pathology. 132(5):767-775
Location-guided screening in cervical cytology offers a potentially significant advance over routine manual screening. A prospective, 2-armed, masked clinical trial of the BD FocalPoint GS Imaging System using SurePath slides (BD Diagnostics-TriPath, Burlington, NC) compared routine manual screening and quality control rescreening with computer- assisted, field-of view screening and device-directed quality control rescreening. The results obtained in the 2 arms were compared with adjudicated reference diagnoses for each slide. Sensitivity, specificity, and negative predictive value were calculated for the detection of atypical squamous cells of undetermined significance and greater (ASC-US+), low-grade squamous intraepithelial lesion and greater (LSIL+), and high-grade squamous intraepithelial lesion and greater (HSIL+) groups. We evaluated 12,313 slides. The detection sensitivitiesfor HSIL+ were increased by 19. 6% (P < . 0001) and for LSIL+ were increased by 9.8% (P < 0001) in the computer-assisted arm, with small statistically significant decreases in specificity. For ASC-US+ sensitivity and specificity, the study arms were not statistically different. Use of this system might be expected to improve accuracy for clinically important entities without increasing equivocal case detection.

Subject terms:

Medical oncology - Cancérologie - Medical laboratory techniques - Techniques de laboratoire médical - General medicine general surgery - Médecine et chirurgie générales - Sciences biologiques et medicales - Biological and medical sciences - Sciences medicales - Medical sciences - Techniques d'exploration et de diagnostic (generalites) - Investigative techniques, diagnostic techniques (general aspects) - Anatomopathologie. Exploration cytologique. Biochimie. Spectrométries. Méthodes cliniques et paracliniques diverses - Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques - Anatomopathologie - Anatomic pathology - Anatomía patológica - Assistance ordinateur - Computer aid - Asistencia ordenador - Cytologie - Cytology - Citología - Diagnostic - Diagnosis - Diagnóstico - Dépistage - Medical screening - Descubrimiento - Détection - Detection - Detección - Essai clinique - Clinical trial - Ensayo clínico - Imagerie médicale - Medical imagery - Imaginería médica - Lésion - Lesion - Lesión - Sensibilité - Sensitivity - Sensibilidad - Cervical cytology - Computer-assisted screening - Cytology imaging system

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Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation
Ioanna Kosmidou, author;Shannnon Wooden, author;Brian Jones, author;Thomas ...
Academic Journal Academic Journal | Journal of Visualized Experiments. (72) Please log in to see more details

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