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Miami, FL, United States

Introduction: Non-diagnostic rates for thyroid fine needle aspiration vary considerably, but reasons for this variation are poorly understood. Methods: Our group reviewed the results of all thyroid aspirations with surgical resection for the last 13 years at our institutions, combined these with those in the literature, and correlated non-diagnostic rates with positivity rates. Results: Non-diagnostic rates were negatively correlated with positivity rates (R2 = 0.55). Studies that had significantly lower non-diagnostic rates than the rest of the literature (2 vs. 15%, p = 0.002) had different or undefined adequacy criteria or used core biopsies in addition to fine needle aspiration. Conclusions: Non-diagnostic rates for thyroid fine needle aspirations are negatively correlated with positivity rates. These data provide more realistic estimates of achievable adequacy rates. © 2010 S. Karger AG, Basel. Source

Renshaw A.A.,Baptist Hospital | Elsheikh T.M.,Cleveland Clinic
American Journal of Clinical Pathology

Previous prospective studies have shown different results when comparing automated and manual screening of gynecologic cytology. The results of 3 large prospective studies were reviewed and relative sensitivity used as a gold standard. No significant differences could be shown in relative sensitivity between the ThinPrep Imaging System and the FocalPoint GS Imaging System (P > .05). When manual screening was restricted to less than 6 hours per day, 50 or fewer slides per day, and at least 6 minutes per slide (<10 slides/h), the relative sensitivity for automation was significantly lower for atypical squamous cells of undetermined significance and above (ASC+) (0.81; 95% confidence interval [CI], 0.79- 0.83) than when manual screening was not restricted (1.07; 95% CI, 1.03-1.10). All 3 sites that screened 10 or more slides per hour manually had a relative sensitivity for automation that was significantly higher for high-grade squamous intraepithelial lesions and above (HSIL+) than for the remaining groups who screened less than 10 slides per hour (1.40 [95% CI, 1.22-1.60] vs 0.97 [95% CI, 0.95-1.00]). These results suggest that location finding of abnormalities (ASC+) may be more strongly associated with time spent screening per day, whereas classification/interpretation skills (HSIL+) may depend on time spent on an individual case. There is no evidence that automated screening devices are more sensitive than manual screening performed at lower well-defined workloads. More restricted workloads (=41 slides/d, =4.5 h/d) for manual screening may perform significantly better than automated screening devices as measured by histologic cervical intraepithelial neoplasia 2 and above. © American Society for Clinical Pathology. Source

At present, the College of American Pathologists checklist requires documentation of communication of critical values in anatomic pathology to caregivers. Recently, our institution has begun using the electronic medical record to document the lack of imminent danger or emergency associated with the case rather than calling the caregiver. I sought to document this trend. The results of all critical values and all endometrial curettings with a diagnosis of "no products of conception seen" for the last 3 years at 1 hospital were reviewed. During the first 18 months, 0 of 11 critical cases were documented by reference to the electronic medical record. During the second 18 months 5 of 14 cases (36%; P = .02) were documented to have an intrauterine pregnancy by ultrasound and the physician was not notified. In our laboratory, cases without products of conception and a documented intrauterine pregnancy are no longer considered critical values in anatomic pathology. Documentation of the lack of imminent danger to the patient through reference to the electronic medical record is an increasingly common and acceptable means of ensuring patient safety and more accurately defining critical values in anatomic pathology. © American Society for Clinical Pathology. Source

Vivero M.,Harvard University | Renshaw A.A.,Baptist Hospital | Krane J.F.,Harvard University
Cancer Cytopathology

BACKGROUND: The Bethesda System category of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is used to classify a variety of mild abnormalities in thyroid FNAs. Modifying terminology is often added to FNA reports, but it is unknown whether specific phrases affect clinical management. To answer this question, the authors correlated treatment of patients who had initial AUS/FLUS diagnoses from Baptist Hospital (Miami, Fla) (BH) and Brigham and Women's Hospital (Boston, Mass) (BWH) with the language used in pathology reports. METHODS: In total, 146 FNAs from BH, including 115 women and 31 men with a median age of 53 years (range, 21-79 years), and 300 FNAs from BWH, including 241 women and 59 men with a median age of 66 years (range, 10-85 years), were included. FNA reports were evaluated for predetermined descriptive phrases and were correlated with subsequent management. RESULTS: More patients with available follow-up underwent excision at BH than at BWH (86% vs 8%; P<.001), and fewer underwent a repeat biopsy (14% vs 92%; P<.001). Qualifiers associated with differing malignancy risk affected patient management (P<.05) at BH, but not at BWH. Reports indicating a scant or limited specimen increased rebiopsy rates at BH (100% vs 4.8%; P<.05), but not at BWH (93% vs 91%; P5.67), as did explicit recommendation for rebiopsy at BH (35% vs 14%; P5.03). No other phrases affected patient management (P>.05). CONCLUSIONS: In practice settings that follow The Bethesda System management guidelines, descriptive report terminology does not modify patient treatment. In less standardized settings, terminology associated with differing risk of malignancy on subsequent excision, pathologist recommendations, and phrases indicative of limited sampling significantly alter patient management. © 2013 American Cancer Society. Source

Siegel W.,Baptist Hospital
The American journal of cardiology

This article provides narration of the events during the development of ergonovine maleate infusions for detecting coronary artery spasm at the Cleveland Clinic in 1973. This was the first safe, reproduceable and reliable test for angiographic visualization of the pathophysiology associated with the Prinzmetal Syndrome termed "angina inversa". Source

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