In-laboratory breast specimen radiography reduces tissue block utilization and improves turnaround time of pathologic examination

Abstract Background This study was performed to determine whether in-laboratory specimen radiography reduces turnaround time or block utilization in surgical pathology. Methods Specimens processed during a 48-day trial of an in-lab cabinet radiography device (Faxitron) were compared to a control group of specimens imaged in the mammography suite during a prior 1-year period, and to a second group of specimens not undergoing imaging of any type. Results Cases imaged in the mammography suite had longer turnaround time than cases not requiring imaging (by 1.15 days for core biopsies, and 1.73 days for mastectomies; p < 0.0001). In contrast, cases imaged in-lab had turnaround time that was no longer than unimaged cases (p > 0.05 for core biopsies, lumpectomies and mastectomies). Mastectomies imaged in-lab required submission of fewer blocks than controls not undergoing any imaging (mean reduction of 10.6 blocks). Conclusions Availability of in-lab radiography resulted in clinically meaningful improvements in turnaround time and economically meaningful reductions in block utilization.

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In-laboratory breast specimen radiography reduces tissue block utilization and improves turnaround time of pathologic examination

10.21203/rs.3.rs-48518/v1 ◽

2020 ◽

Author(s):

Sri Krishna Chaitanya Arudra ◽

Laura C. Garvey ◽

Ian Hagemann

Keyword(s):

Turnaround Time ◽

Surgical Pathology ◽

Control Group ◽

Pathologic Examination ◽

Tissue Block ◽

One Year ◽

Specimen Radiography ◽

Laboratory Specimen

Abstract Background This study was performed to determine whether in-laboratory specimen radiography reduces turnaround time or block utilization in surgical pathology. Methods Specimens processed during a 48-day trial of an in-lab cabinet radiography device (Faxitron) were compared to a control group of specimens imaged in the mammography suite during a prior one-year period, and to a second group of specimens not undergoing imaging of any type. Results Cases imaged in the mammography suite had longer turnaround time than cases not requiring imaging (by 1.15 days for core biopsies, and 1.73 days for mastectomies; p < 0.0001). In contrast, cases imaged in-lab had turnaround time that was no longer than unimaged cases (p > 0.05 for core biopsies, lumpectomies and mastectomies). Mastectomies imaged in-lab required submission of fewer blocks than controls not undergoing any imaging (mean reduction of 10.6 blocks). Conclusions Availability of in-lab radiography resulted in clinically meaningful improvements in turnaround time and economically meaningful reductions in block utilization.

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Re-Excision Rates in Breast-Conserving Surgery for Invasive Breast Cancer after Neoadjuvant Chemotherapy with and without the Use of a Radiopaque Tissue Transfer and X-ray System

Breast Care ◽

10.1159/000493017 ◽

2018 ◽

Vol 14 (5) ◽

pp. 302-307

Author(s):

Suniza Jamaris ◽

Leyla Akpolat-Basci ◽

Miltiades Stephanou ◽

Sarah Wetzig ◽

Yueksel Cubuk ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Invasive Breast Cancer ◽

Breast Conserving Surgery ◽

Control Group ◽

Study Group ◽

Transfer System ◽

Tissue Transfer ◽

Resected Tissue ◽

Specimen Radiography

Background: Significant re-excision rates in breast-conserving surgery (BCS) after neoadjuvant systemic chemotherapy may result from difficulties in defining the surgical target particularly in cases with excellent treatment response. Devices allowing an exact topographic localisation of the lesion in the resected tissue could reduce re-excision rates by optimising the intraoperative detection of involved margins. Methods: 80 patients with invasive breast cancer receiving BCS after neoadjuvant chemotherapy were included in this non-randomized case-control study. 40 patients with specimen radiography performed in a standard approach (control group) were compared to 40 patients with use of a radiopaque tissue transfer system (study group). Results: 19/80 (23.75%) patients required re-excision because of involved margins; among those, 14/40 (35%) were in the control group and 5/40 (12.5%) in the study group. The association between the use of the radiopaque tissue transfer system and the lower re-excision rate was statistically significant (p = 0.023). Conclusion: Our analysis provides a rationale for the routine use of a radiopaque tissue transfer system for specimen radiography in BCS after neoadjuvant chemotherapy for invasive breast cancer in order to reduce re-excision rates.

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Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center

Academic Pathology ◽

10.1177/2374289517736344 ◽

2017 ◽

Vol 4 ◽

pp. 237428951773634

Author(s):

Chelsea R. Mehr ◽

Amrom E. Obstfeld ◽

Amanda C. Barrett ◽

Kathleen T. Montone ◽

Lauren E. Schwartz

Keyword(s):

Resident Education ◽

Tertiary Care ◽

Turnaround Time ◽

Surgical Pathology ◽

Primary Sources ◽

Road Map ◽

Academic Center ◽

Organ Systems ◽

Before And After ◽

Time Required

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.

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Paraffin tissue block radiography: adjunct to breast specimen radiography.

Radiology ◽

10.1148/radiology.173.3.2682773 ◽

1989 ◽

Vol 173 (3) ◽

pp. 695-696 ◽

Cited By ~ 12

Author(s):

M Rebner ◽

M A Helvie ◽

D R Pennes ◽

H A Oberman ◽

D M Ikeda ◽

...

Keyword(s):

Tissue Block ◽

Specimen Radiography ◽

Paraffin Tissue

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Transition to Subspecialty Sign-Out at an Academic Institution and Its Advantages

Academic Pathology ◽

10.1177/2374289517714767 ◽

2017 ◽

Vol 4 ◽

pp. 237428951771476 ◽

Cited By ~ 4

Author(s):

Joanna L. Conant ◽

Pamela C. Gibson ◽

Janice Bunn ◽

Abiy B. Ambaye

Keyword(s):

Quality Assurance ◽

Medical Center ◽

Turnaround Time ◽

Support Staff ◽

Surgical Pathology ◽

Clinician Satisfaction ◽

Multidisciplinary Conference ◽

The University ◽

University Of Vermont ◽

General Sign

Many pathology departments are introducing subspecialty sign-out in surgical pathology. In 2014, the University of Vermont Medical Center transitioned from general sign-out to partial subspecialty sign-out to include gastrointestinal and breast/cervix subspecialty benches; other specimens remained on general benches. Our experiences with the transition are described, including attending pathologist, trainee, support staff, and clinician satisfaction. A survey was e-mailed to all University of Vermont Medical Center anatomic pathology attendings, pathology trainees, pathologist assistants and grossing technicians, and clinicians who send surgical pathology specimens, immediately before and 1 year after transitioning to partial subspecialty sign-out. Quality assurance metrics were obtained for the 18 months prior to and following the transition. Gastrointestinal and breast/cervix attendings were more satisfied with partial subspecialty sign-out compared to those on the general benches. Overall, trainees were more satisfied with general sign-out because of the rotation schedule but preferred partial subspecialty sign-out due to improved teaching and more focused learning while on subspecialty benches. Clinicians remained very satisfied with our department and our reports; no differences were observed. Turnaround time was unchanged. After switching to partial subspecialty sign-out, there were significantly fewer discrepancies following multidisciplinary conference review for gastrointestinal and breast/cervix cases but remained the same for general cases. Fewer formal internal consults were performed after transitioning to partial subspecialty sign-out across all areas, but more notable for gastrointestinal and breast/cervix cases. Our data show improved quality assurance metrics and trainee education in a subspecialty sign-out setting compared to general sign-out setting.

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Microwave Histotechnology Vs Conventional Histotechnology: A Review

CODS Journal of Dentistry ◽

10.5005/cods-5-1-34 ◽

2013 ◽

Vol 5 (1) ◽

pp. 34-39

Author(s):

M Selvamani ◽

B S Shruthi ◽

P Vinodh Kumar

Keyword(s):

Electromagnetic Wave ◽

Turnaround Time ◽

Surgical Pathology ◽

Maximum Output ◽

Processing Methods ◽

Temperature Probe ◽

Time Required ◽

Wave Induced

ABSTRACT Turnaround time is an important consideration in surgical pathology. Attempts to shorten the time necessary for making a histopathological slide from the surgical tissue has been tried in various ways since many decades without compromising the quality of it. One amongst such attempt is the introduction of microwave to the field of his totechnology. Microwaves, a form of electromagnetic wave induced heat when applied in histotechnology, reproducibly yields histolologic material of similar or superior quality to that provided by conventional processing methods making it more popular in the recent years. A laboratory microwave offers features like maximum output of 2000-3000 watts, an in built source of adjustable temperature probe, facility for ventilation of hazardous fumes, but is expensive. Considering the usefulness of microwave in histotechnology by reducing the time required for the diagnosis, replacing the conventional equipments of laboratories to microwave guided ones is a remarkable and an acceptable change.

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Expansion of pharmacist practice in oral oncolytic therapy with a collaborative practice agreement

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220905004 ◽

2020 ◽

Vol 26 (8) ◽

pp. 1886-1893 ◽

Cited By ~ 1

Author(s):

Amanda L Wright ◽

Stephanie F Matta ◽

Julia R Kerr

Keyword(s):

Cost Savings ◽

Improve Patient Care ◽

Turnaround Time ◽

Collaborative Practice ◽

Control Group ◽

Provider Satisfaction ◽

Patient Cost ◽

Oncolytic Therapy ◽

Collaborative Practice Agreement ◽

The Mean

Introduction Collaborative practice agreements have been utilized to expand pharmacist roles and improve patient care outcomes. A need to reduce the time providers spend reviewing oral oncolytic prescriptions for therapy continuation or dose adjustments was identified in the oncology clinics of a community health system. A collaborative practice agreement was created to decrease turnaround time for processing oral oncolytic prescriptions, improve provider satisfaction, and decrease patient prescription costs. Methods A three-month pilot was initiated to evaluate feasibility and provider satisfaction by comparing two provider groups. An additional three months of data were collected post-collaborative practice agreement implementation to evaluate impact. Primary endpoints included: interventions, turnaround time, and patient cost savings. A survey was conducted to determine provider satisfaction. Results The mean turnaround time for pharmacist interventions in the pilot group (n = 54) was 7 min, compared to 3311 min in the control group (n = 87), which was statistically significant ( p < 0.0001). Two interventions in the pilot group resulted in patient cost savings due to dose rounding by a pharmacist. The mean turnaround time of the post-collaborative practice agreement group (n = 197) was 6 min, which was statistically significant when compared to the control group ( p < 0.0001). Conclusion Turnaround time was significantly shorter for prescriptions in the pilot and post-collaborative practice agreement groups compared to the control group. Provider satisfaction increased as the collaborative practice agreement resulted in less time reviewing oral oncolytic prescriptions. Patient costs were also reduced during the pilot phase due to dose rounding by pharmacists.

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Surgical Pathology Extradepartmental Consultation Practices

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-0405-specp ◽

2002 ◽

Vol 126 (4) ◽

pp. 405-412 ◽

Cited By ~ 6

Author(s):

Muhammad Azam ◽

Raouf E. Nakhleh

Keyword(s):

The United States ◽

Turnaround Time ◽

Surgical Pathology ◽

Consultation Rate ◽

Significant Information ◽

Original Diagnosis ◽

Level Of Satisfaction ◽

Practice Parameters ◽

Satisfaction Rates ◽

Case Characteristics

Abstract Objectives.—To document the practice parameters and case characteristics associated with personal (expert) consultations. We also examine the value, level of participant (customer) satisfaction, turnaround time, and rate of personal consultations. Design.—We asked participants in the College of American Pathologists' Q-Probes program to document cases sent for consultation during 4 months or up to 20 cases. They documented patient and specimen characteristics, the turnaround times, and the participants' levels of satisfaction with the consultation experience. Participants.—One hundred eighty laboratories/surgical pathology practices. One hundred seventy-two (95.6%) were from the United States; the remainder were located in Canada and Australia. Main Outcome Measures.—Rate and turnaround time of consultations and participant level of satisfaction. Results.—A total of 2746 consultation cases were examined for an aggregate consultation rate of 0.5% (median, 0.7%). Institutions with a higher occupied bed size and a greater number of surgical pathology cases both had lower consultation rates (P ≤ .05). The median turnaround time (defined as the interval from the date on which the case was sent to the date on which the diagnosis was received) was 6 days. Twenty-nine percent and 68% of cases had a turnaround time within 3 and 7 days, respectively. Fifty-two percent of cases were sent to nationally known experts, and 32% were sent to local experts. Skin (18.0%), hematolymphoid (11.6%), and breast (9.6%) specimens were most commonly sent for consultation. In 70.5% of cases, the consultant confirmed the referring pathologist's original diagnosis, but in 15.9% of cases, the consultant also added significant information. Satisfaction rates were higher with faster turnaround times and verbal reporting. Satisfaction rates were lower for cases in which the patient or the clinician requested the consultation and in which the consultant's diagnosis was ambiguous. Conclusions.—This study establishes a multi-institutional consultation rate of 0.5%, defines the nature of surgical pathology consultations, and demonstrates that satisfaction with consultations is associated with a faster turnaround time and receipt of additional, clinically meaningful information.

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Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0090-ra ◽

2013 ◽

Vol 137 (3) ◽

pp. 326-337 ◽

Cited By ~ 12

Author(s):

Linda M. Ernst ◽

Lori Gawron ◽

Michael K. Fritsch

Keyword(s):

Pregnancy Termination ◽

Placental Tissue ◽

The United States ◽

Legal Issues ◽

Surgical Pathology ◽

Second Trimester ◽

Pathologic Examination ◽

Fetal Demise ◽

Intrauterine Fetal Demise ◽

Clinical Diagnoses

Context.—Dilation and evacuation (D&E) is an alternative method to induction of labor for pregnancy termination and intrauterine fetal demise, and it is the most common mode of second-trimester uterine evacuation in the United States. Many D&E specimens are examined in surgical pathology, and there is little information available in surgical pathology textbooks or the literature to assist pathologists in these examinations. Objective.—To provide an overview of the D&E procedure, discuss related legal issues, provide guidelines for routine pathologic examination of D&E specimens, and demonstrate the importance of careful pathologic examination of D&E specimens. Data Sources.—Case-derived material and literature review. Conclusions.—Pathologic examination of D&E specimens has been understudied. However, the available literature and our experience support the fact that careful pathologic examination of D&E specimens can identify significant fetal and placental changes that can confirm clinical diagnoses or provide definitive diagnosis, assist in explaining the cause of intrauterine fetal demise, and identify unexpected anomalies that may provide further clues to a diagnostic syndrome or mechanism of anomaly formation.

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To Evaluate the Effectiveness of Plasmapheresis as a Method for the Graft Disease Prevention in Patients with Keratoplasty

Ophthalmology in Russia ◽

10.18008/1816-5095-2021-4-946-954 ◽

2021 ◽

Vol 18 (4) ◽

pp. 946-954

Author(s):

S. N. Sakhnov ◽

V. V. Myasnikova ◽

K. I. Melkonyan ◽

S. V. Kravchenko

Keyword(s):

Penetrating Keratoplasty ◽

Comparison Group ◽

Corneal Transplantation ◽

Perioperative Period ◽

Main Group ◽

Surgical Pathology ◽

Control Group ◽

Preoperative Period ◽

Rejection Reaction ◽

Graft Disease

Purpose: to evaluate the effectiveness of plasmapheresis as a method for preventing and treating the graft rejection reaction in corneal transplantation.Patients and methods. The study involved patients with surgical pathology of the cornea, who underwent a prophylactic course of plasmapheresis procedures and underwent penetrating keratoplasty (Main group); and patients with surgical pathology of the cornea who underwent penetrating keratoplasty, but did not undergo plasmapheresis (Comparison group), whose data were analyzed retrospectively. The control group consisted of conditionally healthy individuals of both genders. Subgroups of patients with high and low risk keratoplasty were also identified within the Main group and the Comparison group.Results. Patients with keratoplasty who received a course of therapeutic plasmapheresis in the perioperative period demonstrated a statistically significant increase in the number of cases of a decrease in the level of C-reactive protein and a statistically significant decrease in the median values of the mean stimulated cytochemical index and the mobilization coefficient. Depending on the risk group for keratoplasty, the patients showed different dynamics of the levels of the studied interleukins after the course of plasmapheresis and keratoplasty. In patients of the Comparison group who did not receive a course of plasmapheresis in the preoperative period, over a period of 1.3 years, 22 cases (24 %) developed graft disease, while patients of both subgroups of the Main group who received a course of therapeutic plasmapheresis in the preoperative period, didn’t demonstrate any cases of graft disease. In patients of the Comparison group (in total for two subgroups), the maximum number of cases of graft disease (n = 24) was observed in the first 500 days after surgery. At the same time, the patients of the Main group who underwent plasmapheresis had the best graft survival rates: during the observation period, there were no cases of graft disease (in both subgroups).Conclusion: the obtained data indicate the ability of plasmapheresis, performed in the perioperative period, to prevent the development of graft disease in patients with keratoplasty.

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