خداوند نام و خداوند جای خداوند روزی ده رهنمای

Transcription

1 به نام خداوند جان و خرد کزین برتر اندیشه برنگذرد خداوند نام و خداوند جای خداوند روزی ده رهنمای خداوند کیوان و گردان سپهر ز نام و نشان و گمان برترست به بینندگان آفریننده را نیابد بدو نیز اندیشه راه سخن هر چه زین گوهران بگذرد خرد گر سخن برگزیند همی ستودن نداند کس او را چو هست خرد را و جان را همی سنجد اوی بدین آلت رای و جان و زبان به هستیش باید که خستو شوی پرستنده باشی و جوینده راه توانا بود هر که دانا بود از این پرده برتر سخن گاه نیست فروزنده ماه و ناهید و مهر نگارنده بر شده پیکرست نبینی مرنجان دو بیننده را که او برتر از نام و از جایگاه نیابد بدو راه جان و خرد همان را گزیند که بیند همی میان بندگی را ببایدت بست در اندیشه سخته کی گنجد اوی ستود آفریننده را کی توان ز گفتاربی کار یکسو شوی به ژرفی به فرمانش کردن نگاه ز دانش دل پیر برنا بود ز هستی مر اندیشه را راه نیس

2 Pathology and clinic Pathology and clinic

3 Clinicians Are From Mars and Pathologists Are From Venus

4 just as medical language may be hard for lay people to understand, medical specialists may use language that is obscure to practitioners outside their specialty. Among specialists, the language of diagnostic anatomic pathologist is arguably furthest from daily medical discourse. There has been an implicit recognition of this fact in efforts to standardize pathology reporting. These efforts have lead to the adoption of the so-called Bethesda system for Papanicolaou smear reporting1 and similar attempts to standardize reports in other areas, including tumor resections, transplant biopsies, and liver biopsies. However, little explicit attention has been focused on the ability of clinicians to understand pathology reports, despite the role of reports in guiding treatment.

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7 Pathology Department -Biopsy -Cytology Specimen -Autopsy -Necropsy

8 Quality control in the histopathology laboratory:

9 MEASURING QUALITY IN SURGICAL PATHOLOGY Elements of quality that are important in surgical pathology include report accuracy, timeliness, and report completeness price

10 This standard aims to have the total number of failures in quality, or customer satisfaction at 3.4 defects or fewer than 4 defects per products. By comparison, various studies have estimated surgical pathology error rates from as low as 0.25% (2500 per million) to as high as 40%.4 Most investigators, however, agree that a significant error rate in surgical pathology is in the range of 0.5% to 1%.

11 The concept of quality control in histopathology is relatively young and less well understood. Quality control is traditionally applicable to three phases of operation 1) the pre-analytical phase, 2) the analytical phase 3) the post-analytical phase There is a special focus on external quality assessment

12 The pre-analytical phase is related to sample collection, transport, accession and processing.

13 Various studies indicate that the majority of errors in the laboratory relate to the pre-analytical phase

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15 Analytic phase The analytic phase of the test cycle begins with gross examination of the specimen and ends with diagnosis. All manipulations of the specimen subsequent to gross examinatio such as histological preparation and immunohistochemistry, that lead to a diagnosis are therefore components of the analytic phase of the test cycle. Most critical in this in a diagnosis, including gross dissection and section, embedding, histological sectioning, staining, special and immunohistochemical staining, possible other ancillary studies, and microscopic interpretation. The accuracy of the final diagnosis is a measure of the effectiveness of all of these sequential steps.

16 Analytic aspects The following general recommendations are being made at this stage. 1. For departments with more than one pathologist: -Intra-departmental consultation (review of selected cases by colleagues) -Comparison with other reports (frozen/cytology/histopathology) -Random case review (blinded re-reporting of random cases) By the same person (check for precision) By a different person (check for accuracy) -Intra- and inter-departmental conferences (clinico-pathological conference (CPC)/clinical rounds)

17 2. For laboratories run by single pathologist: reasonable quality may still be achieved by implementing the following: -Random blinded review of reported cases (precision check) -External consultations (may need to be done more often) -Review by experts -Participation in continued medical education (CME) programs

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19 Post-analytic phase The post-analytic phase of the test cycle begins with dictation of the gross and microscopic examination and the final diagnosis and includes transcription, report correction, verification, and report delivery. Keys in the post-analytic phase are accurate transcription, complete reporting, and report delivery.

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22 As stated above, TAT is a critical element of quality and usually covers all aspects of the laboratory test cycle. While TAT may be fragmented into smaller components, the total TAT is the only measure by which the clinician or customerwill judge the laboratory.

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24 1.What might the pathology report say about the physical and chemical characteristics of the tissue? After identifying the tissue as cancerous, the pathologist may perform additional tests to get more information about the tumor that cannot be determined by looking at the tissue with routine stains, such as hematoxylin and eosin (also known as H&E), under a microscope (2). The pathology report will include the results of these tests. For example, the pathology report may include information obtained from immunochemical stains (IHC). IHC uses antibodies to identify specific antigens on the surface of cancer cells. IHC can often be used to: Determine where the cancer started Distinguish among different cancer types, such as carcinoma, melanoma, and lymphoma Help diagnose and classify leukemias and lymphomas (3) The pathology report may also include the results of flow cytometry. Flow cytometry is a method of measuring properties of cells in a sample, including the number of cells, percentage of live cells, cell size and shape, and presence of tumor markers on the cell surface. Tumor markers are substances produced by tumor cells or by other cells in the body in response to cancer or certain noncancerous conditions.) Flow cytometry can be used in the diagnosis, classification, and management of cancers such as acute leukemia, chronic lymphoproliferative disorders, and non-hodgkin lymphoma (2). Finally, the pathology report may include the results of molecular diagnostic and cytogenetic studies. Such studies investigate the presence or absence of malignant cells, and genetic or molecular abnormalities in specimens.

25 What information about the genetics of the cells might be included in the pathology report? report? Cytogenetics uses tissue culture and specialized techniques to provide genetic information about cells, particularly genetic alterations. Some genetic alterations are markers or indicators of a specific cancer. For example, the Philadelphia chromosome is associated with chronic myelogenous leukemia (CML). Some alterations can provide information about prognosis, which helps the doctor make treatment recommendations (3). Some tests that might be performed on a tissue sample include:

26 Fluorescence in situ hybridization (FISH): Determines the positions of particular genes. It can be used to identify chromosomal abnormalities and to map genes. Polymerase chain reaction (PCR): A method of making many copies of particular DNA sequences of relevance to the diagnosis. Real-time PCR or quantitative PCR: A method of measuring how many copies of a particular DNA sequence are present. Reverse-transcriptase polymerase chain reaction (RT-PCR): A method of making many copies of a specific RNA sequence. Southern blot hybridization: Detects specific DNA fragments. Western blot hybridization: Identifies and analyzes proteins or peptides.

27 Can individuals get a second opinion about their pathology results? Although most cancers can be easily diagnosed, sometimes patients or their doctors may want to get a second opinion about the pathology results (1). Patients interested in getting a second opinion should talk with their doctor. They will need to obtain the slides and/or paraffin block from the pathologist who examined the sample or from the hospital where the biopsy or surgery was done.

28 Policy for Rejection of Specimens