Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study).

Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard.

Inverse association of esophageal eosinophilia and Barrett esophagus.

Background: The high frequency of gastroesophageal reflux symptoms reported in patients with eosinophilic esophagitis has suggested that the two disorders may be associated; however, few studies have systematically addressed this issue.

Goals: To determine the frequency of the simultaneous occurrence of esophageal eosinophilia and Barrett esophagus and define the clinical characteristics of patients with both conditions.

Study: From a national pathology database of patients who had esophagogastroduodenoscopy with mucosal biopsies we extracted patients with a diagnosis of Barrett mucosa, eosinophilic esophagitis pattern of injury [(≥15 eosinophils/high-power field (HPF)], or both.

Ileal biopsy: Clinical indications, endoscopic and histopathologic findings in 10,000 patients.

Background: Ileal biopsies are often reported as having a low yield. Data from endoscopy practices in the private setting are lacking.

Aims: To correlate the frequency of histologic abnormalities in ileal biopsies with clinical indications and ileoscopic appearances.

The current spectrum of gastric polyps: a 1-year national study of over 120,000 patients.

Objectives: To use a large pathology database (Caris Diagnostics) to analyze the frequency and associations of gastric polyps in a nationwide US population.

Methods: A total of 121,564 esophagogastroduodenoscopy (EGD) procedures from private practices in 36 states in the Caris Diagnostics database from 1 April 2007 to 31 March 2008 were searched for the endoscopic designations of polyp, nodule, and mass, and for the pathological diagnoses that commonly present as gastric polyps. Pertinent demographic data, clinical indications for EGD, and information regarding Helicobacter pylori infection, reactive gastropathy, chronic inactive gastritis, and intestinal metaplasia were also obtained.

Adherence to biopsy guidelines for Barrett's esophagus surveillance in the community setting in the United States.

Background & Aims: Current surveillance guidelines for Barrett's esophagus (BE) recommend extensive biopsies to minimize sampling error. Biopsy practice patterns for BE surveillance in the community have not been well-described. We used a national community-based pathology database to analyze adherence to guidelines and to determine whether adherence was associated with dysplasia detection.

A case of herpes esophagitis after fluticasone propionate for eosinophilic esophagitis.

Background: A 19-year-old white woman presented with a 6-month history of progressively worsening dysphagia.

Investigations: Esophagogastroduodenoscopy, esophageal biopsies followed by histological evaluation of biopsy samples including immunohistochemical staining for herpes simplex virus.

Diagnosis: Herpes esophagitis with concurrent eosinophilic esophagitis.

Promoter hypermethylation profile of ovarian epithelial neoplasms.

Purpose: Ovarian carcinomas are believed to arise de novo from surface epithelium, but the actual molecular pathogenesis is unknown. The aim of this study was to compare the promoter hypermethylation profiles of ovarian epithelial neoplasms to better understand the role of epigenetic silencing in carcinogenesis.

Experimental Design: We analyzed the DNA promoter methylation status of eight tumor suppressor and cancer-related genes (p16, RARbeta, E-cadherin,H-cadherin, APC, GSTP1, MGMT, RASSF1A) in 23 benign cystadenomas, 23 low malignant potential (LMP) tumors, and 23 invasive carcinomas by methylation-specific PCR.

Evaluation of flashlamp-pumped pulsed-dye laser (585 nm) in nonsurgical delay of dorsal rat cutaneous flaps.

Background: This study evaluated the efficiency of a flashlamp-pumped pulsed-dye laser operating at 585 nm in the delay of a caudally based, 10 x 3-cm dorsal rat skin flap. Two different laser treatment patterns (only longitudinal borders and the entire surface of the proposed flap) for two different fluences (6 J/cm and 8 J/cm) were compared with an acute untreated control flap as well as two surgical delay methods (incision of longitudinal borders and incision of longitudinal borders plus flap undermining).

Methods: Twelve male Sprague-Dawley rats were used in each of seven groups.

Stability of PreservCyt for Hybrid Capture (HC II) HPV test.

The Food and Drug Administration (FDA) has approved the Hybrid Capture II (HC II) assay to test for the presence of high-risk types of human papilloma virus (HPV) DNA using specimens in PreservCyt fixative for up to 21 days after collection. The ability of HC II to determine the presence of HPV DNA in actual patient samples after longer periods of storage has not been shown. To determine if specimens older than 21 days can yield useful results, 207 patient specimens that had been tested for HPV DNA by HC II (primary test) were tested again after a significant period of storage ranging from approximately 2.

Split sample comparison of ThinPrep and conventional smears in endoscopic retrograde cholangiopancreatography-guided pancreatic fine-needle aspirations.

Fine-needle aspiration (FNA) of pancreatic lesions is a common procedure to establish a tissue diagnosis before chemotherapy or surgery. In this study, the authors attempt to compare the diagnostic value of the ThinPrep (TP) method with conventional smears (CSs) in samples obtained by endoscopic retrograde cholangiopancreatography (ERCP)-guided pancreatic FNAs. Material obtained, prospectively, from ERCP-guided pancreatic FNAs was split to prepare CSs (2-5 slides) first, the remainder being rinsed in PreservCyte, and in the laboratory, 1 TP slide was prepared.

Reprocessing unsatisfactory ThinPrep Papanicolaou test specimens increases sample adequacy and detection of significant cervicovaginal lesions.

Background: The objective of the current study was to determine the effect of reprocessing bloody ThinPrep (TP) samples using a glacial acetic acid technique on the unsatisfactory rate.

Methods: During a 12-month study period, all TP gynecologic samples received by the Cytology Laboratory from inpatient, outpatient, and community-based clinics at the University of Texas Southwestern Medical Center and the Parkland Health and Hospital System in Dallas, Texas, were enrolled prospectively into the study. The initial TP slides were evaluated for specimen adequacy based on the 2001 Bethesda System.

Ethnic differences in the prevalence of cryptogenic cirrhosis.

Objectives: Nonalcoholic steatohepatitis (NASH) associated with obesity and type 2 diabetes mellitus (DM) is postulated to be the cause of most cases of cryptogenic cirrhosis (CC). While ethnic differences in the prevalence of obesity and DM in the United States are well documented, there is little information regarding prevalence of CC or NASH among different U.S.

Comparison of ThinPrep and conventional smears in detecting carcinoma in bile duct brushings.

Background: Bile duct brushing cytology is a common procedure for the exclusion of adenocarcinoma in the bile duct. The authors evaluated the use of ThinPrep (TP) to determine whether the information obtained is equivalent to that found with conventional smear cytology (CS).

Methods: Thirty-eight prospectively collected endoscope retrograde cholangiopancreatography-guided bile duct brushing samples were split in the following manner.

Nephrectomy after radiofrequency ablation-induced ureteropelvic junction obstruction: potential complication and long-term assessment of ablation adequacy.

Little information is available concerning the morbidity of radiofrequency ablation (RFA) or the evolution of an RFA lesion over time. We report our findings in a kidney removed 1 year after RFA of a 2.3-cm renal tumor.

Feasibility of laparoscopic partial nephrectomy using pledgeted compression sutures for hemostasis.

Purpose: To develop a technique for laparoscopic partial nephrectomy (LPN) without the use of hilar occlusion that allows large renal resection and excellent hemostasis.

Materials And Methods: Five female domestic pigs underwent right laparoscopic transperitoneal lower-pole partial nephrectomy after placement of pledgeted parenchymal compression sutures tied intracorporeally to induce regional renal hypoperfusion. Postoperatively, serial serum creatinine measurements were obtained to monitor renal function.

Reflex human papillomavirus DNA testing on residual liquid-based (TPPT) cervical samples: focus on age-stratified clinical performance.

Background: Liquid-based ThinPrep technology has made reflex human papillomavirus (HPV) DNA testing possible. In the current study, the clinical performance of reflex HPV testing as an adjunct to routine ThinPrep testing (TPPT) and the impact of age on various test parameters in a predominantly high-risk, minority population were evaluated retrospectively.

Methods: Reflex HPV testing was performed in 2114 women with atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cytology, using probes for low-risk (LR) and high-risk (HR) HPV types.

Detrimental effects of a high fat diet in early renal injury are ameliorated by fish oil in Han:SPRD-cy rats.

Dietary fish oils containing (n-3) fatty acids can modulate renal inflammatory injury. We previously demonstrated that a high fat (HF) diet worsens early renal disease progression in the Han:SPRD-cy rat model of polycystic kidney disease (PKD). Therefore, using HF (20 g/100 g diet) and low fat (LF; 5 g/100 g diet) diets, we compared the effects of menhaden oil (MO), soybean oil (SO) and cottonseed oil (CO) on renal function and histology in male Han:SPRD-cy rats fed the diets for 6 wk in the early stages of renal disease.

Characterization of prostate size, PSA and endocrine profiles in patients with spinal cord injuries.

Aims of this study: From cross-sectional and longitudinal population based studies as well as from autopsy studies it is well documented that total prostate volume increases with advancing age. However, it is not well known (1) which factors are ultimately responsible for this growth phenomenon; or (2) at what time in a persons life the growth tends to occur. At present at least a permissive role for testicular androgens is assumed to be involved in growth regulation.

Cell block findings from residual PreservCyt samples in unsatisfactory ThinPrep Paps: no additional benefit.

Our objective was to determine whether cell blocks (CB) performed on unsatisfactory ThinPrep Pap Test residual samples rendered additional clinically significant pathologic findings not detected in the original ThinPrep Pap smears. One hundred consecutive ThinPrep Paps categorized as unsatisfactory were selected for this study. The cytologic diagnosis of unsatisfactory was based on lack of cellularity (squamous) or complete obscuring blood or inflammation.

Diagnostic utility of the HepPar1 antibody to differentiate hepatocellular carcinoma from metastatic carcinoma in fine-needle aspiration samples.

Background: The cytopathologic distinction between hepatocellular carcinoma (HCC) and metastatic carcinoma (MC) in the liver can be problematic, especially in patients with poorly differentiated HCC, in whom a trabecular pattern, bile production, and Mallory bodies may not be apparent on small fine-needle aspiration (FNA) samples. HepPar1 (OCH1E5) is a monoclonal antibody specifically developed to react with hepatocytes. It rarely reacts with bile duct and nonparenchymal liver cells.

Cholestatic presentation of chronic hepatitis C: a clinical and histological study with a review of the literature.

Bile duct lesions are observed in the livers of chronic hepatitis C patients, but are inconstant and rarely associated with other features of chronic cholestasis and progressive bile duct injury or loss. We aimed to identify the clinical and biochemical characteristics of patients with chronic hepatitis C from our patient database presenting with prominent cholestatic features to determine if there is a correlation between histological evidence of bile duct injury and clinical or biochemical features observed in these patients. We retrospectively reviewed a hepatitis C database including 620 patients to identify those who presented with either alkaline phosphatase (AP) > or = 400 units/liter (normal 30-126 units/liter) or AP > or = 250 units/liter with pruritus.

Assessment of HER-2/neu status in breast cancer. Automated Cellular Imaging System (ACIS)-assisted quantitation of immunohistochemical assay achieves high accuracy in comparison with fluorescence in situ hybridization assay as the standard.

This retrospective study of formalin-fixed infiltrating breast cancer specimens compared manual immunohistochemical assay with a new image analyzer-assisted immunohistochemical quantitation method, using fluorescence in situ hybridization assay (FISH) as the standard. Following the manual immunohistochemical assay, 189 cases, including most manual immunohistochemically positive and some random negative cases, were analyzed by FISH assay for Her-2/neu gene amplification and by the Automated Cellular Imaging System (ACIS) for immunohistochemical staining. Using the FISH standard, the ACIS immunohistochemical assay attained a higher concordance rate and sensitivity than the manual immunohistochemical assay (91.

Clinical relevance of benign endometrial cells in postmenopausal women.

Our objective was to determine if the finding of benign endometrial cells on a Papanicolaou (Pap) smear of a postmenopausal woman is associated with endometrial/uterine pathology, independent of symptomatology and hormone replacement therapy (HRT) status. The medical records of 146 postmenopausal patients who had a Pap smear showing normal-appearing endometrial cells between January 9, 1997 and January 12, 2000 were reviewed. Uterine pathology for each patient was determined by reviewing the results of endometrial sampling (endometrial biopsy or dilatation and curettage), hysterectomy, or pelvic sonogram, which were performed within 24 mo of the cytologic smear.