Erroneous Patient Tissue Contaminants in 1574 Surgical Pathology Slides: Impact on Diagnostic Error and a Novel Framework for Floater Management.

IF 3.7 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY
Simon Lamothe, Masa Peric, Jonathan N Glickman, Yael K Heher
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引用次数: 0

Abstract

Context.—: Tissue contaminants on histology slides represent a serious risk of diagnostic error. Despite their pervasive presence, published peer-reviewed criteria defining contaminants are lacking. The absence of a standardized diagnostic workup algorithm for contaminants contributes to variation in management, including investigation and reporting by pathologists.

Objective.—: To study the frequency and type of tissue contaminants on microscopic slides using standardized criteria. Using these data, we propose a taxonomy and algorithm for pathologists on "floater" management, including identification, workup, and reporting, with an eye on patient safety.

Design.—: A retrospective study arm of 1574 histologic glass slides as well as a prospective study arm of 50 slide contamination events was performed. Using these data we propose a structured classification taxonomy and guidelines for the workup and resolution of tissue contamination events.

Results.—: In the retrospective arm of the study, we identified reasonably sized benign tissue contaminants on 52 of 1574 slides (3.3%). We found size to be an important parameter for evaluation, among other visual features including location on the slide, folding, ink, and tissue of origin. The prospective arm of the study suggested that overall, pathologists tend to use similar features when determining management of potentially actionable contaminants. We also report successfully used case-based ancillary testing strategies, including fluorescence in situ hybridization analysis of chromosomes and DNA fingerprinting.

Conclusions.—: Tissue contamination events are underreported and represent a patient safety risk. Use of a reproducible classification taxonomy and a standardized algorithm for contaminant workup, management, and reporting may aid pathologists in understanding and reducing risk.

1574例手术病理切片中错误的患者组织污染物:对诊断错误的影响和漂浮物管理的新框架。
上下文。-:组织学切片上的组织污染物具有严重的诊断错误风险。尽管污染物无处不在,但目前还缺乏经过同行评审的标准来定义污染物。缺乏标准化的污染物诊断检查算法导致管理上的差异,包括病理学家的调查和报告。-:使用标准化标准研究显微镜载玻片上组织污染物的频率和类型。利用这些数据,我们为病理学家提出了一种“漂浮物”管理的分类和算法,包括识别、检查和报告,同时关注患者的安全。研究人员对1574例组织学玻片进行了回顾性研究,并对50例玻片污染事件进行了前瞻性研究。利用这些数据,我们提出了一种结构化的分类、分类和指导方针,用于组织污染事件的检查和解决。-:在本研究的回顾性研究中,我们在1574张载玻片中的52张(3.3%)上发现了合理大小的良性组织污染物。我们发现尺寸是评估的重要参数,其他视觉特征包括幻灯片上的位置、折叠、墨水和原始组织。该研究的前瞻性研究表明,总的来说,病理学家在确定潜在可操作污染物的管理时倾向于使用类似的特征。我们也成功地报道了基于病例的辅助检测策略,包括染色体的荧光原位杂交分析和DNA指纹图谱。-:组织污染事件未被充分报道,并构成患者安全风险。使用可重复的分类分类法和污染物检查、管理和报告的标准化算法可以帮助病理学家理解和降低风险。
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来源期刊
CiteScore
9.20
自引率
2.20%
发文量
369
审稿时长
3-8 weeks
期刊介绍: Welcome to the website of the Archives of Pathology & Laboratory Medicine (APLM). This monthly, peer-reviewed journal of the College of American Pathologists offers global reach and highest measured readership among pathology journals. Published since 1926, ARCHIVES was voted in 2009 the only pathology journal among the top 100 most influential journals of the past 100 years by the BioMedical and Life Sciences Division of the Special Libraries Association. Online access to the full-text and PDF files of APLM articles is free.
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