American journal of clinical pathology最新文献

{"title":"Optimizing diagnostic utility for diagnosis and management of Helicobacter pylori infections through combined microbiology and pathology approaches: a 7-year study.","authors":"Zoon Tariq, Maher Ali, Rebecca Yee","doi":"10.1093/ajcp/aqag093","DOIUrl":"10.1093/ajcp/aqag093","url":null,"abstract":"<p><strong>Objectives: </strong>Helicobacter pylori infections result in significant global disease burden related to chronic gastritis, peptic ulcer disease, and gastric cancer. Optimal treatment requires knowledge of local resistance epidemiology. We characterized our patient population infected with H pylori in Washington, DC, United States, and evaluated the diagnostic utility of microbiology and surgical pathology approaches for H pylori diagnosis.</p><p><strong>Methods: </strong>A retrospective, observational study was performed from April 2015 to March 2022, consisting of patients positive for H pylori. Review of the electronic medical record for patient demographics, clinical presentation, laboratory results, and clinical management was performed.</p><p><strong>Results: </strong>Top clinical presentations in our patients with H pylori infections (n = 31, mean age 51 years) were abdominal pain (55%), gastroesophageal reflux disease (19%), and nausea/vomiting (10%), with most (84%) experiencing recurrent disease. Concordant findings (n = 105 specimens) between microbiology and surgical pathology were noted in 96% of patients. Microbiology testing provided a faster preliminary positive diagnosis by 3 days (P < .00001). For both approaches, antrum biopsy specimens demonstrated a 100% recovery rate (odds ratio [OR], 5.4). Active gastritis was the most common diagnosis (82%), which significantly increased the likelihood of H pylori seen in microbiology smears (OR, 1.7) and viable recovery of the organism (OR, 2.6) for further antimicrobial susceptibility testing. Our antibiogram revealed more than 55% resistance to first-line drugs, with 77% of our isolates being multidrug resistant.</p><p><strong>Conclusions: </strong>An accurate diagnosis of an H pylori infection is dependent on specimen site and disease severity. Appropriate biopsy collection and ordering of microbiology and surgical pathology tests maximize diagnostic utility. A local antibiogram is essential for guiding empiric therapy.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a virulence gene repertoire as a means to investigate the role in the causal pathway to death of Escherichia coli isolated from postmortem specimens, northern Tanzania.","authors":"Deng B Madut, Matthew P Rubach, Cristina Costales, Robert J Rolfe, Manuela Carugati, Patrick T Amsi, Alex R Mremi, Nathan H Kalengo, Calvin Mosha, Annette Marandu, Michael J Maze, Blandina T Mmbaga, Kajiru G Kilonzo, Venance P Maro, Flemming Scheutz, John A Crump","doi":"10.1093/ajcp/aqag088","DOIUrl":"https://doi.org/10.1093/ajcp/aqag088","url":null,"abstract":"<p><strong>Objectives: </strong>Interpreting postmortem microbiological data is challenging, especially when enteric organisms are isolated. We evaluated whether virulence gene profiles could distinguish hospitalized decedents in whom Escherichia coli was adjudicated to be in the causal pathway to death from those in whom it was not.</p><p><strong>Methods: </strong>We conducted a prospective autopsy study from 2016 through 2019 at 2 hospitals in northern Tanzania. Postmortem cultures were collected from multiple specimen types. The role of E coli in the causal pathway to death was adjudicated using clinical, microbiological, and histopathologic data. Separate from adjudication, whole-genome sequencing was performed on E coli isolates for classification as extraintestinal pathogenic E coli (ExPEC) vs non-ExPEC based on their virulence genes. Logistic regression assessed the odds of isolating ExPEC when E coli was adjudicated as being in the causal pathway to death.</p><p><strong>Results: </strong>We identified 74 E coli isolates from 57 (26.4%) of the 216 decedents enrolled in our study. Among decedents with E coli growth in culture, median (IQR) age was 38 (24-61) years, 14 (24.6%) were female, and E coli was adjudicated as being in the causal pathway to death in 17 (29.8%). Of these 17 decedents, 13 (76.5%) had at least 1 isolate designated as ExPEC compared with 24 (60.0%) of 40 decedents for whom E coli was not deemed causative of death. The odds of isolating ExPEC when E coli was in the causal pathway to death was 2.78 (95% CI, 0.62-12.3; P = .18).</p><p><strong>Conclusions: </strong>No single genomic marker, including ExPEC status, was sufficient to establish the causal role of E coli in death.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I diagnose Erdheim-Chester disease.","authors":"Aishwarya Ravindran, Karen L Rech","doi":"10.1093/ajcp/aqag094","DOIUrl":"10.1093/ajcp/aqag094","url":null,"abstract":"<p><strong>Objectives: </strong>Erdheim-Chester disease (ECD) is one of 3 major types of histiocytic neoplasms, along with Rosai-Dorfman disease and Langerhans cell histiocytosis. It was first recognized as a neoplasm in the 2016 World Health Organization Classification of Haematolymphoid Tumours. About 80% to 90% of cases harbor MAPK pathway mutations.</p><p><strong>Methods: </strong>We discuss the diagnosis of ECD using 3 illustrative cases, consider interpretative challenges, and present a diagnostic algorithm.</p><p><strong>Results: </strong>Erdheim-Chester disease is a systemic disease that shows a characteristic pattern of organ involvement including bone, perinephric soft tissue, skin, heart, and central nervous system. Histologically, ECD shows a spectrum of xanthogranulomatous, lymphohistocytic, or fibrohistiocytic infiltrates. By immunohistochemistry, the neoplastic histiocytes have a macrophage phenotype with expression of CD163, negative to focal S100, and negative CD1a and langerin. These features alone are not specific and thus insufficient for diagnosis. Immunohistochemistry for cyclin D1 and BRAF V600E, correlation with clinical and imaging findings, and mutational analysis for MAPK pathway mutations all play important roles in establishing an ECD diagnosis.</p><p><strong>Conclusions: </strong>The diagnosis of ECD is often challenging due to its clinical and histologic overlap with reactive inflammatory processes. Correlation of histology features with clinical findings, immunohistochemistry, and genetic studies is essential for an accurate and timely diagnosis.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Society for Clinical Pathology (ASCP) and ASCP Board of Certification medical and public health laboratory education financing study.","authors":"Edna Garcia, Jenny Diaz, Melissa Kelly, Ryan Soles, Naomi James, Zoë Baker, Amy Spiczka","doi":"10.1093/ajcp/aqag082","DOIUrl":"10.1093/ajcp/aqag082","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines the cost of completing laboratory education programs across degree levels and evaluates the availability and use of financial resources for laboratory students. Its findings support advocacy to reduce student debt, inform federal and state policy, and help institutions strengthen recruitment and retention by addressing financial barriers.</p><p><strong>Methods: </strong>This national cross-sectional study surveyed laboratory professionals, educators, and current or recent students across the United States and its territories. It was conducted in a collaboration among the American Society for Clinical Pathology's (ASCP's) Institute for Science, Technology, and Policy; the ASCP Evaluation, Measurement, and Assessment Department; and the ASCP Board of Certification.</p><p><strong>Results: </strong>The cost of attending a laboratory education program generally falls at or below the lower end of national averages for educational expenses among students and working laboratory professionals. Respondents most often rely on self-funding, federal student loans, and private loans, with financing methods varying by enrollment period. Logistic regression showed that dependence on federal loans and younger age were the strongest predictors of student loan participation among laboratory professionals.</p><p><strong>Conclusions: </strong>Continued advocacy is essential to ensure that laboratory professionals remain included in federal and state scholarships, grants, and loan forgiveness programs. As policies governing educational funding evolve, it is increasingly important to engage stakeholders in championing financial support for laboratory professionals. Doing so will help reduce the burden of educational costs and strengthen pathways into laboratory careers, ultimately securing recruitment and retention.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing efficiency and improving turnaround time: real-world impact of the Genius Digital Diagnostics System implementation.","authors":"Kristina Weatherhead, Chinh Nguyen, Terry Henry, Sarah Harrington, Yan Lemeshev","doi":"10.1093/ajcp/aqag081","DOIUrl":"10.1093/ajcp/aqag081","url":null,"abstract":"<p><strong>Objectives: </strong>We sought to assess the real-world impact of the Genius Digital Diagnostics System (Genius Dx [Hologic, Inc]) on workload, efficiency, and turnaround time in a high-volume cervical cytology laboratory.</p><p><strong>Methods: </strong>The laboratory information system was retrospectively queried for all Papanicolaou test cases performed between January 1, 2023, and March 31, 2025. A total of 512 177 cases (655 468 reviews) were included. Genius Dx was implemented on August 1, 2024, and cases were classified as preimplementation or postimplementation. Daily caseload, number of reviewers, number of cases per reviewer, and accession-to-sign-out times were compared using independent-samples t tests. Diagnostic distributions were compared using ꭓ2 tests.</p><p><strong>Results: </strong>Average daily cytologist (CT) reviews were similar before and after Genius Dx (747.8 vs 758.4 cases) but required fewer CTs per day (10.4 vs 8.1; P < .001), increasing cases per CT per day from 74.5 to 94.7 (P < .001). Pathologist reviews per day increased (106.0 vs 145.3; P < .001) with fewer pathologists (4.4 vs 3.4; P < .001). Average daily CT case workload increased by 53.5% after implementation. Accession-to-sign-out times decreased for all diagnoses (P < .001). A small but statistically significant shift in diagnostic proportions was observed, with a decrease in negative results and an increase in atypical squamous cells of uncertain significance or higher (ASC-US+) findings with negligible effect size.</p><p><strong>Conclusions: </strong>Implementation of Genius Dx substantially increased reviewer efficiency and reduced turnaround times without compromising diagnostic performance. The increased detection of ASC-US+ findings observed in this study are in line with results from the Genius Dx clinical trial and other published literature.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized protocols for reflexing to a multigene panel for patients with non-small cell lung cancer: prevalence and perceived barriers to comprehensive, pathologist-ordered biomarker reflex testing.","authors":"Lynnette Savaloja Pineault, Nikki Martin, Melissa A Kelly, Robyn L Temple-Smolkin, Alexandra S Brown","doi":"10.1093/ajcp/aqag077","DOIUrl":"10.1093/ajcp/aqag077","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the use of standardized protocols for reflexing to broad, multigene panels in non-small cell lung cancer (NSCLC) and identify barriers that limit timely pathologist‑ordered biomarker reflex testing.</p><p><strong>Methods: </strong>A cross-sectional survey was administered to a national sample of health care professionals involved in NSCLC biomarker testing.</p><p><strong>Results: </strong>Of 111 respondents in the dataset, 77.5% reported using an institutional standardized protocol for comprehensive biomarker testing (CBT), and 88.4% of these protocols included reflexing to a multigene panel. Most respondents with reflex protocols indicated that 80% or more of newly diagnosed patients with NSCLC received CBT; however, fewer respondents reported that results were available before the oncology visit to select first‑line treatment. Pathologists were the primary ordering providers in institutions with standardized protocols. Respondents agreed that pathologist‑ordered reflex biomarker testing improves cancer care and supported Centers for Medicare & Medicaid Services (CMS) recognition of pathologists as ordering physicians for broad biomarker panels. Despite protocol adoption, respondents cited persistent barriers-including reimbursement, insurance authorization delays, and the Medicare 14-day rule.</p><p><strong>Conclusions: </strong>Locally standardized protocols incorporating reflex multigene panel testing have been reported and are associated with high rates of CBT. Institutional and operational barriers delay the availability of results and limit the impact of these protocols on first‑line treatment decisions. Clarifying CMS guidance on pathologists as valid ordering physicians for broad biomarker panels, strengthening coordination with multidisciplinary teams, addressing workflow constraints, and educating the laboratories and payers on pathologists having ordering authority may enhance the effectiveness and adoption of reflex biomarker testing models.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Additive diagnostic value of liquid‑based preparation and conventional smears in Bethesda I thyroid nodules.","authors":"Tzahi Neuman, Nir Zontag, Daniel Khademi, Karine Atlan, Nir Hirshoren","doi":"10.1093/ajcp/aqag046","DOIUrl":"10.1093/ajcp/aqag046","url":null,"abstract":"<p><strong>Objectives: </strong>Fine-needle aspiration (FNA) is crucial for evaluating thyroid nodules, traditionally using conventional smears (CSs). Recently, liquid-based preparations (LBPs) have gained popularity. This study compared CS and LBP accuracy, combined and separately, in reducing nondiagnostic (Bethesda I) results and identified predictors associated with Bethesda I for both methods combined and separately.</p><p><strong>Methods: </strong>A prospective comparison of thyroid FNA results in early 2024, using LBP alone vs LBP combined with CSs, was conducted. Retrospective data were collected from 2087 patients who underwent cytologic evaluation between 2020 and 2023, using CS alone and LBP combined with CSs. The study compared nondiagnostic results between the methods and adjusted for significant predictors.</p><p><strong>Results: </strong>In a prospective analysis of 218 LBP samples, combining CSs improved diagnosis in 15 cases (7%), allowing diagnosis in 12 and upgrading the result in 3 cases compared with LBP alone. In the retrospective analysis (CS, 1126 samples; LBP and CS, 961 samples), nondiagnostic results occurred in 14.2% and 18.2% of the cases, respectively (P = .793). Higher nondiagnostic results were significantly associated with older age, comorbidities, and pure cysts (P = .001) for both methods. For CS only, significant associations were found with abnormal thyroid-stimulating hormone (TSH) levels (P = .050), macrocalcifications (P = .045), and heterogeneous cysts (P = .038).</p><p><strong>Conclusions: </strong>We did not demonstrate an additive effect for the LBP method. However, it may still be preferable in nodules with abnormal TSH levels, heterogeneous cystic features, or macrocalcifications. The prospective findings indicate a clinical advantage for CS analysis. Accordingly, we recommend performing aspiration for both techniques, using CS only if a nondiagnostic result is obtained for LBP.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning-based detection of acid-fast bacilli in microscopy images: a systematic review.","authors":"Kanika Rastogi, Lavleen Singh, Aparajita Khan, Partha Pratim Roy, Venkateswaran K Iyer","doi":"10.1093/ajcp/aqag083","DOIUrl":"10.1093/ajcp/aqag083","url":null,"abstract":"<p><strong>Objectives: </strong>Acid-fast bacillus (AFB) detection by microscopy remains a cornerstone of laboratory diagnosis for mycobacterial infections, despite the limitations of variable sensitivity, labor-intensive workflows, and interobserver variability. Recent advances in artificial intelligence, particularly deep learning, offer promising solutions to automate and augment AFB detection on microscopy images.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with protocol registration in PROSPERO (registration No. CRD42025633886). PubMed and Embase were searched for studies published in the past decade that applied deep learning-based methods to microscopy-based AFB detection. Eligible studies included original research and review articles using Ziehl-Neelsen-stained or auramine-stained specimens and reporting quantitative diagnostic performance metrics. Data on model architectures, annotation strategies, evaluation metrics, and accuracy were extracted. A forest plot was constructed to summarize pooled accuracy estimates across eligible studies.</p><p><strong>Results: </strong>Forty-nine studies met the inclusion criteria. Deep learning models, including convolutional neural networks, object detectors, and transformer-based architectures, demonstrated high accuracies (80%-98%), despite substantial heterogeneity. Weakly supervised learning, multiview and z-stack imaging, and domain adaptation techniques are being used to address variability in staining, focus, and laboratory conditions. Object detection and segmentation models have enabled improved bacillus localization and quantification, while foundation models and transfer learning approaches are reducing annotation burden and improving generalizability.</p><p><strong>Conclusions: </strong>Deep learning-based AFB detection systems demonstrate high accuracy and strong potential to enhance tuberculosis microscopy. Heterogeneity in study design and limited external validation, however, highlight the need for standardized evaluation and multicenter clinical studies before widespread implementation.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The essentials-measurable residual disease in hematopoietic neoplasms: current testing landscape and future directions.","authors":"Savanah D Gisriel, Alexa Siddon","doi":"10.1093/ajcp/aqag079","DOIUrl":"10.1093/ajcp/aqag079","url":null,"abstract":"<p><strong>Objectives: </strong>Measurable residual disease (MRD) analysis, also known as minimal residual disease analysis, has become an essential component of routine clinical management in many hematopoietic neoplasms. Measurable residual disease status in the absence of morphologic disease holds prognostic value and can acutely affect treatment decisions.</p><p><strong>Methods: </strong>Measurable residual disease monitoring is described in acute leukemia, multiple myeloma, and chronic lymphocytic leukemia. We discuss the approach to MRD assessment of these hematologic neoplasms using flow cytometry and molecular techniques.</p><p><strong>Results: </strong>The appropriate use of available ancillary techniques is crucial to assess patients for MRD. Interpreting these results in the appropriate clinical context is challenging and often requires expertise. Incorporating the results into disease management is critical for improved outcomes.</p><p><strong>Conclusions: </strong>Consensus guidelines on MRD assessment in hematopoietic neoplasms continue to evolve. Further, emerging technologies and laboratory availability are important practical considerations for pathologists who are implementing MRD analysis. From this review, pathologists can gain an anecdotal perspective on the application and interpretation of advanced studies to assess the MRD status of patients with hematopoietic malignancies.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communication patterns among surgical pathologists: a retrospective review of ideal strategies in a tertiary care setting.","authors":"Busra N Delikkaya, Jaime Eberle-Singh, Joanna Chan, Allison Goldberg","doi":"10.1093/ajcp/aqag075","DOIUrl":"10.1093/ajcp/aqag075","url":null,"abstract":"<p><strong>Objectives: </strong>Timely communication of significant surgical pathology results is essential for patient safety, yet quantitative data on how pathologists select result recipients, especially in urgent settings, are limited. We examined real-world communication patterns, focusing on STAT vs routine orders.</p><p><strong>Methods: </strong>We retrospectively reviewed pathologist-initiated notifications of significant surgical pathology results at a tertiary academic medical center (January to July 2024). In 324 events, we recorded recipient/provider characteristics, care team involvement, urgency status, procedural setting, and turnaround time (TAT). Events were compared by ordering provider (OP) vs alternate provider (AP) contact and by STAT vs routine designation using χ2 tests.</p><p><strong>Results: </strong>Most notifications were sent to OPs (67%), with 33% sent to APs. Alternate provider contact was more frequent for STAT cases, biopsies, and shorter TATs (all P < .05). Contacted OPs were more often subspecialty trained (P < .001) and on the care team (P = .001). Ordering providers were more likely to be contacted directly when they were attending physicians and subspecialty trained; radiology was the predominant AP specialty (62%), while obstetrics and gynecology and gastroenterology were most common among OPs. STAT cases showed faster TATs, outpatient settings, and more frequent notification of nonordering but subspecialty-trained clinicians (all P < .05). Recipient role did not differ by urgency.</p><p><strong>Conclusions: </strong>Pathologists adjust communication based on urgency, prioritizing rapid notification to qualified clinicians when needed. Flexible recipient selection may support timely clinical action and inform institutional communication policies.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}