American journal of clinical pathology最新文献

{"title":"Reframing pathologic staging in renal cell carcinoma after immunotherapy.","authors":"Katrina Collins, Steven Christopher Smith","doi":"10.1093/ajcp/aqag054","DOIUrl":"https://doi.org/10.1093/ajcp/aqag054","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148196841","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":"Musculoskeletal pain in medical laboratory personnel: a cross-sectional study.","authors":"Letycia C Nuñez Argote, Jarron M Saint Onge, Elizabeth Ablah, Jessica A Williams","doi":"10.1093/ajcp/aqag063","DOIUrl":"10.1093/ajcp/aqag063","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the prevalence of musculoskeletal pain among the laboratory workforce in the United States.</p><p><strong>Methods: </strong>An electronic survey was used to gather data from laboratory workers between October 2021 and February 2022. The instrument included the Standardized Nordic Musculoskeletal Questionnaire, as well as personal and work-related questions. A summary of descriptive statistics and a multivariable analysis using self-reported musculoskeletal pain in the past 7 days were performed.</p><p><strong>Results: </strong>Of 518 medical laboratory professionals in the study, 94% reported musculoskeletal pain in at least 1 body site in the past 12 months, with many experiencing pain in the past 7 days. The sites where musculoskeletal pain was most often reported in the past week included lower back (39%), neck (38%), and shoulders (34%). Sex, race and ethnicity, time in the profession, job title, and organization type were associated with recent musculoskeletal pain.</p><p><strong>Conclusions: </strong>A high prevalence of musculoskeletal pain was documented among medical laboratory personnel. Characterizing musculoskeletal pain in this population can help researchers understand the physiologic impacts of long-term exposure to laboratory work, as well as implement and evaluate prevention and risk reduction measures.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293044","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":"Configuring large language models to deliver patient-facing explanations of pathology reports.","authors":"Will D Jeong, Sherman X J Lin, Morgan Black, Kyla Trinh, Haechan J Yang, Alexandra Brown, Matthew J Cecchini, Jason K Wasserman","doi":"10.1093/ajcp/aqag076","DOIUrl":"10.1093/ajcp/aqag076","url":null,"abstract":"<p><strong>Objectives: </strong>Timely access to pathology reports has increased the need for clear patient-facing explanations. We evaluated whether large language model (LLM)-generated responses to pathology report questions from patients are comparable in quality to explanations written by pathologists and assessed how LLM configuration influences performance.</p><p><strong>Methods: </strong>Sixty-five anonymized real-world patient questions from an online pathology education platform were answered using 5 LLM configurations varying by model architecture, prompting strategy, and retrieval-augmented generation. Responses were evaluated using a structured rubric that assessed accuracy, relevance, clarity, empathy, and safety; they were compared using pairwise arena testing with Bradley-Terry modeling to rank performance.</p><p><strong>Results: </strong>Across rubric domains, LLM responses demonstrated performance comparable to pathologist explanations, with 1 configuration meeting noninferiority criteria. Pairwise arena comparisons indicated that the configuration parameters strongly influenced performance, with both model size and retrieval augmentation associated with improved response preference. The highest-performing configuration combined a larger model with retrieval from a curated pathology knowledge base and was strongly preferred over pathologist-written responses.</p><p><strong>Conclusions: </strong>Carefully configured LLM systems can generate patient-facing explanations of pathology reports comparable in quality to pathologist-written explanations. Prompting strategy, model size, and retrieval integration were associated with performance differences, underscoring the importance of system configuration in developing LLM-based tools to expand access to understandable pathology information.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282992","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":"Exploring fibronodular hepatocellular carcinoma: a case series investigating histopathologic and clinical characteristics and its potential association with cirrhosis.","authors":"Fatme Ghandour, Bassel Zein-Sabatto, Joao Lobo, Chirag Patel, Deepti Dhall, Upender Manne, Sameer Al Diffalha","doi":"10.1093/ajcp/aqag066","DOIUrl":"10.1093/ajcp/aqag066","url":null,"abstract":"<p><strong>Objectives: </strong>Fibronodular hepatocellular carcinoma (FN-HCC) is a newly described variant of hepatocellular carcinoma (HCC), with only 29 cases reported. Histologically, it is divided into multiple smaller, well-defined tumor nodules by extensive fibrosis. Its differential diagnosis includes other HCC variants characterized by fibrous stroma, such as fibrolamellar hepatocellular carcinoma and scirrhous hepatocellular carcinoma. Fibronodular hyperplasia may also be considered in the differential diagnosis. We are reporting 7 cases to help better understand this entity.</p><p><strong>Methods: </strong>We retrospectively identified 7 cases of FN-HCC and analyzed the clinical and histologic features of each tumor, as well as disease progression and patient prognosis.</p><p><strong>Results: </strong>The FN-HCC cases were diagnosed at a median age of 58 years (range, 40-75 years), with a male predilection (n = 6, 86%). Most patients were White (n = 6, 86%), and 1 was African American (n = 1, 14%). Tumors had a mean size of 3.15 cm (range, 1-9 cm) and were mainly located in the right lobe (n = 5, 71%). Background liver was cirrhotic in 6 cases (86%). Five patients were hepatitis C positive (71%). All tumors were surgically removed, with a free resection margin. Among 3 patients with evident vascular invasion, 1 had a positive lymph node. This patient had tumor metastasis 6 years later; otherwise, all patients were disease free on follow-up.</p><p><strong>Conclusions: </strong>Our cohort was concordant with published data showing a male predilection, hepatitis C association, and good prognosis when the disease is discovered before metastasis and is surgically excised with negative margins. However, it contradicts the published literature that associates FN-HCC with the absence of advanced fibrosis/cirrhosis.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148269982","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":"Invasive urothelial carcinoma in association with surface low-grade papillary urothelial carcinoma: clinical and pathologic insights from a rare entity.","authors":"Somnath Mahapatra, Robert M Humble, Fernanda Cordeiro-Rudnisky, Khaled S Hafez, Ulka N Vaishampayan, Arul M Chinnaiyan, Akriti Gupta, Laxmi P Kunju, Aaron M Udager, Simpa S Salami, Todd M Morgan, Samuel D Kaffenberger, Jeffrey S Montgomery, Udit Singhal, Rohit Mehra","doi":"10.1093/ajcp/aqag072","DOIUrl":"10.1093/ajcp/aqag072","url":null,"abstract":"<p><strong>Objectives: </strong>Surface low-grade papillary urothelial carcinoma with an invasive phenotype represents an understudied entity with its clinical behavior, therapeutic responses, and long-term outcomes remaining poorly defined.</p><p><strong>Methods: </strong>We evaluated 17 patients from a single institution with histologically confirmed surface low-grade papillary urothelial carcinoma with an invasive phenotype, followed by longitudinal clinicopathologic analysis to delineate disease trajectories and treatment outcomes.</p><p><strong>Results: </strong>Surface components of all tumors in this cohort demonstrated a low-grade papillary urothelial carcinoma phenotype. At the initial presentation, 53% of patients had invasive disease, while 47% were diagnosed with noninvasive disease. During follow-up, 37% of those with noninvasive disease appeared to progress to invasive disease within 1 year. At the point when invasive disease was diagnosed, pT1 disease was observed in 77% cases, and pT2-4 was observed in 23%. During subsequent follow-up, 77% of patients experienced recurrences, with 41% requiring therapeutic escalation to intravesical Bacillus Calmette-Guérin or systemic chemotherapy for disease progression. High-grade recurrence was identified in 23% patients. Distant metastases developed in 18% of patients, preferentially involving the lungs and bone. The median survival of the cohort was 66 months, and 1 patient died of disease.</p><p><strong>Conclusions: </strong>These findings underscore the variable and unpredictable course of this disease phenotype, emphasizing its potential for aggressive evolution despite surface low-grade tumor histology. Vigilant surveillance and early consideration of definitive treatment may be a prudent strategy to mitigate progression risks in this rare subset of patients.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350313","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 CARE framework for AI dataset documentation in clinical laboratories: a comprehensive checklist and data lineage methodology.","authors":"Christopher A Garcia, Katelyn A Reed, Eric Lantz, Patrick Day, Brian C Stadler, Mark D Zarella, Steven N Hart, Wenchao Han, Thomas E Tavolara, Ezzaddin Al Wahsh, Debra A Novak, David S McClintock","doi":"10.1093/ajcp/aqag029","DOIUrl":"10.1093/ajcp/aqag029","url":null,"abstract":"<p><strong>Objectives: </strong>Traditional laboratory regulatory frameworks provide robust guidance for conventional clinical testing but lack requirements for data documentation for artificial intelligence and machine learning (AI/ML) solutions. This gap creates significant risks since AI solutions directly inherit patterns, biases, and limitations from their training data. Here, we describe the development and implementation of a comprehensive data documentation checklist with accompanying data lineage for use within an AI lifecycle framework for clinical laboratories.</p><p><strong>Methods: </strong>Building on the previously established Clinical AI Readiness Evaluator (CARE) framework, we developed a comprehensive data checklist and data lineage methodology through a multiphase process, including (1) comprehensive review of existing AI/ML data documentation frameworks, (2) focused meetings with 3 institutional AI operations teams, and (3) 3 rounds of iterative refinement by our multidisciplinary team. The checklist's effectiveness was then assessed using 3 diverse AI/ML projects moving through the CARE framework.</p><p><strong>Results: </strong>The CARE Data Checklist and Data Lineage provide a structured approach to documenting critical aspects of datasets used in AI/ML projects, including data composition, demographics, collection methods, labeling processes, usage constraints, maintenance requirements, and a data readiness assessment. The checklist addresses unique data-centric challenges of AI/ML applications, facilitating transparency, reproducibility, and regulatory compliance.</p><p><strong>Conclusions: </strong>The CARE Data Checklist and Data Lineage serve as both a technical guide and a communication tool bridging gaps between technical and clinical stakeholders. By working on these documents early in the AI lifecycle, laboratories can anticipate and address data-related challenges, ultimately saving time, optimizing resources, and improving the reliability of AI-augmented laboratory solutions.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 5","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147873044","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":"Correction to: Elucidating the grading intricacies of idiopathic multicentric Castleman disease histopathology: a pathologist's perspective.","authors":"","doi":"10.1093/ajcp/aqag064","DOIUrl":"10.1093/ajcp/aqag064","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13206018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148025641","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":"Hilar fat invasion is a poorly defined and inconsistently interpreted lung carcinoma staging parameter.","authors":"Kelly J Butnor, Alayna M Westcom","doi":"10.1093/ajcp/aqag044","DOIUrl":"10.1093/ajcp/aqag044","url":null,"abstract":"<p><strong>Objectives: </strong>Hilar fat invasion raises the T category of otherwise pT1 lung carcinomas to pT2a. Pathologists were surveyed to better understand their awareness and interpretation of hilar fat invasion.</p><p><strong>Methods: </strong>Pathologists interested in pulmonary pathology were invited to participate in an online survey of hilar fat invasion assessment.</p><p><strong>Results: </strong>Of 80 respondents, 58% considered hilar fat any fat that is outside the lung but inside the pleural reflection, 32% considered it to be fat inside the pleural reflection near hilar lymph nodes around the main bronchus, and 10% were uncertain or had a different definition. When asked which pT designation is most appropriate for a lobectomy specimen with a pT1-sized invasive carcinoma that directly invades the fat around the lobar bronchus but does not involve the lobar bronchus margin, 69% indicated pT1c, 23% chose pT2a, and 8% were unsure/other. For a pneumonectomy specimen with a pT1-sized invasive carcinoma that directly invades the fat around both the lobar and main bronchus but does not extend beyond the pleural reflection or involve the main bronchus margin, 48% assigned pT2a, 39% chose pT1c, and 13% were unsure/other.</p><p><strong>Conclusions: </strong>There is a lack of consensus among pathologists as to what constitutes hilar fat invasion, resulting in considerable interobserver variability in pT categorization. Making hilar fat invasion a standard pT designation could improve awareness, and defining the anatomic boundaries of hilar fat could result in greater consistency in assigning a pT category to tumors that extend into fat outside the lung.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 5","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004320","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":"Acute leukemias with expression of CD56.","authors":"Alexa J Siddon, Christine Kahlow, Olga K Weinberg","doi":"10.1093/ajcp/aqag021","DOIUrl":"10.1093/ajcp/aqag021","url":null,"abstract":"<p><strong>Objectives: </strong>Recent revisions to acute leukemia classification systems increasingly emphasize genetic drivers of disease; however, critical immunophenotypic features remain essential for accurate diagnosis and risk assessment. CD56, an isoform of the neural cell adhesion molecule, is expressed on natural killer (NK) cells but is aberrantly present across multiple acute leukemias, where it may contribute to diagnostic complexity and adverse clinical outcomes. This review highlights the diagnostic and clinical significance of CD56 expression in acute leukemias.</p><p><strong>Methods: </strong>We review current classification frameworks and relevant literature to examine the role of CD56 immunophenotyping in the evaluation and clinical significance of acute leukemias.</p><p><strong>Results: </strong>CD56 expression is observed in a heterogeneous group of acute leukemias, including subsets of acute myeloid leukemia (AML), NK lymphoblastic leukemia, acute undifferentiated leukemia, and blastic plasmacytoid dendritic cell neoplasm (BPDCN). In AML, CD56 expression has been associated with extramedullary disease, treatment resistance, and inferior survival in several studies, including high-risk subgroups such as AML with the RAM immunophenotype. In NK lymphoblastic leukemia and BPDCN, CD56 represents a key but nonspecific marker that must be interpreted in conjunction with additional lineage-associated antigens and molecular features to avoid diagnostic misclassification. Acute undifferentiated leukemia frequently demonstrates CD56 expression in the absence of definitive lineage markers, further emphasizing the need for integrated diagnostic approaches.</p><p><strong>Conclusions: </strong>Acute leukemias with CD56 expression represent a diagnostically challenging and biologically diverse group of neoplasms. While CD56 lacks lineage specificity, its detection by flow cytometry provides valuable information for differential diagnosis, risk stratification, and, in some settings, minimal residual disease assessment. Accurate classification requires careful integration of immunophenotypic, morphologic, and genetic data. As therapeutic strategies become increasingly risk-adapted and targeted, precise recognition of CD56-positive blastoid neoplasms is essential to optimize patient management and outcomes.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 5","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969652","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":"Salivary and serum microRNAs as noninvasive biomarkers for distinguishing prostate cancer from benign prostatic hyperplasia.","authors":"Mehdi Salehi, Mona Alaee, Maryam Mousavi, Ghodratollah Panahi, Davood Goodarzi, Jamal Amri","doi":"10.1093/ajcp/aqag028","DOIUrl":"10.1093/ajcp/aqag028","url":null,"abstract":"<p><strong>Objectives: </strong>Accurate differentiation of prostate cancer (PCa) from benign prostatic hyperplasia (BPH) is challenging due to prostate-specific antigen's (PSA's) limited specificity. Circulating and salivary microRNAs (miRNAs) have emerged as promising noninvasive biomarkers. This study aimed to evaluate the diagnostic potential of selected miRNAs in serum and saliva, individually and combined with PSA, for distinguishing PCa from BPH.</p><p><strong>Methods: </strong>In this case-control study, 100 male participants (50 with PCa, 50 with BPH) provided paired serum and saliva samples. Ten candidate miRNAs (miR-182, miR-96, miR-18a, miR-193a-5p, miR-744, miR-573, miR-210, miR-323, miR-101, miR-203) were quantified by real-time quantitative polymerase chain reaction, and PSA levels were measured by enzyme-linked immunosorbent assay. Diagnostic accuracy was assessed via receiver operating characteristic analysis, and correlations between serum and salivary markers were evaluated.</p><p><strong>Results: </strong>Compared with the BPH group, 8 miRNAs (miR-182, miR-96, miR-18a, miR-193a-5p, miR-744, miR-573, miR-210, miR-323) were significantly upregulated in PCa, whereas miR-101 and miR-203 were downregulated. Salivary miRNA levels strongly mirrored serum profiles (r = 0.70-0.91, P < .001). The ROC analysis identified miR-182 and miR-96 as the most discriminatory markers (area under the curve [AUC] > 0.82). Combining PSA with these miRNAs improved diagnostic accuracy (serum PSA + miR-182/96: AUC 0.92/0.90, 91%/89% sensitivity, 88.6%/86.2% specificity; saliva: AUC 0.88/0.86, 88%/86% sensitivity, 84%/82% specificity).</p><p><strong>Conclusions: </strong>Selected miRNAs, particularly miR-182 and miR-96, reliably differentiate PCa from BPH in both serum and saliva. Integration with PSA further enhances diagnostic performance, and salivary profiling represents a practical, noninvasive approach for early molecular screening.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 5","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925525","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}