Archives of pathology & laboratory medicine最新文献

{"title":"Accuracy of Cytology Diagnosis for Well Differentiated Neuroendocrine Tumors: Assessment by the College of American Pathologists Non-Gynecologic Slide Program.","authors":"Suzanne Crumley, Rhona Souers, Michael Henry, Tatjana Antic, Anupama Sharma, Stuart Cameron, Chris VandenBussche, Sana Tabbara","doi":"10.5858/arpa.2025-0638-CP","DOIUrl":"https://doi.org/10.5858/arpa.2025-0638-CP","url":null,"abstract":"<p><strong>Context.—: </strong>The diagnosis and characterization of well-differentiated neuroendocrine tumors (WDNETs) on cytology is challenging, with recognized pitfalls that may have therapeutic and prognostic implications.</p><p><strong>Objective.—: </strong>To analyze data curated by the College of American Pathologists educational slide program for accuracy in the cytologic diagnosis of WDNET. The current state of cytologic diagnosis of WDNET is also reviewed for educational purposes.</p><p><strong>Design.—: </strong>The study cohort included non-gynecologic cytology slides reviewed by participants in the College of American Pathologists Non-Gynecologic Cytopathology Education program. Individual responses for cytotechnologists or cytologists (CT) and pathologists were collated for WDNET. The data were analyzed for concordance with the correct general diagnosis and concordance with the correct reference diagnosis. The exact reference diagnosis available for each site was \"pancreatic neuroendocrine tumor,\" \"liver, well/moderately differentiated neuroendocrine tumor,\" and \"lung, well/moderately differentiated neuroendocrine tumor.\" Performance measures were assessed.</p><p><strong>Results.—: </strong>The WDNET analysis includes 8941 responses from 1382 laboratories. The selection of the general diagnosis of \"malignant\" or \"suspicious for malignancy\" was greater than 90% in all body sites. Pathologists correctly identifying WDNET was highest in the pancreas (2501/2738, 91.3%) compared with the lung (805/1019, 79.0%) and liver (1444/1966, 73.4%). Pathologists had better concordance with the diagnosis of WDNET in all sites than CTs (P < .001).</p><p><strong>Conclusions.—: </strong>This large study, encompassing pathologists and CTs, confirms that although participants can identify WDNET on cytology, opportunities for greater accuracy and education persist. The most common incorrect response in the pancreas was adenocarcinoma, while the most common misdiagnosis was small cell carcinoma in the lung and liver.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal Club and Artificial Intelligence.","authors":"Shigeki Matsubara","doi":"10.5858/arpa.2026-0080-LE","DOIUrl":"https://doi.org/10.5858/arpa.2026-0080-LE","url":null,"abstract":"","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 7","pages":"499"},"PeriodicalIF":3.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply.","authors":"David F Keren","doi":"10.5858/arpa.2026-0124-LE","DOIUrl":"https://doi.org/10.5858/arpa.2026-0124-LE","url":null,"abstract":"","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 7","pages":"501-502"},"PeriodicalIF":3.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply.","authors":"Henry D Tazelaar, Marie-Christine Aubry, Anja C Roden, Carolyn Mead-Harvey, Matthew J Cecchini, Donald Guinee, Jeffrey L Myers","doi":"10.5858/arpa.2026-0139-LE","DOIUrl":"https://doi.org/10.5858/arpa.2026-0139-LE","url":null,"abstract":"","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 7","pages":"499-500"},"PeriodicalIF":3.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Immunofixation Electrophoresis Guidance Conflict: A Call to Harmonize.","authors":"Jinous Saremian, Matthew Feldhammer, Scott W Smith","doi":"10.5858/arpa.2025-0350-LE","DOIUrl":"https://doi.org/10.5858/arpa.2025-0350-LE","url":null,"abstract":"","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 7","pages":"500-501"},"PeriodicalIF":3.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using R Statistical Programming to Evaluate the Impact of the Lower Anogenital Squamous Terminology Recommendations on Cervical Biopsy Reporting at a Tertiary Care Academic Center.","authors":"Chelsea R Mehr, Amrom E Obstfeld","doi":"10.5858/arpa.2025-0231-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0231-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Pathology reports contain a tremendous amount of data but harnessing these data for secondary use in research, operational, or quality work can be challenging. Modern software approaches present an opportunity to extract and distill important information from anatomic pathology reports.</p><p><strong>Objective.—: </strong>To evaluate cervical biopsy surgical pathology reports before and after the publication of the Lower Anogenital Squamous Terminology (LAST) criteria, using R programming software.</p><p><strong>Design.—: </strong>We obtained cervical biopsy report data from 2006 to 2017. After validating the R methodology, we used the program to analyze findings in diagnostic terminology and immunohistochemical use relevant to consensus recommendations before and after publication of the LAST criteria.</p><p><strong>Results.—: </strong>More than 36 000 cervical biopsy diagnoses were analyzed during an 11-year period. An 86% drop in the use of human papillomavirus terms and an 8-fold increase in the use of p16 staining were seen. After the publication of the LAST criteria, there was a 6% decline in the rate of low-grade diagnoses and a 5.4% increase in non-cervical intraepithelial neoplasia (CIN) diagnoses (P < .001 for both) with no significant change in high-grade diagnoses. The fraction of high-grade diagnoses did not increase with p16 use.</p><p><strong>Conclusions.—: </strong>Using R programing software, we were able to demonstrate changes and trends in cervical biopsy reporting before and after the publication of the LAST criteria. R programing software represents an innovative technique for conducting operational and quality assessments in surgical pathology.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Human Epidermal Growth Factor Receptor 2 (HER2) Assessment by Organ Systems: A Guidebook to HER2 Testing in Solid Tumors.","authors":"Gulisa Turashvili, Kimberly H Allison, Brett Baskovich, Georgios Deftereos, Julie C Fanburg-Smith, Keren Hulkower, Uma Krishnamurti, Dylan Miller, Madhurya Ramineni, Marilin Rosa, Raja R Seethala, Kaitlin E Sundling, Shi Wei, Lara Harik","doi":"10.5858/arpa.2025-0593-CP","DOIUrl":"https://doi.org/10.5858/arpa.2025-0593-CP","url":null,"abstract":"<p><strong>Context.—: </strong>Human epidermal growth factor receptor 2 (HER2) may show protein overexpression and/or gene amplification in a subset of carcinomas at various sites. Recent developments in HER2-directed therapies have increased the need to optimize HER2 testing, assessment, and reporting of HER2 status. Seven of 11 active biomarker reporting templates developed by the College of American Pathologists include elements for capturing HER2 status, which has presented challenges to accommodate different scoring systems and allow clear, concise reporting.</p><p><strong>Objective.—: </strong>To evaluate the current evidence for HER2 testing, interpretation, and reporting in different tumor types, and to create a guidebook for navigating HER2 assessment by organ systems to improve the accuracy of HER2 testing and its utility as a predictive marker in carcinomas of various primary sites.</p><p><strong>Design.—: </strong>The Biomarker Project Team, composed of members of the College of American Pathologists serving on different committees (Cancer, Pathology Electronic Reporting, Immunohistochemistry, Center Guideline, Molecular Oncology), set out to create a guideline for HER2 testing, assessment, and reporting.</p><p><strong>Results.—: </strong>The Biomarker Project Team identified indications for HER2 testing, scoring criteria, and optimal reporting in carcinomas of different organ systems to improve the accuracy of HER2 (ERBB2) testing by immunohistochemistry and in situ hybridization.</p><p><strong>Conclusions.—: </strong>This guidebook reviews the current guidelines for HER2 testing and reporting in carcinomas of different organ systems. In addition, it discusses the challenges of designing a unified biomarker reporting format to cover alternative scoring systems.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune-Mediated Necrotizing Myopathy: Evolving Insights, Current Understanding, and Future Directions for Myopathologic Diagnosis.","authors":"Chia-Ming Lee, Sean P Ferris","doi":"10.5858/arpa.2025-0292-RA","DOIUrl":"10.5858/arpa.2025-0292-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Immune-mediated necrotizing myopathy (IMNM) is a relatively recently recognized subset of idiopathic inflammatory myopathies (IIMs). Understanding the historical context, current classification, typical pathologic features, and current diagnostic challenges for IMNM is essential for the diagnostic pathologist as the entity continues to evolve.</p><p><strong>Objective.—: </strong>To review pertinent literature on IMNM, emphasize its historical background and the current understanding, elucidate key characteristics in its myopathologic diagnosis, and guide future research efforts.</p><p><strong>Data sources.—: </strong>Pertinent literature from a PubMed query on IIMs and IMNM from 1863 to 2025 is reviewed.</p><p><strong>Conclusions.—: </strong>Recognition of IMNM as a distinct IIM subtype has advanced through the serologic discovery of myositis-specific antibodies and the 2016 European Neuromuscular Centre consensus on IMNM. Nevertheless, challenges persist, particularly in the accurate characterization of seronegative IMNM, limitations in the current clinical criteria for IIMs, and conflicting data on potentially useful markers like p62 immunohistochemistry. A multifaceted approach integrating clinical, serologic, and pathologic data is essential in the continued research to refine the myopathologic diagnosis of IMNM.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CanAssist Breast Risk Stratification in Multifocal/Multicentric Breast Cancer: To Test Each Focus or Not?","authors":"Badada Ananthamurthy Savitha, Tejal Deepak Durgekar, Payal Shrivastava, Deepti K Shivashimpi, Rahul Bhagat, Naveen Krishnamoorthy, Amit Verma, Manjiri M Bakre","doi":"10.5858/arpa.2025-0471-OA","DOIUrl":"10.5858/arpa.2025-0471-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Unlike unifocal early breast cancer, there is a lack of guidelines on prognostic testing in multifocal/multicentric breast cancer (MF/MC BC), which is pivotal in current clinical practice for adjuvant treatment planning. CanAssist Breast (CAB) is a proteomic, artificial intelligence-based prognostic test for evaluating the risk of distant recurrence within 5 years of diagnosis in patients with hormone receptor-positive (HR+), HER2-negative (HER2-) early breast cancer.</p><p><strong>Objective.—: </strong>To study CAB-based recurrence risk stratification of multiple tumor foci in MF/MC BC and evaluate its usefulness in adjuvant chemotherapy recommendations.</p><p><strong>Design.—: </strong>Retrospective data from 6126 patients with HR+/HER2- early breast cancer who underwent CAB testing between January 2022 and May 2025 were reviewed. Of these, 107 patients with MF/MC BC, on whom the CAB test was performed on more than 1 tumor focus, were further studied, and concordance/discordance in CAB risk categories among multiple foci was evaluated.</p><p><strong>Results.—: </strong>In the MF/MC BC, CAB risk assessment of multiple foci revealed discordance in 18 of 107 patients (17%), demonstrating notable intertumoral heterogeneity. Analysis of a stepwise protocol shows that, among 75 patients, 8 (11%) had a clinically high-risk tumor with CAB-low risk, while the clinically low-risk tumor resulted in CAB-high risk, underscoring the complexity of prognostication in MF/MC BC.</p><p><strong>Conclusions.—: </strong>We recommend a tiered approach of CAB testing in patients with MF/MC BC, whereby, if the first tumor shows CAB-low risk, testing of additional tumor foci is recommended. This approach improves risk stratification and enables tailored adjuvant treatment planning, while minimizing the risk of undertreatment.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracholecystic Tubular Nonmucinous Neoplasm of the Gallbladder.","authors":"Burcin Pehlivanoglu","doi":"10.5858/arpa.2025-0522-RA","DOIUrl":"10.5858/arpa.2025-0522-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Intracholecystic neoplasms (ICNs) of gallbladder are a challenging and relatively poorly understood family of tumors. Recently, a distinct category of ICNs, characterized by pedunculated polyps composed of lobules of back-to-back small tubular/acinar units lined by minimally mucinous or nonmucinous cells, has been found to be biologically, behaviorally, and molecularly different from other ICNs, and termed intracholecystic tubular nonmucinous neoplasm (ICTN).</p><p><strong>Objective.—: </strong>To review the clinicopathologic characteristics of ICTN of the gallbladder.</p><p><strong>Data sources.—: </strong>This review is based on the literature and the author's own research.</p><p><strong>Conclusions.—: </strong>ICTNs, initially recognized by their distinctive morphology and growth pattern, have distinct clinicopathologic characteristics. They are unlikely to be diffuse and multifocal like ordinary intracholecystic papillary neoplasms (ICPNs), and they do not appear to confer the field risk that ICPNs do. Instead, they form solitary pedunculated polyps (and often appear as detached debris in the lumen) and occur in the background of uninvolved gallbladder. In fact, they appear to be arising in cholesterol polyps. By morphology and MUC6 expression they resemble pancreatic/biliary intraductal tubulopapillary neoplasms, and they have been also called \"complex nonmucinous pyloric gland adenomas\" in the past. Although their complexity warrants the diagnosis of high-grade dysplasia/carcinoma in situ (and they have been typically diagnosed as \"tubular adenocarcinoma\" in Asia and South America), ICTNs are invasion resistant, with no documented invasive carcinoma developing within this lesion to date. The presence of morules, which display nuclear β-catenin expression, places this lesion in the so-called BROCN family of tumors, which are believed to be hormonally driven. Further molecular studies are needed to explore the roots of their behavior.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}