Archives of pathology & laboratory medicine最新文献

{"title":"Navigating Holistic Assessment in Pathology Residency Selection: A Single-Institution Evaluation of Domain Performance.","authors":"Abdol Aziz Ould Ismail, Weijie Ma, Candice Black","doi":"10.5858/arpa.2025-0543-EP","DOIUrl":"https://doi.org/10.5858/arpa.2025-0543-EP","url":null,"abstract":"<p><strong>Context.—: </strong>The shift from standardized metrics to holistic review in residency selection aims to capture a broader range of competencies essential for pathology practice. However, validation of such frameworks remains limited within specialty-specific contexts.</p><p><strong>Objective.—: </strong>To evaluate the measurement properties and structural integrity of a holistic assessment system used for pathology residency applicants.</p><p><strong>Design.—: </strong>Our program implemented holistic evaluation forms assessing 10 competency domains: General Interview, Communication Skills, Scholarly Activities, Recommendation Letters, Rigor of Education, Leadership, Serving the Underserved, Pathology Dedication, Interest in Program, and Adding a New Perspective. Faculty completed 280 assessments of 96 applicants across 2 National Resident Matching Program cycles (2023-2025). For each domain, we quantified discriminatory ability (variance normalized to scale range), interrater agreement using the intraclass correlation coefficient (ICC), and predictive importance for total applicant scores using random forest (RF) modeling.</p><p><strong>Results.—: </strong>Skill domains showed significant heterogeneity in both overall mean normalized scores (ANOVA [analysis of variance] F = 76.7; P < .001) and within-applicant scoring patterns (Friedman χ2 = 349; P < .001). Pathology Dedication showed the strongest performance, with the highest agreement (ICC = 0.54; rank 1) and high discrimination (spread = 0.09; rank 2). General Interview demonstrated minimal discrimination (spread = 0.02; rank 10) and lowest agreement (ICC = 0.08; rank 10). Adding a New Perspective and Recommendation Letters were the strongest predictors of overall scores (RF = 0.28 and 0.22; ranks 1-2), while Interest in Program-despite high discrimination-had minimal predictive value (RF = 0.02; rank 10).</p><p><strong>Conclusions.—: </strong>Specialty-specific domain (Pathology Dedication) provided reliable and predictive evaluations, whereas General Interview performance contributed least to consistent or meaningful applicant differentiation.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007663","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":"Benign Glandular Lesions of the Urinary Bladder: Diagnostic Criteria and Differential Diagnosis Considerations.","authors":"Liang Cheng, Hui Min Tan, Martin J Magers, Antonio Lopez-Beltran","doi":"10.5858/arpa.2025-0629-RA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0629-RA","url":null,"abstract":"<p><strong>Context.—: </strong>The urinary bladder is a unique organ that may be involved by both benign and malignant glandular lesions. Urothelial carcinoma may possess glandular differentiation, and other glandular malignancies may arise from or secondarily involve the urinary bladder. However, many benign glandular lesions may also involve the urinary bladder, and these can mimic malignancy. Relatively common benign lesions of the urinary bladder that may demonstrate glandular or tubular features include cystitis glandularis, glandular metaplasia, nephrogenic adenoma, Müllerian lesions, prostatic-type polyp, urachal remnant, and pseudocarcinomatous hyperplasia.</p><p><strong>Objective.—: </strong>To provide an overview of the various benign glandular lesions of the urinary bladder, with a focus on clinical and morphologic features, as well as potential ancillary studies (eg, immunohistochemistry) to distinguish them from malignant entities.</p><p><strong>Data sources.—: </strong>Relevant medical literature indexed on PubMed and personal experiences of the senior authors.</p><p><strong>Conclusions.—: </strong>Benign glandular lesions of the urinary bladder typically do not possess high-grade cytologic atypia, frequent mitotic figures, or necrosis. However, diagnostic pitfalls exist for benign lesions with mild-to-moderate cytologic atypia, pseudoinfiltrative growth pattern, or architectural features that mimic malignancy. Being aware of the potential diagnostic pitfalls will help us to not mistake these benign glandular lesions for a malignant process.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007634","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":"External Quality Assessment of Immunocytochemistry on Cytology Samples: A 10-Year Analysis of the United Kingdom National External Quality Assessment Scheme for Immunocytochemistry and In-Situ Hybridisation Cytopathology Module.","authors":"Rúben Rodrigues Roque, Irena Srebotnik Kirbis, Suzanne Parry, Ana Félix","doi":"10.5858/arpa.2025-0617-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0617-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Immunocytochemistry (ICC) is central to diagnostic cytopathology, yet achieving consistent staining quality remains challenging owing to technical complexity and limited standardization. External quality assessment (EQA) programs provide an objective framework for benchmarking ICC performance across laboratories.</p><p><strong>Objective.—: </strong>To analyze performance trends, technical variables, and participant self-assessment in the United Kingdom National External Quality Assessment Scheme for Immunocytochemistry and In-Situ Hybridisation (UK NEQAS ICC & ISH) cytopathology module during a 10-year period.</p><p><strong>Design.—: </strong>Data from 41 EQA runs (June 2014-May 2024) involving 140 laboratories were analyzed. ICC quality on UK NEQAS-provided cytology slides and participant in-house control slides was evaluated by expert assessors using a predefined scoring system (range, 0-20; satisfactory ≥13). Expert scores, participant self-assessment, and assessors' comments were reviewed.</p><p><strong>Results.—: </strong>Of 14 639 slides assessed, 90.3% achieved satisfactory staining quality, with significant improvement over time. Cell blocks showed higher mean scores and fewer suboptimal results than cytospins (15.77 versus 15.19; P < .001). Fixation influenced performance on in-house controls: methanol-fixed preparations had higher mean scores than formalin-fixed samples (16.36 versus 16.05; P = .003) but a higher suboptimal rate, while acetone- and ethanol-fixed samples performed less well. Inappropriate control selection was a major cause of suboptimal results. Participant self-assessment correlated weakly with expert evaluation (r = .30) and tended to overestimate performance.</p><p><strong>Conclusions.—: </strong>ICC performance in cytology is generally satisfactory and improving. While cell blocks offer the most robust standardization, optimized methanol fixation represents a viable alternative for non-cell block samples. The discordance between participant self-assessment and expert review highlights the continuing value of EQA in identifying quality gaps and guiding improvement.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977717","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":"Development of Mesothelioma in Organ Transplant Recipients: A Comprehensive Study of 10 Cases.","authors":"Huihua Li, Andre E Nel, Sergio Pina-Oviedo, John M Carney, Carolyn H Glass, Thomas A Sporn, Richard Attanoos, Aliya N Husain, Sonja Klebe, Beiyu Liu, Victor L Roggli, Elizabeth N Pavlisko","doi":"10.5858/arpa.2025-0385-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0385-OA","url":null,"abstract":"<p><strong>Context.—: </strong>The development of malignancy after organ transplant has been well recognized as a complication of long-term posttransplant immunosuppression. Although rare cases of mesothelioma have been reported in transplant recipients, a comprehensive review of this malignancy in the context of immune suppression is lacking.</p><p><strong>Objective.—: </strong>To provide a comprehensive review of 10 retrospective mesothelioma cases developed after transplant.</p><p><strong>Design.—: </strong>This retrospective study is composed of 10 mesothelioma cases, collected at multiple institutions following solid organ or bone marrow transplant. Patients' clinicopathologic characteristics, histologic features of tumors, and disease prognosis were investigated.</p><p><strong>Results.—: </strong>All 10 patients were males, with a median age of 64 years at the time of mesothelioma diagnosis (range, 57-77 years). The mesothelioma development followed transplant of the kidney (3), liver (3), heart (2), lung (1), and bone marrow (1), among which the bone marrow and kidney recipients showed longer intervals between transplant and development of mesothelioma. Pleural mesothelioma (9) was more common than peritoneal mesothelioma (1). Subtypes of mesothelioma observed included epithelioid (3), biphasic (3), and sarcomatoid (4). Notably, the incidences of sarcomatoid and biphasic subtypes were higher in transplant patients compared with the general population. No association between any subtype of mesothelioma and organ transplanted was observed. Transplant patients passed away shortly (median survival, 10.5 months) after the development of mesothelioma; epithelioid subtype showed the best prognosis, followed by biphasic and sarcomatoid subtypes.</p><p><strong>Conclusions.—: </strong>Although rare, mesothelioma represents another malignancy occurring in the posttransplant population, emphasizing the importance of immune surveillance in cancer development.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870875","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":"Pleuropulmonary Blastoma and Diagnostic Pitfalls: A Report from the International Pleuropulmonary Blastoma/DICER1 Registry.","authors":"Alexander T Nelson, Kris Ann P Schultz, Anne K Harris, Lily Mei, Amanda J Nickel, Douglas R Stewart, Laura A Harney, Megan K Dishop, Jennifer Pogoriler, Damon R Olson, Yoav H Messinger, D Ashley Hill, Louis P Dehner","doi":"10.5858/arpa.2024-0364-OA","DOIUrl":"10.5858/arpa.2024-0364-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Pleuropulmonary blastoma (PPB) is a rare primary lung neoplasm predominantly occurring in infancy and early childhood, which, because of rarity and/or confusion with congenital cystic lung lesions and its variable architectural and morphologic features, can be a diagnostic challenge.</p><p><strong>Objective.—: </strong>To characterize the diagnostic challenges in cases submitted to the International PPB/DICER1 [dicer 1, ribonuclease III] Registry (Registry) with a possible PPB diagnosis.</p><p><strong>Design.—: </strong>This study reviews lesions submitted to the Registry during a 35-year period. Pathologic diagnoses, ancillary studies, and genetic information were reviewed.</p><p><strong>Results.—: </strong>Of the 868 thoracic tumors submitted to the Registry from 1987 to 2022, 79% (685 of 868) were confirmed as PPB by central review. In the remaining 21% (183 of 868) of cases, PPB was either excluded or could not be confirmed with available material. Most of these cases (64%; 117 of 183) were malignant; 31% (56 of 183) were benign, and 5% (10 of 183) were of uncertain malignant potential. The most common benign discrepant diagnosis was congenital pulmonary airway malformation (n = 19), and the most common malignant discrepant or indeterminate diagnosis was rhabdomyosarcoma, including sarcoma with rhabdomyoblastic differentiation (n = 24). DICER1 RNase IIIb hotspot variants were detected by tumor testing in 4 cases with histology discrepant from or inconclusive for classical PPB. Additionally, 4 patients with non-PPB histology were found to have a germline DICER1 pathogenic or likely pathogenic variant without available tumor testing.</p><p><strong>Conclusions.—: </strong>The histomorphologic heterogeneity of PPB resulted in a variety of non-PPB diagnoses among cases not initially classified as PPB. Molecular testing may clarify the diagnosis and provide prognostic and therapeutic insights.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13274514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Breast Cancer Lymph Node Evaluation: Is Neoadjuvant Chemotherapy the Achilles' Heel?","authors":"Musheera Aziz, Ayushi Sahay, I-Chu Hung, Rutvij Khedkar, Sangeeta B Desai, Rajiv Kumar Kaushal","doi":"10.5858/arpa.2025-0463-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0463-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Artificial intelligence (AI) has demonstrated high accuracy in detecting lymph node (LN) metastases in treatment-naïve invasive breast cancer. However, its performance post-neoadjuvant chemotherapy (NACT) remains underexplored, where therapy-related morphologic alterations complicate assessment.</p><p><strong>Objective.—: </strong>To evaluate an AI algorithm (aetherAI) for detecting LN metastases in post-NACT invasive breast cancer.</p><p><strong>Design.—: </strong>This retrospective study included 72 patients (58 [80.5%] post-NACT; 14 [19.5%] treatment-naïve), yielding 526 whole slide images and 1290 LNs. AI-generated LN contours were reviewed and modified, if needed. LN status was independently assessed by 4 pathologists and the AI algorithm. Discordant cases were resolved by consensus/immunohistochemistry to define ground truth, against which AI was compared.</p><p><strong>Results.—: </strong>AI accurately contoured 1089 of 1290 LNs (84.4%). Pathologists showed 94.42% agreement, with 5.58% discordance. Against consensus ground truth, AI achieved 94.06% sensitivity, 90.14% specificity, 91.47% accuracy, and area under the curve (AUC) of 0.92. Performance was superior in treatment-naïve LNs (sensitivity, 98.95%; specificity, 98.08%; AUC, 0.99) compared with post-NACT LNs (sensitivity, 92.71%; specificity, 88.36%; AUC, 0.91) (P < .001). Within the post-NACT group, significantly reduced accuracy was associated with interobserver discordance (P < .001) and smaller metastases (micrometastasis, isolated tumor cells) (P < .001), but not noted in treatment-naïve cases. Most false results were attributable to therapy-induced changes.</p><p><strong>Conclusions.—: </strong>Unlike most prior studies restricted to treatment-naïve LNs, this post-NACT cohort demonstrates that NACT-related alterations reduce AI sensitivity and accuracy. Our findings suggest that incorporating post-NACT nodes into algorithm training will be essential for reliable clinical translation of AI-assisted LN evaluation.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870897","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":"A Machine-Learning Approach to Predicting Adenoma Detection and Surveillance Impact of Deeper Sections in Colorectal Polypectomy Specimens.","authors":"Taofic Mounajjed, Andrew Geiser, Paul Dambowy","doi":"10.5858/arpa.2025-0311-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0311-OA","url":null,"abstract":"<p><strong>Context.—: </strong>In the routine practice of pathology, cutting deeper levels into paraffin blocks of colorectal polypectomy specimens that do not show a lesion on initial hematoxylin-eosin sections is common. However, this practice lacks standardization, and data are limited on the predictability of adenoma detection and the impact on surveillance intervals and resource use.</p><p><strong>Objective.—: </strong>To develop machine learning models that predict which polyps and encounters are most likely to reveal clinically significant lesions on deeper levels and influence patient surveillance intervals.</p><p><strong>Design.—: </strong>We performed a retrospective study of 94 888 patients (145 405 colonoscopies; 392 130 polyps) from 2007 to 2024. Polyp characteristics, deeper-level requests, and clinical/endoscopic features were analyzed. Machine learning models were developed to predict (1) adenoma detection in single polyps with deeper levels and (2) impact on surveillance intervals per encounter.</p><p><strong>Results.—: </strong>Deeper levels were requested in 26 067 jars (11%) and 21 232 encounters (15%), revealing adenomas in 7946 single polyps examined (51%). Predictive models showed high performance: logistic regression for single-polyp conversion (area under the receiver operating characteristic curve 0.88, accuracy 81%) and gradient boosting classifier for surveillance interval impact (area under the receiver operating characteristic curve 0.90, accuracy 83%). Important predictors included polyp size, location, total polyps, and artificial intelligence-assisted colonoscopy.</p><p><strong>Conclusions.—: </strong>Deeper-level sectioning contributes significantly to adenoma detection and influences surveillance intervals. Machine learning provides a practical framework to optimize deeper-level requests, enhancing diagnostic precision and resource allocation.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847402","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":"Examination of Pathologist-Artificial Intelligence Interactions and Their Impact on Pathologist Accuracy Using Artificial Intelligence-Assisted Scoring of Immunohistochemistry for Human Epidermal Growth Factor Receptor 2.","authors":"John Shamshoian, Zahil Shanis, Ryan Cabeen, Limin Yu, Shreya Chakraborty, Marc Thibault, Blake Martin, Harshith Padigela, Dinkar Juyal, Syed Ashar Javed, William Qian, Juhyun Kim, Ylaine Gerardin, Beckett Rucker, Jacqueline Brosnan-Cashman, Harsha Pokkalla, Jimish Mehta, Amaro Taylor-Weiner, Eric Walk, Andrew Beck, Michael C Montalto, Ben Glass, Santhosh Balasubramanian","doi":"10.5858/arpa.2025-0262-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0262-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Advances in computer vision have fueled the development of artificial intelligence (AI)-based algorithms for pathology. AI-assisted approaches may streamline the diagnostic workflow and reduce variability.</p><p><strong>Objective.—: </strong>To assess the impact of an AI-assist model for human epidermal growth factor receptor 2 (HER2) scoring on pathologist reproducibility and accuracy and to understand pathologist-model interactions.</p><p><strong>Design.—: </strong>An AI-Assist algorithm for HER2 scoring, AI-Measurement of HER2 (AIM-HER2), was developed to generate slide-level scores of HER2 immunohistochemistry (IHC) aligned with guidelines from the American Society of Clinical Oncology/College of American Pathologists. AIM-HER2 was assessed in a retrospective reader study wherein HER2-trained pathologists (n = 20) scored breast cancer cases (n = 200) with and without model assistance using a 2-cohort crossover design with a 3-week washout. A separate panel of expert pathologists (n = 5) provided manual reference scores.</p><p><strong>Results.—: </strong>As an AI-assist tool, AIM-HER2 improved interrater agreement both overall and at the 0/1+ and 1+/2+ cutoffs and significantly increased positive percentage agreement at the 0/1+ and 1+/2+ cutoffs. Pathologists displayed a wide range of model override rates, and the quality of these overrides was correlated with each pathologist's manual accuracy. Measurements of AIM-HER2 accuracy were highly dependent on reference panel composition.</p><p><strong>Conclusions.—: </strong>The use of AI-assist tools, such as AIM-HER2, for scoring HER2 IHC in breast cancer may improve pathologist reproducibility and accuracy, particularly at the 0/1+ and 1+/2+ cutoffs. However, improved consistency of pathologist interpretation of AI-assisted IHC scoring guidance may be necessary for AI-assist tools to reach their full potential.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847404","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":"An Innovative Diagnostic Strategy for Malignant Pleural Effusion Using Discontinuous Gradient Centrifugation.","authors":"Jin-Xin Zhu, Lei Yuan, Yong-Tao Zhan, Ying-Jie Li, Hao-Ming Xia, Ming Jiang, Xiang Ao, Jie Zhou, Qian Wang, Dong-Hui Zhang, Zhi-Jie Zhang, Hong-Sheng Li, Ni Qiu","doi":"10.5858/arpa.2025-0442-OA","DOIUrl":"10.5858/arpa.2025-0442-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Malignant pleural effusion (MPE) is a common cancer metastatic complication, and distinguishing it from benign effusions is critical for treatment. Cytology is central to MPE diagnosis, but inflammatory and reactive mesothelial cells often obscure malignant cells, limiting accuracy. Although liquid-based cytology (LBC) improves specificity over conventional smears, its use is constrained by specialized equipment requirements.</p><p><strong>Objective.—: </strong>To investigate a novel discontinuous gradient centrifugation (DGC) technique for improving the diagnostic efficiency of MPE.</p><p><strong>Design.—: </strong>We prospectively analyzed 55 pleural effusion samples (September 2021-April 2023) using DGC and LBC, with cytoblock paraffin embedding and immunohistochemistry as the reference standard.</p><p><strong>Results.—: </strong>Immunohistochemical staining classified 24 cases as benign and 31 as malignant. Class IA was found in 27 (49.09%), IB in 2 (3.64%), IC in 0 (0%), II in 2 (3.64%), and III in 24 (43.64%) cases via DGC; with LBC, class IA was in 9 (16.36%), IB in 7 (12.73%), IC in 8 (14.55%), and II in 8 cases. (14.55%). DGC had 1 false-positive and 3 false-negative results, whereas LBC had 2 false positives and 9 false negatives. Compared with LBC, DGC showed significantly higher sensitivity (90.32% versus 70.97%, P = .001), negative predictive value (88.46% versus 70.97%, P = .003), and overall accuracy (92.72% versus 80.0%, P = .007). Receiver operating characteristic curve analysis revealed a significantly larger area under the curve for DGC (0.931 [95% CI, 0.873-0.989] versus 0.813 [95% CI, 0.704-0.922]).</p><p><strong>Conclusions.—: </strong>DGC is an innovative, highly accurate method for MPE detection, outperforming LBC in clinical practice.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"736-741"},"PeriodicalIF":3.2,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791991","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":"Reassessing Ferritin Levels in Healthy Older Adults: Updated Reference Ranges and Associated Health Outcomes.","authors":"Sultana Monira Hussain, John K Olynyk, Hans G Schneider, Paul Lacaze, Chenglong Yu, Lawrence J Beilin, Andrew M Tonkin, Daniel Clayton-Chubb, Cammie Tran, David Clark, Amanda J Rickard, Robyn L Woods, Rowan G Walker, John J McNeil","doi":"10.5858/arpa.2025-0503-OA","DOIUrl":"10.5858/arpa.2025-0503-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Ferritin is used as a biomarker for iron storage, but levels vary significantly among individuals.</p><p><strong>Objective.—: </strong>To define a ferritin reference range in older adults and explore its associations with health outcomes.</p><p><strong>Design.—: </strong>A post hoc analysis included 5247 men and 6075 women aged 70 years or older from the Aspirin in Reducing Events in the Elderly trial. At enrollment, participants had no diagnosed cardiovascular disease (CVD), dementia, physical disability, or life-threatening illness. Longitudinal data on mortality, CVD morbidity, and serious hemorrhage were linked to baseline ferritin levels. Ferritin levels were analyzed in quintiles (Q) (Q1-Q5), with Q2 through Q4 as the reference category.</p><p><strong>Results.—: </strong>Median ferritin concentrations were 190 μg/L for men and 125 μg/L for women, measured with the Abbott Alinity platform. Sex-specific reference ranges derived using the Clinical and Laboratory Standards Institute guidelines were 23 to 741 μg/L and 19 to 440 μg/L (2.5th-97.5th percentiles), respectively. No relationship was found between ferritin levels and disability-free survival, mortality, or CVD outcomes. However, men with the lowest ferritin levels had increased future incidence of major hemorrhage (hazard ratio [HR], 1.51; 95% CI, 1.10-2.07), gastrointestinal (GI) bleeding (HR, 2.03; 95% CI, 1.12-3.60), and GI cancer (HR, 1.27; 95% CI, 1.04-1.54).</p><p><strong>Conclusions.—: </strong>A suggested reference range for ferritin in older adults using the Abbott Alinity platform is 25 to 740 μg/L for men and 20 to 440 μg/L for women. Low ferritin levels were associated with increased risks of GI bleeding and GI cancer in older men.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"696-706"},"PeriodicalIF":3.2,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791960","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}