Archives of pathology & laboratory medicine最新文献

{"title":"Circulating Nucleated Red Blood Cells: An Updated Reference Interval.","authors":"Eric A Walradth, Theresa J O'Sullivan","doi":"10.5858/arpa.2025-0281-LE","DOIUrl":"https://doi.org/10.5858/arpa.2025-0281-LE","url":null,"abstract":"","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 2","pages":"98-99"},"PeriodicalIF":3.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069444","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":"Filling in the Gaps of Examining Human Epidermal Growth Factor Receptor 2 (HER2)-Low and HER2-Ultralow in Breast Cancer: Clone Choice, Sample Size, and Reevaluating Scores Made on Archived Samples.","authors":"Josef Rüschoff, Guiseppe Viale","doi":"10.5858/arpa.2025-0356-LE","DOIUrl":"https://doi.org/10.5858/arpa.2025-0356-LE","url":null,"abstract":"","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 2","pages":"97"},"PeriodicalIF":3.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069467","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":"Unlocking Diagnostic Potential From Discards: Commentary on Tissue Trimmings as an Alternative DNA Source.","authors":"Nathkapach Kaewpitoon Rattanapitoon, Natthawut Charoenphon, Phatsakul Thitimahatthanakusol, Schawanya Kaewpitoon Rattanapitoon","doi":"10.5858/arpa.2025-0355-LE","DOIUrl":"https://doi.org/10.5858/arpa.2025-0355-LE","url":null,"abstract":"","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 2","pages":"99-100"},"PeriodicalIF":3.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069473","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":"Milestones in Kidney Function Testing: Reflecting on the Journey Toward Serum Creatinine Measurement Standardization and Its Impact on Chronic Kidney Disease Diagnosis and Management.","authors":"Nkemakonam C Okoye, Stephen R Master, Andrew N Hoofnagle, W Greg Miller","doi":"10.5858/arpa.2025-0431-RA","DOIUrl":"10.5858/arpa.2025-0431-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Accurate measurement of serum creatinine is essential for estimating glomerular filtration rate (GFR), which is central to chronic kidney disease (CKD) detection, staging, and management. However, historical biases in creatinine measurement among several instrument/assay manufacturers compromised estimated GFR (eGFR) reliability, hindering CKD detection and management. Initiatives led by the National Kidney Disease Education Program (NKDEP) Laboratory Working Group and other stakeholders have standardized calibration of creatinine measurement and reporting of eGFR.</p><p><strong>Objective.—: </strong>To summarize the journey toward global standardization of serum creatinine measurement procedures, detailing the coordinated efforts that led to calibration traceability to the NIST (National Institute of Standards and Technology) SRM (standard reference material) 967 reference material, examining the role of proficiency testing in monitoring progress, and contrasting the current state of creatinine assay standardization with that of other key kidney function biomarkers, such as cystatin C and urine albumin.</p><p><strong>Data sources.—: </strong>A comprehensive review of peer-reviewed literature from 2005-2025 was conducted, including landmark studies from the Archives of Pathology & Laboratory Medicine, Clinical Chemistry, and clinical practice guidelines from several professional organizations. College of American Pathologists proficiency testing and LN24 survey data were included.</p><p><strong>Conclusions.—: </strong>The global creatinine standardization initiative, driven by the NKDEP Laboratory Working Group, has dramatically reduced intermethod bias in serum creatinine measurement procedures, vastly improving the reliability of eGFR. While the metrologic traceability of calibration for creatinine measurement is now harmonized, challenges with analytical specificity, particularly for Jaffe-based methods, remain. The success of creatinine standardization serves as an important model for ongoing efforts to harmonize cystatin C and urine albumin measurements, ultimately leading to more accurate, equitable, and standardized care for patients with or at risk for CKD.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 2","pages":"118-121"},"PeriodicalIF":3.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069513","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":"Emerging Infections and the Archives of Pathology & Laboratory Medicine.","authors":"David A Schwartz","doi":"10.5858/arpa.2025-0278-RA","DOIUrl":"10.5858/arpa.2025-0278-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Anatomic pathology as a subspecialty has been invaluable in understanding emerging and reemerging infectious diseases throughout many outbreaks and pandemics.</p><p><strong>Objective.—: </strong>To describe the contributions of the Archives of Pathology & Laboratory Medicine to understanding emerging infections.</p><p><strong>Data sources.—: </strong>Medical literature and periodicals.</p><p><strong>Conclusions.—: </strong>The Archives has a long tradition of supporting significant anatomic pathology research into these diseases through timely publishing of original research articles, patient cases, histopathology findings, reviews, and commentaries of public health importance. This was highlighted during the 1976 Legionnaires' disease outbreak in Philadelphia, when the Archives published the first description of the pathologic findings of Legionnaires' disease based on an autopsy study of 26 persons who had died from the novel infection. In that article, John Blackmon, Martin Hicklin, and Francis Chandler at the Centers for Disease Control and Prevention described the pathologic findings of severe pneumonia in all patients and were able to visualize the causative bacillus. The Archives continued to address the importance of emerging infections by publishing a special issue in February 1996 entitled \"Emerging and Reemerging Global Microbial Threats.\" With the increasing importance of emerging infections, a second special issue on this topic was published in August 1997 entitled \"Emerging and Reemerging Infectious Diseases.\" In response to the Zika virus outbreak that began in Brazil in 2015, the Archives became the first peer-reviewed journal to devote a special issue to this emerging viral infection that was causing fetal deaths and congenital malformations, entitled \"The Zika Virus Global Pandemic: The Latest Emerging Infection.\" During the global COVID-19 pandemic, the Archives continued to publish timely articles addressing many important issues about SARS-CoV-2 infections.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 2","pages":"101-107"},"PeriodicalIF":3.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069427","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":"Destombes - The Forgotten Pathologist: Rosai-Dorfman Disease, From Initial Recognition to the Latest and Greatest.","authors":"Michael E Kallen, Genevieve M Crane","doi":"10.5858/arpa.2025-0403-RA","DOIUrl":"10.5858/arpa.2025-0403-RA","url":null,"abstract":"<p><strong>Context.—: </strong>As part of the 100th anniversary of Archives of Pathology & Laboratory Medicine, we revisit a seminal article published by Juan Rosai, MD, and Ronald Dorfman, MBBCh, FRCPath, in this journal in 1969. This is one of the initial series describing the entity now known as Rosai-Dorfman-Destombes disease (RDD), following the case series of the French pathologist Pierre-Paul Louis Lucien Destombes, MD, which describes a striking but enigmatic entity that now bears their names. Rosai and Dorfman described this process using the moniker sinus histiocytosis with massive lymphadenopathy, with presentation in pediatric and young adults, with massive, painless cervical lymphadenopathy and a benign, but potentially protracted course. Histiocytes show characteristic cytomorphologic features (making it one of the most beloved entities by pathologists and board examiners alike), including round, hypochromatic nuclei with prominent nucleoli and abundant pale eosinophilic cytoplasm, with trafficking of inflammatory elements termed emperipolesis.</p><p><strong>Objective.—: </strong>To review the historical context surrounding the recognition of RDD and key clinicopathologic and molecular features.</p><p><strong>Data sources.—: </strong>Historical papers as well as more recent studies advancing our understanding of RDD were identified from the literature, using PubMed and other search engines.</p><p><strong>Conclusions.—: </strong>RDD remains a potentially challenging entity for diagnosis and treatment given variation in presentation, morphologic features, and often a lack of known molecular drivers, which may occur in isolation or in patients with altered immune function, germline disorders, or other neoplastic conditions.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"150 2","pages":"108-117"},"PeriodicalIF":3.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069454","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":"Machine Learning-Based Detection of Intestinal Metaplasia Identifies Clinically Missed Cases.","authors":"John A Willis, Jacqueline Emerson, Wei Chen, Fengming Chen, Avani A Pendse, Katherine S Garman, William R Jeck","doi":"10.5858/arpa.2025-0307-OA","DOIUrl":"10.5858/arpa.2025-0307-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Gastric intestinal metaplasia is a recognized precursor and risk factor to gastric cancer, and correct diagnosis is required for clinical decision-making.</p><p><strong>Objective.—: </strong>To evaluate potential missed intestinal metaplasia diagnoses and develop automated approaches to quantification, we developed an artificial intelligence pipeline for review of both whole slide images and pathology reports.</p><p><strong>Design.—: </strong>A patch-based classifier was trained and applied to 1935 gastric biopsy specimens. Specimens with disagreement between the artificial intelligence pipeline and the clinical pathology report were reviewed by 3 pathologists who were blinded to the diagnoses.</p><p><strong>Results.—: </strong>Following review, 30 of 297 apparently \"false-positive\" artificial intelligence detections were determined to represent undetected intestinal metaplasia. The artificial intelligence quantification of intestinal metaplasia strongly agreed with human scoring (Spearman rank correlation coefficient, 0.90; P < .001). Finally, a large language model-based evaluation of pathology report text showed near perfect ability to categorize reports as positive or negative for intestinal metaplasia (99.3% of specimens) with a few reports evaluated as equivocal (0.7%).</p><p><strong>Conclusions.—: </strong>An artificial intelligence-based quality assurance pipeline could detect missed intestinal metaplasia in as many as 1.5% of gastric biopsy specimens, highlighting a potentially addressable diagnostic gap. An automated pipeline could additionally provide quantitative information that could be informative for management.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"486-492"},"PeriodicalIF":3.2,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031841","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":"Did I Get It Right?: Implementation of Pathology Trainee Report Feedback System Integrated With Digital Pathology.","authors":"Jingjing Cao, Dibson Dibe Gondim","doi":"10.5858/arpa.2025-0421-OA","DOIUrl":"10.5858/arpa.2025-0421-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Effective pathology report feedback is vital for trainee education but is often limited by information technology systems that lack integrated educational support. Most laboratory information systems do not retain resident draft reports after report finalization and lack workflows for structured feedback, hindering self-assessment and progress tracking.</p><p><strong>Objective.—: </strong>To develop and implement a feedback system that allows pathology trainees to compare their preliminary diagnostic reports with finalized faculty reports and corresponding digital slides.</p><p><strong>Design.—: </strong>A custom feedback system was developed, integrating with Cerner Millennium (laboratory information system) and the Paige digital pathology platform. Trainees flagged cases by simulating a report finalization command, which stored their preliminary diagnosis. An automated report compared the resident and faculty diagnoses side by side and included direct links to the relevant digital slides. A total of 3854 cases from 13 trainees were analyzed for diagnostic concordance, categorized as accurate, mostly accurate, partially accurate, or inaccurate.</p><p><strong>Results.—: </strong>Overall diagnostic accuracy was 68.8% (2650 of 3854), increasing to 86.1% (3317 of 3854) when \"mostly accurate\" cases were included. Accuracy varied by trainee (range, 55.5% [238 of 429]-78.3% [553 of 706]) and organ system (highest in neuropathology at 83.8% [31 of 37], lowest in placenta at 46% [46 of 100]). System usage also varied, with some trainees reviewing more than 700 cases and others fewer than 10. Report comparison allowed for assessment of both diagnostic accuracy and report quality.</p><p><strong>Conclusions.—: </strong>This integrated feedback system enables scalable, trainee-centered evaluation of diagnostic performance and report writing, fostering reflective learning in daily practice. The database generated through this system further provides opportunities for deeper data exploration, identification of educational trends, and development of competency-based assessment frameworks.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"478-485"},"PeriodicalIF":3.2,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032026","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":"Impact of Entrustable Professional Activities on Workload and Education in a Canadian Pathology Residency Program.","authors":"Irene Y Xie, Susan J Done, Tra Truong","doi":"10.5858/arpa.2025-0318-OA","DOIUrl":"10.5858/arpa.2025-0318-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Training the next generation of pathologists is vital for high-quality clinical medicine. Competency-Based Medical Education (CBME) and accumulation of \"Entrustable Professional Activities\" (EPAs) are being implemented worldwide to standardize medical training in all specialties. However, CBME research specific to pathology is lacking. Surveys of training programs routinely using EPAs highlight challenges with administrative burden, completion rates, and feedback.</p><p><strong>Objective.—: </strong>To investigate the impact of EPAs on workload and feedback in a pathology program after 5 years of implementation.</p><p><strong>Design.—: </strong>A cross-sectional survey was administered to residents in the Diagnostic and Molecular (Anatomical) Pathology program at the University of Toronto, which transitioned to an EPA-based CBME system in 2019.</p><p><strong>Results.—: </strong>The response rate was 83% (n = 25 of 30). More than half of responding residents submitted at least 4 EPAs per week (52%; n = 13), and most residents (76%; n = 19) estimated spending at least a half hour per week submitting and following up on EPAs. Most residents (92%; n = 23) disagreed with the statement that EPAs provided valuable feedback to their learning; however, all residents (100%; n = 25) agreed verbal feedback at sign-out was one of the most useful assessments of their abilities. Only a minority (36%; n = 9) regularly received verbal feedback alongside an EPA. Respondents overwhelmingly felt that EPAs had a negative effect on the rapport between staff and residents, and cited concerns about staff workloads.</p><p><strong>Conclusions.—: </strong>This study is the first to quantify the workload associated with CBME in a pathology residency program and raises practical considerations for training programs considering implementation of EPAs.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"465-470"},"PeriodicalIF":3.2,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031806","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 Retrospective Report of a Multi-hospital Health System's Response to Mitigate the 2024 Worldwide Shortage of Blood Culture Media and Maintain Standard-of-Care Testing.","authors":"Anita J Reddy, Christine Ramsey, Thomas Fraser, Charles B Foster, Michael Fahey, Lauren Fromwiller, Alex Castator, Scott Dwyer, Kimberly Grider, Michael Cruise, Susan Harrington, David Bosler, Daniel D Rhoads","doi":"10.5858/arpa.2025-0393-CP","DOIUrl":"10.5858/arpa.2025-0393-CP","url":null,"abstract":"<p><strong>Context.—: </strong>The Becton Dickinson BACTEC blood culture media bottle shortage led hospitals to create a mitigation strategy to conserve bottles while ensuring a high quality of care.</p><p><strong>Objective.—: </strong>To describe how our existing framework of teams was able to quickly pivot to implement conservation strategies without negatively impacting patient care.</p><p><strong>Design.—: </strong>A team implemented various mitigation measures based on current inventory, which included education, leveraging electronic medical record guidance and alerts with evidence-based information on appropriate ordering, alternative sources of supply, and real-time dashboards to inform next steps.</p><p><strong>Results.—: </strong>Implementation of educational efforts and alerts resulted in more than 22 000 blood cultures avoided in 6 months, with an increase in blood culture positivity rates by 25%. We did not see any adverse events that impacted the quality of patient care. We observed cost savings of nearly $200 000 in 2024 with these measures.</p><p><strong>Conclusions.—: </strong>Handling widespread shortages in situations of single suppliers requires rapid assembly of key stakeholders with decision-making authority and support of executive leadership. Existing frameworks of experienced teams quickly assessed the situation, worked on mitigation measures, predicted future challenges, and implemented alternatives to ensure patient care was not disrupted.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"425-431"},"PeriodicalIF":3.2,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031984","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}