bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring Extent of Ductal Carcinoma In Situ in Breast Excision Specimens: A Comparison of 4 Methods
Authors: Grin Andrea , Horne Garnet , Ennis Marguerite , O'Malley Frances P. 
Published: February 2021

Abstract
Context.—Measuring the extent of nonpalpable ductal carcinoma in situ (DCIS) in a breast specimen is challenging but important because it influences patient management. There is no standardized method for estimating the extent of DCIS, although serial sequential sampling with mammographic correlation is considered an accurate method.
Objective.—To estimate the extent of DCIS using various methods and to compare these estimations with the extent as determined by the serial sequential sampling method.
Design.—A total of 78 primary breast excisions with DCIS were retrospectively reviewed. All specimens had been sampled using the serial sequential sampling method, which involved mapping the location of each block on the sliced specimen radiograph and calculating the extent through 3-dimensional reconstruction. The other measures for estimating extent included (1) calculating size based on areas of calcification, (2) recording the number of blocks involved by DCIS and multiplying that number by 0.3 cm, and (3) measuring the largest extent of DCIS on a single slide.
Results.—All 3 alternative methods tended to underestimate the DCIS. Discrepancies became more pronounced as size increased. The percentage of cases estimated to within 1 cm of the serial sequential sampling method were 81%, 72%, and 50%, respectively, for the calcification, blocks, and single-slide methods; differences of more than 2 cm were seen in 9%, 8%, and 30% of cases, respectively.
Conclusions.—The single-slide method performed poorly and should be used only when DCIS is limited to a single slide. Although the calcification and the blocks methods gave better estimates, both produced substantial underestimates and/or overestimates that could affect clinical decision making.
Impact of Digital Image Manipulation in Cytology
Authors: Pinco Jeffery , Goulart Robert A. , Otis Christopher N. , Garb Jane , Pantanowitz Liron 
Published: February 2021

Abstract
Context.—Digital images have become an important component of cytology practice. They are used in telecytology, automated screening, educational material, and Web sites and have potential for use in proficiency testing. However, there has been no formal evaluation to date to determine if digital image manipulation (intentional or unintentional) can affect their interpretation.
Objective.—To investigate whether alteration of digital cytology images affects diagnosis.
Design.—Acquired digital images of ThinPrep Papanicolaou test slides were manipulated (rotated 90;dg and brightness, contrast, red-green-blue color, and luminosity adjusted) using Photoshop. A test composed of these altered images, along with their original (unaltered) image and exact duplicates was given to 22 cytologists (13 cytotechnologists, 8 cytopathologists, and 1 fellow). All images were rated as negative, atypical (atypical squamous cells of undetermined significance), low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or positive for cancer. Weighted κ and heterogeneity χ2 statistics were used to measure levels of agreement and assess concordance between groups.
Results.—The level of agreement for identical duplicate images was excellent (κ = 0.81), compared with the poor agreement for manipulated image pairs (κ = 0.21), a statistically significant difference (P &lt; .001). For all altered image types agreement was poor. There was no significant difference between cytotechnologists and cytopathologists in level of agreement (P = .56).
Conclusions.—Manipulation of a Papanicolaou test digital image, irrespective of the specific category of cytologic material photographed, significantly affects its interpretation by both cytotechnologists and cytopathologists. This suggests that care needs to be taken when digital cytology images are used, to specifically ensure that their alteration does not affect diagnosis.
Ovarian Cancer Update: Lessons From Morphology, Molecules, and Mice
Authors: Cho Kathleen R. 
Published: February 2021

AbstractOvarian carcinomas are a heterogeneous group of neoplasms. Pathologists currently employ a morphology-based classification system to divide ovarian carcinomas into major subgroups based on degree (tumor grade) and type of differentiation (eg, serous, endometrioid, clear cell, or mucinous). Molecular studies have shown that specific genetic defects are likely to be present in certain histologic types of ovarian carcinomas and unlikely to be present in others. Within the serous and endometrioid carcinomas, the molecular defects in low-grade versus high-grade tumors also appear to be largely distinct. Recently, mouse models of ovarian carcinoma have been developed that recapitulate many of the morphologic features and biologic behavior of selected subtypes of ovarian cancer. It is expected that these mouse models will yield new insights into ovarian cancer pathogenesis and prove useful for preclinical testing of novel strategies for ovarian cancer treatment.
Adenocarcinoma in Barrett Mucosa Treated by Endoscopic Mucosal Resection
Authors: Appelman Henry D. 
Published: February 2021

Abstract
Adenocarcinoma and dysplasias are recognized complications of Barrett mucosa. In the past, the treatment for this carcinoma was esophagectomy. However, new techniques, including endoscopic mucosal resection, sometimes replace esophagectomy and are becoming standard procedures in clinical practice, not just in major medical centers. Pathologists must learn to handle these specimens, which have extensive artifacts. Also, Barrett mucosa has duplicated stromal layers beneath the mucosa that include a new lamina propria and a new muscularis mucosae. We must be aware of these peculiarities because of staging implications. Regardless of new technology, the diagnostic approach to dysplasia depends on the light microscopic interpretation, which is not as reliable or consistent as one would wish. Hopefully, better diagnostic criteria will arise, and perhaps a new histologic stain or a molecular or genetic test will emerge that complements “our eyeballs.”
Unexpected Neoplasia in Autopsies: Potential Implications for Tissue and Organ Safety
Authors: Sens Mary Ann , Zhou Xu Dong , Weiland Timothy , Cooley A. Marvin 
Published: February 2021

Abstract
Context.—Medical examiner cases are increasingly used as tissue donor referral sources to meet the ever-growing need for transplant tissues. The assumption is often made that traumatic and sudden deaths have minimal risk of unsuspected neoplasia. An autopsy of a registered tissue donor with strong preautopsy clinical assessment of a saddle pulmonary embolus revealed unsuspected acute lymphoblastic leukemia, prompting a review of the incidence of unsuspected neoplasia from a regional forensic autopsy practice.
Objective.—To determine the incidence of (1) unsuspected neoplasia, (2) clinical concordance of known neoplasia, and (3) potential donor referral in a regional forensic autopsy service.
Design.—A retrospective, 5-year review of 412 autopsies from a regional, primarily forensic, autopsy service to determine the incidence of unsuspected neoplasia, clinical concordance of known neoplasia, and the preautopsy assessment of potential donor referral suitability.
Results.—Unsuspected neoplasia rate at autopsy was 7% (29 of 412 patients); cancer was the cause of death in 41% (12 of 29 patients) of these individuals. In patients with a history of cancer, the discordance of cancer diagnosis was 44% (4 of 9 patients [11 patients with known cancer, 2 who refused medical evaluation were excluded from the study]). Nearly 60% (17 of 29 patients) of the unsuspected cancer cases had no apparent reason for deferral of tissue procurement before the autopsy examination.
Conclusions.—The 7% incidence of unsuspected cancer in a forensic autopsy practice raises concern for the potential introduction of neoplastic tissue in the donor pool. To ensure the safety of this vital resource, mandatory complete autopsies on deceased donors are advocated as well as a tissue-recipient registry to track donor-related neoplasia.
Adequate Histologic Sampling of Breast Magnetic Resonance Imaging–Guided Core Needle Biopsy
Authors: Cornea Virgilius , Jaffer Shabnam , Bleiweiss Ira J. , Nagi Chandandeep 
Published: February 2021

Abstract
Context.—The increasing use of contrast-enhanced magnetic resonance imaging (MRI) of the breast as a valuable adjunct to mammography and ultrasound in the detection of breast lesions, in association with needle core biopsy taken from the suspicious areas, has major workload implications for histopathology laboratories wherever breast MRI is practiced.
Objective.—To establish the number of histologic levels necessary for the evaluation of breast MRI-guided needle core biopsy specimens taken from suspicious areas on breast MRI examination.
Design.—Retrospective histologic review of a series of breast MRI-guided core needle biopsies, initially examined routinely at 4 levels, in the Pathology Department at Mount Sinai School of Medicine in New York, New York.
Results.—Accurate diagnostic classification was possible after examination of the first level in 95.4% of cases. For a small group of patients (4.4%), 4 levels were considered to provide additional useful information, although this information did not alter the diagnosis. In only a single case (0.2%) was it likely that routine examination of 4 levels could have led to an incidental finding of a very small intraductal papilloma (0.15 cm) present only at the second histologic level. However, this incidental finding would have not changed the patient outcome.
Conclusions.—Needle core biopsies for MRI-detected abnormalities should be routinely examined at only 1 level. Further levels may be needed in occasional cases to identify more conclusively an associated pathologic abnormality and may be of particular value when assessing atypical intraductal proliferative epithelial lesions.
Sins of Our Fathers: Two ofThe Four Doctorsand Their Roles in the Development of Techniques to Permit Covert Autopsies
Authors: Wright Jr James R. 
Published: February 2021

AbstractContext.—Sir William Osler, MD, and Howard Kelly, MD, were probably the preeminent practitioners of their respective specialties, internal medicine and gynecology, during the late 19th and early 20th centuries. Both were passionately interested in pathology. Although not widely known, during the 1880s, both allegedly pioneered “arm's length” methods to perform covert autopsies that involved removing abdominal and even thoracic organs via the anus, vagina, or a small perineal incision hidden behind the scrotum. These techniques were allegedly used, at least occasionally, to circumvent autopsy-consent regulations and to procure teaching specimens for medical museums.Objective.—To examine the historical evidence for these alleged events and to examine these behaviors within the context of (1) the need to obtain pathologic specimens for teaching gross pathology and clinical pathologic correlation to medical trainees, (2) the loose interpretation of autopsy-consent regulations at “charity hospitals” during the late 19th century, (3) the medical museum movement, and (4) the paternalistic approach to the practice of medicine typical of the times.Design.—To address these issues, standard historiographic methods were used to examine available primary and secondary historical sources.Results.—The evidence suggests that Kelly developed and published 3 arm's length methods for covert autopsies while a resident in Philadelphia, Pennsylvania, and that both Kelly and Osler pioneered the use of these methods in the 1880s. The brief history of these “minimally invasive” autopsy techniques is also examined by reviewing 19th and 20th century textbooks of autopsy technique.Conclusions.—Howard Kelly, MD, and William Osler, MD, pioneered arm's length methods for covert autopsies. In fact, this activity appears to have initiated the 2 doctors' long professional relationship.
Renal Disease in Systemic Lupus Erythematosus With Emphasis on Classification of Lupus Glomerulonephritis: Advances and Implications
Authors: Seshan Surya V. , Jennette J. Charles 
Published: February 2021

AbstractContext.—Systemic lupus erythematosus is an autoimmune disease with protean clinical and pathologic manifestations involving almost all organs in the body. There is a high incidence of renal involvement during the course of the disease, with varied renal pathologic lesions and diverse clinical features. A renal biopsy examined by routine light microscopy, immunofluorescence, and electron microscopy contributes toward diagnosis, prognostic information, and appropriate management.Objectives.—(1) To review the clinical and various pathologic features of renal lesions in systemic lupus erythematosus patients. (2) To introduce the International Society of Nephrology and Renal Pathology Society Classification of Lupus Glomerulonephritis.Data Sources.—A literature review, illustrations with original artwork, and tabulation of clinical and pathologic data of cases obtained from the authors' renal biopsy files examined during the last 8 years were used.Conclusions.—The International Society of Nephrology/ Renal Pathology Society–sponsored Classification of Lupus Glomerulonephritis proposes standardized definitions of the various pathologic findings, describes clinically relevant lesions, incorporates prognostic parameters, and recommends a uniform way of reporting the renal biopsy findings. Lupus glomerulonephritis is divided into 6 classes primarily based on the morphologic lesions, extent and severity of the involvement, immune complex deposition, and activity and chronicity. Special emphasis is laid on describing qualitative as well as quantitative morphologic data and to include the accompanying tubulointerstitial disease and different vascular lesions, which have prognostic and therapeutic significance. This classification is intended to facilitate a higher degree of reproducibility, resulting in better patient care and more effective future clinical and translational research. Renal biopsy findings in systemic lupus erythematosus add new and independent parameters of prognostic significance to established clinical and genetic factors.
Genetic Heterogeneity in HER2 Testing in Breast Cancer: Panel Summary and Guidelines
Authors: Vance Gail H. , Barry Todd S. , Bloom Kenneth J. , Fitzgibbons Patrick L. , Hicks David G. , Jenkins Robert B. , Persons Diane L. , Tubbs Raymond R. , Hammond M. Elizabeth H. 
Published: February 2021

Abstract
Context.—Intratumoral heterogeneity of HER2 gene amplification has been well documented and represents subclonal diversity within the tumor. The reported incidence of intratumor HER2 amplification genetic heterogeneity ranges in the literature from approximately 5% to 30%. The presence of HER2 genetic heterogeneity may increase subjectivity in HER2 interpretation by the pathologist.
Objectives.—To define HER2 genetic heterogeneity and to provide practice guidelines for examining and reporting breast tumors with genetic heterogeneity for improvement of HER2 testing in breast cancer.
Design.—We convened an expert panel to discuss HER2 gene amplification testing by fluorescence in situ hybridization. Components addressed included a definition of HER2 amplification heterogeneity, practice guidelines for examination of the tissue, and reporting criteria for this analysis.
Results.—Genetic heterogeneity for amplification of HER2 gene status in invasive breast cancer is defined and guidelines established for assessing and reporting HER2 results in these cases. These guidelines are additive to and expand those published in 2007 by the American Society of Clinical Oncology and the College of American Pathologists.
Conclusion.—Standardized methods for analysis will improve the accuracy and consistency of interpretation of HER2 gene amplification status in breast cancer.
Fatal Head Injury in Children Younger Than 2 Years in New York City and an Overview of the Shaken Baby Syndrome
Authors: Gill James R. , Goldfeder Lara B. , Armbrustmacher Vernon , Coleman Andrea , Mena Hernando , Hirsch Charles S. 
Published: February 2021

AbstractContext.—Shaken baby syndrome is a controversial topic in forensic pathology. Some forensic pathologists state that shaking alone is insufficient to explain death and that an impact must have occurred even if there is no impact site on the head.Objective.—To examine a large cohort of fatal, pediatric head injuries for patterns of specific autopsy findings and circumstances that would support or dispute pure shaking as the cause of death.Design.—We retrospectively reviewed 59 deaths due to head injuries in children younger than 2 years certified in our office during a 9 year period (1998–2006). The review included autopsy, toxicology, microscopy, neuropathology, and police and investigators' reports.Results.—There were 46 homicides, 8 accidents, and 1 undetermined death from blunt-impact injury of the head. In 10 (22%) of the homicides, there was no impact injury to the head, and the cause of death was certified as whiplash shaking. In 4 (40%) of these 10 deaths, there was a history of shaking. In 5 (83%) of the other 6, there was no history of any purported accidental or homicidal injury. All 8 accidental deaths had impact sites. Of the 59 deaths, 4 (6.7%) had only remote injuries (chronic subdural hematomas, remote long bone fractures) that were certified as undetermined cause and manner. These 4 deaths were excluded from the study.Conclusions.—We describe a subset of fatal, nonaccidental head-injury deaths in infants without an impact to the head. The autopsy findings and circumstances are diagnostic of a nonimpact, shaking mechanism as the cause of death. Fatal, accidental head injuries in children younger than 2 years are rare.
Update on Diagnostic Practice: Tumors of the Nervous System
Authors: Pytel Peter , Lukas Rimas V. 
Published: February 2021

AbstractContext.—Changes in the practice of diagnosing brain tumors are formally reflected in the evolution of the World Health Organization classification. Beyond this classification, the practice of diagnostic pathology is also changing with the availability of new tests and the introduction of new treatment options.Objective.—Glioblastomas, oligodendrogliomas, glioneuronal tumors, and primitive pediatric tumors are discussed in an exemplary way to illustrate these changes.Data Sources.—Review of relevant publications through Medline database searches.Conclusions.—The example of glioblastomas shows how new predictive markers may help identify subgroups of tumors that respond to certain therapy regimens. The development of new treatment strategies also leads to different questions in the assessment of brain tumors, as seen in the example of pseudoprogression or the changes in tumor growth pattern in patients taking bevacizumab. Oligodendrogliomas illustrate how the identification of 1p/19q loss as a cytogenetic aberration aids our understanding of these tumors and changes diagnostic practice but also introduces new challenges in classification. Glioneuronal tumors are an evolving group of lesions. Besides a growing list of usually low-grade entities with well-defined morphologic features, these also include more poorly defined cases in which a component of infiltrating glioma is often associated with focal neuronal elements. The latter is biologically interesting but of uncertain clinical significance. Oligodendrogliomas and glioneuronal tumors both illustrate the importance of effective communication between the pathologist and the treating oncologist in the discussion of these patients. Finally, the discussion of primitive pediatric tumors stresses the clinical importance of the distinction between different entities, like atypical teratoid rhabdoid tumor, “central” (supratentorial) primitive neuroectodermal tumor, “peripheral” primitive neuroectodermal tumor, and medulloblastoma. In medulloblastomas, the recognition of different variants is emerging as a prognostic factor that may in the future also predict therapy responsiveness.
The Assessment of Pathologists/Laboratory Medicine Physicians Through a Multisource Feedback Tool
Authors: Lockyer Jocelyn M. , Violato Claudio , Fidler Herta , Alakija Pauline 
Published: February 2021

Abstract
Context.—There is increasing interest in ensuring that physicians demonstrate the full range of Accreditation Council for Graduate Medical Education competencies.
Objective.—To determine whether it is possible to develop a feasible and reliable multisource feedback instrument for pathologists and laboratory medicine physicians.
Design.—Surveys with 39, 30, and 22 items were developed to assess individual physicians by 8 peers, 8 referring physicians, and 8 coworkers (eg, technologists, secretaries), respectively, using 5-point scales and an unable-to-assess category. Physicians completed a self-assessment survey. Items addressed key competencies related to clinical competence, collaboration, professionalism, and communication.
Results.—Data from 101 pathologists and laboratory medicine physicians were analyzed. The mean number of respondents per physician was 7.6, 7.4, and 7.6 for peers, referring physicians, and coworkers, respectively. The reliability of the internal consistency, measured by Cronbach α, was ≥.95 for the full scale of all instruments. Analysis indicated that the medical peer, referring physician, and coworker instruments achieved a generalizability coefficient of .78, .81, and .81, respectively. Factor analysis showed 4 factors on the peer questionnaire accounted for 68.8% of the total variance: reports and clinical competency, collaboration, educational leadership, and professional behavior. For the referring physician survey, 3 factors accounted for 66.9% of the variance: professionalism, reports, and clinical competency. Two factors on the coworker questionnaire accounted for 59.9% of the total variance: communication and professionalism.
Conclusions.—It is feasible to assess this group of physicians using multisource feedback with instruments that are reliable.
Increased Mean Platelet Volume in Patients With Acute Coronary Syndromes
Authors: Lippi Giuseppe , Filippozzi Luca , Salvagno Gian Luca , Montagnana Martina , Franchini Massimo , Guidi Gian Cesare , Targher Giovanni 
Published: February 2021

Abstract
Context.—Despite remarkable progress, the diagnosis of acute coronary syndromes (ACS) is still challenging.
Objective.—The mean platelet volume (MPV), a simple and reliable indicator of platelet size that correlates with platelet activation, might be an emerging cardiovascular risk marker and potentially helpful in stratifying cardiovascular risk.
Design.—We analyzed MPV values in 2304 adult patients who were consecutively admitted during a 1-year period to the emergency department of the University Hospital of Verona for chest pain suggestive of ACS. In all patients, a baseline blood sample was collected for routine hematologic testing, whereas cardiac troponin T measurements were collected both at baseline and after 4, 6, and 12 hours.
Results.—A total of 456 patients (19.8% of total) had ACS. These patients, all having cardiac troponin T levels of 0.03 ng/mL or greater in addition to ischemic electrocardiographic changes, had higher MPV values than non-ACS patients with normal cardiac troponin T levels (median, 8.0 fL [5th to 95th percentiles, 6.7–10.0 fL] versus median, 7.4 fL [5th to 95th percentiles, 6.5–9.5 fL]; P &lt; .001). The diagnostic accuracy of MPV, calculated as the area under the curve by the receiver operating characteristic analysis, was 0.661 (P &lt; .001). At the 9.0-fL cutoff, the negative and positive predictive values of MPV were 83% and 43%, respectively.
Conclusions.—Because MPV is a simple and inexpensive laboratory measurement, it might be considered a useful rule-out test along with other conventional cardiac biomarkers for the risk stratification of ACS patients admitted to the emergency departments.