Pathology Report

Abstract: The severity grade is an important component of a histopathologic diagnosis in a nonclinical toxicity study that helps distinguish treatment-related effects from background findings and aids in determining adverse dose levels during hazard characterization. Severity grades should be assigned based only on the extent (i.e., amount and complexity) of the morphologic change in the examined tissue section(s) and be clearly defined in the pathology report for critical lesions impacting study interpretation. However, the level of detail provided and criteria by which severity grades are assigned can vary, which can lead to inappropriate comparisons and confusion when evaluating pathology results. To help address this issue, a Working Group of the Society of Toxicologic Pathology's Scientific and Regulatory Policy Committee was formed to provide a "points to consider" article on the assignment and application of pathology severity grades. Overall, the Working Group supports greater transparency and consistency in the reporting of grading scales and provides recommendations to improve selection of diagnoses requiring more detailed severity criteria. This information should enhance the overall understanding by toxicologic pathologists, toxicologists, and regulatory reviewers of pathology findings and thereby improve effective communication in regulatory submissions.

Abstract: The editors of this comprehensive treatise are experts in the field from the United States, Great Britain, and Australia. The book’s 28 chapters are organized traditionally by benign and malignant diseases of each anatomic site. Separate chapters cover the etiology of cervical cancer, colposcopy, hormone effects on endometrium, peritoneum, disorders of sexual development, and sectioning of specimens. Differential diagnoses are discussed in most chapters. All but two chapters were cowritten by one of the editors, giving the text uniformity and avoiding redundancy. Each chapter is well organized, with discussions of both clinical and pathologic features in separately marked sections. The chapters are flagged by color edges for easy access and major topics. Appendixes summarize surgical staging systems, histologic classification of tumors (with SNOMED codes), and synoptic pathology report formats for each tumor site. References are current through 1999. The book is entirely illustrated in color, including gross and microscopic pathology and cytology. Photographs of colposcopy and laparoscopy findings are helpful to nonclinicians. Color charts and tables nicely complement the text by summarizing critical features. During a month of daily use, specific topics were easy to locate using either the table of contents or the index. The numerous charts and tables were particularly useful for quick reference. Difficult areas in gynecologic pathology, such as extraovarian serous lesions (implants), are nicely explained and illustrated, although size criteria for microinvasion in a borderline tumor are not mentioned. There is a British slant to the discussion of cervical cytopathology and histopathology (terms such as dyskaryosis and cervical glandular intraepithelial neoplasia, or CGIN, rather than adenocarcinoma in situ), which may be unfamiliar to Americans. The Bethesda system (low-grade and high-grade squamous intraepithelial lesion, or SIL), which is widely used in the United States for both cytology and histology, is mentioned only briefly. The term proliferating serous (or mucinous) tumor is used in lieu of the more common ovarian tumor of borderline malignancy. A few minor errors were noted, including missing arrows on some photomicrographs and some typographic errors (Magace, instead of Megace). Photomicrographs vary somewhat in color contrast; a few are either too pink or too blue. However, none of these features detracts from the overall quality of the book. This lavishly illustrated, comprehensive volume is a worthy competitor to the venerable Blaustein (a new edition is due this year) and is highly recommended to both gynecologists and pathologists as the new standard book of gynecologic pathology.

Abstract: BACKGROUND. Negative resection margins are likely the most important prognostic factor for a patient with a head and neck squamous cell carcinoma. Frozen-section evaluation allows a positive margin to be corrected before surgical closure and reconstruction. A final pathology report is later issued after examination of all resected tissues. The accuracy of the final pathology report relies on accuracy in the preceding steps. The current process of margin reporting in head and neck cancer resections was studied to reveal possible waste and error in the system. METHODS. Two hundred pathologists were surveyed about their center's current process of frozen-section margin evaluation. The authors of the current study used the membership log of the North American Society of Head and Neck Pathology and the list of the top 50 US cancer centers according to US News and World Report. The authors analyzed the process of frozen-section procedure using Toyota industry principles of quality improvement. RESULTS. The majority of surgeons send small fragments of tissue from the surgical defect cavity. Many pathologists receive small unoriented tissue fragments. Many resample all or most of the margins for the final pathology report without anatomic orientation from the surgeon. Other pathologists do not sample any margins. CONCLUSIONS. Final margin reporting redundancy and waste is due mainly to lack of anatomic correlation at interdisciplinary hand-offs. Oversampling and undersampling of margins may be occurring, and the accuracy of the final pathology report may be compromised. There is currently no consensus on how to best submit tissue for frozen-section evaluation of head and neck resection margins. Cancer 2006. © 2006 American Cancer Society.

Abstract: Surgical resection is the primary treatment modality for colorectal cancer, and the most powerful tool for assessing prognosis following surgery is pathologic analysis of the resection specimen. Although the parameters that determine the pathologic stage are the strongest predictors of postoperative outcome, a number of additional pathologic features have prognostic significance that is independent of stage. These include: histologic grade; small vessel (lymphatic or venular) invasion; extramural venous invasion; perineural invasion; tumor border configuration; host lymphoid response to tumor, and the status of surgical margins. For specimens in which the radial (circumferential) margin is applicable, surgical clearance around the tumor is also of import. It is self-evident that, compared to data derived from additional assays, prognostic information that can be derived directly from standard histologic sections of a tumor is of the greatest cost-benefit to the patient. In the current era of cost containment, it is essential that surgical pathologists evaluate and report the pathologic features that are of prognostic and/or predictive significance in every case of colorectal cancer and, in turn, that the import of these be understood by the treating physicians.