![]() It noted the paucity of quality research in this area, yet there has been little subsequent research. That publication laid out 6 broadly written recommendations outlining key planks of a policy for these diagnoses, but left a great deal of discretion to individual institutions. 4 The consensus statement offered definitions for the terms “urgent diagnosis” and “significant, unexpected diagnosis,” recommending those terms as more meaningful than “critical diagnosis” or “critical value” for anatomic pathology. 2 Since 2005, the College of American Pathologists (CAP) Laboratory Accreditation Program has included a checklist item requiring laboratories accredited by CAP to have a policy regarding timely communication of “significant or unexpected surgical pathology findings.” In 2006, the Association of Directors of Anatomic and Surgical Pathology (ADASP) endorsed “the concept of critical diagnoses in anatomic pathology,” 3 and in 2012, ADASP and CAP collaborated on the Consensus Statement on Effective Communication of Urgent Diagnoses and Significant, Unexpected Diagnoses in Surgical Pathology. 1, 2 It was noted that in most cases anatomic pathology “critical values,” unlike clinical pathology critical values, are information critical rather than time critical, although in certain instances there may be a time dimension to the importance of communication of these results. More than a decade ago, questions began to be raised in the literature about the existence of critical values in anatomic pathology. Eighteen of 38 (47%) laboratories report an auditing mechanism for communication.Ĭommunication of critical values to providers has long been an established practice in clinical pathology. ![]() Most laboratories document date, time, and person to whom the result was communicated in the final report or an addendum report. ![]() The most common time frame was same day many laboratories did not specify a timeframe. A direct phone call to the responsible provider was uniformly considered an acceptable means of communication all other methods had mixed or low support. There was substantial variation in the diagnoses that were considered critical. Twelve of 38 (32%) institutions divided critical values into 2 categories, of which 9 used the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology terminology 24 used only a single term, of which 11 used critical value. Twenty-five of 38 (66%) respondents had read the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology consensus statement. Thirty-five of 38 (92%) had a policy on anatomic pathology critical values. Autopsy examination can answer questions family members may have about the patient’s death, but can also increase understanding of disease for the physicians caring for the patient.Responses were received from 38 institutions. Cytopathologists examine individual cells and small collections of cells to assess for the presence or absence of malignancy.Īutopsy Pathology: This is the anatomic examination of a deceased patient to determine what diseases were present and how extensive they were, and to assemble these findings into an explanation for why the patient died. Obtaining a cytopathology specimen is typically less invasive than obtaining a surgical pathology specimen, so these procedures can be performed in a clinic or a physician’s office. In this way, the pathologist helps guide any subsequent therapy the patient may need.Ĭytopathology: This is the examination of very small amounts of tissue removed by scraping a surface, or by aspiration through a fine needle. Pathologists often also use a variety of specialized molecular techniques to further refine the diagnosis and to predict how the disease may respond to various types of treatment. In all cases, pathologists make their diagnoses by examining thin slices of the lesion under a microscope. ![]() When a biopsy is done (typically a small sampling of a lesion by incision or by an invasive technique like a core needle biopsy or endoscopy), the pathologist determines what disease process is present, and/or the extent of disease. This is the examination of tissue removed as a biopsy or as part of a surgical procedure. Anatomic Pathology has three major divisions:
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