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Christensen RE, Yi MD, Kang BY, Ibrahim SA, Anvery N, Dirr M, Adams S, Amer YS, Bisdorff A, Bradfield L, Brown S, Earley A, Fatheree LA, Fayoux P, Getchius T, Ginex P, Graham A, Green CR, Gresele P, Hanson H, Haynes N, Hegedüs L, Hussein H, Jakhmola P, Kantorova L, Krishnasamy R, Krist A, Landry G, Lease ED, Ley L, Marsden G, Meek T, Meremikwu M, Moga C, Mokrane S, Mujoomdar A, Newton S, O'Flynn N, Perkins GD, Smith EJ, Prematunge C, Rychert J, Saraco M, Schünemann HJ, Senerth E, Sinclair A, Shwayder J, Stec C, Tanni S, Taske N, Temple-Smolkin RL, Thomas L, Thomas S, Tonnessen B, Turner AS, Van Dam A, van Doormaal M, Wan YL, Ventura CB, McFarlane E, Morgan RL, Ogunremi T, Alam M. Development of an international glossary for clinical guidelines collaboration. J Clin Epidemiol 2023; 158:84-91. [PMID: 37019344 DOI: 10.1016/j.jclinepi.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Clinical practice guidelines (CPGs) are often created through collaboration among organizations. The use of inconsistent terminology may cause poor communication and delays. This study aimed to develop a glossary of terms related to collaboration in guideline development. STUDY DESIGN AND SETTING A literature review of collaborative guidelines was performed to develop an initial list of terms related to guideline collaboration. The list of terms was presented to the members of the Guideline International Network Guidelines Collaboration Working Group, who provided presumptive definitions for each term and proposed additional terms to be included. The revised list was subsequently reviewed by an international, multidisciplinary panel of expert stakeholders. Recommendations received during this pre-Delphi review were implemented to augment an initial draft glossary. The glossary was then critically evaluated and refined through two rounds of Delphi surveys and a virtual consensus meeting with all panel members as Delphi participants. RESULTS Forty-nine experts participated in the pre-Delphi survey, and 44 participated in the two-round Delphi process. Consensus was reached for 37 terms and definitions. CONCLUSION Uptake and utilization of this guideline collaboration glossary by key organizations and stakeholder groups may facilitate collaboration among guideline-producing organizations by improving communication, minimizing conflicts, and increasing guideline development efficiency.
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Affiliation(s)
- Rachel E Christensen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland
| | - Michael D Yi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland
| | - Bianca Y Kang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Noor Anvery
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - McKenzie Dirr
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, FL, USA
| | - Yasser S Amer
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Pediatrics Department and Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia; Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Amy Earley
- Kidney Disease Improving Global Outcomes (KDIGO), Brussels, Belgium
| | - Lisa A Fatheree
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; American College of Rheumatology, OH, USA
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Thomas Getchius
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; American Heart Association/American College of Cardiology, Dallas, Texas, USA
| | - Pamela Ginex
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Stony Brook University School of Nursing, Stony Brook, NY, USA
| | - Amanda Graham
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada
| | - Paolo Gresele
- Department of Medicine and Surgery - Head section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Helen Hanson
- St. George's University Hospitals National Health Service Foundation Trust, London, UK
| | | | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Heba Hussein
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Oral Medicine, Oral Diagnosis, and Periodontology Department, Cairo University, Cairo, Egypt
| | - Priya Jakhmola
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucia Kantorova
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Australia; The University of Queensland, Australia
| | - Alex Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, VA, USA
| | - Gregory Landry
- Division of Vascular Surgery, Kootenai Clinic, Coeur d'Alene, ID, USA
| | | | - Luis Ley
- Department of Neurosurgery, Hospital Ramón y Cajal, Madrid, Spain
| | - Gemma Marsden
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Healthcare Infection Society, London UK
| | - Tim Meek
- Association of Anaesthetists, London, UK
| | - Martin Meremikwu
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Department of Pediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Carmen Moga
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Saphia Mokrane
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; WOREL (Werkgroep Ontwikkeling Richtlijnen Eerste Lijn) - Working Group Development of Primary Care Guidelines, Belgium; Department of Primary Care, Université Libre de Bruxelles, Brussels, Belgium; Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Amol Mujoomdar
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Western University, London, ON, Canada
| | - Skye Newton
- Adelaide Health Technology Assessment, University of Adelaide, Australia
| | | | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Emma-Jane Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Chatura Prematunge
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jenna Rychert
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT
| | | | - Holger J Schünemann
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Emily Senerth
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Cardiovascular Angiography & Interventions, Washington, DC, USA
| | | | - James Shwayder
- Department of Pulmonology, Botucatu Medical School-UNESP, São Paulo, Brazil
| | - Carla Stec
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, FL, USA
| | | | - Nichole Taske
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Association for Molecular Pathology, MD, USA
| | - Robyn L Temple-Smolkin
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Association for Molecular Pathology, MD, USA
| | - Louise Thomas
- Head of Quality Improvement, Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Britt Tonnessen
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Amy S Turner
- American College of Rheumatology, OH, USA; American College of Rheumatology, Atlanta, GA, USA
| | - Anne Van Dam
- Canadian Thoracic Society, Ottawa, Ontario, Canada
| | | | - Yung Liang Wan
- Dept. of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Christina B Ventura
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; College of American Pathologists, Northfield, IL, USA
| | - Emma McFarlane
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; National Institute for Health and Care Excellence, Manchester, UK
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Toju Ogunremi
- Healthcare Associated Infections and Infection Prevention and Control Section, National Advisory Committee on Infection Prevention and Control, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Murad Alam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Sultan S, Siedler MR, Morgan RL, Ogunremi T, Dahm P, Fatheree LA, Getchius TSD, Ginex PK, Jakhmola P, McFarlane E, Murad MH, Temple Smolkin RL, Amer YS, Alam M, Kang BY, Falck-Ytter Y, Mustafa RA. An International Needs Assessment Survey of Guideline Developers Demonstrates Variability in Resources and Challenges to Collaboration between Organizations. J Gen Intern Med 2022; 37:2669-2677. [PMID: 34545466 PMCID: PMC9411275 DOI: 10.1007/s11606-021-07112-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/20/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The development of rigorous, high-quality clinical guidelines increases the need for resources and skilled personnel within guideline-producing organizations. While collaboration between organizations provides a unique opportunity to pool resources and save time and effort, the collaboration presents its own unique challenges. OBJECTIVE To assess the perceived needs and current challenges of guideline producers worldwide related to guideline development and collaboration efforts. DESIGN Survey questions were developed by the Guidelines International Network and the US GRADE Network, pilot-tested among attendees of a guideline development workshop, and disseminated electronically using convenience and snowball sampling methods. PARTICIPANTS A total of 171 respondents representing 30 countries and more than 112 unique organizations were included in this analysis. MAIN MEASURES The survey included free-response, multiple-choice, and seven-point Likert-scale questions. Questions assessed respondents' perceived value of guidelines, resource availability and needs, guideline development processes, and collaboration efforts of their organization. KEY RESULTS Time required to develop high-quality systematic reviews and guidelines was the most relevant need (median=7; IQR=5.5-7). In-house resources to conduct literature searches (median=4; IQR=3-6) and the resources to develop rigorous guidelines rapidly (median=4; IQR=2-5) were perceived as the least available resources. Difficulties reconciling differences in guideline methodology (median=6; IQR=4-7) and the time required to establish collaborative agreements (median=6; IQR=5-6) were the most relevant barriers to collaboration between organizations. Results also indicated a general need for improvement in conflict of interest (COI) disclosure policies. CONCLUSION The survey identified organizational challenges in supporting rigorous guideline development, including the time, resources, and personnel required. Connecting guideline developers to existing databases of high-quality systematic reviews and the use of freely available online platforms may facilitate guideline development. Guideline-producing organizations may also consider allocating resources to hiring or training personnel with expertise in systematic review methodologies or utilizing resources more effectively by establishing collaborations with other organizations.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, MN, USA.
| | - Madelin R Siedler
- Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Rebecca L Morgan
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Toju Ogunremi
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Philipp Dahm
- Department of Urology, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, MN, USA
| | | | - Thomas S D Getchius
- Guideline Strategy and Operations, American Heart Association and American College of Cardiology, Dallas, TX, USA
| | - Pamela K Ginex
- Evidence-Based Practice, Oncology Nursing Society, Pittsburgh, PA, USA
| | - Priya Jakhmola
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - M Hassan Murad
- Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Yasser S Amer
- Pediatrics, Quality Management, King Saud University Medical City, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yngve Falck-Ytter
- Gastroenterology Seection, VA Northeast Ohio Healthcare System, Case Western Reserve University, Cleveland, OH, USA
| | - Reem A Mustafa
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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3
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Alam M, Getchius TSD, Schünemann H, Amer YS, Bak A, Fatheree LA, Ginex P, Jakhmola P, Marsden GL, McFarlane E, Meremikwu M, Taske N, Temple-Smolkin RL, Ventura C, Burgers J, Bradfield L, O'Brien MD, Einhaus K, Kopp IB, Munn Z, Scudeller L, Schaefer C, Ibrahim SA, Kang BY, Ogunremi T, Morgan RL. A memorandum of understanding has facilitated guideline development involving collaborating groups. J Clin Epidemiol 2021; 144:8-15. [DOI: 10.1016/j.jclinepi.2021.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
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Goldsmith JD, Fitzgibbons PL, Fatheree LA, Astles JR, Nowak JA, Souers RJ, Volmar KE, Nakhleh RE. Evaluating the Adoption of Laboratory Practice Guidelines. Arch Pathol Lab Med 2019; 144:83-89. [DOI: 10.5858/arpa.2018-0276-cp] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
To date, the College of American Pathologists (CAP) has developed 17 laboratory practice guidelines (LPGs) including updates. In 2013, the CAP was awarded a 5-year cooperative agreement grant from the United States Centers for Disease Control and Prevention to increase the effectiveness of LPGs.
Objective.—
To assess the awareness and adoption of 2 CAP LPGs: immunohistochemical (IHC) assay validation and initial workup of acute leukemia.
Design.—
Baseline surveys for each LPG were conducted in 2010 and 2015, respectively. To measure the adoption of guideline recommendations and inform future updates, a follow-up study consisting of surveys, telephone interviews, and focus group sessions was conducted in laboratories that indicated they perform IHC testing. A follow-up study for the acute leukemia LPG is planned.
Results.—
For the IHC Validation LPG, a total of 1624 survey responses, 40 telephone interviews, and discussions with 5 focus group participants were analyzed. The response rate for the aforementioned 3 modalities was 46%, 13%, and 3%, respectively. All modalities indicated most respondents were aware of the LPG and had adopted most or all of its recommendations. Respondents expressed needs for continued communication, increased specificity, and more prescriptive recommendations when the guideline is updated.
Conclusions.—
While data-driven development of evidence-based LPGs requires significant resources, active data collection to identify gaps and assess adoption contributes to improved laboratory testing practices in support of patient care. The CAP identified sustainable modalities to track metrics and developed multiple tools that should improve guideline development, adoption, and implementation. Of these modalities, written or electronic surveys were the most logistically feasible and had the highest response rate.
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Affiliation(s)
- Jeffrey D. Goldsmith
- From the Department of Pathology, Children's Hospital Boston, Boston, Massachusetts (Dr Goldsmith); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); Pathology and Laboratory Quality Center for Evidence-Based Guidelines (Ms Fatheree) and Statistics/Biostatistics (Ms Souers), College of American Pathologists, Northfield, Illinois; Division of Laboratory
| | - Patrick L. Fitzgibbons
- From the Department of Pathology, Children's Hospital Boston, Boston, Massachusetts (Dr Goldsmith); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); Pathology and Laboratory Quality Center for Evidence-Based Guidelines (Ms Fatheree) and Statistics/Biostatistics (Ms Souers), College of American Pathologists, Northfield, Illinois; Division of Laboratory
| | - Lisa A. Fatheree
- From the Department of Pathology, Children's Hospital Boston, Boston, Massachusetts (Dr Goldsmith); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); Pathology and Laboratory Quality Center for Evidence-Based Guidelines (Ms Fatheree) and Statistics/Biostatistics (Ms Souers), College of American Pathologists, Northfield, Illinois; Division of Laboratory
| | - J. Rex Astles
- From the Department of Pathology, Children's Hospital Boston, Boston, Massachusetts (Dr Goldsmith); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); Pathology and Laboratory Quality Center for Evidence-Based Guidelines (Ms Fatheree) and Statistics/Biostatistics (Ms Souers), College of American Pathologists, Northfield, Illinois; Division of Laboratory
| | - Jan A. Nowak
- From the Department of Pathology, Children's Hospital Boston, Boston, Massachusetts (Dr Goldsmith); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); Pathology and Laboratory Quality Center for Evidence-Based Guidelines (Ms Fatheree) and Statistics/Biostatistics (Ms Souers), College of American Pathologists, Northfield, Illinois; Division of Laboratory
| | - Rhona J. Souers
- From the Department of Pathology, Children's Hospital Boston, Boston, Massachusetts (Dr Goldsmith); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); Pathology and Laboratory Quality Center for Evidence-Based Guidelines (Ms Fatheree) and Statistics/Biostatistics (Ms Souers), College of American Pathologists, Northfield, Illinois; Division of Laboratory
| | - Keith E. Volmar
- From the Department of Pathology, Children's Hospital Boston, Boston, Massachusetts (Dr Goldsmith); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); Pathology and Laboratory Quality Center for Evidence-Based Guidelines (Ms Fatheree) and Statistics/Biostatistics (Ms Souers), College of American Pathologists, Northfield, Illinois; Division of Laboratory
| | - Raouf E. Nakhleh
- From the Department of Pathology, Children's Hospital Boston, Boston, Massachusetts (Dr Goldsmith); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); Pathology and Laboratory Quality Center for Evidence-Based Guidelines (Ms Fatheree) and Statistics/Biostatistics (Ms Souers), College of American Pathologists, Northfield, Illinois; Division of Laboratory
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Fatheree LA, Fitzgibbons PL, Rao P, Thomas NE, Zhou M, Tambouret R. Localized Renal Masses: Comment on Recent American Urological Association Guideline. Arch Pathol Lab Med 2019; 143:659. [PMID: 31121111 DOI: 10.5858/arpa.2019-0023-le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lisa A Fatheree
- 1 Pathology and Laboratory Quality Center for Evidence-Based Guidelines, College of American Pathologists, Northfield, Illinois
| | | | - Priya Rao
- 3 Department of Pathology, UT MD Anderson Cancer Center, Houston, Texas
| | - Nicole E Thomas
- 1 Pathology and Laboratory Quality Center for Evidence-Based Guidelines, College of American Pathologists, Northfield, Illinois
| | - Ming Zhou
- 4 Department of Pathology, University of Texas Southwestern Medical Center, Dallas
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Nakhleh R, Fitzgibbons PL, Nowak JA, Najarian RM, Keren DF, Colgan TJ, Colasacco C, Fatheree LA. The Lifecycle of an Evidence-Based Laboratory Practice Guideline: Origin, Update, Affirmation, and Impact! Arch Pathol Lab Med 2018; 142:438-440. [DOI: 10.5858/arpa.2017-0401-ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Raouf Nakhleh
- From the Department of Pathology, Mayo Clinic Florida, Jacksonville (Dr Nakhleh); the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Najarian); the D
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Stuart LN, Volmar KE, Nowak JA, Fatheree LA, Souers RJ, Fitzgibbons PL, Goldsmith JD, Astles JR, Nakhleh RE. Analytic Validation of Immunohistochemistry Assays: New Benchmark Data From a Survey of 1085 Laboratories. Arch Pathol Lab Med 2017; 141:1255-1261. [PMID: 28557616 DOI: 10.5858/arpa.2016-0559-cp] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A cooperative agreement between the College of American Pathologists (CAP) and the United States Centers for Disease Control and Prevention was undertaken to measure laboratories' awareness and implementation of an evidence-based laboratory practice guideline (LPG) on immunohistochemical (IHC) validation practices published in 2014. OBJECTIVE - To establish new benchmark data on IHC laboratory practices. DESIGN - A 2015 survey on IHC assay validation practices was sent to laboratories subscribed to specific CAP proficiency testing programs and to additional nonsubscribing laboratories that perform IHC testing. Specific questions were designed to capture laboratory practices not addressed in a 2010 survey. RESULTS - The analysis was based on responses from 1085 laboratories that perform IHC staining. Ninety-six percent (809 of 844) always documented validation of IHC assays. Sixty percent (648 of 1078) had separate procedures for predictive and nonpredictive markers, 42.7% (220 of 515) had procedures for laboratory-developed tests, 50% (349 of 697) had procedures for testing cytologic specimens, and 46.2% (363 of 785) had procedures for testing decalcified specimens. Minimum case numbers were specified by 85.9% (720 of 838) of laboratories for nonpredictive markers and 76% (584 of 768) for predictive markers. Median concordance requirements were 95% for both types. For initial validation, 75.4% (538 of 714) of laboratories adopted the 20-case minimum for nonpredictive markers and 45.9% (266 of 579) adopted the 40-case minimum for predictive markers as outlined in the 2014 LPG. The most common method for validation was correlation with morphology and expected results. Laboratories also reported which assay changes necessitated revalidation and their minimum case requirements. CONCLUSIONS - Benchmark data on current IHC validation practices and procedures may help laboratories understand the issues and influence further refinement of LPG recommendations.
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Fitzgibbons PL, Goldsmith JD, Souers RJ, Fatheree LA, Volmar KE, Stuart LN, Nowak JA, Astles JR, Nakhleh RE. Analytic Validation of Immunohistochemical Assays: A Comparison of Laboratory Practices Before and After Introduction of an Evidence-Based Guideline. Arch Pathol Lab Med 2017; 141:1247-1254. [PMID: 28557617 DOI: 10.5858/arpa.2016-0558-cp] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Laboratories must demonstrate analytic validity before any test can be used clinically, but studies have shown inconsistent practices in immunohistochemical assay validation. OBJECTIVE - To assess changes in immunohistochemistry analytic validation practices after publication of an evidence-based laboratory practice guideline. DESIGN - A survey on current immunohistochemistry assay validation practices and on the awareness and adoption of a recently published guideline was sent to subscribers enrolled in one of 3 relevant College of American Pathologists proficiency testing programs and to additional nonsubscribing laboratories that perform immunohistochemical testing. The results were compared with an earlier survey of validation practices. RESULTS - Analysis was based on responses from 1085 laboratories that perform immunohistochemical staining. Of 1057 responses, 65.4% (691) were aware of the guideline recommendations before this survey was sent and 79.9% (550 of 688) of those have already adopted some or all of the recommendations. Compared with the 2010 survey, a significant number of laboratories now have written validation procedures for both predictive and nonpredictive marker assays and specifications for the minimum numbers of cases needed for validation. There was also significant improvement in compliance with validation requirements, with 99% (100 of 102) having validated their most recently introduced predictive marker assay, compared with 74.9% (326 of 435) in 2010. The difficulty in finding validation cases for rare antigens and resource limitations were cited as the biggest challenges in implementing the guideline. CONCLUSIONS - Dissemination of the 2014 evidence-based guideline validation practices had a positive impact on laboratory performance; some or all of the recommendations have been adopted by nearly 80% of respondents.
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George TI, Tworek JA, Thomas NE, Fatheree LA, Souers RJ, Nakhleh RE, Arber DA. Evaluation of Testing of Acute Leukemia Samples: Survey Result From the College of American Pathologists. Arch Pathol Lab Med 2017; 141:1101-1106. [PMID: 28537804 DOI: 10.5858/arpa.2016-0398-cp] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - The classification and prognosis determination in acute leukemia (AL) are complex and it is unclear what testing is being performed in practice. OBJECTIVE - To survey physicians describing their current practice of test ordering in the diagnosis of AL. DESIGN - In anticipation of a guideline by the College of American Pathologists (CAP) and the American Society for Hematology on laboratory testing needed for the initial workup of AL, a baseline survey was designed by an expert panel from CAP. Members of professional societies were asked to describe their current practice of test ordering. RESULTS - Two hundred ninety-four responses were received with 258 respondents analyzed after the first qualifying survey question regarding initial diagnosis of AL. One hundred seventy-six of 249 respondents (70.7%) were board-certified hematopathologists. Flow cytometry and karyotype analysis were routinely performed for acute myeloid leukemia (AML) (99.1% [232 of 234] and 96.2% [225 of 234], respectively) and acute lymphoblastic leukemia (ALL) (98.3% [229 of 233] and 96.6% [225 of 233], respectively). In addition, fluorescence in situ hybridization studies were routinely performed by 81.2% (190 of 234) of respondents for AML and 85.0% (198 of 233) of respondents for ALL; other molecular studies were performed by 78.2% (183) for AML and 54.9% (128) for ALL; immunohistochemistry by 44.9% (105) for AML and 47.6% (111) for ALL; and cytochemistry by 24.8% (58) for AML and 14.2% (33) for ALL. CONCLUSIONS - While flow cytometry and karyotyping are routinely reported as being performed for the diagnosis of AL, there is marked variation in the reporting of testing patterns for other genetic studies, immunohistochemistry, and cytochemistry.
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Affiliation(s)
| | | | | | | | | | | | - Daniel A Arber
- From the Department of Pathology, University of New Mexico, Albuquerque (Dr George); the Department of Pathology, St. Joseph Mercy Hospital, Ann Arbor, Michigan (Dr Tworek); Laboratory and Pathology Quality Center (Mses Thomas and Fatheree) and Statistics Department (Ms Souers), College of American Pathologists, Northfield, Illinois; Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville (Dr Nakhleh); and Department of Pathology, Stanford University, Stanford, California (Dr Arber)
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Nakhleh RE, Nosé V, Colasacco C, Fatheree LA, Lillemoe TJ, McCrory DC, Meier FA, Otis CN, Owens SR, Raab SS, Turner RR, Ventura CB, Renshaw AA. Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology. Arch Pathol Lab Med 2016; 140:29-40. [PMID: 25965939 DOI: 10.5858/arpa.2014-0511-sa] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Additional reviews of diagnostic surgical and cytology cases have been shown to detect diagnostic discrepancies. OBJECTIVE To develop, through a systematic review of the literature, recommendations for the review of pathology cases to detect or prevent interpretive diagnostic errors. DESIGN The College of American Pathologists Pathology and Laboratory Quality Center in association with the Association of Directors of Anatomic and Surgical Pathology convened an expert panel to develop an evidence-based guideline to help define the role of case reviews in surgical pathology and cytology. A literature search was conducted to gather data on the review of cases in surgical pathology and cytology. RESULTS The panel drafted 5 recommendations, with strong agreement from open comment period participants ranging from 87% to 93%. The recommendations are: (1) anatomic pathologists should develop procedures for the review of selected pathology cases to detect disagreements and potential interpretive errors; (2) anatomic pathologists should perform case reviews in a timely manner to avoid having a negative impact on patient care; (3) anatomic pathologists should have documented case review procedures that are relevant to their practice setting; (4) anatomic pathologists should continuously monitor and document the results of case reviews; and (5) if pathology case reviews show poor agreement within a defined case type, anatomic pathologists should take steps to improve agreement. CONCLUSIONS Evidence exists that case reviews detect errors; therefore, the expert panel recommends that anatomic pathologists develop procedures for the review of pathology cases to detect disagreements and potential interpretive errors, in order to improve the quality of patient care.
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Affiliation(s)
- Raouf E Nakhleh
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Dr Nakhleh); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Nosé); Governance (Ms Colasacco) and the Pathology and Laboratory Quality Center (Mss Fatheree and Ventura), College of American Pathologists, Northfield, Illinois; Hospital Pathology Associates, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Lillemoe); the Department of Medicine, Duke University, Durham, North Carolina (Dr McCrory); the Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan (Dr Meier); the Department of Pathology, Baystate Medical Center, Springfield, Massachusetts (Dr Otis); the Department of Pathology, University of Michigan Medical School, Ann Arbor (Dr Owens); the Department of Pathology, Memorial University of Newfoundland/Eastern Health Authority, St John's, Newfoundland, Canada (Dr Raab); the Department of Pathology, St John's Health Center, Santa Monica, California (Dr Turner); and the Department of Pathology, Homestead Hospital, Homestead, Florida (Dr Renshaw). Dr Meier is currently with the Department of Pathology, Massachusetts General Hospital, Boston
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Fitzgibbons PL, Bradley LA, Fatheree LA, Alsabeh R, Fulton RS, Goldsmith JD, Haas TS, Karabakhtsian RG, Loykasek PA, Marolt MJ, Shen SS, Smith AT, Swanson PE. Principles of analytic validation of immunohistochemical assays: Guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med 2014; 138:1432-43. [PMID: 24646069 DOI: 10.5858/arpa.2013-0610-cp] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT Laboratories must validate all assays before they can be used to test patient specimens, but currently there are no evidence-based guidelines regarding validation of immunohistochemical assays. OBJECTIVE To develop recommendations for initial analytic validation and revalidation of immunohistochemical assays. DESIGN The College of American Pathologists Pathology and Laboratory Quality Center convened a panel of pathologists and histotechnologists with expertise in immunohistochemistry to develop validation recommendations. A systematic evidence review was conducted to address key questions. Electronic searches identified 1463 publications, of which 126 met inclusion criteria and were extracted. Individual publications were graded for quality, and the key question findings for strength of evidence. Recommendations were derived from strength of evidence, open comment feedback, and expert panel consensus. RESULTS Fourteen guideline statements were established to help pathology laboratories comply with validation and revalidation requirements for immunohistochemical assays. CONCLUSIONS Laboratories must document successful analytic validation of all immunohistochemical tests before applying to patient specimens. The parameters for cases included in validation sets, including number, expression levels, fixative and processing methods, should take into account intended use and should be sufficient to ensure that the test accurately measures the analyte of interest in specimens tested in that laboratory. Recommendations are also provided for confirming assay performance when there are changes in test methods, reagents, or equipment.
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Affiliation(s)
- Patrick L Fitzgibbons
- From the Department of Pathology, St. Jude Medical Center, Fullerton, California (Dr Fitzgibbons); the Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Brown University, Providence, Rhode Island (Dr Bradley); the College of American Pathologists, Northfield, Illinois (Ms Fatheree and Mr Smith); the Department of Pathology, Kaiser Permanente - Los Angeles Medical Center, Los Angeles, California (Dr Alsabeh); PhenoPath Laboratories, Seattle, Washington (Dr Fulton); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Goldsmith); the Department of Pathology, Mercy Hospital, Janesville, Wisconsin (Dr Haas); the Department of Pathology, Montefiore Medical Center, New York, New York (Dr Karabakhtsian); Regional Medical Laboratory, St John's Medical Center, Tulsa, Oklahoma (Ms Loykasek); the Department of Pathology, University of Minnesota Medical Center, Fairview, Minneapolis (Dr Marolt); the Department of Pathology, The Methodist Hospital, Houston, Texas (Dr Shen); and the Department of Pathology, University of Washington Medical Center, Seattle (Dr Swanson)
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Pantanowitz L, Sinard JH, Henricks WH, Fatheree LA, Carter AB, Contis L, Beckwith BA, Evans AJ, Lal A, Parwani AV. Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med 2013; 137:1710-22. [PMID: 23634907 PMCID: PMC7240346 DOI: 10.5858/arpa.2013-0093-cp] [Citation(s) in RCA: 391] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT There is increasing interest in using whole slide imaging (WSI) for diagnostic purposes (primary and/or consultation). An important consideration is whether WSI can safely replace conventional light microscopy as the method by which pathologists review histologic sections, cytology slides, and/or hematology slides to render diagnoses. Validation of WSI is crucial to ensure that diagnostic performance based on digitized slides is at least equivalent to that of glass slides and light microscopy. Currently, there are no standard guidelines regarding validation of WSI for diagnostic use. OBJECTIVE To recommend validation requirements for WSI systems to be used for diagnostic purposes. DESIGN The College of American Pathologists Pathology and Laboratory Quality Center convened a nonvendor panel from North America with expertise in digital pathology to develop these validation recommendations. A literature review was performed in which 767 international publications that met search term requirements were identified. Studies outside the scope of this effort and those related solely to technical elements, education, and image analysis were excluded. A total of 27 publications were graded and underwent data extraction for evidence evaluation. Recommendations were derived from the strength of evidence determined from 23 of these published studies, open comment feedback, and expert panel consensus. RESULTS Twelve guideline statements were established to help pathology laboratories validate their own WSI systems intended for clinical use. Validation of the entire WSI system, involving pathologists trained to use the system, should be performed in a manner that emulates the laboratory's actual clinical environment. It is recommended that such a validation study include at least 60 routine cases per application, comparing intraobserver diagnostic concordance between digitized and glass slides viewed at least 2 weeks apart. It is important that the validation process confirm that all material present on a glass slide to be scanned is included in the digital image. CONCLUSIONS Validation should demonstrate that the WSI system under review produces acceptable digital slides for diagnostic interpretation. The intention of validating WSI systems is to permit the clinical use of this technology in a manner that does not compromise patient care.
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Affiliation(s)
- Liron Pantanowitz
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Pantanowitz, Contis, and Parwani); the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Dr Sinard); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Dr Henricks); the College of American Pathologists, Northfield, Illinois (Ms Fatheree); the Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (Dr Carter); the Department of Pathology, North Shore Medical Center, Salem, Massachusetts (Dr Beckwith); the Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada (Dr Evans); the Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts (Dr Otis); and University Hospital, London Health Science Center, London, Ontario, Canada (Dr Lal)
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Pantanowitz L, Sinard JH, Fatheree LA, Henricks WH, Carter AB, Contis L, Beckwith BA, Evans AJ, Otis CN, MacDonald J, Parwani AV. Recommendations for Validating Whole Slide Imaging in Pathology: College of American Pathologists Pathology and Laboratory Quality Center. Am J Clin Pathol 2012. [DOI: 10.1093/ajcp/138.suppl1.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nakhleh RE, Myers JL, Allen TC, DeYoung BR, Fitzgibbons PL, Funkhouser WK, Mody DR, Lynn A, Fatheree LA, Smith AT, Lal A, Silverman JF. Consensus statement on effective communication of urgent diagnoses and significant, unexpected diagnoses in surgical pathology and cytopathology from the College of American Pathologists and Association of Directors of Anatomic and Surgical Pathology. Arch Pathol Lab Med 2012; 136:148-54. [PMID: 21992705 DOI: 10.5858/arpa.2011-0400-sa] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Recognizing the difficulty in applying the concept of critical values to anatomic pathology diagnoses, the College of American Pathologists and the Association of Directors of Anatomic and Surgical Pathology have chosen to reevaluate the concept of critical diagnoses. OBJECTIVE To promote effective communication of urgent and significant, unexpected diagnoses in surgical pathology and cytology. DESIGN A comprehensive literature search was conducted and reviewed by an expert panel. RESULTS A policy of effective communication of important results in surgical pathology and cytology is desirable to enhance patient safety and to address multiple regulatory requirements. CONCLUSIONS Each institution should create its own policy regarding urgent diagnoses and significant, unexpected diagnoses in anatomic pathology. This policy should be separate from critical results or panic-value policies in clinical pathology, with the expectation of a different time frame for communication. Urgent diagnosis is defined as a medical condition that, in most cases, should be addressed as soon as possible. Significant, unexpected diagnosis is defined as a medical condition that is clinically unusual or unforeseen and should be addressed at some point in the patient's course. Further details of this statement are provided.
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Affiliation(s)
- Raouf E Nakhleh
- Department of Pathology, Mayo Clinic Florida, Jacksonville, 32224, USA.
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Ducatman BS, Bentz JS, Fatheree LA, Souers R, Ostrowski S, Moriarty AT, Henry M, Laucirica R, Booth CN, Wilbur DC. Gynecologic Cytology Proficiency Testing Failures: What Have We Learned?: Observations From the College of American Pathologists Gynecologic Cytology Proficiency Testing Program. Arch Pathol Lab Med 2011; 135:1442-6. [DOI: 10.5858/arpa.2010-0681-sa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Context.—In 2006, the first gynecologic cytology proficiency tests were offered by the College of American Pathologists. Four years of data are now available using field-validated slides, including conventional and liquid-based Papanicolaou tests.
Objective.—To characterize the pattern of error types that resulted in initial proficiency-test failure for cytotechnologists, primary screening pathologists, and secondary pathologists (those whose slides are prescreened by cytotechnologists).
Design.—The results of 37 029 initial College of American Pathologists Papanicolaou proficiency tests were reviewed from 4 slide-set modules: conventional, ThinPrep, SurePath, or a module containing all 3 slide types.
Results.—During this 4-year period, cytotechnologists were least likely to fail the initial test (3.4%; 614 of 18 264), followed by secondary pathologists (ie, those reviewing slides already screened by a cytotechnologist) with a failure rate of 4.2% (728 of 17 346), and primary pathologists (ie, those screening their own slides) having the highest level of failure (13.7%; 194 of 1419). Failure rates have fallen for all 3 groups over time. Pathologists are graded more stringently on proficiency tests, and more primary pathologists would have passed if they had been graded as cytotechnologists. There were no significant differences among performances using different types of slide sets. False-positive errors were common for both primary (63.9%; 124 of 194 errors) and secondary (55.6%; 405 of 728 errors) pathologists, whereas automatic failures were most common for cytotechnologists (75.7%; 465 of 614 errors).
Conclusions.—The failure rate is decreasing for all participants. The failures for primary pathologist screeners are due to false-positive responses. Primary screening cytotechnologists and secondary pathologists have automatic failures more often than do primary screening pathologists.
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Auger M, Moriarty AT, Laucirica R, Souers R, Chmara BA, Fatheree LA, Wilbur DC. Granulomatous inflammation-an underestimated cause of false-positive diagnoses in lung fine-needle aspirates: observations from the college of american pathologists nongynecologic cytopathology interlaboratory comparison program. Arch Pathol Lab Med 2011; 134:1793-6. [PMID: 21128777 DOI: 10.5858/2009-0491-cpr2.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The false-positive rate for fine-needle aspirates of the lung has been cited as less than 1% for granulomatous inflammation, comprising one of the known causes of false-positive diagnoses. OBJECTIVE To determine the rate of false-positive diagnoses of granulomatous inflammation for lung fine-needle aspirates by assessing the false-positive response rate in the context of the College of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. DESIGN We performed a retrospective review of 1092 participant responses for lung fine-needle aspirate challenges with the reference diagnosis of specific infections/granulomatous inflammation from 1998 to 2008 from the College of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. False-positive rates by participant type (pathologist versus cytotechnologist), general diagnosis category, reference diagnosis, and preparation type were analyzed for the pathologists' responses. RESULTS Of the 502 general category responses for pathologists, 428 (85.3%) were benign, 55 (11%) were malignant, and 19 (3.8%) were suspicious. There was no difference in the false-positive rate between preparations (P = .76) or participants (P = .39). Of those responses by pathologists that were benign, only 68.7% (292 of 425) were an exact match to granulomatous inflammation. Non-small cell carcinoma, adenocarcinoma, and squamous carcinoma represented 64% of false-positive/suspicious responses, while small cell carcinoma and carcinoid comprised 13%. CONCLUSION In an interlaboratory comparison program, granulomatous inflammation represents an important cause of false-positive/suspicious responses in lung fine-needle aspirates (14.8%) and is much higher than false-positive rates reported historically in clinical studies. These results highlight the importance of granulomatous inflammation as a mimic of carcinoma.
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Affiliation(s)
- Manon Auger
- Department of Pathology, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
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Al-Abbadi MA, Bloom LI, Fatheree LA, Haack LA, Minkowitz G, Wilbur DC, Austin MR. Adequate reimbursement is crucial to support cost-effective rapid on-site cytopathology evaluations. Cytojournal 2010; 7:22. [PMID: 21085619 PMCID: PMC2980693 DOI: 10.4103/1742-6413.71740] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 08/12/2010] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mousa A Al-Abbadi
- James H. Quillen VA Medical Center, Department of Pathology, East Teneesee State University, Johnson City, USA
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Eversole GM, Moriarty AT, Schwartz MR, Clayton AC, Souers R, Fatheree LA, Chmara BA, Tench WD, Henry MR, Wilbur DC. Practices of participants in the college of american pathologists interlaboratory comparison program in cervicovaginal cytology, 2006. Arch Pathol Lab Med 2010; 134:331-5. [PMID: 20196659 DOI: 10.5858/134.3.331] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Liquid-based preparations (LBPs) and human papillomavirus testing have led to changes in cervical cytology practices. The College of American Pathologists attempts to track practice patterns using a supplemental questionnaire, which allows laboratories to report diagnostic practices. OBJECTIVE To analyze the 2006 reporting practices and to compare the results with the 2003 survey data. DESIGN Questionnaire was mailed to 1621 laboratories. Participants included laboratories enrolled in the 2006 College of American Pathologists Gynecologic Proficiency Testing Program or the educational Interlaboratory Comparison Program in Gynecologic Cytology. RESULTS Of the 679 responding laboratories (response rate, 42%), most (97.8%; n = 664) had implemented the Bethesda 2001 terminology. The median rate for all preparations with low-grade squamous intraepithelial lesions was 2.5% (2.9% for LBPs) compared with a 2003 median rate of 2.1%; the increase was confined to LBPs. Rates for high-grade squamous intraepithelial lesions (median, 0.5%) and atypical squamous cells have changed little. High-grade squamous intraepithelial lesions and unsatisfactory rates varied at statistically significant levels between types of LBPs. Most atypical squamous cell cases were subclassified as undetermined significance (median, 4.3%). The median ratio of atypical squamous cells to squamous intraepithelial lesions and carcinomas for all specimen types combined was 1.5, similar to the 2003 median ratio of 1.4. The median rates for findings of squamous cell abnormalities for 2006 were significantly higher for LBPs than for conventional smears. CONCLUSIONS Most responding laboratories have implemented the Bethesda 2001 terminology. There is an increase in LBP low-grade squamous intraepithelial lesion rates when compared with 2003 data. Liquid-based preparations have higher median squamous intraepithelial lesion and atypical squamous cell rates.
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Affiliation(s)
- Galen M Eversole
- Department of Pathology, Quest Diagnostics Inc, Las Vegas, Nevada 89119, USA.
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Moriarty AT, Clayton AC, Zaleski S, Henry MR, Schwartz MR, Eversole GM, Tench WD, Fatheree LA, Souers RJ, Wilbur DC. Unsatisfactory reporting rates: 2006 practices of participants in the college of american pathologists interlaboratory comparison program in gynecologic cytology. Arch Pathol Lab Med 2010; 133:1912-6. [PMID: 19961244 DOI: 10.5858/133.12.1912] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2009] [Indexed: 11/06/2022]
Abstract
CONTEXT -Minimum cellular criteria for satisfactory Papanicolaou tests were established with the Bethesda System in 2001, and unsatisfactory rates are used as a quality-reporting measure. OBJECTIVE -To evaluate practices and unsatisfactory rates from laboratories responding to the 2007 College of American Pathologists supplemental questionnaire survey. DESIGN -In 2007, a supplemental questionnaire was mailed to 1621 laboratories enrolled in the 2006 College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology (PAP Education), requesting data from the 2006 calendar year. Unsatisfactory rates, reasons for unsatisfactory specimens, laboratory size, and specimen preparation type were analyzed. RESULTS -A total of 42% of the laboratories responded to the survey. Most of those laboratories (637 of 674; 94.5%) used the Bethesda System minimum cellularity criteria. Of those laboratories responding, 79% (527 of 667) used the Bethesda System criteria for atrophic or postirradiation specimens. Unsatisfactory rates have increased since 1996. SurePath preparations were associated with the lowest unsatisfactory rate (50th percentile, 0.30; 95th percentile, 1.3), conventional Papanicolaou tests had the highest 95th percentile rates (50th percentile, 1.0; 95th percentile, 5.90), and ThinPrep specimens had the highest median percentile (50th percentile, 1.1; 95th percentile, 3.4). The most-common reason for unsatisfactory Papanicolaou tests was too few squamous cells. Air-drying artifact was the least-common reason for unsatisfactory reporting for liquid-based preparations. CONCLUSIONS -Use of the Bethesda System criteria for unsatisfactory specimens is widespread. Unsatisfactory rates have increased since 1996; however, the median rates are 1.1% or less for all preparations. Results from the College of American Pathologists PAP Education supplemental questionnaire continue to provide valuable benchmarking data for cytologic quality-improvement programs in laboratories.
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Crothers BA, Tench WD, Schwartz MR, Bentz JS, Moriarty AT, Clayton AC, Fatheree LA, Chmara BA, Wilbur DC. Guidelines for the reporting of nongynecologic cytopathology specimens. Arch Pathol Lab Med 2009; 133:1743-56. [PMID: 19886707 DOI: 10.5858/133.11.1743] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2009] [Indexed: 11/06/2022]
Abstract
CONTEXT Gynecologic cytology terminology and report formatting have been nationally standardized since the implementation of The Bethesda System of 1988, but standard reporting for nongynecologic cytology has never been formally addressed on the same scale. OBJECTIVES To promote patient safety through uniform reporting in nongynecologic cytology (including fine-needle aspiration cytology) and to improve communication between laboratories and health care providers. DATA SOURCES Sources include the College of American Pathologists Cytopathology Resource Committee; the College of American Pathologists Council on Scientific Affairs Ad Hoc Committee on Pathology Report Standardization; the College of American Pathologists Laboratory Accreditation Program inspection checklists; the Joint Commission for Accreditation of Healthcare Organizations; and the Clinical Laboratory Improvement Amendments of 1988. CONCLUSIONS We describe the major elements of quality nongynecologic cytology reporting and discuss areas of controversy in cytology reporting. Standardized nongynecologic specimen reporting will expand the concept of common report elements already widely implemented in gynecologic cytology reporting. The intent is to improve communication with the health care team while remaining in compliance with federal mandates and accreditation guidelines.
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Affiliation(s)
- Barbara A Crothers
- Department of Pathology and Area Laboratory Services, Walter Reed Army Medical Center, Washington, District of Columbia 20307-5001, USA.
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Moriarty AT, Crothers BA, Bentz JS, Souers RJ, Fatheree LA, Wilbur DC. Automatic failure in gynecologic cytology proficiency testing. Results from the College of American Pathologists proficiency testing program. Arch Pathol Lab Med 2009; 133:1757-60. [PMID: 19886708 DOI: 10.5858/133.11.1757] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2009] [Indexed: 11/06/2022]
Abstract
CONTEXT Automatic failure in gynecologic cytology proficiency testing occurs when a high-grade lesion or carcinoma (HSIL+, Category D) is misinterpreted as negative for intraepithelial lesion or malignancy (Category B). OBJECTIVES To document the automatic failure rate in 2006 and 2007 from the College of American Pathologists proficiency testing program (PAP PT) and compare them to projected values from 2004. DESIGN Identify automatic failures from PAP PT in 2006 and 2007 and compare the rates of failure regarding participant and preparation type to validated slides in the College of American Pathologists Interlaboratory Comparison Program in 2004. RESULTS There were 65 264 participant responses for HSIL+ slides included in this analysis from 2006 and 2007. Overall, 1% (666 of 65 264) of the HSIL+ responses were classified as negative, resulting in automatic failure for the participant. There were significantly fewer automatic failures in 2007 as compared with either 2006 or projected from 2004 data (P < .001). Conventional preparations had a lower automatic failure rate than liquid-based preparations but only for 2006. Both pathologists and cytotechnologists interpreting liquid-based preparations faired better than projected from 2004 data. CONCLUSIONS The automatic failure rate in PAP PT is lower than expected based on 2004 data from the College of American Pathologists Interlaboratory Comparison Program. Automatic failures are a relatively small component (1% or less) of proficiency testing failures. The rate of automatic failure decreased from 2006 to 2007 and may be due to loss of poor performers in the testing pool, the test-taking environment, or removal of less robust slides from the program.
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Affiliation(s)
- Ann T Moriarty
- Department of Pathology, AmeriPath Indiana, Indianapolis, Indiana 46219-1739, USA.
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Moriarty AT, Darragh TM, Souers R, Fatheree LA, Wilbur DC. Performance of herpes simplex challenges in proficiency testing: observations from the College of American Pathologists proficiency testing program. Arch Pathol Lab Med 2009; 133:1379-82. [PMID: 19722743 DOI: 10.5858/133.9.1379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Herpes simplex virus (HSV) is a common sexually transmitted disease that is decreasing in prevalence. Herpes simplex virus challenge cases have performed well in the educational College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. However, since gynecologic cytology proficiency testing (PT) was instituted, performance of HSV challenge cases has worsened. OBJECTIVE To determine if the decrease in performance for HSV challenges is due to inexperience in identifying herpes virus or "gaming" of PT. DESIGN We compare graded (field-validated) and ungraded (educational) slides with HSV prior to PT (1991- 2005) and after PT (2006 and 2007) in an attempt to characterize changes in performance of slides demonstrating purely HSV cellular features. All HSV slides were negative for intraepithelial lesion with the specific reference interpretation of HSV. Slides were excluded from analysis if they demonstrated more than one diagnostic category or had squamous intraepithelial lesion in addition to HSV changes. RESULTS A total of 40 634 HSV responses were evaluated. A significant difference existed in the diagnosis of HSV in PT compared with graded challenges prior to PT (96.6 versus 98.6; P < .001). No difference was seen in educational challenges pre-PT and post-PT (P = .14). No difference was present between slide preparation type; however, a difference was seen between cytotechnologist and pathologist response. CONCLUSIONS There is a change in the performance of slide challenges demonstrating the cellular features of HSV in PT, most likely due to testing strategies of participants, rather than lack of recognition of HSV secondary to decreased prevalence.
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Affiliation(s)
- Ann T Moriarty
- Department of Pathology, AmeriPath Indiana, Indianapolis, IN 46219-1739, USA.
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Moriarty AT, Darragh TM, Fatheree LA, Souers R, Wilbur DC. Performance of Candida--fungal-induced atypia and proficiency testing: observations from the College of American Pathologists proficiency testing program. Arch Pathol Lab Med 2009; 133:1272-5. [PMID: 19653724 DOI: 10.5858/133.8.1272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Candida may elicit cellular changes on otherwise negative screening Papanicolaou tests that may be misinterpreted as atypical squamous cells of undetermined significance. Although these changes have been correctly interpreted in the educational program of the College of American Pathologists, the Interlaboratory Comparison Program in Gynecologic Cytology, the performance of negative slides with Candida faltered when the same field validated slides were included in proficiency testing (PT). OBJECTIVE To identify the performance differences of negative for intraepithelial lesion (NILM) Candida challenges before and after PT. DESIGN We compare the performance of NILM College of American Pathologists slides with Candida as a single reference diagnosis, prior to PT (1991-2006) and after PT (2006-2007). RESULTS There were 147,186 responses for slides with NILM Candida from the College of American Pathologists programs from 1991 through 2007. After PT, 79.7% of incorrect participant responses identified Candida as Category C (low-grade squamous intraepithelial lesion), whereas prior to PT only 59.5% of the incorrect diagnoses were low-grade squamous intraepithelial lesion (P < .001) in the field-validated component of the program. Validated Candida slides performed significantly more poorly in PT (97.2%) than prior to PT (98.3%) (P < .001). Candida challenges performed better in the educational component post-PT (98.3% versus 97.2%; P < .001). Cytotechnologists (97.9%) identified Candida more frequently than pathologists (97.3%) (P < .001) and ThinPrep preparations performed the best of all preparation types. CONCLUSIONS Proficiency testing adversely affects the performance of participants in the identification of NILM Candida. Slides with Candida are more likely to be identified as low-grade squamous intraepithelial lesion in a PT exercise. Misidentification is not due to lack of recognition but most likely an attempt of test takers to optimize their likelihood of passing the examination.
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Affiliation(s)
- Ann T Moriarty
- Department of Pathology, AmeriPath Indiana, 2560 N Shadeland Ave, Suite A, Indianapolis, IN 46219-1739, USA.
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Crothers BA, Moriarty AT, Fatheree LA, Booth CN, Tench WD, Wilbur DC. Appeals in gynecologic cytology proficiency testing: review and analysis of data from the 2006 College of American Pathologists gynecologic cytology proficiency testing program. Arch Pathol Lab Med 2009; 133:44-8. [PMID: 19123735 DOI: 10.5858/133.1.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT In 2006, 9643 participants took the initial College of American Pathologists (CAP) Proficiency Test (PT). Failing participants may appeal results on specific test slides. Appeals are granted if 3 referee pathologists do not unanimously agree on the initial reference diagnosis in a masked review process. OBJECTIVES To investigate causes of PT failures, subsequent appeals, and appeal successes in 2006. DESIGN Appeals were examined, including patient demographic information, Centers for Medicare and Medicaid Services category (A, B, C, or D), exact reference diagnosis, examinees per appeal, examinee's Centers for Medicare and Medicaid Services category, referee's Centers for Medicare and Medicaid Services category, slide preparation type, and slide field validation rate. RESULTS There was a 94% passing rate for 2006. One hundred fifty-five examinees (1.6%) appealed 86 slides of all preparation types. Forty-five appeals (29%) were granted on 21 slides; 110 appeals (72%) were denied on 65 slides. Reference category D and B slides were most often appealed. The highest percentage of granted appeals occurred in category D (35% slides; 42% of participants) and the lowest occurred in category B (9% slides; 8% of participants). The field validation rate of all appealed slides was greater than 90%. CONCLUSIONS Despite rigorous field validation of slides, 6% of participants failed. Thirty percent of failing participants appealed; most appeals involved misinterpretation of category D as category B. Referees were never unanimous in their agreement with the participant. The participants and referees struggled with the reliability and reproducibility of finding rare cells, "overdiagnosis" of benign changes, and assigning the morphologically dynamic biologic changes of squamous intraepithelial lesions to static categories.
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Affiliation(s)
- Barbara A Crothers
- Department of Pathology and Laboratory Services, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
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Bentz JS, Hughes JH, Fatheree LA, Schwartz MR, Souers RJ, Soures RJ, Wilbur DC. Summary of the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program. Arch Pathol Lab Med 2008; 132:788-94. [PMID: 18466027 DOI: 10.5858/2008-132-788-sotcoa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Creating a tool that assesses professional proficiency in gynecologic cytology is challenging. A valid proficiency test (PT) must reflect practice conditions, evaluate locator and interpretive skills, and discriminate between those practitioners who are competent and those who need more education. The College of American Pathologists Gynecologic Cytology Proficiency Testing Program (PAPPT) was approved to enroll participants in a nationwide PT program in 2006. OBJECTIVE Report results from the 2006 PAPPT program. DESIGN Summarize PT results by pass/fail rate, participant type, and slide-set modules. RESULTS Nine thousand sixty-nine participants showed initial PT failure rates of 5%, 16%, and 6% for cytotechnologists, primary screening pathologists, and secondary screening pathologist, respectively. The overall initial test failure rate was 6%. After 3 retests, 9029 (99.6%) of the participants were able to achieve compliance with the PT requirement. No participant "tested out"; however, 40 individuals "dropped out" of the testing sequence (8 cytotechnologists, 9 primary screening pathologists, 23 secondary screening pathologists). Initial failure rates by slide-set modules were 6% conventional, 6% ThinPrep, 6% SurePath, and 5% mixture of all 3 slide types. CONCLUSIONS A total of 99.6% of individuals enrolled in the 2006 PAPPT program achieved satisfactory results. The data confirm that cytotechnologists have higher initial pass rates than pathologists and pathologists who are secondary screeners perform better than those who are primary screeners. There was no difference identified in overall pass rates between the slide-set modules. Further analysis of data should help define the results and ongoing challenges of providing a nationwide federally mandated proficiency testing program in gynecologic cytology.
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Affiliation(s)
- Joel S Bentz
- Department of Pathology, Huntsman Cancer Hospital at the University of Utah Health Sciences Center, 1950 Circle of Hope Dr, Suite 3860, Salt Lake City, UT 84112-5500, USA.
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