Rete testis invasion is consistent with pathologic stage T1 in germ cell tumors

Objectives Rete testis invasion by germ cell tumors is frequently concomitant with lymphovascular or spermatic cord invasion (LVI/SCI); independent implications for staging are uncertain. Methods In total, 171 seminomas and 178 nonseminomatous germ cell tumors (NSGCTs; 46 had 1%-60% seminoma component) came from five institutions. Metastatic status at presentation, as a proxy for severity, was available for all; relapse data were unavailable for 152. Rete direct invasion (ReteD) and rete pagetoid spread (ReteP) were assessed. Results ReteP and ReteD were more frequent in seminoma than NSGCT. In seminoma, tumor size bifurcated at 3 cm or more or less than 3 cm predicted metastatic status. Tumors with ReteP or ReteD did not differ in size from those without invasions but were less than with LVI/SCI; metastatic status or relapse did not show differences. In NSGCT, ReteP/ReteD did not correlate with size, metastatic status, or relapse. Conclusions Findings support retaining American Joint Committee for Cancer pathologic T1 stage designation for rete testis invasion and pT1a/pT1b substaging of seminoma

Subspecialty surgical pathologist′s performances as triage pathologists on a telepathology-enabled quality assurance surgical pathology service: A human factors study

Background: The case triage practice workflow model was used to manage incoming cases on a telepathology-enabled surgical pathology quality assurance (QA) service. Maximizing efficiency of workflow and the use of pathologist time requires detailed information on factors that influence telepathologists′ decision-making on a surgical pathology QA service, which was gathered and analyzed in this study. Materials and Methods: Surgical pathology report reviews and telepathology service logs were audited, for 1862 consecutive telepathology QA cases accrued from a single Arizona rural hospital over a 51 month period. Ten university faculty telepathologists served as the case readers. Each telepathologist had an area of subspecialty surgical pathology expertise (i.e. gastrointestinal pathology, dermatopathology, etc.) but functioned largely as a general surgical pathologist while on this telepathology-enabled QA service. They handled all incoming cases during their individual 1-h telepathology sessions, regardless of the nature of the organ systems represented in the real-time incoming stream of outside surgical pathology cases. Results: The 10 participating telepathologists′ postAmerican Board of pathology examination experience ranged from 3 to 36 years. This is a surrogate for age. About 91% of incoming cases were immediately signed out regardless of the subspecialty surgical pathologists′ area of surgical pathology expertise. One hundred and seventy cases (9.13%) were deferred. Case concurrence rates with the provisional surgical pathology diagnosis of the referring pathologist, for incoming cases, averaged 94.3%, but ranged from 88.46% to 100% for individual telepathologists. Telepathology case deferral rates, for second opinions or immunohistochemistry, ranged from 4.79% to 21.26%. Differences in concordance rates and deferral rates among telepathologists, for incoming cases, were significant but did not correlate with years of experience as a practicing pathologist. Coincidental overlaps of the area of subspecialty surgical pathology expertise with organ-related incoming cases did not influence decisions by the telepathologists to either defer those cases or to agree or disagree with the referring pathologist′s provisional diagnoses. Conclusions: Subspecialty surgical pathologists effectively served as general surgical pathologists on a telepathology-based surgical pathology QA service. Concurrence rates with incoming surgical pathology report diagnoses, and case deferral rates, varied significantly among the 10 on-service telepathologists. We found no evidence that the higher deferral rates correlated with improving the accuracy or quality of the surgical pathology reports

Fifth generation telepathology systems. Workflow analysis of the robotic dynamic telepathology Component

SUMMARY:BACKGROUND:Telepathology is the practice of pathology over distances using video-imaging equipment and a telecommunications network. Two workflow paradigms for telepathology practice are a subspecialty pathology practice (SPP) model and a case triage practice (CTP) model. With the CTP model, developed at the University of Arizona, the telepathologist on call can render a diagnosis independently or, regardless of its subspecialty category, has the option of referring the case to a subspecialty pathologist as needed.FINDINGS:Surgical pathology teleconsultations providing real-time quality assurance (QA) services were established between the University Medical Center (UMC) in Tucson, Arizona, and the Havasu Regional Medical Center (HRMC) in rural Lake Havasu City, Arizona, 300 miles away. HRMC had a single on-site pathologist. From 2005 to 2009, 1815 cases were reviewed by one of ten UMC case triage telepathologists. Each faculty pathologist had an area of surgical subspecialty expertise. 90.9% of cases were signed out directly by the on-service triage pathologist, without consultation with a subspecialty pathologist. The majority of cases were outside of the triage pathologists areas of subspecialty expertise. The diagnostic concordance of the telepathologist's diagnosis with the original pathologist's diagnosis was 94.3%. Major and minor discrepancies were 2.90% and 2.83% respectively. The discordant cases were re-reviewed by light microscopy at the UMC daily QA conference.CONCLUSIONS:This study supports the use of the CTP workflow model for a telepathology QA service. Subspecialty surgical pathologists can efficiently and accurately render QA second opinions outside their areas of subspecialty expertise by telepathology. This workflow model will be applicable to practices using fifth generation telepathology systems.This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at [email protected]

Mobile medical ignorance APP (MOMIA) : a new tool for promoting questions, questioning and questioners (Q3)- anytime, anywhere, anyone

OBJECTIVES/SPECIFIC AIMS: Develop a mobile app for our interactive Virtual Clinical Research Center/Questionarium (VCRC/Q) to elicit, collect and analyze the expanding Unknowns/Questions (\u201cignoramics\u201d) accompanying the exploding Knowns/Answers (informatics) in translational science to investigate, showcase and enhance research advances and inquiry-based training, conferencing, networking and community outreach. METHODS/STUDY POPULATION: Progressive iterations of MoMIA were designed/tested for user friendliness, functionality and efficacy to reprogram our VCRC/Q Web-based platform \u201cgrid\u201d for universal/ubiquitous access to Questions, Questioning and Questioners. Since the mid-1980s, our NIH-funded Curriculum and Summer Institute on Medical Ignorance has involved thousands of diverse questioning medical, undergraduate, high school student and other research trainees as well as professional scientists (including Nobel Laureates) and the general public. RESULTS/ANTICIPATED RESULTS: MoMIA is a Web-based tool (curiosityforall.org) adapted for mobile phones to rapidly and conveniently collect questions from multiple simultaneous users for sorting and future analysis. The VCRC/Q's full menu of resources can be combined with MoMIA to create a customized versions of our Curriculum on Translating Translation and Scientific Questioning in the \u201cExplorarium\u201d site. MoMIA can be demonstrated on your phone at ACTS 2015. DISCUSSION/SIGNIFICANCE OF IMPACT: MoMIA promises to enhance linkage to VCRC/Q resources thereby transforming the grid to promote questions, questioning, and questioners\u2014the engine of translational and all science. Semantics and algorithms are being developed to study the questioning process (\u201ccuriosity\u201d), gather key unanswered questions related to biomedical topics for research/action agendas, and encourage new ways of training, conferencing and networking around the expanding ignorance, thereby counterbalancing the megadata explosion in information