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How Long Should it Take to Get a Pathology Diagnosis?
Justification: A diagnosis of malignancy is of great relevance to the patient and sets in motion numerous activities. How long is it reasonable to wait for a pathologic diagnosis on a biopsy obtained for suspected cancer?
Methods: To address this question, we analyzed our turn-around-time (TAT) for biopsies and cytologies obtained for initial diagnosis of malignancy and compared it to relevant literature. Another goal was to evaluate the influence of special stains on TAT. We obtained from VISTA TAT on surgical pathology and cytopathology specimens in which an initial diagnosis of malignancy was made (excluding non-melanoma skin cancer, GYN, and urine cytologies) between January 2016 and August 2018. We analyzed the impact of histochemical and immunohistochemical stains performed on TAT.
Results and Discussion: During this period, 2014 new malignancies were diagnosed among 31,407 biopsies (6.41%). Average TAT for all biopsies was 1.48 days; average TAT for biopsies with initial diagnosis of malignancy was 2.2 days. 149 new diagnoses of malignancy were made by cytology, with an average TAT of 1.49 days, compared with 1.63 days TAT for all cytologies. Performance of special stains had no statistical impact on TAT when compared with cases with no special stains.
Remarkably, no guidelines have been promulgated by institutions or accrediting bodies for TAT on specimens obtained for initial diagnosis of malignancy. Likewise, such data is not available in the literature; it is unclear how many institutions monitor this. The College of American Pathologists indicates that 90% of routine biopsies should be nalized within 2 working days; the Association of Directors of Anatomic and Surgical Pathology indicates that at least 80% of routine biopsies should be nalized in 3 days. However, guidelines for specimens obtained for initial diagnosis of malignancy, which frequently require special handling/ancillary testing (deeper sections, histo/immunohistochemistry, molecular studies, consultation) are not available.
Recommendations: Institutions should develop practices that prioritize study of specimens obtained to rule out malignancy and should monitor their TAT. All institutions and accrediting bodies (CAP, Commission on Cancer, etc.) should develop guidelines for TAT for initial diagnosis of malignancy and audit this information.
Justification: A diagnosis of malignancy is of great relevance to the patient and sets in motion numerous activities. How long is it reasonable to wait for a pathologic diagnosis on a biopsy obtained for suspected cancer?
Methods: To address this question, we analyzed our turn-around-time (TAT) for biopsies and cytologies obtained for initial diagnosis of malignancy and compared it to relevant literature. Another goal was to evaluate the influence of special stains on TAT. We obtained from VISTA TAT on surgical pathology and cytopathology specimens in which an initial diagnosis of malignancy was made (excluding non-melanoma skin cancer, GYN, and urine cytologies) between January 2016 and August 2018. We analyzed the impact of histochemical and immunohistochemical stains performed on TAT.
Results and Discussion: During this period, 2014 new malignancies were diagnosed among 31,407 biopsies (6.41%). Average TAT for all biopsies was 1.48 days; average TAT for biopsies with initial diagnosis of malignancy was 2.2 days. 149 new diagnoses of malignancy were made by cytology, with an average TAT of 1.49 days, compared with 1.63 days TAT for all cytologies. Performance of special stains had no statistical impact on TAT when compared with cases with no special stains.
Remarkably, no guidelines have been promulgated by institutions or accrediting bodies for TAT on specimens obtained for initial diagnosis of malignancy. Likewise, such data is not available in the literature; it is unclear how many institutions monitor this. The College of American Pathologists indicates that 90% of routine biopsies should be nalized within 2 working days; the Association of Directors of Anatomic and Surgical Pathology indicates that at least 80% of routine biopsies should be nalized in 3 days. However, guidelines for specimens obtained for initial diagnosis of malignancy, which frequently require special handling/ancillary testing (deeper sections, histo/immunohistochemistry, molecular studies, consultation) are not available.
Recommendations: Institutions should develop practices that prioritize study of specimens obtained to rule out malignancy and should monitor their TAT. All institutions and accrediting bodies (CAP, Commission on Cancer, etc.) should develop guidelines for TAT for initial diagnosis of malignancy and audit this information.
Justification: A diagnosis of malignancy is of great relevance to the patient and sets in motion numerous activities. How long is it reasonable to wait for a pathologic diagnosis on a biopsy obtained for suspected cancer?
Methods: To address this question, we analyzed our turn-around-time (TAT) for biopsies and cytologies obtained for initial diagnosis of malignancy and compared it to relevant literature. Another goal was to evaluate the influence of special stains on TAT. We obtained from VISTA TAT on surgical pathology and cytopathology specimens in which an initial diagnosis of malignancy was made (excluding non-melanoma skin cancer, GYN, and urine cytologies) between January 2016 and August 2018. We analyzed the impact of histochemical and immunohistochemical stains performed on TAT.
Results and Discussion: During this period, 2014 new malignancies were diagnosed among 31,407 biopsies (6.41%). Average TAT for all biopsies was 1.48 days; average TAT for biopsies with initial diagnosis of malignancy was 2.2 days. 149 new diagnoses of malignancy were made by cytology, with an average TAT of 1.49 days, compared with 1.63 days TAT for all cytologies. Performance of special stains had no statistical impact on TAT when compared with cases with no special stains.
Remarkably, no guidelines have been promulgated by institutions or accrediting bodies for TAT on specimens obtained for initial diagnosis of malignancy. Likewise, such data is not available in the literature; it is unclear how many institutions monitor this. The College of American Pathologists indicates that 90% of routine biopsies should be nalized within 2 working days; the Association of Directors of Anatomic and Surgical Pathology indicates that at least 80% of routine biopsies should be nalized in 3 days. However, guidelines for specimens obtained for initial diagnosis of malignancy, which frequently require special handling/ancillary testing (deeper sections, histo/immunohistochemistry, molecular studies, consultation) are not available.
Recommendations: Institutions should develop practices that prioritize study of specimens obtained to rule out malignancy and should monitor their TAT. All institutions and accrediting bodies (CAP, Commission on Cancer, etc.) should develop guidelines for TAT for initial diagnosis of malignancy and audit this information.
PAP Test/HPV Co-test: Quality Improvement Initiative to Identify Approaches for Integrative Clinical Care Management
Purpose: Decrease turn-around time (TAT) and increase customer satisfaction.
Relevant Background: Cytologic screening (PAP test) lowered mortality of cervical carcinoma. As high-risk papilloma viruses (HPV) were associated with dysplasia and carcinoma, “co-testing” (HPV status and cytological screening on same specimen)was introduced. Women with negative Pap smear and positive high-risk HPV are at elevated risk.
Previous Status: Pap smears were signed-out; HPV Cotests were sent to reference laboratory; results were informed in supplementary report. This caused slow TAT for HPV Co-test (24% > 12 days) and distress when negative Pap smear was followed by a positive HPV Co-test.
Methods: A team of relevant individuals was convened to decrease TAT for HPV Co-test to 6 days, and to create an integrated Pap-smear/HPV Co-test report. The decision was made to bring HPV testing in-house, utilizing polymerase chain reaction-based assay. The technique was validated; precision, accuracy and lower levels of detection were determined. Standard Operating Procedures were written, and personnel competency was verified. Proficiency tests were performed. Staff met to coordinate logistics of sample transfer.
Data Analysis: In-house HPV testing twice weekly decreased TAT from 10.1 to 5.6 days. Integrated report: HPV test is performed when ordered by clinician or “reflex” if Pap smear is atypical; in both instances, final report is withheld until Co-test result is available. HPV is run inhouse in batches twice a week (5-hour test TAT). When HPV result is available, cytology technician enters Pap smear interpretation and HPV Co-test in a single, integrated report into VistA, it is released by the pathologist or cytotechnologist (day 3-5) and “view-alert” is issued for provider in CPRS. Integrated report consists of a section with cytology findings, and section with HPV status including subtype and risk information.
Results: Average TAT for release of integrated report decreased from 10.1 to 2.7 days. The laboratory achieved a 35% reduction in expenditure costs. Clinicians’ response was uniformly positive.
Implications: It is important to know how VA Medical Centers address PAP-HPV Co-test, and how the system can be modified; particularly, as our female Veteran population increases.
Purpose: Decrease turn-around time (TAT) and increase customer satisfaction.
Relevant Background: Cytologic screening (PAP test) lowered mortality of cervical carcinoma. As high-risk papilloma viruses (HPV) were associated with dysplasia and carcinoma, “co-testing” (HPV status and cytological screening on same specimen)was introduced. Women with negative Pap smear and positive high-risk HPV are at elevated risk.
Previous Status: Pap smears were signed-out; HPV Cotests were sent to reference laboratory; results were informed in supplementary report. This caused slow TAT for HPV Co-test (24% > 12 days) and distress when negative Pap smear was followed by a positive HPV Co-test.
Methods: A team of relevant individuals was convened to decrease TAT for HPV Co-test to 6 days, and to create an integrated Pap-smear/HPV Co-test report. The decision was made to bring HPV testing in-house, utilizing polymerase chain reaction-based assay. The technique was validated; precision, accuracy and lower levels of detection were determined. Standard Operating Procedures were written, and personnel competency was verified. Proficiency tests were performed. Staff met to coordinate logistics of sample transfer.
Data Analysis: In-house HPV testing twice weekly decreased TAT from 10.1 to 5.6 days. Integrated report: HPV test is performed when ordered by clinician or “reflex” if Pap smear is atypical; in both instances, final report is withheld until Co-test result is available. HPV is run inhouse in batches twice a week (5-hour test TAT). When HPV result is available, cytology technician enters Pap smear interpretation and HPV Co-test in a single, integrated report into VistA, it is released by the pathologist or cytotechnologist (day 3-5) and “view-alert” is issued for provider in CPRS. Integrated report consists of a section with cytology findings, and section with HPV status including subtype and risk information.
Results: Average TAT for release of integrated report decreased from 10.1 to 2.7 days. The laboratory achieved a 35% reduction in expenditure costs. Clinicians’ response was uniformly positive.
Implications: It is important to know how VA Medical Centers address PAP-HPV Co-test, and how the system can be modified; particularly, as our female Veteran population increases.
Purpose: Decrease turn-around time (TAT) and increase customer satisfaction.
Relevant Background: Cytologic screening (PAP test) lowered mortality of cervical carcinoma. As high-risk papilloma viruses (HPV) were associated with dysplasia and carcinoma, “co-testing” (HPV status and cytological screening on same specimen)was introduced. Women with negative Pap smear and positive high-risk HPV are at elevated risk.
Previous Status: Pap smears were signed-out; HPV Cotests were sent to reference laboratory; results were informed in supplementary report. This caused slow TAT for HPV Co-test (24% > 12 days) and distress when negative Pap smear was followed by a positive HPV Co-test.
Methods: A team of relevant individuals was convened to decrease TAT for HPV Co-test to 6 days, and to create an integrated Pap-smear/HPV Co-test report. The decision was made to bring HPV testing in-house, utilizing polymerase chain reaction-based assay. The technique was validated; precision, accuracy and lower levels of detection were determined. Standard Operating Procedures were written, and personnel competency was verified. Proficiency tests were performed. Staff met to coordinate logistics of sample transfer.
Data Analysis: In-house HPV testing twice weekly decreased TAT from 10.1 to 5.6 days. Integrated report: HPV test is performed when ordered by clinician or “reflex” if Pap smear is atypical; in both instances, final report is withheld until Co-test result is available. HPV is run inhouse in batches twice a week (5-hour test TAT). When HPV result is available, cytology technician enters Pap smear interpretation and HPV Co-test in a single, integrated report into VistA, it is released by the pathologist or cytotechnologist (day 3-5) and “view-alert” is issued for provider in CPRS. Integrated report consists of a section with cytology findings, and section with HPV status including subtype and risk information.
Results: Average TAT for release of integrated report decreased from 10.1 to 2.7 days. The laboratory achieved a 35% reduction in expenditure costs. Clinicians’ response was uniformly positive.
Implications: It is important to know how VA Medical Centers address PAP-HPV Co-test, and how the system can be modified; particularly, as our female Veteran population increases.