25 / 366
4.7 %, an optical major discordance rate of 4.4 %, and a digital-optical rate
difference of 0.4 with a 95 % confidence interval of ( 0.30 %; 1.01 %).
Conclusion:
This study demonstrates that viewing, reviewing and diagnos-
ing surgical pathology tissue slides by using the Philips Digital Pathology
Solution is non-inferior compared to optical microscopy.
OFP-03-015
Development of a
“
Patient Harm Index
”
to quantify adverse events
in anatomic pathology: An effective motivator towards high reliabil-
ity and error reduction?
O. Hameed
*
, J. Lewis, A. Coogan, M. Abuhhl, M. Exton, J. Davis, A.
Seegmiller
*
Vanderbilt University Med Center, Pathology, Micro & Immunology,
Nashville, USA
Objective:
To describe the development of a novel patient-centric metric
for measuring adverse events in anatomic pathology (AP).
Method:
As part of an institution-wide quality improvement project,
service lines (SL) developed lists of preventable adverse events to aim
for reduction. The sum of such adverse events in each SL represented
their Patient Harm Index (PHI). Historic data were used to develop thresh-
old/target/reach goals.
Results:
Cases with one of following events resulting in patient harm or
potential harm constituted the AP PHI: (1) major diagnostic error, (2)
major frozen section (FS) discrepancy due to sampling, (3) major FS
discrepancy due to interpretation, (4) significant/unexpected finding with-
out documented communication in report and (5) significant diagnostic
delay, specimen loss, or results reported on wrong patient. 48 (4 % re-
duction), 45 (10 % reduction) and 40 (20 % reduction) were set as thresh-
old, target and reach goals, respectively. Progress towards these goals was
discussed at faculty, staff and quality management meetings. By year-end,
38 patients had potential/adverse events. This 24 % reduction in the
potential/adverse event rate (0.061 to 0.046 %) appeared more meaning-
ful when translated into 12 less patients with potential/adverse events.
Conclusion:
By aggregating the total number of potential/adverse events
in time and supplementing other, more traditional
“
rate-based
”
metrics,
the PHI emphasizes the numerator and deemphasizes the denominator,
keeping the focus on the patient rather than the total number of speci-
mens. We believe that this, along with being able to add up all events
together into a single more comprehensible number, provide greater mo-
tivation for error reduction.
OFP-04-001
The differential diagnosis of cervical adenosquamous carcinoma
(CAC) and related entities
I. Barsan
*
, L. Hoang, C. Terinte, A. Pesci, S. Aviel-Ronen, T. Kyokawa, I.
Alvarado-Cabrero, K. Park, E. Oliva, R. A. Soslow, S. Stolnicu
*
Targu Mures, Romania
Objective:
Although the WHO 2014 criteria require the presence of
unequivocal glandular and squamous differentiation, CAC in practice
represent a diverse spectrum of lesions, some of which do not exhibit
unequivocal squamous differentiation.
Method:
Full slide sets from 61 CAC (including glassy cell and related
lesions), invasive carcinomas resembling
“
stratified mucin-producing
intraepithelial lesion
”
(invasive SMILE) and usual-type adenocarcinomas
with squamous metaplasia were collected from 7 institutions worldwide.
CAC was diagnosed only when unequivocal malignant glandular and
squamous differentiation was present. This pattern was distinguished
from 3 lesions: 1) Usual-type adenocarcinoma with benign-appearing
squamous metaplasia; 2) Glassy cell carcinoma; 3) Invasive SMILE
(Schoolmeester and Lastra). TMAs were constructed and immunohisto-
chemistry for p16, p63, vimentin and PR was performed on 44 cases.
Endometrial adenocarcinomas involving cervix were excluded.
Results:
Of the 61 CACs and related lesions classified by 2014 WHO, 32
CAC cases remained, while 9 were reclassified as pure invasive SMILE, 4 as
mucinous adenocarcinoma with invasive SMILE, 7 as usual-type adenocar-
cinoma with invasive SMILE, 6 as usual-type adenocarcinoma with benign-
appearing squamous metaplasia and 1 as poorly differentiated usual-type
adenocarcinoma. 2 glassy cell carcinomas remained. The vast majority of
the CACs and reclassified cases were p16+ and, while none were
vimentin+. 60 % of CACs represented in the TMA were p63+, while only
1/20 reclassified cases were positive. Results for other markers were
tabulated.
Conclusion:
The differential diagnosis of CAC includes one new
entity, usual type adenocarcinoma with squamous metaplasia, and a
newly described lesion, invasive SMILE. P63 should be used to ver-
ify the presence of squamous differentiation (when malignant) to
ascertain a diagnosis of CAC. Study of the clinical significance of
these lesions is ongoing.
OFP-04-002
Histological grading of cervical intraepithelial neoplasia (CIN) in
colposcopically directed punch biopsies: Audit and assessment of
CIN1-2 terminology and its impact on patient management
K. Sheppard
*
, S. Manek
*
Oxford University Hospitals, Dept. of Cellular Pathology, United
Kingdom
Objective:
Aiming for 100 % adherence to the three-tier grading system
(CIN1, 2 and 3), audit use of CIN1-2 terminology in cervical biopsies,
assessing potential overtreatment of low-grade lesions by large loop excision
of the transformation zone (LLETZ) procedures.
Method:
In-depth analysis of all cervical punch biopsies with CIN1-2 diag-
nosis over a 3-year period. Data collected using the electronic patient record
included colposcopic findings, reporting pathologist, and all subsequent cer-
vical histology with grade of dysplasia and use of p16 immunohistochemistry
recorded.
Results:
95.15 % adherence to three-tier grading system. 87/4458 (1.95 %)
biopsies reported CIN1-2. 61/87 subsequent LLETZ procedures showed:
2/61 HPV changes, 10/61 CIN1, 5/61 CIN1-2, 29/61 CIN2, 10/61 CIN2-3
and 5/61 CIN3. Biopsy reported CIN1-2 had low- and high-grade dysplasia
on subsequent LLETZ specimens in 10/61 and 44/61 cases respectively. 12/
4458 (0.27 %) low-grade lesions were potentially overtreated.
Conclusion:
CIN1-2 Is infrequently reported and overtreatment of low-
grade lesions (HPV changes & CIN1) rare. 72.1 % of biopsies reporting
CIN1-2 showed high-grade dysplasia (CIN2 & 3) on subsequent LLETZ
specimens. Block p16 immunostaining can be a useful diagnostic adjunct
when high-grade dysplasia is suspected. We recommend avoiding the use
of CIN1-2 terminology, especially as patient management is based on a
two-tier (low- and high-grade dysplasia) grading system.
OFP-04-003
Invasive stratified mucin-producing carcinoma (SMPC): A study in
morphology, immunohistochemistry and Human papillomavirus
(HPV) status
K. Park
*
, I. Barsan, D. Fix, C. Terinte, A. Pesci, S. Aviel-Ronen, T.
Kiyokawa, I. Alvarado-Cabrero, E. Oliva, R. Soslow, S. Stolnicu
*
Memorial Sloan Kettering, Dept. of Pathology, New York, USA
Objective:
To describe the morphology, immunohistochemical profile
and HPV status in stratified mucin-producing carcinoma (SMPC), an
Monday, 4 September 2017, 14:45
–
16:45, G109
OFP-04 Gynaecological Pathology
Virchows Arch
(
2017
)
471
(
Suppl 1
):
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–
S352
S11