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In 1924, a surgeon and a pathologist had a conversation about some patients with multiple bowel polyps. The pathologist, Dr Cuthbert Dukes, and the surgeon, Mr JP Lockhart-Mummery, noted that patients had a family history of bowel cancer and could have hundreds of colonic polyps. They, with the help of HRJ Bussey, set up the Polyposis Registry. The registry collected information about these patients and the families from 1918 to 1954. They found that patients developed polyps in childhood, the risk of affected children was 50%, and cancer took 15 years to develop from first diagnosis. This was clearly a familial disease. Today, we know this a Familial Adenomatous Polyposis or FAP. The genetic basis for this condition was identified in the 1980s and 1990s. Professor Sir Walter Bodmer led a team to map the location of the Adenomatous Polyposis Coli (APC) gene involved. This is the story of Familial Adenomatous Polyposis (FAP) Our special guests: Professor Sir Walter Bodmer is a professor of the Cancer and Genetics laboratory and Department of Oncology at Oxford University. Areas of research include: HLA, population genetics, Human Genome Project, and mapped the APC gene. He was knighted in 1986. Dr Tristan Rutland is an Anatomical Pathologists, recipient of the Konrad Muller RCPA Outstanding Teaching Award (2020), and recipient of the Resident Advocate Award from the College of American Pathologists. Dr Emelia Ip is a trained medical oncologist, staff specialist in cancer genetics, and co-chair of EviQ Adult Cancer Genetics Reference Committee. Help support us on our donation page.See omnystudio.com/listener for privacy information.
Send us a textDr. Sang Wu is a pathologist at Baylor, Scott & White (Irving, TX) and currently serves as Speaker of the House of Delegates for the College of American Pathologists. The episode focuses on the governance structure of the CAP and the responsibilities carried by each delegate. Dr. Wu previews the upcoming leadership summit in Washington DC April 27, 2025. Finally, Alae joins Giovanni and Dr. Wu for a discussion covering pathologists' perspectives on the future of DP/AI. A forum to engage with the hosts and other listeners has been launched on the DPA website www.digitalpathologyassociation.org. DPA members may login to the DPA Collaborate hub (under the Resources tab) and join the Beyond The Scope community. All listeners are encouraged to use this forum to suggest future topics and guests, submit questions and corrections, and provide general feedback.
If you've ever had to wait longer than you expected for results of a biopsy or other medical test, you know how agonizing and frustrating that wait can be... Now the College of American Pathologists is pushing back on what they call insurance interference that can negatively impact the care patients receive (at 15:51) --- Winter hasn't even officially arrived yet, and if you're already in need of a tropical escape but don't want the hassle of international travel - you're in luck (at 24:54) --- Just in time for the final two-week rush before Christmas, Parent Tested Parent Approved is out with their official Holiday Gift Guide (at 48:18)
The Twin City Toastmasters Club is celebrating its temporary location at Corewell Hospital on Tuesday, November 12th at 7pm at the Corewell Hospital - Upton Room 1. Guest speaker will be Doug Knapman, MBA, Sr Director of Membership and Practice Management at the College of American Pathologists, Doug had the privilege of training physicians to improve their communication skills. This event is free and open to the public.See omnystudio.com/listener for privacy information.
Dr. Shoreh Ershadi is the founder of ANITAGING Institute of California and a renowned expert in clinical biochemistry and pharmacology with over 40 years of experience. Dr. Ershadi shares her compelling journey from Iran to the United States, highlighting her unexpected entry into medical technology and the numerous challenges she faced as a woman in science. From setting up clinical labs and pioneering AIDS testing to founding her own antiaging company, Dr. Ershadi discusses her relentless pursuit of scientific innovation and passion for improving human health. The conversation also touches on her entrepreneurial ventures, the role of art in her life, and her vision for a healthier future driven by natural apoptosis-promoting supplements. Guest links: www.Apoptosis.us | www.facebook.com/apoptosisnutraceuticals | www.instagram.com/apoptosisnutraceuticals | www.threads.com/apoptosisnutraceuticals Charity supported: Save the Children Interested in being a guest on the show or have feedback to share? Email us at podcast@velentium.com. PRODUCTION CREDITS Host: Lindsey Dinneen Editing: Marketing Wise Producer: Velentium EPISODE TRANSCRIPT Episode 037 - Dr. Shoreh Ershadi [00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world. [00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them. [00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives. [00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives. [00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives. [00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference. Hello, and welcome back to another episode of The Leading Difference podcast. I'm your host, Lindsey, and today I'm so excited to introduce you to my guest, Dr. Shoreh Ershadi. With over 40 years of expertise in clinical biochemistry and pharmacology, Dr. Ershadi stands at the forefront of scientific innovation in the field of nutraceuticals and supplements. Board certified by the American Academy of Antiaging Medicine and holding dual doctorate degrees, Dr. Ershadi brings a wealth of knowledge and experience to the world. Dr. Ershadi's distinguished credentials, including National Registry in Clinical Chemistry and Toxicology and American Society of Clinical Pathology certifications, underscore her dedication to precision and quality in laboratory practices. Her visionary leadership and unwavering passion for advancing human health has made her a trusted authority in the field. All right. Well, Shoreh, thank you so much for being here today. I'm so excited to speak with you. [00:01:51] Dr. Shoreh Ershadi: Thank you for having me. I'm very excited to talk to you, especially that you're going to talk about medical technology. And that is something that I have been doing or working at for, I would say over 30 years, easy. 1988, I got my license in California. So it's what, 32 years? [00:02:17] Lindsey Dinneen: Yeah. Excellent. Oh my goodness. Well, this leads perfectly into my first question and that is, can you tell us a little bit about yourself and your background and how you got into medtech? [00:02:29] Dr. Shoreh Ershadi: Okay. That is interesting because I was born in Iran and I studied pharmacology. And before I was graduated, the Department of Health in Iran was hiring pharmacists, pharmacologists. So we all went and took the exam and we passed the exam. We were still at the final stages of doing the thesis and going through final stages of graduation. And then they called me and a few other people for an interview. Apparently I had a high mark in the test, which I did not know. So when we went for the interview, and I went to an American school and then later to a British school in Iran, so I was speaking English. At the interview, there was a gentleman who was back in Iran from United States, and he was a PhD in clinical biochemistry, and he asked me to read something in English. And I read it, and he thought that I had it by heart or something, so he flipped the book and found a more difficult page and said, "Okay, read this," and I read that, and he said, "Okay, I'm hiring you for the reference lab." I had absolutely no clue what he was talking about, what was reference lab. I had no intention to even work for Department of Health because I was not even graduated at that time. And then they said, "Okay, start on such and such date." And when I went there the first day, he said he spoke in English and he said, "You're overqualified." Oh my God. What? I mean, it was funny. Without even planning to get into laboratory, I got into the reference lab of Department of Health. And what he was planning to do was to bring College of American Pathologists, the proficiency testing to all the laboratories in Iran. And he wanted someone who would speak English and who could communicate. So first day of my job, I wrote a letter to College of American Pathologists and I said, "Hi, hello, I'm Shoreh Ershadi, I want to buy a thousand proficiency kits." And of course they responded. So just like that, I got into clinical laboratory. And I became the Director of the Quality Control for Department of Health. And that was before the revolution. So, that was my exciting start into laboratory. [00:05:25] Lindsey Dinneen: Yeah, that's an incredible story. Thank you for sharing that. And [00:05:28] Dr. Shoreh Ershadi: Not voluntarily, but serendipitously, yes. [00:05:34] Lindsey Dinneen: There you go. So then at some point, you came to the U. S. and was that transition really difficult? Was it frustrating? Were you excited? Nervous? [00:05:47] Dr. Shoreh Ershadi: There was a part in between before coming to U. S. There was another test by W. H. O., World Health Organization. So I took that test and I passed that test and I got a scholarship to go to medical school in England to do a master's degree. And when I went there, I told them, "I already have a doctorate in pharmacology. I don't want master's. I want to do PhD." And after a few weeks, they said, "Okay, fine, go to PhD. You don't need to do master." So I was in England for about four years. I did my PhD in clinical biochemistry. And I went back to Iran. That was exactly during the revolution. So while I was studying in England, the country in Iran was on fire. It was, things going crazy everywhere. But I went back and I got married. I had my son in Iran, and I was working in a clinical laboratory in one of the best hospitals in Iran, and it got very difficult for women to work. They were saying, " Now you have to wear a scarf. Now, you can't see male patients, you can only talk to female patients." It was not right. So, 1984, I came to United States, I came to California, and with some friends in Iran who had a clinical laboratory, and they were here before me and had started a lab in Orange County, California. I started a branch of the lab in Westwood, in Los Angeles. So that was my first job or position and that was my entrepreneurial side, which now I wouldn't dare to start a life, but then I did. [00:07:51] Lindsey Dinneen: You didn't know the difference then. [00:07:53] Dr. Shoreh Ershadi: Well, yes, I didn't know. I mean, it was a lot easier, I would say. At that point. The lab was not even accepting Medicare or Medi Cal. It was private insurance. I was doing the billing. I was getting the information. I was drawing the patients. I was separating the samples and sending them to the reference lab that was actually running the tests. But I was doing stat CBCs and I was in a medical building and so all the doctors were so nice to send the samples down to me. It worked. So [00:08:33] Lindsey Dinneen: Amazing. Oh my. [00:08:34] Dr. Shoreh Ershadi: Amazing. Yes. Now it sounds really amazing. It's surreal in a way. Yeah. [00:08:42] Lindsey Dinneen: Yeah. Yeah. Well, so, so with that lab and embracing this entrepreneurial journey, and I'm so thankful it worked out so well for you, but were there any moments where you just thought, okay, I've, I, you have such an amazing background. You're so highly educated, you're brilliant. And then you're starting this entrepreneurial journey, which is kind of a different skill set in a way. How was that transition of becoming kind of your own boss and being in charge of everything? [00:09:12] Dr. Shoreh Ershadi: That was pure ignorance. I mean, now I can say then, I thought I knew what I was doing, but it was a fast learning. First that I was in a different country, that I had never been in the United States. Second, that I had a three year old son that I brought with me and my then husband never came, so I got a divorce and I became a single mom. So, and nobody else was from my family was here. So it was very difficult because I had to take him to daycare and then come work and then go pick him up. And then there was a war, the Iraq war had started in Iran and my parents were in Iran and I was going through a divorce, so it was turmoil. And I had to work and learn in a way it was good because it didn't give me time to think about anything else. It was just forward, no looking sideways, no looking backwards. It was just moving forward. But then again, something else happened that made it even more interesting. One of the days that I was at the lab, some guy came and said, "CDL, Central Diagnostic Lab, is looking for a technical director and they've asked me to come and talk to you." I had absolutely no clue if anyone knew me or knew of me or it was the, I mean, a lot of things happened, which, I mean, I'm happy now, but then it changed my life tremendously. And I don't think I've ever talked to anyone about this in this detail. So, Lindsey, I would say you're the first person I'm telling the story of my life. But anyways, I went for an interview and I got hired right away. I had the lab, so I hired someone to do the work that I was doing in the lab. And then I started working at CDL, Central Diagnostic Labs, which was the largest privately owned lab in the United States at that time. There were 1, 200 employees. So that was a very interesting experience on its own because I was introduced to a world that I did not even know what was going on. So, and that was during AIDS testing. Bio-Rad had just come up with Western blot testing and we did the clinical trial, which was very easy in those days. We had AIDS patients and we had a lot of AIDS samples accumulated or saved frozen and we used them to validate the Western blot by Bio-Rad and I went on National TV 1988 and I said, "CDL is the first lab in the world that is doing a confirmation for HIV AIDS testing." So then, that was major. [00:12:40] Lindsey Dinneen: Yes. [00:12:43] Dr. Shoreh Ershadi: But then, then my family came. My father passed away here. It was, again, a lot of complications going on. And one of the other people that I knew asked me to go and partner with them in a lab. Again, my entrepreneurial part took over and I went for the partnership, and I started from scratch. I started Path Labs practically from scratch. There were two pathologists working with Los Alamitos Hospital, and I went there and I started a lab from just buying test tubes, buying, from absolutely nothing. I was there for six years, I think. six or eight years with Path Labs. That was not so successful. After that, I went to Specialty Labs, which is now Quest. Specialty wanted to start a toxicology lab. So, Path Lab was sold. But there was no money made with the partnership and all that. So that was not a very successful six, eight years of my life. Specialty was good. I went to Specialty and I started Department of Toxicology. I don't know if you remember or you were familiar with specialty. Dr. Peters was there and he was the founder, James Peters. He did only immunology testing. They would receive samples and send out everything else to other labs and only do the immunological tests or some specialty tests. When I started the toxicology department, we started getting samples from all over the world. We were running heavy metals and all that. We had an ICP MS and I started running ICP, and the main test that I developed there was measuring iron in the liver biopsy of patients with hemochromatosis. So we would get one spot, in tip of the needle of the liver and then do a measurement and measure the amount of toxicity with iron in hemochromatosis, which was great. I wrote a paper and we were working with Mayo Clinic and they developed the test. So that was very exciting. Then I started the automated lab because all the chemistry. And all the hematology was going out, was sent out. So that brought a lot of money into the lab, but that was not my lab. It was Dr. Peter's lab. It was wonderful. It was nice. But he was the entrepreneur there. So in the year 2000, I started ANTIAGING Institute of California. After passing the specialist chemist license in California, I got National Registry in Certified Chemistry, Certified Toxicology, and then I took the board exam with American Academy of Antiaging Medicine. And that was again entrepreneurial and I started the company, that would be 25 years ago. I've done a lot of consultation. I've been director of lab during COVID. I went back to city health. And I was Director of City Health running 4, 000 COVID patients a night for airports, for schools, for traveling, for a lot of stuff. And then I worked with Siemens Healthineers on regulations for IVDR. So all the kits that Siemens had, over 700 reagent kits that were sold to the laboratories, they need to get the CE mark to be able to be sold in Europe under the new IVDR regulations. And a lot of it had to go through FDA as well because FDA had to approve if there were any changes made to the kits. So I've done a lot of regulation works. I've done a lot of hands on COVID tests, covered it all. Actually, something else that was very interesting. And this, for MedTechs, I would think this would be interesting to know that it's not just one position. And there's so much you can do, if you want to expand your horizon. For about a year, I helped set up extremely high complex laboratory for testing mother's milk, for making milk bank from mother's milk for NICU for children who were born early and the formulas did not work with them. Some of them were so tiny, less than a pound. And so mother's milk bank, it's called Prolacta Bioscience, the company. And I worked there to establish the clinical lab and to get a license for clear and stuff like that. So. [00:18:21] Lindsey Dinneen: Oh! [00:18:21] Dr. Shoreh Ershadi: A lot of good work going into my up and down career, I would say. [00:18:28] Lindsey Dinneen: I love it. Well, first of all, I'm so honored that you were willing to share so much with me. That is. I really appreciate it. And I really appreciate you being willing to talk about some of the amazing moments you've had and the really high, " Yay, we did this," but also some of the moments where it was a little bit tougher and even you being honest and transparent about, the one company didn't do as well as you would have hoped, but you kept going and you are a living testament to resilience and adaptation. [00:18:59] Dr. Shoreh Ershadi: There is no other choice. I would hope that people would have many choices. I mean, you always make choices in life. Even now, this is a choice to talk to you and I appreciate the opportunity because, if I would choose or if I wouldn't know about you, that would be a totally different episode in my life. So I'm open to take chances. You can say that with my experience, living in three different continents and moving and just leaving Iran and coming to us with a three year old, not being here ever before. And then, just jumping in and, but there was no other choice except for moving forward, or we can say, except for success. Because failure was not an option. What would I do? There was nowhere to go back. Sometimes you may have an option to make a U turn and say, "Okay, I don't like this. I want to do something else. I want to stay home." There was no option, no going back. So it was only forward. [00:20:09] Lindsey Dinneen: Yes, absolutely. So, coming here and like you said, having to move forward and I appreciated what you said, you kind of, you couldn't look to the side, you couldn't look back. You had to keep moving forward. How did you go about building a community that could support you, that you could be friends with, and colleagues with, and feel supported coming in from, not having that. [00:20:36] Dr. Shoreh Ershadi: And that was not very difficult. There were many difficult times during that, that I mean, I don't mind talking about it, being a woman, being a young woman, being from a different background there was a lot of resistance. And I see that today as well. I mean, I can't say, "Oh, here I'm in L. A. and Los Angeles is so easy." It's not. I am hoping that women would not maybe experience all the difficulties that I went through. But we're talking about 40 years ago. I came to The States actually July 22nd would be exactly 40 years. I left Iran July 1st, 1984. So this is the 40th anniversary. Being a woman, I thought, when I went to England one of the first things, the professor was my direct supervisor when I worked with him. And I know you can see my face. This is 40 years later. I have no claims, but the professor told me, "You're a beautiful woman. Why do you want to study? Why are you here for PhD?" And I thought that was the greatest insult in my life. So I fought with that professor for four years. [00:22:15] Lindsey Dinneen: No, I'm sorry. [00:22:17] Dr. Shoreh Ershadi: That wasn't easy, but it was so difficult to prove that I am not just a woman or a pretty girl or a young girl or a young woman, or. That was a major fight. I would say that was as difficult as fighting the revolution in Iran, because you wouldn't expect a British professor to say that to you. And I was the only girl, a PhD student, all the others were guys, and this was medical school. And to me, that was very surprising because when I went to University of Tehran, we had probably more girls than guys in the class. Girls were very prone to education in Iran, and they still are. There's still, I think, 60, 65 percent girls in universities, even here. But to hear that was very difficult. That experience repeated itself. in United States over and over till today that I can say I don't feel old. I'm antiaging, but now that I'm an old woman, I still feel that I have to prove myself that I am equal. And sometimes I would say I'm better, but, just to be honest and modest, you want to be treated equal. And that is very difficult. [00:23:53] Lindsey Dinneen: Yeah. Yeah, you're absolutely right. And As much as I would wish things were improving rapidly, I'm not so sure that they are, but what have you found has been helpful in terms of, helping people understand who might come with a bias, but who, helping those people understand, "No I have this education. I am very capable." What are some strategies that you have found that have worked really well for you? [00:24:22] Dr. Shoreh Ershadi: Not many. I have to be honest with you. I mean, if there are a few people, few women, a few even men who are, would be following the conversation, I want them to know that this is not easy. And maybe a part of my success is that I'm a fighter. And I didn't surrender, but I didn't smile my way up. I fought with everyone that went in that direction. And I don't want to get into details, but many of the stronger men would think that if they flirt with you, if they take you out, if they buy dinner for you, then you're going to do what they say. And my story is, just, I have my guards up and I fought. I wouldn't recommend people to fight. Maybe they can find a better solution. I did not find many. Maybe the reason of working separate and starting my own company, maybe one of the major reasons was that I would not have to say yes to power that I did not want to say yes. I worked very hard. I worked hard, long hours. Medtechs, you have to stay there to get the results out. One Christmas. I stayed from December 24th for I would say 72 hours in the lab, maybe two, three hours shower and sleep and go back because we had a lot of toxicology tests that were waiting and results had to go out. And the probe in the I-C-P-M-S was broken. There was no one to replace it during Christmas. It was, we had to borrow from somewhere, FedEx shipping it. Those things happen, you know that, and you have to work hard. It wasn't an easy journey to say, "Oh, I worked four hours a day." And they said, "Thank you. You're so good. Go home." It wasn't like that. [00:26:44] Lindsey Dinneen: Right. Right. Yeah. Well, thank you. I appreciate you sharing that. And so one thing that was really interesting to me, I was looking at your LinkedIn profile and I see that art is a big part of your life in addition to the science and I saw you listed painting and sculpting and I'm wondering how-- well a couple of things-- how did you first get involved in art? And secondly, do you feel that is helpful in terms of having a sort of therapeutic thing to do that kind of maybe helps with some of those harder moments where it's a little frustrating? [00:27:23] Dr. Shoreh Ershadi: Very helpful. But I was as a kid, I started painting at a very young age. And I was always coloring and painting and making things and all that. And my father, a very educated father, he had two master's degree from a University of Texas and came back to Iran. And that's why, we spoke English and we went to English school. So my father was educated and open minded, I can say. But he always said that "You should study art. And don't go to medicine, you'll get old." He passed away in 1988, and I always, when I started Antiaging, I always said "Okay, if you're looking, you will see that I'm antiaging, I didn't age, I went to medical school, I did all the studies." But my logic, first that I love to do this, I mean, it wasn't just you know, forcing myself. I love science. And to this day I do a lot of research. I play with science. You can see the labels are all fancy. I do the paintings. I do all of that. But my logic, more than being scientific, was that this was a career and art would not be a self supporting career, even at younger age. But I always said that if I was a doctor, I could paint, but if I was an artist, I could not do the scientific part or the medical part that I was interested in. But after the divorce, I was in a relationship for 14 years. And I was working hard, raising a son, being a single mother and all that. When that relationship ended after 14 years, the art just popped out. I started painting, sculpting. It was not under control. You can see that, things happen to me, things come out in a certain period. Maybe, I push them down, force them to stay within me, and then they just pop out in different directions. So art came out itself. But there was a period in between that there was no art. Maybe there was too much stress. Maybe there was a lot of, and right now there's no art. Right now it's more entrepreneurial, starting, scientific, all that. But the art pops out every now and then. [00:30:07] Lindsey Dinneen: That's great. Yeah. So speaking of, what you're doing now, I was wondering if you could share a little bit about your company and maybe what you're excited about for its future as you continue along this path. [00:30:19] Dr. Shoreh Ershadi: Okay. That is, this is now where all the passion is. So everything that I have forced inside for all my life is now just coming out into Apoptosis. Apoptosis is a Greek word and it means "falling of the leaves." In science apoptosis, if you Google it, you'll see it means "programmed cell death." So in our bodies in creation or creator or whichever you wanna put it, and I'm sure being a medtech and all the audience, they know there are thousands of reactions inside the body are happening for me just to sit here and breathe and talk. There are thousands and thousands of enzymes and catalysts and metals and oh, whatever is going on. Programmed cell death or apoptosis is a main part of survival. So it's the future of antiaging because we all-- first of all that life expectancy is much longer now. Longevity is longer and younger people do not want to get old. So, at some point I would say my grandmother's generation and my mother is now 95 years old and she's, thank God, healthy and walking and all that, but even she does not want to get old. So, the image of being old and sick is combined together. But we can age without being sick, without getting Alzheimer's, without losing our memory, without getting all these different kinds of diseases. And one major problem is cancer that was much higher with older people and now the statistic is showing that cancer is happening in younger and younger generations. So what apoptosis does is that it's a program in the body. I did not make it. I wish I did, but it's happening all the time. And apoptosis is getting rid of cancer cells, getting rid of damaged cells, getting rid of neurons that cannot connect and synapses with other neurons to take the message over. So if we encourage apoptosis, then all the damaged cells are removed just like falling leaves. They're removed from the body and they're replaced with new energized healthy new cells. Every 10 years, our entire body is regenerated. So why do we get old? We should always stay at a 10 year age. So at 20 years old, we have recycled cells that even though we're growing, growth and youth is defined as between 20 to 25. From 25 to 30, it's sort of stable. There's a plateau. After 30, we start the aging process. So now, as 30 to 60, is still considered not so deep slip going down. It's sort of a plateau up to 60. And then after 60, 70, 80, 90, people are beginning to age. And it shows, I mean, with different diseases, with wrinkles, with memory loss, with all that. So what I'm doing, I'm using nature's product, plant based products, and this has been proven in science that these plants support apoptosis. So, as we get older, just like all the other reactions, apoptosis does not happen at its ultimate way that it should happen. But if we encourage it, for example, we have here, this one is brain beet. This is all beet roots, and it's an organic product. It's all plant based, but it releases nitric oxide. And it works the same way that Viagra works, but it opens all the arteries, it opens the circulation to the brain, to the heart, so why not use it? Why not promote apoptosis the way nature has programmed it in our body, just help it to work better. So that is all my passion right now. [00:35:28] Lindsey Dinneen: Excellent. Excellent. Well, I love that. Thank you for sharing a little bit about it. I'm excited for our listeners to go and learn more about it and, see how they can maybe also take part in the antiaging movement. [00:35:41] Dr. Shoreh Ershadi: Yes, they can partner with us and I would be thrilled. Actually, this is something that maybe I have learned during the long life experience, is that the more partners you have, the more friends you have, the more you share your knowledge, the better it is. Because at some point, it was like people wanted to keep everything to themselves and they didn't want to share or, but right now it's totally different. If they go to Apoptosis.us, they can go to the science section, they can read the papers. And if they would like to partner, I'll be thrilled to work with as many people as possible and take the message out. Yeah, this is a healthy message. This is something that we should all be talking about. [00:36:36] Lindsey Dinneen: Indeed, we should. Yes. Thank you. Well, pivoting the conversation just for fun, imagine that you were to be offered a million dollars to teach a master class on anything you want. It can be in your industry, but it doesn't have to be. What would you choose to teach? [00:36:56] Dr. Shoreh Ershadi: Well, the million dollar would be great. [00:36:59] Lindsey Dinneen: Indeed. [00:37:00] Dr. Shoreh Ershadi: Yes. Yeah. Would we all want that. But yes, I think that right now, as I said, I would use the million dollars to talk about apoptosis all over because I see even young children, every time I see St. Jude's children, and thank you for your donation to Save the Children. I admire that. And I'm hoping that all the children in the world would have a good, healthy future. The world is crazy. You can look at it right now and see that, I can say my experience has been crazy. It doesn't get any better. It's always up and down. Things are happening all over everywhere in the world. And I would like to talk about health, talk about antiaging, talk about Apoptosis and educate more and more of the young people to learn and to avoid all the toxins that we are creating and we have created, with what we're doing with industry and go back to a plant based life, go back to nature, enjoy nature, go back to art, if possible, all the good things that we can do with our lives. [00:38:21] Lindsey Dinneen: Yes, absolutely. And then, how do you wish to be remembered after you leave this world? [00:38:29] Dr. Shoreh Ershadi: Oh, wow. That's a very difficult... a fighter? Survivor? Yep. Strong women? I would support women all the way. Now in Iran, they're saying, Woman Life Freedom. I'm sure you've heard about that. And I cannot tolerate, to see women covered all over with a window to see outside. To me, that is very disturbing. So I would like to see equal opportunity for women and I would like to maybe be remembered as a survivor. [00:39:14] Lindsey Dinneen: Yes, absolutely. And then, final question, what is one thing that makes you smile every time you see or think about it? [00:39:24] Dr. Shoreh Ershadi: Oh, my granddaughter and my grandson. Yes, I have a five year old granddaughter. Her name is Julia and she is my sunshine. She is my life. The grandson is three months old. He's still too young, but he's getting there. [00:39:45] Lindsey Dinneen: Aw! [00:39:48] Dr. Shoreh Ershadi: Getting emotional. [00:39:51] Lindsey Dinneen: I'm so glad. It's that's beautiful. That's wonderful. [00:39:56] Dr. Shoreh Ershadi: Yes, that is continuation of the fight. That is when you see that what you've done is worth the fight, worth the hard work. [00:40:08] Lindsey Dinneen: Absolutely. Absolutely. Yes. Well, this has been amazing. I so appreciate you telling your story and sharing some of it that maybe you haven't done before, and that's I feel very honored. [00:40:23] Dr. Shoreh Ershadi: Yes. [00:40:24] Lindsey Dinneen: Thank you. Thank you for trusting me. [00:40:28] Dr. Shoreh Ershadi: Well, thank you for bringing all of this out. This has been sitting there suffocating, maybe. [00:40:36] Lindsey Dinneen: Yeah. [00:40:37] Dr. Shoreh Ershadi: Thank you. [00:40:38] Lindsey Dinneen: Absolutely. And we are so honored, you mentioned this, but to be making a donation on your behalf as a thank you for your time today to Save the Children, which works to end the cycle of poverty by ensuring communities have the resources to provide children with a healthy, educational, and safe environment. So thank you for choosing that organization to support. And we just wish you the most continued success as you work to change lives for a better world. [00:41:06] Dr. Shoreh Ershadi: Thank you so much, and thank you for having me, and thank you for making me tell the story. Thank you, Lindsey. [00:41:15] Lindsey Dinneen: Of course. And thank you also so much to our listeners for tuning in. And if you're feeling as inspired as I am right now, I would love if you would share this episode with a colleague or two, and we'll catch you next time. [00:41:29] Ben Trombold: The Leading Difference is brought to you by Velentium. Velentium is a full-service CDMO with 100% in-house capability to design, develop, and manufacture medical devices from class two wearables to class three active implantable medical devices. Velentium specializes in active implantables, leads, programmers, and accessories across a wide range of indications, such as neuromodulation, deep brain stimulation, cardiac management, and diabetes management. Velentium's core competencies include electrical, firmware, and mechanical design, mobile apps, embedded cybersecurity, human factors and usability, automated test systems, systems engineering, and contract manufacturing. Velentium works with clients worldwide, from startups seeking funding to established Fortune 100 companies. Visit velentium.com to explore your next step in medical device development.
This episode of "Cancer Registry World" features Dr. Lara Harik, Associate Professor in the Department of Pathology and Laboratory Medicine at Emory University School of Medicine. Dr. Harik also serves as the current Chair of the Cancer Committee for the College of American Pathologists. In this episode, she discusses the crucial role of cancer registries in the development of synoptic cancer reporting. Enjoy listening and learning!
Through elaborate multidisciplinary collaboration, institutions with National Accreditation Program for Rectal Cancer (NAPRC) standards can deliver a “high level of care” in the surgical treatment of patients with rectal cancer, according to Steven Wexner, MD, PhD, and Arielle Kanters, MD. In a conversation with CancerNetwork®, Wexner and Kanters detailed the history and advancement of the NAPRC as an interdisciplinary initiative to improve the outcomes of those undergoing surgery for rectal cancer. Wexner is the chair in the Department of Colorectal Surgery and director of the Ellen Leifer Shulman & Steven Shulman Digestive Disease Center at Cleveland Clinic, Florida, the founding chair of the NAPRC for the American College of Surgeons Commission on Cancer, and part of the executive committee of the Commission on Cancer. Kanters is a colorectal surgeon, associate fellowship program director, and surgeon leader of the NAPRC program at Cleveland Clinic Main Campus. Wexner spoke about the inspiration for developing the NAPRC as a mission to elevate the level of surgical outcomes in patients with rectal cancer across the United States to those he observed in European countries such as the United Kingdom and Scandinavia. He enlisted leaders from organizations including the Society of Surgical Oncology and the College of American Pathologists to outline and apply appropriate standards for surgical care in rectal cancer. Additionally, Kanters highlighted how enforcing precise guidelines and compliance measures through the NAPRC program facilitates multidisciplinary efforts with colleagues who specialize in radiology and pathology. She stated that these principles help individuals develop their skills across each department, thereby maintaining a high level of treatment for patients with rectal cancer. Findings from a study published in the Journal of the American College of Surgeons indicated that mortality and complication rates appeared to be lower for patients who received surgery for rectal cancer at NAPRC-accredited institutions compared with those who were treated at non-accredited practices. Wexner and Kanters also discussed how potential advancements related to the use of neoadjuvant or adjuvant therapy may further improve patient outcomes in the field. Additionally, they spoke about updated research on immunotherapy and other modalities that they anticipate at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting. Reference Harbaugh CM, Kunnath NJ, Suwanabol PA, Dimick JB, Hendren SK, Ibrahim AM. Association of National Accreditation Program for Rectal Cancer Accreditation with outcomes after rectal cancer surgery. J Amer College Surg. Published March 28, 2024. doi:10.1097/XCS.0000000000001064
In this episode of “Answers From the Lab,” host Bobbi Pritt, M.D., chair of the Division of Clinical Microbiology at Mayo Clinic, is joined by William Morice II, M.D., Ph.D., CEO and president of Mayo Clinic Laboratories. They discuss current events including Medical Laboratory Professionals Week, recent healthcare conferences, advocacy efforts, measles, and bird flu.Their discussion includes:Key takeaways from the Becker's Healthcare Annual Meeting and the College of American Pathologists' (CAP) Pathologists Leadership Summit.The resurgence of measles cases and recent activity of bird flu (H5N1).Tips for staying engaged and being the voice for patients.
I love talking about metacognition, in hopes of improving how I think, how I diagnose, and how I learn. Dr. Smoller loves to teach and is interested in learning theory, and he has active research experience in learning/teaching visual recognition through pattern recognition, fast thinking. And yet, algorithmic thinking (slow thinking) is important, too. Our conversation is based on a lecture he gave at the recent March, 2024 International Society of Dermatopathology meeting. Don't miss this conversation! Dr. Bruce Smoller MD trained in anatomic and clinical pathology at Harvard's Beth Israel Hospital and in dermatopathology with Dr. Scott McNutt at Cornell Medical School/ New York Hospital. He has worked at Stanford University, rising to the rank of Professor of Pathology and Dermatology as well as at the University of Arkansas, where he was Chair of the Department of Pathology and the Director of Dermatopathology from 1997 to 2011. In 2011, he became Executive Vice President of the United States and Canadian Academy of Pathology. Since 2014, he has been Professor and Chair, Department of Pathology and Laboratory Services and Professor of Dermatology at the University of Rochester School of Medicine and Dentistry. Dr. Smoller is a former Editor-in-Chief of the Journal of Cutaneous Pathology and served as the President of the American Society of Dermatopathology, receiving the Nickel Award, which recognizes lifetime excellence in teaching, from the American Society of Dermatopathology. He received a Lifetime Achievement Award from the College of American Pathologists in 2022. He has written over 300 articles and has primary involvement in 18 books.
Three magic words to help conquer fear, that may also be a secret to having a long and productive career. I really enjoyed this conversation with Dr. Bruce Smoller, a giant in the field of dermatopathology and pathology. Also tune in next week for Part 2! Dr. Bruce Smoller MD trained in anatomic and clinical pathology at Harvard's Beth Israel Hospital and in dermatopathology with Dr. Scott McNutt at Cornell Medical School/ New York Hospital. He has worked at Stanford University, rising to the rank of Professor of Pathology and Dermatology as well as at the University of Arkansas, where he was Chair of the Department of Pathology and the Director of Dermatopathology from 1997 to 2011. In 2011, he became Executive Vice President of the United States and Canadian Academy of Pathology. Since 2014, he has been Professor and Chair, Department of Pathology and Laboratory Services and Professor of Dermatology at the University of Rochester School of Medicine and Dentistry. Dr. Smoller is a former Editor-in-Chief of the Journal of Cutaneous Pathology and served as the President of the American Society of Dermatopathology, receiving the Nickel Award, which recognizes lifetime excellence in teaching, from the American Society of Dermatopathology. He received a Lifetime Achievement Award from the College of American Pathologists in 2022. He has written over 300 articles and has primary involvement in 18 books.
In this episode of “Answers From the Lab,” host Bobbi Pritt, M.D., chair of the Division of Clinical Microbiology at Mayo Clinic, is joined by William Morice II, M.D., Ph.D., CEO and president of Mayo Clinic Laboratories. They discuss important industry updates and legislative insights gathered from Dr. Morice's recent trip to Washington, D.C.Their discussion includes:The status of current laboratory-related legislative efforts, including the Protecting Access to Medicare Act (PAMA), the Saving Access to Laboratory Services Act (SALSA), and the Pandemic and All Hazards Preparedness Act (PAHPA).Current issues facing the laboratory industry, including prior authorization, coding, and potential FDA oversight of laboratory-developed tests.The importance of advocating on behalf of laboratories, clinicians, and patients, and engagement opportunities through professional societies like the College of American Pathologists and the American Clinical Laboratory Association.
In 2016, Mike Fraser joined ASTHO as CEO. Throughout the seven subsequent years, he served as an indispensable leader, visionary, mentor, and friend—steering the organization through unprecedented challenges in public health, including the global COVID-19 pandemic. Now, the time has come to bid Mike a bittersweet farewell. In this episode of Public Health Review, we speak with Mike about his profound legacy, celebrate ASTHO's extraordinary achievements under his tenure, and wish him well in his new position as CEO at the College of American Pathologists. Behind the Scenes: What it Takes to do COVID Testing Public Health Review Morning Edition
A Fresh Story, season 5, episode 10 We had the honor of talking to three-time Emmy-winning media and public speaking trainer Kathryn Janicek. Kathryn helps leaders communicate more effectively with the media and any audience. We talked to Kathryn about her own fresh starts in her career, and how she is passionate about supporting people in finding their voice and conquering communications. We chatted about how she met her husband, going through IVF and the loss of her twins, and how she held out hope for her daughter. We loved her advice on how to “balance it all,” and she has so many wise gems throughout the whole episode! Kathryn's 25+ years of experience running live news TV shows, as a media executive, and as a spokesperson means she brings expert perspective and guidance on shaping messaging and delivering with impact. Kathryn Janicek Productions is a team of experts who train in leadership development, executive presence, public speaking, media interview performance, communications, sales and relationship building, and wellness. They train Fortune 500 executives, physicians across the country, and they are the go-to training firm for the American Dental Association, the College of American Pathologists, the Congress of Neurological Surgeons, the American Society of Plastic Surgeons, and other medical associations. Enjoy this episode with Kathryn, check out her website, and follow Kathryn on Instagram.
Artificial intelligence, also known as AI, is streamlining processes within health care, particularly related to diagnosing and managing patient care. In this interview with Becker's Healthcare, M.E. (Doc) de Baca, chair of the College of American Pathologists' Council on Informatics and Pathology Innovation, discusses the complexities of integrating AI into patient care, considering the practical, ethical and collaborative aspects that need to be addressed for effective implementation and improved patient care.
Dr. Emily Volk is a pathologist at the University of Louisville and has served as the President of The College of American Pathologists from 2021-2023. She joins the show to discuss balancing her journey as a pathologist, administrator, and CAP governor with family life. This episode features a behind the scenes look at some of the political issues facing CAP including Dobbs vs. Jackson and the VALID act. Finally, Emily shares her views on the future of pathology.A forum to engage with the hosts and other listeners has been launched on the DPA website www.digitalpathologyassociation.org. DPA members may login to the DPA Collaborate hub (under the Resources tab) and join the Beyond The Scope community. All listeners are encouraged to use this forum to suggest future topics and guests, submit questions and corrections, and provide general feedback.
Stefan Goncalvez & JP Castro – Joffrey Ballet, Frankenstein Dr. Donald Karcher - President, College of American Pathologists
Ron is upset about the relaxed dress code for US Senators. He says it's a new level of disrespect..... Guest: Dr. Emily Volk is President of the College of American Pathologists talking about vaccinations for kids
In this episode, host Sanya Bawa, an amazing intern at SBC interviews Dr. Kulkarni, a pathology specialist, about the clinical perspective of a breast cancer diagnosis. Dr. Kulkarni discusses her journey in the field of pathology and how it offers a collaborative and constantly evolving approach to medicine. Dr. Kulkarni also highlights the importance of pathology in making accurate diagnoses by examining breast samples and biopsies. Our SBC Listeners gain insights into the challenges and advancements in breast cancer research and technology. Tune in to understand the clinical side of breast cancer and gain a new perspective on this diagnosis.Topics covered in this episode:"Understanding Breast Cancer: Insights from a Pathology Specialist""New Technologies and Research in Breast Cancer: A Clinical Perspective""The Importance of a Pathologist in Breast Cancer Diagnosis""Expert Advice on Breast Cancer Treatment and Resources""Empowering Patients and Families: A Conversation with Dr. Renuka Kulkarni"About Dr. KulkarniDr. Kulkarni completed her anatomic and clinical pathology residency at Saint Barnabas Medical Center, Livingston, New Jersey, followed by a surgical pathology fellowship at the Medical College of Georgia, Augusta. She received her medical degree from JJMM Medical College, India. Dr. Kulkarni has expertise in the areas of surgical pathology, immunohistochemistry, breast prognostic markers, and applications of whole slide imaging and image analysis. She is a member of the College of American Pathologists and the American Society of Clinical Pathologists.As always, our podcasts are made possible thanks to donations from listeners like you. If you would like to support our nonprofit organization, please consider making a contribution through survivingbreastcancer.org/donate.Don't forget to also check out all of our free programming and services available to anyone who has been diagnosed with breast cancer. Visit survivingbreastcancer.org/events for more information.Thank you for being a part of our community and for supporting our mission to empower those diagnosed with breast cancer and their caregivers.About SurvivingBreastCancer.org. Survivingbreastcancer.org (SBC) was created in 2017 to help fill the gaps in breast cancer support, education, and resources. It was founded by Laura Carfang, who was recently diagnosed at that time in her early 30's. Since 2017, SBC has grown exponentially, serving members in the global breast cancer community. Over these past few years, the SBC website has been visited by community members (over 1,000,000 page views) across 120+ plus countries, and Laura's podcast, Breast Cancer Conversations has been listened to in over 80 countries. Leveraging technology and breaking down barriers to access and information, SBC puts the patient first, educating, encouraging and inspiring advocacy. Community members are encouraged to participate in the various free programming, events and services and are all invited to contribute to resolving the growing needs of this population. Website:https://www.survivingbreastcancer.org/Events: https://www.survivingbreastcancer.org/eventsDonate NowPlease consider making a donation.https://www.survivingbreastcancer.org/donate-nowSupport the show
Artificial intelligence, also known as AI, is streamlining processes within healthcare, particularly related to diagnosing and managing patient care. In this podcast interview, M.E. (Doc) de Baca, Chair of the College of American Pathologists' Council on informatics and Pathology Innovation discusses the complexities of integrating AI into patient care, considering the practical, ethical and collaborative aspects that need to be addressed for effective implementation and improved patient care.This episode is sponsored by College of American Pathologists.
In this episode of Life Science Success my guests are Rahul Sharma, the co-founder and CSO of Scienetix, a company dedicated to enabling Molecular Diagnosis. Dr. Sharma is a board-certified laboratory director and technical lead for Next Generation Sequencing (NGS) and PCR-based assay development and clinical testing. He has developed multiple Molecular Diagnosis tests and translated them into clinical testing. Additionally, We are joined by Rob Carpenter PhD, MBA the CEO of Scienetix. Rob is a healthcare executive and educator with over 25 years' experience in developing, managing, and assimilating healthcare companies. He is distinctly skilled in business development and various business growth strategies. He is founder and current CEO of Advanta Genetics, a highly complex clinical and research laboratory accredited by the College of American Pathologists with concentration in infectious disease molecular genomics and Scienetix, a bioscientific company centered around products to optimize molecular genomic workflows. In the podcast, Dr. Sharma and Dr. Carpenter talk about the healthcare industry's need to optimize workflow and reduce costs in laboratory testing. Their company, Scienetix, is working on developing extraction-free tests that will eliminate the need for sample pre-processing and make testing more accessible and cheaper for labs. They are also focused on increasing the multiplex capability of PCR reactions, which will allow labs to test for more targets in a single reaction. Dr. Sharma and Dr. Carpenter also discuss their leadership styles and offer advice on being reliable, thinking about the application of science, and staying creative. They express concern about the growing distrust of science and the spread of misinformation, particularly in the age of social media. What excites them most is the opportunity to solve scientific challenges and create products that have a societal impact.
Dr. Riddle is a Senior Pathologist for Ruffolo, Hooper, and Associates, providing services at Tampa General Hospital / USF Health, where she is also the Pathology Residency Site Director. There she does General Anatomic Pathology with a focus in Bone & Soft Tissue, Gastrointestinal Pathology, Neuropathology, and Dermatopathology. She is also Associate Professor and Associate Residency Program Director for the USF Health Department of Pathology and Cell Biology. Dr. Riddle is heavily involved in organized medicine. She has been active in the AMA since 2002, serves on the board of the Florida Society of Pathology (FSP) and COLA, and sits on committees for the College of American Pathologists, the Digital Pathology Association, USCAP, FSP, and her county medical society. She has a specific interest in digital pathology, informatics, high reliable medicine, and creating a culture of quality and patient safety, as well as varied research endeavors. Dr. Riddle has been honored with several awards including the ASCP 2018 “40 under Forty”, the Pathologist Magazine's “Power List”, and the 2021 CAP Resident Advocate Award.Twitter: @NRiddleMD
Why Mitigating Risk of Cuts on Capitol Hill is so Important This Year by College of American Pathologists
Dr. Kristinza Giese is a native of the Washington, DC area and is a graduate of Howard University. In 2006, she graduated from the Medical College of Wisconsin. Her post graduate medical training includes General Surgery Residency at Vanderbilt University Medical Center and Anatomic and Clinical Pathology Residency at University of Washington Medical Center. In 2011, Dr. Giese accepted a Forensic Pathology Fellowship at the Milwaukee County Medical Examiner's Office. She has been an Associate Medical Examiner at the Fond du Lac County Medical Examiner's Office in Fond du Lac, WI and is presently a Deputy Medical Examiner at the Office of the Chief Medical Examiner in Washington, DC. Dr. Giese is board certified in Anatomic, Clinical, and Forensic Pathology. She is also a member of many organizations, including the American Academy of Forensic Science, the National Association of Medical Examiners, the College of American Pathologists, and Delta Sigma Theta Sorority Incorporated. Dr. Giese enjoys teaching and has given multiple volunteer lectures to Forensic Science students and interns. When she is not in the autopsy room, she enjoys playing her violin, playing tennis, and spending time with her two sons, Jay and Julius.Twitter: @NMA PathologyTwitter: @Kristinza23Website: NMA Pathology - NMA Pathology | Home
Ron Balassanian is a Professor of Pathology at the University of California San Francisco (UCSF) with an appointment in UCSF Helen Diller Family Comprehensive Cancer Center. His clinical and research work focuses on fine needle aspiration (FNA) biopsy and general breast pathology, as well as patient communication and global health. Ron has led workshops on training pathologists to perform and interpret ultrasound guided FNA for the College of American Pathologists, the American Society of Cytopathology and the United States and Canadian Academy of Pathology. In collaboration with PATH, a Seattle based NGO, he helped develop the Community Program for Breast Health in Trujillo Peru, using FNA as a cost-effective tool for diagnosis and triage. Through the UCSF Global Cancer Program, he helped develop an US-FNA course in Dar es Salaam Tanzania as part of an ongoing educational collaboration between Muhimbili University and the UCSF Global Cancer Program. At UCSF he developed a patient education program called “Ask Your Pathologist” inviting patients to review their breast cancer slides with a Pathologist to better understand their pathology report. In his clinical service and research work, Ron is passionate about patient centered pathology and bridging the gap between the patient and the pathologist. Twitter: @BalassanianRon
References: Roy-Chowdhuri S, Dacic S, Ghofrani M, Illei PB, Layfield LJ, Lee C, Michael CW, Miller RA, Mitchell JW, Nikolic B, Nowak JA, Pastis NJ Jr, Rauch CA, Sharma A, Souter L, Billman BL, Thomas NE, VanderLaan PA, Voss JS, Wahidi MM, Yarmus LB, Gilbert CR. Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology. Arch Pathol Lab Med. 2020 May 13. doi: 10.5858/arpa.2020-0119-CP. Epub ahead of print. PMID: 32401054. Yatabe Y, Dacic S, Borczuk AC, Warth A, Russell PA, Lantuejoul S, Beasley MB, Thunnissen E, Pelosi G, Rekhtman N, Bubendorf L, Mino-Kenudson M, Yoshida A, Geisinger KR, Noguchi M, Chirieac LR, Bolting J, Chung JH, Chou TY, Chen G, Poleri C, Lopez-Rios F, Papotti M, Sholl LM, Roden AC, Travis WD, Hirsch FR, Kerr KM, Tsao MS, Nicholson AG, Wistuba I, Moreira AL. Best Practices Recommendations for Diagnostic Immunohistochemistry in Lung Cancer. J Thorac Oncol. 2019 Mar;14(3):377-407. doi: 10.1016/j.jtho.2018.12.005. Epub 2018 Dec 18. PMID: 30572031; PMCID: PMC6422775. Sehgal IS, Gupta N, Dhooria S, Aggarwal AN, Madan K, Jain D, Gupta P, Madan NK, Rajwanshi A, Agarwal R. Processing and Reporting of Cytology Specimens from Mediastinal Lymph Nodes Collected using Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A State-of-the-Art Review. J Cytol. 2020 Apr-Jun;37(2):72-81. doi: 10.4103/JOC.JOC_100_19. Epub 2020 Apr 2. PMID: 32606494; PMCID: PMC7315917. Wahidi MM, Herth F, Yasufuku K, Shepherd RW, Yarmus L, Chawla M, Lamb C, Casey KR, Patel S, Silvestri GA, Feller-Kopman DJ. Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report. Chest. 2016 Mar;149(3):816-35. doi: 10.1378/chest.15-1216. Epub 2016 Jan 12. PMID: 26402427.
Dr. Praveen Vikas, Dr. Tyler Johnson, and Dr. Russell Broaddus present the ASCO endorsement of the Mismatch Repair and Microsatellite Instability Testing for Immune Checkpoint Inhibitor Therapy: Guideline From the College of American Pathologists in Collaboration With the Association for Molecular Pathology and Fight Colorectal Cancer. They discuss key evidence-based recommendations, focusing on the appropriate modality of testing (immunohistochemistry, polymerase chain reaction, or next generation sequencing) across multiple cancer types. Additionally, they cover the ASCO endorsement process, points of emphasis raised by the ASCO expert panel, and implications for clinicians and patients. Read the full guideline endorsement, Mismatch Repair and Microsatellite Instability Testing for Immune Checkpoint Inhibitor Therapy: ASCO Endorsement of CAP Guideline at www.asco.org/molecular-testing-and-biomarkers-guidelines. TRANSCRIPT Brittany Harvey: Hello, and welcome, to the ASCO Guidelines podcast; one of ASCO's podcasts, delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at: asco.org/podcasts. My name is Brittany Harvey, and today, I'm interviewing Dr. Praveen Vikas from the University of Iowa, Dr. Tyler Johnson from Stanford University, and Dr. Russell Broaddus from the University of North Carolina; authors on, 'Mismatch Repair and Microsatellite Instability Testing for Immune Checkpoint Inhibitor Therapy: ASCO Endorsement of CAP Guideline'. Thank you for being here, Dr. Vikas, Dr. Johnson, and Dr. Broaddus. Dr. Praveen Vikas: Sure. Dr. Tyler Johnson: Thanks for having us. Dr. Russell Broaddus: Thank you. Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guidelines, and ensuring that the ASCO Conflict of Interest policy is followed for each guideline product. The full conflict of interest information for this guideline endorsement panel is available online with the publication of the guideline endorsement in the Journal of Clinical Oncology. To start, Dr. Vikas, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Praveen Vikas: I don't. Brittany Harvey: And Dr. Johnson, do you have any relevant disclosures that are directly related to this guideline? Dr. Tyler Johnson: I do not. Brittany Harvey: And finally, Dr. Broaddus, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Russell Broaddus: I do not. Brittany Harvey: Great. Thank you all for providing that information. So, starting us off on the content of this endorsement, Dr. Vikas, what is the scope of this guideline endorsement? Dr. Praveen Vikas: So, as you can see from the topic and headline, the guideline endorsement was focused on mismatch repair and microsatellite instability testing for immune checkpoint inhibitor therapy, and this is basically an endorsement by ASCO, of a guideline that was developed jointly by CAP, and others. Brittany Harvey: Great. And then you just mentioned that this is an endorsement of the guideline developed by CAP and other organizations. Can you provide us an overview of how this guideline endorsement process works? Dr. Praveen Vikas: ASCO definitely takes great pride in endorsing some of the guidelines that are relevant to our cancer community, and of course, mismatch repair and microsatellite instability testing has been one of those areas where there is a lack of clear guidance. So, when we were approached from CAP about endorsing this guideline, we definitely realized that there's not much published from most of our oncology community, so we were very excited about looking into this guideline and endorsing it. So, this was very much for a topic that we thought is very useful and very timely. Brittany Harvey: And that's great to hear. So then, Dr. Broaddus, as an author both on the guideline endorsement and as a member of the original guideline panel, what are the key recommendations of the CAP guideline? Dr. Russell Broaddus: So, there are six key recommendations from the College of American Pathologists guideline that ASCO recently endorsed. I like to think of the first four as being bundled together because they're interrelated - we dealt with these by cancer type for the first four. So, for colorectal cancer, there's by far the most published evidence on this type of testing, and the evidence-based guideline found that really did not matter so much whether you used immunohistochemistry, or PCR-based microsatellite instability analysis, or next-generation sequencing-based analysis to detect mismatch repair or microsatellite instability. The three different techniques are almost interchangeable in their metrics. Similarly, for gastroesophageal adenocarcinoma and small intestinal adenocarcinoma, immunohistochemistry and PCR-based MSI are very, very similar. There's not quite enough published evidence to equate next-generation sequencing. There were one or two very, very good papers with limited number of patients. The guideline committee felt like if there was maybe one or two more published papers in this space, that for gastroesophageal adenocarcinoma and small bowel adenocarcinoma, it would be similar to colorectal adenocarcinoma, whereas the three techniques were nearly interchangeable. After that, unfortunately, the published evidence really drops off in both quantity and quality for almost all other cancer types. So, endometrial cancer, there's quite a bit of literature. Most of it really points to the immunohistochemistry outperforms PCR-based MSI analysis and PCR-based next-generation sequencing analysis. Most likely, that's because these PCR-based approaches nearly always are optimized to detect mismatch repair defects in colorectal cancer, or other GI types of cancer. And there's actually very good published evidence that this detection of mismatch repair can be cancer-type specific. So, the recommendation is to use immunohistochemistry for endometrial cancer. Fourth recommendation for all other cancer types not encompassed by those first three recommendations, the committee recommends to choose a laboratory-based approach to detect mismatch repair or microsatellite instability defects, but there is no good published evidence to suggest which is the best approach. And again, like with endometrial cancer, there's evidence that the PCR-based approaches, which are usually optimized for colorectal cancer and GI-type cancers, may not be sufficient to work well with cancer types outside of the GI tract. So, almost by default, the recommendation is to choose immunohistochemistry. Fifth recommendation: Many people tend to equate microsatellite instability and high tumor mutation burden. For sure, in colorectal cancer and other GI tract cancers, these two entities, there is substantial overlap. But for cancer types outside of the GI tract, you can easily have a tumor that has a mismatch repair defect, or high levels of microsatellite instability and not have high tumor mutation burdens. So, the recommendation is to not equate those two entities. And finally, last recommendation is that for all of us to remember that these defects in DNA mismatch repair or microsatellite instability, are also hallmarks of hereditary cancer syndrome - Lynch syndrome, and that if you identify unexpectedly that a patient with an advanced cancer has one of these defects and DNA mismatch repair, to consider the possibility of Lynch syndrome, and to alert the appropriate care team, for those patients' family members can be screened as well. Brittany Harvey: Understood. Thank you for reviewing those evidence-based recommendations made by the CAP panel, and then endorsed by the ASCO panel. So, were there any additional points of discussion or emphasis raised by the ASCO endorsement panel? Dr. Russell Broaddus: Yes. And very appropriately, I believe. One-- and this is purely because of the issue of scope, and not to minimize the importance of these issues. One issue that the CAP guideline did not address was the important issue of pre-analytic variables and how they can impact diagnostic testing. A second issue, again, not considered by the CAP evidence-based guideline group, because of just tremendous scope problems, is how do these tests - immunohistochemistry, PCR-based MSI analysis, PCR-based next-generation sequencing analysis - how do we incorporate their use with PD-L1 immunohistochemistry, for example? Liquid biopsies, as a second example. Should we have a staged approach in assessing tumors with all these different testing modalities? And frankly, the answer is, we don't know right now. I think this represents an excellent area where oncologists and pathologists can actually work to provide the evidence in some specific cancer types on whether multiple modalities provide benefit compared to just one modality. Brittany Harvey: Definitely, those are key points perhaps for future research, and I appreciate you explaining what was in and out of scope of this guideline. So then following that, Dr. Johnson, in your view, what is the importance of this guideline endorsement, and how will it affect ASCO members? Dr. Tyler Johnson: I think to understand the importance of this particular endorsement, it's helpful to zoom the lens out to 30,000 feet for a minute. Pretty much, all oncologists, I think remember 10 or 12 years ago, the types of drugs that we now commonly use for immunotherapy, burst onto the scene with the treatment of melanoma. And those trials were quite remarkable because previous to that, not only did we not have a cure for metastatic melanoma, we hardly had a treatment for metastatic melanoma. We had really almost nothing to offer those patients. And then there was this, initially a small and then a larger, and then a much larger series of patients, who we now know with 10 or 12 years of follow up, that many patients who were treated with immunotherapy, who had metastatic melanoma were actually cured. Not just treated but cured. So, in the decade or so since then, there has been this understandable and appropriate stampede of trying to figure out, "Okay, how do we use similar drugs in all of the other many metastatic tumor types?" And I think to generalize a lot, and to make overly simple a very complicated picture, what has emerged from that is that unfortunately for many metastatic solid tumors, immunotherapy just doesn't do much. It's essentially inert, as best we can tell clinically. But there is a small percentage of patients, exactly what percentage depends on the tumor type and the genetic analysis as we're talking about here, but there's a small percentage, maybe 10-20% of patients, who derive this unbelievable benefit from immunotherapy in metastatic solid tumors, to the point that some of those patients, including in other solid tumors, not just melanoma, appear to be functionally cured by the administration of immunotherapy. And so, the question of course that has resulted from that, is if eight or nine patients are going to get no benefit and maybe even harm from administration of immunotherapy, but one or two patients out of 10 is going to get this really remarkable benefit, it would be so great if we could be much more specific in knowing which patients are going to derive benefit, and which patients are not going to derive any benefit and may even be harmed. And I think that that's the context within which we have to understand this guideline endorsement, is that this is getting us one step further to knowing which patients are likely to get benefit from immunotherapy in metastatic solid tumors. And the really nice thing, as Russell pointed out, is that one kind of shorthand takeaway from this is that it is almost never wrong to look at the question with immunohistochemistry. And that's a great answer, because it is also almost always the most readily available test. And so, if you have a patient who has a metastatic solid tumor and you order immunohistochemistry to look for microsatellite instability, that's almost regardless of the tumor type, it's probably going to give you a reliable answer. And if it shows that they're microsatellite unstable, then that means that that patient, regardless of the tumor type, really probably should get immunotherapy upfront or very close to upfront. And then there are more nuances sort of beyond that. But I think that's really the take home message, that this gives us one powerful tool for discerning who is likely to get benefit from these therapies. Brittany Harvey: Absolutely. That's a key thought that you just mentioned, that this is about delivering personalized medicine to individual patients. So then, you've already touched on this a bit in your last answer, but finally, to wrap us up, how will these recommendations impact patients with cancer being considered for immune checkpoint inhibitor therapy? Dr. Tyler Johnson: I think that many clinical oncologists have the experience that when you sit down to talk to a patient who has newly diagnosed metastatic cancer, what their treatment is going to be, almost all of them have heard about immunotherapy somewhere; in the newspaper, or from friends, or in a cancer support group or whatever. So, most of them want to know what part, if any, immunotherapy is going to play in the care of their cancer right upfront. And I think this gets us one step closer to being able to answer that question. Now, the one thing that-- and Russell touched on this a little bit, but I think it's just important to highlight, this gives us an important way to predict people who are going to respond, but that does not necessarily mean that people who this does not identify as likely responders are therefore not going to respond. And that gets into a much more complicated question that depending on the tumor type, you may have to look at PD-L1 expression, or other things. So, it's just to say that this is not a comprehensive, definitive answer, but it is one important part of the answer. I don't know if Russell or Praveen wants to add any more thoughts about that, but that's kind of how I would contextualize this. Dr. Russell Broaddus: I think where there's a lot of opportunity here for us to start developing the evidence on the utility or not, of such staged approaches that if-- say like, immunohistochemistry does not reveal a mismatch repair defect, should we, for some of these cancer types where we don't routinely assess PD-L1, should we next do PD-L1 immunohistochemistry? And if that doesn't show overexpression, should we next try next-generation sequencing approach? Because sometimes those don't overlap with immunohistochemistry. So, I think there's a lot of room for us to provide this evidence. Dr. Praveen Vikas: Yeah. And one point I would like to add, we had a lot of discussion among our ASCO endorsement panel, was that by recommending IHC or PCR over NGS in certain cancer, there would be scenarios where NGS will be needed, because NGS would tell us a lot more, like HER2 amplifications, and that was our point of discussion. We wanted to make sure that we send that message that even in cases where IHC and PCR is being done, that we may still have additional need for NGS testing. Dr. Tyler Johnson: Yeah. Thank you, Praveen, for that. I should qualify, just to make sure that it's clear, that when I said that IHC is a good go-to, I only meant in terms of testing for this specific thing. Part of the problem with next gen sequencing is that it often takes 4-6 weeks, and so I think the practical approach is, you should send the next-generation sequencing, but in the meantime, you can do the IHC to have an answer to that particular question, and usually in one or two days, depending on the lab, and then the next gen sequencing can come back whenever it comes back, and then you can use that for directing later lines of therapy. Brittany Harvey: Excellent. Well, I've really enjoyed this discussion today, and I want to thank you all for your work on this guideline endorsement, and thank you for your time today, Dr. Vikas, Dr. Johnson and Dr. Broaddus. Dr. Praveen Vikas: Thanks so much, Brittany. Dr. Russell Broaddus: Thank you. Dr. Tyler Johnson: Appreciate the time. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to: www.asco.org/molecular-testing-and-biomarkers-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app, available in the Apple App store or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe, so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy, should not be construed as an ASCO endorsement.
Why You Should Listen: In this episode, you will learn about the role of microbes in chronic disease. About My Guest: My guest for this episode is Dr. Stephen E Fry. Stephen E. Fry, BS, MS, MD has a BS in Microbiology and an MS in Molecular Biology and a Medical Degree all earned at the University of Arizona. He completed his Post graduate training at Banner Health and St Joseph's Medical Center in the Phoenix metropolitan area. He has been in General Practice in the Scottsdale, Arizona since 1992 and has had a special clinical interest in CFS, autoimmune, and vascular disease. He has lectured nationally and has numerous publications, abstracts, and patents. His science interests are in the microbial causation of chronic disease, biofilms, and their treatment. Because of these interests Dr. Fry has worked on new methods for disease detection which have culminated in the development of a Next-Gen Sequencing system for microbial identification. Dr. Fry is the founder of Fry Laboratories LLC, a CLIA clinical diagnostic laboratory that participates in CAP (College of American Pathologists) and API (American Proficiency Institute) validation systems. He founded the Southwest Center for Chronic Disease to help fund basic medical research. His laboratory, Fry Laboratories, specializes in vector-borne diseases, molecular methods of detection of prokaryotes, archaea, protozoans, fungi, and viruses. Dr. Fry enjoys family time and has a private pilot's license, is an avid skier, sailor, and bicyclist. Key Takeaways: Where do things stand today with Protomyxzoa and Funneliformis? What is the role of biofilms in chronic infections? Are fungi or viruses likely more health-impacting? Is kombucha a healthy drink? Why is Next-Gen Sequencing the leading edge technology for exploring the presence of microbes? What microbes play a role in ME/CFS, ALS, MS, Parkinson's, RA, and Cystic Fibrosis? How has the landscape changed in chronic illness patients since COVID came on the scene? Connect With My Guest: http://StephenEFryMD.com http://FryLabs.com Interview Date: December 20, 2022 Transcript: To review a transcript of this show, visit https://BetterHealthGuy.com/Episode177. Additional Information: To learn more, visit https://BetterHealthGuy.com. Disclaimer: The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.
Dr. Lora Bean gives an overview of phenotypically-driven clinical results in this episode of DNA Today!Dr. Lora Bean is a clinical molecular geneticist who currently serves as the Senior Director of Quality Assurance at PerkinElmer Genomics. Dr. Bean has expertise in traditional clinical molecular testing as well as newer techniques such as next generation exome and genome sequencing. She has served as a molecular editor for GeneReviews and as a member of the American College of Medical Genetics Laboratory QA / QC Committee, an item writer for the ABMGG, and is currently a laboratory inspector and a Biochemical and Molecular Genetics Committee member for the College of American Pathologists. Previously, she served as an Associate Professor in the Department of Human Genetics and Senior Director and Regulatory Director of the EGL Genetics (formerly Emory Genetics Laboratory) Molecular Diagnostic Laboratory. Dr. Bean earned her PhD in the Department of Human Genetics at Case Western Reserve University and completed a postdoctoral fellowship at Emory University. She is board-certified by the American Board of Medical Genetics and Genomics and a fellow of the American College of Medical Genetics. On This Episode We Discuss:Differences between gene panels, exome, and genome sequencing Adapting workflows from exome to genome utilizing existing frameworksAdvantages of different types of testingLimiting the floodgates of variants that inevitably come with whole genome sequencingHelpful information for providers to include with specimens to guide the laboratory when the data are analyzedThe role of phenotypic data specifically in classification of sequence variantsDeep intronic variantsKira was off by one, but Dr. Bean was right, ACMG has 73 genes on the list for reporting of secondary findings in clinical exome and genome sequencing: a policy statement of the American College of Medical Genetics and Genomics (ACMG). If you found the topics that we discussed on this episode interesting, check out this recorded presentation from Dr. Bean entitled, “Why Bigger Isn't Only VOUSier.”Learn more about phenotypically-driven clinical results at PerkinElmerGenomics.com and follow them on Twitter, Facebook, and LinkedIn. Stay tuned for the next new episode of DNA Today on October 21st, 2022! New episodes are released on Fridays. In the meantime, you can binge over 205 other episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “DNA Today”. Episodes since 2021 are also recorded with video which you can watch on our YouTube channel. DNA Today is hosted and produced by Kira Dineen. Our social media lead is Corinne Merlino. Our video lead is Amanda Andreoli. See what else we are up to on Twitter, Instagram, Facebook, YouTube and our website, DNAToday.com. Questions/inquiries can be sent to info@DNAtoday.com. When Willow was diagnosed with Multiple Sulfatase Deficiency (MSD), her mother, Amber was told to love and care for Willow but that there was no cure for this terrible fatal condition. Amber set out to find and fund the cure for MSD. That's when she started the United Multiple Sulfatase Deficiency Foundation. She shares this personal experience on Episode 205 of DNA Today including how this affected her family and the relationships she has built with other families in the MSD community. (SPONSORED)TrakGene has designed a genetics electronic health record. Here's what it features: pedigrees, demographic data, genetics information, risk tools, and sophisticated reporting, all within a clinician designed workflow. It integrates with other clinical genetic software, databases, and hospital information systems to maintain accurate patient records.Go check it out at TrakGene.com. And keep your eye out for our full episode interviews with TrakGene coming soon to DNA Today. (SPONSORED)
The Chromogen Siblings are back to talk about the proposed VALID Act. Drs. Mike Arnold (@MArnold_PedPath), Andrew Bellizzi (@IHC_guy), and Sanam Loghavi (@sanamloghavi) speak with Dr. Emily Volk (@EEVMD) of the University of Louisville and President of the College of American Pathologists (CAP, @Pathologists), and Dr. Jonathan Myles (@JonathanMyles10) of the Cleveland Clinic and Chair of the Council on Government and Professional Affairs for the College of American Pathologists. The VALID act has both strong support and strong opposition from groups such as patient advocacy groups and professional organizations. We'll learn about how the proposed VALID Act could change the way laboratory developed testing is regulated, the role of CAP in shaping legislation, and why CAP is supportive of the current version of the VALID Act despite concerns. Read more about the CAP position on the VALID Act: https://www.cap.org/advocacy/laboratory-oversight-and-regulation/laboratory-developed-test-oversight/laboratory-developed-test-oversight-faqs And previous regulatory issues that have shaped the proposed VALID Act: Ovisure letter from the FDA: https://www.fda.gov/medical-devices/ivd-regulatory-assistance/ovasuretm-manufacturer-letter New York Times Article on Prenatal Testing: https://www.nytimes.com/2022/01/01/upshot/pregnancy-birth-genetic-testing.html Featured public domain music: Alpha Hydrae, Won't see it comin'. Featured public domain cover image: https://www.usgs.gov/media/images/us-capitol-building
Welcome to Ask Stago, the podcast dedicated to provide expert answers to your expert questions in hemostasis. In today episode, our expert Lydie Nicoud, R&D reagent manager, will talk with us about the test of fibrinogen. As usual, don't forget to send any question you may have to ask@stago.com, we will be glad to answer to it. Literature sources: Miesbach W, Schenk J, Alesci S, Lindhoff-Last E, Comparison of the fibrinogen Clauss assay and the fibrinogen PT derived method in patients with dysfibrinogenemia .Thromb Res. 2010; 126(6): e428-33 Karapetian H. Reptilase time (RT). Methods Mol Bio 2013; 992:273-7. Mackie IJ, Kitchen S, Machin SJ, Lowe GDO, Guidelines on fibrinogen assays, Br J Hematol 2003; 121: 396-404 Cunningham MT, Olson JD, Chandler WL, Van Cott EM, Eby CS, Teruya J, Hollensead SC, Adcock DM, Allison PM, Kottke-Marchant KK, Smith MD. External quality assurance of fibrinogen assays using normal plasma: results of the 2008 College of American Pathologists proficiency testing program in coagulation. Arch Pathol Lab Med. 2012 Jul;136(7):789-95. doi: 10.5858/arpa.2011-0322-OA. PMID: 22742551.Siriez R, Dogné JM, Gosselin R, Laloy J, Mullier F, Douxfils J Comprehensive review of the impact of direct oral anticoagulants on thrombophilia diagnostic tests: practical recommendations for the laboratory. Int J Lab Hematol 2021; 43(1): 7-20 Related podcasts: S1E9: How to manage HIL samples in the coagulation laboratory? S1E15: Disseminated Intravascular Coagulation (DIC) and fibrin related markers. S2E6: Prothrombin Time routine does not mean "simple". S2E7: APTT, not a one-for-all purposes reagent. Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.
Ordering the right test at the right time is crucial to providing evidence-based patient care to achieve the highest quality outcomes. It can also help increase financial sustainability for a hospital. Both of these objectives can be accomplished through a successful laboratory stewardship initiative. Peace Health understands this quite well. Join us to hear insights from Peace Health on their experience establishing a lab stewardship initiative that improved patient care and outcomes through optimized testing, all while driving down costs for enhanced financial sustainability. Today's podcast is brought to you by the College of American Pathologists.
Dr. Tara Sander Lee is the Senior Fellow and Director of Life Sciences at the Charlotte Lozier Institute, an organization dedicated to policies and practices to protect the sanctity of human life. She is a scientist with 20 years of experience in academic and clinical medicine with an emphasis on the cause of pediatric disease. She obtained a Ph.D. in Biochemistry from the Medical College of WI and fellowship training at Harvard Medical School and Boston Children's Hospital. Dr. Sander Lee is published in various medical journals and textbooks, including her recent co-authored manuscript in the journal Issues in Law and Medicine, -The Perinatal Revolution.- She is a contributor to the book, Choose Life- Answering Key Claims of Abortion Defenders with Compassion. Her chapter is -Knit Together in a Mother's Womb- The Biology of Prenatal Development.- She also served as molecular pathology inspector for the College of American Pathologists and scientific consultant for various entities including the Milwaukee County Medical Examiner, Children's Hospital of Wisconsin, and TAI Diagnostics.--The Biden Administration has become unglued since the United States Supreme Court affirmed that there is no right to abortion granted in our Constitution. As a result, the President is trying to use executive orders or rule making from his cabinet departments in an effort to force hospitals and doctors to violate the Hippocratic Oath and perform this gruesome procedure which takes the life of an innocent baby. Protests have taken place in cities across the country. Even in small town America, 2 or 3 will gather on a downtown street corner bearing signs which read -my body, my choice.-
Dr. Tara Sander Lee is the Senior Fellow and Director of Life Sciences at the Charlotte Lozier Institute, an organization dedicated to policies and practices to protect the sanctity of human life. She is a scientist with 20 years of experience in academic and clinical medicine with an emphasis on the cause of pediatric disease. She obtained a Ph.D. in Biochemistry from the Medical College of WI and fellowship training at Harvard Medical School and Boston Children's Hospital. Dr. Sander Lee is published in various medical journals and textbooks, including her recent co-authored manuscript in the journal Issues in Law and Medicine, -The Perinatal Revolution.- She is a contributor to the book, Choose Life- Answering Key Claims of Abortion Defenders with Compassion. Her chapter is -Knit Together in a Mother's Womb- The Biology of Prenatal Development.- She also served as molecular pathology inspector for the College of American Pathologists and scientific consultant for various entities including the Milwaukee County Medical Examiner, Children's Hospital of Wisconsin, and TAI Diagnostics.--The Biden Administration has become unglued since the United States Supreme Court affirmed that there is no right to abortion granted in our Constitution. As a result, the President is trying to use executive orders or rule making from his cabinet departments in an effort to force hospitals and doctors to violate the Hippocratic Oath and perform this gruesome procedure which takes the life of an innocent baby. Protests have taken place in cities across the country. Even in small town America, 2 or 3 will gather on a downtown street corner bearing signs which read -my body, my choice.-
Liquid biopsy has emerged as a novel diagnostic tool, enabling rapid, non-invasive molecular testing of thyroid cancers. This episode offers insight into some of the opportunities and challenges that are presented by liquid biopsy in this field. To answer questions on this topic, we have invited Professor Frederique Penault-Llorca to join us. She is Professor of Pathology at the University of Clermont-Ferrand and CEO of the Comprehensive Regional Cancer Institute Centre Jean Perrin in Clermont-Ferrand, France. Funding Information: This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty. Faculty Disclosures: Professor Frederique Penault-Llorca has disclosures are as follows: Advisory board: Roche, EliLilly, Illumina, Speaker: Roche, EliLilly, Illumina, References 1. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–1214 2. Albarel F, Conte-Devolx B, Oliver C. From nodule to differentiated thyroid carcinoma: Contributions of molecular analysis in 2012. Ann Endocrinol (Paris). 2012;73:155–164 3. Nylen C, Mechera R, Marechal-Ross I, et al. Molecular markers guiding thyroid cancer management. Cancers (Basel). 2020;12:2164 4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. Version 2.2022. May 5, 2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf (accessed June 2022) 5. Pinchot SN, Al-Wagih H, Schaefer S, et al. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch Surg. 2009;144:649–655 6. Bellevicine C, Sgariglia R, Nacchio M, et al. Molecular testing of thyroid fine-needle aspiration: local issues and solutions. An interventional cytopathologist perspective. J Mol Pathol. 2021;2:233–240 7. Kasraeian S, Allison DC, Ahlmann ER, et al. A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res. 2010;468:2992–3002 8. Lindeman NI, Cagle PT, Aisner DL, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: Guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med. 2018;142:321–346 9. Pennell NA, Arcila ME, Gandara DR, et al. Biomarker testing for patients with advanced non-small cell lung cancer: Real-world issues and tough choices. Am Soc Clin Oncol Educ Book. 2019;39:531–542 10. Belli C, Penault-Llorca F, Ladanyi M, et al. ESMO recommendations on the standard methods to detect RET fusions and mutations in daily practice and clinical research. Ann Oncol. 2021;32:337–350 11. Li MM, Datto M, Duncavage EJ, et al. Standards and guidelines for the interpretation and reporting of sequence variants in cancer: A joint consensus recommendation of the Association for Molecular Pathology, American Society of Clinical Oncology, and College of American Pathologists. J Mol Diagn. 2017;19:4–23
In this segment, Beyond the Scope, we speak to pathologists about their pursuits and interests in and outside of pathology. On this episode, host Dr. Sara Jiang (@Sara_Jiang) speaks with Dr. Kalisha Hill (@KalishaHillMD). Dr. Hill is regional chief medical officer for Ascension St Joseph Joliet and Ascension Saint Mary Kankakee, Medical director of pathology and laboratory services. Dr. Hill also serves on the board of governors for the College of American Pathologists, is the immediate past president of the Illinois Society of Pathologists and recipient of the CAP distinguished patient care award. Why should pathologists take on leadership roles? How does seeing a teratoma influence your choice of career? What brings Dr. Hill a moment of peace in a busy day? Hear about all these questions and more! Featured public domain music: US Army Blues, BugaBlue
Dr. Omalu was the first to identify, describe, and name Chronic Traumatic Encephalopathy as a disease entity. Dr. Omalu has testified twice before the United States Congress and has provided hundreds of testimonies as an expert witness in federal courts across the country. Dr. Omalu is a member of the College of American Pathologists, American Society of Clinical Pathology, American College of Physician Executives, American College of Epidemiologists, American Association of Neuropathologists, American Academy of Forensic Sciences, National Association of Medical Examiners, International Academy of Pathology, and the American Medical Association.Dr. Omalu has eight degrees in the medical sciences and business management, including his MB/BS/MD from the University of Nigeria, his MPH from the University of Pittsburgh, and his MBA from Carnegie Mellon University.His work and life have been featured extensively, including a major Hollywood film by Sony Motion Pictures, “Concussion”, and several New York Times best-selling books including “The League of Denial” and “Concussion”.
On this episode, Emily Volk, MD, FCAP, president of the College of American Pathologists, talks about the ins and outs of COVID-19 testing; knowing when to test, what test to take, and other pressing questions patients may have.
On this episode, Emily Volk, MD, FCAP, president of the College of American Pathologists, talks about the ins and outs of COVID-19 testing; knowing when to test, what test to take, and other pressing questions patients may have.
Join us to hear how Loyola University Health System's new laboratory approach during the COVID pandemic was able to broaden communication and collaboration between clinicians and hospital leadership, improve patient outcomes and streamline process efficiencies while also increasing visibility for the system and reinforcing Loyola as a premiere resource for diagnosing and treating illnesses. Today's podcast is brought to you by the College of American Pathologists.
Dr. Xiaoyin "Sara" Jiang covers the importance of communication, deliberate practice in correlating cytopathology and histopathology findings, the metacognitive aspects of instant pattern recognition vs. teaching the diagnostic process, and humility. Dr. Xiaoyin "Sara" Jiang, MD, is Associate Professor of Pathology at Duke University, Chief of Head and Neck Service, and Director of the Duke Pathology Communications Group. Her areas of expertise are cytopathology, head and neck pathology, and novel applications of social media for medical professionals. She has been honored with awards including the ASCP 2017 "40 under 40" Top Five, Duke's Faculty Research Mentor Award, and the CAP Resident Advocate and Pathology Advancement Awards. Find her on Twitter @Sara_Jiang. Here are links to her quote in The Pathologist https://thepathologist.com/power-list/2016/sara-jiang and the College of American Pathologists https://yourpathologist.org.
In this Mentorship Series episode, Laurie McGraw is speaking with Inspiring Women Monique Terrell, a Senior Director at the College of American Pathologists and Brande Martin, a Director at Covetrus. Monique and Brande ...
Greta Evaristo, MD, is an Anatomical Pathology resident at McGill University, Montreal, Canada. She is particularly interested in GI and hepatopancreaticobiliary pathology and is planning to pursue her fellowship training at the University of Chicago. Her other interests include medical education and digital pathology. She has been an active member of College of American Pathologists, serving on several committees, including the Digital and Computational Pathology committee and Residents Forum's Nominating Committee.Twitter: Greta Evaristo, MD (@gtevaristomd) / Twitter
Welcome to Ask Stago, the podcast dedicated to provide expert answers to your expert questions in coagulation. In today's episode, our guest Kaitlyn Pelc will explain further the different steps to validate an instrument at the installation. Previous episodes in relation to the topic: S2E18 – Practical check list of the implementation of an instrument in your lab: https://www.podcastics.com/podcast/episode/s2e18-practical-check-list-of-the-implementation-of-an-instrument-in-your-lab-103649/ S2E3 – How to establish and control the reference range of my assay: https://www.podcastics.com/podcast/episode/s2e3-how-to-establish-and-control-the-reference-range-of-my-assay-60155/ S2E2 - How to calibrate your reagent as a pro: https://www.podcastics.com/podcast/episode/s2e2-how-to-calibrate-your-reagent-as-a-pro-58249/ Literature sources: CLSI. Protocol for the Evaluation, Validation and Implementation of Coagulometers; Approved Guideline. CLSI document H57-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. CLSI. One-Stage Prothrombin Time (PT-Test and Activated Partial Thromboplastin Time (APTT) Test; Approved Guideline- Second Edition. CLSI document H47-A2. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. CLSI. Procedures for Validation of INR and Local Calibration of PT/INR Systems; Approved Guideline. CLSI document H54-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2005. CLSI. Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Guideline- Third Edition. CLSI document EP28-A3c. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. CLSI. Measurement Procedure Comparison and Bias Estimation Using Patient Samples. 3rd ed. CLSI guideline EP09c. Wayne, PA: Clinical and Laboratory Standards Institute; 2018. CLSI. User Verification of Precision and Estimation of Bias; Approved Guideline- Third Edition. CLSI document EP15-A3. Wayne, PA: Clinical and Laboratory Standards Institute; 2014. College of American Pathologists. All Common Checklist. Northfield, IL: College of American Pathologists; 2021. Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.
Pathology Standards and Hackathon In this episode, host Mohannad chats with Jason Klotzer and Markus Herrmann about pathology imaging standards. The team discusses the unique perspective of digital pathology and how the specialty has adopted DICOM standards to meet the needs of the pathologist's imaging workflow, as well as a hackathon sponsored by the DPA and DICOM Workgroup 26. Jason Klotzer is a customer engineer working for the Healthcare vertical of Google Cloud, and he is based out of Austin, TX and has worked in the medical imaging space for more than 15 years. He has architected several PACS and VNA systems, specializing in visualization of medical images for diagnostic reading, recently focusing on the needs of AI/ML and analytics in medical imaging. Markus Herrmann serves as Director of Computational Pathology at the Massachusetts General Hospital (MGH) and Assistant Professor of Pathology at Harvard Medical School. His research focuses on the development of novel quantitative imaging biomarkers and computer-aided diagnostic tests combining microscopy imaging, computer vision, and mathematical modeling. Markus is active in national and international efforts to advance the standardization and adoption of digital and computational pathology, including the DICOM Working Group 26 Pathology, the IHE Pathology and Laboratory Medicine domain, the Pathology Innovation Collaborative Community, the Digital and Computational Pathology Committee of the College of American Pathologists, and the Regulatory and Standards Task Force of the Digital Pathology Association. Connect with us! You can find our podcast on Apple Podcast, Google Podcasts, Stitcher, or anywhere else you subscribe to podcasts. Please help us out by leaving a review on Apple Podcasts. You can find us on Twitter: @SIIM_Tweets, and individually at @mohannadhussain, @jaynagels, @AliTejaniMD, @AAnandMD Visit us at https://siim.org/page/siimcast Special Thanks to @RandalSilvey of http://podedit.com for editing and post processing support.
Mike Church Show-Freedom Convoy Has Become An Existential Threat To The Cult Of Death's Cabal Time Red Pill Topics & Headlines 6:03am cst Welcome to the Mike Church Show on www.crusadechannel.com Call the show 844-5CRUSADE Make Canon212 your first place to get news each day. Canon212 - News of the Church and the World. Glory and Shine to the Crusade Channel crusadechannel.com/glory HEADLINE RUNDOWN - Russia and Ukraine More on the Freedom Convoy in Canada 23m 36m HEADLINE: The mRNA Covid shots are killing teenagers by Alex Berenson The journal of the College of American Pathologists has a stunning report today on the cases of two teen boys who died following mRNA Covid vaccines. Both boys died in their sleep less than a week after the second dose, and neither had any known health conditions prior to death. Why don't these parents know the risks associated w/ this vaccine for HEALTHY young men? Is it the fault of the parents? Is it the fault of the government? Is it the fault of the CDC and Big Pharma? AUDIO/VIDEO: Chrystia Freeland Deputy Prime Minister & Minister of Finance - changing our crypto and crowdfunding in Canada - proceeds of crime and terrorist act. YOU ARE FREEZING THE ASSETS OF MIDDLE CLASS CITIZENS! This is a direct assault on the citizens of Canada. Will they allow these companies dealing w/ digital currency to continue to do business in Canada? Why aren't they going after these companies they claim are harboring these terrorists dollars? HEADLINE: Why They're So Afraid of the Truckers by Adam Mill ONE TIME DONATION LINK - https://crusadechannel.com/donate-to-the-crusade-channel/ Crusade Channel Teaming Up With Epoch Times www.crusadechannel.com/epoch (affiliate link) If you have any issues that need to be resolved, please email Maggie O'Connell directly at sales@mikechurch.com or Candace her personal email candace@mikechurch.com Do business with those that do business with us. BullDog Kia have been with us since day one of Veritas Radio Network and the Crusade Channel. Get your Kia today from the fine folks at BullDog Kia in Atlanta Georgia. BRAVE BROWSER: Now you can support the Crusade Channel without spending a DIME! Simply use the url to download the BRAVE browser and WE get credit: http://brave.com/mik060 We can earn up to $50,000 for the downloads if our listeners use this browser. 7:15am cst Welcome back to The Mike Church Show! Call the Crusade Channel at 844-5CRUSADE! Join our FREE LIVE chatroom where you can chat with fellow Crusaders. Listen to us on ShortWave - 5850 1h10m AUDIO/VIDEO: FreedomConvoy USA ‘We have a right to resist and we have an obligation to do so!' - Tricia Lindsay You took an oath to protect and defend. These are defensive reactions NOT offensive. What if your Sheriff says no to the above statements? HEADLINE: Why They're So Afraid of the Truckers by Adam Mill We were told that the little heroes should stand up to the Evil that was Communism back in the 80's and 90's remember? Now we are being told that the Ukrainians, the ‘little guys' can't and shouldn't do anything about Putin. 1h36m FreedomConvoy USA ‘We have a right to resist and we have an obligation to do so!' - Tricia Lindsay WHEN THE LAWS CONTRADICT THE LAWS OF GOD, THEY MUST BE IGNORED! Educate yourself so you know how to resist. They are turning our country into one massive slave ship. We need to be comfortable w/ being uncomfortable. Crusader Monastery - The Veritas Radio Network also have a prayer request line. Send your prayer requests to crusadermonastery@crusadechannel.com Do business with those that do business with us. McClure Tables they have been with us since day one of Veritas...
Dr. Roger Hodkinson is the CEO and Medical Director of MedMalDoctors. He received his general medical degrees from Cambridge University and became a Royal College certified general pathologist and a Fellow of the College of American Pathologists. He has been recognised by the Court of Queen's Bench in Alberta as an expert in pathology. Dr. Hodkinson has pleaded to stop the madness of COVID-19 fraud and the vaccines' served up to fight the pandemic. He has called out deception, Big Pharma, corrupt political leaders and a compliant mainstream media. Millions are demonstrating every week around the globe against tyrannical policies of vaccine mandates, vaccine passports and other punitive and cruel measures in the name of public health. While many of us are aware that our Governments are not acting in our interests, we remain unsure of their ultimate objective and just how far they are will go to enforce change. Rick Munn describes himself as ‘a concerned citizen with experience in humanitarian work in East Africa, in prison ministry and post conflict restoration.' Rick's view is that we will see upheaval in many countries in the next 12 months and we should be prepared. Asia Pacific Today. December 17, 2021 Asia Pacific Today believes that your opinion is legitimate. And we believe that our guests have something to say and that their opinion is also legitimate. Throughout the week, Mike Ryan has discussions about politics, polarising issues, current events, and more. We really are connecting with people all over the world that simply speak their mind. There's new videos throughout the week, every week on our website. And we also need our audience to grow. It would really help us grow if you could subscribe to asiapacifictoday.tv
Common Sense Roger Hodkinson The Donald Jeffries Show as Proudly Presented by OCHELLI.COM The Donald Jeffries Show 8-25-2021 Dr. Roger Hodkinson Common Sense Roger Hodkinson Dr. Roger Hodkinson is a medical specialist in pathology and a graduate of Cambridge University, UK. He is a Fellow of the College of American Pathologists and the Royal College of Physicians and Surgeons of Canada. During his long career, he has had many leadership roles in Canadian medicine both provincially and nationally, including being a university teacher, national pathology board examiner, and laboratory accreditation inspector. He was previously the President of the Alberta Society of Laboratory Physicians, an Assistant Professor in the Faculty of Medicine at the University of Alberta, and CEO of a large community-based medical laboratory with a full menu of testing for infectious disease and virology. But he is most proud of his role in public health advocacy for many years as Honorary Chairman of ASH, Action on Smoking and Health, which is the leading non-profit organization in Canada tacking the predatory marketing strategies of Big Tobacco. Don Jeffries talks with Dr. Hodkinson about what he called the “biggest hoax ever perpetrated.” DONALD JEFFRIES ONLINE: Blog: https://donaldjeffries.wordpress.com/ “I Protest” https://donaldjeffries.substack.com/ Twitter page: https://twitter.com/DonJeffries Amazon Author Page: https://www.amazon.com/Donald-Jeffries/e/B004T6NFAS%3Fref=dbs_a_mng_rwt_scns_share Facebook: https://www.facebook.com/donald.jeffries
Welcome to Ask Stago, the podcast dedicated to provide expert answers to your expert questions in haemostasis. In today episode, our expert Arnaud Rouvière, Global process – Service manager, will provide us all the current recommendations to establish your Quality control ranges. As usual, don't forget to send any question you may have to ask@stago.com, we will be glad to answer to it. Learn more - Previous mentioned podcast : Previous episode with Arnaud Rouvière : S1E7 How to determine the mean normal prothrombin time Learn more about the externalization of your Internal quality controls (eIQC) : S1E3 #3 eIQC and EQA: benefits and differences Go further with the episode dedicated to the reagent lot conversion : S2E10 - How to manage lot conversion in your daily lab management? Literature sources: CLSI Statistical Quality Control for Quantitative Measurement Procedures: Principles and definitions; 4th ed. CLSI guideline C24. Wayne PA: Clinical and Laboratory Standard Institute, 2016. ISO 15189:2012 – Meical laboratories – requirements for quality and competence College of American Pathologists. All Common Checklist. Northfield, IL: College of American Pathologists; 2020 Neufassung der Richtlinie der Bundesärztekammer zur Qualitätssicherung laboratoriumsmedizinischer Untersuchungen; Rili-BÄK; – Richtlinie der Bundesärztekammer zur Qualitätssicherung laboratoriumsmedizinischer Untersuchungen. Dtsch Arztebl Int 2014;111:1583–618. English version: Revision of the “Guideline of the German Medical Association on Quality Assurance in Medical laboratory Examinations – Rili-BAEK”. J Lab Med 2015;39:26–69 Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.
** Thanks for downloading this episode. If you'd like to stay in touch with our continuing story, Season 2 continues at This Medical Life, in which Dr Travis Brown continues his exploration of diseases and our approaches to treatment from history to the modern day. Have a look in your podcast app now for This Medical Life, and hit subscribe so you never miss an episode ** The computing world has come a long way in less than 100 years. Since Alan Turing introduced his paper ‘Computing Machinery and Intelligence' in 1950, we have not only achieved the ‘Turing Test' of Artificial Intelligence, but exceeded it. This episode takes a look at Digital Pathology and the prospects of Artificial Intelligence particularly in relation to Anatomical Pathology. Our special guest is Dr Joseph Anderson Dr Joseph Anderson BioConnect on LinkedIn Dr. Joseph Anderson, the host of Digital Pathology Today, is a consultant to early stage and mature companies in the digital pathology and molecular diagnostics space.Previously, he oversaw the clinical pathology group at Genomic Health as the Oncotype Dx Breast Cancer Assay grew to a volume of over half a million tests. He was also involved in the development of new products, including assays for DCIS, Colon Cancer and one of the first commercially available liquid biopsies.He served the College of American Pathologists on the Molecular Oncology Committee, with responsibility for proficiency testing in biomarkers for lung cancer in the United States and across the world and as a member of the House of Delegates representing the State of California. He has served on several working groups and committees for the American Medical Association for CPT coding and reimbursement and assessment of new technologies such as next generation sequencing.Upon graduating from the University of Minnesota Medical School, Dr. Anderson completed residency in Anatomic and Clinical Pathology at Rush University, fellowship in Oncologic Pathology at Fox Chase Cancer Center and post-doctoral training in Molecular Diagnostics at UCSF. He initially worked in private practice, credentialed at 17 various hospitals and surgery centers. Digital pathology Today Link: https://www.digitalpathologytoday.comDigital Pathology Today™ is your podcast all about the world of digital pathology. See omnystudio.com/listener for privacy information.
In this episode we speak with Laura Brigandi to learn about the Pancreatic Cancer Action Network (PanCAN), their outreach to community volunteers by having them engage in grassroots advocacy and tell their personal stories. Laura Brigandi has fifteen years of experience in government affairs. Currently, she serves as the Senior Manager of Advocacy & Campaigns for the Pancreatic Cancer Action Network (PanCAN), where she trains volunteers to engage in grassroots advocacy and outreach in their communities. Before joining PanCAN, Laura held various government affairs roles at the College of American Pathologists, American Federation of Musicians, and Pennsylvania Department of Education. She began her career as a fundraiser for the Rendell for Governor Campaign. Laura holds a Bachelor of Arts in government from Franklin & Marshall College and a Master's in Legislative Affairs from George Washington University's Graduate School of Political Management. In 2017, she received her certificate in PAC and Grassroots Management from the Public Affairs Council. Thank you to our sponsor: Rap Index, tell them Roger sent you. https://www.rapindex.com This podcast is dedicated to the art of advocacy. Also listen for this episodes advocacy tip. Contact Voices In Advocacy at: www.VoicesinAdvocacy.com 480 488-9150 At Voices in Advocacy we work with organizations that want to inspire, educate, engage, and activate their supports to become even better influential advocates.
The computing world has come a long way in less than 100 years. Since Alan Turing introduced his paper ‘Computing Machinery and Intelligence' in 1950, we have not only achieved the ‘Turing Test' of Artificial Intelligence, but exceeded it. This episode takes a look at Digital Pathology and the prospects of Artificial Intelligence particularly in relation to Anatomical Pathology. Our special guest is Dr Joseph Anderson Dr Joseph Anderson Bio Connect on LinkedIn Dr. Joseph Anderson, the host of Digital Pathology Today, is a consultant to early stage and mature companies in the digital pathology and molecular diagnostics space. Previously, he oversaw the clinical pathology group at Genomic Health as the Oncotype Dx Breast Cancer Assay grew to a volume of over half a million tests. He was also involved in the development of new products, including assays for DCIS, Colon Cancer and one of the first commercially available liquid biopsies. He served the College of American Pathologists on the Molecular Oncology Committee, with responsibility for proficiency testing in biomarkers for lung cancer in the United States and across the world and as a member of the House of Delegates representing the State of California. He has served on several working groups and committees for the American Medical Association for CPT coding and reimbursement and assessment of new technologies such as next generation sequencing. Upon graduating from the University of Minnesota Medical School, Dr. Anderson completed residency in Anatomic and Clinical Pathology at Rush University, fellowship in Oncologic Pathology at Fox Chase Cancer Center and post-doctoral training in Molecular Diagnostics at UCSF. He initially worked in private practice, credentialed at 17 various hospitals and surgery centers. Digital pathology Today Link: https://www.digitalpathologytoday.com Digital Pathology Today™ is your podcast all about the world of digital pathology. See omnystudio.com/listener for privacy information.
This episode features Dr. Michael Laposata, MD, PhD. He completed both his doctorate degrees at John Hopkins University in Baltimore, MD, and his residency training at Washington University in St. Louis. He currently serves as the chair of pathology and the director of the MD-PhD program at UTMB.In this episode, we talk about the different sides of pathology and the thought process behind choosing a medical speciality and subspecialty within pathology. Dr. Laposata is passionate about medical student education and mentorship, so tune in for great advice on applying to pathology and residency altogether.RESOURCES:The Pathologist (https://thepathologist.com/)The College of American Pathologists (https://www.cap.org/)American Society of Clinical Pathology (https://www.ascp.org/content)United States and Canada Academy of Pathology (https://www.uscap.org/)Texas Society of Pathologists (https://www.texpath.org/amsimis/)EMAIL: Dr. Laposata: milaposa@utmb.edu Me: atmeffor@utmb.edu
In this series, PathPod gathers pathologists Around The Scope to discuss their work in depth. Today, we hear from forensic pathologists about the diverse areas of practice within the specialty. Our host, Dr. Mike Arnold of Children's Hospital Colorado (@MArnold_PedPath) speaks with Dr. Nicole Jackson (@NicoleJacksonMD), Dr. Nicole Croom (@nicnac363), and Dr. Jordan Taylor (@jet916). Dr. Jackson is Assistant Medical Examiner at the Cook County Medical Examiner's Office (Chicago), an ASCP 2021 40 Under Forty Honoree, and founder and board member of the newly formed Society of Black Pathologists. Dr. Croom and Dr. Taylor are forensic pathology fellows at the King County Medical Examiner's Office (Seattle) and hosts of the Dead Men Do Tell Tales Podcast (@DeadMenDo). When do forensic pathologists go to crime scenes? What makes forensic autopsies different from hospital autopsies? What is the role of forensic pathologists in public health? Professional organizations: National Association of Medical Examiners (NAME): https://www.thename.org/ American Academy of Forensic Sciences: https://www.aafs.org/ National Medical Association: https://www.nmanet.org/ Society of Black Pathologists: https://www.societyofblackpathologists.org/ College of American Pathologists: https://www.cap.org/ American Society for Clinical Pathology: https://www.ascp.org/
Richie is joined by Dr. Roger Hodkinson. Dr. Roger Hodkinson received his general medical degrees from Cambridge University in the UK where he was a scholar at Corpus Christi College. Following a residency at the University of British Columbia he became a Royal College certified general pathologist and also a Fellow of the College of American Pathologists. Roger has been recognized by the Court of Queen’s Bench in Alberta as an expert in pathology. Roger tells Richie, that giving covid-19 jabs to children is akin to government sponsored child abuse. Roger believes that the jabs are completely unnecessary and are proving to be harmful, particularly to people at the end of their lives. He discusses Antibody Dependent Enhancement and why, even though it's an unproven theory, he is nonetheless very concerned about it. Do not miss this conversation.
The College of American Pathologists (CAP), in collaboration with the ASCP and API announced the 2021 update of guidelines for Validating Whole Slide Imaging (WSI) for diagnostic Purposes. We talk with Andrew Evans, MD, PhD, Chair of The Digital and Computational Pathology Committee and Nicole Thomas, MPH, Director of the CAP Center for Evidence Based Guidelines.
Welcome to Ask Stago, the podcast dedicated to provide expert answers to your expert questions in haemostasis. In today episode, our expert Rachael Lamma, a member of our US technical support specialist team, will explain how to handle lot conversion in the daily laboratory organization. As usual, don’t forget to send any question you may have to Ask@stago.com, we will be glad to answer to it. Learn more
In this episode, you will hear from guest Monique Terrell. Monique is a digital strategist, trailblazer and life-long learner. Monique works at the College of American Pathologists as the Senior Director of Annual Meeting, Events and Engagement. She is a natural born leader, empowering others to find their greatness.Listen in as Monique shares her insights on the value of being an authentic leader, how being in the military prepared her for leadership and the importance of “having each other's back” as a team while at work and with your family. She also will give some tips on ways to recharge and unwind, as she continues to determine how to integrate self-care into her routine.Learn more about Monique: https://www.linkedin.com/in/moniqueterrell/ Listen, share and subscribe to the Strive, Thrive & Shine podcast series: http://strivethriveshine.com
Detroit-based Henry Ford Health System developed and implemented a framework connecting clinicians with laboratory professionals, which improved collaboration, removed process waste, improved patient outcomes and resulted in process efficiencies. This podcast is sponsored by the College of American Pathologists (https://www.cap.org).
In this segment, Beyond the Scope, we speak to pathologists about their pursuits and interests in and outside of pathology. What lessons can be taken from leading the microbiology lab in a pandemic? What is it like receiving specimens that are still moving? How could a reduviid bug help with stress relief? On this episode, Dr. Sara Jiang (@Sara_Jiang) speaks with Dr. Bobbi Pritt (@ParasiteGal). Dr. Pritt is the Chair, Division of Clinical Microbiology at Mayo Clinic, Past-president of the Binford-Dammin Society of Infectious Disease Pathologists, and recipient of numerous awards including the 2020 Distinguished Patient Care Award, and the 2012 Excellence in Teaching Award from the College of American Pathologists. She is the creator of the lauded “CREEPY DREADFUL WONDERFUL PARASITES” blog where she has been posting educational parasite cases of the week since 2007: https://parasitewonders.blogspot.com/. Featured public domain music: US Army Blues, BugaBlue
Welcome to Ask Stago, the Podcast dedicated to provide expert answers to your expert questions in coagulation. In today’s episode, our expert Paul, in honor of the upcoming World Hemophilia Day, taking place April 17, will return to our podcast series to cover clinical laboratory testing approaches for patients with inherited or acquired haemophilia. Literature sources: Iorio A, Stonebraker JS, Chambost H, Makris M, Coffin D, Herr C, et al.; Data and Demographics Committee of the World Federation of Hemophilia. Establishing the Prevalence and Prevalence at Birth of Hemophilia in Males: A Meta-analytic Approach Using National Registries. Ann Intern Med. 2019 Oct 15;171(8):540-546. Srivastava A, Santagostino E, Dougall A, Kitchen S, Sutherland M, Pipe SW, et al.; WFH Guidelines for the Management of Hemophilia panelists and co-authors. WFH Guidelines for the Management of Hemophilia, 3rd edition. Haemophilia. 2020 Aug;26 Suppl 6:1-158. College of American Pathologists. Hematology and Coagulation Checklist. Northfield, IL: College of American Pathologists; 2020. Related podcasts: S2E4 – how to determine factor levels in hemophilia - https://www.podcastics.com/episode/62593/link/ ____________________________________________________________________________________________________________ Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.
Welcome to Ask Stago, The Podcast dedicated to provide expert answers to your expert questions in coagulation. In today episode, our expert Alex, will discuss with us how to determine factor levels in hemophilia patients. Literature sources: Alfonso Iorio,Jeffrey S. Stonebraker, Hervé Chambost, et al. Establishing the Prevalence and Prevalence at Birth of Hemophilia in Males: A Meta-analytic Approach Using National Registries. Ann Intern Med.2019;171:540-546. [Epub ahead of print 10 September 2019]. doi:10.7326/M19-1208 Blanchette, VS, Key, NS, Ljung, LR, Manco‐Johnson, MJ, van Den Berg, HM, Srivastava, A, for the Subcommittee on Factor VIII, Factor IX and Rare Coagulation Disorders. Definitions in hemophilia: communication from the SSC of the ISTH. J Thromb Haemost 2014; 12: 1935– 9. Baker, P., Platton, S., Gibson, C., Gray, E., Jennings, I., Murphy, P., Laffan, M. and (2020), Guidelines on the laboratory aspects of assays used in haemostasis and thrombosis. Br. J. Haematol., 191: 347-362. https://doi.org/10.1111/bjh.16776 CLSI, Determination of coagulation factor activities using the one-stage clotting assays. 2nd edition. CLSI guideline H48. Wayne PA: Clinical and Laboratory Standards Institute, 2016. College of American Pathologists. Hematology and Coagulation Checklist. Northfield, IL: College of American Pathologists; 2018 Riley PW, Gallea B, Valcour A. Development and implementation of a coagulation factor testing method utilizing autoverification in a high‑volume clinical reference laboratory environment. J Pathol Inform 2017;8
This multi-institutional study highlights the heterogeneity of Phyllodes tumors of the breast and the importance of accurate pathology assessment and individualized surgical approaches. LEE WILKE: This JCO podcast provides observations and commentary on the JCO article, Contemporary Multi-institutional Cohort of 550 Cases of Phyllodes Tumors from 2007 to 2017 Demonstrates a Need For More Individualized Margin Guidelines by Rosenberger, et al. My name Lee Wilke and I am a professor of surgery and the Hendrix chair in breast surgery research at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. My oncologist specialty is breast surgical oncology. I have no relationships to disclose related to these studies. As medical students we are asked to adopt an expanded vocabulary to describe a multitude of diseases. The word phyllodes is frequently one of those memorable medical school terms whose origin is Greek and describes a leaf-like growth. Phyllodes are rare tumors accounting for less than 1% of breast malignancies, with just over 2,000 patients diagnosed annually in the United States. Originally, the phyllodes tumor was described as cyst like and, therefore, the historic term cystosarcoma phyllodes was applied. Though these tumors are of connective tissue and fibroepithelial origin, they are infrequently cystic and not a true sarcoma. And therefore, the World Health Organization now classifies them as simply phyllodes tumors. They are importantly, for treatment approaches, sub-categorized into benign, borderline, and malignant based on detailed pathologic review of celularity, atypia, overgrowth, mitotic rate, and the borders of the tumor. Phyllodes tumors are listed in the National Institute of Health's genetic and rare diseases program. On the center's website, surgery is described as the primary treatment for these rare malignancies and 1 centimeter margins or greater are recommended for all subtypes of phyllodes tumors, with a note that these tumors are quote, "often treated with mastectomy", unquote. As specialists caring for patients with breast malignancies, we are rapidly learning that the one-size-fits-all approach is not appropriate, and the same is true for those individuals with phyllodes tumors. In the article that accompanies this podcast, to support a shift towards more individualized treatment, Dr. Laura Rosenberger from Duke University in North Carolina assembled a group of key collaborators from 11 US academic cancer centers to pool and evaluate their treatment approaches and outcomes for patients with phyllodes tumors. The investigators identified a total cohort of 550 patients with phyllodes tumors treated between 2007 and 2017. Consistent with systematic reviews of phyllodes tumor data sets, such as that by Lu et al in Annals of Surgical Oncology, with this JCO publication being the largest, the patients have a median age of 44. The malignant cohort is approximately 10%. And median tumor size is three centimeters, with a range to as high as 29 centimeters. Key facts found within this analysis are that 2% of patients underwent nodal evaluation, all with negative nodes. The addition of either a sentinel node or axillary surgery is not without risks to the patient. And unless the pre-surgical diagnosis raises the question of a simultaneous adenocarcinoma, patients undergoing surgery for a phyllodes tumor should not undergo nodal mapping or axillary surgery as these tumors are primarily local malignancies and do not metastasize via the lymphatic network. This is the first key takeaway from this paper, supporting the work of others that nodal surgery in phyllodes tumors is unnecessary. The second notable finding is the heterogeneity, even among academic medical centers, regarding the surgical approach. Approximately 38% of patients, or 209, proceeded to a second surgical intervention. 51 of these patients, or nearly 10% of the entire cohort, had negative margins at their first surgery. Of the group that underwent a second surgery, only six patients, or 3% of those proceeding to a second intervention, had residual disease. On the opposite end of the spectrum, of those patients with a positive surgical margin, which was 42% of the entire group, 74, or 32% of those with positive margins, did not proceed with a second surgery. These outcomes highlight that even among patients being treated at centers that one would assume would function similarly, patients could have everything from positive margins to additional surgery in the setting of negative margins. What is vital to note at this point, however, is that the recurrence rate for this cohort was only 3.3% or 18 patients-- 15 with a local recurrence and three with a distant recurrence. The recurrences were differentially associated with the phyllodes subtypes, with 1.3% in benign, 5.6% in borderline, and 6.9% in malignant phyllodes. In univariate logistic regression analysis, however, margin status and margin width did not predict for a recurrence and neither did type of surgery or patient age. Clearly, a one centimeter margin for a phyllodes tumor is not needed, just as we are likely finding is true for our adenocarcinomas of the breast. The authors don't go so far as to state that a positive margin is acceptable, but highlight the need for a national registry to evaluate an individualized surgical approach in this rare patient population. A final and third key point from this retrospective but important pooled patient analysis is the primary role the pathologist plays in determining the patient outcome. As I frequently comment to my cancer patients, the pathologist is the most important doctor you never meet. In Dr. Rosenberger's analysis, factors that were influential for local recurrence were all pathological variables-- grade, extent of atypia and overgrowth and tumor size. Currently, there are no College of American Pathologists guidelines for reporting phyllodes tumors. With this and other patient data sets highlighting the importance of these pathologic factors in patient outcomes, perhaps a standardization and education program for identifying each of these key findings within a phyllodes tumor should be developed. Without a good pathologist or team of pathologists, oncologic surgeons lack the tools they need to advise the patient on additional surgery and potentially adjuvant therapy. As the use of adjuvant therapy was small in this data set, conclusions could not be provided for or against radiation therapy. Thus, as with all rare tumors, a collaborative and team approach with development of a national registry is needed across community and academic institutions to standardize and evaluate the outcomes for these patients with the eventual goal of providing a more tailored treatment approach. This concludes this JCO podcast. Thank you for listening.
ONS members Meghan Coleman, DNP, CRNP, and Alison McDaniel, BSN, RN, OCN®, join Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss their Evidence-Based Quality Understanding in Pathology (EQUIP) project to solve unequal access to germline and somatic biomarker testing, which earned first place in the inaugural ONS Hackathon. The ONS Hackathon took place over two weeks in November 2020 and gave nurses a platform to develop innovative ways to address challenges in the delivery of quality cancer care. For more information, read the ONS Voice article linked in the episode notes. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by December 18, 2022. The planners and faculty for this episode have no conflicts to disclose, and the episode has no commercial support. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. ONS Voice article: An Oncology Nurse's Primer on Genomics and Biomarker Terminology ONS Voice article: Winning Team Reduces Disparities to Biomarker Testing in First-Ever ONS Hackathon Clinical Journal of Oncology Nursing article: Shifting to a Biomarker Paradigm Across Cancer Care ONS Genomics and Precision Oncology Learning Library American Cancer Society information on cancer biomarker testing American Society for Clinical Pathology College of American Pathologists National Comprehensive Cancer Network (NCCN) Biomarkers Compendium NCCN additional information on biomarker testing
Preliminary data from Moderna's coronavirus vaccine trial is an "spectacular accomplishment," according to Dr. Timothy Shacker from the University of Minnesota Medical School.Are schools more dangerous to young students than restaurants? Dr. Nathaniel Beers from Children's National Hospital in Washington D.C. explains. Hospitals in the Midwest are postponing non-urgent procedures to make room for COVID-19 patients. Dr. Chris Colbert from the Emergency Medicine Residency Program at University of Illinois/Chicago describes what he and his fellow doctors are experiencing. Many American families are planning to have Thanksgiving dinner despite a spike in coronavirus cases. Can you and your family be protected from the virus if everyone gets tested before the holiday? Dr. Patrick Godbey from the College of American Pathologists explains. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices
Preliminary data from Moderna's coronavirus vaccine trial is an "spectacular accomplishment," according to Dr. Timothy Shacker from the University of Minnesota Medical School. Are schools more dangerous to young students than restaurants? Dr. Nathaniel Beers from Children's National Hospital in Washington D.C. explains. Hospitals in the Midwest are postponing non-urgent procedures to make room for COVID-19 patients. Dr. Chris Colbert from the Emergency Medicine Residency Program at University of Illinois/Chicago describes what he and his fellow doctors are experiencing. Many American families are planning to have Thanksgiving dinner despite a spike in coronavirus cases. Can you and your family be protected from the virus if everyone gets tested before the holiday? Dr. Patrick Godbey from the College of American Pathologists explains. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Examination (macroscopic and microscopic) of the placenta can give valuable insights into the intrauterine environment. The College of American Pathologists has issued guidelines about when to submit a placenta for histological examination. In this session, we will review the “what, when, and whys“ of histological placental referral. We will also review abnormal umbilical cord insertion and it’s link to adverse obstetrical/neonatal outcomes. SHOUTOUT TO LAUREN (our podcast listener) for the podcast topic!
An interview with Dr. Kimberly Allison from Stanford University School of Medicine and Dr. Antonio Wolff from Johns Hopkins University on "Estrogen and Progesterone Receptor Testing in Breast Cancer Guideline: ASCO/CAP Guideline Update." This guideline updates key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen and progesterone receptor testing in breast cancer guideline, and focuses on low estrogen receptor expression cases. Read the full guideline at www.asco.org/breast-cancer-guidelines.
Session 116 Residency director and pathologist Michelle Dolan, MD joins me to talk about how to get the most out of your residency and what it means to slap glass. Specialty Stories is part of Meded Media. If you haven’t yet, please do check out all our other podcasts geared towards helping premeds, medical students, and residents along their path to medicine. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:45] Interest in Medicine Michelle initially didn't know what to do back in medical school until during her second-year pathology course. One of their lecturers encouraged them to do a pathology rotation. So she did and she loved it. She had to choose between Internal Medicine and Pathology. What drew her to Internal Medicine was hands-on patient care. But there were also some things that she didn't like. One of those five years could be a clinical intern year. So she decided to do an internship in internal medicine and she realized she really likes hospital care. This was before the advent of the hospitalist. She didn't like the clinical aspect but she liked the slower pace of pathology. [04:30] Traits That Lead to Being a Good Pathologist The ability to focus is an important trait to have in order to be a good pathologist. For instance, you need to be able to sit in one place for an extended period of time at the microscope or the computer screen. If you're going into anatomic physiology, a good chunk of your day is going to be spent "slapping glasses" where you just sit at the microscope and look at a lot of different cases. But not every field in Pathology is like that. One of the things that she likes about the field is how varied it is. You just have to be able to find that good fit for yourself. Because pathology is so varied, there are people who are very visual and love learning by seeing. There are also other parts where it's much more conceptual where you learn a lot by reading and thinking. There are other areas where you can learn by doing. To help you figure out which area to go into is to know yourself. [Related episode: The Pathologist as Medical Detective] [06:45] Pathology as a Varied Field There are not many trained pathologists that are cytogeneticists. One of the benefits of the Pathology residency is the exposure to every area within pathology. You can see what you like and you don't like, or what's a good fit and what isn't. Then you can plan your career from there. Pathology is a broad field in that they can look at a variety of patients from prenatal through geriatrics patients. They look at the entire lifespan. Moreover, pathologists get to know clinicians from a huge number of different fields. Michelle is also boarded in Molecular Pathology, which now goes hand in hand with Cytogenetics. There are so many tests now coming on board for molecular testing, most of which are housed in Pathology laboratories. Those connections among the different fields of medicine are only going to grow. [09:50] Increasing Exposure to Pathology All those being said, Pathology is not a required rotation in medical schools. This is a huge challenge because there's a striking decrease in the number of U.S. medical school graduates choosing Pathology. There's so much curriculum change in medical schools now that Pathology is getting shorted on some face time so it's difficult to engage students. To overcome this challenge, they try to be creative in coming up with ways to engage students. One of which is through a Pathology interest group. They also offer a Post-Sophomore Fellowship (PSF). It's an entire year spent between the first two basic science years and years 3 and 4. It's sort of a hiatus year where the PSF works like a Pathology resident. While a number of people who have done their PSF program have gone on into Pathology, there's also a good number of those who have gone into different paths. It's a great year to learn your clinical medicine because Pathology requires a lot of knowledge of clinical medicine. Because they test a pretty broad patient spectrum, it's very helpful for people going into other fields to have a firm understanding of Pathology. [12:40] Breaking the Stigma There could also be this ego among students where they go into medicine thinking they want to save people's lives. So why go into something they "assume" can't have a big impact on people's lives. There is this weird stereotype around Pathology where people think they're sociopaths. And Michelle admits to still hearing interviewees for residency being questioned by other specialties on choosing Pathology when they're so good with people. This is a big point of contention for a lot of them in Pathology. So much of their jobs require interaction with clinicians. There's a very strong drive now in Pathology to be out there more interacting with patients. They have initiatives like the "see, diagnose, and treat" put forth by the College of American Pathologists. Women from underserved areas would be able to come in and have a pap smear done. They'd be able to see those cells underneath the microscope. A diagnosis would be made at that time and interaction with the pathologist to be able to help them move forward with their care. Most pathologists don't have day-to-day interaction with patients. This was even hard for Michelle initially since she liked working with patients. That being said, there are also some downsides. You can't romanticize the daily work involved in dealing with patients. [16:10] The Effect of Reimbursement Changes on Pathology Michelle admits she's being protected from this being in academia since they take care of billing for her. However, insurance companies don't reimburse well for some of the more complex testing that they want to do have. So they try to subsidize these by the bread and butter stuff so they can generate funding that will support some of the more esoteric testing. Pathology has a very large professional footprint in the College of American Pathologists that they have a very strong advocacy role in Washington. They've pushed very strongly for better reimbursement for pathologists. [18:50] Message to Medical Students on Rotation A lot of their resident applicants actually found themselves being less interested in the surgery, procedure, or direct patient care than they were about seeing what happened to that specimen they took. They were curious about what those cells were in the fluid. Typically, attendings on those other rotations are quite supportive when they realize someone has an interest in Pathology. They actually encourage them to follow it up in the Pathology lab. Michelle recommends that third and fourth-year medical students on rotation should familiarize themselves with their hospital laboratory. You have to understand how tests are properly validated. Know the strengths and limitations of those tests as well as the positive predictive values and negative predictive values. These things seem esoteric but they're very important to know. Much that goes into laboratory medicine is knowing the backstory of those results. A lot of test results are automated results. But you can't just buy any instrument out there. There are extensive validations needed. You need to understand false positives, false negatives, sensitivity, specificity, etc. How low can you go to detect someone with minimal residual leukemia? How confident are you in saying that there's no disease or there's a little bit of disease? These are all important things that are easy when you're on the wards, you say all those numbers. But there's a lot that goes into it. The more that you know about that, the better off you and your patients will be. [22:50] A Day in the Life of a Pathologist A typical day of a pathologist primarily depends on their type of rotations. They offer both anatomic and clinical pathology. The anatomic pathologists look at tissues coming from patient in surgery. Clinical pathologists are involved in hematopathology. They look at bone marrow biopsies. They are the clinical chemists, cytogeneticists, molecular diagnosticians, immunologists, and blood bankers. So it depends on what rotation the resident is on. If they're on anatomic pathology rotation, they are looking at slides most of the day. They may be grossing in specimens. This means they're processing specimens so they can cut them and get them onto the slides. Then they look at them under the microscope. They may be doing frozen sections running back and forth between the O.R. and the grossing room where they do immediate evaluations of tissues. In cytopathology, they may be out doing a fine-needle aspiration or an adequacy assessment if someone is having a procedure done under ultrasound or interventional radiology guidance. In a clinical pathology rotation, they're on blood bank. They may be out doing transfusion reaction workups. They may be consulting on apheresis patients. If they're a hematopathologist, they may be out doing a bone marrow biopsy or evaluation bone marrows under the microscope. Michelle clarifies that although they're not directly involved in patient care, they still want to help patients. They're helping patients by looking at and processing all of these specimens properly. [25:10] How to Be a Competitive Applicant Some of their applicants will almost do a mini-residency where every one of their rotations has been skewed towards pathology. This is not a bad thing actually. But she tells them that they have four years to become a pathologist. What she really likes them to learn well is clinical medicine. So really do good, focused clinical rotations. They will help you become a pathologist. Of course, you should do a basic pathology rotation. This will allow you to figure out if you're a good fit. And also, this will help you develop a good working relationship with a mentor who might be able to give you a good letter of recommendation. It is helpful for program directors to know that the applicant actually knows what pathology is all about. So they don't come into it thinking it's all just forensics or autopsies. Again, know clinical medicine as best as you can. Moreover, pathology has the aura that your answer to a given specimen is the only answer. But this is not true. They consult themselves a lot. There's not just one answer to things. There's often not a definite answer that people are expecting. [28:00] Overcoming Bias Towards DOs Michelle says that they've never seen any bias towards DOs. In fact, a lot of DOs come through their program. They have a lot of applicants who are DOs. One of their strongest residents was a DO who just left for a cytopathology fellowship. So she gives the same advice to interested DO applicants to know clinical medicine. That being said, she has never come across any bias towards DOs. [29:05] What Makes a Great Pathology Resident No matter what field of medicine you're in, you will get out of residency what you put into it. So they want to see someone who's really interested in Pathology. One has to have the drive and they want to see things, participate, and actively do things. A resident can't be exposed to every entity that's in pathology textbooks. They're going to have to do a lot of independent learning and reading. They have to look at the great images that are now available online. They want to see some of that initiative. Get early, stay late. Participate in as many as different conferences as possible. Ask questions. Moreover, they've had people who would seem they'd struggle if it were just based on paper. But they've overcome that. They're stronger for it. Michelle explains that they are liberal in the sense of not judging people on paper. They're willing to give people a second chance. Another misplaced emphasis is trying to do a mini-path residency as explained earlier. You have multiple areas you've done rotations in instead of just focusing on your clinical knowledge. [33:15] What She Would Have Told Her Younger Self Michelle would probably tell her younger self that just because you're looking for the perfect fit, don't worry, you will find that square hole eventually. Keep an open mind. For instance, Michelle kept her forensics rotation to the very end thinking she was going to hate it. But she loved it! Had she just had an open mind and done it a bit earlier, her whole career might be very different since she was already doing her fellowship at that point. Be patient with yourself. They met a number of applicants every year that didn't find anything that really clicked until they did their pathology rotation. [36:02] The Most and Least Like Things Michelle loves interacting with clinicians. She finds it very rewarding as she's able to get a sense from them as to what their struggles are. This way, they'd be able to determine what is needed for them to make a diagnosis and how to help them. They've made some calls that have literally been life-saving. Those may not happen everyday, but they do happen frequently. On the flip side, what she likes the least is the feeling that there is so much in pathology that you can't master. There's just so much to know. And it's becoming more subspecialized. They also have to realize the fact that they're not immune to making mistakes or misses that have significant negative ramifications on patient care. It can be a difficult, almost paralyzing fear that you can develop. You just have to make the best decision and best diagnosis you can and move forward. [37:50] Major Changes in Pathology Michelle thinks that all of the major advances in genetics and genomics is huge. Most of these targeted drug therapies are driven by molecular diagnostics. It's a specialty field you can do a fellowship in Pathology. Personalized medicine and informatics are two other huge areas. Particularly, computational pathology is tied into informatics. [39:35] Final Words of Wisdom Pathologists constantly encourage students to be interested in pathology. They're saddened by why U.S. grads are not turning to pathology as both a great career choice and a great lifestyle choice as well. They have many switchers to Pathology. So just try to get to know a pathologist. Call the lab director. Call the hematopathologist and ask if you can review the slides with them. There are insights that you can get that you cannot get just from reading a report. Understand what it is that you're seeing so you can understand the patterns. So when you're on a medicine rotation or a peds rotation, you can understand these things without necessarily going into Path. Links: Meded Media
Read the related article "Determining If a Somatic Tumor Mutation Is Targetable and Options for Accessing Targeted Therapies." [DR. NATHAN PENNELL] Welcome to the latest Journal of Oncology Practice Podcast brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all recordings, including this one, at podcast.asco.org. My name is Dr. Nate Pennell, medical oncologist at the Cleveland Clinic and consultant editor for the JOP. Today, I want to talk to you about an increasingly common scenario encountered in clinical practice. Molecular testing for biomarkers to help guide treatment of patients has now become a standard part of treatment for many types of cancer. For example, HER2 testing and breast cancer or EGFR mutation testing in lung cancer. But testing is also increasing in other cancer types often using broad, multiplex assays surveying hundreds of genes. Clinicians are being presented with a report that may seem dauntingly complex and hard to interpret. And even when you have a drug recommended, that may be off-label for its use or even experimental, leaving patients and clinicians perplexed as to how to access them. With me today to discuss these issues are Suanna Bruinooge, the director of research, strategy, and operations at ASCO's Center for Research and Analytics, or CENTRA, and Dr. Richard Schilsky, senior vice president and chief medical officer at ASCO. We'll be discussing their paper, "How to Know if a Somatic Tumor Mutation is Targetable-- Options for Accessing Targeted Therapies" published in the August 2019 JOP. Welcome Suanna and Rich, and thanks for joining me today. [DR. RICHARD SCHILSKY] Thanks for having us, Nate. [SUANNA BRUINOOGE] Thanks. [DR. NATHAN PENNELL] So Rich, give me a little background on the problem that you were hoping to address with this paper. Why did ASCO feel it was important to provide a guidance to oncologists about interpreting testing reports and accessing these drugs? [DR. RICHARD SCHILSKY] Well, I think you actually framed the problem very well in your introduction. Obviously there's a lot of tumor genomic profiling that's going on these days, oftentimes for very good reason to identify actionable alterations that are known targets of effective anti-cancer therapies. And what we've been seeing, of course, in more recent years is the more widespread use of genomic profiling, oftentimes for people who have advanced cancer, who no longer have any standard treatment options available. And the physician is looking to see whether or not there's something that might be considered actionable in the tumor genome that could provide a therapy option that wasn't considered. We're also seeing that the testing itself has become much more expansive. So instead of testing for a few genes, many tests are now testing for hundreds of genes. And, of course, they can be many different alterations that could occur within any given gene. So the amount of information that's being provided to oncologists in these test reports is enormous and very difficult to interpret. The nomenclature is difficult to understand. The biological relevance of the alterations is difficult to understand. And whether or not they really lead to a potential course of therapy is oftentimes difficult to figure out, because a lot of what turns up in the reports is difficult to understand and difficult to interpret. So one of our goals in putting this short paper together was to try to provide resources to oncologists to help them navigate these test reports to help them have resources available to, in essence, look up the abnormalities that are being detected and try to figure out whether or not that's something that might be targetable with a particular drug. And then, of course, secondarily as you pointed out, to help walk them through the various strategies they can use to actually obtain the drug that seems like it might be a good choice for their patient. [DR. NATHAN PENNELL] So if I'm looking at one of these reports now and seeing these alterations, how do I decide if that truly is actionable or not? And how do we decide what level of actionability, whether this is something that's really a standard of care now or something that's much more lower level of evidence? [DR. RICHARD SCHILSKY] Yeah, it's a great question. So, I mean, there are actually some conventions regarding the level of evidence to assign to genomic alteration to determine its actionability. And in fact, ASCO working together with the College of American Pathologists and the Association of Molecular Pathology published a paper a couple of years ago, now, sort of assigning levels of evidence. But the convention goes something like this-- if the alteration is the target of an FDA-approved drug, then that's a high level of evidence that the alteration is of clinical importance. It may or may not be of the same level of importance in a histology that is outside of the FDA-approved indication for the drug. Best known example that is often described as BRAF mutations in patients with colorectal cancer, which do not respond nearly as well to BRAF inhibitors, as the same mutations respond when they occur in patients with melanoma. But nevertheless, a BRAF mutation occurring outside of the melanoma indication has still might be considered to be sort of level two evidence of potential actionability. Then as you get further and further away from FDA-approved therapies or FDA-approved indications, then you get into lower levels of evidence. So you have, as you mentioned earlier, variants of unknown significance. These generally are alterations that are detected in the genome that truly are of unknown significance. They have not been well-characterized. It's not clear what their biological relevance is with respect to being related to tumor initiation or progression. It's not clear whether they represent markers of response or resistance to therapy. They're just alterations where really more research is necessary to determine their actionability. Nevertheless, I can tell you that we often find that many physicians think that it might be worthwhile to target APUS sort of just to give something a try. Then at the lowest level of actionability are the germline alterations. Now, even there, it's complicated because, of course, there are some germline alterations that actually direct you to use an FDA-approved drug, like germline BRCA mutations used to direct therapy with PARP inhibitors. But generally speaking, germline alterations or alterations that have been well characterized and known to be functionally benign, there, the evidence for actionability would be considered to be very low. [DR. NATHAN PENNELL] I've certainly seen people treated with targeted drugs for variants of unknown significance and, otherwise, actionable genes, such as EGFR mutations but well outside the tyrosine kinase domain. And it really depends a lot on how well it's presented in these reports as to how easy it is to figure out what's actionable and what's not. [DR. RICHARD SCHILSKY] Well, that's right. And one of the reasons we included in the paper that quite expansive table of knowledge bases that are available is to help oncologists help participants who have elected a tumor board determine where to go to look up an alteration that might actually give them useful information as to, has it ever been reported before in human cancer? If so, is it an alteration that is likely to be biological significance based upon the nature of the alteration and where it's located in the DNA? How close it is to other known ontogenic alterations and so on. So hopefully, readers of the article will find one or more of those knowledge bases' valuable resources, particularly in the context of a molecular tumor board discussion. [DR. NATHAN PENNELL] Absolutely. This is a fantastic resource. And I've got a couple of these bookmarked on my own desktop so that I can look things up, such as mycancergenome.org, for example. So I think our readers hopefully will check into that. So now that we have identified an actionable alteration, and we have a recommendation for a particular drug, what are our options for going about accessing these drugs for our patients? [SUANNA BRUINOOGE] Thanks, Nathan. This is a really good question. And I think we created a figure in the manuscript to really help clinicians and patients walk through what the options are laid out in front of them. And as you can see from the figure, it really does depend on the initial question being, does the targeted drug have FDA approval? And as Dr. Schilsky mentioned earlier, it may depend on whether the indications specifically include the cancer type or histology that your patient has. But let's just say, then that case, it would be considered an on-label indication, and largely be reimbursed by insurers. But let's say, the indication-- the cancer type is not specifically mentioned in the label. In that case, it would be considered an off-label indication. And so in that situation, there is a chance that the company or other researchers are already looking at whether the drug works for that same alteration and other cancer type. In other words, research on off-label indication. And in these situations, as trials have been completed and results are published, they might be noted in either clinical pathways or drug compendia. Or it might be published in scientific journals, like the Journal of Clinical Oncology and Journal of Oncology Practice. So in those situations where there is published data, and that supports the use in a different cancer type, then, you might be in a situation where Medicare or private payers might provide coverage for that off-label use. So in those situations, contacting the insurance companies is what we reference in the article to obtain authorization to prescribe the medication and get coverage. In situations where there isn't published data, there might be clinical trials that are under way. And in those situations, obviously, the clinical trial-- you'd have to look at the eligibility criteria for the clinical trial. Is it something that's available at your clinic? If it's not available at your clinic, is it something that the patient could travel to obtain enrollment in the clinical trial? So that's really on all along that left side of the figure related to whether the cancer type is mentioned on the drug label, whether there's published data. And the payer might cover it off-label, or if the patient would qualify for a clinical trial. If none of those are a possibility, then there still might be an occasion in which the patient would still be interested in accessing the therapy. And then you might want to look into financial assistance options for the patient. And in the manuscript, we talk about, there's recently been a compilation of patient assistance programs. And we include the website in our manuscript. And that does allow a clinician and a patient to look across multiple pharmaceutical companies to see if there might be patient assistance options available if it's already an FDA-approved approved drug. [DR. NATHAN PENNELL] Oh, that's great. So what about for patients who want to access drugs, but for whatever reason, don't have either an approval for off-label use, or there's no trial available? How would patients access drugs in that setting? [SUANNA BRUINOOGE] In that setting, you're probably thinking about a drug that's an investigational use if it does not have an FDA approval. And in this situation, there certainly may be circumstances in which a clinical trial isn't available. Or maybe your patient is not available at your site. Or maybe your patient doesn't qualify and meet the eligibility criteria or isn't able to travel for the clinical trial. And in those situations, there may be options that you and your patient could explore through something called expanded access program. And there's really three options that are sort of broadly described as expanded access program. A company might offer a large or mid-sized expanded access program. It's essentially like a clinical trial, although it may be collecting less data in the course of the clinical trial. It might be for a broader patient population who might not otherwise qualify for the clinical trial. And typically the company might conduct this as a broader access for patients who don't qualify for a clinical trial. Or perhaps in the interim period between which a company submits its application to the FDA, and they're waiting to hear about the FDA review of the drugs. So these are often sort of in that interim time period before a drug might be approved. The third type of expanded access program is an individual patient use. And this is something that is there's actually new resources that are available on a couple of different locations. There's an organization called the Reagan Udall Foundation. So that's Reagan as in the former president. And Udall-- U-D-A-L-L. This is a foundation that supports the work of the FDA in a broad sense. And they have something that's called the Expanded Access Navigator Program that's available on their website. You are a patient Google Expanded Access Navigator. The Reagan Udall website will certainly become available in the listing. And what this does is list all the companies that provide expanded access program. So this is a good starting point to see if a company might be offering either a large or midsize expanded access programs and also list the company context at the company so you can also figure out how to contact the company to find out if your patient qualifies. If there isn't a program. Then fortunately, in oncology, we also have another option that clinicians can explore. The FDA Oncology Center of Excellence recently launched a program that's called Project Facilitate. And this provides both web-based resources, as well as a phone line that is available during business hours which are largely East Coast business hours. And it's a resource for clinicians to contact related to individual patient access requests. And the FDA has staff who are very knowledgeable about the individual patient access pathway. They can help with contacting companies and sort of serve as an intermediary to help navigate those situations. And the FDA role is actually in any of these three expanded access programs. The FDA plays a very important role in reviewing requests from clinicians. And they provide sort of a third-party review of the circumstances. And they're very quick to respond to inquiries in this regard and really do approve virtually all of the requests for access that they receive. And so long as the company provides access to the drug, ultimately, the decision about whether to provide access to the drug is up to the company. There is another avenue, which is described in our manuscript as well. Some states have also passed right-to-try laws. In these circumstances, these laws are at the state level. So not all states have passed them. But they provide a pathway that bypasses FDA review and assessment. They do not require that a company provide the investigational drug. So that circumstance is really still up to the individual company, whether they want to make the drug available outside of clinical trials. [DR. NATHAN PENNELL] I think a couple incredibly important things that I want to make sure everybody got out of this. One is that all of this relies on the pharmaceutical company actually being willing to provide these drugs. So even the right-to-try laws on the state and federal level don't require that the companies give access to the drugs to the patient. So both of those are necessary. And second of all, that the FDA is incredibly helpful in providing access to these drugs. I've personally gone several times through compassionate use single patient's drug access through the FDA. And they've been tremendously helpful and never were in any way a barrier to getting access to the drug. They're fast and responsive. And so I actually haven't personally heard much in terms of the use of the right-to-try laws to access drugs. I don't know if that's something that there was a lot of attention, of course, when the federal government passed the law. But I haven't heard much about it since then. [DR. RICHARD SCHILSKY] Nor have we. I don't think we're aware of any circumstances in oncology where patients have access to investigational drugs through the right-to-try pathway. That may be because the companies are reluctant to make drugs available. Or it may be because appropriate drugs just haven't been on the radar screen. I think all of us, though, would agree that a much better way of providing access to drugs would be to do it in a way where you're actually collecting the information on the efficacy of the drugs and the toxicity of the drugs where you can learn about that process and help lead to an eventual approval. So what is ASCO doing that can help provide access to promising drugs, perhaps, an off-label setting for patients? Many people know the TAPUR is an acronym that stands for Targeted Agents and Profiling Utilization Registry. So it's a quite a mouthful. And so we like to call it TAPUR. So TAPUR is a prospective multi-arm phase II basket trial, which is matching commercially available targeted drugs used to off-label against a genomic alteration in a patient's tumor. So, in essence, we set up TAPUR to be able to learn from the off-label prescribing of targeted drugs to patients who have advanced cancers. And the study has been ongoing now since March of 2016. There are about 1,600 patients who have been enrolled at about 120 sites around the country. We've started to report out both negative and positive results. And we think that negative and positive results are equally important in this setting, because, for example, if a doctor could prescribe a drug off-label, but there's no evidence that the drug actually is beneficial, then those patients are better served by being directed to other clinical trials. So for example, last year, we reported that palbociclib is not effective in either pancreatic or biliary tract cancers that have a CDKN2A alteration. So the implication being, of course, that the next time a doctor sees that alteration showing up on a tumor genomic test report for a patient with one of those cancers, they probably should look for something other than palbociclib. Now, alternatively, we've also begun to identify signals of activity that either have been already reported in more formal clinical trials. And we're just able to affirm that the therapy works in a more real world population or in some cases haven't really yet been identified. So, for example, at this year's ASCO annual meeting, the 2019 meeting, we reported that pembrolizumab has activity in patients with breast cancer that have a high tumor mutational burden. And we think that's an exciting observation. Some of those patients actually had quite prolonged disease control and that the abstract has been presented. The poster is available on the TAPUR website, tapur.org, for anyone who wants to look at the details. And there are some manuscripts of preparation. So TAPUR we hope over time we'll continue to report out both positive and negative results. They can't really help to guide the use of these well-sampled therapies. And, of course, it's also a mechanism, whereby the drugs can be provided to patients at no cost to them, because all the drugs in the study are being provided by the participating pharmaceutical companies. [DR. NATHAN PENNELL] Yeah, it really is a win-win situation. The patients get access to the drugs without having to worry about whether their insurance will cover the off-label use. And the companies learn whether their drugs may have expanded indications outside of where they're currently used. Well, Suanna and Rich, thanks so much for joining me on the podcast today. [DR. SCHILSKY AND MS. BRUINOOGE] Thank you. [DR. NATHAN PENNELL] And until next time, thank you for listening to this Journal of Oncology Practice Podcast. I hope you enjoyed what you heard today. And if you did, don't forget to give us a rating or review on Apple podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JOP's podcasts are just one of ASCO's many podcast programs. You can find all recordings at podcast.asco.org. The full text of the paper will be online at ascopubs.org/journal/jop in August 2019. This is Dr. Nate Pennell for the Journal of Oncology Practice signing off.
Dr. Jennifer Hunt is Chair of Pathology at the University of Arkansas for Medical Sciences. She has served in a number of different leadership roles both at her institution and nationally, including Chief of Staff for her hospital, an elected member of the Board of Governors for the College of American Pathologists, and President of the Association for Molecular Pathology and President of the College of American Pathologists Foundation. As if all that wasn’t enough to make me feel like a slacker, she has a second distinguished career: she maintains a practice as an Executive Leadership Coach which focuses on current and emerging leaders in healthcare. She runs a very popular leadership development program for women to address the impostor syndrome in medicine called “Unlocking the Authentic Self”.
Adjusting to a more collaborative style may take doctors some time, says Dr. Mark Boguski, but if they stop confining themselves to disciplinary boundaries, they'll be able to see connections between different areas of medicine that aren't taught in medical schools. Boguski draws on examples from oncology, where he says doctors are gradually being retrained to think in terms of disease pathways instead of discreet organ systems. Dr. Boguski is the chief medical officer of Liberty Biosecurity and founder of the Precision Medicine Network. He's a member of the U.S. National Academy of Medicine and a fellow of the College of American Pathologists and the American College of Medical Informatics. He's served on the faculties of the U.S. National Institutes of Health, the Johns Hopkins University School of Medicine, and Harvard Medical School, and as an executive in the biotech and pharmaceutical industries. He is the former vice president and global head of genome and protein sciences at Novartis, and a graduate of the medical scientist training program at the University of Washington in St. Louis. He has written a series of books on cancer for the general public, under the series title "Reimagining Cancer." How to rate MoneyBall Medicine on iTunes with an iPhone, iPad, or iPod touch: Launch the "Podcasts" app on your device. If you can't find this app, swipe all the way to the left on your home screen until you're on the Search page. Tap the search field at th top and type in "Podcasts." Apple's Podcasts app should show up in the search results. Tap the Podcasts app icon, and after it opens, tap the Search field at the top, or the little magnifying glass icon in the lower right corner. Type MoneyBall Medicine into the search field and press the Search button. In the search results, click on the MoneyBall Medicine logo. On the next page, scroll down until you see the Ratings & Reviews section. Below that you'll see five purple stars. Tap the stars to rate the show. Scroll down a little farther. You'll see a purple link saying "Write a Review." On the next screen, you'll see the stars again. You can tap them to leave a rating, if you haven't already. In the Title field, type a summary for your review. In the Review field, type your review. When you're finished, click Send. That's it, you're done. Thanks!
Morphologic examination by light microscopy remains an integral part of initial histopathologic assessment for hematolymphoid neoplasms; however, a variety of laboratory techniques are now being used to optimize diagnostic information in the appropriate clinical context. For diagnosing myeloid disorders and acute myeloid leukemia, one approach is to utilize an next gen sequencing panel and DNA-based cytogenomic microarray, according to Dr. Pranil Chandra, Chief Medical Officer of Genomic and Clinical Pathology with PathGroup. In this CAPcast, Dr. Chandra discusses why his laboratory, in conjunction with pathologist and oncologist colleagues, developed this technology and how they’ve implemented it into clinical practice. Dr. Chandra currently serves on the Personalized Healthcare Committee of the College of American Pathologists, and he’s written a short article now posted on CAP.org (https://capatholo.gy/2RO4h96) outlining the reasoning his team used to make this panel their standard of care.
The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello, and welcome to the ASCO Guidelines podcast series. My name is Shannon McKernin, and today I'm interviewing Dr. Carole Fakhry from Johns Hopkins School of Medicine, lead author on Human Papillomavirus Testing in Head and Neck Carcinomas: ASCO Clinical Practice Guideline Endorsement of the CAP Guideline. Thank you for being here today, Dr. Fakhry. Thanks for having me. So first, can you give us a general overview of what this guideline covers? Sure. This guideline serves to guide multi-disciplinary clinicians in the evaluation of head and neck cancers. And it really starts to clarify which HPV tests to order and when. Also discusses some of the imitations of using surrogate HPV testing in specific situations. The College of American Pathology Guidelines were recently published and we are providing an endorsement with certain classifications and discussions of nuances that we as a committee felt were important and clinically significant, specifically, aspects that could alter clinical care. So what are the key recommendations of this guideline? So first and foremost, the key recommendation is that HPV tumor detection should be performed in oropharynx tumors and not for non-oropharynx tumors. An important aspect of that is that HPV tumor testing should not be altered based on sex, race, age, or smoking history. Another important recommendation is that the term "high-risk" only be used when HPV-specific testing is performed. That would establish the tumor is ideologically related to the infection human papillomavirus. In the absence of HPV-specific testing, we recommend that the term HPV-related tumors be used, and that p16 deserving for oropharynx tumors only. And can you tell us a little bit about the qualifying statements made on some of these recommendations, and why the expert panel decided to include these? Sure. So one of the qualifying statements that we did make was a generalized one, and the one that I kind of just touched upon, that the term "high-risk HPV" should only be used in situations when HPV-specific testing was performed. And that's because sometimes things are p16 positive but not necessarily HPV-related or etiologically related to the infections. So as a committee, we wanted to make sure that that was clear. In light of that, one of the recommendations from the CAP Guidelines was that for tissue specimens presenting with medistatic squamma cell carcinoma of unknown primary and cervical upper, or mid-jugular, chain lymph nodes, pathologists should perform p16 in situ hybridisation. They also had added a note saying that additional high-risk HPV testing on p16-positive cases should be performed for tumors located outside of level two or three in the neck, and/or for tumors with keratinizing morphology. So in the qualifying statement, our committee felt that p16 immunohistochemistry alone was not sufficient in the scenario of an unknown primary cancer. We can get false positives and tumors that are p16-positive but not related to HPV. Can arise in situations of metastasis from the skin cancers, salivary gland malignancies, or even lung primaries. Therefore, in the case of an unknown primary, we would recommend HPV-specific testing. What other important consideration that our committee felt was important to clarify was that in the unknown primary, whether or not a tumor is felt to have keratinizing or non-keratinizing morphology, that HPV-specific testing should be done. And the reason for that is that the pathologists acknowledge that considering a tumor keratinizing or non-keratinizing may be a difficult distinction for most pathologists, and that discerning HPV status may actually be easier and may help hone in on the diagnosis. And as part of this, what we did was we created an algorithm which simplified the College of American Pathologists algorithm for HPV detection. So there are fewer nodes in terms of HPV detection. And in general, for oropharynx tumors, we recommend starting a p16 immunohistochemistry. We endorse the 70% cutoff used on immunohistochemistry for p16. And if it's an oropharynx tumor with greater than 70% p16 staining, then that can be considered an HPV-related squama cell carcinoma. For non-oropharynx tumors, we don't ever recommend HPV tumor status evaluation. And then for unknown primary, whether or not it's a level 2 or 3, starting with p16 is adequate, but if it is p16-positive, that needs to be followed up with HPV-specific testing to be deemed HPV-related. In the College of American Pathology algorithm, acknowledging that determining HPV status can be complex, there are more nodes and more decisions that could be made in terms of discerning what's HPV-related and what's not. And so our committee tried to distill it down and simplify the algorithm. And finally, how will these guideline recommendations affect patients? So it is recommended that patients with oropharynx cancer be tested for HPV. And so this really helps their clinicians determine how to best test their tumors. In cases that are not so clear that are not oropharynx tumors, it also helps to guide their clinicians in terms of the when and how to test their tumors. Great. Thank you for your work on this important guideline, and thank you for your time today, Dr. Fakhry. Thanks for having me. And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. If you've enjoyed what you've heard today, please rate and review the podcast and refer the show to a colleague.
HistoQIP is a quality assurance program for histopathology, jointly sponsored by the National Society for Histotechnology and the College of American Pathologists. The primary focus of this program is to improve the quality of histologic preparations routinely performed in the histology laboratory through education. In this CAPcast from the College of American Pathologists, pathologist Dr. Matthew Carr of Western Michigan Pathology Associates and ASCP certified histotechnologist Sue Lewis discuss how the program works and how it can help pathologists, laboratory managers and their staff members improve the quality of their histology laboratory operations. For more information, visit https://nsh.org/content/all-about-histoqip.
The CAP’s recently launched Test Ordering Program offers tools and self-assessment modules to assist pathologists in understanding and improving test utilization, so that the pathologist, in collaboration with clinician colleagues, can improve the value and effectiveness of the wider health care organization. In this CAPcast from the College of American Pathologists, Dr. Ronald Schifman, a pathologist with the Veterans Health Administration, discusses the wide-ranging benefits of this program, which is free to CAP members. Dr. Schifman also shares his experience with improving test utilization at the VA and how these improvements impacted patient care. For more on the CAP's Test Ordering Program, visit http://capatholo.gy/test-ordering-program.
The CAP’s Graduate Medical Education Committee recently published recommendations for Entrustable Professional Activities—or EPAs—for pathology in the journal Academic Pathology (http://capatholo.gy/2xvOXqJ). In this CAPcast from the College of American Pathologists, committee vice-chair Dr. Cindy McCloskey from the University of Oklahoma College of Medicine discusses how and why these recommendations came about and how they can be another means to determine proficiency and evaluate educational outcomes in the workplace and training environment.
Jolean Olson is a mother who enjoyed her time outside in the sun playing with her kids. That all ended when she discovered a large, zit-like bump on her cheek. When the bump remained several days later, Jolean met with several medical professionals. After getting numerous opinions, all saying she had skin cancer, Jolean asked for her pathology report to see the results for herself. Jolean’s pathology report gave her clarity and a better understanding of her diagnosis. She chose a treatment plan best-suited for her, and is now living cancer free. Jolean shares her journey in a video developed by the College of American Pathologists. Twitter: @Pathologists Facebook: @capathologists
ISO 15189 is an international quality standard for medical laboratories. One of the best practices addressed in this standard is risk management. In this CAPcast from the College of American Pathologists, Dr. Frank Schneider, chair of CAP’s 15189 Committee, discusses ISO 15189 and risk management. Dr. Schneider, a pathologist at Emory University Hospital in Atlanta, Georgia, is also the co-author of a chapter on this topic in the new book, Quality Management in Anatomic Pathology, out now from CAP Press: http://capatholo.gy/2tnSsi1. The CAP 15189 program has issued a Risk Management Guideline that provides additional detail about the ISO 15189 requirements for risk management: http://capatholo.gy/2vjbeo4.
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