Difference between revisions of "Critical values"

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'''Critical values''' is a concept which comes from clinical pathology. In the context of surgical pathology it is sometimes called '''critical diagnosis'''.
[[Image:ECG in hyperkalemia.png | thumb| right|200px| Hyperkalemia is a critical value as it is associated with [[cardiac arrhythmias]].]]
'''Critical values''' is a concept which comes to anatomical [[pathology]] from clinical pathology.<ref name=pmid17491125>{{cite journal |author=Allen TC |title=Critical values in anatomic pathology? |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=5 |pages=684–7 |year=2007 |month=May |pmid=17491125 |doi= |url=http://arpa.allenpress.com/arpaonline/?request=get-document&issn=0003-9985&volume=131&issue=5&page=684}}</ref> 


==List==
In the context of surgical pathology, it is, perhaps more appropriately, called '''critical [[diagnosis]]'''.
Gynecologic:
 
*No chorionic villi or trophoblasts on D&C in someone pregnant.
The general consensus is that these findings (critical valves, critical diagnoses) require a phone call and/or discussion with the clinician to ensure the situation is managed appropriately in a timely manner.<ref name=pmid16680772/>
*Fat on endometrial biopsy.
 
==List of critical diagnoses==
===Cytology===
Critical diagnoses as per Pereira ''et al.'':<ref name=pmid16680772>{{Cite journal  | last1 = Pereira | first1 = TC. | last2 = Clayton | first2 = AC. | last3 = Tazelaar | first3 = HD. | last4 = Liu | first4 = Y. | last5 = Leon | first5 = M. | last6 = Silverman | first6 = JF. | title = Critical values in cytology. | journal = Diagn Cytopathol | volume = 34 | issue = 6 | pages = 447-51 | month = Jun | year = 2006 | doi = 10.1002/dc.20443 | PMID = 16680772 }}</ref>
*Unexpected malignancy - vast majority of cases.
*Microorganisms in non-gynecologic specimens and FNA specimens.
 
===Surgical pathology===
The following is primarily constructed from a list in Pereira ''et al.''<ref name=pmid15323136>{{Cite journal  | last1 = Pereira | first1 = TC. | last2 = Liu | first2 = Y. | last3 = Silverman | first3 = JF. | title = Critical values in surgical pathology. | journal = Am J Clin Pathol | volume = 122 | issue = 2 | pages = 201-5 | month = Aug | year = 2004 | doi = 10.1309/7NRW-7G68-4VEP-WPMR | PMID = 15323136 }}</ref>
 
====General====
*[[blood vessels|Large vessel]] in core biopsy specimen.
*Unexpected malignant diagnosis.
*Malignant diagnosis in the context of a medical emergency:
**Neoplasm causing paralysis.
**Malignancy causing superior vena cava syndrome.
 
====Gynecologic====
*D&C on pregnant individual (or specimen labelled "[[products of conception]]") without [[chorionic villi]] or trophoblasts.
*[[Fat on endometrial biopsy]].
*Fat on endocervical canal sampling.
*Fat on endocervical canal sampling.


Diagnostic of infection:
====Diagnostic of infection====
*Fungal.
*Fungal.
*Microbacterial.
*Microbacterial.
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*Viral.
*Viral.


Suggestive of infection:
====Suggestive of infection====
*Necrotic granulomas.
*Necrotic [[granulomas]].


Cardiac:
====Cardiac====
*Mesothelial cells in heart muscle biopsy.
*Mesothelial cells in heart muscle biopsy.


Transplant related:
====Transplant related====
*Transplant rejection.
*Transplant rejection.


Medical diseases:
====Medical diseases====
*Vasculitis.
*[[Vasculitis]].
 
====Renal====
*[[Glomerular crescents|Crescents]] in kidney biopsy.


Renal:
==List of diagnoses that should be reviewed==
*Crescents in kidney biopsy.
*[[AKA]] ''review diagnoses''.
Review diagnoses are diagnoses that have significant treatment implications, and often mandate the opinion of a second pathologist and/or a sub-specialist. There is no general consensus around which diagnoses require review.  


General:
Examples of diagnoses that are high impact and are frequently reviewed:
*Large vessel in core biopsy specimen.
*[[Columnar dysplasia of the esophagus|High grade columnar esophageal dysplasia]].<ref name=pmid9189080>{{Cite journal  | last1 = Wright | first1 = TA. | title = High-grade dysplasia in Barrett's oesophagus. | journal = Br J Surg | volume = 84 | issue = 6 | pages = 760-6 | month = Jun | year = 1997 | doi =  | PMID = 9189080 }}</ref>
*Unexpected malignant diagnosis.
*[[urothelial carcinoma|Muscle invasive urothelial carcinoma of the bladder]].<ref>{{Cite journal  | last1 = Coblentz | first1 = TR. | last2 = Mills | first2 = SE. | last3 = Theodorescu | first3 = D. | title = Impact of second opinion pathology in the definitive management of patients with bladder carcinoma. | journal = Cancer | volume = 91 | issue = 7 | pages = 1284-90 | month = Apr | year = 2001 | doi =  | PMID = 11283928 }}</ref>
*Malignant diagnosis in the context of a medical emergency:
**Neoplasm causing paralysis.
**Malignancy causing superior vena cava syndrome.  


==See also==
*[[Basics]].
*[[Quality]].
*[[Diagnosis]].


Article looking at critical values in cytology: [http://www3.interscience.wiley.com/journal/112606899 http://www3.interscience.wiley.com/journal/112606899].
==References==
{{reflist|1}}


==External links==
[[Category:Quality]]
*[http://ajcp.ascpjournals.org/content/122/2/201.full.pdf AJCP article with partial list].

Latest revision as of 21:09, 4 November 2015

Hyperkalemia is a critical value as it is associated with cardiac arrhythmias.

Critical values is a concept which comes to anatomical pathology from clinical pathology.[1]

In the context of surgical pathology, it is, perhaps more appropriately, called critical diagnosis.

The general consensus is that these findings (critical valves, critical diagnoses) require a phone call and/or discussion with the clinician to ensure the situation is managed appropriately in a timely manner.[2]

List of critical diagnoses

Cytology

Critical diagnoses as per Pereira et al.:[2]

  • Unexpected malignancy - vast majority of cases.
  • Microorganisms in non-gynecologic specimens and FNA specimens.

Surgical pathology

The following is primarily constructed from a list in Pereira et al.[3]

General

  • Large vessel in core biopsy specimen.
  • Unexpected malignant diagnosis.
  • Malignant diagnosis in the context of a medical emergency:
    • Neoplasm causing paralysis.
    • Malignancy causing superior vena cava syndrome.

Gynecologic

Diagnostic of infection

  • Fungal.
  • Microbacterial.
  • Bacterial.
  • Viral.

Suggestive of infection

Cardiac

  • Mesothelial cells in heart muscle biopsy.

Transplant related

  • Transplant rejection.

Medical diseases

Renal

List of diagnoses that should be reviewed

  • AKA review diagnoses.

Review diagnoses are diagnoses that have significant treatment implications, and often mandate the opinion of a second pathologist and/or a sub-specialist. There is no general consensus around which diagnoses require review.

Examples of diagnoses that are high impact and are frequently reviewed:

See also

References

  1. ↑ Allen TC (May 2007). "Critical values in anatomic pathology?". Arch. Pathol. Lab. Med. 131 (5): 684–7. PMID 17491125. http://arpa.allenpress.com/arpaonline/?request=get-document&issn=0003-9985&volume=131&issue=5&page=684.
  2. ↑ 2.0 2.1 Pereira, TC.; Clayton, AC.; Tazelaar, HD.; Liu, Y.; Leon, M.; Silverman, JF. (Jun 2006). "Critical values in cytology.". Diagn Cytopathol 34 (6): 447-51. doi:10.1002/dc.20443. PMID 16680772.
  3. ↑ Pereira, TC.; Liu, Y.; Silverman, JF. (Aug 2004). "Critical values in surgical pathology.". Am J Clin Pathol 122 (2): 201-5. doi:10.1309/7NRW-7G68-4VEP-WPMR. PMID 15323136.
  4. ↑ Wright, TA. (Jun 1997). "High-grade dysplasia in Barrett's oesophagus.". Br J Surg 84 (6): 760-6. PMID 9189080.
  5. ↑ Coblentz, TR.; Mills, SE.; Theodorescu, D. (Apr 2001). "Impact of second opinion pathology in the definitive management of patients with bladder carcinoma.". Cancer 91 (7): 1284-90. PMID 11283928.
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