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Difference between revisions of "Critical values"
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'''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> | [[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]]'''. | ||
===General=== | |||
*Large vessel in core biopsy specimen. | 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/> | ||
==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. | *Unexpected malignant diagnosis. | ||
*Malignant diagnosis in the context of a medical emergency: | *Malignant diagnosis in the context of a medical emergency: | ||
**Neoplasm causing paralysis. | **Neoplasm causing paralysis. | ||
**Malignancy causing superior vena cava syndrome | **Malignancy causing superior vena cava syndrome. | ||
===Gynecologic=== | ====Gynecologic==== | ||
* | *D&C on pregnant individual (or specimen labelled "[[products of conception]]") without [[chorionic villi]] or trophoblasts. | ||
*Fat on endometrial biopsy. | *[[Fat on endometrial biopsy]]. | ||
*Fat on endocervical canal sampling. | *Fat on endocervical canal sampling. | ||
===Diagnostic of infection=== | ====Diagnostic of infection==== | ||
*Fungal. | *Fungal. | ||
*Microbacterial. | *Microbacterial. | ||
| Line 23: | Line 33: | ||
*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=== | ====Renal==== | ||
*Crescents in kidney biopsy. | *[[Glomerular crescents|Crescents]] in kidney biopsy. | ||
==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: | |||
*[[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> | |||
*[[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> | |||
==See also== | ==See also== | ||
*[[Basics]]. | *[[Basics]]. | ||
*[[Quality]]. | |||
*[[Diagnosis]]. | |||
==References== | ==References== | ||
{{reflist|1}} | {{reflist|1}} | ||
[[Category:Quality]] | [[Category:Quality]] | ||