Difference between revisions of "Quality"

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596 bytes added ,  15:06, 22 January 2012
expand IHC section
(expand IHC section)
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**Where did it occur?
**Where did it occur?
*Talk to the clinician.
*Talk to the clinician.
**If it is a ''[[critical diagnosis]]'' contact most-responsible physician immediately... if they are unreachable call physician on-call for the most-responsible physician.  
**If it is a ''[[critical diagnosis]]'' contact most-responsible physician immediately... if they are unreachable call physician on-call for the most-responsible physician... if the patient is out-of-town you may have to coordinate with the emergency department. 
*Talk to the chief of pathology.
*Talk to the chief of pathology.
*Incident report.
*Incident report.
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*Filing problem.
*Filing problem.
*Interpretation of report problem (poorly written, bad interpretation).
*Interpretation of report problem (poorly written, bad interpretation).
===IHC problems===
Work-up of suspected IHC problems:
*Review controls (internal and external).
**Isolated to case vs. larger problem?
***Discuss with lab/make other pathologists of the issue.
*Repeat test - to identify the cause.


==Error reduction==
==Error reduction==
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==Immunohistochemistry==
==Immunohistochemistry==
{{Main|Immunohistochemistry}}
{{Main|Immunohistochemistry}}
A paper by Torlakovic ''et al.''<ref name=pmid20154273>{{Cite journal  | last1 = Torlakovic | first1 = EE. | last2 = Riddell | first2 = R. | last3 = Banerjee | first3 = D. | last4 = El-Zimaity | first4 = H. | last5 = Pilavdzic | first5 = D. | last6 = Dawe | first6 = P. | last7 = Magliocco | first7 = A. | last8 = Barnes | first8 = P. | last9 = Berendt | first9 = R. | title = Canadian Association of Pathologists-Association canadienne des pathologistes National Standards Committee/Immunohistochemistry: best practice recommendations for standardization of immunohistochemistry tests. | journal = Am J Clin Pathol | volume = 133 | issue = 3 | pages = 354-65 | month = Mar | year = 2010 | doi = 10.1309/AJCPDYZ1XMF4HJWK | PMID = 20154273 }}</ref> divides immunohistochemistry (IHC) tests into:
 
Work-up of suspected IHC problems:
*Review controls (internal and external).
**Isolated to case vs. larger problem?
***Discuss with lab/make other pathologists of the issue.
*Repeat test - to identify the cause.
 
IHC process:
#Ischemia time - warm ischemia, preparation of specimen.
#Fixation - under, over, defective fixative, not enough fixative.
#Processing prior to antibody binding, usu. heating (antigen retrieval).
#Antibody-antigen binding.
#Reporter molecule binding.
#Counterstaining.
#Interpretation.
 
Notes:
*Problems can arise at any step.
 
===Classification of IHC tests===
IHC tests are classified in a paper by Torlakovic ''et al.'':<ref name=pmid20154273>{{Cite journal  | last1 = Torlakovic | first1 = EE. | last2 = Riddell | first2 = R. | last3 = Banerjee | first3 = D. | last4 = El-Zimaity | first4 = H. | last5 = Pilavdzic | first5 = D. | last6 = Dawe | first6 = P. | last7 = Magliocco | first7 = A. | last8 = Barnes | first8 = P. | last9 = Berendt | first9 = R. | title = Canadian Association of Pathologists-Association canadienne des pathologistes National Standards Committee/Immunohistochemistry: best practice recommendations for standardization of immunohistochemistry tests. | journal = Am J Clin Pathol | volume = 133 | issue = 3 | pages = 354-65 | month = Mar | year = 2010 | doi = 10.1309/AJCPDYZ1XMF4HJWK | PMID = 20154273 }}</ref>
*''Class I'':
*''Class I'':
**Adjunct to histomorphology.
**Adjunct to histomorphology.
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**Used directly for treatment decisions.
**Used directly for treatment decisions.
**Examples: ER, PR, HER2.
**Examples: ER, PR, HER2.
The implication of irregularies in the different classes are different. Problems in ''Class II'' tests are potentially more severe, as there is no internal control.


==See also==
==See also==
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