Critical values

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

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

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.

List of critical diagnoses

Cytology

Critical diagnoses as per Pereira et al.:

• 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.

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

• No chorionic villi or trophoblasts on D&C in someone pregnant.
• Fat on endometrial biopsy.
• Fat on endocervical canal sampling.

Diagnostic of infection

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

Suggestive of infection

• Necrotic granulomas.

Cardiac

• Mesothelial cells in heart muscle biopsy.

Transplant related

• Transplant rejection.

Medical diseases

• Vasculitis.

Renal

• 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:

• High grade columnar esophageal dysplasia.
• Muscle invasive urothelial carcinoma of the bladder.

See also

• Basics.
• Quality.
• Diagnosis.