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>   


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


The general consensus is that these findings require a phone call and/or discussion with the clinician to ensure the situation is managed appropriately in a timely manner.<ref name=pmid16680772/>  
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==
==List of critical diagnoses==
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====Gynecologic====
====Gynecologic====
*No [[chorionic villi]] or trophoblasts on D&C in someone pregnant.
*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.
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====Renal====
====Renal====
*[[Glomerular crescents|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]].
*[[Quality]].
*[[Diagnosis]].


==References==
==References==

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.