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==
==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>  
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===
====General====
*[[blood vessels|Large vessel]] in core biopsy specimen.
*[[blood vessels|Large vessel]] in core biopsy specimen.
*Unexpected malignant diagnosis.
*Unexpected malignant diagnosis.
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**Malignancy causing superior vena cava syndrome.
**Malignancy causing superior vena cava syndrome.


===Cytology===
====Gynecologic====
Critical diagnoses as per Pereira ''et al.'':<ref>{{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>
*D&C on pregnant individual (or specimen labelled "[[products of conception]]") without [[chorionic villi]] or trophoblasts.
*Unexpected malignancy - vast majority of cases.
*Microorganisms in non-gynecologic specimens and FNA specimens.
 
===Gynecologic===
*No [[chorionic villi]] or trophoblasts on D&C in someone pregnant.
*[[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.
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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.
 
==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.  


===Renal===
Examples of diagnoses that are high impact and are frequently reviewed:
*Crescents in kidney biopsy.
*[[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

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

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.[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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