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Difference between revisions of "Quality"
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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). | ||
==Error reduction== | ==Error reduction== | ||
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==Immunohistochemistry== | ==Immunohistochemistry== | ||
{{Main|Immunohistochemistry}} | {{Main|Immunohistochemistry}} | ||
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== | ||