Critical values

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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.