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Incyte Diagnostics Newsletter Articles

 

Incyte Diagnostics' quarterly newsletter, Informed, contains articles written by our board certified pathologists.  Some of the more recent articles are posted on this page.  You can also subscribe to our electronic newsletter available online for your convenience.

 

ICD-10: Coding Gynecological Specimens for the Laboratory

The practice of medicine has changed dramatically in the last 25 years or so. New conditions have been discovered and many new treatments and medical devices have been developed. The ICD-10 code set that became effective on October 1, 2015, tries to capture the current practice of medicine and provide flexibility as it changes in the future.  Click here to read the entire article 

Immunoglobulin G4-related Disease   
By David C. Hoak, M.D.

Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized syndrome of unknown etiology, most often occurring in middle-aged and older men.  Click here to read the entire article 

Lower Anogenital Standardized Terminology - The LAST Step?   
By David C. Hoak, M.D.

The goal of the LAST project was to have clear, comparable and reproducible communication of diagnosis between and among pathologists and clinicians.  Click here to read the entire article 

Increasing Gonorrhea Rates Statewide   
By David C. Hoak, M.D.

Health officials across the northwest are trying to figure out why they see a sizeable increase in the number of gonorrhea cases recently.  Overall, the state reported a 34% increase in gonorrhea cases in a year’s time.  Click here to read the entire article 

Fibroepithelial Tumors of the Breast   
By Bruce A. Britton., M.D.

Fibroepithelial tumors of the breast represent a class of biphasic tumors ranging from benign to highly malignant. These tumors share the histologic feature of proliferation of both epithelium and stroma, the former of which usually consists of benign glandular epithelium while the latter is composed of spindle cells that vary from uniform and benign to anaplastic.  Click here to read the entire article

Trichomonas - Ancient Protozoan   
By Felix Martinez, Jr., M.D.

Trichomonas is a genus of protozoans that are parasites of vertebrates. Parasites live in their infected host, co-opt its resources, and cause disease.  Click here to read the entire article

Diagnosis of Blastic Plasmacytoid Dendritic Cell Neoplasm   
By Ayumi I. Corn, M.D.

In the correct clinical setting, positivity for CD4, CD56, CD123, and TCL-1 in a morphologically blastoid population supports the diagnosis of blastic plasmacytoid dendritic cell neoplasm.  Click here to read the entire article

Ask the Pathologist: Negative Pap but Positive HPV?   
By David C. Hoak, M.D.

The most common reason for a negative Pap test with a positive HPV result is that the patient has an HPV infection, but the infection is not causing any cellular abnormalities.  Click here to read the entire article

New Codes Mean More Specificity For Gastrointestinal Conditions   

Incyte Diagnostics’ coding staff has begun the ICD-10 training process and would like to share some of what they have learned in this series of articles.  Click here to read the entire article

Testing for Candidiasis   
By Hongxiu Ji, M.D., Ph.D.

Candida is always present in and on the body in small amounts; however, Candida can multiply when an imbalance occurs, such as when normal acidity of the vagina is altered or when hormonal balance changes.  Click here to read the entire article

Should Oral HPV Testing Be Performed to Screen for Oral Carcinoma?   
By David C. Hoak, M.D.

The number of HPV-related oropharyngeal carcinomas is on the rise according to the Annual Report to the Nation on the Status of Cancer, 1975-2009; however, we still don’t have an accepted screening protocol in place to address the situation.  Click here to read the entire article

Molecular Infectious Disease Testing on Vaginal Swabs   
By Felix Martinez, Jr., M.D.

In our world of rapidly evolving technology, does molecular testing for infectious disease offer value? If there is a current practice or test that detects disease and helps administer good care to patients, is there reason to readily adopt a new approach?  Click here to read the entire article

New V Codes Won’t Stand Alone - V72.6x Needs Help to Show Medical Necessity   

One example of inappropriate coding might be prior to a procedure, when a clinician orders tests using a V72.6x code. Never code routine physical or pre-op lab tests with V72.6x.  Click here to read the entire article

Melanoma In Situ Excision Guidelines   
By Alden R. Webb, D.O.

Recommendations for setting the appropriate margins when excising melanoma in situ (MIS) lesions are being revisited.  Click here to read the entire article

Good Smears Equal Good Medicine   
By Ayumi I. Corn, M.D.

Accurate interpretation of bone marrow specimens is highly dependent on two factors: the quality of the sample obtained during the procedure and the quality of specimen processing, in particular the preparation of the bone marrow aspirate smears.  Click here to read the entire article

HPV-Related Head & Neck Squamous Cell Carcinoma   
By David C. Hoak, M.D.

Recent studies reveal that tumor HPV status is an independent prognostic factor for overall survival and progression-free survival among patients with oropharyngeal squamous cell carcinomas.  Click here to read the entire article

Determination of “Indeterminate” Thyroid Nodules   
By Felix Martinez, Jr., M.D.

When indeterminate thyroid results are reported, there are options available for clinicians and their patients to obtain additional diagnostic information, which may help in deciding whether or not to have surgery.  Click here to read the entire article

Working Up Breast Cancer Subtypes   
By Amy M. Backer, M.D.

Determining classification of breast cancer subtypes is important to oncologists and their patients because it helps them formulate an individualized treatment approach that will provide the highest efficacy, lowest toxicity and best chance for a good outcome.  Click here to read the entire article

Incyte Diagnostics Adopts ToGA Guidelines:
Gastric and Esophageal Adenocarcinoma Testing for HER2 Status - IHC vs. FISH
   
By David C. Hoak, M.D.

At Incyte Diagnostics, we have adopted the ToGA guidelines.  We will test a patient’s first biopsy with IHC for HER2 with reflex to ISH (FISH or CISH) for equivocal HER2 by IHC results.  Click here to read the entire article

New Cervical Cancer Screening Guidelines - Should Not Lessen the Importance of the Annual Exam   
By Felix Martinez, Jr., M.D.

In March 2012, four major organizations - preventative, professional and governmental - jointly issued new guidelines for cervical cancer screening.  Major changes are listed in this article.  Click here to read the entire article

BRAF Mutation in Metastatic Melanoma   
By David C. Hoak, M.D.

Until recently, a diagnosis of metastatic melanoma was often accompanied with a poor prognosis for treatment.  Click here to read the entire article

The Origin of Ovarian Carcinoma: Why the Debate Matters   
By Sanjay Logani, M.D.

Early detection of serous ovarian cancer would save the lives of many women, but there is no reliable screening test that has the sensitivity or the specificity to be useful in clinical practice.  Click here to read the entire article

Cystic Thyroid Nodules (CTN) - Summary Points   
By Felix Martinez, Jr., M.D.

Cystic thyroid nodules (CTN) are very common and are frequently aspirated for cytology examination.  In what follows, I attempt to summarize notes, key points, and my experience with cystic lesions.  Click here to read the entire article

ASC-US vs. ASC-H?  What is the difference?   
By Felix Martinez, Jr., M.D.

There is often confusion (and even controversy) among healthcare providers regarding the proper evaluation and management of ASC, especially ASC-H.  Click here to read the entire article

Use of E-Cadherin & P120 catenin IHC for Breast Carcinoma   
By David C. Hoak, M.D.

The combined use of E-cadherin and p120ctn immunostaining on a single slide is very helpful in subclassifying certain breast carcinomas.  Click here to read the entire article

The PAS Stain: A Sensitive Test for Diagnosis of Onychomycosis   
By Felix Martinez, Jr., M.D.

Although culture was long considered the gold standard, the PAS stain has been shown to be a sensitive method for the diagnosis of onychomycosis.  Click here to read the entire article

Distinguishing Adenocarcinoma From Squamous Cell Carcinoma of the Lung   
By David C. Hoak, M.D.

The response to certain drug regimens in patients with non-small cell carcinoma (NSCLC) with adenocarcinoma is different from squamous cell carcinoma patient response.  Click here to read the entire article

Benign Endometrial Cells in Women Over 40 Years of Age: What is the Best Practice?   
By Sanjay Logani, M.D. and Felix Martinez, Jr., M.D.

Q&A on why laboratories utilize the reporting category “Endometrial Cells Present in a Woman over 40 Years of Age” and other important information on this topic.  Click here to read the entire article

Diagnostic Value of Preparing Cell Blocks from Pap Specimens   
By Felix Martinez, Jr., M.D.

Cell block preparation is useful for the detection and diagnosis of many other lesions, so why not use it as a complement to the Pap test, especially for diagnostically difficult cases?  Click here to read the entire article

Endocervical Cells In a Pap Smear: A Concept Changed   
By Felix Martinez, Jr., M.D.

Several studies have shown that women with smears lacking EC/TZ cells are not more likely to have squamous lesions on follow up than are women with EC/TZ cells.  Click here to read the entire article

HNPCC - It's All Relative   
By Amy M. Backer, M.D.

Hereditary nonpolyposis colorectal cancer (HNPCC) is an inherited condition from a parent and develops through changes in their mismatch repair (MMR) genes during DNA replication. This form of genetic destabilization is referred to as the microsatellite instability (MSI) pathway.  Click here to read the entire article

"Reactive" Pap Results - The End of an Era   
By Felix Martinez, Jr., M.D.

Since 1989, there have been several significant developments in the field of cytology that have rendered the category of reactive changes to clinical obsolescence.  This article explains why in a laboratory, reactive changes in a Pap are identified, confirmed to be nonneoplastic, then reported as a ‘Negative’ finding, with clear distinction of the finding from ASCUS or LSIL, without the use of HPV tests.  Click here to read the entire article