Michael Schubert Interviews Dr. Patrick Godbey
Time to Get Political by Michael Schubert – The Pathologist – www.pathologist.com
“Grassroots politics can promote and protect pathology through advocacy and education. PathNET is getting pathologists involved and giving them a voice”
Click on the link below:
Pathologist’s Corner – Dr. Xuebin Yang MD, PhD on Barrett’s Esophagus
Patient’s Guide to Barrett’s Esophagus
What is Barrett’s Esophagus?
Barrett’s esophagus is a precancerous condition and refers to metaplastic conversion of normal squamous epithelium of tubular esophagus (see figure a) to columnar epithelium (figure b). Normally the gastroesophageal junction (GEJ) divides the esophagus and stomach and corresponds to squamocolumnar junction (SCJ “Z-lin”). The esophagus is lined by stratified squamous epithelium. The stomach is lined by columnar epithelium. In some chronic injury setting such as gastroesophageal reflux disease (GERD), the esophageal squamous epithelium goes through a metaplastic process and is converted to a columnar epithelium with goblet cells (which are usually found lower in the gastrointestinal tract and thus also called “intestinal metaplasia”).
The main cause of Barrett’s esophagus is thought to be an adaptation to chronic acid exposure from GERD. GERD is associated with a 10–15% risk of Barrett’s esophagus. Other risk factors associated with the development of Barrett’s esophagus include male gender, central obesity and age over 50 years.
What is the clinical complication of Barrett’s Esophagus?
Barrett’s esophagus is the only recognized precursor of esophageal adenocarcinoma which incidence has been increasing in the United States since 1970s. Patients with Barrett’s esophagus have a 30-125 fold higher risk of developing cancer of the esophagus than the general population.
How is Barrett’s Esophagus diagnosed?
Diagnosis of Barrett’s esophagus requires esophagogastroduodenoscopy (a procedure in which a fibreoptic cable is inserted through the mouth to examine the esophagus, stomach, and duodenum) and biopsy of esophageal lining. According to American College of Gastroenterology guideline, Barrett’s esophagus should be diagnosed when there is extension of salmoncolored mucosa into the tubular esophagus extending ≥1 cm proximal to the gastroesophageal junction (GEJ) with biopsy confirmation of intestinal metaplasia.
Barrett’s esophagus, based on the histopathology, is classified into five categories: nondysplastic, indefinite for dysplasia, low-grade dysplasia, high-grade dysplasia, and adenocarcinoma.
Who should be screened for Barrett’s Esophagus?
Screening for Barrett’s esophagus may be considered in men with chronic (>5 years) and/or frequent (weekly or more) symptoms of gastroesophageal reflux (heartburn or acid regurgitation) and two or more risk factors for Barrett’s esophagus or esophageal adenocarcinoma. These risk factors include: age >50 years, Caucasian race, presence of central obesity (waist circumference >102 cm or waist–hip ratio (WHR) >0.9), current or past history of smoking, and a confirmed family history of Barrett’s esophagus or esophageal adenocarcinoma (in a first-degree relative).
Given the substantially lower risk of esophageal adenocarcinoma in females with chronic GERD symptoms (when compared with males), screening for Barrett’s esophagus in females is not recommended. However, screening could be considered in individual cases as determined by the presence of multiple risk factors for Barrett’s esophagus or esophageal adenocarcinoma (age >50 years, Caucasian race, chronic and/or frequent GERD, central obesity: waist circumference >88 cm, WHR >0.8, current or past history of smoking, and a confirmed family history of Barrett’s esophagus or esophageal adenocarcinoma (in a first-degree relative).
Screening of the general population is not recommended.
If initial endoscopic evaluation is negative for Barrett’s esophagus, repeating endoscopic evaluation for the presence of Barrett’s esophagus is not recommended. If endoscopy reveals esophagitis, repeat endoscopic assessment after proton pump inhibitor therapy for 8–12 weeks is recommended to ensure healing of esophagitis and exclude the presence of underlying Barrett’s esophagus.
What is the surveillance of patients with Barrett’s Esophagus?
The goal of a screening and surveillance program for Barrett’s esophagus is to identify individuals at risk for progression to esophageal adenocarcinoma.
For Barrett’s esophagus patients without dysplasia, endoscopic surveillance should take place at intervals of 3 to 5 years.
Patients diagnosed with Barrett’s esophagus on initial examination do not require a repeat endoscopy in 1 year for dysplasia surveillance.
For patients with indefinite for dysplasia, a repeat endoscopy after optimization of acid suppressive medications for 3–6 months should be performed.
If the indefinite for dysplasia reading is confirmed on this examination, a surveillance interval of 12 months is recommended.
For patients with confirmed low-grade dysplasia and without life-limiting comorbidity, endoscopic therapy is considered as the preferred treatment modality, although endoscopic surveillance every 12 months is an acceptable alternative.
Patients with Barrett’s esophagus and confirmed high-grade dysplasia should be managed with endoscopic therapy unless they have life-limiting comorbidity.
How is Barrett’s Esophagus treated?
Treatments for Barrett’s esophagus include chemoprevention, endoscopic therapy and surgical therapy.
Patients with Barrett’s esophagus should receive once-daily proton pumper inhibitor (PPI) therapy.
Aspirin or NSAIDs should not be routinely prescribed to patients with Barrett’s esophagus as an antineoplastic strategy. Similarly, other putative chemopreventive agents currently lack sufficient evidence and should not be administered routinely.
Patients with nodularity in the Barrett’s esophagus segment should undergo endoscopic mucosal resection of the nodular lesion(s) as the initial diagnostic and therapeutic maneuver. Histologic assessment of the endomucosal resection (EMR) specimen should guide further therapy. In subjects with EMR specimens demonstrating high grade dysplasia, or intramucosal carcinoma, endoscopic ablative therapy of the remaining Barrett’s esophagus should be performed.
In patients with EMR specimens demonstrating neoplasia at a deep margin, residual neoplasia should be assumed, and surgical, systemic, or additional endoscopic therapies should be considered.
Endoscopic ablative therapies should not be routinely applied to patients with nondysplastic Barrett’s esophagus because of their low risk of progression to esophageal adenocarcinoma. Endoscopic eradication therapy is the procedure of choice for patients with confirmed low grade dysplasia, and confirmed high grade dysplasia.
In patients with T1a esophageal adenocarcinoma, endoscopic therapy is the preferred therapeutic approach, being both effective and well tolerated.
In patients with T1b esophageal adenocarcinoma, consultation with multidisciplinary surgical oncology team should occur before embarking on endoscopic therapy. In such patients, endoscopic therapy may be an alternative strategy to esophagectomy, especially in those with superficial (sm1) disease with a well-differentiated neoplasm lacking lymphovascular invasion, as well as those who are poor surgical candidates.
In patients with known T1b disease, EUS may have a role in assessing and sampling regional lymph nodes, given the increased prevalence of lymph node involvement in these patients compared with less advanced disease.
In patients with dysplastic Barrett’s esophagus who are to undergo endoscopic ablative therapy for nonnodular disease, radiofrequency ablation is currently the preferred endoscopic ablative therapy.
Antirefleux surgery should not be pursued in patients with Barrett’s esophagus as an antineoplastic measure. However, this surgery should be considered in those with incomplete control of reflux symptoms on optimized medical therapy.
In cases of Barrett’s esophagus with invasion into the submucosa, especially those with invasion to the mid or deep submucosa (T1b, sm2–3), esophagectomy, with consideration of neoadjuvant therapy, is recommended in the surgical candidate.
In patients with T1a or T1b sm1 adenocarcinoma, poor differentiation, lymphovascular invasion, or incomplete endoscopic mucosal resection should prompt consideration of surgical and/or multimodality therapies.
HAPPY Pathologists’ Assistant Day
We at Southeastern Pathology Associates would like to take this opportunity to acknowledge our Pathology Assistants for their dedication and hard work.
A pathologists’ assistant (PA) is a highly trained allied health professional who provides various services under the direction and supervision of a pathologist. Southeastern Pathology Associates PAs are academically and practically trained to provide accurate and timely processing of laboratory specimens.
For more information on Pathologists’ Assistant Day please click here
Congratulations Michael Mazzotta – Winner of 2016 ASCP Regional Member Award
SEPA Labs would like to congratulate Michael Mazzatta on winning the 2016 ASCP Regional Member Award for the South East Region.
Michael Mazzotta, our pathologists’ assistant (PA), based at our Brunswick location attended the ASCP conference in Las Vegas where he was recognized as one of the leading PA’s in the United States.
This past October, he attended the 2016 Lab Quality Confab held in New Orleans on a full scholarship (sponsored by BioMérieux) where he earned Master Certifications in Change Management and Data Analysis with Lean and Six Sigma. He also achieved his Six Sigma Yellow Belt certification.
Michael has been with SEPA Labs since 2005, he is a certified PA, has earned his MBA and MHA. He is currently a second year doctoral student in health care administration at the Medical University of South Carolina. The accepted title of his thesis is “Automation and Lean Process in and Anatomical Pathology Laboratory”.
SEPA Labs Welcomes New Pathologists
SEPA Labs would like to welcome the four newest additions to our pathology team….
Each of these pathologists comes to SEPA with tremendous experience in various fields of pathology.
Dr. Cheek, Dr. Bit-Ivan, Dr. Jones and Dr. Zulfiqar have joined our Baptist Hospital Team in Jacksonville, FL. We are pleased to have the opportunity to bring their skills to our practice.
Pathologist’s Corner – Dr. Simpal Gill on Hepatitis ABCs
Published: June 8, 2015 – Simpal Gill MD FCAP
What is “Hepatitis”?
Hepatitis is derived from the Greek hêpar, meaning “liver”, and the suffix -itis, meaning “inflammation”. Liver performs important functions such as processing nutrients, clearing the blood of harmful substances and resisting infections by producing immune factors and removing bacteria from the bloodstream.
When the liver is inflamed or damaged, its function can be affected. The inflammation can be self-limiting or progress to cirrhosis or liver cancer. Heavy alcohol intake, toxins, certain medications, and some medical conditions can cause hepatitis. Viral hepatitis is the most common cause of hepatitis in the world. In the United States, the most common types of virus-induced hepatitis include Hepatitis A, Hepatitis B, and Hepatitis C.
Three different types of viruses cause Hepatitis A, Hepatitis B, and Hepatitis C. Although the symptoms are similar, they vary in their mode of transmission and affect the liver differently. Vaccines are available to prevent Hepatitis A and B but not for Hepatitis C. If infected with one type of viral hepatitis in the past, it is still possible to get the other types. Read More...
SEPA Labs celebrates 24 years of service
SEPA Labs Celebrates 24 Years Of Service
SEPA Labs recently celebrated its 24th year serving the medical communities of Georgia, Florida and South Carolina. SEPA continues to grow because of the hard and good work and dedication of our staff, present and past.
Pat Godbey MD, FACOG, FCAP
CEO Southeastern Pathology Associates
CMS Issues Major New ICD-10 Guidance for Physicians
Posted: July 30, 2015
The Centers for Medicare and Medicaid Services and American Medical Association have jointly developed comprehensive guidance for physicians on new ICD-10 compliance flexibilities that both organizations agreed to in early July.
Under pressure from the AMA and other provider organizations, CMS agreed to:
- Not deny claims solely based on the specificity of diagnosis codes as long as they are in the appropriate family of codes, so physicians won’t be penalized because of a coding error;
- Not audit Medicare claims in the first year of ICD-10 based on specificity of diagnosis codes if in the appropriate family of codes;
- Authorize advance payments if Medicare contractors cannot process physician claims coded with ICD-10;
- Not penalize physicians via reduced reimbursements for errors in selecting and calculating quality codes for the EHR meaningful use, PQRS and Value-based Modifier reporting programs as long as they use codes within the appropriate family of codes. Penalties also will not be applied if CMS has difficulty calculating quality scores during the ICD-10 transition; and
- CMS will establish an ICD-10 Ombudsman office to help physicians resolve problems during the transition.
Pathologist’s Corner – Dr. Eric Chand on Pancreatic Cancer
To understand pancreatic cancer, it helps to know about the normal pancreas and what it does. The pancreas lies between the stomach and the spine and is about 6 inches long. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The head of the pancreas is on the right side of the abdomen (belly), behind where the stomach meets the duodenum (the first part of the small intestine). The body of the pancreas is behind the stomach, and the tail of the pancreas is on the left side of the abdomen next to the spleen.
The pancreas is a gland and has two main functions: 1) to make juices that help digest (break down) food (exocrine pancreas cells) and 2) to make hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food. The hormones are made by endocrine pancreatic cells. Read more…
Telepathology Services Come To SEPA Labs
SEPA is proud to announce that we have signed a contract to bring iScan Coreo into service at our central laboratory in Brunswick GA. This highlights our commitment to bring 21st Century telepathology technology to the communities we serve.
FROM THE MANUFACTURER
The iScan Coreo slide scanner offers unprecedented flexibility and performance for the anatomic pathology laboratory
The VENTANA iScan Coreo scanner serves as the springboard for a total digital pathology environment in your anatomic pathology lab. The iScan Coreo scanner provides high speed slide scanning, improved image quality, and advanced slide handling. The scanner is packaged with advanced image viewing software offering pathologists and histotechnologists the ability to view and annotate digital images of scanned slides. The scanner can be fully integrated with the VENTANA Virtuoso image management software to provide users with a comprehensive digital pathology solution to support image acquisition, image management, image analysis, and customized reporting.
iScan Coreo key features
- Compact slide scanner with 160 slide capacity
- One-touch walk away scanning
- Auto-turret supports scanning with 4 objectives
- Live Mode for remote microscopy
- Vacuum slide handling
Pathologist’s Corner – Dr. Summerall on A Patient’s Guide to Colon Cancer and Lynch Syndrome /HPNCC
Posted: March 24, 2015
March is National Colorectal Cancer Awareness Month. Each year, over 140,000 people are diagnosed with colorectal cancer, according to the National Cancer Institute. It is the second most commonly diagnosed type of cancer when men and women are combined. Because of increased surveillance and more effective treatment, deaths from colon cancer are steadily declining. Discoveries in genetics have lead to a greater understanding of the genetic basis of colon cancer, and the discovery of inherited cancer syndromes. Now, in some cases, people may be discovered through genetic testing to have an increased risk of developing colon cancers. These individuals can be closely monitored for early signs of cancer. If discovered, they can be treated early, before the cancer grows large or spreads.
Causes of Colon Cancer
The vast majority of colon cancers are sporadic, meaning their exact cause is unknown. Risk factors that increase the possibility of developing colon cancer include obesity, smoking, heavy drinking, a sedentary lifestyle, and a history of polyps on earlier colon screening examinations.
Approximately 5-10% of colon cancers, however, are caused by known inherited genetic mutations. These inherited genetic syndromes cause a very high incidence of colon cancers in affected individuals, and can predispose them to other types of cancer.
Hereditary Colon Cancer
Some genetic mutations—the polyposis syndromes– cause the formation of numerous pre-cancerous polyps. Some of these polyps progress to cancer. Other genetic mutations do not predispose individuals to the development of polyps, but lead to colon cancer. One of these genetic mutations leads to a cancer syndrome called Lynch Syndrome, also known as Hereditary Non Polyposis Colon Cancer Syndrome (HPNCC). (more)
Baptist Health Selects SEPA Labs for Pathology Services
Posted: March 9, 2015
Baptist Health has selected SEPA Labs (Southeastern Pathology Associates) as the exclusive provider of pathology professional services for all of its inpatient, outpatient and outreach activity. This exclusive contract will include the provision of adult and pediatric pathology services to all five Baptist hospitals, 24/7 on-call pathology services, as well as medical directorship to Baptist Labs in all locations.
The current contract with Jacksonville Pathology Consultants comes to an end May 21, 2015 and on that date, the SEPA team will take over management of all pathology services. SEPA has a solid track record of providing full-service anatomic and clinical pathology services to hospitals in Florida, Georgia and South Carolina, and is staffed by 30 board-certified pathologists. (more…)
Hospital Rating Systems Differ on Best and Worst
Posted: March 5, 2015
Four popular national rating systems used by consumers to judge hospitals frequently come to very different conclusions about which hospitals are the best — or worst — potentially adding to the confusion over health care quality, rather than alleviating it, a new study shows.
The analysis, published on Monday in the academic journal Health Affairs, looked at hospital ratings from two publications, U.S. News & World Report and Consumer Reports; Healthgrades, a Denver company; and the Leapfrog Group, an employer-financed nonprofit organization.
No hospital was considered to be a high performer by all four, according to the study of the ratings from mid-2012 to mid-2013, and the vast majority of hospitals earned that distinction from only one of the four.
Some hospitals were even designated as a high performer by one group and a low performer by another. (more…)
FTC Fines Marketers of Two Apps That Claim to Detect Melanoma
Posted: February 26, 2015
The Federal Trade Commission on Monday announced two enforcement actions against the makers of two smartphone apps — “Mole Detective” and “MelApp” — that claim to be able to detect the symptoms of melanoma simply by snapping a picture of a mole with a smartphone.
The apps were downloaded by thousands of people and claimed to be able to calculate melanoma risk as high, medium or low by analyzing the pictures. The apps were on the market from 2011 to 2012, and cost as much as $4.99 to purchase. Both apps did suggest that users should see a physician if they had real concerns. But Mary Engle, the FTC’s associate director for advertising practices, said that the app advertisements gave an overall impression that they could be used as diagnosis tools.
“You need a trained dermatologist to make that assessment,” Engle said.
Pathologists Corner – Dr. Kosko Molecular Testing in Non-Small Cell Lung Cancer
Posted: February 02. 2015
Lung cancer is the number one cause of cancer related deaths for both men and women in the United States. It is the second most commonly diagnosed cancer in both sexes in the United States. The incidence of lung cancer is declining in both men and women however; the incidence in women is declining at a slower rate than in males.
The majority of patients diagnosed with lung cancer present with advanced disease and treatment is increasingly being based on results of small biopsies or cytology specimens rather than larger resection specimens. Drugs which act as EGFR tyrosine kinase inhibitors and ALK inhibitors have shown significant clinical responses in a subset of patients whose tumors have activating mutations in either EGFR or ALK genes making identification of patients who would benefit from treatment with these medications a priority. Current clinical approaches to treating lung cancer now rely on both identification of the histologic type of tumor and the molecular findings to select the optimal treatment for the individual patient. It is no longer sufficient to stop at a diagnosis of Non-Small Cell Lung Cancer (NSCLC), NOS if adequate tumor tissue is present to take the diagnosis further with the understanding that there will always be some cases in which a diagnosis of NSCLC, NOS is necessary owing to specimen/sample size or quality. In these instances, re-biopsy may be needed to perform molecular testing if a larger resection will not be available. Read more