Transcription

• Elizabeth McMahon

  An updated CAP guideline provides new recommendations to help reduce diagnostic errors, plus a surprise finding about pancreatic lesions and their role in cancer. This is the Path News Network Daily Edition from the College of American Pathologists. I'm Elizabeth McMahon. It's Thursday, May 28th. An updated CAP guideline issued yesterday... calls for structured and timely case reviews to help detect and prevent diagnostic errors. The recommendations update the 2016 Interpretive Diagnostic Error Reduction Guideline issued with the Association of Directors of Anatomic and Subspecialty Pathology. Dr. Suzanne Dintzis is Guideline Chair and Professor of Laboratory Medicine and Pathology at the University of Washington. She says institutions can vary in how they handle quality assurance when pathologists have diagnostic discrepancies or disagreements. It's a reality the update takes into account while also recommending a structured approach.

• Dr. Suzanne Dintzis

  I would say most pathology practices, when there's a difficult or high-risk case, they often recommend review by another pathologist. In this guideline, we call out another senior or... Specialty-trained pathologists might be the best approach before a sign-out of a case. And we encourage laboratories to implement these structured peer review systems, discrepancy tracking and case review as appropriate for their practice setting.

• Elizabeth McMahon

  The guideline includes four good practice statements, encouraging labs to document review procedures, periodically monitor results, address areas of poor diagnostic agreement, and use grading criteria when pathologists identify variability. Dr. Dintzis says the update reflects a more collaborative culture in pathology.

• Dr. Suzanne Dintzis

  There's more recognition now that an open discussion of disagreement and the recognition that there's a lot of uncertainty in what we do really requires a culture shift from this individual. individual responsibility towards continuous calibration and collaboration, right? And the whole idea of a just culture and psychological safety.

• Elizabeth McMahon

  You can find the update by following the current CAP Guidelines link under the Protocols and Guidelines tab on the CAP homepage. A new study is prompting questions about what triggers pancreatic cancer growth. In tumors, cancer cells induce non-malignant cells around them to promote tumor growth. Pancreatic lesions are also surrounded by cells, and researchers expected to see a similar precancerous microenvironment. But in a surprise, a University of Michigan team found that the cellular environment around the lesions was the same as that in a normal pancreas. They used cutting-edge technologies, including single-cell RNA sequencing and spatial transcriptomics, to examine healthy donor pancreases with lesions. They isolated single cells, examined them in two dimensions, and mapped the gene expression of specific tissue sections. The findings, published in the journal Cancer Discovery, likely explain earlier research from the team that showed precursor lesions are common, including in younger people, while pancreatic cancer remains relatively rare. Anti-nuclear antibody testing, or ANA tests, are familiar in the lab and important to consider when you suspect a patient has an autoimmune rheumatic disease such as lupus. But since up to 30% of healthy people can have a positive ANA test result, pathologists must use the test judiciously. But careful decision-making can get more complicated with a menu of other options as testing progresses. The CAP's test ordering program I'm provides essential information on anti-nuclear antibody testing. The program's test modules give you expert-led and reviewed content to bolster your understanding of the latest recommendations. Dr. Elizabeth Weinzierl is a member of the CAP's Quality Practices Committee and author of the module on ANA testing. In an occasional series exploring modules, Dr. Weinzierl discussed testing considerations.

• Dr. Elizabeth Weinzierl

  You have to be really careful. about who you test. So you have to have one of the most important things in using your ANA test is you really need your pre-test probability to be high before you consider ordering the test. And, you know, ANA is great for that. Once you, you know, see a patient with autoimmune disease, if you have a positive ANA, and particularly at a higher titer, you know, one to 80 or higher, you know, that is an indication to keep going further in your testing.

• Elizabeth McMahon

  There are two major methodologies for ANA screening, indirect immunofluorescence, known as IFA, or solid-phase immunoassays. Dr. Weinzierl, who is chief of pathology and laboratory medicine at Children's Healthcare of Atlanta, said while the ANA testing module provides insights for both methodologies, there's one that stands out in initial screening.

• Dr. Elizabeth Weinzierl

  The IFA is considered still more of the gold standard, but it is more time-consuming. It's more manual, so you need techs generally who are quite skilled at doing this, although I will tell you that there are instruments out there that are becoming more and more automated, not only to do the IFA incubation, but also to interpret it by AI-based methods. And so, you know, I think that's going to help streamline some of that quite a bit.

• Elizabeth McMahon

  Learn more about anti-nuclear antibody testing and modules in chemistry, microbiology, immunology, and others at the Test Ordering Program tab on the CAP's Laboratory Improvement page. From AI to new diagnostic technologies, innovation is happening rapidly, but it won't work unless it fits clinical practice. That's one of the messages from a new interview with Dr. Liron Pantanowitz in The Pathologist magazine. He's a professor of pathology at the University of Pittsburgh. and winner of the 2025 CAP Pathology Advancement Award. He emphasizes that monitoring and validating new technologies is critical, especially as AI enters daily practice. Dr. Pantanowitz says that the pathologist of tomorrow will, quote, need to be a lifelong learner, comfortable with technology, ethically grounded, and collaborative. That's all for today's Daily Edition. Be sure to check the show notes for more information on today's stories. Got a story you'd like us to cover on The Daily Edition? Write to us at stories at cap.org. We're back at 5 a.m. Eastern for another episode of The Daily Edition. I'm Elizabeth McMahon. Have a great day.