RESUMEN
OBJECTIVES: This study was aimed to investigate the significance of unexpected vasculitis identified in gastrointestinal (GI) specimens by determining its prevalence and correlation with clinical outcomes. METHODS: GI specimens with histologic evidence of vasculitis were identified in our pathology database over a 10-year period (January 2008 to August 2018). Clinical history, treatment, and follow-up were reviewed. RESULTS: Of the 131,367 GI pathology cases received over the 10-year study period, 29 (0.02%) cases showed histologic evidence of GI vasculitis. The majority (69%, 20/29) were not clinically suspected. Of these, 20% (4/20) of patients were subsequently diagnosed with systemic vasculitis. During the mean follow-up period of 34.0 months, 24% (4/17) of the patients with this unexpected diagnosis died as the result of direct complications of GI vasculitis. We also found that 95% of cases with unexpected vasculitis in their GI pathology specimens were communicated in a timely manner to the ordering physicians, which necessitated the immediate initiation of additional workups in 85% of these patients. CONCLUSIONS: The GI involvement of vasculitis is rarely encountered by pathologists, but its diagnosis carries tremendous clinical significance with a high mortality rate. Therefore, timely communication is highly recommended for the early diagnosis and treatment of this disease.
Asunto(s)
Enfermedades Gastrointestinales/epidemiología , Tracto Gastrointestinal/patología , Vasculitis/epidemiología , Adulto , Anciano , Femenino , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Vasculitis Sistémica/diagnóstico , Vasculitis Sistémica/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: Certain laboratory tests are critical for patient care and must be communicated rapidly. Professional societies have developed guidelines for reporting of "critical values" and significant or unexpected surgical pathology findings. Urgent diagnoses requiring rapid reporting include new or unexpected diagnoses of malignancy. The University of Missouri established a "cancer-tracking" protocol in which all diagnoses of malignancy require acknowledgment by the responsible clinician. METHODS: We reviewed 5 months of compliance with the cancer-tracking protocol. The protocol requires the Department of Pathology to send a letter to the responsible clinician requesting acknowledgment of the report. In total, 1,155 confirmation requests were sent to the physicians named on the request form. RESULTS: Following the first letter, 692 acknowledgments were received, and 356 acknowledgments followed the second letter. In 107 (9%) cases, no response was received. CONCLUSIONS: Confirmation that the physician caring for a patient receives a pathology diagnosis is important for patient management and quality assurance. While the surgical pathology report was placed in the chart, it was impossible to confirm that the responsible physician had reviewed the report in 9% of cases. Techniques for communication and confirmation of transmission of anatomic pathology diagnoses need to be developed.