Winter Meeting 2011 - The Pathological Society of Great Britain ...

P33
‘Brainless’ Autopsy – an Audit
P SR Gankande 1 ; P Gallagher 2
1 Dorset County Hospital, Dorchester, United Kingdom;
2 Southampton General Hospital, Southampton, United Kingdom
The aim of this audit was too see how often and in what circumstances the brain is not
examined at post-mortem.
Method: All adult post-mortem cases performed between January 1st and December 31st
2009 were reviewed. The number of cases in which the brain was not examined was noted
together with the stated cause of death. After careful discussion we considered that brain
examination was not strictly necessary in (1) acute myocardial infarction, especially with
haemopericardium, (2) fresh coronary thrombosis, (3) ruptured aortic aneurysm, (4)
large pulmonary embolus, (5) unequivocal bronchopneumonia in the elderly, (6) cancer
patients with disseminated malignancy or recent chemotherapy, (7) patients who have
spent a long period in intensive care.
Results: In 101 of 764 autopsies the brain was not examined. 65 cases (64%) fell into one
of the seven categories described above. The other 36 cases (36%) did not fall into any
of these categories and should, according to this remit, have had the brain examined. In
contrast in 139 of the 663 cases (21%) in which the brain was examined had a cause of
death that indicated that the brain need not be examined.
Conclusion: Relatives dislike brain examination and many ask for a limited examination.
Our results show that brain examination could have been avoided in 26.7% of all
autopsies. However in 36 cases (4.7%) the brain was not examined when according to our
guidelines it should have been.
P35
Do Cell Blocks Add Value to Cytological Diagnosis?
P S Zaher; M Moonim
St. Thomas Hospital, London, United Kingdom
Purpose of the Study:The use of cell blocks for processing cytology fluids has been
reported since 1947 when Chapman and Whalen (N. Eng.Med 237;15,192) first
described the technique for serous fluids. They are a valuable ancillary tool for evaluation
of non-gynaecological cytology specimens by enabling the cytopathologist to study
morphological detail. They also allow for the evaluation of ancillary studies such as
immunocytochemistry, in-situ hybridisation tests (FISH/cISH) and in-situ PCR. This
study aims to assess the value of cell blocks in cytological diagnosis.
Methods:All non-gynaecological specimens for cytopathology that consisted of both
smears and cell blocks over a three month period were reviewed and analysed. The 190
specimens comprised 119 FNAs from various sites, 28 EBUS FNAs and 43 body fluid and
washing specimens. We retrieved the cell block slides and cytology reports for the 190
cases. The slides were reviewed by a cytopathologist for assessment of material, and after
correlation with the cytology report, a conclusion was made regarding the contribution
of the cell block e.g. confirmed cytological diagnosis but did not add new information,
confirmed primary origin of tumour, confirmed subtype of lymphoma or confirmed
benign nature of cells.
Summary of results:Cell blocks were essential for diagnosis in 26% of cases. For the
different specimen sites their utility was as follows: body fluid and washing specimens
(43%), EBUS FNAs(57%) , FNAs (9%) and thyroid FNAs (0%).
Conclusion:Overall, the cell block technique was contributory to the final cytological
diagnosis, especially for fluid and EBUS FNA specimens. This supports the view that cell
block preparation should be considered for most cytologic specimens after morphologic
review. This study did not find cell blocks to be useful in the evaluation of benign thyroid
nodules.
P34
Audit of Duodenal Biopsy Subsequent to Positive Coeliac
Serology, and Reaudit of Coeliac Serology Testing after
Histopathological Diagnosis of Lymphocytic Duodenosis
P D Maisnam; MM Walker; S Seneviratne
Imperial College Healthcare NHS Trust, London, United Kingdom
Purpose of the study: To identify the rate of duodenal biopsy following positive serological
test for coeliac disease as per the NICE guidelines, identify whether coeliac disease
serology testing is done following a diagnosis of lymphocytic duodenosis on a duodenal
biopsy, and to compare the results with a previous audit.
Methods: A list of patients who had a positive result on IgA tTG testing for coeliac
disease and all duodenal biopsies done in 2009 was obtained. The pathology reporting
system was checked to see if a duodenal biopsy was done in those who tested positive for
coeliac disease on serology, and if serology for coeliac disease was done on those patients
diagnosed with lymphocytic duodenosis.
Summary of results: 88 patients tested positive for coeliac disease on serological testing,
with duodenal biopsy done in 43% of cases subsequently. 72 patients were diagnosed with
lymphocytic duodenosis or features suspicious for coeliac disease on duodenal biopsy.
Serology for coeliac disease was done in only 56% of these cases, of whom 15% had a
positive result for coeliac disease. The previous audit showed that 66% of 55 patients with
lymphocytic duodenosis had serological test for coeliac disease, of which 23% were found
to be positive.
Conclusions: 57% of patients with a positive serological test for coeliac disease did not
have a duodenal biopsy and 44% of patients diagnosed with lymphocytic duodenosis did
not have a serological test for coeliac disease. The aim should be to do serological testing
in all cases diagnosed with lymphocytic duodenosis. Improvement needs to be made on
adherence to guidelines for the diagnosis of coeliac disease. A proposed algorithm for the
approach to diagnosis of coeliac disease based on the NICE guidelines is being developed.
A reaudit is proposed after 1 year to evaluate any improvement in following the guidelines
to complete the audit cycle.
P36
THY Categorisation of Thyroid FNA’s from 2008
P A Soliman
King’s College Hospital, London, United Kingdom
Purpose of the study:To highlight the importance of the guidelines issued by the British
Thyroid Association for fine needle aspiration of the thyroid and to compare our practice
to these guidelines.
Methods:Gathering retrospecitve data of all patients who underwent fine needle aspiration
of the thyoid for the year 2008/2009 at Imperial College Hospitals. The data included
information on the request form, the performer, and the method in which results were
released.
Summary of results:98.8% were designated a THY category 179 cases (99.4%) were
aspirated by competent aspirators. All THY 3, 4 & 5 are discussed through the weekly
thyroid MDT. The majority of thyroid FNA’s are performed by consultants that regularly
perform FNA’s. Only one case was performed by an aspirator not regularly perfoming this
technique. There were only 2 cases that were not given a THY category. One of these cases
was referred to the thyroid MDT for discussion. The side of the thyroid nodule being
aspirated was not provided in the majority of cases.
Conclusions: The guidelines issued by the British Thyroid Association were followed
to a high standard. All thyroid aspirates were reported by pathologists with a specialist
interest in cytopathology. All THY 3, 4 & 5 cases are discussed at the weekly MDT. The
majority of thyroid FNA’s are performed by consultants that regularly perform FNA’s.
We conclude and suggest that request forms need to include the side being aspirated and
to re-audit the changes for 3-6 months and close the audit loop.
30 Visit our website: www.pathsoc.org | Winter Meeting (199 th ) 6 – 7 January 2011 | Scientific Programme