College of American Pathologists
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  Anatomic Abstracts





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November 2002

Pathologic algorithm for predicting lymph node metastasis in clinically localized prostate carcinoma
The risk of significant morbidity and mortality and the cost of pelvic lymphadenectomy for patients with clinically localized prostate carcinoma prompts attempts to develop a model to accurately assess the preoperative lymph node status in such patients. The authors examined the validity of a previously published algorithm based on the pathologic assessment of the sextant biopsy specimen to assess the risk of lymph node metastasis using data from their institution (n=443). The incidence of lymph node metastasis was 44.4 percent in a high-risk group of patients at the institution (> four of six biopsies with any Gleason pattern four carcinoma), 20 percent in an intermediate-risk group (> one of six biopsies with dominant Gleason pattern four, excluding those classified as high risk), and 2.47 percent (10/404) in a low-risk group (all others). The original algorithm, called the Hamburg algorithm, proved to be a valid tool for predicting lymphatic spread in this validation study of data from the authors' institution. The authors concluded that the algorithm may serve as a tool to select patients who do not need to undergo pelvic lymphadenectomy when they undergo radical retropubic prostatectomy, thus reducing morbidity and expense.

Haese A, Epstein JI, Huland H, et al. Validation of a biopsy-based pathologic algorithm for predicting lymph node metastases in patients with clinically localized prostate carcinoma. Cancer. 2002;95:1016-1021.

Reprints: Dr. A. Haese, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287;

Do autopsies hamper the defense in medical malpractice suits?
To determine how autopsy information influences the outcome of medical malpractice litigation, the authors studied state court records in 99 cases of medical malpractice adjudication from 1970 to the present. The three largest groups defined by cause of death at autopsy were acute pulmonary embolism, acute cardiovascular disease, and drug overdose/interaction. Findings for defendant physicians outnumbered medical negligence in the original trial proceedings by a 3:1 margin. The appellate courts affirmed 51 acquittals and 19 findings of negligence and reversed the original trial court decision for technical reasons in 29 cases. The authors found no significant relationship between accuracy of clinical diagnosis (using the autopsy standard) and outcome of a suit charging medical negligence. Defendant physicians usually were exonerated, even when a major discrepancy existed between the autopsy diagnosis and clinical diagnosis and the unrecognized condition was deemed treatable. Moreover, major diagnostic discrepancies were relatively uncommon in suits in which a physician was found to be negligent. Conversely, autopsy findings were helpful to defendant physicians in about 20 percent of cases. The authors believed their study confirmed that a finding of medical negligence is based on standard-of-care issues rather than accuracy of clinical diagnosis. Autopsy findings typically are not the crux of a successful legal argument for either side in a malpractice action. The authors concluded that fear of autopsy findings has no rational basis and is an important obstacle to uninhibited outcomes analysis.

Bove KE, Iery C, CAP Autopsy Committee. The role of the autopsy in medical malpractice cases, I: a review of 99 appeals court decisions. Arch Pathol Lab Med. 2002;126:1023-1031.

Reprints: Dr. Kevin E. Bove, Dept. of Pathology, Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229;

Cytologic smears in the intraoperative evaluation of brain tumors
The authors performed a retrospective analysis of 4,172 patients undergoing surgery at their medical center between 1985 and 1999. There were 3,541 intraoperative smears performed during open procedures and 631 during stereotactic biopsies. Complete correlation with the final diagnosis was achieved in a mean of 89.8 percent (range, 83 to 93.7 percent per year). Diagnostic accuracy increased to 95 percent on average (range, 91.5 to 96.7 percent per year) when cases of partial correlation due primarily to grading deviations were included. The most accurate intraoperative diagnoses were obtained in cases of meningioma (97.9 percent), metastasis (96.3 percent), and glioblastoma (95.7 percent). A significant reduction in diagnostic accuracy was observed in cases of oligodendroglioma (80.9 percent) and ependymoma (77.7 percent). In addition to diagnosis and grading, smear cytology provided resection guidance in cases of well-delineated tumors. The authors concluded that intraoperative smears in neurosurgery are easy to obtain, inexpensive, and highly accurate. Intraoperative smears, as well as stereotactic biopsy procedures, permit reliable intraoperative guidance during lesion targeting and resection.

Roessler K, Dietrich W, Kitz K. High diagnostic accuracy of cytologic smears of central nervous system tumors: a 15-year experience based on 4,172 patients. Acta Cytol. 2002;46:667-674.

Reprints: Dr. Karl Roessler, Dept. of Neurosurgery, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria;