Background: Globally, autopsy rates have been continually declining over the course of several years. Previous studies have shown that the perception of pathologists and clinicians may serve as significant factors which may affect the performance of autopsy and contribute to its decreased rate. This study was conducted to determine the attitudes and perceptions of Filipino clinicians and pathologists toward the autopsy as a medical tool. Methodology: This is a cross-sectional descriptive survey of two groups of physicians. Forty-four (n = 44) pathologists nationwide and thirty-three (n = 33) clinicians from Central Visayas participated in the study. A total of seventy-seven (n = 77) physicians completed a survey using a standardized online questionnaire. Results: Of the 77 respondents, 94% of clinicians and 75% of pathologists believed that autopsies could provide relevant findings that could change future clinical practice. Despite this, only 6% of clinicians and 20% of pathologists indicated that the number of autopsy cases in their institutions was sufficient. With regards to their practice, pathologists most strongly agreed (mean = 4.30) that material for medico-legal autopsies should be readily available for teaching and research. However, they most strongly disagreed (mean = 2.00) that residents receive adequate training in performing medico-legal autopsies. The two groups of physicians surveyed determined that there is a deficiency in the number of autopsy cases. This is further influenced by clinicians’ concerns about litigation, religious/superstitious beliefs, and the delay in releasing autopsy results. Furthermore, pathologists specified that performing autopsies was excessively time-consuming with an unjustifiable cost. Sixty-two percent of the pathologists signified more strongly than the clinicians that modern diagnostic techniques have diminished the need to perform hospital autopsies. Nonetheless, 86% of Filipino physicians acknowledged that the autopsy is an important medical tool that should be performed for patients with unknown diagnoses and unexpected death. The number of observed and/or performed autopsy cases was a major factor that affected the pathologists’ attitudes and perceptions toward autopsy. Conclusion In general, there is recognition of the autopsy’s usefulness as a medical tool among the pathologists and clinicians surveyed. However, the lack of cases referred for autopsy remains a challenge undermining the benefits that are derived from its performance.
Autopsy ; Pathologists ; Attitude

Pathologists ; Pathology, Surgical ; Immunohistochemistry

INTRODUCTION: HER2 test result depends on a good quality histological section of the breast specimen. Laboratories that process specimens using sophisticated and molecular testing should receive suitable specimen for more accurate results and less waste of expensive resources.
METHODS: A questionnaire based on the ASCO-CAP Guidelines for HER2 testing was developed and administered to pathologists from the local laboratories of Metro Manila-Philippines tertiary referral hospitals. Questionnaire responses were analyzed using descriptive statistics.
RESULTS: Most laboratories did quality control/quality assessment monitoring for the pre-analytic, analytic,post-analytic and turn¬around time phases. Many transported their specimens from the operating room to the laboratory
CONCLUSION: Even in standardized procedures, small variations in sample processing for IHC and FISH can still occur. Inexperienced laboratories will have greater problems interpreting HER2 status results. Laboratories should look into their system in handling specimens for an accurate HER2 testing towards quality assurance.

Human ; Male ; Female ; Breast ; Surveys And Questionnaires ; Pathologists ; Laboratories ; Quality Control

BACKGROUND: Challenged with insufficient number and maldistribution of pathologists, the Philippines seemed poised to benefit from telemedicine.

METHODS: The first modern Internet-based telepathology consultation was conducted between the University of the Philippines Manila and the Armed Forces Institute of Pathology in 1997.

RESULTS: While the first remote telepathology consult was a success, more than a decade after this historic referral, telepathology remains in the fringes of mainstream pathology practice despite its huge potential to benefit the underserved population. Challenges with human, organizational, and technology factors hinder its progress.

CONCLUSIONS: While the original consultation faced difficulties in human capacity, connectivity and infrastructure, rapid developments in governance and technology have the potential to eliminate these problems. Substantial improvements in recent years now provide a more conducive environment to deliver telepathology services to remote areas. This paper proposes a framework for the establishment of mature telepathology services to enable its use in areas of greatest need in the country

Human ; Telepathology ; Vulnerable Populations ; Pathologists ; Telemedicine ; Referral And Consultation ; Organizations ; Government ; Internet

INTRODUCTION: A multidisciplinary approach is essential to optimize patient care. In the practice of oncology, surgeons, medical oncologists, and pathologists are essential for the histology-based diagnosis of cancer patients. In breast cancer, hormone receptor and HER2 positivity are both predictive and prognostic, and so testing for these has been strongly recommended for every newly diagnosed breast cancer patient. A unique but meaningful information that can be provided by medical oncologists, as customers, is their satisfaction to the services (e.g. HER2 testing) and product (e.g. reports) of the pathology laboratory. Any quality initiative effort to improve HER2 testing can also be extended to hormone receptor (ER/PR) testing. This study measures the general satisfaction of medical oncologists practicing in Metro Manila with local HER2 testing services and reports.
METHODS: This cross-sectional study had survey questionnaires distributed to medical oncologists practicing in Metro Manila chosen on the basis of their considerable experience with requesting HER2tests and with the use of anti-HER2 therapy in their management of breast carcinoma patients. Demographics, practice information, rating of satisfaction per laboratory service category, and a checklist of elements of IHC/FISH reports were collected.
RESULTS: 32 medical oncologists participated in the survey, most of whom were from tertiary hospitals. Breast carcinoma cases make up around 26-50% of cancer cases in their practice. More than half request HER2 testing for their breast cancer patients. Medical oncologists are generally satisfied with the services for IHC and FISH HER2 testing (composite scores >2) provided by the laboratories. Overall, medical oncologists were very satisfied with diagnostic accuracy and completeness of relevant information in the report. Laboratory services were mostly rated good, with the exception of pathologists' responsiveness to problems and notification of equivocal results. For both IHC and FISH, patient/physician identification, date of service, specimen identification/ site/ type, results, and interpretation were reported to be included in the reports. However, time to/duration of/ type of fixation, method and image analysis method, antibody clone/ vendor, and comment that an FDA-approved method was used, were reported missing by the many.
CONCLUSION: For both IHC and FISH, overall satisfaction was found to be moderately directly correlated with diagnostic accuracy. In a country like the Philippines where quality initiatives of laboratories may still be far from ideal, medical oncologists can demand inclusion of their preferences into assessments processes by laboratories and correct assumptions of laboratory managers as to what element of the services and products they value most. Measurement of customer satisfaction can be integrated into the quality assurance programs of laboratories and corresponding hospitals.  

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Patient Care ; Oncologists ; Surgeons ; Breast Neoplasms ; Surveys And Questionnaires ; Pathologists

A total of 38 patients with frozen section slides who underwent parotidectomy from January 1980 to December 1993 were retrieved from the Department of Pathology. The permanent section slides of the resected specimens were used as the gold standard. The frozen section and permanent section slides were reviewed by two independent pathologists and were labeled either as benign or malignant. If malignant, the tumor grade was determined as either high grade or low grade. Kappas correlation of agreement was used to determine inter-observer variability. Of the 38 slides, 16 were correctly labeled as malignant and 20 as benign. One slide was incorrectly labeled as malignant and 1 as benign. Sensitivity was 94.1 and specificity was 95.2 percent. The prevalence of malignant parotid tumors was 44.7 per cent, with a positive predictive value of 94.1 per cent and a negative predictive value of 95.2 per cent. Kappa statistic for the permanent section was 100 per cent, and 85 per cent for the frozen section. Tumor grading revealed that only 35.2 per cent were labeled correctly as high grade or low grade. This study showed that frozen section could reliably diagnose a malignant parotid tumor but could not reliably determine tumor grade. (Author)

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Frozen Sections ; Pathologists ; Prevalence ; Observer Variation ; Neoplasm Grading ; Parotid Neoplasms ; Sensitivity And Specificity

OBJECTIVE: To determine if salivary ferning correlates significantly with sonographic indices in identifying the fertile period, and whether it may be used as a cheaper, and more convenient way to aid infertility patients in achieving pregnancy.

POPULATION: Subjects who complain of difficulty achieving pregnancy and for whom follicle monitoring was indicated were recruited from the Outpatient Department in a tertiary hospital in Manila.

METHODOLOGY: Patients (n=40) with Primary or Secondary Infertility from April 2013 to August 2015 who require serial follicle monitoring as part of infertility work up were recruited in the study. For every follicle monitoring by ultrasound done by one sonologist, a salivary sample was obtained from the subject and the ferning pattern was determined and recorded by one pathologist blinded as to the day of the subject's menstrual cycle.

RESULTS: There was a total of 40 subjects who underwent 2 serial follicle monitoring during the study. The 1 st TVS (preovulatory) was done between Day 9 to 14 of the cycle with an average of Day 11. Correspondingly, salivary ferning done showed that there were 26 (65.0%) with Salivary Ferning 1 pattern and 14 (35.0%) with Salivary Ferning 2 pattern (p=0.35). This showed no significant difference between follicle monitoring and salivary ferning pattern and either may be used in identifying fertile period preovulatory. The 2nd TVS (postovulatory) was done between Day 12 to 21 with an average of Day 16. All the second ultrasound findings showed signs of ovulation. Correspondingly, there were 1 (2.0%) showed Salivary Ferning 1 pattern, 11 (27.5%) showed Salivary Ferning 2 Pattern and 28 (70.0%) showed Salivary Ferning 3 Pattern 9 (p=0.05). This showed no significant difference between follicle monitoring and salivary ferning pattern, hence, TVS follicle monitoring remains more reliable in identifying that ovulation has occurred.

CONCLUSION: Salivary ferning corresponded well with ultrasonographic findings during the preovulatory phase of the cycle, while no correlation was noted between the salivary ferning pattern and the postovulatory phase of the cycle. Hence, sonographic follicle monitoring remains a better predictor of ovulation, and more effective in identifying the fertile period

Human ; Female ; Adult ; Pregnancy ; Follicular Phase ; Luteal Phase ; Fertile Period ; Tertiary Care Centers ; Outpatients ; Pathologists ; Ovulation ; Ovarian Follicle ; Infertility

BACKGROUND: An artificial intelligence system of Faster Region-based Convolutional Neural Network (Faster R-CNN) is newly developed for the diagnosis of metastatic lymph node (LN) in rectal cancer patients. The primary objective of this study was to comprehensively verify its accuracy in clinical use. METHODS: Four hundred fourteen patients with rectal cancer discharged between January 2013 and March 2015 were collected from 6 clinical centers, and the magnetic resonance imaging data for pelvic metastatic LNs of each patient was identified by Faster R-CNN. Faster R-CNN based diagnoses were compared with radiologist based diagnoses and pathologist based diagnoses for methodological verification, using correlation analyses and consistency check. For clinical verification, the patients were retrospectively followed up by telephone for 36 months, with post-operative recurrence of rectal cancer as a clinical outcome; recurrence-free survivals of the patients were compared among different diagnostic groups, by methods of Kaplan-Meier and Cox hazards regression model. RESULTS: Significant correlations were observed between any 2 factors among the numbers of metastatic LNs separately diagnosed by radiologists, Faster R-CNN and pathologists, as evidenced by rradiologist-Faster R-CNN of 0.912, rPathologist-radiologist of 0.134, and rPathologist-Faster R-CNN of 0.448 respectively. The value of kappa coefficient in N staging between Faster R-CNN and pathologists was 0.573, and this value between radiologists and pathologists was 0.473. The 3 groups of Faster R-CNN, radiologists and pathologists showed no significant differences in the recurrence-free survival time for stage N0 and N1 patients, but significant differences were found for stage N2 patients. CONCLUSION: Faster R-CNN surpasses radiologists in the evaluation of pelvic metastatic LNs of rectal cancer, but is not on par with pathologists. TRIAL REGISTRATION www.chictr.org.cn (No. ChiCTR-DDD-17013842).
Adult ; Aged ; Aged, 80 and over ; Artificial Intelligence ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neural Networks (Computer) ; Pathologists ; Radiologists ; Rectal Neoplasms ; diagnostic imaging ; mortality ; pathology