From the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Lamothe, Peric, Glickman).
The Department of Pathology, Massachusetts General Hospital, Boston (Heher).
Arch Pathol Lab Med. 2023 Dec 1;147(12):1413-1421. doi: 10.5858/arpa.2022-0265-OA.
CONTEXT.—: Tissue contaminants on histology slides represent a serious risk of diagnostic error. Despite their pervasive presence, published peer-reviewed criteria defining contaminants are lacking. The absence of a standardized diagnostic workup algorithm for contaminants contributes to variation in management, including investigation and reporting by pathologists.
OBJECTIVE.—: To study the frequency and type of tissue contaminants on microscopic slides using standardized criteria. Using these data, we propose a taxonomy and algorithm for pathologists on "floater" management, including identification, workup, and reporting, with an eye on patient safety.
DESIGN.—: A retrospective study arm of 1574 histologic glass slides as well as a prospective study arm of 50 slide contamination events was performed. Using these data we propose a structured classification taxonomy and guidelines for the workup and resolution of tissue contamination events.
RESULTS.—: In the retrospective arm of the study, we identified reasonably sized benign tissue contaminants on 52 of 1574 slides (3.3%). We found size to be an important parameter for evaluation, among other visual features including location on the slide, folding, ink, and tissue of origin. The prospective arm of the study suggested that overall, pathologists tend to use similar features when determining management of potentially actionable contaminants. We also report successfully used case-based ancillary testing strategies, including fluorescence in situ hybridization analysis of chromosomes and DNA fingerprinting.
CONCLUSIONS.—: Tissue contamination events are underreported and represent a patient safety risk. Use of a reproducible classification taxonomy and a standardized algorithm for contaminant workup, management, and reporting may aid pathologists in understanding and reducing risk.
组织学切片上的组织污染物是诊断错误的严重风险。尽管它们普遍存在，但缺乏已发表的同行评议标准来定义污染物。由于缺乏针对污染物的标准化诊断工作流程算法，导致管理方式存在差异，包括病理学家的调查和报告。
使用标准化标准研究显微镜载玻片上组织污染物的频率和类型。利用这些数据，我们提出了一种针对“漂浮物”管理的病理学家分类法和算法，包括识别、检查和报告，着眼于患者安全。
进行了一项 1574 张组织学玻璃切片的回顾性研究臂，以及 50 张载玻片污染事件的前瞻性研究臂。利用这些数据，我们提出了一种结构化分类分类法和指南，用于处理和解决组织污染事件。
在研究的回顾性臂中，我们在 52 张（3.3%）1574 张切片中发现了大小合理的良性组织污染物。我们发现大小是评估的一个重要参数，其他视觉特征包括载玻片上的位置、折叠、墨水和组织来源。前瞻性研究臂表明，总体而言，病理学家在确定潜在可操作污染物的管理方法时倾向于使用类似的特征。我们还报告了成功使用基于案例的辅助测试策略，包括染色体荧光原位杂交分析和 DNA 指纹分析。
组织污染事件报告不足，代表患者安全风险。使用可重复的分类分类法和标准化的污染物检查、管理和报告算法，可能有助于病理学家理解和降低风险。
