CAPcasts

Pathology practices are entering a new value-based payment era and the ability to successfully demonstrate contributions to the quality of care provided will likely have a significant impact on their ability to positively impact their own reimbursement in the Merit-based Incentive Payment System, also known as MIPS. The Centers for Medicare & Medicaid Services (CMS) has finalized several changes to the program for 2019, which is year 3 of MIPS.

In this CAPcast, Dr. Emily Volk, vice chair of the CAP’s Council on Government and Professional Affairs and chair of the CAP Qualified Clinical Data Registry Ad Hoc Committee, discusses what pathologists need to know and do for 2019 in order to be successful in year 3 of the program. For more information on MIPS, please visit the Advocacy section of CAP.org: https://capatholo.gy/2KhOIpR.

Thyroid nodules are a common source of diagnostic difficulties for practicing pathologists. The correct diagnosis of these nodules is often difficult given some of the controversies associated with their interpretation and evolving criteria for diagnosis.

In this CAPcast, Dr. Saul Suster discusses controversial areas in thyroid nodule interpretation and recent changes in terminology for papillary carcinoma. Dr. Suster will be teaching a course on this topic on Saturday, Sept. 21 at CAP19 in Orlando, Florida. For more information and to register for CAP19, visit www.capannualmeeting.org.

Advances in minimally invasive thoracic sampling techniques allow pathologists and laboratories to perform multiple ancillary studies on small biopsy and cytology specimens. But with small specimens, ensuring optimum diagnostic yield and judicious triaging of these limited volume samples to perform an ever-growing list of ancillary studies is a challenge, according to Dr. Sinchita Roy-Chowdhuri.

In this CAPcast, Dr. Roy-Chowdhuri, discusses the new CAP guideline, Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies, which provides recommendations for pathologists and proceduralists to optimize testing outcomes for patients with suspected thoracic abnormalities. Dr. Roy-Chowdhuri will be teaching a course on this new guideline at CAP19, which will be held Sept. 21-25 in Orlando, Florida (www.capannualmeeting.org).

Endometrial biopsy is amongst the most frequent specimens evaluated by pathologists. But difficulties in interpretation of findings and the presence of common morphologic mimics, including metaplastic and reactive changes, may lead to misdiagnosis, with important consequences for patient management.

In this CAPcast, Dr. Ricardo Lastra discusses the common pitfalls in diagnosis as well as classification of endometrial precursor lesions and neoplasia, as well as the rare diagnoses that may be present in endometrial biopsy specimens. Dr. Lastra will be teaching a CAP19 course on this topic with Dr. Mamta Gupta on Monday, Sept. 21 in Orlando, Florida.

Colorectal carcinoma remains the most common gastrointestinal malignancy and a common cause of morbidity and mortality. Pathologists are seeing considerable change in the diagnosis, testing, and reporting of colorectal carcinoma. In this CAPcast, Dr. Raul S. Gonzalez will discuss three common areas of concern related to stains, deposits and buds as well as the recent publication of the International Tumor Budding Consensus Conference proceedings is likely to lead to a further increase in applying tumor budding in routine practice.

Dr. Gonzalez will be teaching a course on this topic at CAP19, which will be held Sept. 21-25 in Orlando, Florida. For more information on CAP19, please visit www.capannualmeeting.org.

Colon biopsies, especially polyps, are the bread and butter of many pathologists and issues surrounding these specimens are not uncommon. In this CAPcast, Dr. Lysandra Voltaggio discusses issues and challenging diagnoses as it pertains to colon polyps. Dr. Voltaggio is teaching a course on this topic at CAP19; learn more and register at www.capannualmeeting.org.

Registration is now open for the CAP’s annual meeting, CAP19, which will be held Sept. 21-25 in Orlando, Florida. In this CAPcast interview, Dr. Jennifer Hunt, Chair of Pathology and Laboratory Medicine at the University of Arkansas for Medical Sciences, discusses the rich career and educational opportunities at this annual event. Learn more and register for #cap19ORL: https://www.capannualmeeting.org/.

Immunotherapy targeting the PD-1/PD-L1 pathway represents a new therapeutic paradigm and a promising treatment option for advanced non-small-cell lung cancers, melanoma, and more recently, gastric and gastroesophageal carcinomas. As the role of PD-L1 IHC testing in the diagnostic work-up of solid tumors continues to expand, practicing pathologists are playing an increasingly larger role in test selection and integration of these molecular data into their reports, according to Dr. Larissa Furtado, who is teaching a course PD-L1 testing at CAP19 (www.capannualmeeting.org).

In this CAPcast, Dr. Furtado provides an overview of PD-L1 testing, as well as how pathologists can confront the challenges related to implementing PD-L1 IHC testing into their laboratories.

Because pathologists confront informatics problems on a regular basis, it’s critical for them to effectively diagnose and treat common informatics problems in partnership with other clinical providers, hospital/client leadership, IT staff, and laboratory staff.

In this CAPcast, Dr. John Sinard discusses common process and technology-based informatics issues and how pathologists can develop clinical diagnostic informatics acumen to deal with these issues. Dr. Sinard will be teaching a course on this topic at CAP19, along with his co-faculty Dr. Alexis Carter and Dr. Myra Wilkerson. For more information and to register for CAP19, visit www.capannualmeeting.org.

Pathology systems such as digital microscopy, laboratory instruments, middleware, LIS, and EHR are starting to incorporate components based on machine learning and artificial intelligence. However, pathologists are poorly equipped to verify the quality of performance of the various digital pathology and other laboratory systems other than by using documents provided by the system vendors, according to Dr. Matthew Hanna, who is teaching a CAP19 course on navigating the implementation challenges of systems incorporating machine learning and artificial intelligence (learn more about CAP19: https://capatholo.gy/2Vzqkm9).

In this CAPcast interview, Dr. Hanna discusses these challenges and how pathologists can avoid problems using best practices in performance assessment from initial deployment through ongoing maintenance of quality.