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Figure 1. International Federation of Gynecology and Obstetrics (FIGO) grade 3 endometrioid carcinoma has .50% solid architecture with focalgland formation and moderate nuclear atypia (hematoxylin-eosin, original magnification320).

Figure 2. Undifferentiated carcinoma has monotonous proliferation of medium-sized cells in solid and diffuse pattern (hematoxylin-eosin, originalmagnification320).

Figure 3. Serous carcinoma features a papillary component with slitlike spaces (A and B) and/or a solid component (C and D) with high nucleargrade. Pleomorphic nuclei with prominent nucleoli, hyperchromatic nuclei with smudged chromatin, and increased mitotic activity are readilyobserved (hematoxylin-eosin, original magnification320 [A through D]).

838 Arch Pathol Lab Med—Vol 140, August 2016 Diagnostic Variability in Endometrioid Carcinomas—Thomas et al

Advertising Directors East: Hally Birnbaum Mount Kisco, NY Phone: 914-218-1943; Fax: 847-832-8514 captodayeast@gmail.com

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which was statistically significant (P¼ .01). Both institutionshad a high proportion of mixed SC and endometrioidcarcinoma as a reclassified diagnosis (48% [12 of 25] and36% [4 of 11]). In addition, MSK had a significantly greaterproportion of undifferentiated carcinoma than WSU did(45% [5 of 11] versus 8% [2 of 25]; P¼ .02); WSU had a highproportion of G2EC with focal marked nuclear atypia (28%,7 of 25) while MSK did not have any (P ¼ .03). Overall,mixed endometrioid and SC was the most common subtype(44%; 16 of 36) (Table 1).

Clinicopathologic Parameters of Reviewed Histology:G3EC and Reclassified Subtypes

Patients with G3EC had a median age of 61 years (range,27–90 years) and a follow-up period of 1 to 209 months(mean, 66 months). Most patients presented at stage I (63%;60 of 95), followed by stage III (24%; 23 of 95). Ninety-onepercent (86 of 95) had myometrial invasion, 67% (64 of 95)had lymphovascular invasion, and 20% (19 of 95) hadcervical stromal invasion (Table 2). Disease recurrence was

seen in 22 of 95 patients (23%); of those, 15 (68%) died. Atotal of 60 patients (63%; 60 of 95) died; death by stage ofdisease was stage I, 39 (41%); stage II, 3 (3%); stage III, 14(15%); and stage IV, 4 (4%) (Table 3).For the 7 patients with undifferentiated carcinomas, the

median age was 61 years (range, 42–69 years) and thefollow-up period ranged from 1 to 111 months (mean, 50months). Three of 7 patients (43%) presented with stage Idisease, 2 of 7 with stage III (29%), and 2 of 7 (29%) withstage IV disease. Eighty-six percent (6 of 7) had myometrialinvasion. None of the patients had recurrent disease (Table2). Of the 3 who died, 1 had stage III and 2 had stage IVdisease (Table 3). Patients with mixed epithelial carcinomashad a median age of 62 years (range, 49–80 years) and thefollow-up period was 3 to 135 months (mean, 50 months).Most presented with stage I disease (76%, 13 of 17) and hadmyometrial invasion (94%, 16 of 17). Only 2 of 17 patients(12%) had cervical stromal invasion, and 1 of 16 (6%) hadadnexal involvement (Table 2). A total of 7 of 17 patients(41%) patients died (stage I ¼ 5; stage III ¼ 2). One patienthad recurrent disease (stage I) and was among those who

Figure 4. Mixed epithelial carcinoma. A, Areas of high-grade endometrioid carcinoma showing predominantly solid growth, focal evidence of glandformation, and moderate nuclear atypia. B, Other areas in the same case have serous carcinoma with papillary/glandular architecture, high nucleargrade, increased mitosis, and necrotic luminal debris (hematoxylin-eosin, original magnification320 [A and B]).

Figure 5. International Federation of Gynecology and Obstetrics (FIGO) grade 2 endometrioid carcinoma with focal nuclear atypia. Area ofendometrioid carcinoma showing low nuclear grade with oval nuclei and inconspicuous nucleoli (A), and foci in the same case showing highernuclear grade with rounded nuclei, open chromatin, and distinct nucleoli (B) (hematoxylin-eosin, original magnification320 [A and B]).

Arch Pathol Lab Med—Vol 140, August 2016 Diagnostic Variability in Endometrioid Carcinomas—Thomas et al 839

August 2016

Special Sections—Contributions From the Canadian Anatomic and

Molecular Pathology Conference, Part I; Second Princeton Integrated

Pathology Symposium: Breast Pathology-2015, Part II

Solid Papillary Carcinoma Showing Multiple Circumscribed

Solid Nodules With Fibrovascular Cores

2017 Bonus Distribution at important pathology shows: USCAP (March–San Antonio); ASCO (June–Chicago); CAP17 (October–Washington D.C.); AMP (November–Salt Lake City); ASH (December–Atlanta)

You should advertise in the Archives of Pathology & Laboratory Medicine if:

Pathologists are important targets for your services and products

Your therapeutic drugs are tied to tests establishing personalized diagnostics

You value smart media buying* The Archives is received by 81% of pathologists The Archives is read by 70% of pathologists The Archives provides ad exposure to 38% of pathologists *Kantar Media Readership Survey of Pathologist Publications 2015

All advertising earns a combined rate based on the total number of ad units in the Archives of Pathology and CAP TODAY.

Clampdowns on out-of-network billing climbAnne Paxton

To the average reader, “out-of-network billing”

might seem like a technical concept that should

mainly concern hyperaware insurance wonks. Me-

dia outlets from NBC News to Time to the Huffing-

ton Post have found that phrases like “surprise

medical bill,” “angry patients,” and sometimes

“sticker shock” in recent stories are much more

likely to grab attention.

But out-of-network billing is what those stories are

about—and it’s not being painted in glowing terms.

In fact, a growing number of states have imposed

curbs on out-of-network billing, and the implications

for pathologists could be serious. However, patholo-

gist awareness of the trend is lagging, says Margaret

Havens Neal, MD, president of the Florida Society

of Pathologists. “There are pathologists out there who

don’t recognize this as a major issue for them yet.”

“Anecdotally, we hear about surprise medical

bills more and more,” says Emily E. Volk, MD,

MBA, chair of the CAP Council on Government and

Professional Affairs and chief quality officer, Baptist

Health System, San Antonio. And pathologists,

along with other hospital-based physicians such as

radiologists, anesthesiologists, emergency physi-

cians, hospitalists, and neonatologists, are among

the billers being highlighted. Almost one in every three pri-

vately insured adult patients had re-

ceived a surprise medical bill in the

previous two years, a 2015 Consumer

Reports survey found. When such

patients find out they owe unexpect-

ed amounts because the provider

who took care of them is not part of

the network covered by their insur-

ance—even though the facility may

be covered—it’s the provider who

often gets the blame.Why are such out-of-network bills

on the increase? “It’s because insur-

ance companies are creating narrow

networks, limiting the number of

physicians patients see, so more and

more physicians become ‘out of net-

work,’” says Robert DeCresce, MD,

MBA, director of clinical laboratories

at Rush University Medical Center in

Chicago and chair of the state affairs subcommittee of the CAP Federal and State Affairs Committee.

“Even if you go to an in-network hospi-

tal, the hospital may not give you a

choice between an in- or out-of-net-

work pathologist because their con-

tracts are usually exclusive.” Then the

patient gets billed for the difference

between what the insurance company

allows and what the pathologist

charges. “Is it a deceptive practice by

the hospital or the insurance compa-

ny? That’s a reasonable question to

ask,” Dr. DeCresce says.Some of the rise in such cases may

be linked to the

Finding the fast track with ’14 HIV algorithm

William Check, PhD

Laboratories that use the HIV testing

algorithm the CDC recommended in

2014 report shorter turnaround times

for those with detectable antibodies.

And among state and local public

health laboratories that responded to

a 2015 survey, more than half report

having implemented the algorithm.

This was just some of the information

presented in March at the annual HIV

Diagnostics Conference, where speak-

ers, a handful of whom spoke with

CAP TODAY since, shared data on the

use and efficacy of the algorithm.

“From a recent Association of Pub-

lic Health Laboratories survey [re-

ported at the conference] we know

that the algorithm has been imple-

mented in approximately 55 percent

of state and local public health labs

that responded,” says Michele Owen,

PhD, conference

Reid H

orn

Glucose PT criteria reset stirs standards debateAnne Paxton

It may not be an exact science, but resetting standards is a

long-established means of improving quality of testing,

and it can also be a way of adapting to improvements in

quality that have already been realized. In the case of the

CAP’s recent tightening of proficiency testing criteria for

hospital glucose testing, both purposes are at work. The

new criteria reflect the fact that glucose meter performance

has improved significantly, CAP Chemistry Resource

Committee chair Gary L. Horowitz, MD, explains in the

2016 Program Update on Glucose Meter Performance.

But the change in Survey criteria has brought unex-

pected pushback from one of the leading hospital glucose

meter manufacturers.The CAP’s Chemistry Resource Committee approved

and implemented the new PT grading

JUNE 2016 page 1

—continued on 14

—continued on 78—continued on 58

pathology ◆ laboratorymedicine ◆ laboratorymanagement JUNE 2016

Vol. 30 No. 6 Moving? Fax a copy of the above address with corrections to CAP TODAY: 847-832-8153.

“ We don’t particularly want or choose to be out of network, but

as the insurers’ networks have narrowed, we find ourselves

out,” says Dr. A. Joe Saad.

Synovial sarcomaUse of RT-PCR and FISH assays to detect SS18-SSX2 fusion transcript

Page 88

case report

0616_1_NetBill-Gluco-HIV_2.indd 1

6/8/16 4:24 PM

June 2016

Sarcomatoid Urothelial Carcinoma With Chordoid Differentiation

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CirculationArchives of Pathology & Laboratory Medicine is received and read every month by 13,000 pathologists, including members of the College of American Pathologists, who enjoy their subscriptions as a member benefit through personal written request.

Readership: Pathologists: 13,000 Paid Subscriptions: 1,000 Total: 14,000

The latest PERQ/HCI custom study on pathologist readership shows that Archives of Pathol-ogy & Laboratory Medicine leads all pathology journals in both receivership and readership, and is second only to CAP TODAY in generating advertising exposures to pathologists.

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