The edition · Pathology
Time-zero biopsy should not decide alone whether a donor kidney is discarded
A 203-report meta-analysis finds every histology–outcome link of very low certainty, TNBC after neoadjuvant pembrolizumab needs reporting beyond pCR, and ISUP moves bladder post-treatment reporting towards a standard.
The edition in brief
A meta-analysis of 203 reports on pre-implantation biopsy in deceased-donor kidney transplantation found vascular injury associated with delayed graft function (OR 1.85) and graft failure (HR 1.48), and glomerulosclerosis with graft failure (HR 2.03), but all twelve pooled estimates were of very low certainty. Time-zero histology should be reported as one input among clinical variables, not used as a stand-alone rule to accept or discard an organ. In 203 women with early triple-negative breast cancer given neoadjuvant pembrolizumab-based chemoimmunotherapy, 63.1% had a pathological complete response; residual disease was usually a single confined focus, and nodal response was mixed in 7.4%, so reports should describe residual pattern and nodal response in detail. An ISUP consensus reached agreement on 18 of 19 statements for reporting treatment effects in bladder specimens, supporting standard terminology and a bladder tumour regression grade, but not molecular tests to separate benign mimics from carcinoma. Ten years of the Sherloc points-based variant classification framework, applied to 2.6 million variants, showed that 73% of VUS reclassifications relied on evidence criteria added after the first version. And direct measurement showed that more than two-thirds of paraffin sections fall outside ±10% of the microtome setting.
After neoadjuvant pembrolizumab in TNBC, report the pattern of residual disease and each node's response
After neoadjuvant chemoimmunotherapy for TNBC, report residual pattern, nodal response and baseline TILs, not only pCR and ypN.
ISUP consensus: standard terminology for treated bladder specimens, and a regression grade to come
Report treated bladder specimens in standard terms and state prior therapy; molecular tests are not yet endorsed to separate mimics from carcinoma.
A decade of Sherloc: most VUS reclassifications came from evidence added after launch
Build periodic VUS reinterpretation into genetic reporting; evidence rules change and resolve many of them.
A 4 µm section is rarely 4 µm — thickness varies widely and shows in the H&E
Treat section thickness as a quality variable to monitor, not a fixed microtome setting.
Write what the biopsy cannot tell the surgeon
Every donor biopsy report should state its own adequacy so it is not over-read.
Do not let time-zero histology alone decide to discard a deceased-donor kidney
Report time-zero biopsy as standardised, adequacy-qualified information for a joint decision, not as a discard threshold.
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