The edition · Pathology
A battery-powered TB NAAT: 85% sensitive, but weaker than the cartridge test
A Cochrane review sizes up the first near point-of-care molecular test for pulmonary TB. Also: which phyllodes features predicted metastasis, three Hodgkin stains that failed validation, and how p53 staining changed Barrett's diagnoses in a national panel.
The edition in brief
A Cochrane review of five studies (3,291 people in nine moderate- to high-burden countries) found the one near point-of-care TB nucleic acid amplification test meeting WHO criteria had a pooled sensitivity of 85.4% and specificity of 97.6% against culture. It was less sensitive than Xpert MTB/RIF Ultra (by about 7.5 percentage points) with similar specificity, and far more sensitive than smear microscopy (by 22 points). Sensitivity fell to 79% in people with HIV and 67% in smear-negative, culture-positive disease, and most testing was done in laboratories rather than peripheral sites. In 58 borderline and malignant phyllodes tumours, a stromal mitotic count of 30 or more per 10 high-power fields and malignant heterologous elements were associated with metastasis; one proposed system reclassified half the borderline tumours as malignant without any of them metastasising during follow-up. A Dutch national expert panel reviewing 1,146 Barrett's oesophagus cases found p53 immunohistochemistry was reproducible (kappa 0.65 among 13 pathologists) and changed diagnoses, particularly moving indefinite-for-dysplasia cases to low-grade dysplasia or to non-dysplastic.
Near point-of-care TB NAAT: good specificity, lower sensitivity than Xpert Ultra
This near point-of-care NAAT could improve on smear where Xpert is unavailable, but a negative result does not rule out TB.
In phyllodes tumours, mitoses of 30 or more and heterologous elements predicted metastasis
Sample phyllodes tumours thoroughly and report mitotic count and heterologous elements clearly; they carried the prognostic weight.
c-MET, HLA class II and CD68 staining did not predict outcome in early Hodgkin lymphoma
c-MET, HLA class II and CD68 immunohistochemistry did not predict progression in early Hodgkin lymphoma and should not be reported for prognosis.
Fixation starts in theatre: time to formalin and fixation time decide the stain
Record cold ischaemia and fixation times on every specimen destined for receptor or molecular testing.
p53 staining in Barrett's oesophagus was reproducible and resolved over half of indefinite diagnoses
Use p53 immunohistochemistry, read against standard patterns, to help resolve indefinite-for-dysplasia Barrett's biopsies.
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