Biomarker Testing for Cancer Patients: Barriers and Solutions, Part 2

As you may recall last month I shared common barriers to biomarker testing for cancer patients in the community. I also began to dive-in to a few solutions that I have seen implemented to overcome the barriers. Last month I shared solutions that may help with high cost and long turnaround times for biomarker testing. This month I would like to discuss issues with tissue including quantity.

Here are the top 10 barriers that I’ve seen to biomarker testing in the community:

  1. High cost of testing.
  2. Long turnaround time for results.
  3. Limited tissue quantity.
  4. Preanalytical issues with tissue.
  5. Low biomarker testing rates.
  6. Lack of standardization in biomarker testing.
  7. Siloed disciplines.
  8. Low reimbursement.
  9. Lengthy complex reports.
  10. Lack of education on guidelines.

Sample quantity and quality are both important when considering biomarker testing. If we don’t have enough material we cannot perform the test (quantity not sufficient or QNS). If we have poor quality we cannot trust the results. The old adage of garbage in garbage out holds true for biomarker testing just as it does for all other lab tests.  

I’ll start with sample quantity this month and cover quality issues next month. The issue here is that a variety of biopsy types are performed on patients depending on the location and size of a suspicious mass. Historically we only needed enough material for the pathologist to make a diagnosis. Now we often need enough material for diagnosis and biomarker testing. Some tumor types such as breast and ovarian cancers produce enough material in locations that are easily accessible that tissue quantity is rarely an issue, however other tumor types such as lung and pancreatic cancers there is often an issue with tissue quantity. These tumor types must be handled with care to ensure no tissue recovered is lost.

The first step in addressing tissue insufficiency is knowing where you are starting. Do you have an issue with quantity not sufficient (QNS) rate? If you don’t know how many of your cases are insufficient for biomarker testing, then you can’t determine if you have an issue. If your testing is performed at a reference laboratory, you can request your QNS rate from the lab. They may also be able to provide you with the national QNS rate and then you could benchmark yourself against your peers. It is important to have an accurate QNS rate, so if there are blocks that are not sent to the reference lab because the pathologist has determined the block to be exhausted (no tissue is left) then the QNS rate provided by the reference lab may be artificially low.

It is important to agree upon what is QNS. We consider a specimen to be QNS if we cannot perform biomarker testing on the block. Others may consider the block QNS only if there wasn’t sufficient material for diagnosis. We have to ensure there is enough tumor content in the tissue to proceed with biomarker testing, in our case 10% of the nucleated cells (not volume) must be tumor (determined by pathology review of an H&E slide). If we have enough tumor, we can still end up with a QNS block due to low DNA and RNA yield. So we need sufficient tumor and sufficient tissue. 

Here is a brief overview of solutions I have seen work to address limited tissue that can lead to high QNS rates:

  • Education. The person collecting the biopsy needs to understand how much material is needed. Remember we have moved the goal post. Sufficient material for diagnosis was enough in the past, now we need more material to perform biomarker testing. Educating the team on why we need more material is valuable in ensuring sufficient material is collected.
  • ROSE. Rapid onsite evaluation (ROSE) by a pathologist in the procedure room to determine sufficiency has been shown to decrease the repeat biopsy rate [1]. The pathologist can ensure the biopsy is being collected in a tumor rich region and help ensure areas of necrosis are avoided.  
  • Embedding cores separately. We often get core needle biopsies on lung cancer specimens. We prefer 3-5 cores. It is best practice to independently embed the cores in separate blocks. I have also seen labs that embed no more than 2 cores in one block. This would allow one block to be conserved for diagnosis and the other to be used for biomarker testing.
  • Visual cue for limited tissue. Someone far more creative than me developed a process in histology where in cases of limited tissue the tissue was embedded in a red cassette. This cassette color was a visual cue for everyone handling the block that the tissue was limited and care should be taken when facing into the block. This has evolved over time to a red bead being embedded beside the tissue. Any visual cue and an associated procedure to ensure tissue conservation can help ensure we are conserving tissue in cases where it matters.
  • Limited IHC Stains. The primary reason a biopsy is performed is for diagnosis. It is recommended that as few IHC stains as possible be used to make the diagnosis. This will conserve tissue for biomarker testing.
  • Unstained Slides. Cutting 15-20 unstained slides is considered best practices in tumor types such as lung where biomarker testing will be performed within 30 days. Long term storage of unstained slides is not recommended.
  • Reduce the number of times the block goes on the microtome, because every time the block is put back on the microtome it must be refaced. This results in wasted tissue. This can be prevented by thinking ahead and cutting everything you know will be needed while the block is on the microtome.

References

  1. Collins BT, Murad FM, Wang JF, Bernadt CT. Rapid on-site evaluation for endoscopic ultrasound-guided fine-needle biopsy of the pancreas decreases the incidence of repeat biopsy procedures. Cancer Cytopathol. 2013;121:518-24.

-Tabetha Sundin, PhD, HCLD (ABB), MB (ASCP)CM,  has over 10 years of laboratory experience in clinical molecular diagnostics including oncology, genetics, and infectious diseases. She is the Scientific Director of Molecular Diagnostics and Serology at Sentara Healthcare. Dr. Sundin holds appointments as Adjunct Associate Professor at Old Dominion University and Assistant Professor at Eastern Virginia Medical School and is involved with numerous efforts to support the molecular diagnostics field. 

Microbiology Case Study: A 60 Year Old Male Status-Post Orthotopic Liver Transplant with Headache and Word-Finding Difficulty

Case History

A 60 year old male with a past medical history of ulcerative colitis requiring total proctocolectomy and immunomodulatory therapy followed by an anti-Tumor Necrosis Factor α blocker for the last two years and primary sclerosing cholangitis with subsequent decompensated cirrhosis that ultimately required an orthotopic liver transplant on tacrolimus and prednisone for immunosuppression presents 17 days post-transplant with worsening headache for two weeks with associated word finding difficulty and expressive aphasia.

Laboratory and Diagnostic Findings

Brain magnetic resonance imaging demonstrated, a “Heterogeneous, partially hemorrhagic and centrally necrotic mass within the posterior left temporal lobe…infectious etiologies such as pyogenic/non-pyogenic abscesses to include fungal organisms, are highest on the differential” (Image 1). At the time of admission, his complete blood count demonstrated a leukocytosis (16.48×109 cells/L), anemia (hemoglobin of 7.8 g/dL, hematocrit of 24.8%) and a normal platelet count (367×109 cells/L). The automated differential showed 82% neutrophils, 10% lymphocytes, 6% monocytes, 1% eosinophils, and 1% basophils. A lumbar puncture was performed to obtain cerebral spinal fluid (CSF) and the analysis showed a glucose of 60 mg/dL, protein of 34 mg/dL, nucleated cell count of <1, and 6 red blood cells (completely normal CSF indices). Broad spectrum antimicrobials (Vancomycin, Piperacillin/Tazobactam, Metronidazole and Micafungin) were initiated. A 1,3-β-D-glucan test had a result of >500 pg/mL in both serum and CSF. Galactomannan, Histoplasma urine antigen, Cryptococcus antigen and other fungal testing were negative. Antifungal therapy was changed to voriconazole. Craniotomy was determined to be the best course of action and the patient was taken to surgery for debridement and pathologic evaluation.

Frozen section evaluation during the time of surgery showed granulomatous inflammation. Septate hyphae were observed on the fungal smear. Following surgery, amphotericin was added. Histologic evaluation of the tissue submitted from surgery showed pyogranulomatous inflammation with pigmented, spore-like structures present in multinucleated giant cells on hematoxylin and eosin (H&E) stain (Image 2). Grocott’s methenamine silver (GMS) stain also highlighted short segments of septate hyphae (Image 3).

Cultures from the surgical debridement grew a mould with central pigmentation (Image 4). Direct microscopic examination of the mould revealed thick-walled, oblong conidia with 3-5 cells, and uniformly pigmented hyphae (Image 5). A germ tube test showed germ tubes originating from both ends of the conidia consistent with Bipolaris species.

Image 1. T1-weighted (left) and T2-weighted (right) magnetic resonance imaging of the brain demonstrating a left temporal lobe mass.
Image 2. Hematoxylin and Eosin stained photomicrographs showing pyogranulomatous inflammation with giant cell formation and circular structures within them (left) (40x objective magnification). The right shows gold-brown pigmented structures within granulomatous inflammation (40x objective magnification).
Image 3. Grocott’s methenamine silver stain highlighting short segments of irregular septate hyphae in the brain debridement specimen (10x objective magnification).
Image 4. Mature wooly brown-black colony on potato dextrose agar.
Image 5. Photomicrograph of a lactophenol blue tape prep of the mature fungal colony. Pigmented hyphae and short 3-4 cell conidia are readily identified (40x objective magnification). This specimen also tested germ tube positive (not shown), indicating that this dematiaceous fungus is Bipolaris spp.

The patient’s mental status significantly improved following surgical debridement, 2 weeks of liposomal Amphotericin B, as well as long term treatment with voriconazole. The voriconazole was later switched to posaconazole due to concerns for fluoride toxicity. He completed a year of posaconazole with significant improvement of the abscess observed on imaging and resolution of headaches with no other visual problems. He continued to recover cognitive function with some residual difficulty with reading, comprehension and speech that eventually resolved.

Discussion

Phaeohyphomycosis refers to infections caused by dematiaceous fungi that exist in a variety of forms when seen in tissues and commonly involves skin, soft tissue and nasal sinuses.1 In rare cases, central nervous system (CNS) involvement has been reported. CNS phaeohyphomycosis is predominantly seen in immunosuppressed patients; however, cases involving immunocompetent individuals do exist.2 In one case series from Houston, Texas, five of seven cases of cerebral mycosis were caused by a dematiaceous mould.3 Interestingly, the patient presented in this case came to medical attention around the Dallas-Fort Worth area of Texas.

Cladophialophora bantiana is the most common dematiaceous fungus associated with CNS phaeohyphomycosis, but rare cases of Bipolaris species have been reported previously in literature.4-6

We report a case of CNS phaeohyphomycosis by Bipolaris species following orthotopic liver transplant with an excellent patient outcome. This case is unusual, in part, because the typical hospital course of a patient with phaeohyphomycosis is generally dismal.7 The stories of successful treatment often involve complete debridement of discrete lesions.7-8 In our case, the patient underwent surgical debridement and treatment initially with liposomal Amphotericin B and later transitioned to long term therapy with newer azole antifungals.

References

  1. Revankar SG, Sutton DA, & Rinaldi MG, (2004). Primary Central Nervous System Phaeohyphomycosis: A Review of 101 cases. CID, 38, 206-2016
  2. Filizzola MJ, Martinez F, & Rauf SJ, (2003). Phaeohyphomycosis of the central nervous system in immunocompetent hosts: report of a case and review of the literature. Int J Infec Dis, 7, 282-286
  3. Raparia K, Powell SZ, Cernoch P, Takei H, (2010). Cerebral mycosis: 7-year retrospective series in a tertiary center. Neuropathology, Jun; 30(3): 218-223.
  4. Frank T, Esquenazi Y, Nigo M, Wanger A, Portnoy B, & Shepard S, (2016). Disseminated Phaeohyphomycosis with Brain Abscess and Biliary Invasion Due to Bipolaris spp. In an Immunocompetent Patient. Annals of Clinical & Laboratory Science, 46(4). 
  5. McGinnis MR, Campbell G, Gourley WK, & Lucia HL, (1992). Phaeohyphomycosis Caused by Bipolaris spicifera, An Informative Case. Eur. J. Epidemiol, 8(3), 383-386
  6. Rosow L, Jiang JX, Deuel T, Lechpammer M, Zamani AA, Milner DA, Folkerth R, Marty FM, & Kesari S, (2011). Cerebral phaeohyphomycosis caused by Bipolaris spicifera after heart transplantation. Transpl Infect Dis, 13, 419-423.
  7. Dixon DM, Walsh TJ, Merz WG, McGinnis MR, (1989). Infections due to Xylohypha bantiana (Cladosporium trichoides). Rev Infect Dis, 11: 515-525.
  8. Gadgil N, Kupfermen M, Smitherman S, Fuller GN, Rao G, (2013). Curvularia brain abscess. J Clin Neurosci, Jan;20(1): 172-175.

-John Markantonis, DO is a second year Clinical Pathology resident at UT Southwestern in Dallas. He has interests in Medical Microbiology and Transfusion Medicine.

-Dominick Cavuoti, DO is a Professor at UT Southwestern in the Department of Pathology. He is multifaceted and splits his time as the Medical Director of the Parkland Hospital Clinical Microbiology Laboratory and Parkland Cytology attending among other administrative and educational activities.

-Clare McCormick-Baw, MD, PhD is an Assistant Professor of Clinical Microbiology at UT Southwestern in Dallas, Texas. She has a passion for teaching about laboratory medicine in general and the best uses of the microbiology lab in particular.

A New MLS Graduate's Experience

I wrote last as a student in the medical technologist program at NorthShore University Healthcare System in Evanston. Now, as my first post as a certified medical technologist, I wanted to share what the journey was like becoming certified, finding a job, and transitioning into the professional arena.

Throughout the program, I felt relatively confident in the material and what we were learning and applying in rotations. We took about 1000 tests over the course of the program – at least that’s what it felt like. When the ASCP BOC exam began peaking its head, I wasn’t too intimidated. To me, it was just another test.

The first step was registering for the exam. My intention was to take the exam the day after I graduated, but I was bad and waited one month prior to graduation to register (it can take up to 45 business days to process). Don’t do as I did! Thankfully, the process was quicker than expected and I was only delayed one week after graduation.

The last four weeks of my program were intimidating to say the least! We had cumulative finals in addition to simulated board exams. Therefore, my BOC exam studying began through preparing for these. One of the most valuable resources that I cannot recommend enough is LabCE by MediaLab. I first discovered LabCE through their manual UA and differential simulators, but then discovered that they have testing simulators which our program director used to create practice exams for subjects and for the BOC exam. Their questions range in difficulty and each one has an explanation, which presents a great way to study (at least for me). It helped me develop study guides on material I consistently got wrong or completely forgot.

Two weeks before my exam, I discovered the BOC CLS study guide. I immediately paid for overnight shipping and received it the next day. This turned into my main study tool – I do best quizzing myself, then reading up on topics I got wrong. I would be lying if I said I felt confident when I received that book and went through the first 50 questions. I felt incompetent. Despite my previous review and studying, I felt as if I discovered an entirely new language. The book is very detailed and covers everything from a to z for laboratory science, with some topics only being covered briefly in school. As time went on, the shock factor wore off and I continued to focus on the things I no longer remembered and believed were important.

Despite the endless hours studying, I felt that there was much left to cover and the night before my exam I remember feeling overwhelmed. There is only so much information the human brain can store without the hands-on experience that ingrains what you learn. Throughout the test I felt as if I were failing, something that seems to be common place among BOC test takers. When it was time to see my score, my hands became clammy. Despite the suspense, I passed! When I received my scores later, I did much better than expected!

So, my concluding advice while preparing for the BOC exam is to focus on summarizations of your notes and to review all your formulas throughout your program. Go through as many practice exams as possible to help you see where you’re lacking and to prepare you for the wording on the BOC exam. Throughout my program, I would type up one to two-page notes for exams for later review. These were helpful when I had to go back and review things I did not remember. Additionally, despite the amount of studying you do, there is bound to be information you will not know and that’s okay. You know more than you think you know and through review you will only increase the recoverable information that is already in your head.

Lastly, I wanted to speak about the process of a new grad finding a job and transitioning from a student to a health professional. As I went through rotations, my passion for each specialty changed. At first, I wanted to be a generalist because I wanted to be more marketable and do everything. Then it was blood bank, then micro, and then came molecular (yay!). I began my job search about 2 months before graduation, and applied for those jobs about a month and a half before graduation. Being a soon-to-be new grad, I knew that I might not end up in the exact field I desired right away (which was molecular). I applied for mostly blood bank, micro, and molecular jobs – as these were of the most interest to me.

I applied for about 6-7 jobs in total and I ended up discovering, and eventually obtaining, my current position as an HLA molecular scientist at Northwestern’s transplant lab in Chicago. Throughout the interview process, being 100% honest of what you do and don’t know is the most important advice. Most employers ask a lot of detailed questions only to gauge where they need to start in your training. A good rule of thumb to remember is that if you’re a new grad being interviewed, then the employer is already okay with the fact that you don’t have much experience or knowledge of the specialty.

Before starting, a lot of people warned me about specializing immediately after graduating. While I hear their concerns, for me I plan on staying in the molecular field for the rest of my career – there are many opportunities and molecular is only becoming more and more advanced/widespread.

Now that I am 2 months into my job, I have fallen in love with it. There is endless opportunity to continue learning and to challenge myself. Walking into this specialty, I had two HLA lectures and nothing more. While my first month and a half mostly consisted of DNA isolation and cell lineage DNA isolation for chimerism tests, I have finally started training on an assay and data analysis for engraftment monitoring (chimerism). As a new grad in such a specific specialty, I have accepted that there will be a large learning curve. My advice is to keep your mind open to learning new things and fuel your motivation to learn more and more. Never stop asking questions and never turn down resources others hand you that have helped them.

As I gain more experience in the HLA world, I plan on writing articles tailored to this field and sharing what I learn. I hope my experience as a new grad helps others approaching this new time in their lives and gives them a sense of direction/confidence.

-Ben Dahlstrom is a recent graduate of the NorthShore University HealthSystem MLS program. He currently works as a molecular technologist for Northwestern University in their transplant lab, performing HLA typing on bone marrow and solid organ transplants. His interests include microbiology, molecular, immunology, and blood bank.

Microbiology Case Study: 18 Year Old Male with Shortness of Breath

Case History

A 18 year old male with no significant past medical history presented with 2-3 month cough, hemoptysis, fevers, night sweats and 15 pound unintentional weight loss. He originally started to feel mild shortness of breath with activity following his return from the Pacific Northwest. He was diagnosed with pneumonia and given antibiotics. He denied vaping, hookah use or any smoking. Of note, his maternal grandmother had pulmonary tuberculosis two years ago, but at that time he had a negative interferon-gamma release assay (IGRA). Since that time he had traveled extensively including Europe and Asia.

Upon admission, physical examination showed decreased breath sounds and coarse crackles in the right lower lung field. His blood test results were unremarkable. Chest X-ray and CT scan showed diffuse reticular pattern and a 4 cm cavitary lesion in his right lower lobe (Image 1). Brochoalveolar lavage fluid, sputum as well as blood were submitted to microbiology lab for bacterial, fungal and mycobacterial culture.

Image1. Chest X-ray and CT showed diffuse reticular pattern with a 4cm cavitary lesion in his right lower lobe.

Laboratory results and management

The patient’s Quanti FERON®-TB Gold test (an IGRA) was positive.Laboratory studies including fungal culture to look for endemic fungi and HIV were negative. Auramine-rhodamine (acid fast) staining of sputum smear showed 4+ acid fast bacilli (AFB). Mycobacterium tuberculosis was confirmed by both our laboratory developed TB-PCR assay and a commercial TB-PCR assay (Xpert MTB/RIF). DNA sequencing was performed by the Centers for Disease Control and Prevention (CDC) in order to predict antibiotic susceptibility profiles for first-line anti-tuberculosis drugs including Ethambutol, Isoniazid, Pyrazinamide, and Rifampin. Because the result showed drug-susceptible tuberculosis, the patient started the first-line anti-tuberculosis drugs. Four days after admission, the patient discharged home with follow up with the department of health. After six weeks incubation, the sputum culture grew Mycobacterium tuberculosis with a pan-susceptible antibiotic profile.

Image 2. Ziehl-Neelsen stain of acid fast bacilli (AFB) on sputum smear. Image from the CDC website.

Discussion

Mycobacterium tuberculosis (MTB) remains a global health problem. The continuing spread of drug-resistant tuberculosis is one of the most difficult challenges for MTB control. The CDC recommends rapid laboratory confirmation of MTB with using a nucleic acid amplification test (NAAT), followed early drug susceptibility testing. Our case is consistent with the previous reports that NAAT can identify MTB and DNA sequencing can determine the drug susceptibility within a few days. Our case can be summarized into two points.

First, early NAAT provided diagnosis MTB within 2 days after patient admission, enabling the timely initialization of infection control measures. Although culture remains the gold standard for laboratory confirmation of active TB infection, it can take 6-8 weeks to grow in a culture media since MTB is slow growing pathogen. Early laboratory confirmation of MTB with NAAT led rapid initiation of the patient treatment and transmission interruption.

Second, DNA sequencing guided us to start an optimal anti-tuberculosis treatment within 3 days because of the accurate prediction of susceptibility profiles for first-line anti-tuberculosis drugs. In comparison, the conventional susceptibility testing with the drug-containing medium requires 1 month to complete beyond initial growth and identification of the organism. Recent studies demonstrated high accuracy of genotypic predictions (>91.3 % sensitivity; >93.6% specificity). Our case supports a theory that DNA sequencing can help to determine which anti-tuberculosis drugs should be used for treatment.

Despite the notable advantage, NAAT has limitations. There is a relatively low positive predictive value in smear-negative pulmonary MTB. Recent meta-analysis found that overall sensitivity of NAAT to be 90.4% for diagnosis of pulmonary MTB. The sensitivity of the NAAT further defined to be lower in smear negative (75%) compared to smear positive (98%) pulmonary MTB. Additionally, cost effectiveness of NAAT and DNA sequencing is another concern. Further assessments of the benefit of NAAT and DNA sequencing utilization for smear negative MTB are needed.

In conclusion, our case demonstrated that NAAT and DNA sequencing was beneficial to reduce the time to initiation of an optimal MTB management.

References

  1. Prediction of Susceptibility to First-Line Tuberculosis Drugs by DNA Sequencing. N Engl J Med 2018; 379: 1403-15.
  2. Use of Nucleic Acid Amplification Tests in Tuberculosis Patients in California, 2010-2013. Open Forum Infect Dis. 2016 Oct; 3(4): ofw230.
  3. Assessment by Meta-Analysis of PCR for Diagnosis of Smear-Negative Pulmonary Tuberculosis. J Clin Microbiol. 2003 Jul; 41(7): 3233-3240.

-Sachie Ikegami MD, PhD is a 1st year anatomic and clinical pathology resident at University of Chicago (NorthShore). Sachie’s academic interests include neuropathology and molecular pathology. She is passionate about understanding how pathology informatics improving clinical practice. Outside of the lab, she enjoys jogging.

-Erin McElvania, PhD, D(ABMM), is the Director of Clinical Microbiology NorthShore University Health System in Evanston, Illinois. Follow Dr. McElvania on twitter @E-McElvania. 

By the Numbers: Injuries and Exposures in the Lab

Finding information about the number of Laboratory Acquired Infections (LAIs) and other laboratory injuries in the United States is difficult. Many events are not reported, and of those that are reported at the facility level, only some are required to be reported to national agencies. A report by the CDC cites four studies that collectively identified 4,079 LAIs resulting in 168 deaths occurring between 1930 and 1978. Again, those are just the reported occurrences, and the data says nothing about other injuries in the lab such as slips, trips, and falls, or lacerations.

The Bureau of Labor Statistics (BLS) provides benchmark injury and exposure data for clinical laboratories, but this information too, is limited to that which is reported. That said, the information may still be of value—it can be used to compare your lab’s reportable injury data to labs across the nation. This can provide one form of assessing your overall lab safety.

The BLS provides annual clinical lab workplace injury data in the form of a rate. That rate is obtained via a calculation:

(Number of injuries and illnesses X 200,000) / Employee hours worked = Incidence rate

Incidence rates can be used to show a relative level of injuries and illnesses among different industries and within the same industry. Because a common base and a specific period of time are involved, these rates can help determine both problem areas and progress in preventing work-related injuries and illnesses. In this equation, the number of injuries and illnesses comes from your log of work-related incidents reported on your department’s OSHA 300 log. The worked hours from your lab should not include any non-work time (even if it is paid) such as vacation, sick leave, or holidays. You can estimate the worked hours on the basis of scheduled hours or eight hours per workday. The 200,000 is a constant—it represents the equivalent of 100 employees working 40 hours per week, 50 weeks per year, and provides the standard base for the incidence rates.

It takes time for national annual injury and illness rates to be calculated, so the most recent data from the BLS today is from the year 2018. Back in 2014 the rate for clinical labs was 3.4, and in 2015 it went down to 3.3. In fact, the BLS lab data shows a steady decline in reported incidents over the past twelve years. The most recent rate is 3.1. That’s good news that could mean that lab safety awareness is improving across the country.

How does your laboratory data compare to national numbers? It’s a good idea to use the calculation so that you can see how your lab is doing. If your injury, exposure and illness numbers are on the rise, it’s time to take action. Look for the causes of the incidents and implement methods of prevention. If you see a pattern of the same type of incidents, you may need to execute a safety stand-down around that specific process.

Now that you can compare your reportable data to a benchmark, what about the non-reportable events in your lab? They should get attention as well. Events like closing a finger in a drawer or cutting a finger on a clean microtome blade should always be reported to lab management and the occupational health department, but they may not be required to be reported elsewhere. They still need the same follow-up in the lab, however, and as a lab safety professional, you should be an integral part of the process to engender safety success in the lab.

While there is no national data to compare to for all types of lab injuries and exposures, it is still helpful to collect the information and calculate your lab’s rate. You can keep track of that overall rate and look for trends and make improvements on all incidents in the laboratory. Be sure to promote a culture of transparency and non-punitive reporting so that all lab accidents can be documented.

Knowing how many LAIs and other injuries in laboratories are occurring across the nation is no easy task. The best place to begin is within your own lab. Collect the data and become more familiar with this indicator that can guide you to the right path to improved employee safety in the lab.

Dan Scungio, MT(ASCP), SLS, CQA (ASQ) has over 25 years experience as a certified medical technologist. Today he is the Laboratory Safety Officer for Sentara Healthcare, a system of seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. He is also known as Dan the Lab Safety Man, a lab safety consultant, educator, and trainer.

Association for Molecular Pathology (AMP) – Another Valuable Membership for Technologists

This past November, I was lucky to attend the Association for Molecular Pathology (AMP) annual meeting held in Baltimore, MD. It was the 25th Anniversary of the association and it was interesting to see how it had grown over time. I went to a session moderated by members that had seen AMP in its infancy and it was remarkable to hear how the first meeting was a group of people that could fit in one of the small conference rooms, and how it had grown to offering this meeting for hundreds of people from all around the world. They have been on the forefront of the field of Molecular Diagnostics and have worked hard for many causes affecting those in the field. They discussed important events in the history of the association, such as when AMP, along with other groups, sued Myriad Genetics, Inc, on the practice of gene patenting. Myriad had filed patents for the BRCA1 and BRCA2 genes, and thus they were the only ones who could test those genes for patients. The Supreme Court ultimately ruled that genes are products of nature, which cannot be patented, and this has led to an increase in choice for patients. This, among many other activities, is the way AMP continues to impact the field. They even had a Day of Advocacy the day before the annual meeting began when a group traveled to nearby Washington D.C. to visit with lawmakers about current issues.

If you are a technologist working in a Molecular lab, this meeting is, I believe, the most relevant one for any technologist to attend. If you are not a member of AMP, consider this a shameless plug for membership. The great thing about it is that the association really does its best to be for every one of its members. At the annual meeting, there are sidebars for each type of member, from technologist to trainees, to pathologists. I attended a lunch for trainees and technologists that included two speakers that described their journey through their different careers in the field. They were available to speak with after the session as well. I also attended an informal talk on the exhibit floor that explained the tools available for technologists through AMP, such as the technologist list serve, where I can email every technologist on the membership list for AMP if I have any questions or issues. They also described the website that guides techs to different types of certification tests and links to study guides. These were both great places to network with other technologists as well. The best thing about a technologist membership? It’s discounted compared to the pathologist membership – it’s only $75 a year and provides access to an account that has continuing education opportunities, as well as a digital subscription to the Journal of Molecular Diagnostics. Besides my membership to ASCP, I believe being an AMP member is key to staying up to date in this amazing field.

rapp_small

-Sharleen Rapp, BS, MB (ASCP)CM is a Molecular Diagnostics Coordinator in the Molecular Diagnostics Laboratory at Nebraska Medicine.