Effective August 1, 2010 CIGNA providers and members in Illinois and Indiana will have access to the full test menu of laboratory services provided by Alverno Clinical Laboratories.
Alverno is dedicated to providing high quality, cost effective testing with a focus on service.
Alverno offers an extensive network of conveniently located Patient Service Centers. Our Patient Service Centers are staffed by skilled phlebotomists and offer wait times of less than 15 minutes.
If you would like additional information about the services we offer or to schedule a sales visit, please call Client Services at 800-937-5521.
Reshma Ariga, M.D., is certified by the American Board of Pathology. Dr. Ariga completed her residency at Rush University Medical Center, Anatomic & Clinical Pathology.
Vitamin D testing is useful for diagnosing vitamin D deficiency, rickets, osteomalacia, hypervitaminosis D, and monitoring of vitamin D replacement therapy. The measurement of 25-hydroxy-vitamin D in the serum is the best indicator of vitamin D nutritional status. Alverno Clinical Laboratories is now offering the 25-hydroxy-vitamin D total assay using a chemiluminescent immunoassay for quantitative determination. Vitamin D is a fat-soluble vitamin that plays a role in calcium metabolism. It is derived from dietary ergocalciferol (from plants, in the form of vitamin D2) or cholecalciferol (from animals, in the form of vitamin D3), or by conversion of 7-dihydrocholesterol to vitamin D3 in the skin upon ultraviolet exposure. It is subsequently converted to 25-hydroxy-vitamin D in the liver, and to its active metabolite 1,25-dihydroxy-vitamin D in the kidney, which binds to receptors that regulate calcium and phosphorus metabolism1. 25-hydroxy-vitamin D is the major circulating form of the vitamin and the best indicator of vitamin D status. The exact level reflecting optimal body stores remains unknown, and is dependent on test methodology and population. Severe deficiency (<10 ng/mL) may lead to rickets in children and osteomalacia in adults. Mild-to-moderate deficiency (10-30 ng/mL) can be associated with osteoporosis or secondary hyperparathyroidism. Suboptimal 25-hydroxy-vitamin D levels may occur due to lack of sunshine exposure, inadequate intake, malabsorption, depressed hepatic vitamin D 25-hydroxylase activity, advanced liver disease and enzyme-inducing drugs that increase its metabolism. In contrast, hypervitaminosis D (>100 ng/mL) is rare, and is seen only after prolonged exposure to extremely high doses of vitamin D; it can result in severe hypercalcemia and hyperphosphatemia2. Recent research has linked vitamin D deficiency to a wide variety of other disease states. Monitoring vitamin D status offers patients one potential option to reduce a possible source of risk for common disorders like depression, cancer, heart attack and diabetes. Circulating 25-hydroxy-vitamin D measurement thus offers an important clinical tool in the diagnosis, management and prevention of a variety of disease states. As new studies reveal expanding roles for this vitamin, more clinicians are seeing the potential benefits of assessing vitamin D status among patients of all ages on a regular, continuing basis. References: 1.Lynn Stiff, BS, and Sharon M. Miller, PhC, MT(ASCP), CLS(NCA). Vitamin D: bringing light to the issue. Med. Lab. Observer. June 2009 2. James H. Nichols, Ph.D., DABCC, FACB.Vitamin D Lab Testing. Washington G-2 report. June 2010 For more information about Drs. Ariga, Roberts or Shearon, visit Pathology Consultants, Inc. Elisabeth Shearon, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Fellowship Training in Breast Pathology from the Lynn Sage Breast Center of Northwestern Memorial Hospital. Basal-Like Carcinoma of the Breast Basal-like carcinoma of the breast represents a certain subset of infiltrating mammary carcinoma, accounting for approximately 8-20% of invasive breast carcinomas. Histologically, these tumors grow in sheets with little to no tubule formation, have a high mitotic activity, a high nuclear grade, and show apoptotic changes. Often, pushing borders, central necrosis, and a brisk peri-tumoral stromal lymphocytic response is seen. Typically, these tumors are "triple negative" (negative for ER, PR, and HER2) but also express basal keratins (CK5/6), EGFR, and often p53 as demonstrated by immunohistochemistry. By definition, these tumors have the gene expression profile of basal-like tumors which is not seen in all triple negative tumors, thus distinguishing themselves as a specific subtype of breast carcinomas. Clinically, these tumors are more aggressive than other triple negative tumors and have a poor prognosis. Treatment tailored to this subset of breast carcinomas has yet to be established, yet with increased, diagnosis, clinical recognition, and outcome observation, altered treatment options may be developed. Elisabeth C .Shearon, M.D. Tests performed at Alverno for the diagnosis and treatment of breast cancer: Estrogen and progesterone receptor status (ER and PR) by automated cellular imaging (immunohistochemical analysis) HER2 over-expression by automated cellular imaging (immunohistochemical analysis) HER2 over-expression confirmation by FISH (fluorescence in situ hybridization) _______________________________________________________________________________ Thomas Roberts, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Certification in Radioisotopic Pathology and additional Qualification in Cytopathology. The past decade has seen continuing evolution of the role of Human Papilloma Virus testing in the detection of pre-cancerous lesions of the cervix. Testing for high-risk HPV is now widely recognized as an invaluable partner with cytology for detection of precancerous cervical disease. HR-HPV testing by hybrid capture (Digene®) is 95% sensitive for the detection of cervical intraepithelial neoplasma (CIN) 2,3 cervical disease contrasted with 55% sensitivity for cytology. This comes with only a 4% loss of specificity (“false positives” that might prompt unnecessary colposcopy). Current recommendations for the routine use of HR-HPV testing in addition to cytology are: · Triage for a cytologic diagnosis of ASC-US in women over 20 · Combination with liquid-based cytology for routine screening in women over 30 Women over 30 with both negative cytology and negative HR-HPV are nearly 100% certain not to develop CIN 2,3 over the next 3 years. Based on this, it is possible to safely extend screening intervals up to 3 years for this group. The frequency of a negative cytology with a positive test for HR-HPV in the over 30 group is only 4%. Such women can safely be followed with a repeat HR-HPV at 12 months without need for immediate colposcopy. Three important caveats in the role of HR-HPV in detection and management of precancerous cervical disease are: · There is no need for HR-HPV testing in adolescents · There is no role for low-risk HPV testing in precancerous disease of the cervix · There is no indication for HR-HPV testing in LSIL, HSIL, or malignant cytology of the cervix (Nearly all positive for presence of HPV which is irrelevant to management) Future developments in HPV testing lie in improved sensitivity through the addition of more carcinogenic HPV genotypes to screening and testing for specific high-risk genotypes (16,18) to improve risk stratification and reduce unnecessary interventions.
The measurement of 25-hydroxy-vitamin D in the serum is the best indicator of vitamin D nutritional status. Alverno Clinical Laboratories is now offering the 25-hydroxy-vitamin D total assay using a chemiluminescent immunoassay for quantitative determination.
Vitamin D is a fat-soluble vitamin that plays a role in calcium metabolism. It is derived from dietary ergocalciferol (from plants, in the form of vitamin D2) or cholecalciferol (from animals, in the form of vitamin D3), or by conversion of 7-dihydrocholesterol to vitamin D3 in the skin upon ultraviolet exposure. It is subsequently converted to 25-hydroxy-vitamin D in the liver, and to its active metabolite 1,25-dihydroxy-vitamin D in the kidney, which binds to receptors that regulate calcium and phosphorus metabolism1. 25-hydroxy-vitamin D is the major circulating form of the vitamin and the best indicator of vitamin D status. The exact level reflecting optimal body stores remains unknown, and is dependent on test methodology and population. Severe deficiency (<10 ng/mL) may lead to rickets in children and osteomalacia in adults. Mild-to-moderate deficiency (10-30 ng/mL) can be associated with osteoporosis or secondary hyperparathyroidism. Suboptimal 25-hydroxy-vitamin D levels may occur due to lack of sunshine exposure, inadequate intake, malabsorption, depressed hepatic vitamin D 25-hydroxylase activity, advanced liver disease and enzyme-inducing drugs that increase its metabolism. In contrast, hypervitaminosis D (>100 ng/mL) is rare, and is seen only after prolonged exposure to extremely high doses of vitamin D; it can result in severe hypercalcemia and hyperphosphatemia2. Recent research has linked vitamin D deficiency to a wide variety of other disease states. Monitoring vitamin D status offers patients one potential option to reduce a possible source of risk for common disorders like depression, cancer, heart attack and diabetes. Circulating 25-hydroxy-vitamin D measurement thus offers an important clinical tool in the diagnosis, management and prevention of a variety of disease states. As new studies reveal expanding roles for this vitamin, more clinicians are seeing the potential benefits of assessing vitamin D status among patients of all ages on a regular, continuing basis. References: 1.Lynn Stiff, BS, and Sharon M. Miller, PhC, MT(ASCP), CLS(NCA). Vitamin D: bringing light to the issue. Med. Lab. Observer. June 2009 2. James H. Nichols, Ph.D., DABCC, FACB.Vitamin D Lab Testing. Washington G-2 report. June 2010 For more information about Drs. Ariga, Roberts or Shearon, visit Pathology Consultants, Inc. Elisabeth Shearon, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Fellowship Training in Breast Pathology from the Lynn Sage Breast Center of Northwestern Memorial Hospital. Basal-Like Carcinoma of the Breast Basal-like carcinoma of the breast represents a certain subset of infiltrating mammary carcinoma, accounting for approximately 8-20% of invasive breast carcinomas. Histologically, these tumors grow in sheets with little to no tubule formation, have a high mitotic activity, a high nuclear grade, and show apoptotic changes. Often, pushing borders, central necrosis, and a brisk peri-tumoral stromal lymphocytic response is seen. Typically, these tumors are "triple negative" (negative for ER, PR, and HER2) but also express basal keratins (CK5/6), EGFR, and often p53 as demonstrated by immunohistochemistry. By definition, these tumors have the gene expression profile of basal-like tumors which is not seen in all triple negative tumors, thus distinguishing themselves as a specific subtype of breast carcinomas. Clinically, these tumors are more aggressive than other triple negative tumors and have a poor prognosis. Treatment tailored to this subset of breast carcinomas has yet to be established, yet with increased, diagnosis, clinical recognition, and outcome observation, altered treatment options may be developed. Elisabeth C .Shearon, M.D. Tests performed at Alverno for the diagnosis and treatment of breast cancer: Estrogen and progesterone receptor status (ER and PR) by automated cellular imaging (immunohistochemical analysis) HER2 over-expression by automated cellular imaging (immunohistochemical analysis) HER2 over-expression confirmation by FISH (fluorescence in situ hybridization) _______________________________________________________________________________ Thomas Roberts, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Certification in Radioisotopic Pathology and additional Qualification in Cytopathology. The past decade has seen continuing evolution of the role of Human Papilloma Virus testing in the detection of pre-cancerous lesions of the cervix. Testing for high-risk HPV is now widely recognized as an invaluable partner with cytology for detection of precancerous cervical disease. HR-HPV testing by hybrid capture (Digene®) is 95% sensitive for the detection of cervical intraepithelial neoplasma (CIN) 2,3 cervical disease contrasted with 55% sensitivity for cytology. This comes with only a 4% loss of specificity (“false positives” that might prompt unnecessary colposcopy). Current recommendations for the routine use of HR-HPV testing in addition to cytology are: · Triage for a cytologic diagnosis of ASC-US in women over 20 · Combination with liquid-based cytology for routine screening in women over 30 Women over 30 with both negative cytology and negative HR-HPV are nearly 100% certain not to develop CIN 2,3 over the next 3 years. Based on this, it is possible to safely extend screening intervals up to 3 years for this group. The frequency of a negative cytology with a positive test for HR-HPV in the over 30 group is only 4%. Such women can safely be followed with a repeat HR-HPV at 12 months without need for immediate colposcopy. Three important caveats in the role of HR-HPV in detection and management of precancerous cervical disease are: · There is no need for HR-HPV testing in adolescents · There is no role for low-risk HPV testing in precancerous disease of the cervix · There is no indication for HR-HPV testing in LSIL, HSIL, or malignant cytology of the cervix (Nearly all positive for presence of HPV which is irrelevant to management) Future developments in HPV testing lie in improved sensitivity through the addition of more carcinogenic HPV genotypes to screening and testing for specific high-risk genotypes (16,18) to improve risk stratification and reduce unnecessary interventions.
25-hydroxy-vitamin D is the major circulating form of the vitamin and the best indicator of vitamin D status. The exact level reflecting optimal body stores remains unknown, and is dependent on test methodology and population. Severe deficiency (<10 ng/mL) may lead to rickets in children and osteomalacia in adults. Mild-to-moderate deficiency (10-30 ng/mL) can be associated with osteoporosis or secondary hyperparathyroidism. Suboptimal 25-hydroxy-vitamin D levels may occur due to lack of sunshine exposure, inadequate intake, malabsorption, depressed hepatic vitamin D 25-hydroxylase activity, advanced liver disease and enzyme-inducing drugs that increase its metabolism. In contrast, hypervitaminosis D (>100 ng/mL) is rare, and is seen only after prolonged exposure to extremely high doses of vitamin D; it can result in severe hypercalcemia and hyperphosphatemia2. Recent research has linked vitamin D deficiency to a wide variety of other disease states. Monitoring vitamin D status offers patients one potential option to reduce a possible source of risk for common disorders like depression, cancer, heart attack and diabetes. Circulating 25-hydroxy-vitamin D measurement thus offers an important clinical tool in the diagnosis, management and prevention of a variety of disease states. As new studies reveal expanding roles for this vitamin, more clinicians are seeing the potential benefits of assessing vitamin D status among patients of all ages on a regular, continuing basis. References: 1.Lynn Stiff, BS, and Sharon M. Miller, PhC, MT(ASCP), CLS(NCA). Vitamin D: bringing light to the issue. Med. Lab. Observer. June 2009 2. James H. Nichols, Ph.D., DABCC, FACB.Vitamin D Lab Testing. Washington G-2 report. June 2010 For more information about Drs. Ariga, Roberts or Shearon, visit Pathology Consultants, Inc. Elisabeth Shearon, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Fellowship Training in Breast Pathology from the Lynn Sage Breast Center of Northwestern Memorial Hospital. Basal-Like Carcinoma of the Breast Basal-like carcinoma of the breast represents a certain subset of infiltrating mammary carcinoma, accounting for approximately 8-20% of invasive breast carcinomas. Histologically, these tumors grow in sheets with little to no tubule formation, have a high mitotic activity, a high nuclear grade, and show apoptotic changes. Often, pushing borders, central necrosis, and a brisk peri-tumoral stromal lymphocytic response is seen. Typically, these tumors are "triple negative" (negative for ER, PR, and HER2) but also express basal keratins (CK5/6), EGFR, and often p53 as demonstrated by immunohistochemistry. By definition, these tumors have the gene expression profile of basal-like tumors which is not seen in all triple negative tumors, thus distinguishing themselves as a specific subtype of breast carcinomas. Clinically, these tumors are more aggressive than other triple negative tumors and have a poor prognosis. Treatment tailored to this subset of breast carcinomas has yet to be established, yet with increased, diagnosis, clinical recognition, and outcome observation, altered treatment options may be developed. Elisabeth C .Shearon, M.D. Tests performed at Alverno for the diagnosis and treatment of breast cancer: Estrogen and progesterone receptor status (ER and PR) by automated cellular imaging (immunohistochemical analysis) HER2 over-expression by automated cellular imaging (immunohistochemical analysis) HER2 over-expression confirmation by FISH (fluorescence in situ hybridization) _______________________________________________________________________________ Thomas Roberts, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Certification in Radioisotopic Pathology and additional Qualification in Cytopathology. The past decade has seen continuing evolution of the role of Human Papilloma Virus testing in the detection of pre-cancerous lesions of the cervix. Testing for high-risk HPV is now widely recognized as an invaluable partner with cytology for detection of precancerous cervical disease. HR-HPV testing by hybrid capture (Digene®) is 95% sensitive for the detection of cervical intraepithelial neoplasma (CIN) 2,3 cervical disease contrasted with 55% sensitivity for cytology. This comes with only a 4% loss of specificity (“false positives” that might prompt unnecessary colposcopy). Current recommendations for the routine use of HR-HPV testing in addition to cytology are: · Triage for a cytologic diagnosis of ASC-US in women over 20 · Combination with liquid-based cytology for routine screening in women over 30 Women over 30 with both negative cytology and negative HR-HPV are nearly 100% certain not to develop CIN 2,3 over the next 3 years. Based on this, it is possible to safely extend screening intervals up to 3 years for this group. The frequency of a negative cytology with a positive test for HR-HPV in the over 30 group is only 4%. Such women can safely be followed with a repeat HR-HPV at 12 months without need for immediate colposcopy. Three important caveats in the role of HR-HPV in detection and management of precancerous cervical disease are: · There is no need for HR-HPV testing in adolescents · There is no role for low-risk HPV testing in precancerous disease of the cervix · There is no indication for HR-HPV testing in LSIL, HSIL, or malignant cytology of the cervix (Nearly all positive for presence of HPV which is irrelevant to management) Future developments in HPV testing lie in improved sensitivity through the addition of more carcinogenic HPV genotypes to screening and testing for specific high-risk genotypes (16,18) to improve risk stratification and reduce unnecessary interventions.
The exact level reflecting optimal body stores remains unknown, and is dependent on test methodology and population. Severe deficiency (<10 ng/mL) may lead to rickets in children and osteomalacia in adults. Mild-to-moderate deficiency (10-30 ng/mL) can be associated with osteoporosis or secondary hyperparathyroidism. Suboptimal 25-hydroxy-vitamin D levels may occur due to lack of sunshine exposure, inadequate intake, malabsorption, depressed hepatic vitamin D 25-hydroxylase activity, advanced liver disease and enzyme-inducing drugs that increase its metabolism. In contrast, hypervitaminosis D (>100 ng/mL) is rare, and is seen only after prolonged exposure to extremely high doses of vitamin D; it can result in severe hypercalcemia and hyperphosphatemia2. Recent research has linked vitamin D deficiency to a wide variety of other disease states. Monitoring vitamin D status offers patients one potential option to reduce a possible source of risk for common disorders like depression, cancer, heart attack and diabetes. Circulating 25-hydroxy-vitamin D measurement thus offers an important clinical tool in the diagnosis, management and prevention of a variety of disease states. As new studies reveal expanding roles for this vitamin, more clinicians are seeing the potential benefits of assessing vitamin D status among patients of all ages on a regular, continuing basis. References: 1.Lynn Stiff, BS, and Sharon M. Miller, PhC, MT(ASCP), CLS(NCA). Vitamin D: bringing light to the issue. Med. Lab. Observer. June 2009 2. James H. Nichols, Ph.D., DABCC, FACB.Vitamin D Lab Testing. Washington G-2 report. June 2010 For more information about Drs. Ariga, Roberts or Shearon, visit Pathology Consultants, Inc. Elisabeth Shearon, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Fellowship Training in Breast Pathology from the Lynn Sage Breast Center of Northwestern Memorial Hospital. Basal-Like Carcinoma of the Breast Basal-like carcinoma of the breast represents a certain subset of infiltrating mammary carcinoma, accounting for approximately 8-20% of invasive breast carcinomas. Histologically, these tumors grow in sheets with little to no tubule formation, have a high mitotic activity, a high nuclear grade, and show apoptotic changes. Often, pushing borders, central necrosis, and a brisk peri-tumoral stromal lymphocytic response is seen. Typically, these tumors are "triple negative" (negative for ER, PR, and HER2) but also express basal keratins (CK5/6), EGFR, and often p53 as demonstrated by immunohistochemistry. By definition, these tumors have the gene expression profile of basal-like tumors which is not seen in all triple negative tumors, thus distinguishing themselves as a specific subtype of breast carcinomas. Clinically, these tumors are more aggressive than other triple negative tumors and have a poor prognosis. Treatment tailored to this subset of breast carcinomas has yet to be established, yet with increased, diagnosis, clinical recognition, and outcome observation, altered treatment options may be developed. Elisabeth C .Shearon, M.D. Tests performed at Alverno for the diagnosis and treatment of breast cancer: Estrogen and progesterone receptor status (ER and PR) by automated cellular imaging (immunohistochemical analysis) HER2 over-expression by automated cellular imaging (immunohistochemical analysis) HER2 over-expression confirmation by FISH (fluorescence in situ hybridization) _______________________________________________________________________________ Thomas Roberts, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Certification in Radioisotopic Pathology and additional Qualification in Cytopathology.
Recent research has linked vitamin D deficiency to a wide variety of other disease states. Monitoring vitamin D status offers patients one potential option to reduce a possible source of risk for common disorders like depression, cancer, heart attack and diabetes. Circulating 25-hydroxy-vitamin D measurement thus offers an important clinical tool in the diagnosis, management and prevention of a variety of disease states. As new studies reveal expanding roles for this vitamin, more clinicians are seeing the potential benefits of assessing vitamin D status among patients of all ages on a regular, continuing basis. References: 1.Lynn Stiff, BS, and Sharon M. Miller, PhC, MT(ASCP), CLS(NCA). Vitamin D: bringing light to the issue. Med. Lab. Observer. June 2009 2. James H. Nichols, Ph.D., DABCC, FACB.Vitamin D Lab Testing. Washington G-2 report. June 2010 For more information about Drs. Ariga, Roberts or Shearon, visit Pathology Consultants, Inc. Elisabeth Shearon, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Fellowship Training in Breast Pathology from the Lynn Sage Breast Center of Northwestern Memorial Hospital. Basal-Like Carcinoma of the Breast Basal-like carcinoma of the breast represents a certain subset of infiltrating mammary carcinoma, accounting for approximately 8-20% of invasive breast carcinomas. Histologically, these tumors grow in sheets with little to no tubule formation, have a high mitotic activity, a high nuclear grade, and show apoptotic changes. Often, pushing borders, central necrosis, and a brisk peri-tumoral stromal lymphocytic response is seen. Typically, these tumors are "triple negative" (negative for ER, PR, and HER2) but also express basal keratins (CK5/6), EGFR, and often p53 as demonstrated by immunohistochemistry. By definition, these tumors have the gene expression profile of basal-like tumors which is not seen in all triple negative tumors, thus distinguishing themselves as a specific subtype of breast carcinomas. Clinically, these tumors are more aggressive than other triple negative tumors and have a poor prognosis. Treatment tailored to this subset of breast carcinomas has yet to be established, yet with increased, diagnosis, clinical recognition, and outcome observation, altered treatment options may be developed. Elisabeth C .Shearon, M.D. Tests performed at Alverno for the diagnosis and treatment of breast cancer: Estrogen and progesterone receptor status (ER and PR) by automated cellular imaging (immunohistochemical analysis) HER2 over-expression by automated cellular imaging (immunohistochemical analysis) HER2 over-expression confirmation by FISH (fluorescence in situ hybridization) _______________________________________________________________________________ Thomas Roberts, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Certification in Radioisotopic Pathology and additional Qualification in Cytopathology.
Circulating 25-hydroxy-vitamin D measurement thus offers an important clinical tool in the diagnosis, management and prevention of a variety of disease states. As new studies reveal expanding roles for this vitamin, more clinicians are seeing the potential benefits of assessing vitamin D status among patients of all ages on a regular, continuing basis.
References:
1.Lynn Stiff, BS, and Sharon M. Miller, PhC, MT(ASCP), CLS(NCA). Vitamin D: bringing light to the issue. Med. Lab. Observer. June 2009
2. James H. Nichols, Ph.D., DABCC, FACB.Vitamin D Lab Testing. Washington G-2 report. June 2010
Elisabeth Shearon, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Fellowship Training in Breast Pathology from the Lynn Sage Breast Center of Northwestern Memorial Hospital.
Basal-like carcinoma of the breast represents a certain subset of infiltrating mammary carcinoma, accounting for approximately 8-20% of invasive breast carcinomas. Histologically, these tumors grow in sheets with little to no tubule formation, have a high mitotic activity, a high nuclear grade, and show apoptotic changes. Often, pushing borders, central necrosis, and a brisk peri-tumoral stromal lymphocytic response is seen. Typically, these tumors are "triple negative" (negative for ER, PR, and HER2) but also express basal keratins (CK5/6), EGFR, and often p53 as demonstrated by immunohistochemistry. By definition, these tumors have the gene expression profile of basal-like tumors which is not seen in all triple negative tumors, thus distinguishing themselves as a specific subtype of breast carcinomas. Clinically, these tumors are more aggressive than other triple negative tumors and have a poor prognosis. Treatment tailored to this subset of breast carcinomas has yet to be established, yet with increased, diagnosis, clinical recognition, and outcome observation, altered treatment options may be developed.
Elisabeth C .Shearon, M.D.
Estrogen and progesterone receptor status (ER and PR) by automated cellular imaging (immunohistochemical analysis)
HER2 over-expression by automated cellular imaging (immunohistochemical analysis)
HER2 over-expression confirmation by FISH (fluorescence in situ hybridization)
_______________________________________________________________________________
Thomas Roberts, M.D. is certified by the American Board of Pathology, Anatomic and Clinical Pathology, with Subspecialty Certification in Radioisotopic Pathology and additional Qualification in Cytopathology.
The past decade has seen continuing evolution of the role of Human Papilloma Virus testing in the detection of pre-cancerous lesions of the cervix. Testing for high-risk HPV is now widely recognized as an invaluable partner with cytology for detection of precancerous cervical disease. HR-HPV testing by hybrid capture (Digene®) is 95% sensitive for the detection of cervical intraepithelial neoplasma (CIN) 2,3 cervical disease contrasted with 55% sensitivity for cytology. This comes with only a 4% loss of specificity (“false positives” that might prompt unnecessary colposcopy). Current recommendations for the routine use of HR-HPV testing in addition to cytology are:
· Triage for a cytologic diagnosis of ASC-US in women over 20
· Combination with liquid-based cytology for routine screening in women over 30
Women over 30 with both negative cytology and negative HR-HPV are nearly 100% certain not to develop CIN 2,3 over the next 3 years. Based on this, it is possible to safely extend screening intervals up to 3 years for this group. The frequency of a negative cytology with a positive test for HR-HPV in the over 30 group is only 4%. Such women can safely be followed with a repeat HR-HPV at 12 months without need for immediate colposcopy.
Three important caveats in the role of HR-HPV in detection and management of precancerous cervical disease are:
· There is no need for HR-HPV testing in adolescents
· There is no role for low-risk HPV testing in precancerous disease of the cervix
· There is no indication for HR-HPV testing in LSIL, HSIL, or malignant cytology of the cervix (Nearly all positive for presence of HPV which is irrelevant to management)
Future developments in HPV testing lie in improved sensitivity through the addition of more carcinogenic HPV genotypes to screening and testing for specific high-risk genotypes (16,18) to improve risk stratification and reduce unnecessary interventions.
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