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- Title
FAILURE RATES OF CULTURED LYMPH NODE SPECIMENS FOR CYTOGENETIC ANALYSIS OVER A FIVE-YEAR PERIOD AT DANBURY HOSPITAL: A QUALITY MANAGEMENT ASSESSMENT TOOL.
- Authors
Birusingh, Rhea J.; Arsham, Marilyn; Delayo, Julia; Adomaitis, Laura; Katz, Jennifer; Ligi, Richard; Siddiqui, Rina
- Abstract
Genetic testing is a rapidly growing field in laboratory medicine with expanding clinical implications. As new technologies are added to the already broad array of available diagnostic tests, laboratories performing these tests must maintain an extremely high standard of quality management. A systematic approach to quality management and improvement within the laboratory at Danbury Hospital is rigorously pursued, as the laboratory's goal is to offer optimal patient care. This study examines one quality management tool that is utilized by the College of American Pathologists (CAP) Inspection Team. The focus of this project was to evaluate the failure rate of lymph nodes as a quality management tool because of its critical yet varying parameters in defining and following protocol, such as: specimen collection; transportation; storage and processing; compliance; and documentation of failures and subsequent corrective actions. These variables are the major components in determining optimal standard operating procedures, which are the foundation of an effective quality management program. Quality management data were reviewed for lymph node specimens received by the cytogenetics laboratory at Danbury Hospital over a five-year period, from 2003-2007. The total number of lymph nodes along with the failure rates (i.e., cells from lymph nodes that failed to yield metaphase chromosomes) was tabulated by year. Of 313 lymph nodes (or tumor specimens utilizing similar processing procedures) received during this period, 47 failed to yield results, or 15%. The most common cause for failure was inadequate specimen quantity, which was found in 19/47 cases, or 40%. The second cause, transport delay (e.g., specimen was received or processed a minimum of one day after it was obtained) with or without quantity or quality inadequacies, was found in 12/47 or 26%. Poor specimen quality (e.g., necrotic, inked, dense or hard texture) was third, 8/47 or 17%. A combination of quantitative and qualitative inadequacy was noted in 1/47 or 2%; the same percentage was noted due to procurement error. The remaining cases, 6/47 or 13%, were presumed to be of sufficient quality and quantity; however, metaphases were not seen after processing. The causes for these specimen failures are thus unknown. The lack of similar reports on this subject matter in our review of the literature supports the need for such investigation. Successful cytogenetic analysis of lymph nodes depends directly upon the presence of viable, dividing cells in the sample and optimal chromosome processing. Tests performed are highly specialized; thus, strict adherence to established guidelines must be enforced and monitored. The low failure rate observed in this study exemplifies the laboratory's commendable adherence to standard operating procedures.
- Subjects
DANBURY (Conn.); CONNECTICUT; LYMPH nodes; HUMAN chromosome abnormality diagnosis; GENETIC testing; CLINICAL pathology; HOSPITAL care -- Quality control; HOSPITALS
- Publication
Connecticut Medicine, 2009, Vol 73, Issue 1, p15
- ISSN
0010-6178
- Publication type
Article