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* Context.--Quality measures that are supported by evidence-based clinical practice guidelines are preferred for assessing the quality of pathologists' practices. Careful testing of a measure ensures that scores obtained by that measure reflect the quality of a pathologist's practice. Objective.--To specify a new quality measure and to demonstrate through testing that it is suitable for measuring pathologists' appropriate incorporation of information regarding microsatellite instability (MSI) and/or mismatch repair (MMR) status in pathology reports for colorectal, endometrial, gastroesophageal, and small bowel carcinoma. Design.--The College of American Pathologists collaborated with the American Gastroenterological Association to specify and test the new measure. Face validity testing was used to investigate the validity of the measure. Feasibility testing was conducted to understand if data elements required by the measure specification were readily acces sible. Signal-to-noise analysis was used to characterize the measure's reliability. Results.--Guideline recommendations for MSI and/or MMR testing supported specifications for the measure. Face validity testing indicated that the measure could distinguish the quality of care provided. Data elements required by the measure specification were found to be accessible, which supported the measure's feasibility. Reliability testing showed that differences in measure score were attributable to real differences in performance rather than random variation in scoring. Conclusions.--The Mismatch Repair or Microsatellite Instability Biomarker Testing Status in Colorectal Carcinoma, Endometrial, Gastroesophageal, or Small Bowel Carcinoma measure was appropriately specified, and testing demonstrated that it is well suited for characterizing the quality of pathologists' communication of MMR and/or MSI status. (Arch Pathol Lab Med. 2024;148:728-734; doi: 10.5858/arpa.2022-0418-OA), The Medicare Access and CHIP Reauthorization Act of 2015 established the Quality Payment Program (QPP), which allowed for adjustments to reimbursement based on a provider's demonstration of quality and cost [...]

ATRX is one of the most frequently altered genes in solid tumors, and mutation is especially frequent in soft tissue sarcomas. However, the role of ATRX in tumor development and response to cancer therapies remains poorly understood. Here, we developed a primary mouse model of soft tissue sarcoma and showed that Atrx-deleted tumors were more sensitive to radiation therapy and to oncolytic herpesvirus. In the absence of Atrx, irradiated sarcomas had increased persistent DNA damage, telomere dysfunction, and mitotic catastrophe. Our work also showed that Atrx deletion resulted in downregulation of the CGAS/STING signaling pathway at multiple points in the pathway and was not driven by mutations or transcriptional downregulation of the CGAS/STING pathway components. We found that both human and mouse models of Atrx-deleted sarcoma had a reduced adaptive immune response, markedly impaired CGAS/STING signaling, and increased sensitivity to TVEC, an oncolytic herpesvirus that is currently FDA approved for the treatment of aggressive melanomas. Translation of these results to patients with ATRX-mutant cancers could enable genomically guided cancer therapy approaches to improve patient outcomes., Introduction ATRX, or [alpha]-thalassemia/mental retardation, X-linked, is a chromatin remodeling protein and tumor suppressor, with mutations or copy number alterations occurring in approximately 6% of the more than 65,163 tumors [...]

Purpose. Recently, the association between ATRX and a more aggressive sarcoma phenotype has been shown. We performed a retrospective study of sarcomas from an individual institution to evaluate ATRX as a prognosticator in soft tissue sarcoma. Experimental Design. 128 sarcomas were collected from a single institution and stained for ATRX. The prognostic significance of these markers was evaluated in a smaller cohort of primary soft tissue sarcomas (n = 68). Kaplan–Meier curves were created for univariate analysis, and Cox regression was utilized for multivariate analysis. Results. High expression of ATRX was found to be a positive prognostic indicator for overall survival and metastasis-free survival in our group of soft tissue sarcomas both in univariate analysis and multivariate analysis (HR: 0.38 (0.17–0.85), P = 0.02 and HR: 0.49 (0.24–0.99), P = 0.05 , respectively). Conclusions. High expression of ATRX is a positive prognostic indicator of overall survival and metastasis-free survival in patients with STS. This is consistent with studies in osteosarcoma, which indicate possible mechanisms through which loss of ATRX leads to more aggressive phenotypes. Future prospective clinical studies are required to validate the prognostic significance of these findings. [ABSTRACT FROM AUTHOR]

* Context.--Quality measures are a cornerstone in measuring physicians' performance within the Centers for Medicare & Medicaid Services' Quality Payment Program (QPP). Clinicians' performance on quality measures and other categories within the QPP determines Medicare part B payment adjustments. Driven by evidence-based clinical practice guidelines, quality measures should focus on high-priority facets of health care, support a desired patient outcome, and address an area with evidence of a gap or variation in provider performance. Objective.--To meet the goals of the QPP, a broad array of quality measures must be developed that allows pathologists the flexibility to choose activities and measures most meaningful to their practice and patient population while also trying to mitigate the challenges of implementation and data collection. Design.--In this second manuscript of the series, we present the development of additional College of American Pathologists-developed quality payment measures for use in the QPP. We also discuss the relationship of quality measure reporting with reimbursement and the challenges with capturing data for quality reporting. Results.--The College of American Pathologists identified 23 new measures for quality performance reporting that reflect rigorous clinical evidence and address areas in need of performance improvement. Conclusions.--Development of quality measures is a necessary and ongoing effort within the College of American Pathologists. Increased awareness about pathology-specific issues in measure development and reporting is essential to ensuring pathology's ability to demonstrate value and meaningfully participate in the QPP. (Arch Pathol Lab Med. 2020;144:697-705; doi: 10.5858/arpa.2019-0378-OA), The Medicare Access and CHIP Reauthorization Act of 2015 led to the creation of a new Quality Payment Program for the Centers for Medicare & Medicaid Services (CMS), which has [...]

* Context.--Quality measures assess health care processes, outcomes, and patient perceptions associated with high-quality health care, which is commonly defined as care that is effective, safe, efficient, patient centered, equitable, and timely. Such measures are now being used in order to incentivize provision of high-quality health care. Objective.--To meet the goals of the Quality Payment Program, quality measures will be developed from clinical practice guidelines and relevant, peer-reviewed research identifying evidence that the measure addresses 3 areas: a high-priority aspect of health care or a specific national health goal or priority; a meaningful focus, such as leading to a desired health outcome; and a gap or variation in care. Design.--Within the College of American Pathologists (CAP), the Measures and Performance Assessment Subcommittee is tasked with developing useful performance measures. Participating practitioners can then select measures that are meaningful to their respective patients and practices, and reflect the quality of the services they provide. Results.--The CAP developed 23 quality measures for reporting to the Centers for Medicare & Medicaid Services that reflect rigorous clinical evidence and address areas in need of performance improvement. Conclusions.--Because the implications of reporting on these pathology-specific metrics are significant, these measures and the process by which they were designed are presented here in peer-reviewed fashion. The measures described in this article (part 1) represent recent efforts by the CAP to develop meaningful measures that reflect rigorous clinical evidence and highlight areas with opportunities for performance improvement. (Arch Pathol Lab Med. 2020;144:686-696; doi: 10.5858/arpa.2019-0377-OA), The Medicare Access and CHIP Reauthorization Act of 2015, which replaced the Sustainable Growth Rate, had broad bipartisan support and established the Quality Payment Program (QPP), which has 2 payment [...]

* Context.--Within Medicare's Quality Payment Program, and more specifically the Merit-based Incentive Payment System, pathologists stand to potentially lose or gain approximately $2 billion during the initial 7 years of the program. If you or your group provides services to Medicare beneficiaries, you will likely need to comply with the program. Objective.--To avoid potential reductions in Medicare reimbursement, pathologists need to understand the requirements of these new payment programs. Data Sources.--Each year the Centers for Medicare & Medicaid Services publish a Final Rule detailing the program requirements and updates. 2020 marks the fourth reporting year for the Merit-based Incentive Payment System. Performance this year will impact 2022 Medicare Part B distributions by up to [+ or -] 9%. Conclusions.--By staying up to date with the ever-evolving Merit-based Incentive Payment System requirements, pathologists will be better equipped to successfully comply with this relatively new payment system, reduce the burden of participating, understand the reporting differences of the various performance categories, and thereby be able to maximize their scoring and incentive potential. (Arch Pathol Lab Med. 2020;144:679-685; doi: 10.5858/arpa.2019-0376-RA), In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), which was game-changing for our health care system. (1) This legislation replaced the sustainable growth rate system and [...]

To the Editor.--It's time to call out the elephant in the room--about half of pathologists need to report quality measures and other activities to the government to avoid a 9% [...]

Context.--Graft-versus-host disease of the gastrointestinal tract is a common complication of hematopoietic stem cell transplant associated with significant morbidity and mortality. Accurate diagnosis can be difficult and is a truly clinicopathologic endeavor. Objectives.--To assess the diagnostic sensitivity of gastrointestinal graft-versus-host disease using the 2015 National Institutes of Health (NIH) histology consensus guidelines and to analyze histologic findings that support the guidelines. Design.--Patients with allogeneic hematopoietic stem cell transplants were identified via a retrospective search of our electronic medical records from January 1, 2005, to January 1, 2011. Endoscopies with available histology were reviewed by 2 pathologists using the 2015 NIH guidelines. The clinical diagnosis was used as the gold standard. A nontransplant set of endoscopic biopsies was used as a control. Results.--Of the 250 total endoscopies, 217 (87%) had a clinical diagnosis of gastrointestinal graft-versus-host disease. Use of the NIH consensus guidelines showed a sensitivity of 86% and a specificity of 65%. Thirty-seven of 58 (64%) cases with an initial false-negative histopathologic diagnosis were diagnosed as graft-versus-host disease on our review. Conclusions.--Use of the NIH histology consensus guidelines results in a high sensitivity and specificity, thereby decreasing false-negatives. Additionally, use of the NIH guidelines aids in creating uniformity and diagnostic clarity. Correlation with clinical and laboratory findings is critical in evaluating the differential diagnosis and to avoid false-positives. As expected, increased apoptosis with decreased inflammation was associated with a pathologic diagnosis of graft-versus-host disease and supports the NIH guidelines. doi: 10.5858/arpa.2017-0054-0A, Graft-versus-host disease (GVHD) of the gastrointestinal (GI) tract is a common complication of hematopoietic stem cell transplant (HSCT) and is associated with significant morbidity and mortality. (1-6) Graft-versus-host disease develops [...]

Ultrafine grained (UFG) and nanostructured steels have gained attention in the last years because of the possibility of improving both strength and ductility, but also because of their potential for improving several properties in metal applications which allows replacing some conventional steels. The refinement of the microstructure obtained through Severe Plastic Deformation (SPD) has allowed for the improvement of mechanical properties and the performing of several studies related to corrosion control, mitigation, and protection. In this review, the corrosion behavior of ultra-fine grained (UFG) steels is presented regarding the existing literature and the microstructural changes produced through different SPD processes. A focus is placed on the importance of the processes for grain refinement and microstructural changes and, therefore, on the corrosion behavior. [ABSTRACT FROM AUTHOR]