Introduction to Evidence-Based Pathology and Laboratory Medicine

  • Alberto M. Marchevsky
  • Mark R. Wick


Evidence-based medicine is an evolving discipline that applies analytical and quantitative methods to evaluate the validity of available medical information, with the overall goal of identifying scientifically sound data or “best evidence.” This evidence is integrated to improve medical practice through clinical guidelines and other tools that are used for education, standardization of care, quality initiatives, and coverage decisions. The ideas of EBM have spread rapidly through medicine during the past decade and are recently eliciting a growing interest in Anatomic Pathology and Laboratory Medicine.


Evidence-based medicine, definition Evidence-based pathology and ­laboratory medicine Pathology and laboratory medicine Evidence Search engines for evidence-based medicine 


  1. 1.
    Sackett D. Evidence-based medicine. Lancet. 1995;346:1171.PubMedCrossRefGoogle Scholar
  2. 2.
    Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–2.PubMedCrossRefGoogle Scholar
  3. 3.
    Sackett DL. Evidence-based medicine. Semin Perinatol. 1997;21:3–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Straus SE, Sackett DL. Bringing evidence to the clinic. Arch Dermatol. 1998;134:1519–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Straus SE, Richardson WS, Glasziou P, et al. Evidence-based medicine. How to practice and teach EBM. New York, NY: Elsevier; 2005.Google Scholar
  6. 6.
    Marchevsky AM, Wick MR. Evidence-based medicine, medical decision analysis, and pathology. Hum Pathol. 2004;35:1179–88.PubMedCrossRefGoogle Scholar
  7. 7.
    Fleming KA. Evidence-based pathology. J Pathol. 1996;179:127–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Costa J. Reflections about evidence-based pathology. Int J Surg Pathol. 2007;15:230–2.PubMedCrossRefGoogle Scholar
  9. 9.
    U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. Technology assessment. 2010.Google Scholar
  10. 10.
    Steinberg EP, Graziano S. Integrating technology assessment and medical practice evaluation into ­hospital operations. QRB Qual Rev Bull. 1990;16:218–22.PubMedGoogle Scholar
  11. 11.
    Steinberg EP. Health care technology assessment. Med Sect Proc. 1986;53–63.Google Scholar
  12. 12.
    Sackett DL, Rosenberg WM. The need for evidence-based medicine. J R Soc Med. 1995;88:620–4.PubMedGoogle Scholar
  13. 13.
    Carson SS. Outcomes research: methods and implications. Semin Respir Crit Care Med. 2010;31:3–12.PubMedCrossRefGoogle Scholar
  14. 14.
    Carter BS. A new era of outcomes research. Neurosurgery. 2009;64:N15.PubMedCrossRefGoogle Scholar
  15. 15.
    Krumholz HM. Outcomes research: myths and realities. Circ Cardiovasc Qual Outcomes. 2009;2:1–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Tanjong-Ghogomu E, Tugwell P, Welch V. Evidence-based medicine and the Cochrane Collaboration. Bull NYU Hosp Jt Dis. 2009;67:198–205.PubMedGoogle Scholar
  17. 17.
    Peirolo R, Scalerandi M. Markovian model of growth and histologic progression in prostate cancer. Phys Rev E Stat Nonlin Soft Matter Phys. 2004;70:011902.PubMedCrossRefGoogle Scholar
  18. 18.
    Brown AW, Malec JF, McClelland RL, et al. Clinical elements that predict outcome after traumatic brain injury: a prospective multicenter recursive partitioning (decision-tree) analysis. J Neurotrauma. 2005;22:1040–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Galligan DT, Ramberg C, Curtis C, et al. Application of portfolio theory in decision tree analysis. J Dairy Sci. 1991;74:2138–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Hui L, Liping G. Statistical estimation of diagnosis with genetic markers based on decision tree ­analysis of complex disease. Comput Biol Med. 2009;39:989–92.PubMedCrossRefGoogle Scholar
  21. 21.
    Link RE, Allaf ME, Pili R, et al. Modeling the cost of management options for stage I nonseminomatous germ cell tumors: a decision tree analysis. J Clin Oncol. 2005;23:5762–73.PubMedCrossRefGoogle Scholar
  22. 22.
    Gross R. Decisions and evidence in medical practice. St. Louis, MO: Mosby; 2001.Google Scholar
  23. 23.
    Ebell MH. Evidence-based diagnosis. New York, NY: Springer; 2001.Google Scholar
  24. 24.
    American College of Physicians. Clinical efficacy assessment project. Internet Communication. 2010.Google Scholar
  25. 25.
    Marchevsky AM. The application of special technologies in diagnostic anatomic pathology: is it consistent with the principles of evidence-based medicine? Semin Diagn Pathol. 2005;22:156–66.PubMedCrossRefGoogle Scholar
  26. 26.
    Marchevsky AM. Evidence-based medicine in ­pathology: an introduction. Semin Diagn Pathol. 2005;22:105–15.PubMedCrossRefGoogle Scholar
  27. 27.
    American Cancer Society. Treatment decision tools. Internet Communication. 2010.Google Scholar
  28. 28.
    Agency for Healthcare Research and Quality (AHRQ). National guideline clearinghouse. Internet Communication. 2010.Google Scholar
  29. 29.
    Clarke M. The Cochrane Collaboration and the Cochrane Library. Otolaryngol Head Neck Surg. 2007;137:S52–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Chen TH, Li L, Kochen MM. A systematic review: how to choose appropriate health-related quality of life (HRQOL) measures in routine general practice? J Zhejiang Univ Sci B. 2005;6:936–40.PubMedCrossRefGoogle Scholar
  31. 31.
    Deenadayalan Y, Grimmer-Somers K, Prior M, et al. How to run an effective journal club: a systematic review. J Eval Clin Pract. 2008;14:898–911.PubMedCrossRefGoogle Scholar
  32. 32.
    Hunt DL, Haynes RB. How to read a systematic review. Indian J Pediatr. 2000;67:63–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Vanhecke TE, Barnes MA, Zimmerman J, et al. PubMed vs. HighWire Press: a head-to-head comparison of two medical literature search engines. Comput Biol Med. 2007;37:1252–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Booth A. Mapping the evidence base of pathology. J Pathol. 1999;188:344–50.PubMedCrossRefGoogle Scholar
  35. 35.
    Rapport RL, Lancaster FW, Penry JK. Critical evaluation of a computer-based medical literature search and retrieval system. Postgrad Med. 1972;51:47–50.PubMedGoogle Scholar
  36. 36.
    Bakkalbasi N, Bauer K, Glover J, et al. Three options for citation tracking: Google Scholar, Scopus and Web of Science. Biomed Digit Libr. 2006;3:7.PubMedCrossRefGoogle Scholar
  37. 37.
    Freeman MK, Lauderdale SA, Kendrach MG, et al. Google Scholar versus PubMed in locating primary literature to answer drug-related questions. Ann Pharmacother. 2009;43:478–84.PubMedCrossRefGoogle Scholar
  38. 38.
    Kulkarni AV, Aziz B, Shams I, et al. Comparisons of citations in Web of Science, Scopus, and Google Scholar for articles published in general medical journals. JAMA. 2009;302:1092–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Shultz M. Comparing test searches in PubMed and Google Scholar. J Med Libr Assoc. 2007;95:442–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Cancer Care Ontario. Cancer Care Ontario. Internet Communication. 2010.Google Scholar
  41. 41.
    Anonymous. What does the Cochrane Collaboration say about adherence to evidence-based practice recommendations? Physiother Can. 2009;61:116.Google Scholar
  42. 42.
    Winkelstein Jr W. The remarkable Archie: origins of the Cochrane Collaboration. Epidemiology. 2009;20:779.PubMedCrossRefGoogle Scholar
  43. 43.
    Amin MB. The 2009 version of the cancer protocols of the college of American pathologists. Arch Pathol Lab Med. 2010;134:326–30.PubMedGoogle Scholar
  44. 44.
    Amin MB. Key issues in reporting common cancer specimen findings using the College of American Pathologists cancer protocols. Arch Pathol Lab Med. 2006;130:284–6.PubMedGoogle Scholar
  45. 45.
    Fechner RE. Selected topics from ADASP. Am J Clin Pathol. 1996;106:S1–2.PubMedGoogle Scholar
  46. 46.
    Simpson PR, Tschang TP. ADASP recommendations: consultations in surgical pathology. Association of Directors of Anatomic and Surgical Pathology. Hum Pathol. 1993;24:1382.PubMedCrossRefGoogle Scholar
  47. 47.
    Vollmer RT. Primary lung cancer vs metastatic breast cancer: a probabilistic approach. Am J Clin Pathol. 2009;132:391–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Multivariate statistical analysis for anatomic pathology. Part II: failure time analysis. Am J Clin Pathol. 1996;106:522–34.Google Scholar
  49. 49.
    Multivariate statistical analysis for pathologist. Part I, The logistic model. Am J Clin Pathol. 1996;105:115–26.Google Scholar
  50. 50.
    Vollmer RT. Twin concordance: a set theoretic and probability theory approach. J Theor Biol. 1972;36:367–78.PubMedCrossRefGoogle Scholar
  51. 51.
    Snedecor GW, Cochran WG. Statistical methods. Ames, IA: The Iowa State University Press; 1980.Google Scholar
  52. 52.
    Connelly LM. Research considerations: power analysis and effect size. Medsurg Nurs. 2008;17:41–2.PubMedGoogle Scholar
  53. 53.
    Zodpey SP. Sample size and power analysis in medical research. Indian J Dermatol Venereol Leprol. 2004;70:123–8.PubMedGoogle Scholar
  54. 54.
    Giard RW, Hermans J. The diagnostic information of tests for the detection of cancer: the usefulness of the likelihood ratio concept. Eur J Cancer. 1996;32A:2042–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Hara M, Kanemitsu Y, Hirai T, et al. Negative serum carcinoembryonic antigen has insufficient accuracy for excluding recurrence from patients with Dukes C colorectal cancer: analysis with likelihood ratio and posttest probability in a follow-up study. Dis Colon Rectum. 2008;51:1675–80.PubMedCrossRefGoogle Scholar
  56. 56.
    Gupta R, Dastane AM, McKenna Jr R, et al. The predictive value of epidermal growth factor receptor tests in patients with pulmonary adenocarcinoma: review of current “best evidence” with meta-analysis. Hum Pathol. 2009;40:356–65.PubMedCrossRefGoogle Scholar
  57. 57.
    Gupta R, Dastane A, McKenna Jr RJ, et al. What can we learn from the errors in the frozen section diagnosis of pulmonary carcinoid tumors? An evidence-based approach. Hum Pathol. 2009;40:1–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Gupta R, McKenna Jr R, Marchevsky AM. Lessons learned from mistakes and deferrals in the frozen section diagnosis of bronchioloalveolar carcinoma and well-differentiated pulmonary adenocarcinoma: an evidence-based pathology approach. Am J Clin Pathol. 2008;130:11–20.PubMedCrossRefGoogle Scholar
  59. 59.
    Herbst J, Jenders R, McKenna R, et al. Evidence-based criteria to help distinguish metastatic breast cancer from primary lung adenocarcinoma on thoracic frozen section. Am J Clin Pathol. 2009;131:122–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Westfall DE, Fan X, Marchevsky AM. Evidence-based guidelines to optimize the selection of antibody panels in cytopathology: pleural effusions with malignant epithelioid cells. Diagn Cytopathol. 2010;38:9–14.PubMedGoogle Scholar
  61. 61.
    Marchevsky AM, Gupta R, Balzer B. Diagnosis of metastatic neoplasms: a clinicopathologic and morphologic approach. Arch Pathol Lab Med. 2010;134:194–206.PubMedGoogle Scholar
  62. 62.
    Marchevsky AM, Wick MR. Evidence levels for publications in pathology and laboratory medicine. Am J Clin Pathol. 2010;133:366–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Cundiff DK. Evidence-based medicine and the Cochrane Collaboration on trial. MedGenMed. 2007;9:56.PubMedGoogle Scholar
  64. 64.
    Overman VP. The Cochrane collaboration. Int J Dent Hyg. 2007;5:62.PubMedCrossRefGoogle Scholar
  65. 65.
    Travis WD, Gal AA, Colby TV, et al. Reproducibility of neuroendocrine lung tumor classification. Hum Pathol. 1998;29:272–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Hirsch FR, Matthews MJ, Yesner R. Histopathologic classification of small cell carcinoma of the lung: comments based on an interobserver examination. Cancer. 1982;50:1360–6.PubMedCrossRefGoogle Scholar
  67. 67.
    Roggli VL, Vollmer RT, Greenberg SD, et al. Lung cancer heterogeneity: a blinded and randomized study of 100 consecutive cases. Hum Pathol. 1985;16:569–79.PubMedCrossRefGoogle Scholar
  68. 68.
    Cross SS. Kappa statistics as indicators of quality assurance in histopathology and cytopathology. J Clin Pathol. 1996;49:597–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Jensen P, Krogsgaard MR, Christiansen J, et al. Observer variability in the assessment of type and dysplasia of colorectal adenomas, analyzed using kappa statistics. Dis Colon Rectum. 1995;38:195–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Malpica A, Matisic JP, Niekirk DV, et al. Kappa ­statistics to measure interrater and intrarater agreement for 1790 cervical biopsy specimens among twelve pathologists: qualitative histopathologic analysis and methodologic issues. Gynecol Oncol. 2005;99:S38–52.PubMedCrossRefGoogle Scholar
  71. 71.
    Tezuka F, Namiki T, Higashiiwai H. Observer variability in endometrial cytology using kappa statistics. J Clin Pathol. 1992;45:292–4.PubMedCrossRefGoogle Scholar
  72. 72.
    Venkataraman G, Ananthanarayanan V, Paner GP. Accessible calculation of multirater kappa statistics for pathologists. Virchows Arch. 2006;449:272.PubMedCrossRefGoogle Scholar
  73. 73.
    Summerskill W. Cochrane Collaboration and the evolution of evidence. Lancet. 2005;366:1760.PubMedCrossRefGoogle Scholar
  74. 74.
    Marchevsky AM, Wick MR. Evidence-based guidelines for the utilization of immunostains in diagnostic pathology: pulmonary adenocarcinoma versus ­mesothelioma. Appl Immunohistochem Mol Morphol. 2007;15:140–4.PubMedCrossRefGoogle Scholar
  75. 75.
    Moussa AS, Kattan MW, Berglund R, et al. A nomogram for predicting upgrading in patients with low- and intermediate-grade prostate cancer in the era of extended prostate sampling. BJU Int. 2010;105:352–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Kattan MW. Do we need more nomograms for predicting outcomes in patients with prostate cancer? Nat Clin Pract Urol. 2008;5:366–7.PubMedCrossRefGoogle Scholar
  77. 77.
    Steinberg EP, Luce BR. Evidence based? Caveat emptor! Health Aff (Millwood). 2005;24:80–92.CrossRefGoogle Scholar
  78. 78.
    Treadwell JR, Tregear SJ, Reston JT, et al. A system for rating the stability and strength of medical evidence. BMC Med Res Methodol. 2006;6:52.PubMedCrossRefGoogle Scholar
  79. 79.
    Guerette PH. Managed care: cookbook medicine, or quality, cost-effective care? Can Nurse. 1995;91:16.PubMedGoogle Scholar
  80. 80.
    Holm RP. Cookbook medicine. S D Med. 2009;62:371.PubMedGoogle Scholar
  81. 81.
    Leape L. Are practice guidelines cookbook medicine? J Ark Med Soc. 1989;86:73–5.PubMedGoogle Scholar
  82. 82.
    Parmley WW. Practice guidelines and cookbook medicine–who are the cooks? J Am Coll Cardiol. 1994;24:567–8.PubMedCrossRefGoogle Scholar
  83. 83.
    Steinberg KE. Cookbook medicine: recipe for disaster? J Am Med Dir Assoc. 2006;7:470–2.PubMedCrossRefGoogle Scholar
  84. 84.
    Wick MR, Bourne TD, Patterson JW, et al. Evidence-based principles and practices in pathology: selected problem areas. Semin Diagn Pathol. 2005;22:116–25.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineCedars-Sinai Medical CenterLos AngelesUSA

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