Abstract
This is the first edition of a book on the modern topic of ‘Evidence Based Pathology and Laboratory Medicine’. It is laid out in two rather independent parts, chapters on laboratory medicine in general and chapters focused more on histopathology. Although the audience for this book is not initially clear, it seems to be targeting US clinical pathology residents or graduates with experience and interest in both fields. This might deter UK readers where the specialties are taught separately, and a specialist in one branch would not necessarily have much experience in the other. In fact, many of the most interesting examples, graphs and pictures relate to histopathology and the reader with a laboratory medicine background may have to dig hard to find relevant parts.
After an introduction to the history of evidence-based pathology and laboratory medicine, the first chapter ends by listing websites and search engines that provide useful advanced sources of evidence-based practice in the field, including The Cochrane Collaboration, ISI Web of Knowledge and UpToDate. The next two chapters describe the principles and practice of evidence-based pathology and define the best evidence in pathology.
Some areas are repeated in a very similar way in different chapters, for example, the origin of the receiver operator characteristic curve in chapters 3 and 4.
The biostatistics tools required for understanding and practising evidence-based pathology are described well in chapter 4, while chapter 8 describes power analysis and sample size calculation, and chapters 10 and 15 deal with meta-analysis. While most statistical examples in the book relate to histopathology, there are examples from other fields such as proteomics. One good example is a study of trials looking at the probability of prostate cancer in men with a prostate-specific antigen of 4 ng/mL or more. Some statistical examples are confusing or perhaps contain typographical errors.
We felt that the evidence-based approach to evaluating published literature in chapter 11, which reads like a presentation by a very experienced teacher with advanced presentation skills, is possibly the most relevant to clinical biochemistry. The first table in the chapter provides a good basis for the discussion throughout the chapter. The reader could refer back to the table while going through different sections for reference, so the thought stream is never disturbed.
Chapter 18, on the use of decision analysis tools for selection of laboratory test is interesting and relevant to the current financial situation in National Health Service (NHS) laboratories, where demand management in the context of evidence-based laboratory medicine (EBLM) is required. Useful websites were mentioned, e.g. labtestonline.org and symptoms.webmd.com. The part regarding the electronic health record and incentives to use certain tests in the USA have relevance in the UK in relation to the current NHS Quality Outcomes Framework and because many UK hospitals now have an electronic patient records system. The final chapter of the book concerning law is mostly oriented to the American system and slightly difficult to understand for readers who are not familiar with this.
In summary, the book contains a combination of subjects that are directly related to EBLM and some subjects more relevant to histopathology. Despite a few glitches in some statistical examples, the book gives a well-described view of the definition, application and predicted future of this rather young field in laboratory medicine.