We recommend genetic counseling and consideration of prophylactic gastrectomy in young, asymptomatic carriers of germ-line truncating CDH1 mutations who belong to families with highly penetrant hereditary diffuse gastric cancer.

The use of telepathology for clinical applications in Canada has steadily become more attractive over the last 10 years, driven largely by its potential to provide rapid pathology consulting services throughout the country regardless of the location of a particular institution. Based on this trend, the president of the Canadian Association of Pathologists asked a working group consisting of pathologists, technologists, and healthcare administrators from across Canada to oversee the development of guidelines to provide Canadian pathologists with basic information on how to implement and use this technology. The guidelines were systematically developed, based on available medical literature and the clinical experience of early adopters of telepathology in Canada. While there are many different modalities and applications of telepathology, this document focuses specifically on whole-slide imaging as applied to intraoperative pathology consultation (frozen section), primary diagnosis, expert or second opinions and quality assurance activities. Applications such as hematopathology, microbiology, tumour boards, education, research and technical and/or standard-related issues are not covered.

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Health care resources in Canada are limited, and there is tremendous pressure to reduce laboratory budgets. It is almost impossible to acquire new pathologist positions to adequately meet service demands. There is a need to determine objectively the appropriate pathologist workload. I looked at multiple indicators (total accessioned cases, number of specimens, slides, blocks, Royal College of Pathologists [London, England] model, population served, and level 4 equivalent [L4E]) that might reflect the pathologist's work and determine which indicators are the best. L4E is a calculated weighted value based on complexity levels of individual anatomic pathology consultation. Of all indicators analyzed, L4E is the best reflection of a pathologist's anatomic pathology work because it has the best statistical values, is a direct output measurement of pathologist consultations, and uses data routinely collected in many North American laboratories.

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