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Emina Torlakovic

Standardization of bone marow marker analysis


Bone marrow immunohistochemistry (IHC) is performed mostly on the bone marrow tissue biopsy (BMTB). Occasionally, it is also performed on the clot section. IHC is increasingly used in diagnostic surgical pathology including lymph nodes and its use is also in rise in bone marrow pathology. The rising trend is lower than in other field due to two reasons: i) advancements in flow cytometry, and ii) complexities of pre-analytical phase. Standardization of the pre-analytical phase is lacking, but it is a key factor that will determine how successful we will be in standardizing BMTB IHC. Currently, various combinations of tissue fixation and tissue decalcification lead to more than 1,000,000 possible protocols for processing of the BMTB. This also prevents organization of BMTB IHC proficiency testing. ICSH has formed a working group charged to develop standards for BMTB IHC. Results of these efforts are presented.

External Quality Assessment for Standardization in Applied Immunohistochemistry


Canadian Immunohistochemistry Quality Assurance (CIQC) is the first national EQA program in Canada that provides proficiency testing (PT) in diagnostic immunohistochemistry (IHC). This is an academic program that was established in 2008. The emphasis of the program is to provide high quality samples for Class II IHC tests (predictive and prognostic IHC tests) and it also occasionally provides Class I PT samples. Breast cancer markers, Ki-67, GIST markers, MMR markers, and ALK-1 for lung cancer are Class II tests that are included in its schemes. The program also provides samples for HER2 ISH. The novel features of this program are: i) introduction of digital microscopy to IHC PT; ii) TMA-based PT samples that enable calculation of sensitivity, specificity, and kappa-values; iii) TMA Scorer software which enables self-reporting and instant comparison with reference results; iv) Garrattograms, and v) analyses of principles and methods used for IHC PT, which are published in peer-reviewed journals.


Dr. Emina Emilia Torlakovic is board certified in Anatomic and Clinical Pathology with subspecialty boards in Haematopathology. She is an associate professor at the Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto. She is a staff haematopathologist and is a medical director of the Immunohistochemistry Laboratory at the University Health Network (UHN) Department of Laboratory Haematology.

She is a co-founder of the Canadian Immunohistochemistry Quality Control also known as CIQC. Since December 2009, CIQC is a part of the CAP-ACP Section for Patient Safety and Quality Assurance. She also co-directs CAP-ACP/CIQC Annual Seminar in Diagnostic Immunohistochemistry.

Dr. Torlakovic is the Chair of the National Standards Committee for High Complexity Testing of the Canadian Association of Pathologists (CAP-ACP). This committee prepared and published the first Canadian guidelines for standardization of immunohistochemistry testing in pathology. Dr. Torlakovic currently chairs the International Council for Standardization in Hematology Working Party for Standardization of Bone Marrow Immunohistochemistry, which is working on developing international guidelines for bone marrow tissue processing and analyses. She was also a member of the Americal Society of Clinical Oncology/College of American Pathologists Expert Panel (ASCO/CAP) that published guidelines for hormone receptor testing in breast cancer.

Dr. Torlakovic is also known in gastrointestinal pathology, where her most significant contribution was a discovery of a sessile serrated adenoma and her classification of serrated polyps of the colon is most recently adopted for WHO classification.

Dr. Torlakovic has published over 70 peer reviewed manuscripts, authored a book on Bone Marrow Immunohistochemistry, and has lectured widely nationally and internationally on immunohistochemistry, quality assurance, and hematopathology.

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