The Papanicolaou Award, established in 1958, is the highest Award given by the Society and is presented annually to a physician or PhD member. Recipients are in recognition of meritorious contributions in the field of Cytopathology.

Educational Objectives:
1. Identify characteristic morphologic features of HPV-related head and neck cancers in cytologic and tissue biopsies of primary and metastatic lesions
2. Confirm viral status by selective use of HPV detection assays
3. Discuss the impact of HPV status on outcome of head and neck cancers and understand its emerging role in clinical decision-making

While the incidence of traditional head and neck squamous cell carcinomas associated with smoking and drinking has decreased in the US, HPV-related squamous cell carcinomas of the oropharynx have increased significantly. The HPV-related cancers are distinctly different from non-HPV-related head and neck squamous cancers in terms of demographic profile, risk factors, clinical behavior, prognosis, and morphology. This session will provide an update on the epidemiology, biology, morphologic features, clinical aspects, and diagnosis of HPV-related head and neck cancers. Issues related to different methods of HPV detection will be addressed. HPV-related cancers have a better prognosis in terms of locoregional control and overall survival than traditional squamous cell carcinomas. The session will include a discussion of therapeutic trials assessing treatment de-escalation for patients with HPV-related cancers given their better prognosis and the significant toxicity of conventional cancer therapy.

Pancreatic Cytopathology - Terminology update
Martha B. Pitman, MD

Role of FNA in the diagnosis of Solid "Non-adenocarcinoma" Tumors
Syed Z. Ali, MD

Cystic Lesions: Cytomorphology and Role of Fluid Analysis
Martha B. Pitman, MD

Cytopathology of Pancreaticobiliary Brushings
Lester J. Layfield, MD

The Clinical Perspective of Pancreatic Cancer - Role of Multidisciplinary Clinics, New Therapies and Molecular Markers
Joseph Herman, MD

Educational Objectives:
1. Understand the concept that viruses do not replicate during persistence in tumor cells. They either maintain latency or lose the ability to replicate as a result of integration or mutation. Virus-caused cancers are biologic accidents
2. KSHV is the cause of 3 human proliferative disorders: Kaposi’s sarcoma, primary effusion lymphomas, and a subset of Castleman’s disease. All 3 express the major viral oncoprotein: Latency Associated Nuclear Antigen (LANA)
3. MCV is a ubiquitous human infection and causes Merkel cell carcinoma. Transformation is dependent of the expression of MCV viral tumor (T) antigen proteins: Large T (LT) and small T (sT)

Although 1 in 5 cancers worldwide are caused by infection, the underlying principles on how and why viruses cause cancer remain elusive. Seven known human tumor viruses span the entire spectrum of virus biology. The two newest members, Kaposi’s sarcoma herpesvirus (KSHV) and Merkel cell polyomavirus (MCV) respectively causing Kaposi’s sarcoma (KS) and Merkel cell carcinoma (MCC) provide novel insights into the connections between virus infection and cancer.

2012 Papanicolaou Award: Dr. Dina R. Mody

The Papanicolaou Award, established in 1958, is the highest award given by the Society and is presented annually to a physician or Ph.D. member. Recipients are in recognition of meritorious contributions in the field of Cytopathology.



2012 Cytotechnologist Award for Outstanding Achievement: Dr. Marilee Means

The Cytotechnologist Award for Outstanding Achievement, established in 1969, is presented annually to an ASC Cytotechnologist. Selection of the recipient is in recognition of meritorious service or accomplishments to the field of cytology.



2012 Excellence in Education Award: Dr. Ibrahim Ramzy

This Award was established in 1998 and is presented annually to a cytotechnologist or physician member of the ASC. The Award is in recognition of meritorious service or accomplishments in the field of cytopathology education to include the education of cytotechnologists, pathology residents and/or cytopathology fellows.

2012 President’s Award

The President’s Award was established in 1992 and is presented annually to an ASC member. Selection of the recipient is at the discretion of the current ASC President.

Awardee To Be Announced

Educational Objectives:
1. Demonstrate the current challenges in diagnosis of biliary tract malignancy in biliary brushing specimens, including cholangiocarcinoma, pancreatic carcinoma and metastatic tumors involving the biliary tree
2. Demonstrate the most useful cytomorphologic features for making a definitive diagnosis of malignancy and which features overlap with the findings found in reactive conditions such as biliary stone disease and primary sclerosing cholangitis
3. Define how FISH techniques can be applied to cytology specimens to enhance the diagnostic accuracy of biliary brush cytology for the detection of neoplasms involving the biliary tract

Biliary strictures represent a clinical challenge as they can be associated with inflammatory conditions such as chronic pancreatitis, primary sclerosing cholangitis (PSC) or malignancy (pancreatic carcinoma or cholangiocarcinoma). Patients with PSC are at risk for developing cholangiocarcinoma thus compounding the challenge of determining which strictures are benign or malignant. Biopsy or brush cytology of the structured area has low sensitivity for the detection of malignancy (8-57% from literature review) due to both sampling and interpretation challenges. Fluorescence in situ hybridization (FISH) which detects cells with chromosomal abnormalities consistent with malignancy has been shown to improve the sensitivity of bladder cancer detection in urine cytology specimens. FISH applied to biliary brush specimens at our institution have been shown to also improve the diagnostic sensitivity and specificity for malignancy diagnosis. Currently, both conventional cytology and FISH are performed on all biliary brush specimens at our institution. Clinical follow-up on over 1000 patients with combined cytology and FISH analysis on biliary brush specimens has allowed us to create a statistical risk assessment for malignancy on each specimen based on a combination of patient age, PSC status, cytology result and FISH result. Having this unique data set with paired cytology slides has allowed us to identify cytology cases that were true interpretation errors (FISH positive, excluding sampling error). Analysis of this study set has allowed honing of cytomorphological skills to identify which features are most predictive of malignancy and which are nonspecific in biliary brush specimens. The combined use of both FISH and improved cytology skills has facilitated earlier diagnosis of malignancy offering potential for curative treatment, especially in patients with PSC. The panel luncheon presentation would focus on the most helpful cytomorphologic features for evaluating biliary brush specimens and the benefits of adding FISH analysis to further improve diagnostic accuracy.

Educational Objectives:
1. Review the underlying factors that are changing demands on cytologists who perform immediate adequacy on lung specimens in the new era of targeted therapies and molecular testing
2. Demonstrate practical approaches for achieving suitable diagnoses while preserving cellular material for additional ancillary studies needed for targeted therapies
3. Correlate cytologic findings from touch preparation with corresponding small biopsies from the lung, with an emphasis on how touch preparations differ from FNA and on pitfalls in adequacy assessment and interpretation
4. Compare and contrast endoscopic ultrasound-guided FNA material with material gathered percutaneously by CT guidance

In recent years, therapeutic options for lung cancer have markedly expanded, with numerous additional targeted drugs currently in the development pipeline. While this offers new hope for patients, it also places an increasing burden on cytologists who now need to provide more information about the morphology of the carcinoma they are examining while preserving cells for vitally important molecular ancillary testing.
The goal of this session is to review cytology material in association with corresponding small biopsies of lung carcinoma. Special emphasis will be placed on emerging diagnostic issues and related problems of ensuring “adequacy”. In the past the main job of the cytologist was just to confirm malignancy and separate small cell carcinoma from non-small cell carcinoma. Usually only a relatively small number of cells and just a single good quality slide would suffice for this limited role. Now this is just the beginning of an ever-more complicated diagnostic algorithm. In many cases immunocytochemistry is now essential, hinging on the ability of the cytology laboratory to perform staining on smears or consistently create good cell blocks. Tips for doing both will be part of the session. In the not-so-distant past, immunocytochemistry algorithms mostly focused on maximizing diagnostic certainty, often resulting in panels of four or more markers to separate adenocarcinoma from squamous cell carcinoma. Now, however, preservation of material for genetic testing is at least as important as subtyping, leading to new recommendations to only use two markers. The most commonly used two-marker panel, p63 and TTF-1, can be difficult to interpret and the implications of various staining patterns, as well as optimal ways to proceed, will be discussed. Depending on the morphology and immunocytochemistry, additional molecular studies including PCR for EGFR and FISH for ALK, may also be needed. The session will briefly review the clinical logic behind all of this testing and the increasingly subtle interaction between morphology and treatment, including the correlation with certain adenocarcinoma subtypes with EGFR and ALK mutations. The various cytology materials that can be used for molecular testing, along with pros and cons of different approaches, such as the use of alcohol-fixed smears as opposed to formalin-fixed cell blocks, will also be elaborated upon, especially with regard to how cytologists can “stretch” limited material so as to maximize the success of all testing modalities and thereby avoid repeat testing and the associated delays.
As oncologists and surgeons push for ever-more specific diagnoses, there is a growing burden on cytologists not just to perform immediate adequacy but to assure that sufficient cells are present for all possible testing. The demand for more material is accelerating the trend toward increasing numbers of CT-guided core biopsies of lung tumors. The cytology of touch preparations, including how it differs from conventional FNA material and pitfalls in correlation with the corresponding biopsy, will be reviewed. EBUS-guided FNA of lung tumors and mediastinal nodes has also become more main stream in recent years as a less invasive means of sampling tumors. A review of this technology and the corresponding cytology challenges, particularly the resultant increase in mediastinal lymph node analysis, will also be included in the session.

Educational Objectives:
1. Distinguish and diagnose fine needle aspiration biopsies of benign/reactive nodal lymphoproliferative processes
2. Distinguish and diagnose fine needle aspiration biopsies of nodal and extranodal malignant lymphoproliferative disorders
3. Discuss morphologic and phenotypic limitations of FNA biopsies, and recognize indications, advantages/disadvantages, pitfalls and limitations of FNA biopsy of lymphoproliferative lesions
4. Integrate cytomorphology with ancillary immunophenotypic and molecular analyses to render more specific interpretations
5. Practice a multi-modality diagnostic approach to FNA biopsies of nodal lymphoproliferative disorders

Fine needle aspiration (FNA) biopsy of lymph nodes is the mainstay is often the first step in the diagnosis of primary lymphoproliferative disorders. FNA is being increasingly accepted by most patients and clinicians as a non-invasive method for evaluating lymphadenopathy, and is particularly suited for deep-seated lymph nodes. FNA of lymph nodes has high sensitivity and specificity in distinguishing between benign and malignant lesions. The purpose of this course is to present FNA biopsy of lymphoproliferative lesions and correlative results of ancillary techniques, especially immunophenotyping, in this vast array of reactive and neoplastic entities. In the context of clinical presentations, the aspiration cytomorphologic features of benign and malignant lymphoid disorders will be detailed. The former will include reactive follicular hyperplasia, infectious mononucleosis, Castleman's disease, granulomatous inflammation, Rosai-Dorfman disease, and suppurative lymphadenitis. Both nodal and extranodal neoplastic lymphoproliferative disorders will be presented, Hodgkin lymphoma and the non-Hodgkin lymphomas, from the perspective of the current WHO classification. Correlation with histopathology will be done when relevant. The often-crucial role of immunophenotyping of aspirated material by flow cytometry will be presented including a discussion of both the basics and the necessary details.

Educational Objective:
1. Provide participants with a framework and practical approach with which to diagnose the most common bone and soft tissue lesions on cytologic and small biopsy specimens
2. Learn how to incorporate clinical and imaging information in the formulation of differential diagnoses
3. Learn how to triage specimens for ancillary studies to facilitate a definitive diagnosis
4. Learn the appropriate and most cost effective use of ancillary techniques (immunohistochmical, karayotyping, molecular, flow cytometry, and histochemical), as well as their application to diagnosis
5. Learn some of the most common diagnostic pitfalls and how to avoid them

Mesenchymal neoplasms are a heterogenous group of lesions with well over 100 recognizable subtypes. Because of their relative scarcity, many diagnosticians find them extremely challenging to diagnose with confidence. However, there is increasing pressure from the medical community to provide more timely and accurate diagnosis on the smallest amount of tissue possible, ranging from fine needle aspiration to core needle biopsy specimen. The purpose of this presentation is to provide cytotechnologists and cytopathologists with a multidisciplinary based paradigm to accurately classify the more frequently encountered benign and malignant bone and soft tissue tumors. The participants will learn a realistic approach to the use of morphology and ancillary techniques in this challenging area, how to triage the specimens, how to avoid diagnostic pitfalls, and how to handle situations when limitations of cytologic techniques preclude a precise diagnosis. The lecture is case-based and interactive. With the use of both a pre and post-lecture test for knowledge assessment, the participants will be able to see the results of their learning immediately. This comprehensive yet practical presentation is suitable for individuals in both community and academic practices.

Educational Objectives:
1. Review the cytomorphology and diagnostic challenges in cytological specimens from thoracic lesions including the lung, lymph nodes, thymus, mediastinal soft tissue, and pleura
2. Understand the various cytological patterns for lesions in the mediastinum including epithelioid, lymphoid, and spindle cell lesions, and how this can help one to formulate a differential diagnosis
3. Recognize and understand how ancillary studies such as FISH and molecular techniques can be applied in thoracic and mediastinal cytopathology

This session will provide a comprehensive review of challenging lesions that can be seen in the thoracic cavity, including mediastinal lymph nodes, soft tissue, lung, and pleura. After a brief introduction and didactic presentation, a case-based approach will be utilized to highlight interesting cases, including challenging mesotheliomas, endobronchial ultrasound guided FNA (EBUS-FNA) cases, and other image-guided FNAs of the lung and mediastinum. The discussion will focus on the cytomorphology, differential diagnosis, and diagnostic pitfalls. In addition, there will be a focus on discussing the ancillary studies and updating the audience on how we utilize these tests in our practice as well as present salient points of the current literature in this area of cytopathology. We will emphasize how fluorescence in-situ hybridization (FISH) and molecular techniques can be applied to thoracic cytological specimens. The cases will highlight common diagnostic dilemmas, including mesothelioma and its variants, non-small cell carcinomas of the lung, neuroendocrine tumors, thymic tumors, spindle cell lesions, and lymphoid lesions.

Educational Objectives:
1. Define the most common techniques for cytologic aspiration of the pancreas with emphasis on endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) and its pitfalls
2. Recognize normal pancreatic cytology, reactive changes associated with chronic pancreatitis and their distinction from ductal adenocarcinoma and other tumors
3. Understand the importance of clinical information (patient demographics, tumor location and radiologic appearance) in the diagnosis and distinction of solid and cystic neoplasms from their mimics
4. Identify key cytologic features that distinguish well and poorly differentiated ductal adenocarcinoma from chronic pancreatitis and other pancreatic tumors
5. Recognize the benefits and limitations of ancillary testing in cytologic diagnosis of pancreatic tumors (including cyst fluid analysis, immunohistochemical and molecular studies)

With recent advances in imaging and interventional techniques such as endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA), there has been a marked increase in preoperative cytologic specimens that cytopathologists and cytotechnologists must evaluate. Changes in terminology and classifications of pancreatic neuroendocrine and mucinous tumors have also added to the new information one must absorb. This course will provide an overview of challenges and practical clues in the cytologic diagnosis of pancreatic specimens. Discussions will include: EUS-guided FNA and its pitfalls, pancreatic adenocarcinoma and its distinction from cytologic mimics, differential diagnosis of solid and cystic pancreatic lesions/tumors and use of ancillary studies in diagnosis. Following this course, you will be able to differentiate pancreatic ductal adenocarcinoma, especially the well differentiated type, from chronic pancreatitis and other neoplasms, evaluate cystic pancreatic tumors more efficiently and use clinical information to help in doing so.

Educational Objectives:
1. Know the basic histomorphology of organs often subjected to fine-needle aspiration
2. Learn the concept and pitfalls of cytohistologic correlation
3. Appreciate basic histology in small biopsy samples and cell block preparations

The main aim of this workshop is to bridge the gap between basic histology and cytopathology for cytotechnologist. In the daily screening of cytopathology samples the significance and function of many basic histologic features as compared to cytomorphology seen in smears and monolayer preparations are obscure to the cytotechnologist. This workshop will illustrate and discuss the salient cytologic and architectural features seen in histologic samples of commonly biopsied organs and their presentation in various cytologic preparations. The presentations will also discuss the potential pitfalls in the interpretation of normal cell elements.

Educational Objectives:
1. Use a case based approach to highlight the cytomorphology of common and uncommon renal lesions, their pitfalls, and differential diagnoses
2. Discuss diagnostic algorithms based on cytologic findings coupled with ancillary studies and clinical information
3. Discuss the use of ancillary studies in reaching a final diagnosis

FNA and core biopsy of the kidney play an increasingly important role in the management of renal masses and may guides clinicians to select pre-nephrectomy adjuvant therapy, partial or total nephrectomy, chemotherapy, or follow-up. We will present 8 diagnostically challenging cases with clinical findings, cytomorphology, ancillary studies, and surgical pathology/clinical follow up. The cases will cover renal cell carcinoma (clear cell, chromophobe, papillary, medullary, and sarcomatoid), oncocytoma, urothelial carcinoma, angiomyolipoma, lymphoma, and metastatic malignancies. The diagnostic considerations based on FNA and touch prep cytomorphology will be discussed. Current ancillary studies useful in reaching a final diagnosis will also be presented. We will use the following materials in a case based PowerPoint presentation: clinical information, FNA smears/touch preparations (Diff-Quik and Pap stained), H&E stained cell blocks /core biopsies, ancillary studies, and pertinent literature review as applicable.

Educational Objectives:
1. Review the current status of thyroid FNA and challenging aspects of the Bethesda Classification
2. Review the variety of processing methodologies for optimal cytomorphology and molecular testing
3. Review common molecular pathways involved in thyroid neoplasia
4. Discuss how ancillary testing may improve our ability to interpret cytomorphologic alterations
5. Discuss the pathologic and clinical significance of molecular alterations in the context of the Thyroid Bethesda Classification System diagnoses

Integration of ancillary studies to routine cytopathologic analysis has become a common part of diagnostic practice. Recently, the molecular pathways of common thyroid malignancies have become better understood. In particular, point mutations in BRAF and RAS genes and RET/PTC rearrangements are found in over 70% of papillary thyroid carcinomas. Follicular carcinomas are associated with RAS point mutation and PAX8-PPAR gamma rearrangement in approximately 80% of cases. Incorporation of molecular techniques has the potential of refining the cytologic diagnosis of thyroid FNAs. In this session, we will discuss the current standard of thyroid FNA practice and the need for implementing molecular testing. Specific emphasis will be placed on optimal techniques for obtaining samples for molecular studies and the interpretation of molecular results in the context of the Thyroid Bethesda Classification diagnoses. The discussion will include how molecular testing can improve the pre-surgical cytologic practice so that the cytopathologist can better guide the clinicians in managing the patients.