Enjoy two hour, in-depth discussions on specific topics. These non-microscopic workshops emphasize interaction in small groups.
Enjoy two hour, in-depth discussions on specific topics. These non-microscopic workshops emphasize interaction in small groups.
|November 16, 2010|
|7:30 am - 9:30 am||Cytology Workshop #1
Practical Cytology Informatics
Liron Pantanowitz, M.D.
Anil Parwani, M.D., Ph.D.
1) To provide an overview of pathology informatics and laboratory information systems
2) To demonstrate how informatics can be leveraged to perform cytopathology quality assurance
3) To review digital imaging and its applications in the field of cytopathology
Informatics, the application of computers and information systems to information management, has become essential for the successful operation of the cytopathology laboratory. Automation, emerging information technologies and digital imaging are rapidly being adopted by cytology laboratories (e.g. automated Pap test screening, telecytology). There are no current standard informatics textbooks or teleconferences specifically oriented towards the practice of cytology. UPMC are leaders in pathology informatics, and would like to share their experience and expertise in this field.
This workshop will cover all aspects of informatics pertinent to the practice of cytology. It will address the needs of both the novice and computer specialist. Participants will gain an understanding of laboratory information systems, addressing the workflow process specific to the cytology laboratory. The utilization of software, electronic databases and spreadsheets to perform necessary quality control measures (e.g. screening and performance indicators) will be highlighted. Computer assisted screening and practical applications of digital imaging will be described, including telecytology and virtual microscopy. Finally, we will reflect on future trends and the impact of novel technologies in the field.
|7:30 am - 9:30 am||Cytology Workshop #2
Cytology of Head & Neck: A Kaleidoscope of Problematic Lesions
Manon Auger, M.D.
1) To provide a structured approach for the resolution of differential diagnoses of selected problematic lesions in the Head & Neck region, eg. cystic lesions, thyroid follicular and Hürthle cell lesions, basaloid tumors of the salivary gland, lymphoid lesions and metastasis in lymph nodes
2) To increase awareness of the registrants with diagnostic pitfalls of the Head & Neck region
3) To familiarize the registrants with the new diagnostic Bethesda System for reporting thyroid cytopathology
This workshop will consist of a case-based didactic presentation focusing on the approach to the resolution of differential diagnoses of selected problematic lesions in the Head & Neck region, including but not restricted to cystic lesions, granulomatous inflammation, lymphoid lesions, basaloid tumors of salivary glands and follicular/Hürthle cell lesions of the thyroid gland. Emphasis will be placed on the recognition of diagnostic pitfalls. Histological correlation will be amply illustrated.
|7:30 am - 9:30 am||Cytology Workshop #3
Effusion Cytology – Charting a Course Through and Navigating the Waters
Michael Roh, M.D., Ph.D.
Claire W. Michael, M.D.
1) To review the clinical importance of and the algorithmic approach to evaluating effusion specimens
2) To present the various cytomorphologic patterns associated with reactive mesothelial cells, malignant mesothelioma, common and uncommon epithelial malignancies, and non-epithelial malignancies in effusions.
3) To discuss traditional and newly discovered immunohistochemical adjuncts in determining the origin of metastatic malignancies in effusions.
4) To discuss recent advances with respect to the application of molecular adjuncts (including cytogenetics and fluorescence in situ hybridization) to routine cytomorphologic evaluation of effusion specimens
The workshop will be subdivided into four sections. The first section will discuss the importance of effusion cytology in clinical staging, decision-making, and treatment and present an algorithmic approach to evaluating effusion specimens. This will serve as an introduction that will precede the second section which will discuss the various cytomorphologic features and presentations of reactive mesothelial cells followed by a discussion of the diagnosis of malignant mesothelioma on cytology. The third section will review the common as well as uncommon epithelial malignancies that present in fluids in a case-based format. The workshop will conclude with a discussion of non-epithelial malignancies, including sarcomas, in a case-based format. During these sessions, diagnostic pitfalls will be discussed and recent advances with respect to immunohistochemical and molecular adjuncts to routine cytomorphologic evaluation will be presented.
|7:30 am - 9:30 am||Cytology Workshop #4
FNA Cytology of Mediastinal Lesions
Xiaoqi Lin, M.D.
Ritu Nayar, M.D., MIAC
1) Use a case based approach to highlight the cytomorphology of common and uncommon mediastinal lesions and their differential diagnosis
2) Discuss the diagnostic algorthithms based on cytologic findings coupled with ancillary studies and clinical information
3) Discuss how to use ancillary studies to reach a final diagnosis
We will present 6 diagnostically challenging cases with clinical findings, cytomorphology, ancillary studies and surgical pathology/clinical follow up. The cases will cover thymoma, thymic carcinoma, mesothelioma, lymphoma, germ cell tumors, recently described rare NUT midline carcinoma, and their differential diagnoses. 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 (DiffQuik and Pap stained), H&E stained cell blocks/core biopsies, ancillary studies, and pertinent literature reviews as applicable.
|7:30 am - 9:30 am||Cytology Workshop #5
Genitourinary Tract Cytopathology: Who’s Afraid of Urines and Renal FNA’s?
Guliz Barkan, M.D., FIAC
Umesh Kapur, M.D.
Swati Mehrotra, M.D.
1) Review the indications, cytomorphologic features of urine cytology and discuss potential pitfalls
2) Improve the participant’s ability to recognize normal renal cytology, common, and uncommon neoplasms in renal aspirations by highlighting the key morphological features
3) Give an overview of the current and emerging ancillary tests in genitourinary tract (GU) cytology
4) Illustrate a systematic approach to GU cytology by incorporating the newer modalities to morphology
This workshop provides a comprehensive review of the morphologic criteria and guidelines for the cytologic diagnosis of genitourinary tract (GU) neoplasms and non-neoplastic lesions using real cases to segue into the discussion. The workshop is comprised of 2 sections: Urine and renal FNA cytology. It is designed to address the salient morphological features, the current state-of-the-art ancillary tests, and the pitfalls associated with them. The practical integration of ancillary tests (DNA ploidy, biomarkers, FISH, and novel tests designed to detect malignancy) in urine cytology and renal FNA’s will be discussed. Approach to differential diagnoses and diagnostic role of ancillary studies in renal cytology will be covered in light of the newer sensitive imaging techniques and personalized treatment modalities of the 21st century. An interactive form with audience participation will be utilized where the course will commence with a pretest and end with a posttest followed by discussion with the facilitators.
|10:30 am - 12:00 pm||Cytology Workshop #6
Update on Liquid-Based Pap Test: Morphology, Molecular Testing and Management
Rana S. Hoda, M.D., FIAC
Syed A. Hoda, M.D.
1) Facilitate diagnostic interpretation of gynecological (Pap test) specimens on liquid-based preparations
2) Demonstrate practical applications of ancillary (including HPV, p16) tests on these specimens
3) Review of ASCCP management guidelines for various Pap test diagnostic categories
Liquid-based preparations (LBP), SurePath and ThinPrep, have replaced conventional preparatory methods of Pap test specimens. An array of lesions present in the Pap test can pose a diagnostic challenge in LBP. This practical course has been designed to discuss problematic aspects in differential diagnosis of squamous and glandular lesions in liquid-based Pap test.
At the course, an introductory session will outline technical aspects of LBP and differences in cellular morphology in ThinPrep and SurePath. A selected set of 10 Pap Test cases will form the basis of this Course. These cases will include atrophy, inflammatory, “atypical”, LSIL, HSIL, squamous carcinoma, and atypical and neoplastic glandular lesions. The cases will be analyzed step-wise—starting with cytological findings (as seen on two common LBP: SurePath and ThinPrep), and moving to differential diagnosis. HPV-testing and image-guided screening will be described and current management guidelines for each category of cases will be outlined. The optimal cytopathology reports will then be formulated. Histological correlation and quality control and assurance issues encompassing HPV testing and automated screening will also be discussed.
|10:30 am - 12:00 pm||Cytology Workshop #7
Creating a Good Image: Electronic Image Enhancement with Photoshop®
Daniel F. I. Kurtycz, M.D.
1) To discuss the characteristics of quality electronic photomicrographs 2) To discuss color theory and color balancing as it pertains to photomicrographs
3) To familiarize participants with electronic manipulation of digitized images at a novice level using standard desktop computer tools
4) To explain the sharpening of images and the correction of lighting gradients
5) To explain common image formats used for presentation and publication
Since almost all presentations are now given by means of computers and electronic projection systems there is a need to teach people how to work with scanned or captured digitized images. In a seminar format, we propose to instruct individuals on the theory and practice of electronic image manipulation using desktop computers and the most popular image editing tool, Adobe Photoshop®. Characteristics of quality electronic photographs will be discussed. We will show how to color balance, brighten and sharpen images.
|10:30 am - 12:00 pm||Cytology Workshop #8
Endoscopic Ultrasound Guided Fine Needle Aspiration of the Pancreas: Impact of Interaction between Endosonographer and Cytopathologist
Darshana Jhala, M.D., B. Mus.
Nirag Jhala, M.D., M.I.A.C.
Girish Mishra M.D., M.S.
1) Participants will be able to recognize importance of interaction between endosonographer and cytologist in arriving at difficult solid and cystic lesions of the pancreas
2) Participants will be able to recognize important differential diagnosis and understand use of judicious ancillary studies including immunocytochemistry, flow cytometry and molecular diagnostics to arrive at definitive interpretation
3) Recognize impact of understanding salient EUS imaging features and immediate cytologic evaluation (ICE) in triaging samples for difficult pancreatic lesions
This course will highlight key issues relevant to the practice of cytotechnologists and cytopathologists in arriving at a diagnosis of pancreatic lesions. It will highlight relevance of communication between endosonographers and cytopathologists and highlight key EUS imaging features that helps generating sound differential diagnosis. Furthermore it will highlight implications of immediate cytologic evaluation (ICE) and its value in triaging samples for judicious use of ancillary studies to arrive at diagnosis. This course will take case based approach to highlight an approach to diagnose difficult solid and cystic lesions of the pancreas.
|10:30 am - 12:00 pm||Cytology Workshop #9 - CANCELED
Histologic Correlation with Atypical GYN Cytology: A Means to Reduce Error and Improve Diagnosis
Heather Currens, MAED
Stephen S. Raab, M.D.
1) Recognize the histologic features in biopsies which correlate to Pap diagnoses of LSIL, HSIL, adenocarcinoma and reactive changes
2) Identify some of the common pitfalls in evaluation of Pap tests as seen in correlated biopsy samples
3) Discuss the significance of pelvic washings obtained during a staging case for a GYN malignancy
4) Identify the appropriate initial workup of a sample from a GYN malignancy of unknown origin
The evaluation of histologic correlates of gynecologic cytology provides a method to reduce diagnostic error and improve practice. This workshop focuses on the use of correlation root cause analysis and quality improvement methods to address the challenges in Pap test and washing cytology. The workshop will be conducted through a didactic interplay between an expert gynecologic surgical pathologist and a cytopathologist with extensive audience participation. The cytopathologist and surgical pathologist will use a simulated case format to discuss classic and rare problems in cytologic diagnosis, including the atrophic smear, rare atypical metaplastic cells, atypical squamous cells of undetermined significance, glandular lesions, and challenging washing specimens. For each area, the surgical pathologist will discuss how histopathologic correlation and histopathologic recognition may improve cytology practice and reduce over or under diagnosis. Each section will conclude with a discussion of quality improvement initiatives that may be implemented in cytology laboratories. The workshop will involve discussion of the HPV virus and its effect on cervical squamous epithelium, the appearance of low and high grade squamous lesions, invasive squamous cancers, and additional squamous lesions including atrophy and reactive squamous changes in the presence of inflammation. Glandular cervical and endometrial lesions will be discussed, including neoplasia, polyps, microglandular hyperplasia, and tubal metaplasia. We will review the significance of pelvic washing from staging cases for gynecologic cancers, with particular emphasis on the staging implications of findings and morphology of several different cancers and reactive mesothelial proliferations. Additionally, we will discuss the appropriate initial workup of a cytology specimen taken to identify a gynecologic malignancy whose specific organ of origin is unknown.
|10:30 am - 12:00 pm||Cytology Workshop #10
Introduction to the Use of Ultrasound as Adjunct to Head and Neck Fine Needle Aspiration
Nicole Massoll, M.D.
Mark Lupo, M.D., FACE
1) To learn basic ultrasound terminology
2) To learn ultrasound anatomy
3) To learn ultrasound features of thyroid nodules
4) To learn ultrasounds features of lymph nodes
5) To practice hands-on skills of the ultrasound machine
This workshop will introduce cytopathologists to the use and terms needed for ultrasound guided fine needle aspiration. Participants will get familiar with ultrasound features of neck anatomy and the unique features of thyroid nodules and lymph nodes. A hands-on portion will allow participants to try ultrasound guided fine needle aspiration on phantom nodules.
|1:30 pm - 3:30 pm||Cytology Workshop #11
State of the Art Cytomorphology and Corresponding Molecular Diagnostics
Brian Collins, M.D.
Joel Bentz, M.D.
G. Denice Smith, Ph.D.
1) Recognize those cytology cases with emerging applicable new molecular diagnostic technology
2) Understand the application of molecular diagnostic testing in cytopathology
3) Be familiar with how to integrate molecular pathology data into the diagnostic process
4) Learn how to report the information in order to clearly communicate its significance
The utilization of molecular diagnostic is becoming an increasing important part of the cytopathology laboratory. There has been significant growth of available testing methodologies applicable to a wide variety of specimen sources submitted for diagnosis. This case based course will utilize morphology based cytopathology cases to demonstrate and illustrate the corresponding emerging molecular diagnostics. The underlying concepts, technology and tools used with be discussed. These will include in situ hybridization, nucleic acid amplification, and mutation analysis. Participants will learn how these tools can help improve diagnostic accuracy and identify subsets within diseases which impact patient care and management. Results reporting and clear communication of findings and corresponding educational recommendations will be discussed. Topics covered will include pancreatobiliary, thyroid, pulmonary, urinary, cervical, head and neck, and soft tissue cytopathology tests.
|1:30 pm - 3:30 pm||Cytology Workshop #12 - CANCELED
Immunochemistry for Cells: Principles, Differentials and Targeted Therapies
Rouzan Karabakhtsian, M.D., Ph.D.
Ann T. Moriarty, M.D.
1) Understand the principles of immunocytochemistry (ICC), and review the regulatory aspects of ICC
2) Familiarity with various preparations/fixations used in cytology laboratory for ICC work-up
3) Identify antibodies most commonly used in cytology preparations, recognize immunostaining patterns for different antibodies, and implement semiquantitative evaluation of immunostains
4) Formulate the immunophenotypic characteristics for the most commonly encountered differential diagnoses, and discuss the importance of selected immunopanels to subtype neoplasms for novel targeted therapies
5) Assess ER/PR and Her-2/Neu oncoprotein expression in breast aspirates (review of validation studies), and address the role of image analysis in ICC
Immunocytochemistry is indispensible in pathology and its role is continually expanding. In cytology we are faced with applications and procedural complexity of more antibodies than ever before. This workshop will give the participants a grasp of ICC concepts relating to daily cytology practice. We will discuss the issue of fixation as it relates to ICC work-up, review common antibodies and their usefulness in making the differential diagnosis, and define selected immunopanels to subtype neoplasms for targeted therapies. The workshop will use videomicroscopy to enable active learning by participants while they integrate clinical information, morphology, and immunochemistry to formulate a differential diagnosis.
|1:30 pm - 3:30 pm||Cytology Workshop #13
Errors in Non-Gynecological Cytopathology and Pathology: There is More to Learn from System Failures than from System Successes
Walid E. Khalbuss, M.D., Ph.D
Sara E. Monaco, M.D.
Liron Pantanowitz, M.D.
1) Identify common errors made in non-gynecological cytopathology, analyze their root cause, and how best to reduce or prevent them
2) Recognize the importance of cytological-histological correlation in non-gynecological cytopathology and demonstrate that follow-up is often the best teacher
3) Illustrate how cytopathology can be used as a measure of quality assurance for errors in surgical pathology
Error reduction is an important aspect of continuous quality improvement. Error reduction and patient safety in healthcare has recently come to the forefront of medical practice. Follow-up is the great teacher in cytopathology. The cytopathology laboratory is required to perform cytological-histological correlation in order to improve the diagnostic yield and reduce errors. This seminar will review and discuss selected cases (long and short cases) in which errors or pitfalls were experienced prior to signing out the case and/or upon follow up. Selected images from each case will be presented, followed by an interactive discussion between the instructors and the audience. These cases will highlight the diagnostic dilemmas and important pitfalls encountered, including screening and interpretation errors. Key difficulties that arise with well-differentiated neoplasms, benign entities that mimic malignancy, malignancies with bland cytology, and coincident entities will be presented. Educational cases with errors in surgical pathology that were discovered by means of cytological diagnoses will also be presented.
|1:30 pm - 3:30 pm||Cytology Workshop #14
The Problem Pap Test: Challenging and Unusual Cases in GYN Cytopathology
Jamie L. Covell, B.S., CT(ASCP)
Karen M. Atkison, M.P.A., CT(ASCP)CMIAC
1) Be able to recognize and discuss differential diagnoses for difficult cases
2) Describe criteria for making morphologic evaluations in unusual cases
3) Discuss the importance of clinical history in the evaluation of Pap tests
This workshop will discuss the cytologic findings and differential diagnoses for a series of challenging and/or unusual cases seen in liquid-based Pap tests. Both ThinPrep and SurePath preparations are included. Clinical information and the use of ancillary testing (where appropriate) will also be presented. We will evaluate each specimen as a routine screening case seen in the laboratory and use a step by step approach to formulate a cytologic interpretation. Cytologic and/or tissue follow-up will confirm or provide the final diagnosis for each case. Participants will have the opportunity to review images from the cases prior to the workshop, formulate their own interpretations and then compare them with the other participants as well as the presenters. Interactive participation and lively discussion will be essential.
|1:30 pm - 3:30 pm||Cytology Workshop #15
Advanced Use of Ultrasound for Fine Needle Aspiration of the Head and Neck
Nicole Massoll, M.D.
Mark Lupo, M.D. FACE
1) To review the ultrasound features of thyroid nodules
2) To review the ultrasound features of benign and malignant lymph nodes
3) To learn the ultrasound features of salivary gland lesions and parathyroids
4) To practice hands-on use of the ultrasound for fine needle aspiration of phantom nodules
5) To practice hands-on use of the ultrasound to find true human head and neck anatomy
This workshop will advance the cytopathologists ability to use the terms needed for ultrasound guided fine needle aspiration. Participants will review the ultrasound features of head and neck anatomy and the features of thyroid nodules, lymph nodes, parathyroid and salivary glands. A hands-on portion will allow participants to try ultrasound guided fine needle aspiration on phantom nodules as well as practice identification of true human head and neck anatomy.