Educational Objectives:
1) Review the current status of ancillary testing in cytopathology
2) Review FNA technique and specimen processing for optimal cytomorphology and molecular testing
3) Review common molecular pathways
4) Discuss the pathologic and clinical significance of molecular alterations found in thoracic, pancreatic, and thyroid cytopathology specimens
5) Compare molecular testing to other ancillary tests (e.g. immunochemistry) and discuss the emergence of additional technologies affecting the refinement of cytopathologic diagnoses
Integration of ancillary studies in routine cytopathologic analysis is becoming a common part of diagnostic practice. Recently, the molecular pathways of common neoplasms in the thorax, pancreas, and thyroid are better understood. For example, progression of pancreatic cystic neoplasms is associated with KRAS mutation and loss of heterozygosity involving tumor suppressor genes including p53, p16, PTEN, APC, CDKN2A, CMM, MCC, and VHL. Mesotheliomas are associated with homozygous deletion of p16/CDKN2A and a subset of pulmonary adenocarcinomas harbor EGFR mutations. In thyroid neoplasia, 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 may refine the cytologic diagnosis but must be integrated with other pathologic and clinical parameters. In this session, we will discuss the application of molecular tests to cytology samples. 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 cytologic findings.

Educational Objectives:
1) Appreciate the emerging role of informatics in cytology QA
2) Gain insight into how informatics can allow innovation in the QA process.
3) Better utilize reporting systems, monitors and indicators in the laboratory
4) Expand your QA processes to gain educational feedback for your residency and fellowship programs, with demonstration of graduated competency
Automation and emerging information technologies are being increasingly adopted in cytopathology to augment Pap test screening, improve diagnostic accuracy and facilitate the quality assurance process. Laboratory informatics, the application of computers and information systems to information management in the pathology laboratory, has now become an essential component in the field of cytopathology. Providing information in a manner that is most effective for patient care is the primary mission of the cytology laboratory, and informatics is our latest, greatest tool to help us realize this goal. The application of informatics to the QA process can not only facilitate standard and federally required QA indicators, but can also allow for the monitoring of innovative measures which better reflect your laboratory practice and offer more meaningful feedback. This discussion will demonstrate how informatics can be specifically used to make your QA process work faster, easier, and smarter, while allowing for creative and clinically useful monitoring beyond CLIA for your cytotechnologists, residents, fellows, and patients.

Educational Objectives:
1) Non-gynecologic specimens such as bronchial brushings, washings and lavages are often evaluated to diagnose lesions ranging from carcinoid tumors to large cell neuroendocrine carcinoma. The features of these lesions will be discussed in detail along with differential diagnoses
2) Fine needle aspirations of lung, pancreas or liver often show lesions with salt and pepper chromatin which may represent primary or metastatic lesions. This diagnostic challenge will be reviewed in a case based manner
Salt and pepper chromatin is noted in a variety of clinical settings involving evaluation of cytology specimens. Mostly salt and pepper chromatin is noted in neuroendocrine neoplasms, both benign and malignant in a variety of locations. This cytologic feature may be encountered in diverse specimens like cerebrospinal fluids, bronchial brushings and washings and fine needle aspirations from the lung or pancreas. This video microscopy tutorial will focus on these specimen types and evaluate the diagnostic criteria of commoner lesions with salt and pepper chromatin.

Educational Objectives:
1) Describe the major events and stages through which Diagnostic Cytopathology developed and matured in Saudi Arabia
2) Describe major future developments that underscore the vision and scope of ongoing Cytopathology (services and/or institutions) development in Saudi Arabia
Diagnostic cytopathology is characterized by two positively-related spheres: global demand, and the Human Papilloma Virus (HPV). HPV knowledge predisposes diagnostic demand, inviting system development then expansion.

Diagnostic cytopathology in North America developed systematically through evolving terminology, application and execution, and molecular, and techno-sophistication. Diagnostic cytopathology in Canada matured similarly through institutions that developed synchronously. Effective Canadian networks link public demand, therapeutic safety-nets, responsive training programs, and legislative surveillance to maintain overall effectiveness. Epidemiologic data borne from the Canadian experience attest to overall system maturity.

Cytopathology in the greater Gulf regions, Saudi Arabia being the larger member, developed differently; however the trans-Atlantic divide created yet another near-perfect case of events.

Components of the Canadian system were adopted and implemented strategically in high-demand regions, mainly through Canadian expertise. Major, exemplary, accredited institutions as the King Abdulaziz Medical City hospital in Riyadh, Saudi Arabia, boasts a comprehensive, all-inclusive diagnostic system; characterized by targeted application, internationally-benchmarked statistical and epidemiologic data, responsive and tailored teaching platforms, and mechanisms to certify and credential local graduates/cytologists.

Despite the incremental developmental stages, Diagnostic Cytopathology in major institutions in Saudi Arabia is comparable fully to that of equivalent Canadian institutions; however, differs by unprecedented growth in scope and vision, and services development.