|November 15, 2010|
|12:00 pm - 1:45 pm||Roundtable Discussion #9
Molecular Application in Cytopathology: Improving Diagnostic Certainty Through Ancillary Testing
N. Paul Ohori, M.D.
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.
|12:00 pm - 1:45 pm||Roundtable Discussion #10
ABC's of Cytopathology: Hot Topics
Susan E. Spires, M.D.
1) Review CPT/RUC Process In CPT Code Creation and Valuation
2) Understand and Become Conversant with Coding Rules, Payment Policy and Payment Edits
3) Elucidate Current "Hot Spots" in payment and How to Remain Compliant with Regulations
4) Address Individual Coding Problems by Participants
Based primarily on Medicare payment rules and policy, this session is designed to provide an initial brief general background on code development and to describe in substantive detail, current and ever-changing payment policies and edits. Additionally, the most recent payment issues as they pertain to cytopathology specimens with some potential solutions to limitations posed by payers will be elucidated. The bulk of the session will be spent addressing individual current coding problems and issues facing the participants of the roundtable session. All are invited to bring their specific coding questions and conundrums for elucidation of solutions. Resources for coding advice and continuing coding education will be provided.
|12:00 pm - 1:45 pm||Roundtable Discussion #11
The Role Innovation and Informatics Can Play in Cytology QA: Less Pain and More Gain
Robert A. Goulart, M.D.
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.
|12:00 pm - 1:45 pm||Roundtable Discussion #12
The Lean Cytopathology Laboratory: Applying Lean Tools for Effective Problem Solving
Kalyani Naik, M.S., SCT(ASCP)
1) Explain the role of lean in the cytopathology laboratory’s continuous quality improvement plan
2) Identify lean tools that can be used to engage and empower employees to participate in effective problem solving
3) Apply lean tools to develop effective solutions to real life problems or errors in the cytopathology laboratory
While lean was initially developed for and utilized in the industrial setting, many areas of medicine, including laboratory medicine, are now successfully applying lean principles and tools as a means of ensuring continuous quality improvement, reducing errors and waste, and maximizing efficiency. As an integral component of a cytopathology laboratory’s comprehensive quality assurance plan, lean principles and tools can engage and empower employees to identify and implement effective solutions to everyday problems. This roundtable discussion will focus on how lean fits into a cytopathology laboratory’s comprehensive quality assurance plan to assure continuous improvement. Specific tools, such as the A3 and root cause analysis that can be used to effectively resolve problems will be shared. Participants will have the opportunity to apply these lean tools to develop solutions to real life problems or errors encountered in the cytopathology laboratory.
|12:00 pm - 1:45 pm||Roundtable Discussion #13
Salt and Pepper: Where's the Beef?
Momin T. Siddiqui, M.D., FIAC
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.
|12:00 pm - 1:45 pm||Roundtable Discussion #14
Residents and Fellows Performing FNA: How to Comply with the ACGME Requirements and What is Best
Mousa Al-Abbadi, M.D., FIAC
1) Provide venues to cytopathologists in educational centers to facilitate training and teaching residents and cytopathology fellows how to perform FNA and comply with the new ACGME requirements
2) Be familiar with different techniques that are used in FNA
3) How to demonstrate competence in performing FNA
This discussion is designed to address the requirements by the ACGME for residents and cytopathology fellows to be competent in performing FNA. Despite the fact that the ACGME didn't specify a certain number of FNA procedures; it is agreed upon that all residency as well as cytopathology fellowship training programs are required to provide training in FNA performance. They are also asked to assure competency in that regard. This interactive discussion will address the need to comply with the ACGME requirement. The participants will learn more about how to utilize their different pathology sections to facilitate and create more chances to perform the procedure.
|12:00 pm - 1:45 pm||Roundtable Discussion #15 - CANCELED
Diagnostic Cytology from Canada to Saudi Arabia
Nikolaos Chantziantoniou, B.Sc., ART(CSMLS), CMIAC
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.
|12:00 pm - 1:45 pm||Roundtable Discussion #16
Starting Up an On-Site Adequacy Service
Deborah Chute, M.D.
1) Understand the administrative challenges of starting an on-site adequacy service
2) Be able to discuss the technical aspects of starting an on-site adequacy service, including the use of real-time web-based video microscopy
3) Discuss the potential role of cytotechnologists in starting and continuing an on-site adequacy service
In many fields of clinical medicine, the ability of cytology adequacy assessments to improve diagnostic rates and decrease repeat procedures has been well documented. Radiologists, gastroenterologists, endocrinologists, surgeons and oncologists are increasingly requesting our services in this manner. In addition, what has largely been restricted to large academic centers is now expanding into private practice hospitals. Many cytopathologist practices have not traditionally had on-site adequacy techniques available, but are considering adding this valuable service. This session will address the administrative, technical, and personnel challenges and choices that make starting a new on-site adequacy service appear overwhelming. The presenter will draw upon their previous experience with rapid assessment services. New technologies, including implementation of web-based cameras for beaming images across hospitals will be discussed. And finally, the role cytotechnologists in the development and implementation of an on-site adequacy service will be discussed. By the end of the presentation, the attendees will have the information and tools needed to start an adequacy service at their institution.