Cytology Workshops

Hilton Americas Houston

November 2-6, 2007

Houston, Texas

 

Cytology Workshops

3.0 CME Credits per session
($130.00 for members,
$260.00 for non-members)

 

The ASC offers both Microscopic and Non-Microscopic Cytology Workshops with interaction and exchange of information emphasized among a small number of participants.  The Microscopic Cytology Workshops start with a lecture, and then participants have an opportunity to view cytology slides on individual Binocular microscopes.  A question and answer segment follows.  The Non Microscopic Workshops are more in depth discussions of the topic.

 

Please note: Entry into each Cytology Workshop requires a ticket, which will be collected by a Workshop volunteer stationed at the entrance of each Workshop room. The Scientific Program Committee requests that you respect this policy and not attempt to enter without a ticket.


Session 1
Tuesday, November 6, 2007
8:30 am – 12:00 pm

 

MICROSCOPIC WORKSHOPS

Workshop #1 – Cytology of the Respiratory Tract
Director:
     Manon Auger, M.D., F.R.C.P. (C)
Faculty:
     Heather Barwick, B.Sc, R.T.(CSMLS); CT(ASCP)IAC

Educational Objectives:

  1. To provide a structured approach for the diagnostic interpretation of various cytological specimens from the respiratory tract (including fine needle aspirates, bronchial washings/brushings, sputa) with an emphasis provided on resolution of differential diagnoses
  2. To illustrate a wide range of cytological presentations of benign and malignant pulmonary lesions
  3. To familiarize the registrants with diagnostic pitfalls

This workshop includes a comprehensive didactic portion, followed by a practical glass slide session, with focus on the demonstration of the spectrum of cytological features/variants of specific benign and malignant pulmonary lesions.  Emphasis will be placed on the recognition of diagnostic pitfalls and on approaches to resolve differential diagnostic dilemmas.  Histological correlation will be amply illustrated.  Diagnostic limitations of respiratory tract cytology will be discussed.  A collection of approximately 150 high quality cases will be available during the microscopic session, for each participant to review on his own microscope, to include the lesions discussed in the didactic portion.  “Unknown” cases will be provided for self-assessment and reviewed at the conclusion of the workshop.  A comprehensive handout will be distributed to each registrant. (Intermediate/Advanced)

 

Workshop #2 - Recognizing and Classifying Atypical Glandular Cells on ThinPrep® Pap Tests
Director:
     Martha B. Pitman, M.D.
Co-Director:
     Eileen Ludlow, CT(ASCP)
Faculty:
     Suzanne Werneke, CT(ASCP)
     Katie Eighme, M.S., CT (ASCP)

Educational Objectives:

  1. Attendees will learn to recognize glandular cell abnormalities on ThinPrep® Pap Test
  2. Attendees will learn to classify atypical glandular cells according to TBS 2001
  3. Attendees will learn specific criteria for the various types of glandular cell abnormalities as listed in TBS 2001
  4. Attendees will see criteria demonstrated via video microscope
  5. Attendees will apply demonstrated criteria to unknown glass slides

Using at least 82 biopsy confirmed cases of glandular cell abnormalities detected on ThinPrep® Pap test slides, including all of the TBS 2001 atypical glandular cell categories of abnormality, along with the expertise of the course directors and faculty, workshop attendees will learn the criteria for classification of glandular cell abnormalities in ThinPrep® Pap tests according to TBS 2001. The course director will demonstrate and summarize criteria for all categories using a projection microscope.  Participants will then apply these criteria to unknown glass slides, some of which have the histologic correlate also available for review. (Intermediate)

 

Workshop #3 - Urinary Cytology Pitfalls and Updates
Director:
     Abdelmonem Elhosseiny, M.D.
Co-Director:
     Laura Schned, M.D.

Educational Objectives:

  1. Recognize the pitfalls in urinary cytology and how to avoid them
  2. Understand the WHO 2004 classification of urothelial tumors and its correlation with cytology
  3. Acknowledge the role of new technology in urinary cytology

The workshop starts with a short pretest followed by a didactic session addressing the indications of urine cytology and its limitations, the various pitfalls and how to best avoid them, current role of ancillary testing in urine cytology, and correlating cytology with histology for quality assurance purposes. Following the didactic session is a microscopic review of extensive cytologic material with histologic correlation. The workshop will conclude with the post test. Participants will have an ample opportunity to interact with the faculty. (Intermediate)

 

Workshop #4 - ThinPrep® Processing of Non-Gynecologic Specimens:  Review of Diagnostic Sensitivity and Morphologic Detail
Director:
     Momin T. Siddiqui, M.D.
Co-Director
     Raheela Ashfaq, M.D.

Educational Objectives:

  1. Non-gynecologic cytologic specimen processing by ThinPrep® including its utility in bloody and mucoid specimens
  2. Assessment of adequacy for a diagnosis
  3. Morphologic assessment of normal constituents of Non-Gyn specimens
  4. Morphologic assessment of non-neoplastic conditions, which include reactive and infectious processes
  5. Morphologic assessment of tumor including commoner malignancies, identified in these specimens
  6. Utility of liquid-based processing for ancillary studies

This course is geared towards cytotechnologists, pathology residents/fellows and cytopathologists.  It will educate the participants on all major areas of non-gynecologic cytology using ThinPrep® processing.  It will include technical aspects of using ThinPrep® staining as well as morphologic details of commoner benign and malignant brushings, bronchoalveolar lavage, body cavity fluids, bladder washings, and bile duct brushings.  Also included would be morphologic pitfalls that may be encountered in these specimens. (Advanced)

 

NON-MICROSCOPIC WORKSHOPS

Workshop #5 – Clinical, Therapeutic and Cytomorphologic Issues in Gynecologic Cytology
Director:
     Harvey Cramer, M.D.
Faculty:
     Melissa Randolph, B.S., CT(ASCP)
     Jeffrey M. Rothenberg, M.D., M.S.

Educational Objectives:

  1. Understand the structure and content of the 2001 Bethesda System
  2. Familiarize oneself with the cytomorphology of all of the entities described in the 2001 Bethesda System
  3. Understand current screening guidelines as established by the American College of Obstetrics and Gynecology
  4. Understand the 2001 Consensus Guidelines for the Management of Patients with Cervical Intrapepithelial Neoplasia and updates to these guidelines
  5. Understand the role of HPV testing in improving the diagnosis and triage of patients with cervical cytologic abnormalities
  6. Understand the therapeutic implications of both common and uncommon cytologic diagnoses and the complexities regarding patient management that are sometimes unexpectedly encountered and rarely appreciated by cytotechnologists or cytopathologists
  7. Develop an awareness of the potential pitfalls in gynecologic cytology diagnoses and strategies to avoid diagnostic errors

Registrants will receive a CD ROM containing relevant clinical information and selected cytology images from 10 patients representing the spectrum of cervicovaginal diseases described in The Bethesda System. Each case will illustrate either an important cytologic and/or clinical dilemma. The gynecologist will first describe the clinical setting and his initial clinical differential diagnosis. The cytomorphology, cytomorphologic differential and final diagnoses will then be presented by the cytotechnologist and cytopathologist. The clinical implications of the cytologic diagnosis and the appropriate therapeutic options will be addressed by the gynecologist. Follow-up surgical pathology findings and patient outcome will then be presented by the cytopathologist. (Intermediate)

 

Workshop #6 – Molecular Diagnostics for Cytotechnologists
Director:
     E. Blair Holladay, Ph.D., SCT(ASCP)CM
Co-Director:
     Lynnette C. Savaloja, SCT(ASCP)

Educational Objectives:

  1. Describe molecular diagnostics relevant to cancer pathology
  2. Describe in vitro diagnostic tests and assays using analyte specific reagents (ASR’s)
  3. Discuss and illustrate automated technologies, i.e., Hybrid Capture® signal amplification and polymerase chain reaction (PCR) and their specific uses in cancer diagnostics
  4. Discuss CPT coding and reimbursement for each specified molecular assays

This workshop will educate cytotechnologists on morphology-based molecular diagnostic assays relevant to cytology, either FDA-approved or analyte specific reagents (ASR’s).  The participants will learn microscopic analysis of slides stained via chromogenic in situ hybridization for nucleic acids (HPV, Her2/nue, etc.)  Tissue microarrays and molecular markers for FNA or brushings (breast, pancreas) will be instructed.  Instruction will include discussion of automated technologies, such as Digene HCII® (HPV, CT/NG) and Light Cycler® (PCR) for current and future oncology diagnostics.  Lastly, proper utilization of CPT coding and utilization will teach participants to maximize reimbursement for molecular diagnostic assays useful in cytology. (Intermediate)

 

Workshop #7 – Fluid Cytology Update: The Many Faces of Mesothelial Cells and Malignant Cells in Fluid Cytology
Director:
     Walid E. Khalbuss, M.D., Ph.D., FIAC
Faculty:
     Marilyn M. Bui, M.D., Ph.D.

Educational Objectives:

  1. Define the criteria in the diagnosis of non-neoplastic and neoplastic lesions that can be detected by body cavity fluid cytology
  2. Analyze the pitfalls in the interpretation of effusion preparations
  3. Demonstrate the many faces of reactive mesothelial cells and the many faces of malignant cells in body cavity fluid cytology
  4. Review the role of cellblock preparations and ancillary studies in the determination of benign versus malignant effusion, and the identification of the primary site of malignant effusion

The program will start with an instructor-audience interactive discussion on the cytomorphological criteria in the diagnosis of reactive/proliferative mesothelial cells, inflammatory/infectious conditions and neoplastic lesions in body fluid with emphasis on the many faces and similarities of reactive/proliferative mesothelial cells and malignant cells. The diagnostic pitfalls of papillary structures, vacuolation of mesothelial cells, psammoma bodies, collagen balls, endometriosis, endosalpingiosis, and the issue of borderline tumors reporting will be addressed. The role of ancillary studies (special stains, immunocytochemical staining, flow cytometric studies and EM) will be discussed. The second part of the presentation will be a review and discussion of 20 interesting cases in fluid cytology with emphasis on problematic areas in body cavity fluid cytology. (Intermediate)

Workshop #8 – Normal Cytology – Unexpected Diagnostic Challenges and Pitfalls
Director:
     Umesh Kapur, M.D.
Co-Director
     Eva M. Wojcik, M.D., MIAC

Educational Objectives:

  1. To recognize the normal organ system cytology in different types of preparations (direct smears, liquid based preparations, brushings, washings, cytospins, cell blocks)
  2. To understand the potential diagnostic pitfalls arising from misinterpretation of cytologic material from normal structures
  3. To discuss the diagnostic challenges arising from neoplasms mimicking normal cytology
  4. To evaluate ancillary techniques useful for the differential diagnosis

Today, as cytologists, we are faced with greater than ever diagnostic challenges.  Not the least of them is the ever-increasing phenomenon of being asked to diagnose smaller and smaller deep-seated lesions being detected by newer and more sophisticated imaging modalities.  The foremost challenge is to recognize the normal cytology of the organ system and not to give a false positive diagnosis.  In many instances, normal cytology mimics more ominous lesions. For example, renal proximal tubular epithelium may mimic a renal clear cell carcinoma or normal gastrointestinal mucosa may be mistaken for pancreatic mucinous lesions.  This workshop will provide a comprehensive review of cytologic criteria, ancillary techniques and discuss the potential diagnostic pitfalls.  To increase the challenge, neoplastic entities mimicking normal tissue will also be presented.  (Novice/Intermediate)

 

Workshop #9 – Diagnostic Limitations and Pitfalls in Aspiration Cytopathology of Liver, Kidney and Adrenal Gland
Director:
     Syed Z. Ali, M.D.
Co-Director:
     Yener S. Erozan, M.D.

Educational Objectives:

  1. Achieve sound familiarity with diagnostic limitations of aspiration cytopathology in liver, kidney and adrenal gland
  2. Learn to develop a diagnostic algorithm when dealing with FNA of these organ systems
  3. Accurately recognize “difficult-to-diagnose” lesions in liver, kidney and adrenal gland aspiration pathology
  4. Learn to avoid potential diagnostic pitfalls by accurately identifying the “look-alike” lesions
  5. Achieve a sound working knowledge of ancillary techniques (particularly the newer immunomarkers) in “hard-to-classify” lesions

Liver, kidney and adrenal gland are areas where FNA plays a pivotal role in patient management. The cytologic interpretive aspects of these procedures are often full of diagnostic pitfalls and problems. This workshop provides an extensive review of the selected “diagnostically-difficult” areas (e.g. regenerative hepatic atypia versus well-differentiated hepatocellular carcinoma (HCC), cystic renal lesions, unusual renal tumors, primary and selected metastatic adrenal tumors, the critical role immunostaining in these three organ systems). Lecture, case-based discussion will be employed. (Intermediate)

 

Workshop #10 – Cytologic Evaluation of Salivary Gland Aspirates: A Case-Based Approach with Histologic Correlation
Director:
     William C. Faquin, M.D., Ph.D.
Faculty:
     Celeste N. Powers, M.D., Ph.D.

Educational Objectives:

  1. Participants should be able to recognize the characteristic cytologic features of commonly encountered as well as diagnostically challenging salivary gland tumors
  2. Participants should be able to formulate a differential diagnosis and discuss the pitfalls in the cytologic diagnosis of salivary gland tumors
  3. Participants should be able to understand the role and limitations of fine needle aspiration in the evaluation of salivary gland neoplasia
  4. Participants should be able to effectively use ancillary techniques in the cytologic evaluation of difficult salivary gland tumors

Tumors of the salivary gland include a wide range of benign and malignant neoplasms that often pose diagnostic challenges for cytopathologists. This course will use a case-based approach to discuss practical aspects of diagnosing major types of salivary gland tumors with particular emphasis on the differential diagnosis, diagnostic problems and pitfalls. The course will correlate cytomorphology with histopathology during individual case discussions. The advantages of fine needle aspiration cytology as well as the limitations of this technique will be discussed where relevant. While the emphasis in this course will be upon the light microscopic cytologic features of salivary gland tumors, ancillary studies that are helpful in the diagnostic workup will also be covered.

Eight cases that include both fine needle aspiration material and corresponding histology will be used to initiate a discussion of the differential diagnosis and pitfalls of various salivary gland tumors.  The case-based topics to be covered include: 1) matrix-containing tumors, 2) oncocytic tumors, 3) basaloid salivary gland tumors, 4) lymphoproliferative lesions, 5) cystic and mucinous tumors, 6) high-grade salivary gland tumors, 7) clear cell tumors, and 8) spindle cell lesions. (Intermediate)

 


Session 2
Tuesday, November 6, 2007
1:30 pm – 5:00 pm

 

MICROSCOPIC WORKSHOPS

Workshop #11 – High Risk HPV Testing: The Morphology of Positive and Negative Cases: A Slide-Based Workshop
Director:
     Rosemary Tambouret, M.D.
Co-Director:
     David C. Wilbur, M.D.

Educational Objectives:

  1. 1. Understand the biology of and testing methodologies for HR HPV
  2. 2. Correlate morphology with HR HPV results
  3. 3. Fine tune morphologic classification of atypical cells
  4. 4. Provide an objective method for quality assurance of morphologic interpretation

In this glass slide-based workshop, cytology cases will be presented from reproductive age and postmenopausal women who have had reflex or primary screening testing for high risk HPV. The lecture portion will review the biology of HPV, testing methods for HPV, and management guidelines. Observations of morphologic patterns seen in association with HPV positive and negative cases will be reviewed. Slide sets will show these changes along with the HPV results and the clinical follow up. The implications for overall diagnostic classification and management will be discussed. (Intermediate)

 

Workshop #12 – Thyroid Fine-Needle Aspirates Assessed by Diff-Quik and Ultrafast Papanicolaou Stains with Histologic Correlations
Director:
     Grace C.H. Yang, M.D., FIAC
Faculty:
     Wei Sun, M.D., MIAC

Educational Objectives:

  1. Overview of histology and cytology of common and rare thyroid lesions
  2. Practical and algorithmic approach to triage thyroid lesions
  3. Distinguishing follicular variant of papillary carcinoma from follicular neoplasm at low power using the artifact of Ultrafast Papanicolaou stain
  4. Increasing the yield of follicular neoplasms in pre-op FNA diagnosis of follicular lesions
  5. Clues from gross examination of the smears prior to staining
  6. Adequacy based on ultrasound and cytology correlation
  7. Familiarize with Diff-Quik and Ultrafast Papanicolaou stains
  8. Optimize smear preparation and minimize unsatisfactory rate by proper technique

This workshop begins with an overview of thyroid lesions, the sensitivity of FNA in detection papillary carcinomas and the limitations in assessing microfollicular and Hürthle cell nodules, followed by an in-depth discussion of common and uncommon lesions, and the strategy to minimize false positive and false negative cases.  It will be followed by slide review of 250 cases of tissue-proven follicular adenoma, follicular carcinomas (including Hürthle cell, clear cell, spindle cell), papillary carcinomas (including follicular variant, cystic, Warthin-like, microcarcinoma), medullary carcinomas, as well as anaplastic carcinomas, colloid nodule, Hashimoto’s thyroiditis, etc.  At the conclusion of the workshop, the participants will feel confident in assessing thyroid FNA. (Intermediate)

 

Workshop #13 – Pancreas Cytopathology – A Systematic Approach
Director:
     David C. Chhieng, M.D., M.B.A., M.S.H.I.
Co-Director:
     Edward B. Stelow, M.D.

Education Objectives:

  1. To understand the role of FNA biopsy in the evaluation and management of patients with pancreatic masses
  2. To become familiar with the cytologic features of benign and malignant pancreatic lesions
  3. To understand structured algorithms for interpreting pancreatic FNA
  4. To recognize potential pitfalls in diagnosing pancreatic lesions, particularly look-alike lesions 
  5. To learn the effective use of ancillary studies, such as immunohistochemistry and flow cytometry, for the diagnosis of difficult cases

FNA has played an increasingly pivotal role in the management of patients with pancreatic disease.  This workshop is designed to provide a comprehensive review of the cytology of pancreatic lesions, with an emphasis on diagnostically challenge entities.  The workshop will be divided to three parts.  The first part consists of didactic lecture using a case-based approach.  The second part consists of microscopic review of approximately 150 study sets.  Five ‘unknown’ cases will be circulated for self-assessment and reviewed at the conclusion of the workshop.  A comprehensive handout will be distributed to each registrant. (Intermediate)

 

Workshop #14 – Lung and Mediastinal FNA with Radiologic Correlation
Director:
     Scott Anderson, M.D.
Co-Director:
     Sharon Mount, M.D.
Faculty:
     Timothy St. John, CT(ASCP)

Educational Objectives:

  1. Provide exposure to a wide variety of pulmonary and mediastinal primary and metastatic tumors as well as non-neoplastic entities.
  2. Gain a fundamental knowledge of CT images of the lung and mediastinum that will prove useful for the cytologist at the time of rapid diagnosis
  3. Identify cases at the time of rapid diagnosis that may benefit from immunocytochemical investigation, flow cytometry analysis or microbiologic culture so that appropriate submission of sample may occur
  4. Gain familiarity with ThinPrep® specimens obtained from needle rinses at the time of FNA

The workshop begins with a pretest followed by a didactic lecture covering a practical approach to pulmonary and mediastinal lesions as sampled by CT guided FNA.  Following the didactic presentation will be the microscopic review of carefully chosen cytology cases including fixed, air dried and ThinPrep® slides, with histologic and radiologic correlation.  Approximately 150 slide/radiology packets will be available for circulation.  The workshop will conclude with discussion of the post-test. (Intermediate)

 

NON-MICROSCOPIC WORKSHOPS

Workshop #15 – Creating a Good Image: Electronic Image Enhancement with Photoshop®
Director:
     Daniel F.I. Kurtycz, M.D.
Co-Director:
     Jimmie Stewart, III, M.D., FASCP
Faculty:
     John Shalkham, M.A., SCT(ASCP)

Educational Objectives:

  1. To discuss the characteristics of quality electronic photomicrographs
  2. To explain various image formats
  3. To discuss color theory and color balancing as it pertains to photomicrographs
  4. To explain the sharpening of images and the correction of lighting gradients
  5. To familiarize participants with electronic manipulation of digitized images at a novice level using standard desktop computer tools

As most presentations are now given by means of notebook computers and electronic projection systems, there is a need to teach people how to work with scanned or captured digitized images. In a half-day seminar, 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. (Intermediate)

 

Workshop #16 – Metastatic Malignancies of Unknown Primary Origin: A Case-Based Approach with Histologic Correlation
Director:
     Reena Jain, M.D.
Co-Director:
     Ema Berbescu, M.D.

Educational Objectives:

  1. Recognize the characteristic cytologic features and histologic patterns of metastatic malignancies of unknown origin (MMUO)
  2. Use an algorithmic approach to morphologic classification of malignancies of unknown primary site
  3. Formulate a good working differential diagnosis by taking clinical parameters, including the age and sex of patient, and the anatomic distribution of disease into consideration
  4. Effectively use ancillary techniques to pinpoint either the specific cell lineage or site of origin

Metastatic malignancies of unknown origin (MMUO) account for approximately 3-10% of all malignant neoplasms and is therefore one of the 10 most frequent cancer diagnoses in individuals.  It often poses diagnostic challenges for cytopathologists and cytotechnologists.  This workshop uses a case-based and algorithmic approach to morphologic classification of malignancies of unknown primary origin with particular emphasis on relevant clinical data, differential diagnoses, diagnostic problems, and pitfalls.  The course will correlate cytomorphology with histopathology during individual case discussions.  The selective use of ancillary techniques like histochemistry, immunhistochemistry and molecular diagnostics to determine either the specific cell lineage or site of origin will also be discussed.  In addition, the advantages as well as limitations of positive effusion cytology and fine needle aspiration cytology will be discussed where relevant. (Advanced)

Workshop #17 – Practical Statistics for Cytology:  How to Use Statistical Measures for Quality Control
Director:
     Stephen S. Raab, M.D.

Educational Objective:

  1. To learn the principles of statistics that may be used to monitor laboratory quality and personnel performance

We will use a case-based format to investigate how statistical measures may be used in day-to-day cytology practice and cytology quality control.  We will discuss measures of central tendancy, sensitivity and specificity, interobserver variability, frequency, and significance testing using practical examples encountered in the laboratory.  We will focus on how cytotechnologists and cytopathologists may use laboratory data for improvement. (Intermediate)

 

Workshop #18 – Cytopathology of the Genitourinary Tract:  From Morphology to Molecular Markers
Director:
     Eva M. Wojcik, M.D., MIAC
Co-Director:
     Güliz A. Barkan, M.D.

Educational Objectives:

  1. Review the cytologic features and discuss potential pitfalls in urinary cytology
  2. Update on molecular studies and other adjunctive tests that may increase the sensitivity of urinary