Cytology Workshops

November 3-8, 2006

Sheraton Centre Toronto

Toronto, Ontario, Canada

 

$125.00 for members, $200.00 for non-members

 

Session 1:

Tuesday, November 7, 2006
8:30 am – 12:00 pm

 

NON-MICROSCOPIC WORKSHOPS

 

Workshop # 1 – Clinical, Therapeutic and Cytomorphologic Issues in Gynecologic Cytology

Director:
     Harvey Cramer, M.D.
Faculty:
     Trent Coy, B.S., CT, MP(ASCP)
     Jeffrey M. Rothenberg, M.D., M.S.

 

Educational Objectives:

  • Understand the structure and content of the 2001 Bethesda System
  • Familiarize oneself with the cytomorphology of all of the entities described in the 2001 Bethesda System
  • Understand current screening guidelines as established by the American College of Obstetrics and Gynecology
  • Understand the 2001 Consensus Guidelines for the Management of Patients with Cervical Intrapepithelial Neoplasia and updates to these guidelines
  • Understand the role of HPV testing in improving the diagnosis and triage of patients with cervical cytologic abnormalities
  • 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
  • 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 # 2 – Cytologic Evaluation of Salivary Gland Aspirates: A Case-Based Approach with Histologic Correlation

Director:
     Wiliam C. Faquin, M.D., Ph.D.
Faculty:
     Celeste N. Powers, M.D., Ph.D.

 

Educational Objectives:

  • Participants should be able to recognize the characteristic cytologic features of commonly encountered as well as diagnostically challenging salivary gland tumors
  • Participants should be able to formulate a differential diagnosis and discuss the pitfalls in the cytologic diagnosis of salivary gland tumors
  • Participants should be able to understand the role and limitations of fine needle aspiration in the evaluation of salivary gland neoplasia
  • 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. (Intermediate/Advanced)

 

Workshop #3 – Career Development for the Academic Cytopathologist and Cytotechnologist

Moderator:
     Douglas P. Clark, M.D.
Faculty:
     Julie G. Nyquist, Ph.D.

 

Educational Objectives: 

  • To clearly identify scholarly goals and values.
  • To examine individual mentoring networks and identify strengths and weaknesses.
  • To identify areas of opportunity for scholarship in cytopathology education and research.

The goal of this workshop is to present practical advice to junior or mid-career pathologists and cytotechnologists who are interested in developing their academic careers in cytopathology. The faculty will include academic cytopathologists and experts in medical education. Topics to be discussed will include: defining your academic mission; obtaining new research skills; identifying research funding sources; finding mentors and collaborators. The format will include brief presentations by faculty, interactive  career evaluation exercises, and an extensive question and answer period.  A  detailed resource guide will be given within the syllabus. (Novice)

 

MICROSCOPIC WORKSHOPS

 

Workshop # 4 – Applications of Fine Needle Aspiration Biopsy of Breast and Regional Lymph Nodes in the Management of Breast Disease

Director:
     Savitri Krishnamurthy, M.D.

 

Educational Objective:

  • Familiarity with the cytologic features of commonly encountered breast lesions and recognition of the applications of fine needle aspiration biopsy of breast and regional lymph nodes in the management of breast diseases

Cytologic features of the commonly encountered palpable and nonpalpable breast lesions including fat necrosis, cysts, fibroepithelial lesions including fibroadenoma, phyllodes tumor, ductal hyperplasia with and without atypia, ductal and lobular carcinoma will be extensively covered. The correlation of sonographic features with cytologic features and relevant pitfalls of each of these entities will also be discussed. The emerging role of FNA of breast for investigation of satellite lesions in patients undergoing breast conservation surgery will be stressed. The utility of FNA of regional lymph nodes in the preliminary staging of breast carcinoma particularly in selecting patients for sentinel lymph node biopsy and pitfalls in the interpretation will be outlined. Lastly, the evaluation of breast prognostic and predictive markers including estrogen, progesterone receptors and HER2/neu on cytologic specimens, including the current issues and problems in their evaluation will be covered. (Novice/Intermediate)

 

Workshop # 5 – Urinary Cytology Pitfalls and Updates

Director:
     Abdelmonem Elhosseiny, M.D.
Co-Director:
     Bobbi Pritt, M.D.
Faculty:
     Lynan Moy, CT(ASCP)

 

Educational Objectives:

  • Recognize the pitfalls in urinary cytology and how to avoid them
  • Understand the WHO 2004 classification of urothelial tumors and its correlation with cytology
  • 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 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 # 6 – Fine Needle Aspiration of Bone and Soft Tissue Tumors

Director:
     Leslie G. Dodd, M.D.
Co-Director:
     Keith E. Volmar, M.D.

 

Educational Objectives:

  • To familiarize participants with the cytologic, and where appropriate histologic, appearance of selected mesenchymal lesions
  • Will cover the “best practice” recommendations including use and application of ancillary tests and interpretation of cytology in multidisciplinary setting
  • Will cover important limitations of diagnosis of mesenchymal lesions by FNA

The first part of the course will be didactic with a case-based approach. The lecture portion will begin with introductory material including epidemiology and clinical features as well as historical insights into the use of FNA and other small biopsy techniques in the diagnosis of bone and soft tissue lesions. The cases presented will be selected to represent some of the more commonly encountered lesions in general practice but will also include entities selected because of special clinical relevance attached to the diagnosis. The last part of the course will be allotted to independent review of glass slide materials. (Intermediate/Advanced)

 

Workshop # 7 – 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:

  • Understand the biology of and testing methodologies for HR HPV
  • Correlate morphology with HR HPV results
  • Fine tune morphologic classification of atypical cells
  • 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 # 8 – Fine Needle Aspiration of Lymphoproliferative Disorders Using a Multiparameter Approach

Director:
     Ruth L. Katz, M.D.
Co-Director:
     Nancy P. Caraway, M.D.
Faculty:
     Linda G. Payne, CT(ASCP)
     Elizabeth Thomas, M.S., CLSp(CG)

 

Educational Objectives:

  • Discuss the techniques of obtaining an adequate aspirate and triaging specimens for cytology and ancillary studies such as immunophenotyping, proliferation markers, cytogenetics (FISH) and molecular studies
  • Diagnose and subclassify lymphoproliferative disorders according to the REAL/WHO classification using a multiparameter approach
  • Discuss the limitations and caveats of diagnosing lymphomas by FNA

Diagnosing lymphoproliferative disorders on FNA specimens can be a challenging. We present a multiparameter approach that has proved to be useful in diagnosing most lymphomas. There will be an emphasis on the diagnosing the more common B-cell lymphomas; however, certain T-cell lymphomas and Hodgkin lymphomas will also be addressed. The participants will have the opportunity to review over 200 packets on a variety of lymphoproliferative disorders including reactive processes, B-cell lymphomas, and Hodgkin lymphoma. The majority of study sets will include immunocytochemistry or flow cytometry. (Intermediate/Advanced)

 

Workshop # 9 – 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:

  • Provide exposure to a wide variety of pulmonary and mediastinal primary and metastatic tumors as well as non-neoplastic entities.
  • 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
  • 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
  • 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)

 

Workshop # 10 – ThinPrep Processing of Non-Gynecologic Specimens:  Review of Diagnostic Sensitvity and Morphologic Detail

Director:
     Momin T. Siddiqui, M.D.
Co-Director
     Raheela Ashfaq, M.D.

 

Educational Objectives:

  • Non-Gynecologic Cytologic specimen processing by ThinPrep® including its utility in bloody and mucoid specimens
  • Assessment of adequacy for a diagnosis
  • Morphologic assessment of normal constituents of Non-Gyn specimens
  • Morphologic assessment of non-neoplastic conditions which include reactive and infectious processes
  • Morphologic assessment of tumor including commoner malignancies, identified in these specimens
  • 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 area of non-gynecologic cytology using ThinPrep® processing.  It will include technical aspects of using ThinPrep® staining as well as detailed 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)

 


Session 2:

Tuesday, November 7, 2006
1:30 pm – 5:00 pm

 

NON-MICROSCOPIC WORKSHOPS

 

Workshop # 11 – 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:

  • Define the criteria in the diagnosis of non-neoplastic and neoplastic lesions that can be detected by body cavity fluid cytology
  • Analyze the pitfalls in the interpretation of effusion preparations. Demonstrate the many faces of reactive mesothelial cells and the many faces of malignant cells in body cavity fluid cytology
  • 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 # 12 -Practical Statistics for Cytology:  How to Use Statistical Measures for Quality Control

Faculty:
     Stephen S. Raab, M.D.

Educational Objective

  • 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 tendency, 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 # 13 – CANCELLED

MICROSCOPIC WORKSHOPS

 

Workshop # 14 – A Potpourri of Gynecologic Diagnostic Dilemmas on ThinPrep® Cytology

Director:
     Suzanne M. Selvaggi, M.D.
Co-Director:
     Thomas M. Scheberl, B.S., SCT(ASCP)

 

Educational Objectives:

  • Define the difficult diagnostic areas such as ASC-H, HSIL involving endocervical glands vs. endocervical AIS, and background changes in radiation change, atrophy/atrophic vaginitis and invasive squamous cell carcinoma on ThinPrep® Pap Test™ as compared to the conventional smear
  • Compare and contrast benign/inflammatory background changes with tumor diathesis on ThinPrep® slides
  • Acquaint the participants with both background and cellular patterns for squamous and glandular lesions which offer clues to the presence of invasive carcinoma on ThinPrep® cytology

In 1996, the ThinPrep® Pap Test™ was FDA approved as an alternative to the conventional Papanicolaou smear in the diagnosis of cervivovaginal lesions. Since that time, articles and monographs have been published on the cytomorphologic features of the more classic gynecologic lesions. This workshop will present a potpourri of gynecologic diagnostic dilemmas on ThinPrep® cytology, including the cytologic features of ASC-H, the cytologic features of HSIL involving endocervical glands versus endocervical adenocarcinoma in situ, background changes in radiation, atrophy/atrophic vaginitis and invasive squamous cell carcinoma – can they be reliably distinguished and warning signs of invasive carcinoma, including squamous and glandular lesions, on ThinPrep® cytology. Following the didactic session, a variety of slide packets, several with histologic correlation, will be available for review. (Intermediate)

 

Workshop # 15 – 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:

  • 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
  • To illustrate a wide range of cytological presentations of benign and malignant pulmonary lesions
  • 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 # 16 – Endoscopic Ultrasound-guided FNA Cytology

Director:
     Mai Gu, M.D., Ph.D.
Co-Director:
     Fritz Lin, M.D.
Faculty:
     Sophie Ghafari, M.B.A., SCT (ASCP)

 

Educational Objectives:

  • Specimen adequacy assessment.
  • Recognition of normal cellular contamination in abnormal smears
  • Criteria for differentiating reactive glandular cells versus well-differentiated adenocarcinoma of the pancreas, esophagus, ampulla of Vater and stomach, particularly in samples with low cellular yield.
  • Diagnostic pitfalls of uncommon tumors of the pancreas, such as endocrine tumors, solid pseudopapillary tumor and intraductal papillary mucinous neoplasm (IPMN)
  • Cytologic criteria for differentiating spindle cell lesions, eg. Smooth muscle tumor versus gastrointestinal stromal tumor of the gastrointestinal tract
  • Criteria and pitfalls in the diagnosis of liver and bile duct neoplasms and other less common lesions
  • The application of ancillary techniques – immunocytochemistry and histochemistry

Endoscopic ultrasound-guided FNA procedure is now considered to be the standard of care for diagnosis and staging of neoplastic disorders.  The workshop is designed to acquaint the pathologists, cytopathologists and cytotechnologists with benign and malignant lesions of various organs in cytologic samples obtained by endoscopic ultrasound-guided FNA Procedure.
This course begins with a brief presentation of the normal and reactive cells from various anatomic sites, followed by an in-depth discussion with case illustioations of routine and diagnostically challenging cases.  Immunocytochemistry and diagnostic pitfalls with case illustrations will also be discussed.  The presentation will be followed by a slide review by the participants of neoplastic lesions derived from various organs, and these include, but are not limited to, the esophagus, stomach, ampulla of Vater, pancreatobiliary tract, mediastinum and lymph nodes.  At the conclusion of the workshop, the participants will have gained a hands-on experience of the practice of clinical cytology after a thorough review of the selected cellular material obtained by endoscopic ultrasound-guided FNA. (Intermediate)

Workshop # 17 – Challenges in Gynecologic Glandular Lesions

Director:
     Sharon Mount, M.D.
Co-Director
     Abdelmonem Elhosseiny, M.D.
Faculty:
     Timothy St. John, CT (ASCP)

 

Educational Objectives:

  • Recognize the cytologic features of glandular lesions in liquid based preparation.
  • Identify the mimics and pitfalls of glandular lesions
  • Establish a differential diagnosis based on cellular morphology and age groups.

The workshop begins with a brief pretest followed by a didactic lecture covering cytologic approach to glandular lesions originating from endocervix, endometrium, and extra uterine sites.  Emphasis on the diagnostic pitfalls of these lesions will be addressed based on cellular morphology and age groups.  Microscopic review of carefully chosen illustrarative cases with histologic correlation will follow the didactic presentation.  The workshop will conclude with discussion of the post-test.(Intermediate)

Workshop # 18 – High Resolution Effusion Cytology Processed by Ultrafast Papanicolaou Stain

Director:
     Grace C.H. Yang, M.D., FIAC
Faculty:
     Wei Sun, M.D.

 

Educational Objectives:

  • Learn the processing of effusions to obtain high resolution cytology
  • Learn the triple approach, i.e., Ultrafast Papanicolaou stain FNA type smear (UFP), Diff-Quik stained FNA type smear (DQ), CytoRich Red fixed traditional Papanicolaou stained 1.7 cm Hettich cytospin (CR)
  • Learn to make compact cell blocks with maximal cells within minimal viewing area.
  • Learn to order minimal immunostains by maximize information obtained from cytomorphologic analysis
  • Learn to distinguish different cell types based on highly resolved cytoplasmic features, and benign from malignant based on highly resolved nuclear features

We have collected 300 carefully chosen teaching packets of pleural, peritoneal and pericardial effusions as well as pelvic washings with the triple approach: Each teaching packet will include cytology slide (UFP, DQ or CR), cellblock, immunostain, and histopathology when available. Each participant will receive a handout with color figures and a CD Rom with three movies demonstrating how to process compact cell block, UFP stain, and Hettich Cystospins.

The novel aspect of this workshop is the enhanced cytologic features in UFP-processed smears. The cells are larger with enhanced nuclear contour, chromatin, nucleolar (red) and cytoplasmic features. Novel cytologic features such as the long microvilli of malignant mesothelioma and enhanced nuclear details are used to separate this entity from mesothelial hyperplasia and non-mucinous adenocarcinoma; the distinction of signet-ring cell carcinoma from macrophages and macrophage-like carcinoma by the clear-cut nuclear features. Interesting cases such as primary effusion lymphoma, desmoplastic small round cell tumor, Hodgkin lymphoma, rhabdomyosarcoma of uterus, gastric adenocarcinoid will be presented. Papillary tissue fragments with psammoma bodies, ranging from benign to malignant will be presented. (Intermediate)

 

Workshop # 19 – 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.
Faculty:
     Frances H. Burroughs, SCT(ASCP)IAC

 

Educational Objectives:

  • Achieve sound familiarity with diagnostic limitations of aspiration cytopathology in liver, kidney and adrenal gland
  • Learn to develop a diagnostic algorithm when dealing with FNA of these organ systems
  • Accurately recognize “difficult-to-diagnose” lesions in liver, kidney and adrenal gland aspiration pathology
  • Learn to avoid potential diagnostic pitfalls by accurately identifying the “look-alike” lesions