2012 ASCP Annual Meeting
SAM Eligible Sessions

Wednesday, October 31, 2012

8:00 AM - 10:00 AMDiagnostic Pitfalls in Everyday Head and Neck Cytology: Causes and Solutions

Speakers:

  • William Faquin, MD, PhD
  • Zubair W. Baloch, MD, PhD, FASCP

Description:

This course is designed to focus on practical pitfalls in the FNA diagnosis of common head and neck lesions. While this session will be primarily in lecture format, it will use a case-based approach that will encourage questions and open forum discussion. The cytologic differential diagnosis and histologic follow-up of various primary and metastatic lesions which are difficult to diagnose on FNA will be covered. A special emphasis will be placed on tumors that show overlapping cytologic features and are common sources of errors. The topics will be illustrated in detail by using examples of various benign and malignant thyroid, salivary gland, and other head and neck lesions, such as those with papillary and follicular architecture, oncocytic features, and those with a prominent lymphocytic component. The value of special techniques such as immunohistochemistry and genetic alterations will also be discussed.

Learning Objectives:

  • Recognize and avoid common pitfalls in head and neck cytopathology and reduce potential false positive and false negative diagnoses.
  • Apply practical cytomorphologic criteria to the diagnosis of everyday head and neck cytology specimens and improve diagnostic accuracy.
  • Apply appropriate ancillary studies in the diagnostic workup of head and neck cytology specimens.

8:00 AM - 10:00 AMFlow Cytometry Immunophenotyping with Emphasis on Differential Diagnosis of Difficult Cases with High Clinical Impact on Therapeutic Decisions

Speakers:

  • Wojciech Gorczyca, MD, PhD
  • Caroline An, MD
  • Lawrence E. Hertzberg, MD

Description:

Flow cytometry (FC) plays an important role in the diagnostic process, and often provides information which is helpful in the therapeutic decisions making process and prognostication of AML, especially APL, pediatric ALL, high grade lymphoma and distinguishing between B- and T-cell lymphoproliferations. Alternatives to FC analysis are few when it comes to analysis of blood or samples with limited cellularity. The course will focus on (1) diagnosis of different types of AMLs, with emphasis on differential diagnosis between APL and HLA-DR- AML, (2) monocytic proliferations, (3) high grade B-cell lymphomas, (4) HCL versus splenic lymphomas versus 'atypical' HCL, (5) T-cell lymphoproliferations, (6) analysis of limited samples, (7) differentiating hematogones from residual lymphoblasts, (8) FC pattern of normal maturing myeloid cells and features associated with MDS and MPN, (9) identification of minute clonal B-cell populations, and (10) differentiating thymocytes from T-ALL.

Learning Objectives:

  • Recognize phenotypic patterns of typical and atypical lymphoid and myeloid malignancies [including (a) APL and HLA-DR-negative AML, (b) features associated with neoplastic monocytosis, (c) patterns of low and high grade B-cell lymphomas, (d) differential diagnosis of mature T-cell lymphoproliferations, (e) hematogones versus residual blasts in B-ALL, (f) diagnosis of lymphomas based on limited sample (200 events collected), (g) features of dysmaturation associated with MDS, CML and other myeloproliferative neoplasms, (h) pattern of benign thymocytes versus T-ALL, and (i) rare clonal events].
  • Choose the most appropriate additional tests based on the flow cytometry findings and formulated differential diagnoses.
  • Recognize the therapeutic implications of the FC findings, which lead to better communication with treating physicians.

8:00 AM - 10:00 AMAmerican Pathology Foundation: Mis-Hires: How To Avoid Making One and How To Avoid Being One

Speakers:

  • Lewis Hassell, MD

Description:

Ask anyone you know and they will be able to tell you a horror story about a hiring mistake. These are far too common in the workplace generally, and the laboratory/pathology practice is no exception. In this interactive session, participants will identify from case studies important knowledge, skills and practices critical to success at each phase of the hiring process. Key concepts to be covered will be continuous recruitment, honing, owning and maintaining the process, navigating the interview process with purpose and efficiency, other forms of assessment in advance of hiring, negotiation processes and due diligence, orientation and training, and continued recruitment. Approaching the process from both the perspective of the candidate for employment and the prospective employer will generate enhanced value to participants.

Learning Objectives:

  • Construct a complete identification and screening process to properly enrich a panel of job applicants.
  • Design critical interview/evaluation methods to accomplish the goals of each party in the recruitment dance.
  • Apply effective performance evaluation and feedback methods to retain employees/continue employment.

8:00 AM - 11:00 AMDiagnostic Pitfalls in Thoracic Tumors

Speakers:

  • Cesar A. Moran, MD FASCP
  • Neda Kalhor, MD

Description:

The thoracic cavity may be the site of a gamut of tumors of different etiologies. In addition, the thorax involves structures such as the pleura and mediastinum that in isolation give rise to specific tumors that may pose problems not only in diagnosis but also in classification. Therefore, the present course will address new developments in handling, staging, sub-typing, classification, and diagnosis of diverse conditions from the three compartments of the thorax the mediastinum, the pleura, and the lung. The material selected will allow for a broader assessment of the different problems that may be encountered in these anatomic structures and will include tumor as well as tumor-like lesions that may mimic malignant conditions.

The course will focus on solving problems and provide accurate information for patient care. When important and relevant, information will be provided on the use of more sophisticated studies that although not available in some laboratories, the practitioner must know of their usefulness. The course will be case-based with step by step approach from the conventional morphologic approach to the use of ancillary tools. Six cases will be used as a setting to interact with the audience and to elaborate on the work-up of these cases.

Learning Objectives:

  • Develop the skills to diagnosed uncommon thoracic tumors Lower malpractice risk through a better understanding of essential imaging findings.
  • Assess the use of immunohistochemical studies to properly work thoracic tumors.
  • Identify the different nomenclatures used in the classification of thoracic tumors.

9:00 AM - 11:00 AMAssociation for Pathology Informatics: Informatics in the Anatomical Pathology Laboratory - Making It Work for You

Speakers:

  • Liron Pantanowitz, MD
  • Anil V. Parwani, MD, FASCP

Description:

Pathology informatics has become critical to help pathology laboratories meet current and future challenges. Some of these challenges include providing synoptic reporting, patient safety, subspecialty centralization, and personalized medicine. Many of these challenges can be met by leveraging existing and advancing technologies, such as specimen tracking and telepathology. However, without current standards and easy guidelines to follow the selection, implementation and actual use of these technologies in the laboratory today can be overwhelming. This educational session is specifically geared towards helping attendees overcome technical challenges. Key aspects of synoptic reporting and prospective peer review at sign out within the laboratory information system will be demonstrated. Attendees will also be shown how best to select, implement and employ a barcode system in their Anatomical Pathology laboratory. Finally, the pros and cons of whole slide imaging will be discussed, as well as a practical review of the clinical applications for digitized slides. This session will address the needs of both the novice and computer specialist. This educational activity will be geared towards practicing pathologists, sharing with them best practices, key concepts, and practical skills they will be able to take back to their own laboratory.

Learning Objectives:

  • Better leverage the laboratory information system to improve the quality of their pathology reporting.
  • Select, implement and employ a barcode system in their Anatomical Pathology laboratory.
  • Feel more comfortable with whole slide imaging and its clinical applications.

10:00 AM - 11:00 AMAmerican Society for Cytotechnology: Challenging Cases for the Cytopathology Professional During Immediate Assessment. Are You Prepared?

Speakers:

  • Donna K. Russell, M Ed, CT(ASCP)HT

Description:

Update your knowledge of image-guided fine needle aspirations from cytotechnology professionals engaged in immediate assessment and specimen triage. Radiologic findings, clinical history and cytologic criteria will be presented from a variety of contemporary image-guided techniques. Billing guidelines will be discussed. Case studies from a variety of techniques will be demonstrated, along with ancillary testing. Techniques include endoscopic ultrasound-guided FNA, endoscopic ultrasound guided FNA, Super Dimension bronchial FNA, Cat-scan image-guided FNA and ultrasound-guided fine needle aspiration. Challenging cases with differential diagnoses will be provided. Live case(s) will be presented via the internet for 'hands on' exposure to immediate assessment and appropriate specimen triage.

Learning Objectives:

  • Enhance skills utilizing cytologic, radiologic and clinical findings during FNA immediate assessment and specimen triage.
  • Recognize the importance of adequate sampling for appropriate specimen triage and critically evaluate the utility of emerging tests and ancillary techniques.
  • Identify challenging cases in the cytologic evaluation of FNAs requiring immediate assessment.

10:00 AM - 12:00 PMCutaneous Lymphoma: Morphology, Immunohistochemistry and Molecular Testing

Speakers:

  • Aaron Auerbach, MD MPH
  • David S. Cassarino, MD, PhD, FASCP

Description:

Recently, the WHO has published the 2008 Classification of Haematopoietic and Lymphoid Tissues. New entities have been described, and older entities have been reclassified. Many pathologists may have not yet incorporated these classifications into their daily practices. Our plan for this course is to examine the topic of cutaneous lymphomas, both from the perspective of a dermatopathologist and a hematopathologist. We will outline the above-mentioned WHO classification, and present illustrative cases. We will present the clinical findings helpful in making these diagnoses, and we will examine the specific morphologic characteristics, as well as the immunophenotypic and molecular findings of these lymphomas. We will focus on selected T-cell and B-cell lymphomas, including mycosis fungoides and leg-type large B-cell lymphoma. We will also note situations in which it is impossible to render a definite diagnosis, and the approach to signing out such difficult and borderline cases.

Learning Objectives:

  • Learn how to make the distinction between different lymphomas which can show overlapping clinical and histologic features.
  • Learn to apply the use of appropriate immunohistochemical stains in order to confirm the diagnosis.
  • Identify newly described entities in the 2008 WHO Lymphoma Classification.

10:00 AM - 12:00 PMIntegration of Molecular Ancillary Techniques Into Routine Cytology Practice: Issues in Current State of the Art and Critical Future Trends

Speakers:

  • Michael Roh, MD, PhD
  • Stewart Knoepp, MD, PhD

Description:

The educational session will be divided into three parts. First, we will discuss examples of molecular studies routinely applied to cytology specimens as well as emerging molecular diagnostic assays designed to provide diagnostic, therapeutic, and prognostic information using cytology specimens. Examples include subclassification of non-small cell carcinoma FNAs, EGFR mutational analysis in FNAs of lung adenocarcinoma, mutational analysis of thyroid FNAs, and BRAF mutational analysis of FNAs of metastatic melanoma. We will then poll the audience as to the various platforms used for these ancillary studies in their routine practices. Finally, in an interactive format, we will present an integrated, optimized approach for triaging cytologic tissue allowing for specimen adequacy for cytodiagnosis as well as the performance of relevant ancillary studies.

Learning Objectives:

  • Identify examples of molecular techniques routinely requested on cytologic specimens and be aware of additional techniques likely to be increasingly utilized in the future.
  • Recognize the advantages and disadvantages of various platforms (e.g., cell blocks, direct smears, Whatman cards, frozen specimens, etc.) with which ancillary studies are performed.
  • Devise strategies for optimal triage of cytologic specimens for performing diagnostically and prognostically relevant ancillary studies.

11:00 AM - 12:00 PMMTE1 Critical Diagnosis in AP

Speakers:

  • Jan F. Silverman, MD, FASCP

Description:

Surgical Pathology

11:00 AM - 12:00 PMMyelodysplastic Syndromes (MDS), Aplastic Anemia, and Other Bone Marrow Failure States

Speakers:

  • Friederike Kreisel, MD
  • Michele Paessler, DO

Description:

MDSs are a group of clonal hematopoietic stem cell diseases characterized by cytopenias, dysplasia, ineffective hematopoiesis, and an increased risk of acute leukemia in ~30% of cases. MDS shows overlapping clinical features with aplastic anemia, paroxysmal nocturnal hemoglobinuria, and certain lymphomas. When working up a potential case of MDS, other causes of cytopenias, namely nutritional deficiencies or excess, medications, viral infections, and lymphoproliferative disorders need to be considered in the differential diagnosis. Using case presentations we will illustrate typical cases of MDS and aplastic anemia, as well as disease conditions that mimic MDS or aplastic anemia. The most common types of inherited bone marrow failure syndromes and their diagmostic approach will be included in the discussion. This course will offer a systematic approach to the work-up of patients with cytopenias integrating clinical, laboratory, phenotypic, and genetic features into final diagnosis.

Learning Objectives:

  • Describe the diagnostic criteria delineated by the current World Health Organization in the subclassification of myelodysplastic syndromes, and focus on differential diagnostic considerations mimicking myelodysplasia. Outline a systemic approach to ancillary studies needed in the distinction of the different entities.
  • Describe the diagnostic criteria for aplastic anemia and guidelines for adequacy of a specimen for interpretation, as well as outline a systemic approach to ancillary studies needed in the distinction of acquired and inherited aplastic anemia and bone marrow failures mimicking aplastic anemia.
  • Upon completion of this course, participants should be able to develop a systematic diagnostic algorithm for pancytopenia and isolated cytopenias integrating clinical, laboratory, morphologic, immunophenotypic, and genetic features.

1:00 PM - 2:00 PMUnusual and Challenging Lesions in Gynecological Cytology (Pap Test).

Speakers:

  • Walid E. Khalbuss, MD, PhD, FASCP
  • Durgesh N. Rana, MD, FRCPath

Description:

Rare neoplastic and non-neoplastic entities identified in the Pap test pose challenges due to their infrequent occurrence in the daily practice of gynecological cytology, with a consequent lack of experience in identifying these lesions. Furthermore, these uncommon lesions give rise to important diagnostic pitfalls that cytologists should be aware of when evaluating Pap tests. These conditions can be divided into three categories: 1) Rare infectious/inflammatory conditions 2) Unusual malignancies and variants of cervical carcinoma with their cytologic mimics, including squamous and glandular lesions and 3) Extrauterine malignancies. Recognition of these rare conditions can help to improve the accuracy and precision of Pap test diagnoses and decrease the potential for misdiagnosis and litigation. In addition, identifying these lesions will help to achieve more timely management of patients with such conditions. This is a case-based interactive instructor-audience workshop.

Learning Objectives:

  • Recognize the cytological features of rare infectious and inflammatory lesions seen in the Pap test.
  • Recognize uncommon primary and secondary malignancies identified in the Pap test.
  • Recognize diagnostic pitfalls and mimics of challenging glandular lesions in Pap test.

1:00 PM - 2:00 PMIncreasing Practice Profit Margins: Overcoming the Challenges

Speakers:

  • Terrence Bauer, CEO

Description:

In the current economic climate, maintaining profit margins can be challenging for medical practices, where billing and collections are impacted by staffing shortfalls and regulatory overhauls. Questions surrounding ACO participation and EHR implementation leave many practices wondering whether their current billing and collections methods will be able to keep up. Collections are especially challenging for laboratories, where patients rarely see or even speak with the provider. More than ever, pathology practices are looking for ways to reduce expenses and maximize revenues to increase profitability. This session will explain how medical billing and practice management outsourcing works and how it benefits pathology practices by increasing collection rates, reducing the necessity for in-house expertise, and ensuring compliance with industry regulatory mandates and privacy laws.

Learning Objectives:

  • Learn why medical billing and practice management outsourcing makes business sense in today's evolving healthcare climate with real-world examples; Pathology practices achieving 80-90% collection rates.
  • Learn how outsourcing to a practice-specific outsourcing partner helps physicians comply with insurance requirements and other regulatory mandates and privacy laws
  • Learn how to leverage technology to gain a clear understanding of business performance

1:00 PM - 2:00 PMPathology Informatics: Theory and Practice - Introduction To A New Text By The Editors

Speakers:

  • Mark Tuthill, MD, FASCP
  • Ulysses GJ. Balis, MD
  • Liron Pantanowitz, MD

Description:

This session will provide a broad overview of pathology informatics specifically as it relates to the textbook 'Pathology Informatics: Practice and Theory' recently published by the ASCP press. All the editors will be present to briefly highlight the key aspects of this book written for pathologists, trainees, technical and adminstrative staff. Time will be alloted to answer questions and stimulate open discussion.

Learning Objectives:

  • Understand the overall content addressed in the textbook.
  • Describe how this book can be used to support the practice and education of pathology informatics.
  • Appreciate the evolving political and institutional importance of pathology informatics.

1:00 PM - 4:00 PMCystic Lesions of the Head and Neck: A Diagnostic Roadmap

Speakers:

  • Zubair W. Baloch, MD, PhD, FASCP
  • Virginia A. LiVolsi, MD, MASCP
  • Ozgur Mete, MD

Description:

A wide variety of pathologic entities, including non-neoplastic lesions, as well as benign and malignant neoplasms can affect the head and neck. These can clinically present as either cystic or solid and cystic mass. This course will focus on the diagnostic and classification challenges that are faced by the pathologist in the diagnosis of cysts/cystic lesions of the head and neck. The discussion will include cytologic and histologic features and differential diagnosis of lesions appearing in the lateral neck and those which are medially located. Cases presented will include developmental/congenital lesions, neoplastic ones (both benign and malignant), and degenerative cysts. The value of special techniques in the diagnosis of head and neck lesions including immunohistochemistry and molecular tests will also be discussed.

Cases to be discussed:

  1. Congenital / developmental cysts such as branchial cyst, bronchial cyst & thyroglossal duct cyst.
  2. Thymic cyst and parathyroid cyst.
  3. Thyroid goiterous nodule vs. cystic papillary thyroid carcinoma.
  4. Lymph node with cystic metastases originating from squamous cell carcinoma or papillary thyroid carcinoma.
  5. Salivary gland lesions with cystic change: lymphoepithelial cyst, Warthin's tumor, mucoepidermoid carcinoma.
  6. Cystic odontogenic lesions.

Learning Objectives:

  • Discuss and highlight the key diagnostic features and criteria in the diagnosis of cystic lesions of head and neck.
  • Illustrate and provide a schematic approach to the diagnosis of the cystic lesions of head and neck.
  • Provide a pathologists view of the role of radiologic examination in the facilitating the pathologic diagnosis of various benign and malignant cystic lesions of the head and neck.

3:00 PM - 4:00 PMEmerging Molecular Diagnostic Tests and Therapies for Melanoma

Speakers:

  • Aleodor A. A. Andea, MD, MBA

Description:

Malignant melanoma is the leading cause of mortality among cutaneous neoplasms. The diagnosis and differentiation of melanoma from benign nevi is currently based on morphology however; in a significant number of cases a definitive diagnosis of melanoma is not possible. Recent molecular studies have revealed genomic differences between melanomas which harbor numerous chromosomal gains and losses and benign nevi which have no detectable chromosomal aberrations. Assays evaluating these abnormalities are ready to be implemented into clinical practice and could become important tools in the diagnosis of this deadly disease. The course will focus on the utility of comparative genomic hybridization as well as fluorescent in situ-hybridization in establishing a diagnosis of melanoma. A variety of other immunoperoxidase tests will also be discussed. In addition, data reflecting the efficacy of the newly FDA approved BRAF inhibitor (vemurafenib) in metastatic melanoma will be presented.

Learning Objectives:

  • Recognize the categories of melanocytic lesions for which an accurate histologic diagnosis is difficult.
  • Determine appropriate ancillary studies that may help establish a correct diagnosis.
  • Become familiar with the indications and limitations of ancillary studies.

Thursday, November 1, 2012

7:00 AM - 8:00 AMWhat is Significant and Expected in Critical Diagnoses (Urgent Diagnosis) in Anatomic Pathology?

Speakers:

  • Jan F. Silverman, MD, FASCP

Description:

Roundtable Session 02: What is Significant and Expected in Critical Diagnoses (Urgent Diagnosis) in Anatomic Pathology?

7:00 AM - 8:00 AMEmployee Empowerment "The Good, The Bad and The Ugly"

Speakers:

  • Donna K. Russell, M.Ed, CT(ASCP)HT

Description:

Roundtable Session 06: Employee Empowerment "The Good, The Bad and The Ugly"

8:00 AM - 9:00 AMDistinguishing Reactive Lymphoid Lesions from Malignant Lymphoma in Extranodal Sites

Speakers:

  • Rajan Dewar, MD, PhD, FASCP

Description:

Diagnosing a lymphoma when it arises in a lymph node is fairly straightforward. However, when a practicing pathologist sees a relatively large lymphoid infiltrate in a extranodal site, such as a colonic or breast biopsy, how much should this be worked out with ancillary techniques? Should this lesion be referred to a specialist hematopathologist for an expert opinion and second look? If so, which lesions needs to be referred, which needs to be worked up? Frequently, these lesions are not subjected to the same primary diagnostic tests such as flow cytometry, which aids a lot in lymph node work-up, and hence it is challenging for a practicing general pathologist. This course will highlight the important morphological features seen in a malignant lymphoma in an extranodal location, key first and second level work-up necessary to distinguish if a lesion is worrisome or needs expert referral.

Learning Objectives:

  • Key morphological features of an extranodal malignant lymphoma.
  • Key morphological features essential to distinguish a reactive lymphoid lesion from a lesion that needs further advanced work-up with ancillary techniques and tools.
  • Clinical features of malignant extranodal lymphoma, presentation and management. The realistic effect of delay in diagnosis / erroneous diagnosis.

8:00 AM - 9:00 AMAmerican Pathology Foundation: Cultural Risk Management 101: Creating an Organization and Culture of Safety

Speakers:

  • Lewis Hassell, MD

Description:

History and Culture matter, even in a scientific laboratory. This is not an advertisement for a liberal arts education, but rather truth learned from observation and engagement with a variety of healthcare and other organizations. This session will engage the participants in self-assessment of the health or vulnerability of their organization. Key characteristics of healthy organizations that promote the safest possible environment for patients will be illustrated. Most importantly, pathways of cultural change will be discussed such that each participant will be able to identify specific means by which they can impact the culture (and safety) of their organization in a postive manner.

Learning Objectives:

  • Inventory healthy and unhealthy elements within their organizational culture that potentially impact patient safety.
  • Describe key features of healthy organizations and the pathways of change that lead towards them.
  • Plan actions that can positively enhance their organizational culture, regardless of what level of control they operate from within the organization.

8:00 AM - 10:00 AMFNA of Thyroid and the Bethesda Classification: Challenges and Controversies Surrounding FNA Diagnoses and Terminology

Speakers:

  • Tarik Elsheikh, MD, FASCP
  • Zubair W. Baloch, MD, PhD, FASCP

Description:

This course will explore the practical aspects of the Bethesda system thyroid FNA classification, and some of the controversy surrounding it. The proposed Bethesda system diagnostic categories with their associated cancer risks and management recommendations are discussed. Examples of reporting formats are displayed. The course will also focus on the differential diagnosis of commonly encountered challenges such as follicular patterned,oncocytic, and cystic lesions. Detailed cytologic criteria are emphasized, including distinguishing between FLUS/AUS, neoplasm, and suspicious for malignancy diagnoses. Specimen adequacy and the minimal criteria needed for a definitive diagnosis of papillary carcinoma are highlighted. Finally, potential pitfalls and how to best avoid them are illustrated.

Learning Objectives:

  • Be familiar with the thyroid Bethesda classification and some of the surrounding controversies.
  • Understand the various diagnostic categories and their associated cancer risks and management recommendations, as proposed by the Bethesda classification.
  • Improve the ability to distinguish between diagnostically challenging cases such as follicular patterned and oncocytic lesions, and recognize the minimal criteria for diagnosing papillary carcinoma; and Identify potential pitfalls and how to best avoid them.

8:00 AM - 10:00 AMThe Art of Scientific Writing and Manuscript Review

Speakers:

  • Frank H. Wians, PhD, MT(ASCP), DABCC, FACB
  • Steven H. Kroft, MD, FASCP

Description:

This workshop should appeal to both well-published and never--published pathologists and laboratory professionals who are interested in learning, in an audience participation mode, about effective writing techniques and the manuscript review process. The presenters will cover manuscript preparation from 'Instructions to Authors' to 'Response to Reviewer Comments.' Attendees will suggest improvements to real-world examples from 'deidentified' manuscripts to illustrate the 'do's and dont's' of manuscript preparation, proofreading, journal selection, and response to reviewer comments. Useful tips will be provided on how to review a scientific manuscript that reflects credit on the Reviewer, the authors, and the journal in which the manuscript is published by ensuring the quality and accuracy of both the science and the writing contained in a scientific manuscript. Attendees will be encouraged to prepare and submit scientific manuscripts for publication and to volunteer as Reviewers.

Learning Objectives:

  • Learn effective writing techniques.
  • Apply effective writing techniques to improve the accuracy-brevity-clarity (the 'abc's' of effective writing) of each sentence in a scientific manuscript.
  • Prepare better scientific manuscripts and manuscript reviews.

8:00 AM - 11:00 AMAMP/ASIP/ASCP: Genomic Testing: What Pathologists Need to Know

Speakers:

  • Richard Haspel, MD, PhD
  • Mark S. Boguski, MD, PhD
  • Mark E. Sobel, MD, PhD
  • Mary S. Williams, MNA, MT(ASCP)SM

Description:

Pathologists, in their key diagnostic role, must understand genomic testing. A whole exome sequence currently costs less than $1000 and next-generation sequencing techniques have already led to personalized chemotherapy for cancer patients. This session, a joint collaboration of the American Society for Investigative Pathology (ASIP), Association for Molecular Pathology (AMP) and ASCP, will focus on practical issues for the pathologist utilizing both lectures (covering current methods in genomic testing and evidence for clinical benefit) and interactive approaches related to interpreting genomic data. Using actual genomic data sets, participants will be taken through the process of data collection, analysis and annotation. In addition, a panel discussion will explore the present and future of genomic pathology. The session has been developed by members of a national genomics education committee who are experts in molecular pathology, medical education and genetic counseling.

Learning Objectives:

  • Identify the technical and interpretive limitations of genomic testing of importance to a pathologist.
  • Evaluate the clinical applications of currently available genomic pathology testing and evidence for benefit.
  • Develop skills needed by pathologists in order to interpret genomic testing.

9:00 AM - 10:00 AMDiagnostic Accuracy

Speakers:

  • Martin H. Kroll, MD, FASCP

Description:

Pathologists and laboratory professionals can play a big role in cost containment and improving the quality of patient care by interpreting which new tests are useful for clinical use. Expertise in evaluating the utility of tests includes both in-house tests and send-out tests. One needs experience with the tools for diagnostic accuracy (evidence-based medicine), such as ROC curves, odds ratios and relative risk to confidently interpret the clinical utility of new tests and even old ones. These tools are useful when analyzing whether one should replace one test with another or for building test algorithms. The FDA requires diagnostic accuracy information with submissions. This session will provide the participant with the experience necessary to interpret ROC curves, relative risk and odds ratios and apply that knowledge to develop best practices.

Learning Objectives:

  • Interpret predictive value, ROC curves, odds ratios and relative risk.
  • Describe the proper use of these tools.
  • Explain the proper ways for planning and performing these studies.

9:00 AM - 11:00 AMOrthopaedic Mishaps and Some Lessons Learned: An Interactive Session Between Orthopedic Surgeon and Pathologist

Speakers:

  • Paul E. Wakely, Jr., MD, FASCP
  • Joel Mayerson, MD

Description:

This session emphasizes a team-based approach between an oncologic orthopedic surgeon and a surgical pathologist specializing in bone and soft tissue pathology. It employs a case-based format and focuses on errors made in the course of diagnostic work-up using actual cases in which both the surgeon and the pathologist were directly or indirectly involved participants, and attempts to use the errors made to broaden the horizons of those pathologists who infrequently deal with bone and soft tissue neoplasia. Highlighted categories of myxoid, small round cell, squamoid, and vascular malignancies are included whith this set of cases.

Learning Objectives:

  • Accurately diagnose a selection of challenging bone and soft tissue neoplasms.
  • Appropriately correlate radiographic images with clinical picture, immunohistochemistry, and histopathology.
  • Generate a relevant set of differential diagnoses for a range of bone and soft tissue lesions.

9:00 AM - 11:00 AMCommunicating with Colleagues, Clinicians, and Patients

Speakers:

  • Suzanne Dintzis, MD, PhD
  • Maxwell Smith, MD
  • Stephen Raab, MD
  • Thomas Gallagher, MD

Description:

The session will begin with didactics on the general topic of communication theory, noise, and barriers. The more specific topic of communication and patient safety will include discussion of uncertainty and error in pathologist-clinician communication, root cause and collegiality in pathologist - lab personnel communication and mitigation in pathologist - patient communication. The lectures will be followed by hands on scenarios with audience participation in simulated scenarios including pathology error disclosure to a clinician, error disclosure to a colleague pathologist and error disclosure to a patient. The medical-legal implication of pathology disclosure will be addressed.

Learning Objectives:

  • Provide an approach to effectively communicate with other pathologists, treating physicians, and patients.
  • Highlight the barriers in discussing pathology error with colleagues, other physicians and patients.
  • Practice communication skills in a workshop session.

10:00 AM - 11:00 AMUpdate Cardiovascular Disease Biomarkers: A Systems Approach

Speakers:

  • Martin H. Kroll, MD, FASCP
  • Ishwarlal Jialal, MD, PhD, FASCP

Description:

This course updates cardiovascular biomarkers and integrates them with other organ systems such as inflammation, renal disease and coagulation, allowing the participant to formulate translation of guidelines into clinical practice and develop best practices.. It will discuss biomarkers such as hsCRP, myeloperoxidase, adiponectin, non-HDL-cholesterol, Apo-B, lipoprotein phsopholipase A2, microalbuminuria, FGF-23, troponin and BNP, synthesizing the effects of inflammation, diabetes and renal function with its effects on these biomarkers Other markers, such as non-HDL-cholesterol or apoB may replace LDL-C, while lipoprotein phospholipase A2 (LP-PLA2) can predict the likelihood of plaque rupture. The session will discuss interpretation of natriuretic hormones (BNP and NT-proBNP) in the presence of renal disease, the cardio-renal syndrome, the use of ultrasensitive troponin in detection of myocardial infarction, and the detection of acute renal injury using NGAL KIM, and FGF23.

Learning Objectives:

  • Formulate means to translate the scientific basis for cardiovascular biomarkers (hsCRP, myeloperoxidase, adiponectin, non-HDL-C, apo-B, LPA2, BNP, microalbumin, troponin, NGAL KIM, FGF23) into useful markers for disease.
  • Develop best practices for cardiovascular and related biomarkers.
  • Recognize the interplay among organ systems and their effect on cardiovascular disease, with special emphasis on inflammation, diabetes mellitus, renal disease and coagulation.

10:00 AM - 11:00 AMImmunohistochemistry to the Rescue

Speakers:

  • Amy Chadburn, MD, FASCP
  • April Young

Description:

The session will include a short introduction of unusual, but occasionally encountered situations where IHC can be helpful (necrotic tissue, poor fixation, etc), followed several case scenarios which will be presented in a 'tag-team' approach employing the Laboratory Director (MD) presenter, Laboratory personnel presenter and audience: 1. case presentation (MD), 2. request for solutions (AUDIENCE), 3. our approach (LABORATORY PERSONNEL/MD), 4.the results (MD/LABORATORY PERSONNEL), 5. patient or situation outcome (MD/LABORATORY PERSONNEL), 6. questions/comments (AUDIENCE). The session will emphasize creative thinking and employing the expertise of all members of the laboratory team to implement quality, but timely, patient care.

Learning Objectives:

  • To see 'non-traditional' methods of IHC that one can use to assist in making a diagnosis.
  • Working together as a team the IHC staff and MDs can develop plans to optimize the material available as well as streamline events / procedures to facilitate test results and patient diagnosis thereby improving patient care.
  • Impress upon the audience the need to have procedures in place, material available and flexible/creative minds to rapidly establish new tests to help the patients (TEAM WORK) thereby maintaining quality assurance standards.

10:00 AM - 11:00 AMAmerican Pathology Foundation: Organizational Structure and Meeting Management for Optimal Effectiveness

Speakers:

  • Leslie Hamilton, MT(ASCP)

Description:

This session will examine different pathology practice organizational structures and provide participants with suggestions for maximum operational efficiency within their current system. Participants will also review the key elements of running an effective meeting and their impact on improved outcomes for the practice.

Learning Objectives:

  • Assess the need for modifications to current organizational structures.
  • Discuss the effects of organizational structure on staffing, communication, and performance.
  • Identify ten tools for running effective meetings.

10:00 AM - 11:00 AMWaffle Words: Clarity of Communication in a World of Uncertainty and Ambiguity

Speakers:

  • Lewis Hassell, MD; Sarah Lindley;

Description:

'So what is it?' one surgeon commented after reading a biopsy report filled with 'suggestive of's' and 'could be's.' Surgical pathology reports use a variety of 'waffle words' to express diagnostic uncertainty, and for a variety of reasons. Not surprisingly, clinicians and others in the health professions interpret and act upon these phrases in different ways based on their understanding (or misunderstanding) of the intent of the pathologist. We will illustrate this problem with examples and data from our experience and other studies, as well as audience interaction.
Comparison between standardized reporting schemes in cytopathology and action levels in other clinical disciples will be explored for clues that may improve communication in surgical pathology.
Different reporting options to express and more clearly communicate ambiguity or uncertainty that bring the pathologist closer to the central decisions of clinical care will be presented.

Learning Objectives:

  • Recognize ways in which they communicate diagnostic uncertainty in their practice.
  • Evaluate and implement diagnostic reporting schemes that effectively and clearly communicate the intended level of diagnostic certainty.
  • Understand how they might evaluate the clinical appropriateness and effectiveness of responses to this kind of language or changed reporting methods.

1:00 PM - 3:00 PMThe 5 Rights for Clinical Excellence in Transfusion Medicine - Part 1

Speakers:

  • Carolyn D. Burns, MD, FASCP
  • Phillip J. DeChristopher, MD, PhD, FASCP

Description:

The 5 Rights of Clinical Excellence in Transfusion Practice (Right product, Right patient, Right dose, Right time and Right reason) will be discussed in the context of the most recent evidence-based guidelines for RBC transfusion. A brief review of transfusion-associated adverse events will also be presented, including information from the Hemovigilance Network and the Serious Hazards of Transfusion Study (SHOT).Prepare by bringing your problem cases to discuss.

Learning Objectives:

  • Transform current evidence-based guidelines for RBC transfusion to apply key performance indicators for quality transfusion practice.
  • Apply educational materials to improve recognition of adverse effects of transfusion to better organize helpful reporting, clinical management and preventive approaches.
  • Review support from recent studies which offer guidance on RBC use in specific subpopulations such as patients with acute coronary syndromes and those requiring massive transfusion or elective orthopedic surgery.

2:15 PM - 3:15 PMCPT Coding and Related CMS Payment Policy: Trends for Pathology and Laboratory Medicine

Speakers:

  • Mark Synovec, MD

Description:

This lecture will provide a brief summary of current issues related to Current Procedural Terminology (CPT) coding as it pertains to pathology and clinical laboratory services, as well a current trends in the CPT Editorial Process. Issues related to Medicare payment for new coding system (eg, molecular pathology) will also be discussed.

Learning Objectives:

  • Understand the significant changes for CPT coding for laboratory and pathology services in 2012.
  • Learn the big issues that are being formulated for Pathology and Laboratory CPT coding in the near future.
  • Understand the issues that CMS are considering related to #1 and #2 and review any announced recently policies related to the same.

2:15 PM - 4:15 PMEvaluating and Reporting Tumors After Neoadjuvant Therapy in Breast Cancer and Testicular Tumors: Generating A Meaningful Pathology Report

Speakers:

  • Fang Fan, MD, PhD, FASCP
  • Ivan Damjanov, MD, PhD

Description:

The new demands and responsibilities for pathologists in evaluating and reporting tumors after neoadjuvant therapy makes it imperative for us to understand the expectations and follow guidelines in dealing with post-therapy specimens. In this course, we will review the current consensus recommendations and summarize our experience for handling post-therapy breast specimens and post-therapy specimens of metastatic testicular germ cell tumors. We will describe typical therapy related changes in tumors and normal tissues, and show how to include these findings in standardized pathology reports. Important diagnostic problems and potential pitfalls in diagnosing therapy related changes will be discussed. Following the review, we will use a case-based approach to analyze individual cases using the strategies discussed in the review part of the presentation. This course provides practical guidelines for pathology work-ups of post-therapy tumors. Participants will benefit from attending this course by comparing, reviewing, modifying and hopefully improving their own practice and thus apply new information to their daily work. The importance of effective communication with our clinical colleagues (radiologists, surgeons and oncologists) in handling post-therapy specimens in order to achieve high-quality patient care is emphasized.

Learning Objectives:

  • Define neoadjuvant chemotherapy of breast cancer; describe how malignant germ cell tumors of testis are managed clinically.
  • Discuss how to handle breast specimens after neoadjuvant chemotherapy, including evaluation of residual tumor, margin status, and axillary lymph nodes; list the most important parameters that must be included in the pathology report of breast cancer after neoadjuvant chemotherapy.
  • Describe various morphologic features of metastatic germ cell tumors after chemotherapy, and learn how to use the correct reporting terminology that has defined clinical implications.

2:15 PM - 4:15 PMMedical Liver Biopsy Interpretation: A Practical Guide for Accurate Diagnosis and Informative Reporting

Speakers:

  • Lisa M. Yerian, MD, FASCP
  • Julia C. Iezzoni, MD, FASCP

Description:

The histopathologic assessment of the liver biopsy specimen is an important part of the diagnostic evaluation, clinical management, and prognostication of patients with medical liver disease. As such, liver biopsies are regularly performed and are common specimens in most Surgical Pathology Laboratories. Despite the clinical importance and frequency of these specimens, many practicing pathologists and pathologists-in-training are uncertain on how to effectively evaluate, diagnose, and report these specimens, including common liver disease entities. Accordingly, using a case-based format, this course will: 1) present a readily applicable practical guide for systematically evaluating medical liver biopsy specimens; 2) discuss a pattern-recognition based approach for the accurate diagnosis of regularly encountered liver diseases, including entities to be considered in the differential diagnosis; and 3) identify the clinically important diagnostic, therapeutic and prognostic information to be included in the surgical pathology report of liver biopsies for the each of the liver diseases discussed. As a result, the participants will learn how to systematically evaluate, accurately diagnose and effectively report medical liver biopsy specimens.

Learning Objectives:

  • Systematically evaluate medical liver biopsy specimens.
  • Apply a pattern-recognition based approach to accurately diagnosis regularly encountered liver diseases, including entities to be considered in the differential diagnosis.
  • Identify the clinically important diagnostic, therapeutic and prognostic information to be included in the Surgical Pathology report of liver biopsies for regularly encountered medical liver diseases.

2:15 PM - 4:15 PMImmunohistochemistry in Genitourinary Pathology: Diagnostic Utility and Pitfalls

Speakers:

  • Jim Zhai, MD
  • Ximing Yang, MD

Description:

Case-based with interactive style format will be used. Each case will start with key histological features, mimics, major differential diagnoses, possible traps and clinical significance. Using an analytic diagnostic approach to distinguish theses frequently encountered, and yet potentially dangerous cases, is the focus of this course. Selected cases will cover common scenarios, such as the separation from small focus of prostatic adenocarcinoma and its mimics; renal epithelioid angiomyolipoma from renal cell carcinoma; classification of various types or kidney tumors; distinction between a primary urinary adenocarcinoma and a secondary tumor; distinction of muscularis mucosa from muscularis propria in a biopsy material containing invasive urinary carcinoma; metastatic clear cell renal cell carcinoma vs. other origins; documenting the percentile of different differentiation components of a testicular mixed germ cell tumor.

Some emerging biomarkers, such as PIN4, ERG, RCC marker, PAX8, smootherlin, TFE3, OCT4, glypican-3 etc., will be discussed. Appropriate panel of antibodies, working algorithm, immunostain interpretations, and potential pitfalls will be stressed.

Upon completion, participants will be able to understand the frequently encountered diagnostic dilemmas, their overlapping histological features, and potential clinical consequences. The participants will be able to select appropriate panel of biomarkers, how to accurately interpret immunostains and avoid the pitfalls.

Learning Objectives:

  • Recognize the frequently encountered diagnostic dilemmas in genitourinary system, and select an appropriate panel of immuno-markers.
  • Gain expertise and confidence in interpreting immunostains, and avoid pitfalls which may lead to misdiagnosis.
  • Apply practical immunohistochemistry more effectively to reach accurate diagnostic conclusions and reduce the turnaround time.

2:15 PM - 4:15 PMPrimer for the Cytopathologist Interested in Performing Ultrasound Guided Fine Needle Aspiration Biopsies

Speakers:

  • Joe Jakowski, MD
  • Alycia Reid, BS, RT, RDMS

Description:

This course is designed to provide the cytopathologist with a basic understanding of ultrasound physics, instrumentation, needle placement techniques, and sonographic anatomy as a prerequisite to performing ultrasound guided fine needle aspiration biopsies. Didactic lectures will cover the basics of the ultrasound machine (physics, knobology, including using Doppler), the sonogram and imaging patterns, and normal sonographic anatomy of the thyroid, breast, salivary glands, soft tissues, and lymph nodes. Emphasis will be placed on practical applications of obtaining good needle placement and a good sonographic image. Some common pitfalls in sonography will also be addressed. The course will conclude with a presentation of a number of sample sonograms for the audience to use key learning objects to evaluate and correct any image quality or needle placement problems.

Learning Objectives:

  • Understand the basics of ultrasound physics, ultrasound instrumentation, and be able to assess a sonogram and different sonographic image patterns.
  • Recognize normal sonographic anatomy of the thyroid, breast, salivary glands, soft tissues, and lymph nodes.
  • Utilize the key learning objectives to correctly evaluate sample sonograms presented including correcting common imaging and needle placement problems.

2:15 PM - 4:15 PMThe Diagnosis and Classification of Acute Leukemias - What Really Matters in the Molecular Era?

Speakers:

  • Anand Lagoo, MD, PhD
  • Michael B. Datto, MD, PhD
  • Catherine Rehder, PhD; Evan Kulbacki, MD

Description:

This session is of interest to practicing pathologists, residents, cytogeneticists and laboratorians involved in flow cytometry and molecular testing. Four didactic presentations are planned. The session is divided into four didactic presentations - (1) Outline the WHO classification of acute leukemias and contrast it with the FAB classification. Briefly narrate the major treatment options and overall prognosis in acute leukemias. Describe the disease defining and disease modifying mutations commonly seen in acute myeloid leukemia and examine their clinical associations. (2) Define the recurrent cytogenetic abnormalities in acute leukemias. Introduce the newer array based approaches used to identify genetic changes in acute leukemia. (3) Examine the role of flow cytometry in acute leukemia at diagnosis and follow up and provide examples of different types of acute leukemias. Explore the correlation between immunophenotype, morphology, and cytogenetic and molecular genetic abnormalities. (4) Suggest an optimal, resource appropriate, work up for new acute leukemia and how best to incorporate this diverse information into a unified pathology report.
The session begins with a pre-test and ends with a post-test and question and answer period. In addition, the participants have the opportunity to enter their diagnostic interpretations of typical cases throughout the session.

Learning Objectives:

  • Recognize the differences between the FAB classification and WHO classification of acute leukemias and the superior clinical relevance of WHO classification.
  • Correctly apply the WHO classification to new cases of acute leukemia using clinical history, morphology, flow cytometry, cytogenetics and molecular genetic information.
  • Devise a strategy based on the resources available in their practice to provide clinically relevant pathology report in acute leukemia cases.

2:15 PM - 5:15 PMCytopathology of Infectious Diseases. A Virtual Video Microscopy Workshop

Speakers:

  • Walid E. Khalbuss, MD, PhD, FASCP
  • Liron Pantanowitz, MD

Description:

Microorganisms are frequently encountered in cytology specimens. It may be difficult in some cases to determine if a microorganism represents contamination, colonization, mimickers of organisms or a true infection. Cytological specimens may be the primary method used to detect infectious agents. The identification of microorganisms based upon cytomorphologic appearance can on occasion prove difficult. This workshop will utilize a case-based approach using Virtual Slide Microscopy to focus on the utility of cytopathology in the diagnosis of infectious diseases, with emphasis devoted to the detection and identification of both common and rare microorganisms in various cytologic specimens. Cytologic techniques of specimen procurement, staining, and the role of ancillary studies for the identification of infectious agents will be discussed.

Learning Objectives:

  • Understand the utility of cytopathology in the diagnosis of infectious diseases.
  • Recognize the cytomorphology of common and rare infectious agents that may be present in cytology specimens.
  • Be familiar with the morphological structures and contaminants that may mimic pathogens.

3:15 PM - 4:15 PMBuilding Annual Antibiograms: A Team Approach

Speakers:

  • Lynda Glenn, MS
  • Alfred DeMaria, Jr., MD
  • Kerri Barton, MPH

Description:

Hospital antibiograms report aggregated susceptibility results of bacterial isolates tested against specific antibiotics. Antibiograms are generated annually and in a variety of formats. One or more hospital department(s) may be involved in the analyses. The Massachusetts Department of Public Health (MDPH) has been collecting hospital antibiograms since 1999. MDPH calls for the standardization of antibiogram generation using the Clinical and Laboratory Standards Institute (CLSI) M39A-3 recommendations in addition to utilizing a team approach, including microbiology, pharmacy, pathology, infection prevention and infectious disease. This didactic session will demonstrate the importance of involving a team of experts in generating the hospital antibiogram while using 'best practices' published in the M39A-3 CLSI document. MDPH will also communicate results from Massachusetts state-wide antibiogram data analyses including antimicrobial susceptibility trends that have been identified over time. Trend analyses can highlight similarities and differences in local, regional and national antimicrobial resistance patterns. However, standardization of these data is imperative in order to establish appropriate data comparisons, highlighting the importance of implementing CLSI recommendations.

Learning Objectives:

  • Create a team of healthcare professionals to analyze annual antibiogram data using best practices (CLSI M39-A3).
  • Disseminate antibiogram information to hospital departments to improve antibiotic use in the facility.
  • Design a quality improvement project to identify trends in antibiotic resistance using annual antibiogram data; communicate trends to healthcare professionals.

4:15 PM - 5:15 PMTraining Strategies in Cytopathology: Pathways and Approaches to Excellence and ACGME Compliance

Speakers:

  • Gordon Yu, MD

Description:

Effective training of residents in cytopathology is a critical but challenging component of any pathology training program, given its expanding role in clinical diagnosis and management in the context of a limited training period. In this session, approaches to effective resident training in cytopathology will be presented and discussed in the context of the six general competencies, as well as recent changes to program requirements mandated by the ACGME. Theoretical and practical issues for training will be discussed, including optimal teaching techniques and laboratory workflow adjustments which will optimize the training experience. Tangible examples of effective and ineffective training methods will be emphasized and discussed by participants in this highly interactive session, such that a well-defined outline for a quality, structured educational program in cytopathology is created at the conclusion of the session.

Learning Objectives:

  • Identify critical components of effective resident training in cytopathology which lead to diagnostic excellence and ACGME compliance.
  • Identify important training goals in cytopathology and compare strategies for effective training with those for other core residency rotations.
  • Recognize ineffective training and teaching strategies in cytopathology in order to modify existing rotation experiences.

4:15 PM - 6:15 PMAt LAST! Standardization of HPV-related Neoplasia:The CAP-ASCCP Lower Anogenital Squamous Terminology (LAST) Project

Speakers:

  • Lisa Fatheree, SCT(ASCP)
  • Teresa Darragh, MD, FASCP
  • David C Wilbur, MD, FASCP
  • Mark H. Stoler, MD FASCP
  • Alan G. Waxman, MD, MPH, FACOG

Description:

The CAP Pathology and Laboratory Quality Center, in conjunction with the American Society for Colposcopy and Cervical Pathology (ASCCP), propose a standardized terminology for HPV-related squamous neoplasia of the lower anogenital tract. Nomenclature for squamous dysplasias and early cancers of the lower anogenital tract have historically been controversial and non reproducible, with multiple 'competing' terminologies proposed and utilized by different pathology sub-specialties. Use of these different terminologies has caused confusion among clinicians with potential mismanagement consequences. In the past two decades, significant strides have been made in our understanding of the biology of HPV-related squamous disease and the molecular characterization of these neoplasias.

This session will feature the pathologist and clinician collaboration in review of the final histological terminology recommendations made at the LAST (Lower Anogenital Squamous Terminology) Consensus Conference held on March 13-14, 2012 in San Francisco, CA with the leading pathologists and clinicians in the field. Participants will increase their state-of-the-art understanding of HPV-related squamous lesions of the lower anogenital tract and enhance communication with their clinical colleagues regarding the diagnosis and clinical management of preneoplasia and early HPV related squamous lesions of the anogenital tract.

Learning Objectives:

  • Adopt the new and revised terminologies for the HPV-related lesions of all lower anogenital tract body sites (cervix, vulva, vagina, penis, anus and perianus for improved reliability and reproducibility of diagnoses.
  • Evaluate the need for select molecular markers as an adjunct to diagnosing HPV-related lesions of the lower anogenital tract body sites.
  • Clarify the communications between pathologists and clinicians regarding HPV-related squamous lesions of the lower anogenital tract.

4:15 PM - 6:15 PMSmall Cell Tumors of Bone: From Clinical Demographics to Molecular Pathology

Speakers:

  • Gene P. Siegal, MD, PhD, FASCP
  • Shi Wei

Description:

This session will introduce the broad range of small, blue, round cell tumors of bone and how one utilizes the gross, histopathologic, ultrastructural, cytogenetic and molecular genetic evidence to reach a diagnosis. The content will be delivered via conventional lecturing supplemented by an audience response system and question and answer period. Topics to be covered range from neuroblastoma in bone, through Ewing's/PNET and small cell osteosarcoma to plasmacytoma and metastatic neoplasms. Eight to 10 entities will be covered over the 120 minute period of instruction. Key to understanding will be the integration of the traditional demographic, imaging and histopathologic evaluation of these lesions with molecular approaches. It will assume only a minimal understanding of molecular biology and proposes to present the information in a low stress, easy to digest format which should maximize retention.

Learning Objectives:

  • Create a differential diagnosis based on patient's age, gender, bone and bone site involved.
  • Recognize the most common small, blue, round cell bone lesions based on histologic, immunohistochemical, ultrastructural and molecular characteristics.
  • Identify and differentiate the most common primary and metastatic small, blue, round cell tumors of bone.

4:15 PM - 6:15 PMDiagnosing Lung Carcinoma on Small Biopsies and Cytology: From Terminology to Molecular Diagnoses

Speakers:

  • Anjali Saqi, MD, MBA
  • Andre Moreira

Description:

Most patients diagnosed with lung cancer present at advanced stage, and often cytology or small biopsy specimens are the only tissue available. Also, more minimally invasive procedures that yield these smaller samples are being performed.

As these changes have been occurring, personalized therapies that target specific molecular alterations have emerged. So new algorithms have been proposed for optimizing the manner in which lung carcinomas are diagnosed: morphologically, immunohistochemically, and molecularly.

This course will review the updates in thoracic oncology and its implications by presenting the multidisciplinary approach for lung cancer diagnosis proposed by the IASLC/ATS/ERS. Optimal techniques for acquisition and processing of tissue will be illustrated. An immunohistochemical algorithm for sub-classifying non-small cell carcinomas, while conserving tissue for molecular testing, will be discussed. These topics will be reinforced through brief unknown case presentations.

Learning Objectives:

  • To improve patient care, the participant will be able to sub-classify lung carcinomas based on the new diagnostic terminology, morphology, and ancillary techniques.
  • The participant will be exposed to the various minimally invasive techniques by which small tissue biopsies for diagnoses are acquired (e.g. endobronchial ultrasound guidance, navigational bronchoscopy), and how best to handle the tissue to provide the critical answers for targeted therapy.
  • Review the specific and detectable molecular alterations (ie EGFR and KRAS) in the different subtypes of lung carcinomas and introduce the indications and contraindications of the most common drugs used in treating lung carcinomas.

4:15 PM - 6:15 PMIntra-Operative Neuropathology - What You and The Neurosurgeon Really Need to Know

Speakers:

  • Cynthia A. Welsh, MD

Description:

When it's just you and the neurosurgeon alone in the hospital in the evening or weekends it can be intimidating. Management of the intraoperative neuropathology specimen can be facilitated by a number of measures, including correlation with radiologic features, procedures to gain the most information possible from the specimen itself, and understanding what facts the neurosurgeon really needs to know. This course introduces pearls and pitfalls involved in interpreting the patient's MRI, freezing brain tissue, setting up and interpreting cytology preparations, and communicating with the clinician. It is designed as a case-based discussion of diagnostic and therapeutic issues involved in interpreting intra-operative neurosurgical specimens. The course discusses the uses and limitations of the different techniques available in evaluation of these specimens. The specific cases provide points for discussion of differential diagnosis of neoplastic and non-neoplastic lesions.

Learning Objectives:

  • Link location and other information on MRI brain scans with a narrower differential diagnosis.
  • Draw parallels between the morphology and cytology of neuropathology specimens.
  • Associate the relevance of pathology diagnosis to intraoperative neurosurgical decision making.

5:15 PM - 6:15 PMLaboratory Assays for Alcohols and Glycols: Sorting Through the Tangle of Test Options

Speakers:

  • Matthew D. Krasowski, MD, PhD

Description:

This session will lead attendees through the laboratory assays useful in assessing ethanol use and in diagnosing and managing ingestion of toxic alcohols (ethylene glycol, methanol). The format will be an interactive 50 minute lecture.The emphasis will be on newly available assays (carbohydrate deficient transferrin, ethyl glucuronide, ethyl sulfate, ethylene glycol enzymatic assay) and recently published literature. The strengths and limitations of the osmolal gap will also be discussed in detail. The presenter will show examples of how these assays have been incorporated into testing algorithms at an academic medical center for treating toxic alcohol ingestions in the emergency setting and for assessing ethanol sobriety in substance abuse and liver transplant programs testing. Given the prevalence of ethanol abuse and toxic alcohol ingestions, the topics presented should be of broad interest to laboratory professionals.

Learning Objectives:

  • Compare the strengths and limitations of carbohydrate deficient transferrin, ethyl glucuronide, and ethyl sulfate in assessing ethanol use.
  • Explain the role of osmolal gap in the diagnosis and management of toxic alcohols ingestion, including common causes of elevated osmolal gap other than alcohols.
  • Appraise the analytical options for directly measuring toxic alcohol concentrations, including gas chromatography and enzymatic assays for ethylene glycol.

5:15 PM - 6:15 PMFusion Transcripts that Characterize Epithelial Malignancies of Salivary Gland Origin: Exploring Diagnostic, Prognostic, and Therapeutic Utility

Speakers:

  • Joaquin Garcia, MD

Description:

The discovery of fusion transcripts has revolutionized the diagnosis, surveillance, and treatment of mesenchymal and hematolymphoid malignancies. More recently, several epithelial malignancies of diverse anatomic sites have been characterized by fusion transcripts as well (kidney, prostate, salivary gland, etc.). As an example within the context of salivary gland neoplasia, an association between mucoepidermoid carcinoma and t(11;19)(q21;p13) has been well-established and is currently used in clinical practice to confirm the diagnosis in challenging cases; its utility in forecasting biological behavior remains a topic of investigation. This interactive session will inform pathologists about fusion transcripts that characterize epithelial salivary gland malignancies. Although there will be a brief discussion regarding pathobiology and cytogenetic nomenclature, emphasis will center on diagnostic, prognostic, and therapeutic utility of fusion transcript identification.

Learning Objectives:

  • Detail histomorphologic overlap in salivary gland neoplasia, accentuating the need for ancillary tests that improve our ability to distinguish select salivary gland lesions from one another.
  • Discuss shortcomings of current grading schema in salivary gland neoplasia, highlighting specific grading schema that lack reproducibility and clinical relevance.
  • Assess diagnostic, prognostic, and therapeutic utility of fusion transcript identification in salivary gland neoplasia.

5:15 PM - 6:15 PMMaintenance of Certification: Update 2012

Speakers:

  • Betsy Bennett, MD, PhD

Description:

This session will review the current requirements of the American Board of Pathology Maintenance of Certification (MOC) Program. The four parts of MOC will be explained and examples will be given of how the requirements may be met. Changes effective in 2013 for the reporting requirements for more than one certificate will be explained in detail. The structure of the examination (Part 3) and the components of systems based practice (Part IV)will be reviewed. Initiatives by state and federal agencies encouraging participation in MOC by all pathologists will also be discussed.

Learning Objectives:

  • List the components of Maintenance of Certification (MOC).
  • Explain the reporting requirements for each 2-year period in the 10-year MOC cycle and describe activities that will meet these requirements.
  • Plan MOC activities required to meet requirements of each reporting period.

Friday, November 2, 2012

7:00 AM - 8:00 AMUnderstanding and Implementing the Thyroid FNA NCI Bethesda Reporting Scheme

Speakers:

  • Walid E. Khalbuss, MD, PhD, FASCP

Description:

Roundtable Session 12: Understanding and Implementing the Thyroid FNA NCI Bethesda Reporting Scheme

8:00 AM - 9:00 AMEndometrial Pathology, Benign To Malignant, A More Practical Approach For The General Surgical Pathologist

Speakers:

  • Jamie Shutter, MD

Description:

The typical general surgical pathologist encounters a significant number of endometrial biopsies and/or curettage specimens in their everyday practice. However, not all are comfortable with them for a variety of reasons such as inadequate or no clinical information, a lack of understanding of what is clinically important to include in the surgical pathology report as well as whether a specimen is even adequate to accurately make a definitive diagnosis. This session will go over the different types of endometrial specimens you will encounter and what is considered adequate for definitive diagnosis as well as what features are important to focus on in the surgical pathology report. And of course what is not necessary to mention that might generate a phone call from a confused gynecologist. I will also discuss how to incorporate the clinical history into your evaluation of the more commonly encountered benign patterns as well as discuss the clinical impact of these diagnoses on patient care. I will also briefly discuss endometrial intraepithelial neoplasia (EIN) and its impact on evaluation of the endometrial specimen as well as show common patterns of malignant entities that are important to recognize.

Learning Objectives:

  • Develop a systematic approach to the common endometrial specimens.
  • Incorporate clinical information with the pathology to give a more meaningful diagnosis to the gynecologist.
  • Communicate when small amounts of tissue are adequate for diagnosis and when they are not.

8:00 AM - 10:00 AMSurgical Pathology and Cytopathology of Neoplasms of the Pancreas, Ampulla, Gallbladder and Biliary Tract

Speakers:

  • N. Volkan Adsay, MD, FASCP
  • Michelle Reid, MD

Description:

This session is an educational overview of challenges and practical clues in the diagnosis of pancreatobiliary specimens.

Dr. Adsay will also review selective problematic solid and cystic pancreatic lesions encountered on histologic evaluation with emphasis on neoplastic duct structure, location, perineural invasion, relationship to blood vessels and peripancreatic fat, duct architecture, luminal contents, stromal and cytologic changes.

Dr. Reid who will give a cytologic review of pancreatic FNA in general, EUS-FNA in particular, including its pitfalls and use of ancillary studies in diagnosis. The most common solid and cystic pancreatic lesions will be reviewed with emphasis on the critical role of the cytopathologist as triage clinician and diagnostician.

Dr. Adsay will include a demonstration of the orientation, dissection and sampling of Whipple specimens based on evidence-based best practices. A review of ampullary and gallbladder tumors along with new concepts of flat dysplasia of the biliary tract and gallbladder will follow.

Learning Objectives:

  • Recognize and diagnose the most common solid and cystic pancreatic neoplasms on cytology as well as histology; Acquire knowledge of new concepts in terminology and histologic grading of pancreatic neuroendocrine tumors; Appropriately select ancillary studies for the diagnosis of pancreatic tumors.
  • Recognize new methods for pancreatic fine needle aspiration (FNA) especially endoscopic ultrasound-guided FNAs and its pitfalls and limitations; Recognize the importance of cytopathologists as key members of the clinical team in determining specimen adequacy, processing and triage; Recognize the key cytologic features of the most commonly encountered solid and cystic pancreatic neoplasms; Evaluate the need for, benefits and limitations of ancillary studies in the diagnosis of pancreatic tumors.
  • Be competent in the proper dissection of Whipple (pancreatoduodenectomy) specimens ensuringThe accurate tumor identification and sampling, as well as how to increase lymph node yield for optimal patient staging; They will be able to distinguish ampullary and periampullary tumors from pancreatic tumors; Recognize flat (low and high-grade) dysplasia and invasive carcinoma of the gallbladder and biliary tract and distinguish these from non-neoplastic mimics.Pathologists will apply this newly acquired information to their routine practice; Residents and fellows will have more in-depth knowledge of pancreatobiliary pathology in preparation for board examination and job placement.

8:00 AM - 11:00 AMDiagnosing Cutaneous Adnexal Tumors: The Tip of the Iceberg

Speakers:

  • Doina Ivan, MD
  • Victor G. Prieto, MD, PhD, FASCP

Description:

Short overview of histology of cutaneous adnexal neoplasms, noting the expansion in our understanding and classification of these tumors.Discussion of several relevant cases which will include clinical information, gross and microscopic description, differential diagnosis, followed by discussion of the diagnosis as well as of the important microscopic findings and clinical features of the discussed entity.Discussion of specific adnexal tumors that may be associated with clinical syndromes or systemic disorders, emphasizing their diagnostic criteria and features enabling their accurate distinction, presentation of unusual tumor subtypes that are frequently missed in clinical practice and differential diagnosis from tumors metastatic to skin. We will also discuss current immunohistochemical markers, molecular and genetic testing (such as Muir-Torre-syndrome, microsatellite instability, immunohistochemical studies for hMLH1, hMSH2, hMSH6 and genetic testing).

Learning Objectives:

  • Learn a practical algorithm that will allow them to confidently distinguish between benign and malignant cutaneous adnexal lesions and between primary and metastatic lesions (with significant clinical and therapeutical implications).
  • Determine which cutaneous tumors might be associated with systemic syndromes and learn the appropriate approach and communication with clinical team for further diagnostic and therapeutic management of the patient.
  • Learn about novel immunohistochemical studies that are currently utilized for the differential diagnosis of cutaneous adnexal tumors and molecular studies that are used either for the diagnosis of certain genetic conditions in which cutaneous adnexal tumors may be encountered, or to identify potential molecular therapeutic targets.

8:00 AM - 11:00 AMPrecision Diagnosis of Gestational Trophoblastic Disease in the Molecular Era

Speakers:

  • Pei Hui, MD, PhD
  • Natalia Buza, MD

Description:

Gestational trophoblastic diseases (GTD), particularly hydatidiform moles, are common diagnostic entities with significant medical and social implications. Histological diagnosis of
molar pregnancies has long suffered from significant difficulties in recognizing early complete hydatidiform moles and diagnosing partial hydatidiform moles. Trophoblastic tumors
(placental site trophoblastic tumor and epithelioid trophoblastic tumor) also pose diagnostic challenges due to their rarity and frequent involvement of unusual anatomic locations.
There has been substantial refinement in recent years in the histological criteria and immunohistochemistry available for the diagnosis of gestational trophoblastic diseases. A major
portion of the workshop will address these diagnostic issues. Emerging molecular diagnosis of GTD has been recently proven to have powerful discriminatory capabilities in the
diagnosis and subtyping hydatidiform moles, particularly by short-tandem-repeat (STR) DNA genotyping. This emerging molecular application is superior to traditional ploidy analysis
by flow cytometry and immunohistochemistry. With increasing acquirement of molecular diagnostic capabilities at most medical centers, there is increasing demand for integrating
molecular diagnostic testing and morphologic interpretation to provide much needed diagnostic accuracy in GTDs. The second portion of this workshop will educate the audience with
regard to the genetic basis of STR DNA genotyping, techniques and its applications in the diagnostic evaluation of GTDs. The workshop will involve both didactic and case-based
discussions. During the workshop, there will be 10 unknown cases to illustrate the key learning objectives using audience response system (ARS).

Learning Objectives:

  • Learn the salient molecular alterations/genetic basis of gestational trophoblastic disease.
  • Sharpen diagnostic expertise in histological evaluation of GTD and be able to use ancillary studies, including immunohistochemistry and DNA genotyping in the confirmation and subtyping of gestational trophoblastic diseases.
  • Recognize when and how to consult clinicians on the significance and implications of the results of molecular diagnostic tests in reference to the morphologic interpretation.

9:00 AM - 11:00 AMIntroduction to Ultrasound Guided Fine Needle Aspiration Biopsy: A Hands-on Practicum with Clinical Case Reviews

Speakers:

  • Joe Jakowski, MD
  • Alycia Reid, BS, RT, RDMS

Description:

This course is designed for the cytopathologist as an introductory to the basics of ultrasound (US) guided fine needle aspiration technique. A short didactic lecture on US guided fine needle aspiration technique will be followed by a hands-on practical that will allow each participant to experience operation of an US machine for echolocation and for US guided needle placement into a simulated target (phantom).* The course will conclude with a presentation of a number of real patient cases for participants to correctly evaluate the sonogram and cytology findings. The presented cases will cover a variety of lesions from many different anatomical sites and will incorporate a review of normal sonographic anatomy for comparison.

*A prerequisite understanding of basic US technology and instrumentation by the attendee will help maximize their learning experience in this course. Because of the hands-on nature and desire to provide a one-on-one teaching experience, the course will be limited to up to 25 participants.

Learning Objectives:

  • Develop an understanding of the basics of the ultrasound guided fine needle aspiration technique.
  • Practice operation of the ultrasound machine for echolocation and ultrasound guided needle placement into a simulated lesion (phantom).
  • Utilize the key learning objectives to correctly evaluate real patient cases including evaluation of the ultrasound and cytopathology findings.

9:15 AM - 10:15 AMMichele D. Raible Lecture for Residents "The Pathology-Time Continuum"

Speakers:

  • Robert Folberg, MD, FASCP

Description:

Michele D. Raible Lecture for Residents "The Pathology-Time Continuum"

10:00 AM - 11:00 AMHepatic Neoplasms and Tumor-Like Lesions - An Update

Speakers:

  • Gary C. Kanel, MD

Description:

This updated session reviews the pathology of benign and malignant primary hepatic neoplasms, metastatic tumors, and non-neoplastic mass lesions, with further emphasis on differential diagnoses. The various special stains, immunoperoxidase stains, and new up-to-date diagnostic tools necessary to arrive at the diagnoses are also presented. Emphasis is made on the common problems facing the pathologist when the morphology does not in fact match the classical features. Discussion of diagnostic difficulties in interpreting biopsies of pre-neoplastic and dysplastic lesions is also presented.

Learning Objectives:

  • Identify the basic morphologic features of the various neoplastic and tumor-like hepatic lesions seen on needle, wedge biopsy and tumor resection surgical pathology material.
  • Assess which histochemical and immunoperoxidase stains are most useful in arriving at the diagnosis and differential possibilities.
  • Know the various epidemiologic and risk factors associated with these conditions, as well as the new state-of-the-art laboratory techniques, to help arrive at clinico-pathologic diagnoses.

10:00 AM - 11:00 AMLaboratory Inspections: How To Ensure Your Lab Will Meet The Regulatory Guidelines

Speakers:

  • Jonathan Heller, MHS, DLM (ASCP)

Description:

Since regulatory agencies can arrive at the laboratory at anytime, laboratory directors, managers, supervisors and technologists need to always ensure that their daily practice meets the regulatory requirements. And with multiple priorities to balance and limited resources, this important need of laboratory compliance continues to be a challenge. This session will review tactics that one healthcare system (MedStar Georgetown University Hospital & MedStar Health) have implemented to assist the laboratory team in regulatory compliance. Participants will also be exposed to lessons learned from an experience that involved inspection teams from multiple regulatory agencies at the same time. Additional tools and resources for laboratory leaders will be reviewed to provide the participants with a “regulatory tool box” of strategies to use in their laboratory.

Learning Objectives:

  • Further understanding and knowledge of the different regulatory agencies and how to comply with the various standards.
  • Develop easy solutions to meeting the needs for a higher level of regulatory compliance within the laboratory setting.
  • Identify ways to increase faculty and staff awareness, knowledge and appreciation for the regulatory compliance needs of the laboratory.

2:00 PM - 3:00 PMEthical Dilemmas Facing Physicians-In-Training

Speakers:

  • Lauren B. Smith, MD

Description:

Examples of ethical dilemmas facing residents will be presented. The presentation will include approximately 5 cases. Topics include everyday issues that confront residents as well as more unique situations. While many cases are specifically geared toward issues in pathology, broader topics that apply to all specialties will also be presented. The cases include discussions of honesty, professionalism, knowing what you don't know, handling 'sticky' situations, and how to handle situations in which fellow residents need assistance/intervention due to substance abuse/mental health impairment.

Learning Objectives:

  • Recognize ethical dilemmas in daily practice.
  • Think more critically when ethical issues arise.
  • Know resources that are available if ethical issues arise.

2:00 PM - 4:00 PMPatient Safety Strategies that Enhance the Visibility and Value of the Laboratory and Improves Staff Morale

Speakers:

  • Diana Mass, MT(ASCP)MA; Connie Bishop, BS;

Description:

An Institute of Medicine (IOM) national agenda for improving patient safety focuses on the resolution of problems in healthcare and reducing medical errors. This seminar will recognize the relationship of appropriate laboratory utilization and patient safety which provide medical decision support. Skills required for pathologists and laboratory professionals to serve as consultants will be identified. The University of North Carolina Hospital's Core Laboratory Ambassador Program to improve patient safety and enhance the visibility and morale of laboratory staff will be discussed. An important goal of this program to retain laboratory personnel will be described. Program implementation and additional outcomes will be presented as an approach to achieving the IOM agenda with laboratory staff acting as consultants.

Learning Objectives:

  • Recognize the relationship among appropriate laboratory utilization, cost savings, and patient safety.
  • Identify the attributes and competencies of a consultant who will improve patient safety and contribute to the value of the laboratory.
  • Develop a successful consultant strategy that increases the laboratory's visibility, contributes to a laboratorian's job satisfaction, and enhances patient safety.

2:00 PM - 5:00 PMSpecial Types of Invasive Breast Carcinoma; Diagnostic Criteria with Prognostic and Therapeutic Significance

Speakers:

  • Farnaz Hasteh, MD
  • Noel Weidner, MD

Description:

This course will provide an intensive, comprehensive, and practical review of special type of invasive breast carcinomas. Overall, up to 35% of invasive breast carcinomas can be considered of 'special' type (tubular, lobular, medullary, metaplastic, colloid and adenoid cystic carcinomas). Since many of the invasive breast carcinomas of special type (InvC,NST) have a relatively favorable prognosis, correct diagnosis is important especially for the patient management and appropriate therapeutic procedures. This diagnosis is sometimes very difficult which is partly due to controversial diagnostic criteria (especially in diagnosing medullary carcinoma and making distinctions between infiltrating lobular and ductal carcinomas) or concurrent mixed other patterns of breast carcinoma like invasive low grade ductal carcinoma of no special type (NOS). In this course faculties will discuss current nomenclature, histologic classification, diagnostic criteria and differential diagnosis of these types.

Learning Objectives:

  • Discuss the diagnostic criteria for classification of special type of invasive breast carcinomas.
  • Identifiy potential diagnostic pitfalls in diagnosis from the benign entity.
  • Describe the clinical implications associated with these diagnoses.

3:00 PM - 4:00 PMInfections Without Borders

Speakers:

  • Jeannette Guarner, MD, FASCP

Description:

In 2003, the well publicized outbreak of SARS coronavirus reminded us that emerging infectious agents do not need passports to cross international borders. Every day, there are unnoticed infectious agents that cross from one country to another using a variety of vectors. For example, respiratory viruses pass from person to person in invisible air particles, anthrax can be traded in furs, while plague and monkeypox can be imported in rodent pets. International travelers may return home with an infection acquired abroad or foreign visitors may enter a country with an unsuspected infection. This session will use case presentations and the audience response system to discuss the epidemiologic, pathologic and microbiologic aspects of some of these infections (malaria, mycobacteria, plague, dengue, and yellow fever). Because of public health concerns, encountering patients with these diseases triggers a series of responses, not only at the hospital level, but also at the state and country level which allow communities to respond and control outbreaks. Participants will be able to recognize these diseases and consult with the appropriate public health entities. They will be able to assess their capability to diagnose these diseases using tests available in their hospital and those that need to be sent-out to outside laboratories including the state health laboratory.

Learning Objectives:

  • Identify the epidemiology, clinical and pathologic presentation and microbiologic aspects of malaria, mycobacteria, plague, dengue, and yellow fever.
  • Recognize these diseases and consult with infectious disease physicians and the appropriate health care entities.
  • Assess what tests are available in their laboratory for diagnosing of these entities and what tests will need to be sent out.

3:00 PM - 5:00 PMSex Cord Stromal Tumors of the Ovary: An Overview with an Emphasis on Practical Diagnostic Considerations

Speakers:

  • Oluwole Fadare, MD
  • Katja Gwin, MD

Description:

Essentially, this will be a basic overview of sex cord-stromal tumors with an emphasis on the differential diagnosis of each entity, and how best to accurately reach a correct diagnosis for a given case. We will systematically cover every entity recognized in the 2003 WHO classification (Tavassoli FA, Devilee P, IARC, Lyon, France 2003). For each entity, there will be brief descriptions of basic clinical attributes, and a detailed description of pathologic features, including morphologic variants, differential diagnosis and ancillary diagnostic techniques.

Learning Objectives:

  • Know how to correctly diagnose sex cord-stromal tumors of the ovary.
  • Know the differential diagnoses and diagnostic pitfalls for each entity in the ovarian sex-cord stromal tumor category.
  • Understand the spectrum of ancillary diagnostic techniques that are valuable for the diagnosis of ovarian sex cord-stromal tumors.

3:00 PM - 5:00 PMPrinciples and Practice of Pathologist-Performed Ultrasound-Guided Fine Needle Aspiration of Head & Neck

Speakers:

  • Rana Hoda, MD, PhD, FASCP
  • David Lieu, MD
  • Jean-Marc Cohen, MD

Description:

US-FNA performed by pathologists enables them to also function as clinical consultants and radiologists. A brief introductory session will outline the components, brief physics and artifacts of US, normal anatomy of head & neck and US characteristics of a nodule. An interactive case-study approach will then be used to present six illustrative cases from head & neck including thyroid, salivary gland and lymph nodes. Faculty will highlight assessing the nodules on US with emphasis on: measurement and US characteristics of a mass (size, shape, solid versus cystic mass, echogenicity, calcifications and vascularity); distinguishing normal tissue from neoplastic masses and benign from malignant masses; placement of needle and US-FNA and tips on setting up an US-FNA practice, report format and billing. Cytology and histology of the cases will be reviewed. The session will conclude with a hands-on-workshop where participants will have an opportunity to practice US-FNA on phantom devices.

Learning Objectives:

  • Understand the basics, benefits and limitations of ultrasound.
  • Recognize ultrasound characteristics of masses and distinguish from artifacts and normal structures.
  • Demonstrate accurate needle placement, performance and interpretation of US-FNA.

4:00 PM - 5:00 PMDiagnostic Approach to Myeloproliferative Neoplasms with An Emphasis on Molecular Genetic Information

Speakers:

  • Sophia Yohe, MD
  • Robert W. McKenna, MD, MASCP

Description:

This course is designed to provide insights into the use of molecular genetic studies in classification and prognosis of myeloproliferative neoplasms. Rapid advances in understanding the pathogenesis of myeloid neoplasms have occurred in recent years accompanied by significant advances in treatment of patients with these diseases. Molecular pathogenesis of myeloproliferative neoplasms and the role of molecular/genetic studies in the diagnosis, classification, and follow-up of myeloproliferative neoplasms will be highlighted through practical approaches to real-life challenges. Participants will gain information about recent developments in diagnosis and prognosis of myeloproliferative neoplasms, along with indispensable guidance for use of molecular genetic studies for accurate diagnoses of the common and unusual patient conditions encountered in practice.

Learning Objectives:

  • Develop and apply a multidisciplinary approach to diagnosis and classification of myeloproliferative neoplasms based on the revised 2008 WHO classification of hematopoietic neoplasms.
  • Recognize the prognostic and/or therapeutic implications of a molecular genetic abnormality and communicate the significance of the findings to the referring clinician.
  • Devise an individual practice-based system for efficient and appropriate use of cytogenetic and molecular techniques for myeloproliferative neoplasms.

4:00 PM - 5:00 PMBlood Smear Review - Diagnoses You Don't Want to Miss

Speakers:

  • LoAnn Peterson, MD, MASCP

Description:

This session will discuss the importance of blood smear review in evaluating acute hematologic disorders. Early recognition of the possibility of these disorders not only impacts the subsequent work up but may also influence therapy and the subsequent outcome of the patient. Medical technicians/technologists and/or pathologists are often the first individuals to recognize these disorders. For example, recent studies document that early deaths of patients with acute promyelocytic leukemia (APL) have not decreased with ATRA therapy even though overall survivals have improved dramatically. Since the current recommendation is that ATRA be initiated at the first suspicion of APL, it is crucial for the laboratory to recognize the possiblility of APL so that therapy is not delayed. Participants in this session will learn the key feactures of several acute hematologic disorders identifiable on a blood smear examination and the importance of effective communication with the treating clinicians.

Learning Objectives:

  • Recognize the possibility of acute promyelocytic leukemia on a peripheral blood smear review.
  • Recognize the possibility of othere hemtologic emergencies by a peripheral blood smear review.
  • Recognize benign conditions on a blood smear examination that could be confused with a malignant disease.

Saturday, November 3, 2012

7:00 AM - 8:00 AMLung Adenocarcinoma vs. Squamous Cell Carcinoma: Why Do We Care?

Speakers:

  • Donald G. Guinee, MD, FASCP

Description:

Roundtable Session 28: Lung Adenocarcinoma vs. Squamous Cell Carcinoma: Why Do We Care?

8:00 AM - 9:00 AMGray Zones and Double Hits: Distinguishing Burkitt Lymphoma from Other High-Grade B-Cell Lymphomas

Speakers:

  • Patrick A. Treseler, MD, PhD, FASCP

Description:

While the diagnosis of Burkitt lymphoma (BL) is often straightforward, some cases resembling BL may have atypical morphologic and/or immunophenotypic features that overlap with other types of high-grade B-cell lymphoma, particularly diffuse large B-cell lymphoma (DLBCL). The 2008 WHO classification places such cases in a category called 'B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and BL,' which has recently been shown to include cases with translocations of both MYC and genes such as BCL2 and BCL6, which are more typically translocated in lymphomas other than BL. Such lymphomas, termed 'double-hit lymphomas', have an extremely poor prognosis, and may represent an entity distinct from BL and DLBCL. Using recommendations from the WHO and other authorities, this course will present an algorithm that guides one to the proper diagnosis for cases in which BL is in the differential diagnosis, using techniques commonly available to practicing pathologists.

Learning Objectives:

  • Describe the prototypic morphologic appearance and immunophenotype of Burkitt lymphoma, as well as the variations from this norm that are permissible and impermissible for that diagnosis according to published guidelines.
  • Describe the clinical, morphologic, immunophenotypic, and genetic features of double-hit lymphomas, including those that distinguish them from classical Burkitt lymphoma.
  • Produce an algorithm detailing how to approach the diagnosis of cases resembling Burkitt lymphoma, to include circumstances in which rearrangements for MYC, BCL2, and BCL6 genes should be sought using fluorescense in situ hybridization or other methods.

8:00 AM - 9:00 AMElectronic Policy and Procedure Management System to Support ISO 15189 Accreditation

Speakers:

  • Mark Tuthill, MD, FASCP

Description:

Electronic management of laboratory policies and procedure can provide significant efficiency for the modern laboratory and is becoming an increasingly important information technology solution. This is emphasized by the requirements necessary to achieve ISO 15189 accreditation as well as to comply with the College of American Pathology's document management requirements. This presentation will explore these requirements, electronic document management system selection, and our experiences with enterprise wide implementation of our selected system to support the Pathology and Laboratory Medicine service line at Henry Ford Health System. Participants will gain exposure to electronic document management and control systems, and will learn the essential features for system selection and understand how such system relation to ISO and CAP accreditation.

Learning Objectives:

  • Define document management and understand requirements for document management.
  • Understand the process for selection of document management software and describe requirements for system selection.
  • Develop strategies for and implementation process.

8:00 AM - 10:00 AMPractical Issues in Pathological Staging and Grading of Breast Carcinoma: Perspectives from a Surgical Pathology and Medical Oncology Team

Speakers:

  • Syed A. Hoda, MD, FASCP
  • Anne Moore, MD

Description:

Illustrative cases will highlight various important clinical aspects of 2010 TNM Breast Cancer Staging. These cases will include microinvasive carcinoma, micrometastatic carcinoma, multiple simultaneous ipsilateral carcinoma, inflammatory carcinoma, residual carcinoma status-post neoadjuvant chemotherapy. 5 Cases will be presented and offered to the audience for pathological staging.

Attending this session will enhance your understanding of the 2010 TNM Breast Cancer Staging, clarify the surgical pathology reporting aspects by interacting with pathology faculty and help you understand the oncology implications by interacting with medical oncology faculty.

Learning Objectives:

  • Outline the various changes made in the latest version of the AJCC-UICC TNM Breast Cancer Staging System.
  • Understand the reasons for various changes in the Staging System for breast carcinoma.
  • Resolve practical problems associated with the pathological staging of breast carcinoma.

8:00 AM - 10:00 AMSurgical Pathology of Sinonasal Tract Tumors

Speakers:

  • Lester R. Thompson, MD, FASCP

Description:

Specific cases of primary sinonasal tract and nasopharynx tumors and nonneoplastic mimics will be shown via digitized slides, followed by a presentation of the specific and unique histologic features that help to diagnose each of the lesions. This information will be set in the context of a differential diagnosis, specifically tested by audience questions that highlight the features that should have been learned. At the conclusion of this session, attendees will have a better understanding of the specific unique tumor types of the sinonasal tract and an ability to more correctly render a diagnosis that is clinically relevant.

Learning Objectives:

  • Formulate distinct and focused differential diagnoses for primary sinonasal tract tumors.
  • Develop pertinent and discriminating immunohistochemical and molecular studies to assist the diagnosis.
  • Apply the knowledge in making treatment recommendations that drive patient outcome.

8:00 AM - 10:00 AMGastrointestinal Lymphomas: Entities and Mimics

Speakers:

  • Lauren B. Smith, MD
  • Scott R. Owens, MD

Description:

The format will be case-based. The GI pathologist will present each case, discussing the potential differential diagnosis (including reactive pitfalls) based on the findings on H&E sections and using the results of the ARS to guide the discussion. The hematopathologist will discuss the immunohistochemical work-up, again using suggestions based on the ARS responses, and the final diagnosis. This tag-team approach will be used for each case. Cases include common entities such as MALT lymphoma, mantle cell lymphoma, and diffuse large B-cell lymphoma in addition to unusual cases such as enteropathy-associated T-cell lymphoma, immunoproliferative small intestinal disease (IPSID), plasmablastic lymphoma, and primary intestinal follicular lymphoma. Communication between the subdisciplines, the differential diagnosis, and reactive pitfalls will be emphasized, with information about the clinical implications and recent developments touched on in the context of the final diagnosis.

Learning Objectives:

  • Understand common GI lymphomas, and their neoplastic and reactive mimickers
  • Become familiar with less common GI lymphomas and their differential diagnoses
  • Develop a systematic approach to the diagnosis and subclassification of GI lymphomas

8:00 AM - 10:00 AMHemoglobinopathies: The How, Why and What

Speakers:

  • James D. Hoyer, MD, FASCP
  • Jennifer L. Oliveira, MD

Description:

"This session will focus on two aspects of hemoglobinopathies and thalassemias: 1) Describing the methodology, 2) Presenting various case studies including interaction with the audience in how to proceed in the workup of each case. The major methodologies used in the diagnosis of hemoglobin disorders will be reviewed. The advantages and limitations of each will be reviewed. A series of case studies will be utilized to illustrate the appropriate workup of hemoglobin disorders. The extent of the workup needed based on the complexity of the case will be emphasized. Appropriate utilization of resources will be stressed. Audience participation is encouraged."

Learning Objectives:

  • Review the methodologies commonly in use currently to diagnose hemoglobinopathies and thalassemias and discuss the advantages and limitations of each method.
  • Utilize a series of interactive case studies to illustrate the common and clinically significant hemoglobin disorders.
  • Discuss the appropriate utilization of testing in the workup of these disorders, particularly more esoteric or expensive technologies such as mass spectrometry or molecular testing.

10:00 AM - 11:00 AMDouble Take: Mimics of Acute Leukemia in the Pediatric Population

Speakers:

  • Sunita Park, MD

Description:

Learn the most common pitfalls in the diagnosis of pediatric leukemia in a case scenario format. More than just hematogones, we will discuss mimics of B-LL, T-LL, and AML and discuss the importance of appropriate laboratory testing to arrive at the correct diagnosis, emphasizing the importance of flow cytometry. You won't want to miss this engaging and informative session!

Learning Objectives:

  • Become familiar with benign/reactive conditions that can mimic pediatric acute leukemia.
  • Understand how to order appropriate testing to facilitate the correct diagnosis.
  • Incorporate ancillary techniques, such as flow cytometry and molecular diagnostics, into arrive at the correct diagnosis.

10:00 AM - 12:00 PMTeam Approach to Glandular Abnormalities on Pap Tests: Cytopathologist's Approach to Diagnosis and Gynecologist's Perspective on Management

Speakers:

  • Rana Hoda, MD, PhD, FASCP
  • Kevin M. Holcomb, MD

Description:

This session is conducted by an experienced Cytopathologist (a specialist in endocervical cytology) and an experienced Gynecologist (a specialist in Gynecological Oncology). Primarily, the session will enable confident diagnosis of various reactive, benign and neoplastic glandular lesions on Pap Tests. The course discussion will evolve around six wide-ranging cases on liquid-based Pap Tests. Comparative analysis of various lesions on conventional smears, common artifacts, diagnostic dilemmas and potential pitfalls will be highlighted. The role of HPV-test in endocervical lesions will be outlined. Clinical implications of various cytological interpretations will be outlined by the Gynecologist. Current diagnostic and management guidelines will be reviewed. The importance of clinical correlation will be emphasized. An interactive approach will ensure audience participation. Practicing pathologists, pathologists-in-training and cytotechnologist will benefit from this session.

Learning Objectives:

  • Recognize diagnostic criteria, differential diagnosis and potential pitfalls of glandular lesions on liquid-based Pap tests.
  • Utilize ancillary tools, including immunocytochemistry and HPV-testing.
  • Understand the clinical impact of cytologic diagnosis on subsequent patient management based on ASCCP recommended guidelines.

10:00 AM - 12:00 PMAmerican Association of Pathologists' Assistants: Pediatric Cardiology Morphology Workshop

Speakers:

  • Diane E. Spicer, BS

Description:

This two hour workshop on congenital cardiac morphology will use video demonstration as well as hands on examination of cardiac specimens from the Van Mierop Archive at the University of Florida and the collection at All Children’s Hospital in St. Petersburg, Florida. Using the morphological method, normal cardiac anatomy will be the initial focus to facilitate the understanding of the more complex lesions. By using the morphological characteristics of the atrial and ventricular chambers and the vascular structures along with analyzing the possible combinations of atrioventricular and ventriculo-arterial connections, the class participants will understand the usefulness and practicality of the sequential segmental analysis approach to the examination of the congenitally malformed heart. Upon completion of the workshop, those attending should be able to adequately describe any type of congenital cardiac malformation or combination of malformations.

Learning Objectives:

  • Participants will be able to perform and explain the sequential segmental analysis approach to the examination of the congenitally malformed heart using the morphologic method.
  • Participants will be able to describe any type of congenital cardiac malformation or combination of malformations.
  • Participants will learn attitudinally correct nomenclature and will be encouraged to make it a part of their routine protocol, because true descriptive terms are easier to understand than any alpha-numeric classification.

10:00 AM - 12:00 PMTeam Approach To Diagnosis of Fungal Infections

Speakers:

  • Jeannette Guarner, MD, FASCP

Description:

Fungal infections are becoming more frequent because of expansion of at-risk populations such as patients receiving transplants and longer life of immunosuppressed patients. Fungi previously considered non-pathogenic, including a variety of hyaline and dematiaceous molds, are now common infections of immunosuppressed patients. This has brought diagnostic dilemmas including defining infection versus colonization. In addition, the range of endemic fungal infections has expanded because of climate change, extension of human habitats, ease of travel, and shifting populations. Nowadays, pathologists and microbiology laboratories are asked to make a diagnosis in smaller pieces of tissue. Additional diagnostic challenges include the presence of resistance to different drugs by different fungi even with the expanded therapeutic armamentarium.
Histopathology continues to be a rapid and cost-effective means of providing a presumptive or definitive diagnosis of invasive fungal infections. However, pathologists and clinicians need to be aware of the limitations and pitfalls of tissue diagnosis. This workshop will use case presentations and the audience response system to discuss the epidemiologic, pathologic and microbiologic aspects of fungal infections. Participants will recognize these diseases in tissue, communicate to clinicians with appropriate evidence-based diagnosis that will help treatment, and recommend alternative tests for organism-specific diagnosis.

Learning Objectives:

  • Identify the epidemiology, clinical and pathologic presentation and microbiologic aspects of fungal diseases that occur in immunocompetent and immunosuppressed individuals.
  • Recognize these diseases in tissue and recommend alternative tests for diagnosis when cultures are not available.
  • Communicate the results in an appropriate evidence-based manner.

10:30 AM - 12:30 PMSurgical Pathology of Diagnostically Challenging Thyroid Gland Lesions

Speakers:

  • Lester R. Thompson, MD, FASCP

Description:

Specific cases of primary and secondary thyroid gland tumors and nonneoplastic mimics will be shown via digitized slides, followed by a presentation of the specific and unique histologic features that help to diagnose each of these lesions. This information will be set in the context of a differential diagnosis, specifically tested by audience questions that highlight the features that should have been learned. At the conclusion attendees will have a better understanding of the vagaries of thyroid gland pathology, and an ability to more correctly address problems in diagnosis.

Learning Objectives:

  • Recognize a variety of reactive and neoplastic lesions of the thyroid gland, formulate a differential diagnosis, and identify important histologic criteria to separate them.
  • Select and integrate immunohistochemical, molecular and/or genetic procedures that aid in diagnosis or have prognostic significance.
  • Understand their clinical behavior and be able to communicate effectively with clinicians about their management.

11:00 AM - 12:00 PMIntegrated Laboratory Diagnosis of Plasma Cell Neoplasms - A Morphologic, Genetic, and Flow Cytometric Approach

Speakers:

  • Michael Linden, MD, PhD
  • Robert W. McKenna, MD, MASCP

Description:

While the diagnosis of a plasma cell neoplasm such as multiple myeloma is often straightforward, there have been two major influences over the last two decades that influence our interpretation of samples: 1) There are numerous new tests that can be performed on serum and bone marrow samples; and 2) New chemotherapy options, including autologous stem cell transplant, have lead to prolonged patient survival and increased and more complex analysis of bone marrow and serum samples. The first half of the the session will review the morphologic, serologic, genetic, and clinical data necessary to classify plasma cell neoplasms. The second portion of the session will focus on the flow cytometric immunophenoptyping of samples from patients with plasma cell neoplasms, including myeloma, at diagnosis and post-therapy. We will describe our experiences at a large transplant center and suggest step-wise algorithms to select the appropriate tests to evaluate for minimal residual disease.

Learning Objectives:

  • Recommend to the clinical team the most relevant ancillary laboratory diagnostic tests for the diagnosis and monitoring of residual disease in patients with plasma cell neoplasms.
  • Distinguish between the different types of plasma cell neoplasms based on their morphology, genetics, immunophenotype, and clinical features.
  • Describe the most common immunophenotypic abnormalities documented by flow cytometric immunophenotyping of neoplastic plasma cells and how they are influenced by underlying genetics and subsequent therapy.

12:30 PM - 1:30 PMEmotional Intelligence, Communication Skills & the Laboratory Medicine Professional: Steps to A Fulfilling Career and Enhanced Patient Care

Speakers:

  • Vinay Prasad, MD;

Description:

We will analyze the 5 core concepts of Emotional Intelligence and their value in the daily activities of laboratory medicine professionals and leaders. We will identify the steps to improve emotional intelligence, enhance social awareness and practice tools to improve teamwork and develop professional relationships. We will implement the expanded ACGME competencies and subcompetencies as they relate to interpersonal skills for pathology. We will understand the clinician's perspectives, expectations and limitations, and select effective methods of quick, precise and clear communication. Participants are urged to attend this educational session to empower themselves, help them become valued team members, and learn about 'mindfulness based stress reduction.' Participants will apply 'appreciative enquiry' and communicate effectively as a valued team member.

Learning Objectives:

  • Develop a healthy relationship with clinical staff based on sound ethical values to communicate properly.
  • Improve self management and social awareness.
  • Work effectively as a valuable member of a team.

12:30 PM - 3:30 PMHodgkin Lymphoma: What Every Practicing Pathologist Needs to Know

Speakers:

  • Patrick A. Treseler, MD, PhD, FASCP

Description:

Hodgkin lymphoma has been a mystery for generations, and pathologists have often struggled to distinguish it from histopathologic imitators. Basic scientific discoveries have greatly improved our understanding of this enigmatic disorder, however, suggesting that virtually all cases of classical Hodgkin lymphoma are derived from a unique type of germinal center B-cell that has undergone crippling mutations of its immunoglobulin gene expression apparatus. This course provides a historical perspective on Hodgkin lymphoma, then describes the range of morphologic and immunophenotypic features that can be displayed in individual cases, including patterns of expression of novel transcription factors, emphasizing features that permit distinction of classical Hodgkin lymphoma from pathologic mimics such as anaplastic large cell lymphoma, anaplastic and other variants of diffuse large B-cell lymphoma, lymphocyte predominant Hodgkin lymphoma, and reactive immunoblastic hyperplasia.

Learning Objectives:

  • Describe how Hodgkin lymphoma differs from other B-cell lymphomas in terms of its basic biology, including expression of recently described transcription factors.
  • Describe the typical morphology and immunophenotype observed in classical Hodgkin lymphoma, including expression of recently described transcription factors, as well as variations from the norm that can be observed in individual cases.
  • Reliably distinguish classical Hodgkin lymphoma from its histopathologic imitators, including anaplastic large cell lymphoma, anaplastic and other variants of diffuse large B-cell lymphoma, lymphocyte predominant Hodgkin lymphoma, and reactive immunoblastic hyperplasia.,/

12:30 PM - 3:30 PMClinical and Laboratory Standards Institute: The Nuts and Bolts of New Test Implementation of Molecular Diagnostics into a Routine Clinical Laboratory

Speakers:

  • Leslie Hall, M. M. Sc.
  • Jean Amos Wilson

Description:

This session will be an interaction of two speakers and will provide the framework for implementation of a molecular test into a clinical laboratory. Although it is geared for the laboratorian not familiar with molecular testing, other stakeholders will benefit from this session. Presentations will describe the "nuts and bolts" of new test implementation including how to know what you don't know, with emphasis on CLSI documents, the nitty gritty of strategic planning with examples of go and no go scenarios, designing your workflow with emphasis on uni directional workflow in existing laboratories, new test validation with emphasis on FDA approved or cleared tests, the safety perspective of molecular testing and information on how to stay current with each of the molecular subspecialties (infectious disease, oncology, genetics and pharmacogenetics). Participants will be asked to provide examples of molecular testing under consideration for implementation in their clinical practice for strategic business analysis. Questions will be welcomed on each aspect of new test implementation.

Learning Objectives:

  • The entire management team (which includes but is not limited to: laboratory directors, supervisors, technical specialists, quality specialists, teaching technologists, etc.) will gain an understanding of the nuts and bolts of the implementation process for a new molecular test into laboratory practice.
  • Participants will have a 'hand's on' experience with strategic business planning using a SWOT analysis (strengths, weaknesses, opportunities and threats) example of molecular test implementation of a 'go' and 'no go' test.
  • Discussion will center around establishing 'uni directional workflow' for nucleic acid molecular testing in an existing clinical laboratory.

1:30 PM - 3:30 PMA Practical Diagnostic Approach to the Non-Neoplastic Endometrial Biopsy

Speakers:

  • Oluwole Fadare, MD

Description:

This course will present a practical diagnostic approach to the non-neoplastic endometrial biopsy that ensures that the optimal amount of information is conveyed to the clinician. There will be an emphasis on diagnostic pitfalls such as metaplasias, breakdown, and hormonal related changes, that can potentially result in misinterpretation. Updated information will be presented on the significance of basic entities such as chronic endometritis, histologic dating, and the evaluation of hyperplasias in the post treatment setting, among others.

Learning Objectives:

  • Accurately interpret the pathologic findings in an endometrial biopsy or curettage and avoid diagnostic pitfalls.
  • Present pathologic findings in a manner that optimizes communication and which addresses the diagnostic questions.
  • Update their knowledge of non-neoplastic endometrial pathology.

1:30 PM - 3:30 PMCan You Hear Me Now? Ear and Temporal Bone Surgical Pathology

Speakers:

  • Lester R. Thompson, MD, FASCP

Description:

Specific cases of primary ear and temporal bone diseases and neoplasms will be shown via digitized slides, followed by a presentation of the specific and unique histologic features that help to diagnose each of these lesions. This information will be set in the context of a differential diagnosis, specifically tested by audience questions that highlight the features that should have been learned. At the conclusion of this session, attendees will have a better understanding of the specific unique reactive lesions and tumor types of the ear and temporal tract and an ability to more correctly render a diagnosis that is clinically relevant.

Learning Objectives:

  • Recognize a variety of reactive and neoplastic lesions of the ear and temporal bone region, specifically developing a differential diagnosis based on exact anatomic site, and identify important histologic criteria useful in distinguishing between lesions.
  • Select and integrate immunohistochemical, molecular and/or genetic procedures that aid in diagnosis or have prognostic significance for lesions of the ear and temporal bone.
  • Understand their clinical behavior and be able to communicate effectively with clinicians about their management, especially given the very compact and small size of the ear and temporal bone region.

1:30 PM - 3:30 PMStress: Recognizing and Managing What's Bothering You

Speakers:

  • Christine Pitocco, MS, MT(ASCP)BB

Description:

Stress should not always be considered a bad thing. Sometimes it propels you into action and may even propel you into making changes in your life. Stress can cause wear and tear on the body. One must be able to identify their stressors and how they react to stress before it can be managed.This session is intended to teach the audience, how to identify stressand stressors what it can do to a person if not managed, and techniques that can be implemented to manage stress.

Learning Objectives:

  • Identify your stressors.
  • Describe the health implications if stress is not managed.
  • Identify stress management techniques.

2:30 PM - 3:30 PMA Practical Guide to the Laboratory Diagnosis and Monitoring of Monoclonal Gammopathies

Speakers:

  • Jonathan Genzen, MD, PhD

Description:

This session is designed to enhance the core-knowledge of monoclonal gammopathy testing for all members of the clinical laboratory team. Updates on recent advances in the field will be provided throughout the presentation. The session will begin with a concise clinical review of monoclonal gammopathies. The fundamentals of laboratory testing for these conditions will be presented in an easy to understand language. Common laboratory interferences and technical limitations will be addressed. Through an interactive case-based approach, the session will also review common and challenging patterns observed on protein and immunofixation electrophoresis of serum and urine. The presenter will deliver an interactive 45 minute lecture with integrated questions and clinical scenarios for the audience to respond to. This will be followed by a 10 minute question and answer period.

Learning Objectives:

  • Identify at least four clinical conditions where testing for monoclonal proteins is essential.
  • Identify the strengths and weakness of assays used to diagnose and monitor monoclonal gammopathies.
  • Interpret common patterns observed on protein and immunofixation electrophoresis of serum and urine.

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