Education: Pathologist Sessions

Empower your practice with advanced education.

From understanding how to bill more effectively to gaining a comprehensive look at groundbreaking advances in cancer prevention, this year's Annual Meeting provides the in-depth insights you need for your practice. You'll collaborate with like-minded clinicians and learn from the most respected names in pathology.

Here's a complete look at programming customized for pathologists like you.

Wednesday, October 31, 2012

8:00 AM - 10:00 AMAnatomic Pathologist's Role in Patient Safety

Speakers:

  • Jan F. Silverman, MD, FASCP

Description:

Since the 1999 Institute of Medicine's report on deaths due to medical errors, the medical community has stepped up its efforts to decrease medical errors and build a safer health system. It is estimated that 70 percent of all medical decisions that affect or change the patient�s clinical course are related to laboratory data and nearly all cancer diagnoses are based on the pathologist's interpretation of surgical pathology and cytopathology specimens. As a result, the work of anatomic pathologists greatly affects patient safety.

Learning Objectives:

  • Recognize types of surgical pathology and cytology cases which are more prone to errors.
  • Recognize the value of standardization and protocol/checklists in anatomic pathology reporting.
  • Identify which cases need a second opinion and develop processes for internal quality assurance, and intra- and extra- departmental consultation.

8:00 AM - 9:00 AMAmerican Pathology Foundation: Ready For A Change? Learn How To Manage Successful Change In Your Lab

Speakers:

  • Vasundara Ramarajan, MS

Description:

Change is hard. It involves moving from the known to the unknown place. This session explains the journey of change at a personal and institutional level, and illustrates ways to manage responses to change. Key strategies to manage staff resistance and handle ambiguous situations will be presented. Understanding the cognitive and emotional factors that influence change management will enable managers to lead staff at various phases of change to ensure successful and sustainable practices. An interactive presentation will present principles of the stages of change, characteristics of fear surrounding change and skills to overcome these. Then, participants will be encouraged to demonstrate and role play scenarios and reframing situations to gain practical knowledge

Learning Objectives:

  • Participants will identify the stages of change and apply them to three situations in the workplace.
  • Participants will evaluate three different cognitive and emotional strategies for change management.
  • Participants will roleplay one situation using techniques to sustain change.

8:00 AM - 11:00 AMThe Society for Hematopathology: Hematopathology - New Diagnostic Frontiers

Speakers:

  • John L. Frater, MD
  • Yi-Hua Chen
  • Lawrence M. Weiss, MD
  • Antonio Subtil, MD

Description:

The purpose of this session is to present topics of interest to pathologists encountering hematologic disorders which may be particularly challenging to diagnose. The speakers, who are all expert hematopathologists, will present the following topics: reactive lymphadenopathies including IgG4-related sclerosing disease; challenging aspects of the diagnosis of cutaneous lymphomas; and large granular lymphocytic leukemia. The speakers will discuss their own published work, other published literature, and the clinical and diagnostic features of these diseases. Each presenter will deliver the content in a 45 minute lecture followed by a 10 minute question and answer session with the audience.

Learning Objectives:

  • To readily identify the entities described in these lectures.
  • To appropriately utilize ancillary technologies, including immunohistochemistry, flow cytometry, and molecular diagnostics.
  • To appreciate recent advances in the scientific literature relevant to the disease entities discussed in this session.

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 - 11:00 AMRodger C. Haggitt Gastrointestinal Pathology Society: Pathologic Evaluation of Colon Cancer Cases: Everything You Ever Wanted to Know...and More

Speakers:

  • Rhonda Yantiss, MD
  • Mary Kay Washington, MD
  • Alyssa M. Krasinskas, MD, FASCP
  • Robert M. Najarian, MD
  • Steven Wexner, MD
  • Mariana Berho, MD

Description:

Members of the Rodger C. Haggitt Gastrointestinal Pathology Society Education Committee felt that a multidisciplinary discussion of colorectal cancer may be helpful to practicing surgical pathologists. Recent changes to the AJCC TNM Cancer Staging Manual, the WHO Tumor Classification, and the CAP guidelines have led to confusion and inconsistent reporting practices among pathologists. Advanced surgical techniques have changed the way patients with colon cancer are managed, yet many pathologists, residents, and pathology assistants do not understand the anatomy of resultant specimens. The topics of discussion will include: 1. Surgical Management of Rectal Cancer: What Pathologists Need to Know---Steve Wexner 2. Pathologic Evaluation of Malignant Polyps--Robert Najarian 3. Pathologic Staging Issues: Applying Criteria of the AJCC 7th edition--Kay Washington 4. Ancillary Testing of Colon Cancer: The Routine and Esoteric--Alyssa Krasinskas

Learning Objectives:

  • Understand factors that determine the type of surgical approach used to treat colon cancer patients and know how to handle resection specimens appropriately.
  • Apply pathologic staging criteria accurately to surgical and endoscopic resection specimens, such that clinicians can make informed management decisions.
  • Interpret results of ancillary tests used to determine treatment strategies for cancer patients and identify potential at-risk family members.

8:00 AM - 10:00 AMCommon Consultation Conundrums in Breast Pathology

Speakers:

  • Sandra Shin, MD

Description:

Difficult or problematic breast lesions are commonly submitted to breast pathology consultants for a second opinion because of 1) unusual, unexpected or ambiguous histological features and/or immunohistochemical staining results, 2) lack of consensus in lesion classification, 3) unclear reporting guidelines, or 4) rarity of the lesion. The purpose of this course is to provide pathologists with a practical approach to such problematic breast lesions that they will be able to apply in their daily practice. Topics that will be discussed will include diagnostic problems with papillary, fibroepithelial, columnar cell and in situ lesions, small glandular proliferations, among others. The application and pitfalls of adjunctive immunohistochemical studies used to help resolve these differential diagnostic dilemmas will be emphasized.

Learning Objectives:

  • Develop a practical diagnostic approach when encountering a problematic breast lesion
  • Correctly classify and diagnose problematic breast lesions
  • Understand the uses and limitations of immunostains in resolving diagnostic dilemmas in breast pathology

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 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.

10:00 AM - 12:00 PMEndoscopic Ultrasound Guided Fine Needle Aspiration of the Pancreas:Challenges and Opportunities

Speakers:

  • Nirag Jhala, MD
  • Darshana Jhala, MD
  • Nuzhat A. Ahmad, MD

Description:

This course will use case based approach to focus on salient EUS findings and utilize those findings to initiate algorithmic cytologic approach to arrive at a diagnosis. This course will use this approach to demonstrate salient features of common solid pancreatic masses including pancreatic adenocarcinoma, autoimmune pancreatitis and non ductal tumors such as pancreatic endocrine neoplasm. It will also highlight use of ancillary studies that may help in supporting a diagnosis of pancreatic carcinoma in cases suspicious for carcinoma. This course will also demonstrate how multidisciplinary approach can help diagnose various pancreatic cysts and avoid pitfalls. The course will also highlight how new developments such as use of EUS guided Tru cut biopsies can further aid in improving diagnostic accuracy of this technique for diagnosing pancreatic lesions.

Learning Objectives:

  • Use algorithmic approach to various solid lesions of the pancreas.
  • Use a comprehensive approach to diagnosis of pancreatic cysts
  • Determine need of ancillary studies for various solid and cystic lesions.

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 PMBest Practices for Immunohistochemical Detection and Interpretation of ER, PR, and HER-2/neu Protein Overexpression in Breast Cancer

Speakers:

  • Richard W. Cartun, MS, PhD
  • Andrew Ricci, Jr., MD

Description:

Accurate detection and interpretation of estrogen receptor (ER) protein, progesterone receptor (PR) protein, and HER-2/neu protein overexpression are critical for determing adjuvant 'Personalized' therapy in patients with breast cancer. This session will review 'Best Practices' for breast biospecimen collection, fixation and processing, tissue sectioning, as well as immunohistochemical staining for ER, PR, and HER2 protein overexpression. The use of fluorescence in situ hybridization for HER-2/neu gene amplification will also be addressed. Comparison of internal laboratory results with published benchmarks will be discussed. Participants will be given the opportunity to evaluate and score ER, PR, and HER2 immunohistochemical stains performed on a series of breast cancer cases.

Learning Objectives:

  • Accurately detect and interpret immunohistochemical stains for ER, PR, and HER2 performed on breast cancer specimens.
  • Use a simple semi-quantitative scoring system for scoring ER and PR immunohistochemical stains.
  • Appreciate the importance of minimizing cold ischemic time and ensuring adequate fixation in formalin for breast specimens.

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.

11:00 AM - 12:00 PMAcademy of Clinical Laboratory Physicians and Scientists: Consulting on Blood Disorders: Laboratory Medicine Pearls to Impress Colleagues and Improve Patient Care

Speakers:

  • Henry M. Rinder, MD, FASCP
  • Marisa B. Marques, MD, FASCP
  • Jill Adamski, MD, PhD
  • Alexa Siddon, MD

Description:

As medical information and laboratory data expand, the pathologist must develop and maintain consultative and diagnostic expertise on blood disorders. This session is chock-full of clinical pearls for pathologists to hone their consultative skills on hematologic, coagulation, and transfusion-based issues. This dynamic program will hit 3 important topics in one hour; an interactive program will allow opportunities for audience response, questions, and case-sharing. The session will highlight lab algorithms for hypercoagulability testing, approach to transfusion associated lung injury, and assessment of cutting edge assays to prognosticate for patients with chronic lymphocytic leukemia. Laboratory professionals will also find important new information on laboratory methods and testing modalities in this session, making this an opportunity for the entire pathology team to fine-tune their clinician and laboratorian skills.

Learning Objectives:

  • Participants will evaluate the utility of testing and devise a consultation using case-based questions, e.g. using a testing algorithm for patients with venous thromboembolism to avoid false-positive results. Besides medical knowledge, this activity will provide assessment of additional competencies in patient care, e.g. recommendations for treatment of lung injury following transfusion, professionalism, e.g. assessing individual needs for prognostication in hematologic malignancy, and practice-based learning, e.g. making a final determination as to when thrombophilia testing is clinically justifiable.
  • Participants will identify, through an interactive format, a minimum of three 'high-performing' strategies for pathology consultation in transfusion, coagulation and hematology. These will include, but are not limited to: (a) evidence-based establishment of appropriate timing for hypercoagulability testing (practice-based learning and interpersonal communication skills); (b) targeting requests for prognostic testing in CLL as a comprehensive pathology consultation (systems-based practice, patient care); and (c) devising diagnostic strategies for consultation on complex clinical disorders such as transfusion associated lung injury, which optimize pathology at the bedside (patient care, systems-based practice and practice-based learning).
  • Participants will acquire expertise in 3 separate blood disorder topics, based on the most recent quarterly AJCP concise reviews. Attendees will: (1) learn to decide when and how to test for hypercoagulability, (2) be able to apply clinical and laboratory findings for the differential diagnosis of TRALI, and (3) ascertain personalized prognostic testing for CLL.

1:00 PM - 2:00 PMPathology Practice Issues

Speakers:

  • Jane Pine Wood, JD

Description:

This session will address the principal legal challenges facing pathologists, including the in-sourcing of pathology services by other specialties, exclusive contracting by payors, strategies for dealing with ACOs and other health care reform initiatives, negotiating hospital contracts, and common pathology billing issues.

Learning Objectives:

  • Identify and handle common pitfalls and risks associated with the marketing of pathology services.
  • Address the significant legal and business issues associated with the in-sourcing of pathology services.
  • Identify strategies for contracting with payors and ACOs.

1:00 PM - 3:00 PMYour Role in the Clinical Team

Speakers:

  • Julie R. Taylor, PhD

Description:

CDC convened an Institute on Critical Issues in Health Laboratory Practice to focus on the role of the clinical laboratory in providing quality testing services for improved patient outcomes. Clinical Laboratory Integration into Healthcare Collaborative (CLIHC) was established to address Institute-identified 'gaps' and optimize the effective use of laboratory services by clinicians. CLIHC is composed of laboratory professionals and clinicians, supported by CDC's Division of Laboratory Science and Standards, and addresses challenges to optimizing laboratory services. CLIHC efforts will increase awareness about major challenges to effective use of laboratory services, provide evidence for solutions to problems associated with inappropriate test selection/interpretation test results.This presentation will describe the CLIHC projects and how they might help ASCP members improve their collaborative work with other healthcare professionals in a clinical team.

Learning Objectives:

  • Determine the impact of inappropriate laboratory test utilization on clinical diagnosis
  • Assess physicians' challenges to the appropriate selection of laboratory tests and result interpretation with the goal of identifying potential solutions to improve patient care
  • Recognize how laboratory professionals can help address gaps in medical school curricula to improve physicians' knowledge of laboratory medicine.

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 - 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 - 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.

1:00 PM - 3:00 PMInternational Society of Breast Pathology: Breast Pathology Update

Speakers:

  • Aysegul A. Sahin, MD FASCP
  • Laura Collins, MD
  • Juan Palazzo, MD

Description:

This course will cover current diagnostic and management issues in breast pathology with emphasis on current developments. The course will consist of review of two topics:

  1. Review of Immunohistochemisrty in diagnostic breast Pathology: Emphasis will be placed in the interpretation and use of prognostic and myoepithelial cell markers as well as markers used in the differential diagnosis of breast lesions. We will discuss predictive markers and their potential applications, pitfalls with the use of all markers and a panel oriented approach as opposed to the use of single markers, their advantages and disadvantages. At the end of the session participants would have a better understanding of when and how to interpret immunohistochemistry in breast pathology.
  2. Molecular classification of breast cancer: New approaches to classify invasive breast cancer, the different molecular phenotypes and the relevance this classification systems to clinical practice will be discussed.

Learning Objectives:

  • Understand the role and limitations of immunohistochemistry in diagnosis of breast lesions.
  • Recognize the clinical significance of biomarkers that can be evaluated by immunohistochemistry and implement effective methods to help to prevent tissue handling problems that can affect immunohistochemistry results.
  • Understand the emerging role of molecular biology in classification of breast cancer.

2:00 PM - 4:00 PMClinical Laboratory Management Association: Utilize CLMA's 'Body of Knowledge for Medical Laboratory Management' to Achieve ASCP's DLM Certification

Speakers:

  • Anne Pontius, MBA, MT(ASCP)
  • Rebecca Kenner, BS, DLM, MT(ASCP)
  • Patty J. Eschliman

Description:

This educational session is designed to assist laboratory managers and administrators in their quest to achieve ASCP Diplomate in Laboratory Management (DLM) certification and bring recognition to the laboratory management profession through DLM certification. Tools will be presented for attendees to perform a management competency gap analysis utilizing the CLMA Body of Knowledge for Medical Laboratory Management and testing aspects of the DLM examination. Attendees will be provided with a list of various resources to bridge their competency gaps.

Learning Objectives:

  • Perform management competency gap analysis on him/herself and staff by utilizing the CLMA Body of Knowledge for Medical Laboratory Management and testing areas of the ASCP Diplomate of Laboratory Medicine.
  • Determine appropriate educational resources to bridge gaps in managerial competencies established from a gap analysis.
  • Promote the laboratory management professional by understanding the unique set of competencies needed to be a successful manager or administrator and the knowledge necessary to successfully pass the ASCP DLM certification.

2:00 PM - 4:00 PMFine Needle Aspiration Cytology of Metastatic Malignancies of Unknown Primary

Speakers:

  • Jan F. Silverman, MD, FASCP
  • Tarik Elsheikh, MD, FASCP

Description:

Metastatic malignancies of unknown primary origin is the eighth most common form of malignancy, accounting for 0.5 to 3.5 percent of all malignant solid tumors. In fact, it is estimated that 10 to 15 percent of oncology patients have a tumor of unknown primary origin. Fine needle aspiration (FNA) is often the first procedures in the work-up of these cases and plays a pivotal role for the diagnosis of metastatic disease. This presentation is designed to assist the pathologist faced with the challenge of determining the primary site when there is no previous history of malignancy, prior pathology is not available for review, or there is an unpredictable pattern of metastasis.

In this course, Drs. Elsheikh and Silverman will employ a case study approach in comprehensive discussions of:

  1. A contemporary clinicopathologic approach for the work-up of metastatic disease of unknown primary site that includes cytomorphology, ancillary studies, and clinicopathologic correlation including recognition of common and unusual patterns of metastasis
  2. The cytologic subclassification of malignancies into cell lineage and morphologic categories such as clear cell, oncocytic, spindle, small cell, and large pleomorphic cell neoplasms
  3. The potential pitfalls in diagnosis when look-alikes are encountered
  4. The selective use of ancillary studies (especially immunohistochemistry) as an aid in determining cell lineage and site of origin

Learning Objectives:

  • Describe in detail the various cytomorphologic features of metastatic malignancies, emphasizing differential diagnosis and clues to their possible site of origin.
  • Discuss the use of ancillary studies in the work-up of metastasis, with particular emphasis on immunohistochemistry using an algorithmic approach.
  • Present the various patterns of metastasis to common and unusual sites encountered in FNA biopsy and utilization of this information in narrowing down a primary site.Discuss the advantages and limitation of molecular studies in the workup of metastasis of unknown primary.Highlight the cost-effectiveness and clinical significance of the cytologic work-up of metastatic disease of unknown primary and what pathologic information the oncologist needs for prognostication and treatment decision.

2:00 PM - 3:00 PMIn Vivo Microscopy: An Educational Forum for Pathologists

Speakers:

  • Guillermo J. Tearney, MD PhD

Description:

In vivo microscopy is being practiced today, providing images that are similar to microscope slides, but obtained without excision from living patients. Pathologists in general are currently not aware and/or not practicing the interpretation of in vivo microscopy images. This education session will help educate pathologists about the technology, generating an awareness that hopefully will translate into greater participation in this field.

This will be a didactic teaching presentation that will provide a general understanding of in vivo microscopy technologies, a basic tutorial on how to diagnose the images, and a discussions of ways in which pathologists can be involved with in vivo microscopies in their own practice settings.

Learning Objectives:

  • Learn about in vivo microscopy technologies and clinical applications.
  • Have a basic understanding on how to interpret the images.
  • Understand ways in which pathologists can become involved in this field.

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

8:00 AM - 9:00 AMThe Era of Endoscopic Assessment and Treatment of Esophageal Neoplasia: 'Optical Biopsy' Meets Pathology Practice.

Speakers:

  • Melissa Upton, MD, FASCP
  • Vani J. Konda, MD

Description:

The management of Barrett's associated neoplasia has undergone revolutionary changes in endoscopic assessment and therapy with impacts on pathology practice. Endoscopic evaluation of the esophagus now may utilize advanced techniques such as narrow band imaging (NBI), optical coherence tomography (OCT), confocal laser endomicroscopy (CLE), or spectroscopic techniques. CLE provides gastroenterologists with an 'optical biopsy', and microscopic assessments are occurring in the endoscopy suite. These types of imaging modalities may alter biopsy protocols for surveillance of neoplasia. Furthermore, endoscopic mucosal resection (EMR) has replaced esophagectomy in specialized centers as both a therapeutic and diagnostic procedure for intramucosal neoplasia and can provide a tissue specimen for accurate histopathological staging. Advances in endoscopic treatment in the esophagus have also included endoscopic ablative treatments, such as PDT (photodynamic therapy), RFA (radiofrequency ablation) and cryotherapy.

This course is intended to equip pathologists with more detailed knowledge and familiarity with evolving endoscopic techniques and tools, and to enhance diagnostic skills for histopathological assessment of specimens from patients being managed with these modalities. We also hope to prepare pathologists for interactions with gastroenterologists who are using 'optical biopsies' in the procedure rooms to provide improved endoscopic assessments and optimal tissue acquisition in order to manage esophageal diseases.

Learning Objectives:

  • Summarize the kinds of optical imaging being used for esophageal endoscopy, their applications, and their respective advantages and disadvantages in the diagnosis and treatment of neoplasia.
  • Discuss the impact of new endoluminal techniques, including optical biopsies such as confocal laser endomicroscopy (CLE) on biopsy strategy, endoscopic treatment, pathology specimens, and clinical-pathologic correlation.
  • Provide a strategy for optimal gross description, sectioning, histological evaluation, grading and staging of neoplasia, and reporting of post-ablation biopsies and of endoscopic mucosal resection (EMR specimens) and their margins.

8:00 AM - 10:00 AMCollege of American Pathologists: Digital Imaging: It's a Brave New World for Pathology

Speakers:

  • Kim Kruger, MBA, MT(ASCP)
  • Liron Pantanowitz, MD
  • Kenneth J. Bloom, MD
  • Anil V. Parwani, MD, FASCP

Description:

Pathology practice will change forever with the mainstream use of digital imaging. So why hasn't this technology innovation taken off? Digital imaging is used today in undergraduate and post-graduate education, tumor conferences and pathology board examinations. But it is the practical issues, obstacles and pending regulations to implementation that currently limit this technology's application for clinical use (i.e., frozen sections, routine diagnosis, pathology consultations). Recent FDA classification of digital imaging technology as a Class III device creates validation challenges for vendors and laboratories. Expert faculty will share their knowledge and experience in helping to better understand the current state of digital pathology, barriers to implementation and, once in the laboratory, realistic validation for clinical purposes. Participants will have the opportunity to learn more about the College of American Pathologists' efforts in this arena including their evidence-based validation recommendations for Whole Slide Imaging and the benefits these practical guidelines provide in promoting pathologist adoption of this new technology.

This session is sponsored by the College of American Pathologists.

Learning Objectives:

  • Describe current developments in the digital imaging field, including new regulations.
  • Review the implementation requirements of digital imaging in pathology practice and contrast the pros and cons impacting mainstream adoption of this technology.
  • Apply guidelines to validate the use of digital imaging technology for clinical purposes.

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.

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 - 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 - 11:00 AMLiver Pathology in 2012: Update and Approach to Common Diagnostic Challenges

Speakers:

  • Nirag Jhala, MD
  • Sanjay Kakar, MD
  • Dhanpat Jain, MD
  • Ryan Gill, MD, PhD
  • Kisha Mitchell, MD

Description:

The state of current knowledge in four specific areas of hepatic pathology that are frequently encountered by pathologists in their daily practice will be the basis of this discussion. We will demonstrate morphologic patterns of hepatocellular carcinomas and show practical approach to diagnosis of hepatic mass lesions. We will also highlight opportunities and limitations of various immunohistocehmical markers applied for the diagnosis of hepatic mass lesions. Furthermore, this course will help formulate a practical approach to diagnosis and differential diagnosis of cholestatic liver injury patterns in adults. Finally we will highlight one of the more challenging aspects of liver pathology facing diagnostic pathologists.

Learning Objectives:

  • Recognize differential diagnosis, identify pitfalls and understand the overlapping histologic patterns that can be seen in drug induced liver injury (DILI), fatty liver disease and their mimics.
  • Develop a practical approach to diagnosis and differential diagnosis of cholestatic liver injury.
  • Formulate a practical approach to diagnosis of hepatic mass lesions and become conversant with opportunities and limitations of various immunohistocehmical markers applied for the diagnosis of hepatic mass lesions.

8:00 AM - 9:00 AMGet a Leg Up on Gross Bone Pathology

Speakers:

  • Willa Rae Rader, PA(ASCP)cm

Description:

This lecture will be an overview of all aspects of gross pathology of bone lesions commonly encountered in Surgical Pathology. This will include a brief review of bone anatomy, detailed look at common benign and malignant bone lesions, and proper specimen handling including sectioning and processing. This lecture will emphasize the importance of gross examination and processing in the final diagnosis and staging of malignant bone tumors and will include gross requirements of cancer protocols.

Learning Objectives:

  • Review of bone anatomy common to the Surgical Pathology gross bench.
  • Identify gross benign and malignant bone lesions and understand grossing protocols.
  • Will highlight proper handling of bone specimens at the gross bench and the important role of gross examination in the final diagnosis.

8:00 AM - 10:00 AMProstatic M&Ms: A Practical Approach to the Diagnosis of Prostatic Malignancy and Its Mimics

Speakers:

  • Omar Hameed, MD

Description:

This course is designed to provide both pathologists in practice and those in training with an effective and practical approach to the diagnosis of prostate needle biopsy material, specifically for the distinction between prostatic adenocarcinoma and its mimics. This will include a discussion of the morphological criteria for diagnosis, the differential diagnosis, and the role of immunohistochemistry in the diagnosis. A large series of cases will be used to highlight the differences between minimal and unusual variants of prostatic adenocarcinoma and their different mimics including:
- Small gland lesions such as atrophy, adenosis, crowded benign glands, sclerosing adenosis, basal cell hyperplasia, Cowper glands, mesonephric remnants and nephrogenic adenoma
- Medium to large gland lesions such as clear cell cribriform hyperplasia, and hyperplastic glands
- Non-glandular lesions such as granulomatous prostatitis, prostatic xanthomas and paranglia, and signet ring cell change.

Learning Objectives:

  • Develop a systematic approach to the interpretation of prostate needle biopsy material and recognize sources of difficulty in the diagnosis.
  • Recognize the different mimics of malignancy and how to distinguish them from minimal and unusual variants of prostatic adenocarcinoma.
  • Recognize the utility and limitations of immunohistochemistry in the evaluation of prostate needle biopsies and how it can (or cannot) be used to discriminate between prostatic adenocarcinoma and its mimics.

8:00 AM - 11:00 AMNational Society for Histotechnology: Is Your Lab Providing Reproducible Immunohistochemical Results?

Speakers:

  • Elizabeth A. Sheppard, MBA, HT(ASCP)
  • Richard W. Cartun, MS, PhD
  • Elizabeth A. Chlipala, HTL(ASCP)

Description:

Immunohistochemistry has become an integral component in providing diagnostic,prognostic and patient therapy related information. It is for these reasons that it is essential that quality results are reproducible. This session will provide information on the effects of preexamination variables and their influences on reproducublity. Also included will be a practical approach to ensure proper validation and quality control criteria that meets regulatory body requirements. Lastly this session will provide pitfalls and solutions to commom areas that ensures a diagnostic result.

Learning Objectives:

  • Implement the proper preexamination techniques that impact testing results
  • Understand appropriate mandated validation and quality control to meet standards
  • Recognize causes of poor results and how to implement change

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.

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 AMGYN Cytopathology: Are We Ready for the New Cervical Cancer Guidelines?

Speakers:

  • David Wilbur
  • Mark H. Stoler, MD FASCP
  • Marcela DelCarmen, MD, MPH
  • Brooke Koltz, MD
  • Brenda Sweeney

Description:

Cervical Cancer Screening Guidelines were published in 2002, which incorporated HPV DNA testing. Numerous studies have been published to support changes to recommended age-appropriate screening guidelines and the management of abnormal screening results. Recently published new Cervical Cancer Screening Guidelines are based on the principles of the GRADE guideline development process to more formally evaluate evidence and incorporate the quality of that evidence into recommendations. Contributions were obtained from six working groups and a recent symposium which was attended by 25 organizations. The screening guidelines address age-appropriate screening by cytology and high-rish HPV testing, follow-up of women after screening, age of discontinued screening, primary HPV screening & HPV vaccinated screening strategies. A panel will present background data to support changes and review the changes to cervical cancer screening guidelines. An interactive question session will follow.

Learning Objectives:

  • Understand the development process of evidence review for the new cancer screening guidelines.
  • Recognize the changes from the previous cancer screening guidelines and management of abnormal screening results.
  • Identify future considerations regarding HPV testing as primary screening approved and screening strategies for women vaccinated against HPV 16 and HPV 18 infections.

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.

2:15 PM - 4:15 PMDigital Pathology - Is it for Me?

Speakers:

  • Keith J. Kaplan, MD

Description:

This session will describe the evolution and status of digital pathology, including image analysis as well as the use of digital pathology for primary and secondary diagnosis.

Learning Objectives:

  • Define uses for digital pathology
  • Gain comfort in imaging, quality, service improvement and patient-focused enhanced outcomes
  • Evaluate image analysis, telepathology and other clinical oriented uses for digital pathology

2:15 PM - 3:15 PMElements of a Successful Distance Education Program

Speakers:

  • Karen Honeycutt
  • Debra M. Wood, MS, HT(ASCP)

Description:

Distance education (DE) or distance learning is an established, successful instructional methodology utilized for various educational levels. Asynchronous distance learning can provide more learner flexibility than the synchronous, face-to-face classroom environment. Internet-based course management systems and digital lecture capture options are a few of the technology opportunities that allow learners to access instructional content anytime and almost anywhere. Learner-centered instructional design allows students to interact with peers and instructors so as not to learn in isolated silos. Representatives from two laboratory educational programs will discuss the critical success factors when incorporating distance learning strategies to teach laboratory practitioners. Each speaker will describe their DE program, their successes, lessons learned, challenges and limitations.

Learning Objectives:

  • Describe distance education strategies that provide a flexible and efficient educational infrastructure.
  • Discuss instructional design elements that address known factors critical for successful distance education.
  • Recognize challenges to providing distance education in laboratory practitioner professional programs.

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 - 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.

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 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 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 - 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 PMAdvancing Patient-Centered Care for Women Across Our Globe:
The Laboratory is Part of the Puzzle

Speakers:

  • Eric G. Bing, MD, PhD, MBA
  • Kimberly Allison, MD
  • John Nkengasong, PhD

Description:

This session focuses on the challenges of defining and delivering patient-centered care to women in different settings across the globe â€" using breast cancer care as a case study.

The number of new cases of breast cancer has jumped dramatically worldwide, from approximately 640,000 in 1980 to more than 1.6 million in 2010, with over half of those new cases in the developing world. The stigmas attached to breast cancer, as well as its life threatening nature and the complexity of cancer treatment options, each with its own potential risks and benefits, make it difficult for patients to make decisions about their care. Advances in treatment have improved life expectancy, but these advances have come at a steep price because treatments can impose substantial morbidity and burden on patients and their families.

Optimal patient care is only realized through patient-centered care, which has been defined as providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensures that patient values guide all clinical decisions. How do we, as practitioners, use the knowledge and tools we have available to provide the best outcomes for our patients, while keeping ever mindful of the patient as a person? The critical roles that pathology and laboratory medicine play in breast cancer diagnosis, management and therapy, present multiple opportunities to deliver quality patient-centered care.

3:15 PM - 4:15 PMSuccession Planning: How Can We Staff Tomorrows Lab?

Speakers:

  • E Susan Cease, BS

Description:

With limited time and resources, lab leaders need evidence based tools and new strategies to fill both technical and management positions. This session will review succession planning, how it is evolving, and the tools you can utilize to plan and implement in your workplace. We will discuss the demographic impact of an aging workforce on current and future staffing needs and explore the tools associated with succession planning. Additonal tools and models, including career development and formal education will be discussed as a viable adjunct to current standards.

Learning Objectives:

  • Identify the components of a traditional succession planning model and determine how that model is changing to meet the current work environment.
  • Recognize the challenges related to workforce shortages in the laboratory profession.
  • Recognize that an effective succession plan can encompass the entire range of lab professions, as well as key leadership positions.

4:15 PM - 5:15 PMAmerican Pathology Foundation: Training of Clinical Laboratory Personnel

Speakers:

  • Jeanne Carr, PhD
  • Richard Warren, MT(ASCP)SH, DLM

Description:

This session will focus on designing a training program that will aid in providing clinical laboratory personnel with thorough instruction while providing the institution with necessary documentation to meet requirements of various regulatory agencies. Topics to be covered include: how training and competency differ; developing meaningful checklists for training; setting acceptable criteria for performance; action to take in cases of unacceptable performance; incorporating trainee’s feedback; and the Lab Director's responsibility in the process. Examples of a successful program will be presented followed by an open floor discussion of application. Attendees will be asked to share their experiences and ideas for these processes.

Learning Objectives:

  • Design a program for initial training laboratory personnel.
  • Identify ways to involve employees in developing and maintaining the training program.
  • Modify the session's example forms for use in their own laboratories.

4:15 PM - 6:15 PMLimited Tissue Samples in the Era of Personalized Medicine: Diagnostic Challenges, Molecular Analysis and Controversies

Speakers:

  • Zubair W. Baloch, MD, PhD, FASCP
  • Amy Chadburn, MD, FASCP
  • Virginia A. LiVolsi, MD, MASCP
  • Jamie Shutter, MD
  • Victor G. Prieto, MD, PhD, FASCP
  • David J. Dabbs, MD, FASCP

Description:

Traditionally the evaluation of the patients with a presumptive diagnosis of cancer has long focused on acquisition of tissue for the purposes of confirming malignancy and basic histologic typing. In the current era of personalized medicine where therapy is based on histologic as well as molecular analysis, there is now sufficient data to support a rethinking of traditional pathology approach to tissue. Small samplings of the pathologic tissue have become a norm over large resections in everyday pathology practice to provide accurate histologic sub-typing as well as preserve the tissue for molecular studies. It is well-known that the inter-observer variability is still higher in interpretation of these small tissue samples as compared to rendering diagnosis on large resection specimens. One of the main reasons for this variability is that many tumors have more than one morphologic feature and the immunohistochemical stains use to identify these are far from perfect.

In this session consisting of 5 expert pathologists the topic of small biopsy pathology for various organs will be discussed. The faculty will provide their view regarding the best practices for handling small biopsy samples. The discussion will include diagnostic challenges/pitfalls, role of immunohistochemistry and relevant molecular tests.

Each Speaker will have 25 minutes (20 min case presentation+5 min questions)

Learning Objectives:

  • Provide a pathologists view of the role of basic morphology in the diagnosis and triage of small biopsy specimens for ancillary tests.
  • Highlight the role of molecular techniques as an aid to pathologic diagnosis.
  • Describe the role of the molecular pathologist in targeted therapy decisions based on small biopsy specimen diagnosis and discuss known 'best-practices' and means of implementation.

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 PMCompanion Diagnostics 101

Speakers:

  • Kenneth Emancipator, MD, FASCP

Description:

This program will systematically review companion diagnostics that have become the standard of care. These include, but are not limited to, the EGFR over-expression test, EGFR mutation test, KRAS mutation test, BRAF mutation test, and the ALK fusion mutation test. The content will be updated, as appropriate, if FDA approves new tests. For each companion diagnostic, the program will describe exactly what the test measures, the drug(s) for which the test is used, and the scientific rationale for using the test in that manner. The program will take a critical look at the evidence base to support the use of each test. The program will explore the inevitable complexities that will arise as more companion diagnostics become standard of care: Are various tests that purport to measure the same analyte interchangeable? Does the performance of a test vary with tissue type. Finally, the program will discuss some applications outside of oncology, such as CYP2C9 for warfarin and CYP2C19 for Plavix.

Learning Objectives:

  • Explain what is meant by a 'companion diagnostic.' Describe the similarities and differences between companion diagnostics and more traditional clinical diagnostic tests.
  • Explain the difference between a 'predictive' versus a 'selective' companion diagnostic.
  • Name at least three companion diagnostics that are already well-established. Explain how each is used, and the scientific rationale for that use.

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.

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 - 5:15 PMClinico-Pathologic Communication in Gastrointestinal Pathology

Speakers:

  • David N.B. B. Lewin, MD, FASCP
  • Lawrence Comerford, MD, MS

Description:

This is a lecture/ dual presenter dialog case based format, utilizing audience response system to emphasize the importance of clinician (gastroenterologist) and pathologist interaction in the diagnosis of gastrointestinal biopsy specimens. An emphasis on the minimum necessary clinical information for a variety of clinical senarios in gastrointestinal pathology will be illustrated. Topics will include biopsies of polypoid lesions in the colon (especially in the setting of inflammatory bowel disease), esophageal, gastric and small bowel biopies.

Learning Objectives:

  • Understand the importance of clinical information to accurate, clinically relevant diagnoses in gastrointestinal pathology.
  • Be able to recognize the minimum clinical information needed for different clinical senarios.
  • Understand the implication of dysplasia diagnoses in inflammatory bowel disease.

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 PMThe Role of Pathology in the Patient-Centered Era

Speakers:

  • James M. Crawford, MD
  • David Nace, MD

Description:

This plenary session will present the opportunities available to the specialty of Pathology and Laboratory Medicine in the immediate years before us. Key trajectories in healthcare reform include: patient centered healthcare; accountable care (in its many guises); and value-based practice of medicine, which requires healthcare to be delivered so as to enhance the patient experience, improve population health outcomes, at equal or lower cost. Three speakers will address: the context of the clinical laboratory in accountable care; the patient centered medical home; value-based utilization of laboratory testing; data management and interoperability; cost management of laboratory services; and performance of the laboratory as a patient- and client-centered provider. The ability of individual laboratories to succeed as local and regional providers requires all laboratory professionals to understand the importance of their contributions to patient-centered and value-based healthcare.

Learning Objectives:

  • Participants will understand how the current dynamics of health care reform present novel opportunities for the clinical laboratory to demonstrate value.
  • Participants will identify essential components of being a successful clinical laboratory in the patient-centered era of healthcare, so as to be identified as a “value-added” laboratory.
  • Participants will become aware of opportunities for the laboratory to enhance the patient experience, promote improved test utilization, and contribute to the delivery of population-based healthcare.

5:15 PM - 6:15 PMAmerican Pathology Foundation: Competency Assessment of Clinical Laboratory Personnel

Speakers:

  • Jeanne Carr, PhD
  • Richard Warren, MT(ASCP)SH, DLM

Description:

This session will focus on designing a competency assessment program that will aid in providing clinical laboratory personnel with a systematic assessment while providing the institution with necessary documentation to meet requirements of various regulatory agencies. Topics to be covered include: how training and competency differ; planning a competency program that allows the employee to have input in the design; setting acceptable criteria for performance; action to take in cases of unacceptable performance; and the Lab Director's responsibility in the process. Examples of a successful program will be presented followed by an open floor discussion of application. Attendees will be asked to share their experiences and ideas for these processes.

Learning Objectives:

  • Design a program for ongoing competency assessment of laboratory and managerial personnel.
  • Identify ways to involve employees in developing and maintaining the competency assessment program.
  • Modify the session's example forms for use in their own laboratories.

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.

Friday, November 2, 2012

8:00 AM - 10:00 AMEverything You Always Wanted to Know about the Board of Certification (But Were Afraid to Ask)

Speakers:

  • Patricia Tanabe, MPA, MLS(ASCP)CM

Description:

Using traditional didactic lecture and an active question and answering period, this presentation will address certification and certification-related issues.

For those unfamiliar with the ASCP Board of Certification, this presentation will provide an explanation of the inner workings of the ASCP Board of Certification and its governing board, the Board of Governors. The certification examination development process will be discussed at length. For the certified medical professional, this session will provide information on the Continuing Maintenance Program (CMP), the benefits of voluntary CMP, and how to navigate and access information to complete the process. Also, information on certification verification and licensure will be presented.

Learning Objectives:

  • Understand the BOC processes and procedures for certification and CMP.
  • Navigate the BOC webpages to access information and/or apply for certification or CMP.
  • Understand the workings of the BOC and its governing board, the Board of Governors.

8:00 AM - 9:00 AMAmerican Pathology Foundation: Understanding and Preventing a RAC Audit

Speakers:

  • John R. Outlaw, CHC, CHBME

Description:

This session will explore the Recovery Audit Contractor (RAC) program from an audited practice's perspective and present strategies for the successful resolution of a RAC audit on your practice.

Learning Objectives:

  • Review the current regulatory environment and issues that have led to the establishment of the Recover Audit Contractor (RAC) Program.
  • Understand the process and potential outcomes of a RAC audit on your practice.
  • Explore strategies and best-practices for preventing OR resolving with a RAC audit.

8:00 AM - 9:00 AMUpdated Review of B-Cell Lymphomas with Plasmacytic Differentiation: Evolving Concepts, Diagnostic Dilemmas and Practical Approach for Pathologists

Speakers:

  • Saad Shaheen, MD

Description:

The early part of this presentation will highlight a few issues related to diagnosis of lymphoplasmacytic lymphoma in previous lymphoma classification schemes, which tended to broaden its definition. This may prove valuable to participants who are a few years out of training and are more familiar with current classification.

Representative cases of marginal zone lymphoma, lymphoplasmacytic lymphoma, gamma heavy chain disease, hepatitis C virus associated type II mixed cryoglobulinemia and select cases of plasma cell myeloma variants will be illustrated in the power point slides. Multiple differential diagnostic tables and flow chart like diagnostic algorithms will accompany or supplement the presentation. Information regarding other aspects of lymphoplasmacytic lymphoma, such as cell of origin and important molecular correlates, will briefly be included in the presentation, with more detailed information supplemented (ie, as pdf). The emphasis will be on practical diagnostic points which will allow for more confident diagnoses by the participants.

Toward the conclusion of this presentation, newer flow cytometric and immunohistochemical diagnostic methods will be briefly reported. However, this will be presented with the caveat that currently there are no immunophenotypic, cytogenetic, or molecular markers that can reliably distinguish lymphoplasmacytic lymphoma from marginal zone B-cell lymphomas in difficult cases.

Learning Objectives:

  • Confidently and reproducibly make the diagnosis of lymphoplasmacytic lymphoma even if somewhat less than classic morphologic and immunophenotypic findings are present.
  • Apply newer testing strategies that will help the participant to better distinguish lymphoplasmacytic lymphoma from marginal zone lymphoma.
  • Familiarize the participant with other entities that may enter into the differential diagnosis, such as lymphoplasmacytic variant of plasma cell myeloma and gamma heavy chain disease.

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 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.

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 - 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 - 9:00 AMASCP-Clinton Global Initiative (CGI): Expanding the Laboratory Workforce for the 21st Century

Speakers:

  • Andrea Bennett, MT(ASCP), MPH

Description:

This session will provide an overview of the ASCP-Clinton Global Initiative (CGI) project to alleviate the shortage of laboratory professionals. Expanding the Laboratory Workforce for the 21st Century is a 5-year, ASCP commitment to expand the capacity of the clinical laboratory workforce in the state of New York, with implications for future similar initiatives across the nation. ASCP’s commitment activities include the expansion of current educational programs, curriculum development for both classroom and distance learning, the establishment of a coordinated network of clinical rotation sites, the creation of an accelerated technician to technologist career pathway, and the development of an electronic instrumentation simulation laboratory. As a result of these activities, ASCP and its CGI partners seek to increase the number of graduating laboratory professionals in New York from approximately 10% each year over a 5 year period.

9:00 AM - 10:00 AMChanging Anatomic Pathology From A Descriptive To A Quantitative To Discipline: Now or Never?

Speakers:

  • Robert W. Dunstan, DVM, MS, DACVP

Description:

Whole slide imaging and sophisticated image analysis software have allowed for quantification of progressively complex morphologic changes. What is the potential of this technology? What are its pitfalls? Is it even reasonable to expect that practitioners of anatomic pathology can change to be more quantitative in their assessments? More importantly, what happens to anatomic pathology if the discipline does not embrace the potential of this technology? This seminar will discuss where we are with image analysis, where we are going and what is required to make image analysis a routine aspect of morphologic assessment and its impact on diagnostic anatomic pathology and the development of morphology based biomarkers. Teaching--Objective based with projected slidesWhy Attend? Session will discuss technologies that allow for the transformation of anatomic pathology and will soon be routinely available to all practitioners.

Learning Objectives:

  • Understand the basics of whole slide imaging and image analysis.
  • Understand how these methods can be used to standardize processes in anatomic pathology.
  • Understand how standardization will improve accuracy in the use of IHC for biomarker detection and routine morphologic assessment.

9:00 AM - 10:00 AMWho Needs Clinical Pathology? I am a Forensic Pathologist! The Utility of Clinical Pathology after Death: The Old, the New and the Not So Useful

Speakers:

  • Jennifer L. Hammers, DO
  • Bennet Omalu

Description:

Several carefully selected cases will be presented and the audience asked to propose useful clinical testing techniques to determine the cause and manner of death based on their knowledge of the resources available to them in their day-to-day practice. The presenters will then, in a didactic format, outline clinical pathology practices (including clinical chemistry, toxicology, microbiology/virology, molecular) that are well established as being useful, those that are on the forefront and those that have been performed without significant success. A strong emphasis will be placed on molecular testing including cutting-edge testing including cardiac channelopathies as well as more established testing for diseases such as pulmonary thromboembolism. All five cases will then be reviewed and evaluated by examining the actual clinical testing available and utilized, and the rationale for the determined cause and manner of death.

Learning Objectives:

  • Participants will recognize commonly utilized clinical information and testing in forensic death investigation and how to implement the information to determine cause of death and manner of death.
  • Participants will evaluate the role of clinical pathology testing as it relates to public health and relatives of a decedent.
  • Participants will assess established and advances in clinical pathology techniques relating to sudden death, with particular focus on molecular testing.

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.

10:00 AM - 11:00 AMThe Real CSI: Case Studies in Forensic Toxicology

Speakers:

  • William E. Schreiber, MD, FASCP

Description:

This session will provide a broad overview of forensic toxicology - what it is, who works in the lab, what tests are offered and how they are performed. The presentation will include examples of key concepts, including types of samples, post-mortem redistribution, major metabolites of common drugs, etc. Examples of cases seen in a forensic toxicology lab will be presented, with opportunity for audience interaction and comment. This is a basic or intermediate level course that will introduce participants to the type of work done in forensic toxicology and how it differs from routine clinical work.

Learning Objectives:

  • List the toxicology tests that are performed as part of a routine death investigation.
  • Recommend specific toxicology tests that should be performed in several common scenarios.
  • Interpret test results in selected cases.

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 AMUse of Molecular Biomarkers in Cervical Histology to Aid in Diagnosis of Cervical Neoplasia and Interactive Presentation of Challenging Case Studies

Speakers:

  • Mamatha V. Chivukula, MD, FASCP

Description:

The fundamental thread of this course is to understand current practices in cervical cytology,as well understand emerging new concepts and new entities in cervical pathology. New concepts and diagnostic entities will be presented in a didactic lecture as case studyformat so that the practicing pathologist will understand how to apply them and their diagnostic criteria in order to be able to recognize and properly diagnose them. Some of these current practices and evolving concepts also include testing by immunocytochemistry. This session will help you understand the evolving concepts in cervical cancer screening and use of HPV co-testing, recognize the utility and use of molecular biomarkers in cervical histology to aid in diagnosis of cervical disease and review the potential role and utility of biomarkers p16, Pro-ExC and Ki-67 as immunohistochemistry tools.

Learning Objectives:

  • Understand the evolving concepts in cervical cancer screening and use of HPV co-testing to correlate with the cervical histologies.
  • Role and utility of the merging biomarkers in squamous as well as glandular lesions.
  • Interactive case studies provides an exercise for the audience and also provides a chance to apply the course knowledge in a set of challenging cases with cytohisto correlation.

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 - 5:00 PMTissue Transplantation: It's All About Teamwork

Speakers:

  • Carolyn D. Burns, MD, FASCP
  • Phillip J. DeChristopher, MD, PhD, FASCP
  • Wendy Frizzo, MT(ASCP)
  • Jennifer Rhamy, MT(ASCP)SBB, HP, MBA, MA
  • Matthew Kuehnert, MD; Ellen F. Lazarus, MD

Description:

This session will explore the necessary collaborative management of tissue allografts within facilities. An increasing number of laboratories are being asked to shoulder the responsibilities of tissue services. This necessitates additional resources and learning for personnel. Definitions of what constitutes “tissue” , regulatory issues surrounding tissue, and tools for engaging collaborative management in either academic or community hospitals will be presented.

Learning Objectives:

  • Identify the scope of tissue products and applicable regulatory issues.
  • Acquire the tools to implement key elements of a tissue transplantation program.
  • Demonstrate knowledge surrounding recognition, reporting and reacting to adverse events associated with tissue transplantation.

2:00 PM - 4:00 PMConsultative Clinical Pathology: Improving Communication, Building Trust, and Working Together to Improve Patient Care

Speakers:

  • Megan Kressin, MD
  • Adam Seegmiller
  • Mary Zutter, MD
  • Michael Laposata, MD
  • Mia Levy, MD, PhD

Description:

In this session, participants will learn strategies for transforming their practice into consultative clinical pathology. The diagnostic management team utilized at Vanderbilt University will present a model of pathologists working with clinical teams to improve patient care and reduce costs. Experts will show how to identify areas of the lab which would benefit from an improved partnership with clinical colleagues, how to build the trust necessary to implement cooperative test ordering, how bioinformatics tools can enhance testing and reporting, how comprehensive and interpretative reporting leads to improved care, and how to use the iterative process for continuous improvement. Many of the examples exemplified in this session will relate to issues in hematopathology and coagulation, but strategies will be applicable to all areas of the pathology laboratory. Participants will learn skills to establish partnerships with clinical teams and become essential consultative pathologists.

Learning Objectives:

  • Participants will identify areas of their laboratory that will benefit from a partnership with clinical colleagues.
  • Participants will devise strategies for improving patient care through increased communication with clinical colleagues, building trust between each group to allow for pathologist-directed reflex testing, and comprehensive report generation using site-specific bioinformatics tools.
  • Participants will transform their laboratory practices to encompass the role of clinical consultant.

2:00 PM - 3:00 PMApplications of Mass Spectrometry in Clinical Microbiology

Speakers:

  • Nathan A. Ledeboer, PhD, DABMM

Description:

The use of mass spectrometry in the clinical microbiology laboratory is exponentially increasing throughoutout the world. More than 100 manuscripts have been published over the last two years evaluating performance of mass spectrometry. Over the next 5 years it is likely that mass spectrometry will replace up to 80% of traditional biochemical identifications due to increased accuracy of the identification and lower cost. This session will consist of a presentation followed by a question and answer period that will provide the attendee with an overview of mass spectrometry in the clinical microbiology. The session will evaluate performance of this technique on gram positive and gram negative bacteria, yeast, filamentous fungi, mycobacteria, direct testing from positive blood culture bottles, direct testing from clinical specimens, and basic susceptibility testing.

Learning Objectives:

  • Describe applications of mass spectrometry in the microbiology laboratory for routine organism identification.
  • Describe beta-lactamase testing using mass spectrometry.
  • Discuss application of mass spectrometry for identification of mycobacteria compared to HPLC and sequencing.

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.

2:00 PM - 5:00 PMAssociation for Molecular Pathology: The Omics Era: An Introduction to Molecular Diagnostics

Speakers:

  • Laura J. Tafe, MD
  • Gregory J. Tsongalis, PhD
  • Kimberly Lebel, MT(ASCP), CG, MB

Description:

This course is designed for laboratory technologists with little or no exposure to Molecular Diagnostics. The course will review key molecular technologies including PCR, gel and capillary electrophoresis and sequencing, as well as provide updates on modern technologies and platforms used in the clinical laboratory. In addition, this course will focus on illustrating, using, in part, a case based format, new advances and clinical applications for molecular diagnosis in the areas of infectious disease, pharmacogenomics, genetics, and oncology.

Learning Objectives:

  • Describe current technologies used in molecular diagnostics.
  • Discuss clinical applications of molecular diagnostics.
  • Differentiate between diagnostic, prognostic and targeted therapy applications.

3:00 PM - 4:00 PMLymphoproliferative Disorders Presenting in the Peripheral Blood: Importance of Peripheral Blood Smear Review

Speakers:

  • John R. Krause, MD, FASCP

Description:

A selected series of cases will be presented in which lymphproliferative disorders were first diagnosed or suspected from the review of a peripheral blood smear. Photomicrographs of the abnormal peripheral blood cells will be shown. A discussion will then follow which will include morphologic subtleties in the evaluation of the smear, followed by bone marrow review and the use of ancillary modalites to include flow cytometry, cytogenetics and molecular testing. The importance of the peripheral blood smear review will be stressed as an diagnostic modality which may be lead to an earlier diagnosis of the neoplasm. Participants should attend to evaluate their skills in peripheral blood interpretation and which further diagnostic modalities to propose, recommend or choose. This session would be appropriate for practicing pathologists,residents and laboratory professionals.

Learning Objectives:

  • Participants will apply the review of peripheral blood smears in their practice.
  • Participants will recognize abnormal lymphoid cells and recommend additional diagnostic steps that need to be taken.
  • Participants will recognize their role as an important part of the clinical team and be able to effectively communicate the diagnostic results to the clinician.

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.

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.

4:00 PM - 5:00 PMSynchronous Detection of miRNA, Its Target and Downstream Protein in Transferred FFPE Section and Application in Clinical Diagnosis and Basic Research

Speakers:

  • Shiying Cui, PhD

Description:

In the class, we will use slides to describe a method that allows us to qualitatively detect the expression of miRMA, its target and downstream proteins on the series transferred FFPE sections by ISH and IHC staining. We will introduce all the materials and methods, and focus on the following items:

Comprehensive application of transferred FFPE section
Validation of reciprocal expression of miRNA with its target by ISH
Validate miRNA with different mRNA and protein
Validation of mRNA and protein on the HE stained transferred tissues with different markers.

Learning Objectives:

  • How to synchronously detect/validate the key miRNA, its target and downstream protein in transfered FFPE section.
  • How to transfer a H&E stained section from original slide to a charged slide.
  • How to detect a specific gene with different molecules on a limited number of transfered sections.

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.

Saturday, November 3, 2012

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 - 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 - 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 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 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 AMAmerican Society for Clinical Laboratory Science: Promoting Appropriate Laboratory Utilization Through Effective Consultation with the Healthcare Team

Speakers:

  • Diana Mass, MT(ASCP)MA

Description:

Providing costâ€"conscious care, while ensuring quality, remains the goal of health care reforms. Laboratory information is a critical element of such care. More than 4.3 billion laboratory tests are performed each year. This impressive figure has focused a bright light on laboratory medicine and appropriate test utilization is now under major scrutiny. The role in providing guidance to healthcare practitioners regarding appropriate test utilization is becoming an imperative as test menus become more complex and interpretation of various test results requires explanation. These roles lie in the pre- and post-analytic phases of the testing continuum. It does not matter how precise or accurate a test is in the analytic phase if the results add little value to the effectiveness of a patient's outcome. This role serves a significant function as the profession moves into providing effective consultative services for a patient-centered medical delivery system that reduces medical errors.

Learning Objectives:

  • Explain the necessity to provide appropriate test utilization services to improve patint-care outcomes and reduce medical errors.
  • Describe the critical skills that contribute to the effectiveness of consulting practice.
  • Describe empowerment as a function of leadership and consultative competence.

9:00 AM - 10:00 AMCharting the Course and Setting the Keel - Achieving Meaningful Use and Patient Safety Through Adoption of American Recovery and Reinvestment Act

Speakers:

  • Pamela D. Banning, MT(ASCP)cm, PMP(PMI)

Description:

Avoid the 'perfect storm' of missing out on federal incentives for your facility or risk being penalized in future years by not striving for Meaningful Use Phase 1 or 2 under the American Reinvestment and Recovery HITECH Act. This session will pull together a seaworthy crew with insights on proper standardization of reporting terminology in the labs, teaching handy details of when, where and how to use LOINC or SNOMED CT vocabulary standards. Informatics isn't for the faint of heart or land lovers; this session will help get your sea legs. Attendee issuance of a Meaningful Use checklist, project plan template and polling audience participation will create a custom set of equipment/strategies for each attendee to address at their facility upon return to their port.

Learning Objectives:

  • Prioritize areas of adherence in their own laboratories, evaluating in checklist form the federal government's mandate for phases one and two of the ARRA HITECH Act.
  • Assess from a provided project management plan the phase of vocabulary implementation their site is in, and the obstacles or dependencies that surround that particular phase.
  • Draw lines of assimilation on how patient safety and clinical outcomes can be improved through standardized use of electronic laboratory and hospital medical record systems.

9:00 AM - 12:00 PMPulmonary Pathology - New and Evolving Concepts, Diagnostic Dilemmas and Controversies

Speakers:

  • Donald G. Guinee, MD, FASCP
  • William D. Travis, MD

Description:

This course serves as a means to discuss new and evolving concepts, diagnostic dilemmas and areas of controversy in Pulmonary Pathology. Specific topics addressed include 1) the current role of molecular testing in non small cell lung cancer (NSCLC) including EGFR, EML4-ALK, K-ras and others, 2) the determination of histologic phenotype (e.g. adenocarcinoma vs. squamous cell carcinoma) by appropriate immunohistochemical stains, 3) the new classification of pulmonary adenocarcinoma including the proposed reclassification of bronchioloalveolar cell carcinoma as adenocarcinoma in situ, 4) the distinction of fibrosing nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP) patterns and their mimics, 5) the pathologic spectrum of subacute and chronic hypersensitivity pneumonitis , 6) the classification of pulmonary neuroendocrine neoplasia, and 7) the recent identification of pulmonary manifestations of IgG4 related sclerosing disease.

Learning Objectives:

  • Recommend the use of specific ancillary molecular tests in helping to predict the response of non small cell lung carcinoma to new therapeutic agents such as gefitinib, erlotinib, crizotinib and others. They will be able to communicate the rationale behind their use.
  • Diagnose non mucinous bronchioloalveolar cell carcinoma and interpret the rationale behind its proposed reclassification as adenocarcinoma in situ. Participants will be able to assess microinvasion and evaluate its significance.
  • Recognize key diagnostic features helpful in the distinction of a UIP pattern from fibrosing NSIP and chronic hypersensitivity pneumonitis. They will be able to better integrate clinical and radiologic correlation in arriving at the best overall interpretation.

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 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 PMGI Pathology: New Approaches to Old Problems

Speakers:

  • Robert E. Petras, MD, FASCP

Description:

This session tackles problem areas of gastrointestinal surgical pathology in which new information impacts on everyday practice. Topics to be covered include: update on colorectal cancer including microsatellite testing; epithelial polyps of the gut and polyposis syndromes including a discussion on serrated colorectal polyps; gastrointestinal stromal tumors in the era of targeted therapies; neuroendocrine proliferations of the stomach; and Barrett esophagus with a review of the American College of Gastroenterology and the American Gastroenterological Association recommendations on definition and surveillance.

Learning Objectives:

  • Apply the Bethesda criteria for MSI testing on tumor samples.
  • Recommend management options for neuroendocrine and epithelial proliferations of the gut.
  • Recognize and properly report metaplastic changes of the esophagus and gastroesophageal junction.

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.

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.

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 - 2:30 PMGenitourinary Synoptic Reporting: Perspectives from a Pathologist and a Urologist

Speakers:

  • Debra Zynger, MD
  • Kamal Pohar, MD

Description:

During this course, a Genitourinary Pathologist and Urologist will review current pathology guidelines for synoptic reporting in genitourinary organs (kidney, bladder, prostate, testis, renal pelvis, ureter and penis) and treatment that is given based upon synoptic parameters. Each organ will be reviewed, emphasizing elements used to guide management. Items traditionally included which are not required or do not have clinical relevance will be highlighted in order for the practicing pathologist to increase their work efficiency and produce more clear, concise synoptics. Interactive cases studies with audience response will be utilized to demonstrate classic pitfalls. The clinical algorithm used by urologists based upon reported elements will be described. After this course you will know the clinical impact of items included in your genitourinary synoptic reports and will be able to review and modify your synoptics to more effectively communicate with your urology clinical team.

Learning Objectives:

  • Participants will design synoptics for genitourinary malignancies to include required reporting elements and eliminate elements which have no clinical relevance and are not required.
  • Participants will identify genitourinary synoptic elements that are pivotal to therapeutic strategy.
  • Participants will define patient management based upon the findings stated in the synoptic report.

12:30 PM - 3:30 PMDiagnosis and Prognostication of Gastro-Entero-Pancreatic Neuroendocrine Neoplasms: A Multidisciplinary Approach.

Speakers:

  • Aejaz Nasir, MD, Mphil, FASCP
  • Domenico Coppola, MD
  • Larry Kvols, MD

Description:

This course will cover current approaches toward diagnostic, prognostic and predictive aspects of Gastro-Entero-Pancreatic Neuroendocrine Neoplasms with a special emphasis on: 1) Pathologic differential diagnosis; 2) Histologic grading; 3) Pathologic staging; 4) Determination of primary source in metastatic neuroendocrine carcinoma of unknown primary site; 5) Histopathologic mimics of low-grade and high-grade neuroendocrine carcinomas; 6) Mixed neuroendocrine and non-neuroendocrine neoplasms; 7) Diagnostic pitfalls in neuroendocrine tumor pathology and 8) Multi-disciplinary management of neuroendocrine neoplasms.

Learning Objectives:

  • Formulate their approach toward diagnosis, differential diagnosis and prognostication of Gastro-Entero-Pancreatic Neuroendocrine Neoplasms.
  • Use histologic grading and pathologic staging of Gastro-Entero-Pancreatic Neuroendocrine Neoplasms and utilize immunohistochemistry and other ancillary approaches to work-up diagnostically challenging cases.
  • Develop a multi-disciplinary approach toward diagnosis and management of Gastro-Entero-Pancreatic Neuroendocrine Neoplasms.

12:30 PM - 2:30 PMOne Organization's Approach to On-The-Job Training

Speakers:

  • Heather l. Gordy, PhD, MBA, MT(ASCP)SBB

Description:

On-the-job training is training provided to staff in the work environment. This organization was experiencing opposition between the Training and Operations departments. A multi step approach was used to develop a collaborative OJT program. The program resulted in the learners being able to work independently at an acceptable productivity level when released to task.

Learning Objectives:

  • Describe the use of instructor's versus OJT's in this organization.
  • Describe 2-3 benefits of using OJTs.
  • Apply new approaches to training.

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 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.

2:30 PM - 3:30 PMHandling Requests for Remnant Fresh Tissues and Archived Diagnostic Blocks: Legal, Ethical and Social Issues

Speakers:

  • Sarah M. Dry, MD
  • Paul Papagni, JD

Description:

Caught between a scapel and a rock, pathologists are fielding increasing numbers of requests for remnant fresh tissues and archived diagnostic blocks for research. Each of these can be linked to an individual patient and a wide variety of patient-specific data. Federal initiatives now encourage collaborative, inter-institutional research. Moreover, personalized medicine translates to more requests for molecular testing on small biopsy samples. What are pathologists' legal and ethical responsibilities for distributing these tissues, and what responsibilities do we have to our patients? This session will help you understand critical ethical, legal and social issues and implement protocols for efficient handling of requests for remnant fresh tissues and archived diagnostic materials.

Learning Objectives:

  • Understand pathologists' legal and ethical responsibilities surrounding the use of remnant fresh tissue and diagnostic archival blocks for research studies and clinical testing.
  • Understand the difference between research and clinical use, and pathologists' responsibilities for both.
  • Develop strategies for handling requests for extensive clinical testing on small tissue samples, especially when the tests requested are not yet recognized as standard of care.

2:30 PM - 3:30 PMFragile X (FMR1) Related Disorders: A Clinical and Diagnostic Perspective

Speakers:

  • Jane C. Goh, MS
  • Lisa Hentze
  • Samar Roy
  • Silvia Spitzer, PhD
  • Jordan Laser, MD

Description:

Fragile X syndrome is the most common inherited cause of mental retardation. Fragile X (FMR1) testing as a diagnostic tool is not restricted to young males with classical symptomatology, it is also used for carrier screening and other FMR1 related disorders such autism. The molecular basis of the disease is a triplet expansion in the FMR1 gene, genetic testing requires quantification of the number of repeats. Recent advances in Fragile X testing provide unprecedented sizing accuracy, however, leaves many labs uncertain as to which methodology/algorithm best suits their patient population. This program will a) provide an overview of the FMR1 related disorder and its pathogenesis; b) describe the advantages and disadvantages of current testing methodologies for FMR1; and c) provide attendees the knowledge to select the appropriate testing algorithm, depending upon their patient demographics and needs. The format of the presentation will be a combination of didactic and case-based examples.

Learning Objectives:

  • Describe the various clinical presentations of FMR1 related disorders.
  • Compare the various diagnostic algorithms for FMR1 testing and related disorders.
  • Explain the various pre and post analytical elements critical to successful FMR1 testing.

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