Cytopathology is considered a subspecialty of anatomic pathology but in reality the discipline touches on all areas of anatomic pathology, albeit from the vantage point of the individual cell rather than tissue. The cytopathology laboratory functions separately but in parallel with the other anatomic pathology and clinical pathology labs. Correlation of cytopathology findings with test results obtained on concurrent tissue samples and other ancillary tests (biochemical and molecular) helps to improve diagnostic accuracy.
Correlation with clinical and radiologic findings is also important. Residency training in cytopathology trains residents to be competent using a stepwise process for each organ system:
Indications for cytological examination
How to procure the specimen
Specimen processing
Test platforms used
Reporting terminology
Cytomorphology of normal cells and pathologically altered cells
The learning goals are in tune with the pathology milestones. The resident is expected to be at level 1 at the start of residency. Therefore the learning objectives are divided into the levels 2, 3 and 4 to correlate with the milestones. Residents may advance at a more or less accelerated pace through these levels.
General
Introduction to cytopathology video
Milestone: I have watched on Learn Pathology or attended introductory lecture to cytology.
Understand the cytological screening process of a Pap Test
Be familiar with the cytology requisition form(s) available for cytology specimens
Demonstrate familiarity with collection techniques for all specimen types
Understand how to use the image-guided screener
Learn the CoPath System for cytology sign out
Learn the processing procedures for the various types of cytology specimens
Witness the HPV processing procedure of the Roche Cobas system
Watch the DVD of the FNA technique and practice the FNA technique and smearing skills on phantoms
Be familiar with the ultrasound machine knobology and how to handle the transducer
Medical Knowledge
Understand the cytological criteria for the routine cytological diagnoses
Demonstrate knowledge of the Bethesda System for reporting gynecologic and thyroid cytology
Demonstrate knowledge of specimen adequacy and the basic reporting system for cytopathology
Demonstrate an investigatory and analytical thinking approach to clinical situations, including the development of a reasonable differential diagnosis based on available clinical information, microscopic features, and current published information
Understand the utility and limitations of the diagnostic work up of cytology specimens including: selection of special stains, immunocytochemistry, flow cytometry, and molecular studies.
Demonstrate familiarity with the clinical and radiologic manifestations of various diseases during workup of cytology and fine needle aspiration cases, and use such knowledge to formulate cytologic diagnoses
Review the basic concepts of ultrasound characteristics that support benign and malignant masses
Practice Based Learning and Improvement
Actively participate in morning cytology conference
Review cytology study sets
Write up interesting cases for the cytology study sets and review with an attending
Participate in cytology multidisciplinary conferences and meetings if available during the 4 week block
Participate in the QA review process of the cytological-histological correlation process for both GYN and Non-GYN cytology samples
Interpersonal and Communication Skills
Demonstrate effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning and writing skills
Demonstrate an interest in cytology material during teaching sessions asking relevant questions and responding appropriately to questions from attending pathologists
Professionalism
Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
Demonstrate a commitment to excellence and ongoing professional development by completing directed and independent reading from cytology textbooks and journals, undertaking literature searches on various cytopathology topics when appropriate
Demonstrate a commitment to ethical principles pertaining to confidentiality of patient information
Systems-Based Practice
Demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
Understand how the handling of cytology and fine needle aspiration material affects other healthcare professionals in the overall care of the patient including: making accurate diagnoses with efficient use of routine and special stains and other testing including epidemiologically important infectious diseases; achieving rapid turnaround time for cytology reports; and timely communication of results to clinicians to expedite implementation of adequate therapy or discharge from hospital
Understand the difference between various medical practices and healthcare delivery systems (fee for service, discounted fee for service, capitated systems, ACO) and how they affect the practice of cytology
Demonstrate knowledge of methods for controlling health care costs and allocation of resources, including understanding the hospital capital budget process as it pertains to the laboratory, and understanding monthly cytology budget reports
Practice cost-effective healthcare and resource allocation that does not compromise the quality of care, including judicious, cost-conscious ordering of cytology special stains and ancillary lab tests during the performance of fine needle aspiration biopsies
Demonstrate knowledge of how to coordinate patient care with healthcare managers and healthcare providers to assess, coordinate, and improve healthcare, and knowledge of how these activities can affect system
Rotation Layout
Rotation overview
Clinical rotations
Anatomic Pathology residents spend four weeks on the cytology service during AP1 (rotation-1), and six weeks during AP2 (rotation-2). Each week that you are on the cytology service, you will be assigned to work a faculty member who is on-service, and you will have an opportunity to review and diagnose current cytology cases. Additionally, there are structured learning modules for rotation-1 and rotation-2.
Rotation 1 (4 weeks)
Rotation-1 curriculum is intended to be completed during four weeks of AP1.
Khalbuss WE, Means M, eds. Gynecological and Breast Cytopathology Board Review and Self-Assessment. Springer New York, 2013. ISBN-10 1461472695, ISBN-13: 978-1461472698
Cibas, E. S. and B. S. Ducatman (2014). Cytology : diagnostic principles and clinical correlates. Philadelphia, PA, Saunders/Elsevier.
Ali, S. Z. and E. S. Cibas (2010). The Bethesda system for reporting thyroid cytopathology : definitions, criteria, and explanatory notes. New York, Springer.
Nayar, R. and Wilbur, D. (2015). The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes, Springer.
Bibbo, M. and D. Wilbur (2014). Comprehensive Cytopathology: Expert Consult: Online and Print, Elsevier Health Sciences.
Gupta, P. and Z. Baloch (2011). Cytohistology: Essential and Basic Concepts, Cambridge University Press.
DeMay, R. M. (2012). The Art & Science of Cytopathology, ASCP Press.
