Cytopathology Rotation

Goals and Objectives

By the end of training in Cytopathology, the resident will master the following skills:

Patient Care

• Know the spectrum of normal cervical cytology, and the predictable effects of age, menstrual cycle, pregnancy, castration and hormonal replacement.
• Know the signs of inflammation and infection in cervical cytology, especially as related to sexually transmitted pathogens.
• Accurately diagnose lesions of cervical neoplasia, including ASC, low- and high-grade squamous intraepithelial lesions, and squamous carcinoma.
• Know the algorithms for follow-up of patients with various diagnoses on cervical cytology.
• Know the spectrum of normal endometrial and endocervical cytopathology, including the predictable effects of age, menstrual cycle, pregnancy, castration and hormone replacement.
• Accurately diagnose lesions of endometrial and endocervical neoplasia, including glandular atypias and adenocarcinomas.
• Know the spectrum of normal, reactive and neoplastic changes in body fluids (CSF, abdominal, pelvic, pleural, and urine.
• Know the spectrum of normal, reactive and neoplastic cytology in non-GYN specimens including FNA of various organs/sites.
• Accurately diagnose vulvar and vaginal neoplastic lesions, including intraepithelial neoplasias and carcinomas.
• Have a working knowledge of fine needle aspiration cytology for superficial and deep lesions.
• Be able to perform and evaluate for adequacy fine needle aspirations of lesions under U/S or CT guidance.
• Know the main laboratory preparatory techniques/procedures relating to processing and staining GYN and non-GYN specimens.
• Have a working knowledge of normal findings inflammatory diseases and neoplasia in cytopathology specimens from the respiratory tract, the breast, the gastrointestinal tract, the urinary tract, effusions, cerebrospinal fluid, salivary glands, the thyroid, lymph nodes, liver, pancreas, kidney, the retroperitoneum, the mediastinum, bone and soft tissue and female genital organs.

Medical Knowledge

• Understand the techniques used to obtain and preserve specimens for cytopathologic examination including cervical spatula and brush samples, alveolar lavage and endobronchial brush sampling, urine sediment, cerebrospinal fluid, effusions, fine needle aspiration of tissues and various other non-GYN samples.
• Understand the techniques used for the preparation of cytopathologic slides including direct smears, touch preparations, cytocentrifuge preparations, Thin Prep specimens and all cell blocks.
• Understand the common staining methods, including the Papanicolau, Diff-Quik, and hematoxylin and eosin techniques.
• Understand the use of special stains in cytopathology.
• Understand the correlation between cervical, endocervical and endometrial cytology and biopsy diagnoses.
• Understand the process and significance of cyto-histologic correlation for GYN and non-GYN specimens.

Practice-Based Learning and Improvement

• Understand and learn from QA/QC procedures (screening negatives, resolving technical problems).

Interpersonal and Communication Skills

• Know and use the Bethesda classification system for cervical cytopathology.
• Be able concisely to convey assessment of specimen adequacy at the time of fine needle aspiration specimen preparation.
• Be able to concisely and accurately convey cytologic interpretations in writing and verbally.

Professionalism

• Comply with HIPAA standards with regard to confidential patient information. Professional interaction with all the cytopathology staff is demanded. A genuine attitude of concern and assistance is expected towards all clinicians at all levels of interaction.

System-Based Practice

• Know the administrative structure of the Cytopathology Department, and the role of each member, including the clerical staff, the laboratory staff, the cytotechnologists, and the laboratory supervisor.
• Participate in consultative services performing fine needle aspirations, attending Tumor Boards to promote integrated healthcare delivery.

Duration

Based on their preferences, residents in the PGY1 year may be assigned to an introductory Cytopathology rotation to cover basic techniques and diagnoses.

In PGY3, residents take a core rotation of 8-10 weeks which includes educational opportunities via regular case sign-out and from teaching collections.

Cytopathology lectures are provided to for residents at all levels as part of the corresponding subspecialty modules that form the basis of the anatomic pathology curriculum.

Duties and Responsibilities of Residents by Year

Residents in all years should attend the cytopathology lectures throughout their training.

PGY1

• Become familiar with the layout and personnel of the laboratory, common staining procedures in cytopathology including Papanicolau, Diff-Quick and Methenamine Silver preparations.
• Attend signout daily, alternating between the signouts for gynecologic cytopathology and non-gynecologic cytopathology on a daily basis.

PGY 3 & 4

• Residents in the cytopathology core are expected to spend the majority of their time on cytopathology activities and to complete all of the core slide sets.
• Attend signout daily, alternating between the signouts for gynecologic cytopathology and non-gynecologic cytopathology on a daily basis.
• Learn proper methods for the collection and preparation of samples as direct smears, cytospin preparations and ThinPrep slides by spending time with the technical staff in the preparation laboratory.
• Attend any ASCP teleconferences that may be scheduled during the rotation.
• Attend and perform adequacy procedures of under the supervision of a member of the Staff.
• In the last weeks of the rotation, participate actively in the independent screening and rescreening of cytopathology materials in addition to attending the final sign-out conference.

Supervision and Evaluation

Residents are supervised and evaluated according to the Goals and Objectives set out in this Program Statement by faculty who interact with the Residents in sign-out conferences during the cytopathology rotation, as well as the Cytopathology Teaching Coordinator.