Volume LI | Number 6
November 2014 T h e A S C B u l l e t i n ® i s p u b l i s h e d b y t h e A m e r i c a n S o c i e t y o f C y t o pat h o l o g y
ASC Annual Scientific Meeting Perspectives
IV 62nd Annual Scientific Meeting Highlights VI
Case Study: Leg Mass in a 42 year Old Male
Cyto-econferences – December 2014 and January 2015
VIII Book Review IX
In Memoriam Alexander Meisels, MD
ASC Annual Scientific Meeting Perspectives Jane Bernstein, MD, Cytopathology Fellow Editor’s Note: To provide readers of The ASC Bulletin who are not able to attend the 62nd Annual Scientific Meeting a glimpse of the new research findings, trainees with highly-rated scientific abstracts have been invited to contribute to this special feature. This continues a tradition started last year to honor the best and brightest of the young presenters. They have provided a brief summary of their research and their response to being selected to present their work. These budding cytopathologists exemplify the ongoing vitality of our specialty.
Yale University/New Haven Hospital
Poster 64: What would we miss if HR-HPV Testing was used for Primary Cervical Cancer Screening? The FDA recently approved the Cobas HPV test for primary cervical cancer screening in women aged 25 years or older. This is the first HPV DNA test in the US to be used independent of cytology for screening. Falsenegative high risk (HR) HPV results, even if Jane Bernstein, MD rare, can be clinically relevant, when HR HPV testing is used alone. We set out to investigate the occurrence and clinical significance of
Volume LI | Number 6 | November 2014
decided to analyze data from our own institution. We focused particularly on patient outcomes and surgical management based on the results of follow-up cytology (as recommended by the Bethesda System). Looking at all AUS/FLUS cases from 2011 to 2014 in our institution through a retrospective review, we found some interesting results. It turned out that there was no statistically significant difference in neoplastic rate at surgery between patients with and without a repeat AUS/ FLUS cytology. Patients who had negative repeat cytology, however, avoided surgery, suggesting that repeat cytology does in fact help in surgical decision making. I would like to thank Dr. Stefan Pambuccian and Dr. Swati Mehrotra for their guidance and inspiration in this study, as well as their invaluable help in analyzing our data. I am excited to have my poster accepted and to be attending my first ASC Annual Scientific Meeting. It is an incredible opportunity to get an unparalleled, up-close look at the cytopathology work being done at other institutions.
abnormal cytology and negative HR HPV status by reviewing the 24,000 liquid-based Pap tests with negative HR HPV cotesting in women 25 years or older evaluated at our institution over a one year period. Overall, abnormal cytology (ASCUS or above) was noted in 4% of cases. Follow-up was available in 60% of women. Approximately one quarter were found to have significant uterine lesions, including 9 CIN 2+ squamous lesions, 3 endometrial simple hyperplasias, 4 endometrial adenocarcinomas, and 1 fallopian tube adenocarcinoma. In addition, of the 5% of women aged 40 or older with endometrial cells noted by cytology, 4 were diagnosed with endometrial adenocarcinoma on subsequent follow-up. Using CIN 2+ as the cutoff, 1.5% of women had a significant HPVrelated uterine lesion that would have gone undetected if HR HPV testing had been used alone as the primary screening test. In addition, a small percentage of non-HPV related uterine malignancies would go undetected. This research was performed under the direction of two mentors. Dr. Angelique Levi has been a longstanding source of career advice and a great example of a pathologist who transitions deftly between cytopathology and surgical pathology. Dr. David Chhieng is the business-savvy leader of our division who has taught me to always keep clinical management algorithms in mind when evaluating cases. I am indebted to both of them for their guidance. Previously, I attended the ASC Annual Scientific Meeting in Las Vegas as a recipient of the Resident Travel Scholarship. That experience played an integral role in convincing me to pursue cytopathology, and I am eager to return to the Annual Scientific Meeting this year as a cytopathology fellow.
Zarine Kamaluddin, MD, Pathology Resident University of Toledo Medical Center
Poster 77: Atypical Squamous Cells, cannot exclude High Grade Dysplasia with Negative High Risk Human Papilloma Virus Testing: Is Colposcopy Necessary? The follow-up of atypical squamous cells cannot exclude high grade dysplasia (ASC-H) Pap test with negative high risk human papilloma virus testing (hrHPV) Zarine Kamaluddin, MD is controversial. Although current guidelines recommend colposcopy regardless of hrHPV status, some recent studies have called into question the need for followup colposcopy in ASC-H Pap test with negative hrHPV testing. We compared follow-up biopsy rates of high grade squamous intraepithelial lesion (HGSIL) in ASC-H Pap tests with positive or negative concurrent or reflex hrHPV testing. We found that while ASC-H/hrHPV+ results were associated with a higher rate of HGSIL at biopsy (65%), a significant portion of ASC-H/ hrHPV- cases also had HGSIL on subsequent biopsy (29%). Our study reinforces the current management guidelines for ASC-H (colposcopy irrespective of hrHPV status). It also emphasizes the importance of the Pap test in addition to HPV
Ian Hughes, MD, Chief Resident Loyola University Medical Center
Poster 110: Analyzing the Cytologic and Histologic Outcomes of a FLUS-tering Diagnosis (Follicular Lesion of Undetermined Significance) Does it pay to repeat the thyroid fine needle aspiration (FNA)?
Ian Hughes, MD
Many papers have been written regarding the category of atypia/ follicular lesion of undetermined significance (AUS/FLUS), and we
Volume LI | Number 6 | November 2014
testing as a primary screening tool for cervical dysplasia/carcinoma. I am indebted to my mentors Dr. Richard L. Cantley and Dr. Luis E. De Las Casas for their able guidance that has made this research possible. I am excited and look forward to being a part of the ASC Annual Scientific Meeting for the first time.
Charanjeet Singh, MD, Cytopathology Fellow
Kate M. Serdy, MD, Pathology Resident
My project focuses on an imagebased cytopathology learning and reference application (app) that is built on an iOS platform. The app, CytoAtlas, is available for free in the Apple App Store for iPhone Charanjeet Singh, MD and iPad. Cytopathology training across institutions typically varies depending on in the particular cases seen at each institution. Up to now there have been limited means of overcoming this variability due to the unavailability of a visual platform for quick-reference. In contrast to traditional teaching modalities, handheld devices can provide such a platform because of their portability, ubiquitous internet connectivity, and real-time presentation of dynamic information. We have created the CytoAtlas App to advance cytopathology education using this dynamic new technology. Together with my mentor, Dr. Sinchita Roy-Chowdhuri, we procured cytology material from over 100 diagnostic entities encompassing various organ systems, captured more than 1200 high quality images, and tabulated morphologic descriptions, highlighting key features and ancillary studies for each entity. We collaborated with ProQMS, an informatics management company, to design our cloud-based application. Our goal is to continue expanding our database by adding newer entities, provide an interactive learning resource, and extend availability to android-based platforms. We want to thank the ASC for providing us a platform to share our project with the cytopathology fraternity and are excited about presenting our app at the 62nd Annual Scientific Meeting in Dallas. We believe that our project inculcates the motto of the ASC, i.e. innovation, education, collaboration, and advocacy of learning in the field of cytopathology. Dr. Roy-Chowdhuri, my mentor and a cytopathologist at MD Anderson Cancer Center, has always believed that one can enhance their own knowledge by sharing it with others. I will always be grateful to her for sharing her knowledge with me, keeping me motivated, and guiding me through our team’s undertaking of this project
University of Texas MD Anderson Cancer Center
Poster 9: Image-based Cytopathology Reference App on iOS Platform
University of Pittsburgh Medical Center
Platform 5: The Value of the ThinPrep Test for Endometrial Carcinoma Diagnosis: A Large Study Cohort from an Academic Medical Center Our study is a retrospective review examining the utility of the liquid-based Pap test as a screening tool for endometrial carcinoma. Kate M. Serdy, MD Previously, several smaller studies have shown that liquid-based Pap tests detect abnormal cytologic findings in 31.9-89.6% of cases. We collected 554 cases of endometrial carcinoma diagnosed histologically from 2006-2013, which had Pap tests performed at our institution within 36 months prior to the histopathologic diagnosis. Four hundred and five of these patients had Pap test results within five months of histopathologic diagnosis. We found that the Pap test results of 51.1% of patients in this cohort had abnormal cytologic findings and that 44% showed either a glandular abnormality or benign endometrial cells in women 40 years or older. In addition, the presence of a glandular abnormality on the Pap test correlated with poor prognostic features including the tumor type (type II), size (≥3 cm), depth of invasion (≥50%), cervical involvement, lymphovascular invasion and advanced FIGO stage. While not a very sensitive screening tool, the liquidbased Pap test does play a role in the detection of endometrial carcinoma. These findings provide evidence to support regular screening, especially in the postmenopausal population. I would like to thank Dr. Chengquan Zhao for his mentorship. I am delighted to have the opportunity to present our work at the ASC 62nd Annual Scientific Meeting. I think that this is the ideal forum to showcase our findings, and I look forward to the feedback that it generates.