A s the new Chair of the Canadian Society for Cytopathol-

ogy, I would like to express my gratitude for entrusting

me with this key position, which will give me the opportunity

to serve the Canadian cytopathology community; a mission to

which I am deeply committed. I would also like to express my

appreciation to Dr. Harman Sekhon, our previous Chair, for

his dedication and leadership.

The three early-phase objectives of my mandate will be to

enhance the visibility of our society, to increase the number of

members by making our membership more attractive, and to

solidify the CSC educational mission across Canada. In that

regard, I am happy to announce that the CSC membership will

become free of charge to all Canadian Pathology residents and

fellows, as well as cytotechnologists in training.

Also importantly, the executive team is currently and enthusi-

astically working on creating a new CSC website, which will

launch in the next few months. The website will be updated

regularly to include, among other items, practical summaries of

all the current cytopathology guidelines, and a member-only

section with access to a set of educational materials varying

from ‘case of the month’ to ‘online webinars’ to ‘system-based

educational modules’. This material will constitute an

important educational tool for CSC members who are trainees,

pathologists and cytotechnologists to obtain a CSC certificate

of participation after completing the modules. Of significant

importance, is the fact that these activities will be officially

recognized and accredited by the Royal College of Physicians

and Surgeons of Canada,

and will therefore serve as

practical and very affordable

continuing medical educa-

tion activities available to all

CSC members. We are also

exploring other potential

ideas toward the goal of

making the CSC member-

ship more fluid and interac-

tive.

On another note, I am pleased to announce that the topic of

the CSC Symposium/Kulcsar Lecture at the next CAP-ACP

meeting, to be held in Niagara Falls, will be ‘the Milan System

for reporting salivary glands cytopathology’, and will be given

by Dr. Marc Pusztaszeri from McGill University on June 23rd.

Dr. Pusztaszeri is an eminent cytopathologist, and one of the

editors and authors of the Milan System. For CSC members,

the CAP-ACP annual meeting is the ideal setting to demon-

strate their connection to the society and cytology community,

to communicate and exchange ideas, and to build collaborative

and collegial relationships. This year’s attendance at the

Kulcsar Lecture will also send a meaningful signal in times of

positive and dynamic changes.

CSC Bulletin FEBRUARY 2019

Hugh Curry Awards

Message from the Chair

Dr. Fadi Brimo, MD, FRCP(C) Pathologist and Associate Professor McGill University and McGill University Health Center fadi.brimo@mcgill.ca

CANADIAN SOCIETY of CYTOPATHOLOGY

INSIDE THIS ISSUE: Biomarker Testing p: 3 AFC in Cytopathology p: 4 Hugh Curry Awards 2018 p: 5

E n tant que nouveau président de la Société Canadi-

enne de Cytopathologie (SCC), je voudrais exprimer

ma gratitude pour m'avoir confié ce poste clé qui me per-

mettra de servir la communauté Canadienne de cytologie,

une mission à laquelle je tiens profondément. Je voudrais

également exprimer ma reconnaissance à notre président

sortant, le Dr. Harman Sekhon, pour son dévouement et

son leadership.

Les trois objectifs initiaux de mon mandat seront

d'accroître la visibilité de notre société, d'augmenter le

nombre de membres en rendant l’adhésion à la SCC plus

attrayante et de renforcer la mission éducative de la SCC

à travers le Canada. À cet égard, je suis heureux d’an-

noncer que l’adhésion à la SCC deviendra gratuite pour

tous les résidents et les boursiers (fellows) Canadiens ain-

si que pour les cytotechnologues en formation.

Également, le comité exécutif travaille actuellement avec

enthousiasme sur la création d’un nouveau site Web de la

SCC, qui sera opérationnel au cours des prochains mois.

Le site Web, qui sera mis à jour régulièrement, contien-

dra, entre autres, des résumés pratiques de toutes les

lignes directrices actuelles de cytopathologie ainsi qu’une

section réservée aux membres, qui comprendra un en-

semble d’activités pédagogiques variantes du "cas du

mois" à des "séminaires en ligne" ou même des "modules

éducatifs de différents systèmes". Ce matériel constituera

un outil pédagogique important pour les résidents, les

pathologistes et les cytotechnologues membres du SCC

qui pourront obtenir un certificat officiel de participation

une fois les modules complétés. Il est particulièrement

important de souligner que ces activités seront officiel-

lement reconnues et accréditées par le Collège Royal des

Médecins et Chirurgiens du Canada, et donc celles-ci con-

stitueront des outils de formation continue pratiques et

très abordables pour tous les membres de notre société.

Nous explorons également d'autres idées potentielles

dans le but de rendre l’expérience des membres plus flu-

ide et interactive.

D’un autre côté, je suis heureux d’annoncer que le thème

de notre symposium / conférence Kulcsar lors de la pro-

chaine réunion du CAP-ACP à Niagara Falls sera «le sys-

tème de Milan de la cytopathologie des glandes salivaires»

et sera donné le 23 juin par Dr. Marc Pusztaszeri de

l'Université McGill. Le docteur Pusztaszeri est un cyto-

pathologiste éminent, et est par ailleurs l’un des éditeurs

et des auteurs du système de Milan. Pour les membres de

la SCC, la réunion annuelle du CAP-ACP est le cadre idé-

al pour démontrer leur attachement à la société et à la

communauté de cytologie, pour communiquer et échang-

er des idées et pour établir des relations de collaboration

collégiales. Cette année, votre participation à la confé-

rence Kulcsar enverra également un signal significatif en

cette période de changement positif et dynamique.

SOCIÉTÉ CANADIENNE DE

CYTOPATHOLOGIE

2

Fadi Brimo, MD, FRCP(C) Pathologiste et Professeur Agrégé Université et Centre Universitaire de Santé McGill fadi.brimo@mcgill.ca

Message du Président

3

BIOMARKER TESTING AND REPORTING THE FIXATIVES USED IN CYTOLOGY CELL BLOCK PRODUCTION

Dr. S. Boerner University of Toronto & University Health Network

The critical issue:

It is imperative that Cytology laboratories include more

information in the gross description of the Cytology

reports indicating how a specimen has been handled.

Biomarker testing of cytology samples in the setting of lung

cancer is the standard of care. A number of biomarkers are

evaluated by immunohistochemical (IHC) staining such as

ALK-1, PD-L1 and ROS-1. These IHC tests have been vali-

dated on formalin-fixed paraffin embedded tissue and cytol-

ogy cell blocks are an excellent substrate for testing. In fact,

cytology cell blocks may be the only material available to

permit this testing to be performed. However, if the sample

has been exposed to other preservatives/fixatives before

formalin fixation, the IHC results may be affected and vali-

dation of such pre-analytical variables is necessary and is not

yet complete for all biomarkers.

Many laboratories do not have the biomarker IHC assays

available to them “in-house” and refer the sample to refer-

ence centres for biomarker assessment. The reference labor-

atory is dependent on the information provided in the cytol-

ogy report to determine the suitability of a sample for testing.

Unfortunately, the gross descriptions of many cytology re-

ports do not contain sufficient information to determine if

the cell block can be used for biomarker assessment.

Thus, it is paramount that Cytology laboratories include

more information in the gross description of the Cytology

reports detailing the handling of the specimen. In particular,

the gross description must note if the sample is received as a

“fresh” specimen or if preservatives/fixatives were added

prior to receipt. In addition, the processing of the specimen

by the cytology lab must be noted in the gross description if

the specimen was exposed to other preservatives or fixatives

such as ethanol/methanol during cell block production. For

example, “rinsing/washing” fresh effusion specimens with

an alcoholic solution during cell block production to reduce

blood and protein content and enrich the cellular compo-

nents. Finally, the ultimate fixative used for the cell block

needs to be recorded.

Below are some examples of gross descriptions that include

the relevant information necessary to determine the suitabil-

ity of a cell block of IHC biomarker assessment.

Examples of Cytology Report Gross Descriptions:

Examples for Specimens Received Fresh:

• 570 mL of cloudy yellow fresh fluid received. 45 mL of

specimen processed and one alcohol fixed, Papanicolaou

stained ThinPrep slide produced. Cell block 1A pro-

duced from 45 mL of fresh sample with 10% neutral

buffered formalin fixation.

• 15 mL of red fresh fluid received. 15 mL of specimen

processed and one alcohol fixed, Papanicolaou stained

ThinPrep slide produced. Cell block 1A produced from

the remaining 10 mL of the residual PreservCyt followed

by fixation with 10% neutral buffered formalin.

• 320 mL of yellow fresh fluid received. 45 mL of speci-

men processed and one alcohol fixed, Papanicolaou

stained ThinPrep slide produced. Cell block 1A pro-

duced from 90 mL of fresh sample rinsed with 50% eth-

anol and then fixed with 10% neutral buffered formalin

Examples of Specimens Received with a Preservative/

Fixative:

• 30 mL of cloudy, orange CytoLyt with solids received.

Specimen processed in toto. 1 alcohol fixed, Papanico-

laou stained ThinPrep slide produced from 15 mL of

sample and cell block 1A produced from 15 mL of

methanol/ethanol fixed sample followed by fixation with

10% neutral buffered formalin.

• 70 mL of cloudy yellow fluid received in 50% ethanol.

10 ml used to produce 2 Papanicolaou stained cytospin

slides. 60 mL used to make cell block 1A following for-

malin fixation.

• 20 mL of red, cloudy Saccomanno fluid received. 4 Pa-

panicolaou stained cytospins slides are made from 10

mL of sample. Cell block 1A is produced from 10 mL

of fluid followed by formalin fixation.

The Area of Focused Competence (AFC) status was developed by the Royal College of Physicians and Sur-geons of Canada (RCPSC) to provide “a mechanism to formally recognize disciplines that meet a legitimate societal health need, but that do not meet the current criteria for a primary specialty or subspecialty”, and this by providing advanced training within an additional or highly specific and narrow scope.

In April 2012, RCPSC made the decision to assign the newly developed status of AFC to Cytopathology, the first dis-cipline in pathology to acquire AFC status in Canada. Trainees can come from either an Anatomical Pathology (AP) or General Pathology (GP) background, with Royal College certification or eligibility.

AFC training is typically 12 months in duration, competency-based, and no final exam is mandated. If all the compe-tencies are successfully demonstrated by the trainee, the trainee obtains a “Diploma” certificate from the RCPSC: “DRCPSC”.

During the year the trainee is expected to create a portfolio to achieve six goals, each linked to one or more key mile-stones. These milestones are in turn linked to assessment tools where the candidate demonstrates the competencies.

The six goals are: 1) Interpretation of specimens 2) Management of the laboratory 3) Performance of fine needle aspirates 4) Selection and interpretation of ancillary studies 5) Advancement of Cytopathology through scholarship 6) Engagement of government, other physicians and healthcare professionals

in emphasizing the importance of Cytopathology in patient wellness and care

References

Auger M, Islam S, Weir M. An historic step for advanced cytopathology training in Canada. Cancer Cytopathol 2015 (1):7-9 Weir MM, Boerner SL, Auger M. The Canadian Area of Focused Competence (AFC) in cytopathology experience: the first four years. JASC 2016; 5:309-312 Royal College of Physicians and Surgeons of Canada website, in particular: http://www.royalcollege.ca/rcsite/credentials-exams/exam-eligibility/areas-focussed-competence-afc-diploma-e http://www.royalcollege.ca/rcsite/accreditation-pgme-programs/afc-programs/search-programs-by-afc-e http://www.royalcollege.ca/rcsite/documents/arps/afc-programs-directors-e#cytopathology.

Available Programs

• Western University, London. Program Director: Dr. Michele Weir: michele.weir@lhsc.on.ca • McGill University, Montreal. Program Director: Dr. Manon Auger: manon.auger@mcgill.ca • University of Toronto, Toronto. Program Director: Dr. Scott Boerner, AFC Director: scott.boerner@uhn.ca • University of Calgary, Calgary. Program Director: Dr. Steve Gorombey: steve.gorombey@cls.ab.ca

4

Dr. Manon Auger McGill University & McGill University Health Center

AREA OF FOCUSED COMPETENCE IN CYTOPATHOLOGY:

AN OVERVIEW

2018 HUGH CURRY AWARDS

Christine Orr completed her medical training at the University of Saskatchewan and is currently a

fourth-year medical resident in Anatomical Pathology at Queen's University in Kingston, Ontario.

She is actively involved in research in gastrointestinal and head & neck pathology as well as cytolo-

gy. At present, she is investigating the molecular pathways affected by metformin in diabetic colo-

rectal cancer patients.

The CSC congratulates Dr. Christine Orr and Ms. Susan McRae, two recipients of the Hugh Curry Awards for their excellent work and high-quality projects in the field of cytopathology.

Susan McRae joined the London Health Sciences Centre Pathology

and Laboratory Medicine (PaLM) department as a cytotechnologist in

1989. She attended the Michener Institute in Toronto for her cytology

training and was the last cytotechnologist to earn an ART from the

CSMLS in 2011. When Charles Sturt University in Australia partnered

with the Michener Institute to offer a Master of Medical Science

(Cytology) through distance education, Susan pursued this opportunity, finishing her degree in

2008. She also travelled to Australia to sit the International Academy of Cytology examinations.

Susan is also involved in the cytology community outside of PaLM, serving as clinical coordinator

for the Michener cytology student program, as a member of the IQMH Scientific committee, as

well as serving on the Executive of the Canadian Society of Cytopathology. Susan has been the senior MLT in Cytology since

2014. Both winning abstracts follow.

5

THYROID CYTOLOGY: HAS LIQUID-BASED CYTOLOGY DECREASED THE NUMBER OF UNSATISFACTORY THYROID FINE NEEDLE ASPIRATES? Christine E. Orra, Charles Leducb, David Hurlbuta, Marosh Manducha, a Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario. b Department of Pathology and Cell Biology, University of Montreal, Montreal, Quebec.

Objective: Evaluate the percentage of unsatisfactory samples from thyroid fine needle aspirates (FNA) via liquid-based prepara-tion (LBP) versus conventional smear (CS). Methods: Diagnoses from thyroid FNA CSs September 2009 to December 2012 (n=652) and thyroid FNA LBPs January to December 2016 (n=559) at our institution were correlated with FNA site (academic vs community) and operator (radiologist vs clinician). Data and Results: Overall percentages of unsatisfactory thyroid FNAs were significantly higher in the LBP (201/559) vs CS cohorts (188/652) (p=0.0095). When corrected for site and operator, this trend was only seen in FNAs obtained by the academic radiology department (LBP 63/189; CS 28/203; p=<0.00001). FNAs obtained in the community (LBP 84/206; CS 114/284; p=0.9258) or the academic clinic (LBP 53/164; CS 19/74, p=0.361) showed no significant differences in unsatisfactory rates. Community obtained FNAs had more unsatisfactory samples compared to FNAs from the academic center (LBP 112/353; CS 47/277) in both the LBP (p=0.0346) and CS (p<0.00001) cohorts. FNAs obtained in the academic radiology department com-pared to the academic clinic had fewer unsatisfactory samples in the CS cohort only (p=0.0289) with no significant difference in the LBP cohort (p=0.9096). Conclusions: Our results suggest community obtained FNAs yield more unsatisfactory results than those from the academic center independent of the cytological preparation. Furthermore, only samples from the clinical radiology department displayed a significant difference between the two preparations; however, the cohorts were obtained at different time periods, and may repre-sent a change in radiology personnel suggesting unsatisfactory thyroid FNA rates are operator/site dependent and independent of the FNA preparation.

2018 HUGH CURRY AWARDS

6

REDUCING ATYPICAL DIAGNOSTIC RATES IN BILIARY BRUSH CYTOLOGY Susan McRae, Mariamma G. Joseph, Michele M. Weir. Department of Pathology, London Health Sciences Centre, London ON

Objective: ERCP guided biliary brushing is a simple, relatively safe technique for evaluating bile duct obstruction. These challenging specimens may result in high atypical diagnostic rates. Our study examines: 1) our atypical cytology diagnostic rate and outcomes; and 2) cytomorphologic features for atypical (atyp), suspicious (susp) and positive (pos). Method: Reports of 348 biliary cytology specimens from 2013-16 were reviewed for diagnostic category and outcome (resection or endoscopic ultrasound fine needle aspiration (EUS-FNA)). One cytotechnologist (CT) blindly reviewed 75 cases (25 each atyp/susp/pos). Four CT and one pathologist (CP) blindly reviewed 12 cases (5 atyp/6 susp/1 pos). Cellularity (# abnormal groups and # atypical single cells) and nine other features were examined. Data and Results: Our atypical diagnostic rate was 36% (127/348). 83 (64%) had follow up and 64 (77%) had a posi-tive diagnosis (46 on resection, 18 at EUS-FNA). The range of # abnormal groups and # atypical single cells identi-fied by one CT correlated with the original diagnoses. Four CT and one CP agreed on # abnormal groups and # sin-gle atypical cells for each diagnosis. Statistical significance was not found in any of the other nine features in predicting diagnosis. Conclusions: Our atypical diagnostic rate is at the high end (12-40% in literature) with high # of positive diagnoses on follow-up. For one reviewer, increased # abnormal groups and # atypical single cells stratified into the diagnostic categories. This was reproduced by additional CT/CP reviewers. Other features reviewed did not assist with diagnosis stratification.

Do you know a colleague who is not a member of the Canadian Society of Cytopathology? Membership is open to all pathologists, residents, fellows and cytotechnologists, as well as cytotechnolo-gists in training.

Information on membership and applications forms is available at:

https://www.cap-acp.org/cmsUploads/CAP/File/CSC_membership_application_form_2019.pdf or by directly contacting Dr. Al-Nourhji at Omar.Al-Nourhji@saskhealthauthority.ca.

Support your society in the work we do for education, standardization and advocacy in cytology.

Current Executive Committee

Dr. Fadi Brimo (McGill University, Montreal): Chair

Dr. Cheng Wang (Dalhousie University, Halifax): Vice-Chair

Dr. Harman Sekhon (University of Ottawa, Ottawa): Former Chair

Dr. Omar Al-Nourhji (University of Saskatchewan, Saskatoon): Treasurer

Dr. Gabor Fischer (University of Manitoba, Winnipeg): Secretary

Dr. Marc Pusztaszeri (McGill University, Montreal): Member at large

Dr. Cady Zeman-Pocrnich (Western University, London): Member at large

Ms. Susan McRae (London Health Science Center, London): Affiliate member

Dr. Si Kei Lou (University of Toronto, Toronto): Resident Representative