2018 Annual Meeting

The Limited Sample-Doing More With Less on Aspirates, Biopsies and Intraoperative Consultations

March 21, 2018

Physicians can earn a maximum of 6 AMA PRA Category 1 Credits
Physicians can earn a maximum of 6 SAM Credit Hours

Course Description

In this era of minimally-invasive procedures for diagnosis, prognosis and treatment decisions, pathologists are often the “first responders” analyzing and triaging limited specimens, including aspirates and small biopsies, and are continuously asked to make more specific diagnoses from those smaller samples. Clinicians increasingly request information regarding specific classification of the malignant tumors, and in many cases, application of additional prognostic and therapeutic markers to help guide their management. Although morphology remains the cornerstone of cytology and histology, ancillary studies can confirm and/or subclassify a malignancy in many cases; and although most pathologists recognize the crucial role of ancillary testing, it can be extremely frustrating for many of us to keep up with new advances and rapidly growing developments in the fields of immunohistochemistry and molecular techniques. There exists abundant literature describing new antibodies and molecular tests and panels, but it can be especially overwhelming to decipher which tests are actually most practical in the workup of a specific neoplasm or clinical presentation.

For these reasons, one of the purposes of this course is to present the efficient utilization of these ancillary studies based on differential diagnoses generated by the cytologic and/or histologic evaluation. In this long course, we gathered some of the top experts in their fields to discuss their strategies and most practical approaches to maximizing the information gained from limited specimens from a variety of organs, including lung, colon, soft tissue, brain, breast, metastases of unknown primary origin and hematologic specimens. Diagnostic challenges and potential pitfalls associated with limited specimens will be highlighted, and importantly, discuss which of the ancillary tests are more practical. This approach is of critical importance in helping the pathologist to serve as the gatekeeper for preserving tissue adequacy and becoming most efficient in triaging such specimens.

In summary, this course is meant for practicing pathologists and pathologists in training to appreciate the limitations of working up small specimens; but also give pathologists the tools and strategies to meet the challenge of providing clinicians with the information they need to appropriately diagnose and treat their patients in this era of targeted therapy.

Target Audience

  • Practicing academic pathologists
  • Practicing community pathologists
  • Pathologists-in-Training

Course Objectives

  • Provide strategies to maximize information gained from limited samples acquired from a variety of organs
  • Explore diagnostic challenges and potential pitfalls associated with limited specimens
  • Learn efficient utilization of ancillary studies based on differential diagnoses generated from the cytologic/histologic evaluation
  • Characterize pathologists as the gatekeepers for preserving tissue adequacy and sustaining efficient triage of specimens
  • Give pathologists tools and strategies to provide clinicians with information they need in this era of targeted therapies

Schedule

8:00 AM Welcome/Introduction of Morning Speakers
Jan F. Silverman, M.D., Allegheny General Hospital, Pittsburgh, PA
8:05 AM Colorectal Carcinoma Biopsies and the Work-up for Genomic Syndromes
Wendy Frankel, M.D., The Ohio State University Wexner Medical Center, Columbus OH
8:40 AM Small Lung Biopsies and FNAs for Molecular/FISH Work-Up
Carol Farver, M.D., Cleveland Clinic, Cleveland, OH
Jennifer Brainard, M.D., Cleveland Clinic, Cleveland, OH
9:25 AM Questions
9:30 AM Break
10:30 AM Limited Biopsies of Soft Tissue Tumors: The Contemporary Role of Immunohistochemistry and Molecular Diagnostics
Jason L. Hornick, M.D., Ph.D., Brigham and Women’s, Boston, MA
11:10 AM Diagnostic Strategies for Small Biopsies and Aspirates of Lymphoid Tissues
Erik Ranheim, M.D., Ph.D., University of Wisconsin School of Medicine, Madison, WI
11:45 AM Questions
12:00 PM Lunch
1:00 PM Introduction of Afternoon Speakers
Tarik Elsheikh, M.D., Cleveland Clinic, Cleveland, OH
1:05 PM Intraoperative Consultation of Brain Tumors
Christine Fuller, M.D., Cincinnati Children’s Hospital, Cincinnati, OH
1:40 PM FNAs of Metastatic Malignancies of Unknown Primary Origin
Tarik Elsheikh, M.D., Cleveland Clinic, Cleveland, OH
and Jan F. Silverman, M.D., Allegheny General Hospital, Pittsburgh, PA
2:25 PM Questions
2:30 PM Break
3:30 PM Problematic Issues in Breast Core Needle Biopsies
Stuart Schnitt, M.D., Dana Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA
4:10 PM Molecular Diagnostics in Cytopathology and Small Biopsies
Michael Roh, M.D., Mayo Clinic, Rochester, MN
4:45 PM Questions
5:00 PM Closing Remarks and Wrap Up

Continuing Medical Education and Maintenance of Certification

The United States and Canadian Academy of Pathology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The United States and Canadian Academy of Pathology designates this live activity for a maximum of 6 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The USCAP is approved by the American Board of Pathology (ABP) to offer Self-Assessment credits (SAMs) for the purpose of meeting the ABP requirements for Maintenance of Certification (MOC). Learners must take and pass the post-test in order to claim SAMs credit.

Physicians can earn a maximum of 6 SAM credit hours.

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