Curriculum

Goals and Organization of the Curriculum for the Fellowship Program in Cytopathology

  • Provide an organized, comprehensive, and structured plan for study which progresses in degree of sophistication and demand throughout the year-long fellowship.
  • Educate the fellow in all aspects of the art and science of cytopathology including gynecologic and nongynecologic exfoliative cytologic diagnosis as well as FNA diagnosis of lesions of superficial and deep body sites.
  • Support the fellow in developing proficiency in FNA biopsy technique and rapid on-site evaluation (ROSE).
  • Integrate the principles of Quality Assurance (QA) of the Cytology Laboratory into the fellow’s experience with active participation in Cytology-Surgical Pathology correlation, CAP Proficiency testing, and Rescreening program.

Topics for Mastery

  • Cytology specimen preparation: direct smears, ThinPrep, Cytospin, routine and special stains, cell blocks.
  • Gynecologic Cytopathology
    1. Normal cervicovaginal cytology
    2. Hormonal effects on the cervix and vagina
    3. Infectious agents found in cervicovaginal cytologic specimens
    4. Squamous abnormalities: The Bethesda System and ASCCP guidelines for clinical management
      1. Low grade SIL
      2. High grade SIL
  • Squamous cell carcinoma
  1. Post-therapy changes
  1. Glandular abnormalities: The Bethesda System and ASCCP guidelines for clinical management
    1. Endocervical
    2. Endometrial
  2. Other uterine and extrauterine malignancies that may be detected on cervicovaginal cytology
  • Urinary Cytology: The Paris System
    1. Instrumented and voided specimens
  • Respiratory Cytology (exfoliative)
    1. Bronchial brushings and washings
    2. Bronchoalveolar lavage
      1. Special stains
  • Gastrointestinal Cytology (exfoliative)
    1. Anorectal specimens
    2. Oral specimens
  • FNA of Thyroid nodules: The Bethesda System
  • FNA of Head and Neck
    1. Benign cystic lesions
    2. Squamous cell carcinoma
      1. HPV testing guidelines
    3. Salivary gland lesions: The Milan System
    4. Lymphoma
  • FNA of Breast
  • FNA of cutaneous metastases
  • FNA of lung masses and mediastinum (EBUS)
  • FNA of Pancreas (EUS)
  • FNA of Liver, Kidney, and other deep body sites
  • Exfoliative cytology of effusions
  • Special ancillary techniques in cytologic diagnosis
    1. Immunohistochemistry
    2. Flow cytometry
    3. FISH
  • Emphasis will be on appropriate test selection and interpretation
  • Management of the Cytology Laboratory

Schedule

First Quarter (July-September)

  1. Active responsibilities in fellow’s daily work schedule
    1. Fellow orientation to cytology laboratory
      1. A detailed orientation schedule will be provided to the fellow and will include a general orientation to the Pathology Department and Surgical Pathology bench, frozen section training, and preparation for on-call duties. This will occur during the first two weeks of July.
    2. Techniques in preparation of cytologic specimens
      1. Fellow will spend time in the Cytology Prep Room under the supervision of the Prep Room technologist
  • Introduction to FNA
    1. Fellow will attend all Pathologist-performed FNA procedures. These generally occur in ENT clinic, Oncology outpatient clinic, or hospital floors. At first, the fellow will observe the procedure. At the discretion of the attending pathologist, the fellow will gradually perform the FNA and be asked to determine the adequacy of the specimen given the clinical findings. The fellow will always be supervised by the attending pathologist and will not be expected to render a diagnosis independently.
    2. Fellow will attend all FNAs performed under radiologic image guidance and be an active participant in ROSE for specimen adequacy. This may occur in radiology or in the cytology lab in cases of EBUS or EUS.
  1. Introduction to QA in the Cytology Laboratory
  2. Daily sign out with the attending pathologist
    1. Fellow should preview daily as many cases as possible with priority given to abnormal gynecologic specimens and pathologist performed FNA specimens
  3. Attendance is mandatory at all Cytology lectures (a schedule will be provided) and ASC webinars
  • Fellow will lead a monthly unknown case conference, given to the pathology residents, under the supervision of an attending cytopathologist
  • Fellow will present at multidisciplinary tumor boards on a regular basis
  1. Begin research project

***Topics for focused study during first quarter:

Cytology specimen preparation

FNA technique

Gynecologic cytopathology

Second Quarter (October-December)

  1. Active responsibilities in fellow’s daily work schedule
    1. Continue to develop technical and diagnostic skills in FNA by attending and performing all pathologist-performed FNAs and evaluating radiology-performed FNAs for adequacy
    2. Participate in QA activities
  • Continue daily sign out with attending pathologist
    1. Fellow should continue to preview as many cases as possible with priority shifted to non-gynecologic exfoliative specimens
  1. Attendance is mandatory at all Cytology lectures (a schedule will be provided) and ASC webinars
  2. Fellow will continue to lead a monthly unknown case conference, given to the pathology residents, under the supervision of an attending cytopathologist
  3. Fellow will continue to present at multidisciplinary tumor boards on a regular basis
  • Continue work on research project
  • One Medicine-Pathology Correlation conference should be completed during this quarter

***Topics for focused study during second quarter:

Non-gynecologic exfoliative cytopathology including urine, effusions, respiratory, GI, and oral

Third Quarter (January-March)

  1. Active responsibilities in fellow’s daily work schedule
    1. Continue to actively participate in FNA procedures
    2. Participate in QA activities
      1. Perform a mock inspection of the Cytology Laboratory under the supervision of the Cytology Lab Supervisor
  • Continue daily sign out with attending pathologist
    1. Fellow should have developed sufficient speed by this point to preview all cases
  1. Attendance is mandatory at all Cytology lectures (a schedule will be provided) and ASC webinars
  2. Fellow will continue to lead a monthly unknown case conference, given to the pathology residents, under the supervision of an attending cytopathologist
  3. Fellow will continue to present at multidisciplinary tumor boards on a regular basis
  • Continue work on research project
  • A second Medicine-Pathology Correlation conference should be completed during this quarter

*** Topics for focused study during third quarter:

FNA diagnosis of Head and Neck including salivary glands, thyroid, and lymph nodes with application of ancillary testing (immunohistochemistry, HPV testing, flow cytometry)

FNA of breast and soft tissue

Fourth Quarter (April-June)

  1. Active responsibilities in fellow’s daily work schedule
    1. Continue to actively participate in FNA procedures
    2. Participate in QA activities
  • Continue daily sign out with attending pathologist
  1. Attendance is mandatory at all Cytology lectures (a schedule will be provided) and ASC webinars
  2. Fellow will continue to lead a monthly unknown case conference, given to the pathology residents, under the supervision of an attending cytopathologist
  3. Fellow will continue to present at multidisciplinary tumor boards on a regular basis
  • Complete research project and submit paper for peer review
  • A Journal Club presentation should be completed during this quarter
  1. A special TQI presentation should be given during this quarter

*** Topics for focused study during fourth quarter:

FNA diagnosis of lung neoplasms including triage for immunohistochemical and molecular diagnostic studies

FNA of other deep body sites including liver, adrenal, kidney, and pancreas

Management and regulations of the Cytology Laboratory

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