- Email: [email protected]
Impact of Education on Institutional and Faculty ASC-US Rates
Abstracts Results: This experiential view has contributed to screening of over 400 total native and transplant renal IF panels, ranging in diagnostic categories from primary glomerulonephritis, systemic diseases and hereditary disorders. All diagnostic entities have unique morphologic IF features recognized and documented by CTs. The agreement rate between CT and pathologist ranges in the 92.5% agree rate (93% agreement [4 cases disagree out of 56) in 2017; 92% agreement [11 cases disagree out of 144] in 2016.) Conclusion: Cytotechnologists, emerging in their careers through expanded scope of practice, are uniquely suited for this role to microscopically review IF panels for native and transplant renal patients. Through quality control measures, coordinating care with pathologists, CTs are contributing to patient care through this innovative measure while ensuring efficiency. PST134 Cytotechnologists Accurately Pre-screen Special Stains GMS/AFB on Histologic or Cytologic Specimens and Immunohistochemistry Stains for H. pylori and Ki67 Index on Histologic Specimens Mary Rego, BA SCT(ASCP)MBCM, Cinzia LoBuono, MS, CT(ASCP), Lisa Ring, SCT(ASCP), MBCM, Heather Smith, BS, SCT (ASCP), MBCM, Brenda Sweeney, MS, SCT, CLA(ASCP)MBCM, David Wilbur, MD. Massachusetts General Hospital, Boston, MA Introduction: Cytotechnologists are trained to assist pathologists with the screening of specimens for abnormalities such as neoplasia, inflammatory, and infectious conditions. Pathologists use immunohistochemistry (IHC) and special stains to assist in the identification of features not otherwise obvious in standard preparations. Extension of cytotechnologist screening to such ancillary preparations could be a valuable productivity enhancement. This study tested the cytotechnologists’ ability to screen for microorganisms on acid fast (AFB), fungal (GMS), and H. pylori preparations, and to quantitate the Ki67 proliferation index from both histologic and cytologic specimens. Materials and Methods: The cytotechnologists were given introductory training on screening of AFB and GMS stains and IHC stains for Ki67 index and H. pylori. Three cytotechnologists reviewed study sets of these preparations, from cytologic and histological samples. After reviewing the study sets, three cytotechnologists were given a 10 case slide test. They rendered an interpretation of negative or positive for bacteria, mycobacteria, or fungus, and gave a percentage of Ki67 positive cells. The interpretations were compared to the final diagnosis from the original surgical pathology or cytology report. Results: Respectively, the sensitivity and specificity for the detection of AFB were 75% and 89%. The H. pylori detection sensitivity and specificity were 100%. The sensitivity and specificity were also 100% for fungi on GMS stained slides. The cytotechnologists came within a 10% range of correctly quantifying the Ki67 proliferation index in 90% of the cases. Conclusion: Cytotechnologists were able to identify the presence of fungi and H. pylori on stained slides with precision. In addition, they were able to identify and quantify AFB and Ki67 index on various samples with reasonable accuracy. In conclusion, cytotechnologists have the morphological skills to assist pathologists by accurately screening for microorganisms on special stains and IHC, and for quantifying a Ki67 proliferation index. PST135 Diagnostic Value of Cytopathology and Flow Cytometry Analysis of Vitreous Humor Colby Cantu, MD, Rajesh Dash, MD. Duke University Health System, Durham, NC Introduction: Vitreous humor cytology is increasingly used as part of a screening device for vision-threatening disease and diagnostically challenging cases, including non-specific inflammation, infectious etiologies, and neoplasms. Reports in vitreous fluid cytology have focused on diagnostic utility, but no reports have focused on the utility of cytologic
S57 evaluation and flow cytometry analysis (FCA) of vitreous fluid in combination. Materials and Methods: Retrospective review of medical records was conducted for all patients whose vitreous humor was sent for pathologic review to our institution between 2010 and 2016. Review included patient symptomatology, FCA results, cytology results, and resection results if applicable. Results: 102 vitreous fluid samples were analyzed from 92 patients. Cytologic evaluation (101/102) and FCA (81/102) were both frequently utilized. Enucleation occurred sparingly after initial evaluation (2/92). The most common indications for cytological evaluation included lymphoma (73), non-specific inflammation (42), infection (20), and non-lymphomatous neoplasm (9). Some specimens had multiple indications. 73 cases were evaluated for suspected lymphoma; cytologic interpretations included non-diagnostic (47/73), positive or suspicious for lymphoma (15/73), acute inflammation with or without infectious agents (6/73), and granulomatous inflammation (5/73). FCA was performed in 66/ 73 of these cases; results included non-diagnostic (46/66), polyclonal Bcells (11/66), and monoclonal B-cells (9/66). 28 cases were evaluated for inflammation, infection, and non-hematolymphoid neoplasm; cytology showed non-diagnostic (18/28), acute inflammation (5/28), suspicious for melanoma (2/28), suspicious for lymphoma (1/28), suspicious for retinoblastoma (1/28), and amyloid (1/ 28). FCA was performed in 12/28 of these cases, revealing non-diagnostic results in every case. Conclusions: Cytology and FCA are most useful in combination and in the appropriate clinical context. FCA is non-contributory to final integrated diagnosis for non-lymphomatous workup, and is therefore not a costeffective evaluation strategy. PST136 Impact of Education on Institutional and Faculty ASC-US Rates Emily McMeekin, BS, CT(ASCP)CM1, Jennifer Brainard, MD1, Amanda Bruening, MS, CT(ASCP)1, Dawn Underwood, MS, CT(ASCP)1, Deborah Chute, MD2. 1Cleveland Clinic, Cleveland, OH; 2Cleveland Clinic Foundation, Cleveland, OH Introduction: Important laboratory Pap test quality metrics include monitoring the ASC rate, ASC:SIL ratio, and ASC HPV+ rate. However, what a laboratory should do when the rates show a worrisome trend is not as well defined. In late 2015, our laboratory noted a worrisome trend (see Table 1). Therefore, our laboratory decided to implement a systemic education program in early 2016, and we monitored the effectiveness of our program. Materials and Methods: An educational intervention was designed for March/April 2016. Cytotechnologist education consisted of: a group meeting to discuss metrics, a lecture and written materials provided by the Cytotechnology School Program Director on ASCUS criteria, a quiz on challenging ASCUS cases, and encouragement to seek consultation on borderline cases. Each cytotechnologist was provided their individual metrics regularly. Cytopathologist education consisted of the following steps: a group meeting to discuss metrics and encouragement to bring borderline cases to the daily consensus conference. Each faculty was provided his/her individual metrics quarterly. The ASC rate, ASC:SIL ratio and ASC HPV+ rate was collected for the institution and each individual faculty in 2016 for Jan-March (pre-interventions, Q1), AprilJune (post-interventions, Q2), and July-Sept (post-interventions, Q3). ASC-H was included in the calculation of ASC %, ASC:SIL and ASC HPV+ rates. Results: The results of the overall institutional metrics are provided in Table 1. There was a substantial decline in the overall lab ASC rate and ASC:SIL ratio, and the ASC HPV+ rate went up. Individual faculty changes in ASC:SIL ratio and ASC HPV+ rate were variable, but overall showed improvement (see Figures 1 and 2). Conclusions: In our institution, and educational program has been very effective in improving Pap test metrics. It is helpful to do re-education at all levels within the department, from cytotechnologist to cytopathologist.
S58
Abstracts Jan-March (post-reporting, Q1 2017). ASC-H was included in the calculation of ASC rate, ASC:SIL and ASC HPV+ rates. Results: The results of the overall institutional metrics are provided in Table 1. There was a decline in the overall lab ASC rate and a mild decrease in the ASC:SIL ratio. The and the ASC HPV+ rate went up substantially. Individual faculty changes in ASC:SIL ratio and ASC HPV+ rate were variable, but generally showed an increase in the ASC HPV+ rate and a decline in the ASC:SIL ratio (see Figures 1 and 2). Conclusions: Access to HPV results has further reduced our laboratory’s ASC rates and decreased the ASC:SIL ratio. The ready availablity of hrHPV results has clearly changed staff practice patterns. The implications are still unclear, and further examination of follow-up data and NILMHPV+ rates is ongoing.
PST137 Impact of HPV Reporting on Institutional and Faculty ASC-US Rates Deborah Chute, MD1, Amanda Bruening, MS, CT(ASCP)2, Emily McMeekin, BS, CT(ASCP)CM2, Dawn Underwood, MS, CT(ASCP)2, Jennifer Brainard, MD2. 1Cleveland Clinic Foundation, Cleveland, OH; 2 Cleveland Clinic, Cleveland, OH Introduction: Important laboratory Pap test quality metrics include monitoring the ASC rate, ASC:SIL ratio, and ASC HPV+ rate. On October 11, 2016, our laboratory implemented the Roche COBASÓ HPV test for the detection of high risk HPV (hrHPV). Along with reporting the hrHPV genotype, the new analyzer’s reporting system integrated with our LIS, and the hrHPV result is now visible to the cytotechnologist and cytopathologist at the time of screening and sign-out. Previously, the results were only available through the electronic medical record, which imposed barriers to determining hrHPV status before interpretation. We monitored the impact of hrHPV reporting on our laboratory’s metrics. Of note, this implementation occurred approximately 7 months after an education intervention in our laboratory (see separate abstract). Materials and Methods: The ASC rate, ASC:SIL ratio and ASC HPV+ rate was collected for the institution and each individual faculty for July-Sept (pre-reporting, Q3 2016), Oct-Dec (post-reporting, Q4 2016), and
PST138 A LEAN Resolution to an Unexpected Rise in Unsatisfactory ThinPrepÓ Pap Tests Donald York, CT(ASCP)CMIAC, Stan Seko, CT(ASCP), Alaa Afify, MD, John Bishop, MD, Alicia Calderon Bhambra, DO. UC Davis Medical Center, Sacramento, CA Introduction: The Hologic ThinPrepÓ Pap Test is the most utilized methodology for cervical cytology sample collection. This methodology utilizes
S57 evaluation and flow cytometry analysis (FCA) of vitreous fluid in combination. Materials and Methods: Retrospective review of medical records was conducted for all patients whose vitreous humor was sent for pathologic review to our institution between 2010 and 2016. Review included patient symptomatology, FCA results, cytology results, and resection results if applicable. Results: 102 vitreous fluid samples were analyzed from 92 patients. Cytologic evaluation (101/102) and FCA (81/102) were both frequently utilized. Enucleation occurred sparingly after initial evaluation (2/92). The most common indications for cytological evaluation included lymphoma (73), non-specific inflammation (42), infection (20), and non-lymphomatous neoplasm (9). Some specimens had multiple indications. 73 cases were evaluated for suspected lymphoma; cytologic interpretations included non-diagnostic (47/73), positive or suspicious for lymphoma (15/73), acute inflammation with or without infectious agents (6/73), and granulomatous inflammation (5/73). FCA was performed in 66/ 73 of these cases; results included non-diagnostic (46/66), polyclonal Bcells (11/66), and monoclonal B-cells (9/66). 28 cases were evaluated for inflammation, infection, and non-hematolymphoid neoplasm; cytology showed non-diagnostic (18/28), acute inflammation (5/28), suspicious for melanoma (2/28), suspicious for lymphoma (1/28), suspicious for retinoblastoma (1/28), and amyloid (1/ 28). FCA was performed in 12/28 of these cases, revealing non-diagnostic results in every case. Conclusions: Cytology and FCA are most useful in combination and in the appropriate clinical context. FCA is non-contributory to final integrated diagnosis for non-lymphomatous workup, and is therefore not a costeffective evaluation strategy. PST136 Impact of Education on Institutional and Faculty ASC-US Rates Emily McMeekin, BS, CT(ASCP)CM1, Jennifer Brainard, MD1, Amanda Bruening, MS, CT(ASCP)1, Dawn Underwood, MS, CT(ASCP)1, Deborah Chute, MD2. 1Cleveland Clinic, Cleveland, OH; 2Cleveland Clinic Foundation, Cleveland, OH Introduction: Important laboratory Pap test quality metrics include monitoring the ASC rate, ASC:SIL ratio, and ASC HPV+ rate. However, what a laboratory should do when the rates show a worrisome trend is not as well defined. In late 2015, our laboratory noted a worrisome trend (see Table 1). Therefore, our laboratory decided to implement a systemic education program in early 2016, and we monitored the effectiveness of our program. Materials and Methods: An educational intervention was designed for March/April 2016. Cytotechnologist education consisted of: a group meeting to discuss metrics, a lecture and written materials provided by the Cytotechnology School Program Director on ASCUS criteria, a quiz on challenging ASCUS cases, and encouragement to seek consultation on borderline cases. Each cytotechnologist was provided their individual metrics regularly. Cytopathologist education consisted of the following steps: a group meeting to discuss metrics and encouragement to bring borderline cases to the daily consensus conference. Each faculty was provided his/her individual metrics quarterly. The ASC rate, ASC:SIL ratio and ASC HPV+ rate was collected for the institution and each individual faculty in 2016 for Jan-March (pre-interventions, Q1), AprilJune (post-interventions, Q2), and July-Sept (post-interventions, Q3). ASC-H was included in the calculation of ASC %, ASC:SIL and ASC HPV+ rates. Results: The results of the overall institutional metrics are provided in Table 1. There was a substantial decline in the overall lab ASC rate and ASC:SIL ratio, and the ASC HPV+ rate went up. Individual faculty changes in ASC:SIL ratio and ASC HPV+ rate were variable, but overall showed improvement (see Figures 1 and 2). Conclusions: In our institution, and educational program has been very effective in improving Pap test metrics. It is helpful to do re-education at all levels within the department, from cytotechnologist to cytopathologist.
S58
Abstracts Jan-March (post-reporting, Q1 2017). ASC-H was included in the calculation of ASC rate, ASC:SIL and ASC HPV+ rates. Results: The results of the overall institutional metrics are provided in Table 1. There was a decline in the overall lab ASC rate and a mild decrease in the ASC:SIL ratio. The and the ASC HPV+ rate went up substantially. Individual faculty changes in ASC:SIL ratio and ASC HPV+ rate were variable, but generally showed an increase in the ASC HPV+ rate and a decline in the ASC:SIL ratio (see Figures 1 and 2). Conclusions: Access to HPV results has further reduced our laboratory’s ASC rates and decreased the ASC:SIL ratio. The ready availablity of hrHPV results has clearly changed staff practice patterns. The implications are still unclear, and further examination of follow-up data and NILMHPV+ rates is ongoing.
PST137 Impact of HPV Reporting on Institutional and Faculty ASC-US Rates Deborah Chute, MD1, Amanda Bruening, MS, CT(ASCP)2, Emily McMeekin, BS, CT(ASCP)CM2, Dawn Underwood, MS, CT(ASCP)2, Jennifer Brainard, MD2. 1Cleveland Clinic Foundation, Cleveland, OH; 2 Cleveland Clinic, Cleveland, OH Introduction: Important laboratory Pap test quality metrics include monitoring the ASC rate, ASC:SIL ratio, and ASC HPV+ rate. On October 11, 2016, our laboratory implemented the Roche COBASÓ HPV test for the detection of high risk HPV (hrHPV). Along with reporting the hrHPV genotype, the new analyzer’s reporting system integrated with our LIS, and the hrHPV result is now visible to the cytotechnologist and cytopathologist at the time of screening and sign-out. Previously, the results were only available through the electronic medical record, which imposed barriers to determining hrHPV status before interpretation. We monitored the impact of hrHPV reporting on our laboratory’s metrics. Of note, this implementation occurred approximately 7 months after an education intervention in our laboratory (see separate abstract). Materials and Methods: The ASC rate, ASC:SIL ratio and ASC HPV+ rate was collected for the institution and each individual faculty for July-Sept (pre-reporting, Q3 2016), Oct-Dec (post-reporting, Q4 2016), and
PST138 A LEAN Resolution to an Unexpected Rise in Unsatisfactory ThinPrepÓ Pap Tests Donald York, CT(ASCP)CMIAC, Stan Seko, CT(ASCP), Alaa Afify, MD, John Bishop, MD, Alicia Calderon Bhambra, DO. UC Davis Medical Center, Sacramento, CA Introduction: The Hologic ThinPrepÓ Pap Test is the most utilized methodology for cervical cytology sample collection. This methodology utilizes