Day 1 :
Keynote Forum
Shahla Masood
University of Florida College of Medicine, USA
Keynote: Breast cancer prediction and early detection: The potential of cytomorphology and hTERT gene DNA methylation
Biography:
Shahla Masood is currently a Professor and Chair of the Department of Pathology at University of Florida College of Medicine, Jacksonville and Chief of Pathology and Laboratory Medicine at Shands Jacksonville. She is also the Director of the Pathology Residency Training Program, as well as Cytopathology and Breast Pathology Fellowship Training Program. In addition, she is the Medical Director of Shands Jacksonville Breast Health Center. An internationally recognized expert in breast cancer diagnosis and prognosis, she has fostered the concept of an integrated multidisciplinary approach in breast cancer care, research and education. She has recently been appointed to chair a committee of the National Accreditation Program for Breast Centers (NAPBC) with a new initiative to explore the possibility of expansion of this program to an international level.
Abstract:
As a major public health problem, breast cancer remains as the second leading cause of cancer death among women across the globe. Breast cancer is not only a physical illness with significant mortality and morbidity, it is also associated with remarkable psychosocial impairments. The significance of the impact of breast cancer on women’s lives has resulted in worldwide effort to fight against this disease. During the last several years, substantial progress has been made in the diagnosis and management of breast cancer. In addition, discovery of new knowledge about the fundamental biology and genetic makeup of breast cancer has opened up exciting opportunities for early breast cancer detection and prevention. Access to accurate diagnosis is the fundamental step in receiving effective breast cancer treatment and influencing reduction in breast cancer mortality. However, the major barriers to access to diagnostic tools are cost, as well as the invasive nature of the surgical procedures that discourage patients from taking advantage of the diagnostic capabilities. An alternative option is to use minimally invasive sampling procedures such as fine needle aspiration biopsy (FNAB) and core needle biopsy (CNB) to obtain cellular/tissue samples for the evaluation of morphologic and biologic features of a breast lesion. FNAB involves the insertion of a small needle, similar to the one used to draw blood, and, in contrast to CNB, is considered to be the most cost-effective and atraumatic procedure that is easily tolerated by patients, and that can provide a rapid, bedside diagnosis. In addition, FNAB does not need anesthesia and there is minimal hemorrhage and discomfort to the patient. FNAB and CNB share similar diagnostic limitations, as there are cases with features of entities such as atypical ductal hyperplasia, low grade ductal carcinoma in situ, papillary, fibroepithelial and mucinous lesions that require follow-up surgical excision for the establishment of an accurate diagnosis. To overcome this problem, we have developed a cytologic grading system and evaluated a malignancy-associated biomarker, (DNA methylation for hTERT) that has the potential to increase the diagnostic accuracy of breast FNAB. This study is designed to use this cytologic grading system known as the “Masood Cytology Index” and DNA methylation for hTERT in 600 cases of breast FNAB archived at the University of Florida College of Medicine – Jacksonville, Department of Pathology and Laboratory Medicine. The results of these tests will be compared with the available clinical follow-up of these patients and a diagnostic/predictive index will be established. This index will be used as a reliable diagnostic tool for everyday practice of breast pathology, and a predictive risk factor for high-risk individuals to become aware of their risk for subsequent development of breast cancer and to benefit from available breast cancer risk reduction modalities and prevention therapy. In the era of patient protection and the Affordable Care Act, the results of this study will reinforce the diagnostic accuracy of FNAB and establish its role as the most cost-effective sampling procedure. This access to diagnosis and therapy is the key to timely treatment and mortality reduction.
Keynote Forum
Yun Gong
MD Anderson Cancer Center, USA
Keynote: The role of cytology in the era of molecular medicine
Biography:
Yun Gong received MD degree in 1984 and then finished her post-graduate Pathology training in 1989 at Zhejiang Medical University in China. She then worked as a post-doctor and Research Associate in the Shanghai Institute of Cell Biology, Chinese Academy of Sciences; Catholic University of Nijmegen, The Netherlands; and The Scripps Research Institute, La Jolla, California. From 1998 to 2002, she received her residency training in Anatomic and Clinical Pathology at Northwestern University Medical School in Chicago, followed by one-year cytopathology fellowship training at MD Anderson Cancer Center. From 2003, she became a faculty member at the Dept. of Pathology, MD Anderson Cancer Center, and currently is a Full Professor. She has numerous publications on the fields of cytopathology and breast cancer biomarker research (120 peer-review articles, 18 invited articles, 6 book chapters and 1 book, 118 abstracts). She is a member of 9 Editorial Boards of professional journals and is a member of the Scientific Program Committee, American Society of Cytopathology (ASC).
Abstract:
Genomic alterations are known to play an important role in cancer initiation and progression. Molecular tests have been increasingly incorporated into pathology practice. Common applications include assisting pathology diagnosis, predicting prognosis and therapeutic response, and identifying patient’s eligibility for targeted therapy. The lecture will outline the role of molecular tests in the diagnosis of HPV-related cancer, thyroid cancer, hematopietic malignancies, detection of tumor of unknown origin, and management of lung cancer, breast cancer and other solid tumors.
To successfully conduct molecular tests, a high quality tumor sample is imperative. The lecture covers practical experience of MD Anderson and covers the strategies regarding how to use small and limited FNA samples for making the most informative diagnosis and yet preserve tumor tissues for cytogenetic and genomic tests that, in turn, facilitate diagnosis and targeted therapies.
Keynote Forum
James P. Basilion
Case Western Reserve University, USA
Keynote: Defining the Cutting Edge: The use of molecular imaging to define tumor margins
Biography:
Basilion obtained his PhD in Molecular Pharmacology from the University of Texas, Houston TX. Follow postdoctoral studies at the NIH (NICHD) with Dr. R. Klausner he had a short stent in industry and then became an assistant professor of radiology at Harvard Medical School and Massachusetts General Hospital. Currently, Dr. Basilion is a full tenured professor at Case Western Reserve University, Vice-Chair for Basic Research at the Department of Radiology, Director of the Case Center of Imaging Research, Director of the NFCR Center for Molecular Imaging at Case, and Co-director of the Cancer Imaging Program for the Case Comprehensive Cancer Center. He is also President elect for the World Molecular Imaging Society.
Abstract:
A challenge for surgical removal of cancer is to maximize the removal of the cancerous tissue while minimizing removal of normal tissues. This is critical for a number of prevalent cancers. Several investigators have shown the utility of systemically delivered optical imaging probes to image tumors and guide surgical removal in small animal models of cancer and recently first-in-man studies have demonstrated feasibility in Europe. However, to date there are no FDA approved cancer-selective optical imaging probes that can be used to guide surgery.
The future direction of this field is to develop and translate into clinical use effective optical imaging probes for real-time assessment of surgical margins during tumor resection. Here we demonstrate a method for imaging tumors margins during surgery that may impact patients in the next few years. Specifically, we show that optical imaging probes topically applied ex vivo to resected tumor and surrounding normal tissue can rapidly differentiate between tissues. In contrast to systemic delivery of optical imaging probes which label tumors uniformly over a long period of time (i.e. hours), topical probe application results in rapid and robust probe activation that is detectable as early as 5 minutes following application. Importantly, labeling is primarily associated with peri-tumor spaces, defining tumor margins. This methodology provides a means for rapid visualization of tumor and potentially infiltrating tumor cells and has potential applications for directed surgical excision of tumor tissues. This technology could find use in surgical resections for any tumors having differential regulation of cysteine cathepsin activity.
Keynote Forum
Mari Yang
Hoag Memorial Presbyterian Hospital, USA
Keynote: Transforming burnout to engagement by optimizing today’s dynamic medical laboratories
Time : 11:00-11:40
Biography:
Mari Yang is currently the Director of Anatomic Pathology and Cytology at Hoag Memorial Presbyterian Hospital in Newport Beach, CA. Mari graduated with a Doctorate in Management and Organizational Leadership from the University of Phoenix in 2016. Mari is certified in Cytotechnology and Histotechnology with the American Society for Clinical Pathology. Mari also has a Masters in Health Administration. Working in Laboratory Medicine for over 10 years, Mari’s goal is to elevate Laboratorians across the nation through education and modeling practices. Mari’s hope is to provide a voice for Laboratory professionals by raising awareness and recognition for this respected profession
Abstract:
Laboratory services may be considered the life source of health care and yet goes primarily unnoticed until an adverse event arises. Laboratory services are vital in 65% to 70% of patient diagnoses by providing critical and timely medical test results. Aside from professional obligations, laboratory personnel face an unprecedented time in healthcare resulting in significant restructuring of the laboratory. The expectations for faster, more precise, and technological advanced testing continues to grow leading to extreme demands on medical laboratory services. Some of these expectations may translate to negative job related effects such as burnout, increased staff turnover, absenteeism, job dissatisfaction, and poor health. To mitigate these challenges, personnel may benefit from access to development tools to alleviate employment pressures. Areas of focus will include a comparative analysis of leadership styles. In addition, an optimization proposal will be offered through exploring enhanced communication, team development, and workplace culture. Despite the eminent rapid changes in healthcare coupled with stringent workplace expectations, the medical laboratory team has the opportunity to transform and lead change with a carefully developed plan
- Cancer Cytopathology | Diagnostic Cytopathology | Histopathology | Exfoliative Cytopathology | Cervical Cytopathology | Cytopathology Case Reports | Surgical Pathology | Fine Needle Aspiration Cytology
Session Introduction
Gjumrakch Aliev
GALLY International Biomedical Research Inc, USA
Title: The mitochondrial DNA overproliferation and deletion in the context of the Neurodegeneration: Recent Challenge
Biography:
Gjumrakch Aliev, MD, PhD, President “GALLY” International Biomedical Research Institute Inc., San Antonio, Texas, USA. He also hold appointment with the University of Atlanta, Atlanta, Georgia, USA as a Professor of Cardiovascular, Neuropathology, Gerontology, Health Science and Healthcare Administration, and Leading Scientist in the Institute of Physiologically Active Compounds, Russian Academy of Sciences. He received his MD in 1982, from the Baku Medical University (former USSR) with cum laude
Abstract:
It is widely accepted that during neuronal energy crisis, cerebral hypometabolism and vascular hypoperfusion are major and potentially treatable contributors to the loss of function in patients with stroke as well as Alzheimer disease (AD). We have determined the cellular and subcellular features of vascular lesions and mitochondria in brain vascular wall cells as well as neurons from human AD brain biopsies, human short postmortem brain tissues, rat model of 2 vessel occlusion (2-VO), yeast artificial chromosome (YAC), and C57B6/SJL transgenic positive (Tg+) mice overexpressing amyloid beta precursor protein (AßPP). We expand our models towards the E4 isoform of apolipoprotein E (ApoE) which is involved in cardiovascular and cerebrovascular disorders and is the most prevalent risk factor for late onset of sporadic AD. In situ hybridization, using mitochondrial DNA (mtDNA) probes for human wild type, 5kb deleted and mouse mtDNA, was performed in conjunction with immunocytochemistry using antibodies against AßPP, 8-hydroxyguanosine, all three isoforms of nitric oxide synthase (neuronal, inducible and endothelial NOSs), GRK-2 and cytochrome c oxidase. We have also measured age-dependent effects of the human ApoE4 on cerebral blood flow (CBF) using ApoE4 transgenic mice compared to age-matched wild-type (WT) mice by use of [14C] iodoantipyrene autoradiography. Spatial memory and temporal memory tests were also employed to determine the potential protective effects of ALCAR+LA as a selective mitochondrial antioxidants treatment. Our animal study applies the vascular dementia paradigm to ApoE4 Tg+ mice in order to analyze the effects of the selective mitochondrial antioxidants ALCAR+LA on cerebral blood flow (CBF), neuropathology, brain and vessel ultrastructural abnormalities and behavior. A significant higher degree of mitochondrial damage was found in neurons and cerebrovascular cell walls in AD and in animal models used when compared to age-matched controls and non-treated subjects. These abnormalities coexist with the over expression of GRK-2, AßPP and inducible NOS immunoreactivity in these cells, and closely related to amyloid deposition in the same regions. They were also characterized by the presence of large, lipid-laden vacuoles in the cell body of severely damaged neurons and cytoplasmic matrix of the vascular endothelium. In situ hybridization revealed deleted mtDNA positive signals in the damaged mitochondria of neurons, vascular endothelium and perivascular cells. Moreover, brain microvessels with atherosclerotic lesions revealed endothelium and perivascular cells, which stained positively and in clusters when probed with wild and deleted mtDNA probes. These mtDNA deletions were associated with increased amounts of immunoreactive GRK-2, AßPP, 8OHG, and COX in the same cellular and subcellular compartments. Moreover, GRK overexpression appeared to be a selective hallmark for mitochondrial damage at the earlier but not late stages of neuronal and other brain cellular compartment lesions. ApoE4 associated factors reduced the CBF gradually and created brain hypoperfusion when compared to the WT and the differences in CBF were greatest as animals aged from 6 weeks to 12 months. Transmission electron microscopy (TEM) with colloidal gold immunocytochemistry and in situ hybridization using human and mouse DNA probes showed structural damage and mitochondrial DNA overproliferation and/or deletion in the young and aged microvessels endothelium of ApoE4 animals, extending to the cytoplasm of perivascular cells, perivascular nerve terminals, hippocampal neurons, and glial cells. These blood flow changes associates with severe structural lesions in young and aged microvessels endothelium of ApoE4 animals extended to the cytoplasmic matrix of perivascular cells, perivascular nerve terminals and hippocampal neurons and glial cells in the damaged regions of the brain. The mitochondrial structural alterations coexist with mitochondrial DNA overproliferation and/or deletion in all brain cellular compartments. Most likely, further development of these alterations can lead to blood brain barrier (BBB) failure and breakage during the development of AD. In contrary to this observation, the animals that received selective mitochondrial antioxidants (ALCAR+LA) treatment showed an absence of any cellular or subcellular abnormality in brain cellular compartments. Spatial and temporal memory tests showed a trend in improving cognitive function in ApoE4 Tg+ mice that were fed with the selective mitochondrial antioxidants (ALCAR+LA).
Our conclusion is that for the first time we were able to demonstrate the potential pharmacologic modulation of brain hypometabolism and therefore the cognitive improvements by using combination of selective mitochondrial antioxidants/metabolites, a gene expression modification substance (A10) and supplement for brain aging (BLF) with diet changes and brain exercise training. This represents a completely new and more effective strategy to treat stroke, Alzheimer and/or other types of dementia. Moreover, further increase in the examination of the ultrastructural degeneration caused by aging, especially under cardio- and cerebrovascular disease complications, is likely to contribute to our understanding of neurodegenerative etiology and will indicate a new avenue for the development of novel prophylactic and treatment strategies by offering selective mitochondrial antioxidants like ALCAR+LA and gene expression modification substrate (A10) and brain aging supplement (BLF) to the stroke, AD and/or other demented patients.
Farnaz Hasteh
University of California, USA
Title: Litigation risk cases in cytology: How to approach the discrepancy, discover the root cause and implement the relevant countermeasures
Biography:
Hasteh received her Doctor of Medicine in 1995 from Iran University of Medical Sciences in Tehran/ Iran. She completed her Pathology residency (AP-CP) at William Beaumont Hospital in Royal Oak, Michigan, where she was the Chief Resident in Pathology (2002-2003), teaching and directing residents. While at Beaumont, she was the recipient of Dr Richard H. Walker Award. This annual award, bestowed by faculty and resident peers, recognizes exceptional, demonstrated teaching ability in Pathology. Dr. Hasteh then went on to complete a surgical pathology fellowship at Stanford University Medical Center followed by a cytopathology fellowship at the University of Michigan Health System in Ann Arbor, Michigan. A highly-skilled diagnostic pathologist, Dr. Hasteh joined the faculty at UCSD in August, 2006. She is the director of Cytopathology fellowship program at UCSD Medical Center
Abstract:
This course with provide a practical review of a few false negative and false positive cytology cases that were discovered in the setting of intradepartmental quality assurance (QA), peer review or after correlation with the surgical outcomes. The cause will be a case based presentation in a broad range of cytology fields from gynecological, non-gynecologic and finally FNA cases. This session will emphasis on diagnostic pitfalls, differential diagnosis, detailed cytomorphologic features, review of clinical, radiological histories and finally comparison with corresponding histology. The emphasis will be in discovering the roots of errors and implementing a safer system to prevent mistakes. This presentation is an interactive presentation which we expect and encourage audience participation. This course is designed for surgical pathologists, cytopathologists, cytopathology fellows, cytotechnologists and patholosits-in-training.
Mansour Mehzad
Secretary of the Iranian Society of Clinical Cytology
Title: Intraoperative cytological diagnosis of the breast lesions
Biography:
Mansour Mehzad, Iranian pathologist, educator. Diplomate Board Pathology. Research fellow Aberdeen (Scotland) School Medicine, 1975. Member International Academy Cytology, Iranian Medical Council, Iranian Society Pathology, Iranian Board Pathology.
Abstract:
Although FNA has markedly improved preoperative diagnosis of the breast lesions but in many cases the FNA report is not informative and decisive either due to scant cellularity of smears or sampling from neighbouring tissues of a small tumor even in sonography guided FNAs. In these cases an intraoperative diagnosis is mandatory. For many years frozen section was the only way for this purpose which needs a cryostat and a skilled technician to prepare sections. Unfortunately the price of cryostat apparatus is high and not economic in developing countries. The second procedure using in some laboratories has been imprint cytology during surgery. This method although may be useful for soft tumors such as brain tumors, sarcomas or medullary and mucoid carcinomas of the breast but most of the breast neoplasms are firm and fibrous and impossible to collect enough cells by this method. An alternative method that I have used since 20 years ago is scraping of the fresh breast specimens in order to collect cells. The specimen is cut and the surface of the lesion is cleaned by a dry gauze to remove possible blood and exudates. The cut surface of the lesion is scraped by a sharp scalped blade and several smears are prepared from the material. The smears are fixed in 95% alcohol for 1 minute and stained by rapid H&E method. The microscopic results are called to the operating room and whole procedure lasts in each case approximately 4 minutes. This method for intraoperative diagnosis of the breast lesions is cheap, easily performed, informative, reliable and can be used as an alternative for frozen sections in cases where FNA has not established definitegnosis.The sentinel lymph nodes can be easily diagnosed in the same way