Cytology Rotation (AP-1 and AP-2)

Residents training in anatomic or combined anatomic-clinical pathology will complete a minimum of two months of cytology training. This training is designed to provide a framework upon which to build, leading to possible sub-specialization and expertise as a cytopathologist. Residents are encouraged to do additional elective rotations in cytology if this is aligned with their future career interests.

The service is divided into three units, GYN, non-GYN, and FNA/consults with three attendings on service at all times. As the cytology fellow is an integral part of the cytology service, the resident will work closely with the cytology fellow, under direct supervision of the cytopathology attending, in training and performance of FNA biopsy, triaging of specimens, cytologic preview, case work-up, and communication with clinicians. The attending on service will review all aspects of the cases with the resident at the time of signout.

During the first days of the first rotation, the resident should spend a few hours in the prep lab with a senior cytotechnologist familiarizing themselves with the various laboratory techniques routinely used in preparation of both GYN and non-Gyn specimens. These include ThinPrep, SurePath, cell blocks, cytospins, smears, and routine stains such as Diff Quik.

The resident is responsible for previewing all non-GYN specimens and a portion of the GYN specimens, often in conjunction with the fellow, and will participate in daily signout. Signout for the non-GYN service may occur twice a day.

The resident will be instructed on proper FNA technique by the cytopathology fellow and on-service attending, and will be expected to perform 5 FNA biopsies over the two months of training. Before a resident may perform an FNA on a patient, initial instruction will include practice on a food item, followed by observation at the bedside. The resident will participate with the fellow in adequacy assessment of deep US, CT, and EUS-guided FNAs.

An abundance of teaching material is available in the cytology division including, glass study sets, books, journals, ASCP and CAP workshops, and unknown slides. The resident is expected to utilize these resources to enhance their cytology education. Residents are also expected to attend and participate in regularly scheduled cytology conference, including cytology-histology correlation, weekly consensus conference, and pertinent tumor boards.

Additional Resident Duties and Responsibilities

  • Observe routine specimen preparation under the guidance of a senior cytotechnologist during the first week of the first rotation
  • Attend daily signout
  • Attend all cytopathology conferences
  • Practice laboratory preparation of cytology specimens including PAP smears, FNAs, and fluids
  • Practice smear techniques
  • Practice FNA technique and attend patient FNAs with cytopathology fellow and attending
  • Attend image guided, cytology assisted FNAs and observe preliminary assessment process

Additional Goals and Objectives for the Cytology Rotation

Patient Care:

  • Understand the techniques used in cytopathology to obtain and preserve specimens, including conventional PAP smears, liquid-based PAP smears, fine needle aspiration, brush specimens, endoscopic ultrasound, bronchial alveolar lavage, and fluids (including urine, CSF, effusions, ascites)
  • Understand the preparation of cytology specimens and slides, including PAP smears (Thin Prep and SurePath), HPV typing, touch preps, direct smears, and centrifugation.
  • Understand commonly used stains, including, Diff Quik, H and E, PAP stain, special stains, and immunohistochemical stains; their limitations; and how they apply to cytopathology
  • Triage the specimen appropriately for optimal diagnostic evaluation

Medical Knowledge:

  • At the conclusion of the eight-week rotation, the resident should fully understand the morphologic criteria used to define normal, reactive, atypical, dysplastic, and malignant cells in common cytology specimens, including FNAs and fluids, and GYN specimens (CSF, thyroid, head and neck, breast, GI, GU, lymph nodes, fluids, soft tissue, bone), and GYN specimens
  • Specific medical knowledge goals that should be attained at the conclusion of the first four-week rotation include:
    • Understand normal GYN, Non-GYN, and Fluid cytology
    • Understand and be able to apply the newly revised Bethesda system
    • Understand the diagnostic criteria for reactive changes, ASCUS, LGSIL, HGSIL, AGUS, adenocarcinoma, and squamous carcinoma in PAP smears
    • Understand the diagnostic criteria for atypical, dysplastic, and malignant non-GYN and fluid specimens
    • Understand the purpose of cytology-histology correlation and participate in monthly conference
  • Specific medical knowledge goals that should be attained at the conclusion of the second four-week rotation include:
    • Accurately diagnose common abnormalities of the cervix, endometrium, vagina and vulva, including reactive processes, dysplasia and malignancy
    • Accurately diagnose common abnormalities in FNAs and fluid specimens including reactive processes, dysplasia, and malignancy
    • Present cytology teaching cases as necessary, with assistance from the cytopathology fellow, at tumor board and unknown resident conference
    • Review cytology consult cases with cytopathology fellow prior to signout with the attending
    • Understand the limitations of assessment of a disease process by cytopathology
    • Gain exposure to CPT and ICD-9 coding for common cytology specimens