Cytopathology

Requirements 

Pathology house officers are required to complete a minimum of four months of cytopathology.

Goals 

The goal of the cytopathology rotation is to develop competency in this subspecialty of anatomic pathology. To this end, it is expected that the pathology house officer will become conversant with the diagnostic criteria necessary for the accurate interpretation of cervicovaginal specimens, exfoliative non-gynecologic specimens, and fine needle aspirates from a variety of superficial and deep sites. Additionally, it is expected that the pathology house officer will become familiar with the techniques required to prepare cytologic specimens obtained from the various sources described above. Finally, the house officer should develop an understanding of the regulatory and management issues pertaining to cytopathology, including quality assurance and improvement issues.

Responsibilities 

The pathology house officer is expected to participate in the daily sign-out of current cytopathology specimens with the attending pathologist and fellow at the multi-headed microscope. Also, the house officer will be present for rapid on-site evaluation of fine needle aspirates of superficial and deep sites and will assist in obtaining fine needle aspirates from superficial sites, as requested by the clinical services. This includes intraoperative aspirates. Generally, the cytopathology fellow will carry the cytopathology beeper approximately two (2) days a week; the resident will carry it the remainder of the time. During his or her second rotation on cytopathology, it is anticipated that the house officer will spend a greater proportion of his or her time participating in the sign-out of current cases, though still continuing to develop greater proficiency in performing and evaluating fine needle aspirates. Finally, the house officer and the cytopathology fellow are responsible for assembling the monthly cytopathology conference. They may alternate presenting the conference or present it jointly.

When performing or observing procedures on patients, a "dress code" is strongly recommended. Clothing should be neat and clean. In men, a necktie is appropriate. Heavy and excessive jewelry is to be avoided. A white lab coat should be worn. The institutional identification badge should be clearly visible.

The department offers a 1-year cytopathology fellowship.

Objectives

  1. To become familiar with the proper handling and preparation of a variety of routine cytology specimens, including cervicovaginal smears and monolayers, brushings, washings, sputa, body cavity fluids, and fine needle aspirates. Residents should know how cell blocks, cytospins and aspirate smears are made.
  2. To develop competency in obtaining fine needle aspirates from superficial sites and in preparing aspirate smears.
  3. To recognize the normal cellular constituents of a cervicovaginal sample.
  4. To identify infectious organisms commonly seen in cervicovaginal samples (e.g. candida, trichomonas, lepthothrix, Gardnerella, herpesvirus).
  5. To recognize cellular changes resulting from inflammation, radiation therapy, IUDs, and infections.
  6. To know the criteria for diagnosing squamous intraepithelial lesions, adenocarcinoma in situ, and carcinomas in cervicovaginal samples.
  7. To be able to classify cervicovaginal smears according to the Bethesda System.
  8. To know the criteria for assessing the adequacy of a cervicovaginal sample.
  9. To know the CLIA 1988 rules applying to cytopathology.
  10. To recognize the normal cellular constituents of exfoliative respiratory specimens.
  11. To identify infectious organisms seen in respiratory specimens (e. g. herpes virus, cytomegalovirus, aspergillus, cryptococcus, histoplasma, etc).
  12. To recognize cellular changes resulting from inflammation and repair, chemotherapy and radiation therapy, and infection in exfoliative respiratory specimens.
  13. To recognize and classify pulmonary neoplasms in exfoliative respiratory specimens.
  14. To identify correctly mesothelial cells in exfoliative and washing specimens.
  15. To know the criteria for distinguishing between mesothelial cells and adenocarcinoma in body cavity fluid specimens.
  16. To recognize the non-neoplastic cellular constituents of urinary tract specimens.
  17. To identify infectious organisms commonly seen in urinary tract specimens (e.g. candida, cytomegalovirus).
  18. To know the criteria for diagnosing urothelial carcinoma in urinary tract specimens.
  19. To recognize the normal cellular constituents of cerebrospinal fluid.
  20. To identify infectious organisms commonly seen in cerebrospinal fluid (e.g. cryptococcus).
  21. To classify tumors identified in cerebrospinal fluid.
  22. To recognize the normal cellular constituents of the gastrointestinal tract.
  23. To identify infectious organisms commonly occurring in the gastrointestinal tract (e.g. candida, herpes virus, cytomegalovirus).
  24. To recognize cellular changes resulting from inflammation and repair, chemotherapy or radiation therapy and infection in exfoliative cytology specimens and endoscopic-ultrasound directed aspirates obtained from the gastrointestinal tract.
  25. To know the criteria for identifying glandular dysplasia and carcinoma in the gastrointestinal tract.
  26. To become familiar with the criteria for identifying benign and malignant neoplasms, infections, and reactive conditions in fine needle aspirates obtained from a variety of sites, including:
    • Lung
    • Liver
    • Breast
    • Mediastinum
    • Pancreas
    • Lymph nodes
    • Head and neck, including salivary glands
    • Thyroid
    • Adrenal gland
    • Kidney
    • Bone and soft tissue
  27. To be able to render on-site interpretations of fine needle aspirates.
  28. To understand the basis of proper billing procedures.

Suggested Studies

 

 

The Manual of Cytotechnology, 7th edition, Keebler and Somrak
The Art and Science of Cytopathology, DeMay
The Bethesda System, Kurman and Solomon
Modern Cytopathology (Geisinger, et al, 2004)
Kodachrome slide sets are available in the cytotechnologists’ sign-out area (cervicovaginal cytology set especially recommended).
Numerous glass slide teaching sets are available in the cytotechnologists’ sign-out area.

 

Faculty and Staff

Simon Bergman, MD
Director of Cytopathology

James O. Cappellari, MD
Associate Director of Cytopathology

A. Julian Garvin, MD, PhD
Department Chair, AP Faculty

Graham E. Parks, MD
Assistant Professor, Pathology 

Quick Reference

Pathology Residency Training Program
Program Director:
Ryan T. Mott, MD

Tel: 336-716-4311
Fax: 336-716-7595

Wake Forest Baptist Medical Center
Medical Center Boulevard
Winston-Salem, NC 27157
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Last Updated: 07-11-2014
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