PrintCytopathology Fellowship
Teaching Faculty
Program Director
Stefan Pambuccian, MD
Contemporary cytopathology is viewed as a clinically oriented subspecialty that aims to rapidly diagnose significant patient problems with atraumatically collected material. The goal is improved patient care through highly skilled application of the methods available in our discipline. This includes educating our clinical colleagues to the possibilities and advantages of cytologic evaluations, as well as realizing the full application of newer diagnostic modalities to cytologic material. The laboratory's philosophy features an active, interventional stance for the modern cytopathologist through performing aspirations in the clinic, participating in radiographically directed aspirations, and acting as a consultant to the clinical staff.
Interactions between the cytopathology fellow and services devoted to necropsy, clinical pathology, and surgical pathology are most commonly based on follow-up of patients who have been previously studies by cytologic means. Staging of malignancies initially diagnosed in histologic biopsies is often addressed by fine needle aspiration. In the setting of certain types of disease, cytologic specimens are collected for cytogenetic, immunophenotypic, flow cytometric, or hormone receptor analysis. Communication with the laboratories responsible for these studies is an important component of complete evaluation of some cytology cases. Follow-up of cytology cases in surgical pathology is a daily activity, as a part of quality control, and in preparation of teaching sets. Both of these are important areas of activity for the fellow.
The procedure for work-up of cases varies with the type of case. Gynecologic cases are prepared and screened by staff cytotechnologists. The fellow works closely with the cytopathology staff in signing out these slides. In the second one-half of the training program, the fellow has primary sign-out privileges. Non-gynecologic, non-aspiration cases are addressed in a similar manner. Fine needle aspirations of palpable masses are performed by the fellow, following several months of supervised activity in this field. Preparation of smears, application of the initial rapid stain, and communication of rapid diagnoses are all accomplished by the fellow. Radiographically guided aspirations of deep masses are attended by the fellow, who prepares the smears, applies a rapid stain and gives a preliminary interpretation of specimen adequacy. Based on the diagnostic possibilities suggested by the combined clinical radiographic and rapid cytologic findings, the fellow makes decisions about specimen allocation to the various media required for cell blocks, electron microscopy, immunocytochemistry, cytogenetics, flow cytometry, and microbiologic culture.
In all cases, the patient's previous pathology and cytology specimens are available for review. The current clinical history is considered as the case is evaluated. Frequent contact with the physicians on clinical services insures rapid and accurate correlation of all pertinent information. As the fellow prepares and evaluates cases in the manner just described, the cytopathology staff is available for consultation. This includes bedside assistance with difficult aspirations. Regularly scheduled conferences insure that all significant abnormal findings are ultimately seen by several individuals at all levels of the service. This insures both high-quality teaching, and constant review of diagnostic patient material.
During interactions with the clinical staff, the fellow is encouraged to take an active role, not only in obtaining detailed information about material currently being studied, but in educating other physicians about applications of cytology and its advantages in specific situations. This includes recognizing situations in which cytologic evaluations (particularly fine needle aspiration) are not appropriate. This exchange of information occurs informally as cases are discussed at the microscope, in written form through results reporting, and in multidisciplinary patient-care conferences.
As the fellow gains experience, the teaching responsibilities increase. This includes supervision of residents in case preparation and evaluation, as well as introducing residents to the technique of fine needle aspiration. In the second one-half of the year, there is ample opportunity to engage in formal teaching of cytotechnology students and pathology residents.