Non gynecological Cytopathology

Module details

Title

Non gynecological Cytopathology

Type

Specialist

Module code

SLS332

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with knowledge and understanding of the aetiology, pathogenesis and main clinical features of relevant non- gynaecological cancers. They will understand and gain experience of the role of the cytology laboratory in the diagnosis of non-gynaecological malignancy.

 

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Analyse non-gynaecological samples to identify normal morphology, inflammation, benign neoplasia and malignancy.	Action View
# 2	Learning outcome 1	Competency Interpret adequacy of samples at on-site clinical procedures, including: endobronchial ultrasound (EBUS) endoscopic ultrasound (EUS) bronchoscopy endoscopic retrograde cholangio-pancreatography (ERCP) fine-needle aspiration (FNA) of palpable and non-palpable lesions.	Action View
# 3	Learning outcome 2	Competency Prepare a diagnostic pathway, from diagnosis to treatment for non- gynaecological cancers, to include: respiratory tract urinary tract gastrointestinal tract serous cavities thyroid gland salivary glands lymph nodes.	Action View
# 4	Learning outcome 2	Competency Perform the reception and basic preparation of specimens for the investigation of non- gynaecological cancer.	Action View
# 5	Learning outcome 3	Competency Perform to quality standards appropriate specialised cytopathological techniques as part of the systematic investigation of non-gynaecological cancer.	Action View
# 6	Learning outcome 3	Competency Perform to quality standards at least three of the following specialised techniques, including: immunocytochemistry immunofluorescence fluorescence in-situ hybridisation molecular techniques interrogation of molecular databases electron microscopy flow cytometry image analysis.	Action View
# 7	Learning outcome 4	Competency Use and evaluate new equipment relevant to the cytological investigation of non-gynaecological cancer.	Action View
# 8	Learning outcome 5	Competency In discussion with a supervisor, interpret in the correct clinical context the results of cytological investigations in non-gynaecological cancer, to include: respiratory tract urinary tract gastrointestinal tract serous cavities thyroid gland salivary glands lymph nodes.	Action View
# 9	Learning outcome 5,6,7	Competency In discussion with a pathologist, prepare and issue reports from the selected cases of non- gynaecological cancer.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Prepare 10 FNA samples in a clinical setting and stain using a rapid staining technique.	DOPS
Using gradient density media prepare 5 blood stained serous effusion samples. Assess the preparation microscopically and comment on the cytological picture.	DOPS
Prepare 5 cells blocks from range of cytology samples. Write short notes on different cell block techniques.	DOPS
Under supervision carry out immunocytochemical testing on range cytology samples, using a range of markers.	DOPS
Under supervision carry out molecular biology testing on range of cytology samples. May require travel to a testing centre.	DOPS
Set up a microscope for Kohler illumination.	DOPS
Prepare 5 synovial fluid samples for crystal analysis and under supervision carry out polarising microscopy assessment.	DOPS
Perform microscopical interpretation of 5 serous effusion samples and based on morphology and clinical history suggest an appropriate further ancillary testing.	DOPS
From evidence gathered and discussions with relevant clinical colleagues, produce a clinical pathway document detailing the impact of non gynaecological cytopathology in the diagnostic process on the overall patient pathway.	OCE
From evidence gathered at various cancer MDTs and discussions with relevant clinical colleagues, produce a reflective account of the learning acquired including differential diagnosis and patient management.	OCE
Perform microscopical interpretation of Papanicolaou and Romanowsky stained slides from 10 of respiratory, serous effusion and urinary tract samples with range of cytological abnormalities and discuss the features with consultant cytologist.	OCE
Attend a one stop FNA clinic and under supervision carry out adequacy assessment on five cases.	OCE
Attend paracentesis and Thoracentesis procedures and discuss the role of cytology in patient management	OCE
Attend EBUS procedure and under supervision carry out adequacy assessment on five patients, and write reflective notes on role of EBUS on diagnostic pathway	OCE
Attend bronchoscopy procedure and observe sampling procedure for cytology and write reflective notes.	OCE

Learning outcomes

1. Recognise and interpret the microscopical appearance of cells and relate to the pathobiological process.
2. Recognise the clinical presentation of cancers detected by non- gynaecological cytopathology.
3. Perform to internal quality standards a range of established cytopathological techniques used in non-gynaecological cytopathology. Advise on or request appropriate additional tests to aid in the diagnosis of disease.
4. Identify and evaluate new equipment, methods, or procedures to enhance the contribution of the cytopathology laboratory to the diagnosis and management of non-gynaecological malignancies.
5. Draft interpretative reports that involve cytopathological findings as part of the investigation of non-gynaecological malignancies.
6. Work in partnership with other clinical specialisms as part of the diagnosis and review of non-gynaecological malignancies.
7. Analyse national and international data on the incidence, diagnosis, management and survival of malignancies detected by non-gynaecological cytopathology.

Learning outcomes

1. Explain the aetiology, pathogenesis and main clinical features of cancer of the respiratory tract, urinary tract, serous cavities, thyroid gland, salivary glands and lymph nodes.
2. Discuss and justify the applications of non-gynaecological cytology sampling techniques.
3. Discuss the application of specialised techniques to cytology samples.
4. Critically evaluate specialised techniques currently under development that may play a future role in cellular pathology.
5. Discuss and gain experience of the cytopathological report and the multidisciplinary team in the management of non-gynaecological cancer and patient care.

Indicative content

• Aetiology, pathogenesis and main clinical features of cancer in the following areas:
  • respiratory tract
  • urinary tract
  • serous cavities
  • thyroid gland
  • salivary glands
  • lymph nodes
• Applications of non-gynaecological cytology sampling techniques, including:
  • exfoliative techniques
  • aspiration techniques
  • application of specialised techniques to a variety of cytology samples
  • immunocytochemistry
  • Immunofluorescence
  • fluorescence in-situ hybridisation
  • molecular techniques, e.g. PCR
  • electron microscopy
  • image analysis
  • quantitation
  • molecular databases
  • flow cytometry
• Critical evaluation of specialised techniques currently under development that may play a future role in cellular pathology

Activities

• Attend, and where appropriate assist in, the collection of specimens for cytopathological investigation. To include:
  • exfoliative techniques
  • brush techniques
  • aspiration techniques.
• Attend and participate in multidisciplinary review meetings at which cytopathology results are presented as part of the clinical record. Wherever possible include those cases included in your portfolio of named cancers. Record the outcomes of the multidisciplinary review meetings.
• Include details of investigations undertaken, including histochemical and molecular techniques, with explanations, in the portfolio of cases prepared for learning outcome 1.
• Perform a detailed evaluation of one new piece of equipment, method or procedure. Critically appraise the results of the evaluation and produce a report with recommendations.
• Write a cytopathology report of a range of non-gynaecological cancers, appreciating the partnership between the cytopathology laboratory and other clinical specialisms.
• Suggest ways in which improved diagnostics could lead to better clinical outcomes in non-gynaecological malignancy.
• Prepare a portfolio of a minimum of 10 illustrative cases of non-gynaecological malignancies. Include the plan of laboratory investigation.
• Review prepared microscope slides on a double-headed microscope with a supervisor and draft a diagnosis taking into account all relevant clinical details.
• Perform an audit on a specific topic analysing the morphological findings and clinical outcomes.