Events during September 2023

Specialist portfolios: Updated, flexible and achievable

The requirement of extensive and complex testing on cytology samples is widely and routinely recognised. ROSE performed by scientists in the clinical setting provides a standardised, clinically effective, reproducible methodology for a variety of anatomical sites, some of which cytology is the only modality for sampling.

Real-time adequacy assessment eliminates the need for more invasive or repeat procedures by ensuring sufficient cell yield is obtained to conduct all the tests required for ancillary and molecular testing. This streamlines the patient pathway by reducing the referral to treatment time and reduces waiting list pressures, resulting in cost reduction for healthcare trusts and improved patient care and outcomes.

The presentation will explore the new IBMS ROSE qualification with the aim to inspire scientists to become skilled in ROSE.

Changing and expanding roles in Cellular Pathology

The aim of this presentation is to explain the growing importance of the use of cytopathology cell blocks in the diagnostic process and how this has evolved over recent years. In the past they were used as an 'extra' to the traditional Papanicolaou and Romanowsky stains whereas now they have an essential role in providing material for ancillary testing - immunocytochemistry and molecular studies.

The variety of methods of cell block preparation will be covered and why it is important that a department choses what method, or methods, are best suited to what is required from the finished result.

The cellular pathology of clots and cell blocks

Cell blocks from Diagnostic Cytopathology (DC) samples have always had value in the diagnostic process as a complement to the traditional cytology stains – Papanicolaou and Romanowsky. It has become more important to provide material for Immunocytochemistry to refine malignant diagnosis, and more recently, the use of molecular testing to aid in the choice of tailored chemotherapy regimens. If this information can be obtained from DC samples, which are less invasive than biopsy samples, the patient will benefit.

External Quality Assurance of cell block preparations has up to now been covered by the Tissue Diagnostic scheme. However, this is not entirely appropriate as cytopathology departments use a variety of cell block preparation methods and fixatives. The increase in number of cell block Haematoxylin and Eosin slides submitted to our evaluation service and the queries we receive regarding advice on best preparation methods suggested there was a need for a separate scheme for evaluation of cell blocks. A circulated survey indicated that there is a need for such a scheme. In response to this we performed 2 pilot studies which were well supported and successful, leading to the launch of the live scheme in April 2023.

This presentation covers the development of the scheme and the results of the 2 pilots. As an ongoing process the scheme will be able to garner information about ‘best methods’ and this can be passed on to laboratories experiencing problems and improve standards. UKNEQAS CPT is not just a ‘tick box’ service for UKAS, it is also an advisory service which aims to improve diagnostic practices.

Whats new in Diagnostic Cytology (Reporting systems; biomarker testing)

Develop an understanding of the required equipment used in a modern Mohs laboratory
Understand how to embrace design and automation in a modern Mohs laboratory.
Understand the required skills while they are using automated and advanced equipment in Mohs laboratory.
To be aware how automated and advanced equipment will provide enhanced and more accurate results and improve quality performance.

Delegates will:

Gain an appreciation of the diversity and range of tumour types that can be assessed using Mohs.
Comprehend the complexity of technical requirements to ensure cases are dealt with effectively.
Recognise unusual findings and be able to adjust the investigative procedures in a 'live' setting
Appreciate tumour pattern recognition in Mohs cases

Direct immunofluorescence (DIF) techniques provide the gold standard diagnostic tests for a number of autoimmune immunobullous diseases, including pemphigus and pemphigoid and have clinical utility in other autoantibody-mediated disorders. They are typically performed on unfixed, frozen skin, mucosal and renal biopsies. For optimal diagnostic value, material for DIF requires careful preparation and a number of factors contribute to the quality of the assessed tissue sections. In particular, weak specific fluorescence intensity and high non-specific background fluorescence can hinder accurate interpretation.

This presentation will provide a brief overview of best practice for optimising DIF performance, with a focus on skin and mucosal biopsies. Troubleshooting and helpful tips will be provided covering areas including specimen preparation and the importance of using an appropriate transport medium, rinsing considerations prior to block preparation, factors influencing embedding and cryotomy, protocols for optimising fluorescence and appropriate use of conjugates, imaging considerations for digital pathology solutions, storage of material prior to reporting and best practice strategies for maintaining internal and external quality control, with reference to the NEQAS CPT DIF EQA scheme.