Scientific Workshops

Scientific Workshops will be held on Saturday July 9 and Sunday July 10.

 

Saturday July 9 Morning – 0800-1130

Saturday July 9 Afternoon – 1300-1630

Sunday July 10 Morning – 0800-1130

Back to top

 

W0911 Between the hope and the hype: molecular pathology in the age of precision medicine
Saturday July 9, 0800-1130

 

Harriet Feilotter, Queen’s University

George M. Yousef, University of Toronto

 

Objectives:

At the end of the session, the participants will be able to:

  • Understand the evolving central role of the pathologist in patient management in the upcoming age of precision medicine.
  • Have a grasp of the basics of next generation sequencing, and its clinical applications and limitations.
  • Understand the basic principles of new evolving technologies/approaches in molecular pathology and their advantages and limitations.
  • Appreciate the phases of implementation and challenges that face molecular pathology in the age of precision medicine.

The promise of precision medicine (PM) has been upon us for years. PM aims to eliminate the “one-size fits all” model of medicine, which has mainly centered on reaction to a disease (treating the symptoms) based on average responses to care, by shifting the emphasis to prevention and early intervention for high-risk individuals. Stepping into a new era of genomic medicine, pathologists need to be familiar with and understand the concept of precision medicine. Also, the role of the pathologist is gradually evolving. The pathologist is no longer a “diagnostic specialist” but an active participant in patient management. New technologies are fast evolving and are approaching the clinic. There is an urgent need for pathologists to understand the basic principles and limitations of these technologies. Next generation sequencing is a reality in the clinic. Pathologists need to know how to interpret the results of NGS and understand its applicability and limitations in the clinical lab. There is also an urgent need for pathologists to participate in decisions to approve new testing modalities based on cost/effectiveness in patient management. Pathologists should be prepared to address the phases of implementation and the new challenges that face our transition into the era of PM, including how to deal with ethical and QC issues etc. Finally, there is also a need for training of pathologists and residents on molecular pathology and the basic concepts of molecular profiling approaches that represent the revolution of PM.

The workshop is designed as a series of 4 lectures designed to teach the novice pathologist the basics of emerging molecular technologies, including next generation sequencing. The application of these technologies to the area known as molecular pathology is leading the way to precision medicine, a term that will be discussed and explained. Particular attention will be paid to some of the limitations and challenges that are posed by the use of molecular biomarkers in molecular pathology.

Back to top

 

 

W0912 2015 WHO classification of lung tumours – the impact on pathology practice
Saturday July 9, 0800-1130

 

Marcio Gomes, University of Ottawa

David M. Hwang, University Health Network

 

Objectives:

At the end of the session, the participants will be able to:

  • Plan an optimized approach to the diagnosis of non-small cell lung carcinoma, providing a safe diagnosis while preserving tissue for ancillary testing.
  • Recognize the different patterns of lung adenocarcinoma, how to report them and their clinical relevance.
  • Apply an algorithmic approach to the diagnosis of basaloid lung tumours.
  • Integrate clinical, radiological and pathological features in the interpretation of biopsies of lung nodules/masses.
  • Discuss difficult staging issues, including the presence of multiple lung tumours, and their impact on clinical management.

The 2015 WHO classification of lung tumours has changed considerably in comparison to the last version (2004). While the overall classification has been simplified, the diagnostic approach has changed and incorporates new criteria. Histological patterns of lung adenocarcinoma have demonstrated correlation with clinical behaviour; immunohistochemistry has acquired a pivotal role on the differential diagnosis of non-small cell lung carcinoma, and radiological and molecular features are now used for the diagnosis, staging and management of lung cancer.

In this hands-on workshop the new classification will briefly reviewed and the most clinically relevant changes to the pathologists’ practice will be highlighted. Through case-based discussions and interactive exercises, the participants will have the opportunity to apply the new diagnostic concepts and criteria to the diagnosis of lung cancer. The gate-keeper role of pathologists in the handling of tissue samples in this era on individualized medicine will be explored, and practical strategies for optimal use of resources will be discussed. Instant polling will be used to test newly acquired knowledge and skills.

Back to top

 

 

W0913 Case based approach to soft tissue tumors
Saturday July 9, 0800-1130

 

Kelly Dakin-Hache, QEII Health Sciences Centre

 

Objectives:

At the end of the session, the participants will be able to:

  • Understand the WHO 2013 classification of soft tissue tumors based on “cellular differentiation” and “biological behavior”.
  • Develop an approach to the workup of soft tissue lesions based on histological patterns.
  • List important entities in the differential diagnosis of soft tissue lesions.
  • Diagnose soft tissue lesions based on “histological features”, “immunophenotype”, and “molecular testing”.
  • Use distinguishing histological features, immunophenotype, and molecular testing to diagnose soft tissue lesions.

This workshop would include the following elements:

  • Digital (virtual) slides of selected cases will be available to participants for review prior to the workshop
  • Powerpoint presentation will be used to provide a brief introduction to soft tissue lesions focusing on the basis of classification and the approach to diagnosis prior to review of the cases
  • Audience participation will be encouraged to discuss the histological findings, differential diagnosis, and distinguishing tests to support the final diagnosis
  • Instant polling will be utilized to survey the audience
  • Powerpoint presentation will be used to discuss the case diagnosis and to provide additional related cases to cover the main distinguishing histological features and patterns for a broad number of soft tissue lesions

Back to top

 

 

W0914 Statistics for pathologists: Primer on diagnostic accuracy statistics
Saturday July 9, 0800-1130

 

Nick Myles, University of British Columbia

 

Objectives:

At the end of the session, the participants will be able to:

  • Learn how to find, extract, calculate and interpret basic statistical parameters used to inform diagnostic accuracy using examples from breast, GI, ENT and gynecologic surgical pathology:
    • A. formulate answerable questions and testable hypothesis: PICO and PIRTO framing.
    • B. understand the concept of BIAS and strategies for assessment of bias in diagnostic pathology literature.
    • C. understand the differences between EXPLORATORY and CONFIRMATORY analyses in diagnostic pathology research.
    • D. understand the concept and numeric measurements of RISK.
    • E. understand the concepts and numeric measurements of DIAGNOSTIC ACCURACY and PRECISION.
    • F. understand the concept and numeric measurements of DIAGNOSTIC ACCURACY.
    • G. understand P-VALUE, its use and abuse and robust alternatives (95% CONFIDENCE INTERVALS).

Imagine you decided to:

  • use new antibody we just heard from the sponsoring company, or
  • use new out of box technology to improve diagnostic accuracy of cancer detection, or
  • wish to stop doing old way diagnostics in favour of new technology or, alternatively,
  • stop using new impressive panels of IHC and go back to H&E?

The body of pathology literature growth rapidly at incremental rapid pace, therefore practical pathologists need training and guidance on how to find the highest level medical research evidence in order to inform their daily diagnostic pathology practice across all subspecialty areas of diagnostic pathology, which is methodologically different from the medical evidence on medical interventions.

Therefore there is an ultimate need in pathology “numeracy” to enable pathologists to re-gain their status as independent critical thinkers and not passive consumers of excessive volumes of diagnostic research information. This requires development of some basic yet fundamental medical statistical skills necessary for reading and critical appraisal of modern pathology literature to inform daily diagnostic pathology practice.

The workshop will be based on real life diagnostic scenarios and data from published diagnostic pathology examples and will enable the participants to use analytical tools (online statistical calculators, software for critical appraisal and systematic reviews form open reputable peer-reviewed sources) to calculate basic statistics related to diagnostic testing in anatomical pathology (understand concepts of prevalence, pre-test and post-test probabilities, sensitivity, specificity and likelihood ratios of the tests).

The workshop director is a practicing breast and general anatomical surgical pathologist, who, in addition to his medical and pathology training, has obtained a MSC in Evidence-Based Medicine from Oxford University.

Back to top

 

 

W0921 Intraepithelial neoplasias of the external genitalia and associated inflammatory dermatological lesions
Saturday July 9, 1300-1630

 

Michelle Downes, Sunnybrook Health Sciences Centre

Carolyn Shiau, Royal Columbian Hospital

Dominique Trudel, CHUM

 

Objectives:

At the end of the session, the participants will be able to:

  • Identify penile intraepithelial neoplasia and select relevant ancillary tests.
  • Diagnose vulval intraepithelial neoplasia and compare with cervical terminology.
  • Explain the role of HPV in the development of penile and vulvar lesions.
  • Differentiate common inflammatory lesions of the penis and vulva associated with malignancy.

This is a combined multimodal workshop with lectures and digital slides for review and discussion. There will be 3 lectures covering penile intraepithelial neoplasia, briefly reviewing invasive squamous cell carcinomas of the penis and review of relevant ancillary investigations. The second lecture will focus on vulval intraepithelial neoplasia with comparison to cervical terminology. HPV will be discussed including epidemiology and vaccination. The third lecture will cover inflammatory lesions of the external genitalia relevant to malignancy and will review potential mimics. The digital component is comprised of ~10 cases chosen to generate discussion around entities reviewed in the lectures. There will be a 30 minute panel led discussion after case review. This session will be of value to pathology residents (all levels), PA’s, general and anatomic pathologists.

Back to top

 

 

W0922 Hematopoietic neoplasms with unusual presentations and findings: avoiding the pitfalls with hematopoietic and non-hematopoietic neoplasms; “what not to miss”
Saturday July 9, 1300-1630

 

Catherine A. Ross, Juravinski Cancer Centre and Hospital, McMaster University

Monalisa Sur, Juravinski Cancer Centre and Hospital, McMaster University

 

Objectives:

  • To present unusual presentations of hematopoietic neoplasms in order for the attendees to gain an awareness of these presentation to avoid these diagnostic pitfalls in their practice.
  • To highlight uncommonly encountered hematopoietic neoplasms for educational purposes.
  • To gain appreciation of the diagnostic features.
  • To present areas of morphologic overlap where non-hematopoietic and hematopoietic lesions may be confused and show overlapping features, for attendees to recognize and be able to accurately diagnose these neoplasms.
  • To demonstrate the utility of ancillary studies such as flow cytometry, immunohistochemistry, and molecular studies in arriving at correct diagnosis.
  • To provide a clinical context for these cases, to underscore the importance of accurate, timely diagnosis in these patients.

Unusual presentations of hematopoietic neoplasms, whether by site, clinical presentation or morphology, often create difficulties in diagnosis, which can lead to delays in treatment, or even inappropriate therapies being applied. It is important to be aware of some of these entities to avoid the pitfalls to ensure that best patient care is provided. Since there is an important role of clinicopathologic correlation, the workshop directors from a large consultation practice have selected several cases wherein the impact on patient care of accurate and timely diagnosis will be highlighted. These cases will be presented with helpful hints to the approach and diagnosis, and how to avoid diagnostic traps.

The workshop will address three major themes: common hematopoietic lesions that present in unusual sites that may delay recognition of these entities, lesions that have features that may overlap with non-hematopoietic neoplasms, and lesions that simply are unusual and serve as reminders in generating proper differential diagnosis. Additionally, the potential importance of ancillary studies such as flow cytometry and molecular studies as well as important immunohistochemical findings will be highlighted.

The presentation will include cases that have been encountered in a large academic hematopathology practice. The spectrum of cases will include the many faces of Hodgkin’s lymphoma, variants of diffuse large B-cell lymphoma (morphologic diversities) which may be misdiagnosed or interpreted as non-hematopoietic neoplasms, myeloid sarcoma/AML presenting in unusual sites and mimicking non-hematopoietic lesions. Other cases will also include non-hematopoietic neoplasms that may, by presentation or morphology, resemble hematopoietic neoplasms. Cases of in-situ lymphomas with subtle features in lymph node dissections submitted as part of a staging procedure for other malignancies will be addressed. Newer entities which are under-recognized and have a broad differential diagnosis will also be discussed.

Back to top

 

 

W0923 Top 10 consultations in gynaecologic and obstetric pathology
Saturday July 9, 1300-1630

 

Martin Chang, Mount Sinai Hospital; University of Toronto

Carlos Parra-Herran, Sunnybrook Health Sciences Centre; University of Toronto

 

Objectives:

At the end of the session, the participants will be able to:

  • Cite a variety of common scenarios where consultation with a gynaecologic pathology expert is requested.
  • Develop a deeper understanding of the process by which the consultant evaluates cases sent for second opinion.
  • Identify the key clinical and pathologic elements that must be provided when a case is sent for external consultation in gynaecologic and obstetrics pathology.

Specific learning objectives:

  • Summarize the diagnostic criteria of differentiated vulvar intraepithelial neoplasia and the most common diagnostic pitfalls.
  • Describe useful diagnostic principles to accurately estimate extent of cervical stromal invasion in challenging situations (cervical intraepithelial lesions with superficial invasion, multifocal invasion).
  • Diagnose preinvasive endometrial neoplasia (“endometrioid intraepithelial neoplasia” / “atypical endometrial hyperplasia”) in the setting of hormonal therapy, and distinguish it from benign mimickers (including simple and complex endometrial hyperplasia).
  • Formulate a practical approach to the diagnosis of uterine mesenchymal lesions with endometrial stromal and smooth muscle differentiation.
  • Apply histopathologic criteria and immunohistochemistry in the diagnosis of ovarian mucinous neoplasms. List the limitations of pathologic evaluation in classifying these tumours.
  • Compare the clinicopathologic features of the most common ovarian sex cord stromal tumors.
  • Describe the spectrum of non-carcinomatous epithelial “atypias” of the fallopian tube mucosa, and their differences with tubal intraepithelial carcinoma.
  • Differentiate between molar and non – molar aneuploid gestations based on histopathologic evaluation of immature placental tissue.

This course is directed to pathologists in training and practicing general pathologists who frequently encounter diagnostic challenges in gynaecologic and obstetric surgical pathology. The activity will go over the process by which the consultant approaches cases for second opinion and will reinforce practical take-home points for the general pathologist. The goal of the course is to give attendants useful information to solve diagnostic dilemmas in gynaecologic pathology from the expert pathologist perspective. In addition, the course intends to provide guidance to determine when an expert opinion is required and what information needs to be communicated to the expert in order to achieve an optimal diagnosis.

The course has a case-based format. Ten difficult cases in gynaecologic pathology, including lower genital tract, upper genital tract and placenta, will be presented. Cases exemplify common diagnostic challenges where a second (expert) opinion is usually warranted. Although this will not be a hands-on microscopy session, digital image content will be made available to workshop participants in advance.

Presentation of each case includes relevant clinical history and imaging, main macroscopic and microscopic findings and results of ancillary studies (immunohistochemistry, special histochemistry). A list of differential diagnoses will be formulated, and dialogue regarding the best diagnosis may be opened to the audience if possible. Discussion of the correct diagnosis will follow with review of the current terminology, definition and diagnostic criteria, as well as an overview of the most important mimickers and confounders. Practical points summarizing the expert’s recommendations will be listed at the end of each case.

Back to top

 

 

W0924 A guide to total quality improvement: how to choose, track, and act on relevant quality metrics education
Saturday July 9, 1300-1630

 

Yael K. Heher, Beth Israel Deaconess Medical Center

Stephen Raab

 

Objectives:

At the end of the session, the participants will be able to:

  • Utilize a simple framework for selecting which quality metrics to track.
  • Acquire a QI toolkit to close gaps between target and current performance including understanding concepts such as Root Cause Analysis, Fishbone diagrams, Learn-Plan-Do-Study-Act.
  • Understand the different ways QI projects can be identified (reactive vs proactive).
  • Understand how quality control and quality assurance are different from quality improvement.

Targets of quality improvement efforts typically identified via adverse events (the reactive method) or via ongoing tracking of quality metrics (the proactive method). Frequently, anxiety following discovery of errors or near-misses can lead to a fire-fighting type of approach in quality management. Crucial decisions are made about workflow change without real data or thoughtful and targeted improvement efforts. Little is known about whether interventions were successful, or simply created more work for providers and staff. From a proactive standpoint, quality metrics collected and analysed often related mainly to accreditation, or simply to what data is easily available. In this course, we provide a clear framework participants can use to understand vulnerabilities and build successful quality improvement initiatives.

The course format will include a combination of didactic teaching and illustrative exercises involving simulations activities. Each section of the course will involve and introduction and discussion of specific quality concepts and then a simulation exercise that depicts real pathology work.

This course is intended for both practicing surgical pathologists and pathologists-in-training.

Back to top

 

 

W1011 Interpretation of GI biopsies – a practical approach to reporting common entities
Sunday July 10, 0800-1130

 

David Driman, Western University and London Health Sciences Centre

Jeremy Parfitt, Western University and London Health Sciences Centre

Joanna Walsh, Western University and London Health Sciences Centre

 

Objectives:

At the end of the session, the participants will be able to:

  • Understand the diagnostic approach to common entities encountered in GI biopsy sign-out, including: – inflammatory disorders of the esophagus, stomach, duodenum and colon – polyps, particularly serrated polyps of the colorectum – dysplasia in Barrett’s esophagus and IBD.
  • Differentiate malignant from pseudomalignant lesions, particularly pseudoinvasion in colorectal polyps.
  • Identify the clinical consequences of pathological reporting in selected conditions.
  • Recognize and use contemporary reporting terminology in GI biopsy sign-out.

This seminar style workshop would cover most common entities encountered in routine GI biopsy signout. While it would be didactic in style, audience participation would be actively encouraged. It may include some form of self-assessment component.

Back to top

 

 

W1012 Sudden cardiac death and CV surgical pathology
Sunday July 10, 0800-1130

 

Jagdish Butany, Toronto General Hospital, University of Toronto

Mathieu Castonguay, Dalhousie University

Vidhya Nair, Hamilton General Hospital, McMaster University

 

Objectives:

At the end of the session, the participants will be able to:

  • Review of the structure of the heart with particular reference to the conduction system and its examination.
  • Discuss the epidemiology and causes of SCD.
  • Discuss the classification SCD with emphasis on the Cardiomyopathies.

This case based course will focus on examination of the heart and the recognition of conditions causing sudden cardiac death. The course will also demonstrate the common cardiac and vascular specimen types encountered by a surgical pathologist.

The course is designed for and will be useful for the pathologist who is not an expert cardiac pathologist, and is designed for general surgical pathologists, residents and fellows. The presenters will demonstrate pictorially the common methods of examination of the heart, the need for routine sections; as well as the need for special sections in individual cases. The course will illustrate common categories of cardiovascular pathology encountered at autopsy (examination of cases of SCD). An overview of common CV surgical pathology specimens will be offered, including atherosclerosis, aortic aneurysms, cardiac tumors, native valve pathology, cardiac biopsies – diagnostic and therapeutic, and prosthetic devices.

On completing the course the participants will be familiar with the commonly encountered categories of cardiac and vascular surgical pathology as well as the workup and differential diagnosis of these specimens, as well as an approach to the workup and diagnosis of cardiac conditions leading to sudden cardiac death.

Back to top

 

 

W1013 Best practice guidelines for hospital pathologists performing medicolegal autopsies
Sunday July 10, 0800-1130

 

Kristopher Cunningham, Ontario Forensic Pathology Service; University of Toronto

Jayantha Herath, Ontario Forensic Pathology Service; University of Toronto

Matthew Orde, University of British Columbia

 

Objectives:

At the end of the session, the participants will be able to:

  • Explain the stepwise process for managing and conducting a medicolegal autopsy.
  • Describe injuries.
  • Use laboratory testing beyond toxicology.
  • Construct a professionally independent and impartial opinion on the cause and mechanism of death.
  • Construct a final medicolegal autopsy report.

Medicolegal postmortem examinations are not the same as hospital postmortem examinations. Medicolegal postmortem examinations are performed to advance a death investigation in the interest of the public. In Canada, medicolegal autopsies are primarily conducted by a Forensic Pathologist. However in certain circumstances, a hospital pathologist may be called upon to perform a routine medicolegal postmortem examination. Through the use of case studies involving hangings, motor vehicle collisions and sudden cardiac deaths, this 3.5 hour workshop will review the stepwise process followed by a Forensic Pathologist when performing a routine medicolegal autopsy. Following the Ontario Forensic Pathology Service Practice Manual for Pathologists, this workshop will focus specifically on: case history, describing injuries, using laboratory testing beyond toxicology, formulating the cause of death, and producing a final report.

Back to top

 

 

W1014 What ISUP with prostate cancer? Grading, variants and new developments
Sunday July 10, 0800-1130

 

David Berman, Queen’s University, Queen’s Cancer Research Institute

Lawrence True, University of Washington

Theodorus H. Van der Kwast, Princess Margaret Cancer Center, University Health Network

George M. Yousef, St. Michael’s Hospital, University of Toronto

 

Objectives:

At the end of the session, the participants will be able to:

  • Apply the latest ISUP grading system for prostate cancer in daily practice.
  • Correctly distinguish Gleason grade 3 patterns from Gleason grade 4 / 5 patterns in prostate needle biopsies.
  • Identify and report the presence of intraductal carcinoma in prostate needle biopsies.
  • Recognize unusual variants of prostate cancer in prostate needle biopsies.
  • Understand the potential clinical importance of large scale genomic profiling studies in prostate cancer.

The management of patients with prostate cancer is mainly dictated by the biopsy Gleason score. Currently, most men with a low risk prostate cancer are managed by active surveillance and in these men the presence of any amount of Gleason grade 4 constitutes an important trigger for active therapy. A recent survey among pathologists after the introduction of the ISUP 2005 modified Gleason grading system showed a tendency to over-grade prostate biopsies. The importance to distinguish high grade PIN from intraductal carcinoma has also attracted recent interest, because of its potential clinical implications. Through very active management by the International Society of Urologic Pathologists (ISUP) diagnostic and grading criteria for urologic malignancies have undergone several changes addressing these issues. Indeed, an overhaul of the Gleason grading system was the subject of a day-long ISUP meeting in the fall of 2014. Additional changes in the field are arising through increasing activity in cancer genomics, which are linking an increasing number of genomic changes with prognosis and with response to targeted therapies.

The workshop, entitled “What ISUP with bladder and prostate cancer? Grading, variants and new developments” will address these challenges in an engaging and interactive format. Using scanned images and multiple choice questions, the organizers will provide participants with a pre-workshop assessment to orient them to critical comparisons between entities and grading systems. Participatory exercises will be utilized throughout the workshop to engage the audience and to elicit and address knowledge areas that need additional exploration and explanation. At the end of the sessions, participants will be recruited to utilize knowledge from prior portions of the workshop to diagnose scanned slide images and to answer multiple choice questions. These active learning experiences will reinforce learning that occurred during the workshop.

Back to top