Preconference Workshops

IMPORTANT UPDATE! The following workshops have Advance Materials for review by participants:

W1012 Case Based Approach to Soft Tissue Tumors
W1014 Breast Pathology: Challenges and Pitfalls
W1022 Intraepithelial Neoplasias of the External Genitalia and Associated Inflammatory Dermatological Lesions
W1023 2015 WHO Classification of Lung Tumours – The Impact on Pathology Practice

 

The following Preconference Workshops will be held on Saturday, June 10:

 

Saturday June 10 Morning – 0900-1230

Saturday June 10 Afternoon – 1400-1730

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CONCURRENT MORNING WORKSHOPS

 

W1011 Statistics for Pathologists: Primer on Diagnostic Accuracy Statistics
Saturday June 10, 0900-1230

 

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.

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W1012 Case Based Approach to Soft Tissue Tumors
Saturday June 10, 0900-1230

 

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.
  • Use distinguishing histological features, immunophenotype, and molecular testing to diagnose soft tissue lesions.

This workshop will 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

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W1013 Interpretation of GI Biopsies – A Practical Approach to Reporting Common Entities
Saturday July 10, 0900-1230

 

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:

  • Cite 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 will cover most common entities encountered in routine GI biopsy signout. Audience participation will be actively encouraged.

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W1014 Breast Pathology: Challenges and Pitfalls
Saturday June 10, 0900-1230

 

Anita Bane, McMaster University

Hala Faragalla, St. Michael’s Hospital

Anna Marie Mulligan, University Health Network

 

Objectives:

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

  • Establish an approach to effectively diagnose spindle cell lesions.
  • Accurately identify variants of invasive mammary carcinoma and understand their prognostic significance.
  • Recognize the spectrum of papillary lesions and apply an approach for classification and diagnosis.
  • Understand the pathologist’s role in molecular testing in breast cancer in the molecular era from selecting an appropriate block for testing and correlating the molecular result with histological features.
  • Effectively diagnose sclerosing lesions with emphasis on benign and malignant mimics.

This work shop is directed at anatomical pathologists, pathology residents, fellows and pathology assistants. This workshop will be provided by three subspecialized breast pathologists. The workshop will be divided into six case-based discussions to include common and uncommon lesions encountered in everyday practice including papillary lesions, spindle cell lesions and sclerosing lesions. In addition, guidelines and practical tips for interpretation and reporting predictive biomarkers will be provided.

For each clinical case, high resolution histologic virtual images of the case plus radiologic finding will be provided. The key morphological features, immunohistochemical profile, diagnostic features, differential diagnosis, mimics and pitfalls will be discussed. The clinical management and implication for each of these entities will be highlighted.

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CONCURRENT AFTERNOON WORKSHOPS

 

W1021 Hematopoietic Neoplasms with Unusual Presentations and Findings: Avoiding the Pitfalls with Hematopoietic and Non-hematopoietic Neoplasms; “What Not to Miss”
Saturday June 10, 1400-1730

 

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.

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W1022 Intraepithelial Neoplasias of the External Genitalia and Associated Inflammatory Dermatological Lesions
Saturday June 10, 1400-1730

 

Blaise Clarke, University Health Network

Michelle Downes, Sunnybrook Health Sciences Centre

Karen Naert, University of Calgary

 

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.

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W1023 2015 WHO Classification of Lung Tumours – The Impact on Pathology Practice
Saturday June 10, 1400-1730

 

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.

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W1024 Leadership Role of Pathologists in a Patient-Centered Era
Saturday June 10, 1400-1730

 

Sandip K. SenGupta, Queen’s University

 

Objectives:

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

  • Appreciate the Pathologist’s central role in the provision of integrated, patient-centered healthcare.
  • Learn successful strategies for providing valueadded pathology services in your healthcare organization.
  • Establish Pathologists’ leadership role beyond the laboratory and into the coordinated care environment.
  • Evaluate pathology practice to identify needed adjustments for a more team-based approach.
  • Apply medical informatics principles to manage individual patient and population laboratory information.
  • Affect positive change in an evolving health care delivery system.

The field of pathology has seen monumental changes in recent years. With the advent of personalized medicine and understanding the molecular basis of disease, healthcare has been transformed. At the same time, healthcare organizations are in the midst of another transformation: from volume- to value-based healthcare, including in laboratory medicine. Pathologists intersect with all major medical specialties and are well-positioned at the hub of laboratory testing. The important and diverse contemporary leadership roles that Pathologists can demonstrate in their local environment(s) to create and add value to their services will be discussed through a review of the rapidly changing North American healthcare landscape, and also through case studies that provide additional insights into evolving leadership skill sets and experiences that are required to ensure growth and sustainability of our profession in the decades to come.

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