Advanced practitioner in anatomic pathology: The time has come

Abstract

In this issue of Cancer Cytopathology, Kopp et al 1 from the Mayo Clinic show how properly trained cytotechnologists can go outside their traditional scope of practice to aid the pathologist in the making of tissue microarrays (TMAs) for research. As background, at the Mayo Clinic, demands on pathologists' time have been increasing, and this is associated with workforce shortages, increasing specimen complexity and interpretation requirements, and decreased reimbursement. As such, important research has been substantially postponed because up to the present, pathologists have been completely responsible for the making of TMAs. TMAs are composite specimens in which small sections (donor cores) from many different paraffin blocks and/or cases are placed into a single block that can then be used to test reagents against multiple samples simultaneously. TMAs are, therefore, very useful in determining the operating characteristics of immunohistochemical and molecular tests. However, to make an optimal TMA, the proper tissue and area within that tissue need to be selected from each case. This selection process means not only that the tissue containing the best, or most representative, target area (eg, the neoplasm or infectious organism) needs to be appropriately identified but also that the selected areas must be free of technical artifacts and other confounding features. This process requires significant morphologic knowledge and skill and diligent screening of the samples under consideration. In this study, cytotechnologists, under the supervision of pathologists, reviewed the study design to understand the research goals for each TMA construction, reviewed the glass slides of the target tissues, and selected the most appropriate blocks for inclusion in the TMA. They then reviewed blocks and slides together to identify the best blocks and areas within the blocks from which the donor cores would be taken. Cytotechnologists then scored the TMA cores for immunohistochemical results. Scoring included the reactivity in the invasive or in situ tumor, stroma, and benign tissues; the type of staining (nuclear, cytoplasmic, or membranous); the quantity of staining (the percentage of cells) and/or the staining intensity; and so forth as needed for each individual TMA research objective. The results of the study showed that appropriately trained cytotechnologists completed all of these tasks successfully. In either complete or percentage spot checks by supervising pathologists, disagreements on tissue selection or scoring were well within the ranges expected from interpathologist correlations and were associated with expected areas of subjective disagreement, such as the best area for obtaining donor cores or stain intensity. Interestingly, cytotechnologists actually performed better at some aspects of the process, most notably in technical assessments of the paraffin block material. The authors concluded their work by noting that research requiring TMAs that had been on hold for years because of a lack of pathologist time wa...

Exploring staff turnover, burnout, and resilience in cytology reference laboratories: A workforce qualitative study

“…Other facilities, according to the authors, utilised the cytotechnologists for molecular procedures, such as fluorescence in situ hybridisation (FISH) and chromogenic in situ hybridisation (CISH). The editorial further pointed out that the involvement of cytotechnologists to prescreen FISH assays improved laboratory efficiency and helped the lab achieve $400 000 savings 36 . In fact, in a recent survey of laboratory employers in the greater New York region, reference laboratories have expressed interest in cytotechnologists who, in addition to traditional cytology screening, are also proficient in FISH skillsets 37 …”

“…In an environment of decreased reimbursement, the work demands for pathologists have increased and integrating the cytotechnologists' location‐skill and morphology expertise into pathology research can improve the quality of effort, productivity, and job satisfaction as well 34,35 . Sweeney and Wilbur, in an editorial published in 2018, pointed to some of the laboratories that have been successful at engaging their cytotechnologists to the full potential by using career ladders, such as taking on added responsibilities outside of the traditional gynaecological and non‐gynaecological screening 36 . These include acting as a pathologist‐extender, prescreening biopsy specimens for the pathologists or special stains for organisms.…”

“…34,35 Sweeney and Wilbur, in an editorial published in 2018, pointed to some of the laboratories that have been successful at engaging their cytotechnologists to the full potential by using career ladders, such as taking on added responsibilities outside of the traditional gynaecological and non-gynaecological screening. 36 These include acting as a pathologist-extender, prescreening biopsy specimens for the pathologists or special stains for organisms. Other facilities, according to the authors, utilised the cytotechnologists for molecular procedures, such as fluorescence in situ hybridisation (FISH) and chromogenic in situ hybridisation (CISH).…”

“…The editorial further pointed out that the involvement of cytotechnologists to prescreen FISH assays improved laboratory efficiency and helped the lab achieve $400 000 savings. 36 In fact, in a recent survey of laboratory employers in the greater New York region, reference laboratories have expressed interest in cytotechnologists who, in addition to traditional cytology screening, are also proficient in FISH skillsets. 37 It is therefore important for commercial laboratories to be inclusive and offer work-life balance so that young working cytotechnologists, with family obligations, can thrive at the laboratory and not feel the pressure to have to work overtime and on weekends.…”

Cytotechnology schools: Future outlook

“…The six entry-level competency categories that serve as the underpinnings of the new curriculum are rooted in cognitive, psychomotor, and affective learning domains aligned with current and future trends in diagnostic cytopathology practice. 1,33 Cytologists, graduating from graduate level programs with the new curriculum will first and foremost be morphologists, skilled in locating cells and recognizing cellular patterns associated with both benign and malignant disease processes. They will also be prepared to use companion techniques; using computer assisted screening devices designed to assist in locating abnormal cells, selecting appropriate ancillary tests such as flow cytometry and microbiology to accurately diagnose disease, and performing rapid on-site evaluation during fine-needle aspiration procedures among other practical skill sets.…”