Cytopathology Rotation

The program provides three months of cytology with the curriculum taking the resident through gynecologic, non-gynecologic and fine needle aspiration material. There is ample patient material and numerous study sets are available for review. The outstanding cytopathology faculty at Cedars-Sinai includes board-certified cytopathologists and California-licensed cytotechnologists, all of whom are involved with resident teaching. With approximately 2300 FNAs annually, residents learn the performance, handling and interpretation of direct fine-needle aspirates and CT-guided aspiration, becoming proficient in fine needle aspiration of superficial lesions. The 7000 annually received non-gyn cytologies ensures residents see the full range of lesions evaluated cytologically. Correlation of cytology samples with associated surgical pathology specimens is performed. In addition, there is active clinical and translational research ongoing in cytopathology. Residents present a cytology conference once during each rotation.

Rotation Structure

The resident on rotation in the Cytology service attends sign-out with the Cytology I attending. In the event that there are two residents assigned, the second resident signs out with Cytology II attending. The resident is expected to:

  • Preview the daily slides, look up the relevant clinical information on their cases and, if necessary, pull out and review previous histopathology and/or cytology slides, request special stains, and review special stains with responsible attending so that the case may be signed out in a timely manner.
  • Write up cases of fine needle aspiration biopsies and take representative pictures on thyroid cases.

The American Society for Cytopathology recommends that residents review at least 1500 cytology specimens during the course of their training. This means at least 500 cases a month. The resident covers the FNA service during the month. He/she will attend FNA procedures with the attending on call and learn to perform the procedure based on the discretion of the attending.

Residents on cytology rotation I and II screen a set number of GYN slides then review them with the cytotechnologist for a minimum of ten multihead sessions. This will help them learn the basics and give them an exposure to screening slides.
The Resident on Cytology rotation II spends the first day of the rotation in the laboratory observing the various techniques of cytology specimen preparations. It is expected that during the course of the residents' training in cytology, they will be familiar with the various types of specimens, the methods of sampling, preservation techniques and laboratory preparatory processes. Other educational opportunities include utilizing cytopathology study sets, attending ASC teleconferences, participating in CAP Interlaboratory Comparision Programs for gyn and non-gyn cytology samples and attending the cytology QA conference.

Every resident on the cytology rotation prepares a talk on any cytology topic of their choice under the guidance of a cytology faculty mentor of their choice. These may include basic topics, new advances, or research projects. Residents are expected to review literature for their presentations and include new and/or recent information on all topics.

Specific Cytopathology Goals and Objectives

Patient Care:

  • Obtain relevant clinical information on cases, pull out and review previous histopathology and/or cytology slides if available, request special stains, and sign out cases in a timely manner.
  • Create reports of fine needle aspiration biopsies including representative images for select cases.
  • Become proficient in the performance of fine needle aspiration.
  • Perform cytopathology/histology correlation.

Medical Knowledge:

  • Define the diagnostic criteria of entities diagnosed cytologically.
  • Identify the appropriate use and interpretation of histochemical and immunohistochemical stains in working up cytopathology specimens.
  • Identify the lesions appropriate for fine needle aspiration and the techniques for proper performance.

Interpersonal and Communication Skills:

  • Construct a clear, cogent, accurate and properly formatted cytopathology report.
  • Interact with physician or clinical support staff to obtain more information and to report a preliminary or final diagnosis in a clear manner that inspires confidence and fosters collegiality.
  • Deliver a well organized and clear cytology conference.

Professionalism:

  • Self-identification of the resident as the case physician. Assigned cases are the resident's cases.
  • Reliably follow instructions for obtaining additional studies or information.
  • Keep close track of pending cases and notify Attending of unexpected problems or delays.

Practice-Based Learning and Improvement and Systems-Based Practice:

  • Describe the role of proficiency exams in cytopathology laboratories.
  • Explain the CAP Interlaboratory Comparision Program.
  • Discuss the role of, and demonstrate how to organize, a Cytology QA conference.
  • Maintain ongoing case-based reading.
  • Utilize the information provided by the clinician and/or seek additional information to aid diagnosis.