“Together Towards Tomorrow”

As we start 2019, full of new resolutions, hopes and optimism, I have written down the following presidential address for The ASC Bulletin, outlining my goals and initiatives for the Society.

The cytopathology community in general (and the ASC in particular), is like a big extended family; hence, over the past 25 years I have had the pleasure of knowing so many ASC members at a personal level. However, for those of you who do not know me yet, I would like to briefly introduce myself. I completed my Anatomic/Clinical Pathology training at North Shore University Hospital in New York followed by an Oncologic Surgical Pathology fellowship at the Memorial Sloan-Kettering Cancer Center and a Cytopathology fellowship at The Johns Hopkins Hospital in Baltimore. Johns Hopkins captivated me so deeply that ever since completing my training in 1997, I have been on its staff. I have been an ASC member since 1993. Right from the beginning when I stepped into Pathology, I was blessed with great mentors who all had a long and distinguished relationship with the Society. They inculcated in me a strong sense of dedication and selfless service to the ASC – Drs. Steve Hajdu, Patricia Saigo, Yener Erozan and Dorothy Rosenthal (all Past Presidents of the ASC). The Johns Hopkins Hospital itself was a huge motivating factor for me to get involved with the ASC very early in my career – the Cytopathology lab named after the great Dr. John K. Frost and the Cytoprep lab named after Gary W. Gill, both truly remarkable individuals with a long and distinguished service record for the ASC.

At the recent ASC Annual Scientific Meeting in Washington DC, I opened my short president-elect address by reading a quote from President Lincoln – “The best way to predict your future is to create it.”  ASC’s future is bright as a result of dedicated and steadfast members like you – striving and endeavoring (and “creating it”) today to ensure that the ASC will lead the profession for decades to come. As your new President, I seek your help and assistance to make certain that we all add measurably to our beloved Society and further its mission of education, research and patient advocacy.

My Goals and Initiatives

New Committees and Task Force

In my professional career, the most successful and rewarding experiences have resulted from close mutual collaborations with like-minded individuals and organizations, most of whom have been overseas. With that firm conviction in mind, my first order of business has been to create a new committee – “The International Membership and Liaison Committee” to explore and seek new membership and collaborations and broaden our base at a more global level. The committee is co-chaired by two outstanding individuals – Drs. Guliz Barkan and Diana Esther-Rossi. I’m happy to report that in the short time that this committee has been in existence, it has already taken a few steps to ensure a robust international outreach. There is a new “international competition” planned by the committee called the “World Vision Cytopathology Contest,” which we anticipate will be a very popular event and will be presented as part of our main scientific session at the Annual Scientific Meeting in Salt Lake City in November 2019.

I have also fulfilled my promise I made when I was nominated to run in the ASC’s election for the President; I am committed to addressing the problem and impact of “small tissue biopsy samples” on our practice of FNA cytopathology. As we know, these small biopsy samples create some unique and troubling issues in cytopathology not only diagnostically speaking but also with regards to billing and accounting. To that end, I have formed “The Small Biopsy in Cytopathology Task Force,” co-chaired by two uniquely qualified individuals – Drs. Stefan Pambuccian and Justin Bishop. The task force is actively investigating the issues involved and will assess the impact of the small biopsy samples on our practice and reimbursement. A detailed report is expected to be prepared by the end of summer and is planned to be presented at the 2019 Annual Scientific Meeting as a “white paper.”

“A World of Opportunities” – Global Expansion and Collaboration in Research and Education

Thanks to the positive and enthusiastic response from the International Academy of Cytology (IAC), most of its leadership attended our 2018 Annual Scientific Meeting in Washington, DC. This gave us the unique opportunity to have an important face-to-face meeting with the IAC officers. A decision was made to move ahead with the plans of having an “International Congress of Cytology” in the US, jointly arranged by the ASC-IAC in 2022. Stay tuned for further details as we are actively sorting out details of this most exciting event. As a well-known Japanese poet Ryunosuke Satoro once said, “Individually, we are one drop. Together, we are an ocean,” we expect that such collaboration will benefit both the IAC and the ASC and will eventuate in furthering the mission that both organizations share in common. We are also in active discussions with a number of overseas national and regional organizations to join hands mainly in educational efforts.

Our strength as a professional society is also in the size of our membership base. We are planning new strategies to recruit/retain new/existing members. The international committee initiatives are also synergistic to this effort – “Grow beyond borders – become more global.” Also, based on some excellent recommendations by the outgoing “Membership Committee” and its chair Dr. Rosanne Wu, I have put together plans to form a special subcommittee to look at our annual membership renewal fee structure/categories as well as the registration fee for our Annual Scientific Meeting, to make our membership more attractive to potential new members. A final decision will be made as soon as the subcommittee informs me and the executive board of its recommendations. Also, to further help the important task of the membership committee, I have formed the new “Ambassador Committee” and given it specific charges of introducing new members to benefits and programs offered by the ASC and represent the Society at a local/regional level to increase new member involvement.

“Re-engaging ASC’s Past Leaders”  

This has always been very close to my heart since I assumed the presidency. Past leaders of the ASC (presidents, EB members, committee chairs) and their immense contributions have never been forgotten. However, there is a definite need to have a structured plan in place for the Society to take advantage of their wisdom and experience. I have renewed efforts this year to involve many of them as advisors on some standing committees. I have also requested the Chair of the Scientific Program Committee find ways to invite them as faculty at the Annual Scientific Meeting. The “pearls of wisdom” can never get outdated and their simple presence at the Meeting adds so much value and significance. New and junior members in particular, would be thrilled to see these highly acclaimed and famous individuals amongst them. We cannot treasure the present and shape our future without honoring our past.

 “The Challenge of Change” – Embracing New Technologies

Every passing year we see the introduction of new and clinically valuable diagnostic tools, which help us measurably to achieve higher accuracy in our daily interpretation of cytologic specimens. We have all witnessed the monumental impact of molecular tests, precision medicine and cancer genomics on our profession. To me, the single most important reason for cytopathology to be so successful as a profession is its ability to adapt and integrate the latest cutting-edge technologies in the practice. The next significantly important and breakthrough technology knocking at our door is “machine learning” or “artificial intelligence.”  Consequently, I have advised Dr. Paul Wakely (Chair, Scientific Program Committee) on this issue, and we will have up-to-date expert presentations in the form of a “State of the Art” session during our 2019 Annual Scientific Meeting in Salt Lake City.

 “Reaffirming our Identity”

I firmly believe that the pathway to success for us as a profession is reasserting our identity as cytopathologists and cytotechnologists. We should feel pride in what we do every day – play a vital role as an important member of a multidisciplinary team taking care of a sick patient. We should find new and better ways to define/introduce cytopathology to all. To that end, I plan to work closely with the “Social Media Committee,” which is under the able chairmanship of Dr. Amy Clayton, who has some fresh ideas to accomplish this goal up for the year.

“The Measure of Tomorrow” – Mentoring in Cytopathology

Not everyone is as lucky as some of us are when we embarked on our journey to the cytopathology world with some of the best mentors guiding our paths to success. I plan to make mentoring a priority for this year. I urge all of you to find at least one student or trainee to exclusively mentor this year. Be a role model and help guide their journey. Motivate and encourage them and make them believe in their talent, abilities and potential to outshine in the profession. Share with them your own vision of success and remind them that the right time is right now – that the “future is today.”

At the end, I would like to thank each and everyone of you to entrust me with the distinguished honor of leading this great organization. I cannot appreciate enough, the selfless help and contributions of so many of you who chair or serve as members of various committees, Executive Board, and editorial board members/reviewers of the JASC. ASC’s present is strong and its future is bright. Let’s all make sure that we lead the profession for many decades to come. It’s time to join hands once again and take a firm step “Together Towards Tomorrow.”

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ASC-ASCP Workgroup on the Emerging Roles in Cytopathology

Barbara A. Crothers, DO President, American Society of Cytopathology

Summer solstice has come and there is a sunny future for cytotechnology! Wonder why that is? You can find out by reading the upcoming Journal of the American Society of Cytopathology’s articles on the work from the ASC-ASCP Workgroup on the Emerging Roles in Cytopathology, to be published in the September edition. If you are a member of ASCP, watch for the joint publication in Laboratory Medicine.

There is an early release online on July 1st.

The titles of the articles are:

These manuscripts represent the culmination of over 4 years of collaborative work between the American Society for Clinical Pathology (ASCP) and our Society. The enduring projects that emerged from this effort are the highly successful Advanced Cytopathology Education (ACE) course and the ACE University—an online curriculum. 

ACE Live is intended to bring cutting-edge updates in cytopathology to the grass roots practitioners, those who may not have the resources to travel to the ASC annual meeting. The ACE course, usually co-sponsored with ASCP, was co-sponsored this year from May 4-6 with the American Society for Cytotechnology (ASCT) in Salt Lake City, UT. Based on the course evaluations, of 106 participants, 96% rated the course as highly satisfactory and enhancing knowledge and/or work skills. The focus for this year was on new cytology terminology—The Paris System for Reporting Urinary Cytopathology, The Bethesda System for Reporting Thyroid Cytopathology, and advances in pancreatic fine needle aspiration.

ACE University is a work-in-progress that is intended to provide practitioners and cytotechnology schools with educational modules to fill in practice gaps. The first module, on Rapid Onsite Evaluation (ROSE), has been developed and serves as the model for future topics. Completion of all available modules will earn the participant a certificate in advanced cytopathology practices and, hopefully, a chance to advance career progression and bring cytopathology into the future. Who knows? It may evolve into a required component for a Master’s degree in Cytotechnology for programs looking to supplement their curriculum.

 

PLANTING CYTOSEEDS

A garden requires patient labor and attention. Plants do not grow merely to satisfy ambitions or to fulfill good intentions. They thrive because someone expended effort on them.

Liberty Hyde Bailey

 It’s SPRING – time to plant seeds! There are two types of seeds in cytology – people and ideas. It takes the right people, with dedication and motivation, to instigate change. And it takes ideas that can take root, branch out, cross-pollinate and grow into something new and beautiful. The ASC has been working on both.

Barbara A. Crothers, DO President, American Society of Cytopathology

Growth is painful; so is change. Flowers and fruit don’t emerge without both. It is the journey of growth and change that defines us as humans and it is part of our natural condition. As an optimist, I believe that we usually make things better through experimentation, personal growth and change. Our profession – indeed, all of health care – is in a time of monumental change. What is important is that we have a vision for our contributions to the future. Growth doesn’t happen overnight; it has been happening for years. I recall when the idea of a mid-level practitioner was first pitched to the ASC Executive Board by Jean Taylor, SCT(ASCP) in 2004 – it caused quite a stir! Now we have the very individuals that were envisioned and are on the way to solidifying a curriculum that will become the standard for all future “cytotechnologists,” if that title is retained.

I’ve been hearing from some of our cytotechnologist members lately about the state of cytotechnology, and they’ve been experiencing growing pains. One of them asked, “What happened to cytotechnology, and why haven’t you converted everyone to a Master’s Degree Program?” Cytotechnology is changing, and for the better. Gone are the “screeners” who “dotted” slides for pathologists. Newly minted cytotechnologists are more involved with diagnostics, specimen adequacy and quality, and ancillary testing. They have evolved into pathologist extenders, moving into other positions where their background and skills are valued. When I think of the cytotechnologists that I’ve worked with in my career, most of them are now involved with molecular testing and diagnostics, histology/ immunohistochemistry, management, quality improvement and/or research. Several have obtained Master’s degrees in public health, business or other health-related areas. Some now work at the Centers for Medicare and Medicaid Services, Food and Drug Association, and National Institutes of Health; others have managed anatomic pathology laboratories. I’ve seen upward mobility of cytotechnologists improve, from the old glass-ceiling job, where the only “promotion” options were to become a cytology school instructor or a cytology supervisor, to the current state where many expanded positions are available.

The change to a Master’s degree program is happening; the Cytotechnology Programs Review Committee (CPRC) reports the following:

At present, there are 24 accredited Cytotechnology training programs in the United States and Puerto Rico. There are 8 certificate-only Programs, 8 degree-only Programs, and 9 certificate and degree Programs.  As of 2017, there are 5 Masters Programs with another to begin in 2018. While the number of Programs has decreased, satellite sites and distant learning/online education have become more prevalent.  The CPRC continues to focus on “phase II entry-level competencies” and collecting data as part of the process of moving 3 different levels of education to a Masters level curriculum.  Fitting [this] robust curriculum into the current academic structure is difficult; realistically, most Programs are educating their students at Masters level in bachelor and certificate programs.

The CPRC will be working this year on recommending new entry level competencies (ELC) for the 2018 revision of the Standards and Guidelines for the Accreditation of Educational Programs in Cytotechnology. These competencies will define the new cytology mid-level practitioner. These are powerful seeds, indeed, that will yield a new crop of “cytotechnologists” who will not be as limited in their scope of practice. The movement towards a team approach in medicine requires partners trained in rapid on-site evaluation, triage of specimen for ancillary testing, digital pathology and informatics, and molecular techniques.

Cytotechnologists were seeded into our organization decades ago, became ASC members, had their own board and then became members of the Executive Board. They are now committee Chairs and members. They are the heart behind the organization and remain a driving force in sowing seeds of change. The ASC/ASCP (American Society for Clinical Pathology) Workgroup, consisting primarily of cytotechnologists, was established in 2014 to identify professional trends and develop goals and outcomes to support the profession’s longevity. I am delighted to report that the culmination of their tireless efforts will be available to you in the fall, as manuscripts in the Journal of the American Society of Cytopathology and the ASCP’s Laboratory Medicine. They will be publishing their data on current and future trends (collected through focus groups and a Delphi Study), the ASCP Board of Certification Practice Analysis data, and the outcomes of the Advanced Education in Cytopathology grass-roots courses. Now that their initial goals have been achieved, the ASC/ASCP is restructuring to become the Workgroup on Emerging Roles for Cytopathology (WERC).

Speaking of planting seeds, the ASC has been invited to join the ASCP and USCAP “Africa Calls” efforts to deliver cytopathology education to sub-Saharan Africa. The ASCP has been supporting this effort for over 20 years, with 22 sites in 13 countries, but these programs are looking for teaching slide sets and physical materials. If your institution or program has materials that they would like to contribute, please contact David B. Kaminsky, MD, FIAC, the Executive Vice-President of the United States and Canada Academy of Pathology (USCAP). The ASC will be investigating ways that we can facilitate these efforts through our organization. Meanwhile, the WERC will be “werking” on the ACE University – a certificate program that will offer cutting-edge updates to cytopathology practices in the form of on-line modules for current practitioners to fine-tune current skill sets.

There’s still time to get out into your cytogarden and spread a few seeds of your own; you never know what might take root.

PREPARING THE SOIL

The glory of gardening: hands in the dirt, head in the sun, heart with nature. To nurture a garden is to feed not just the body, but the soul.

— Alfred Austin

Barbara A. Crothers, DO President, American Society of Cytopathology

I want to talk about the importance of soil–and foundations. Soil is more than just dirt; it is teaming with essential microbial life and potential. If it’s healthy, it provides the necessary nutrients and minerals needed for growth. But soil requires attention, too- we all know that crop rotation was introduced due to soil depletion. Farmers understand that one needs to nourish the soil so that it can nourish plants. Sometimes that just means letting it lie, but sometimes it means composting, tilling, burning, slashing and mulching.

A large part of the ASC “soil” is our collaboration with otherorganizations- areas into which we can extend our roots and form symbiotic relationships. I’ve spent the first few months of my term solidifying relationships and creating new ones, as have many of the ASC leaders. Late last year, ASC President Edmund Cibas wrote a heartfelt letter to Dr John Kirby, Dean of the College of the Environment and Life Sciences, University of Rhode Island, to implore him to reconsider the closure of their excellent Cytotechnology Program. In it, he emphasized the changing roles of cytotechnologists and their contributions to cancer diagnoses other than Pap testing. The University of Rhode Island Cytotechnology Program services a large northeastern region and its loss would adversely impact personalized care to regional oncology patients. I’m pleased to report that his efforts, and those of the Program Director, Barbara Klitz MS, CT (ASCP), had the desired effect of keeping the program open. By unanimous decision, this program now falls under the Cell and Molecular Biology Department- a perfect fit! If you know of any potential cytotechnology student candidates, have them check out the University of Rhode Island program for enrollment, so that they may plant their feet in that rich soil.

Garden Soils are Microbiomes

One of my first actions was to write a personal letter to President R. Bruce Williams MD, College of American Pathologists (CAP), offering to partner with their organization for the See, Test and Treat Program to offer cervical cancer screening services to underserved women. In addition, we are exploring ways to team up on defining new roles for cytotechnologists to address future cytopathology workforce needs. The closure of cytotechnology (CT) schools is disturbing, but it also opens up opportunity to shift the focus of CT training from screening to supportive roles that advance newer oncology testing techniques, such as fluorescent in-situ hybridization (FISH), rapid on-site evaluation (ROSE) of minimally-invasive procedural specimens for adequacy and triage, and specimen preparation/selection for molecular analysis. The CAP also sponsors a National Pathology Organizations meeting of 9 organization which met February 9th to coordinate advocacy efforts. Common shared interests included the status of laboratory workforces, including shortages of cytotechnologists, medical technologists, and forensic pathologists; responses to FDA laboratory developed procedures and Centers for Medicare and Medicaid’s (CMS) request for information (RIF) on next-generation sequencing reimbursement; and support for graduate medical education and research. All of the organizations, including ASC, agreed to collaborate as a unified voice on common issues.

Cytology’s Role in Next Generation Sequencing testing

One of the ways that the ASC showed its support for sister organizations was in our response to CMS’s RIF on next-generation sequencing (NGS) reimbursement.  In our on-line public comment response, ASC supported the Association for Molecular Pathology’s position by cautioning against the stringently drafted reimbursement guidelines for NGS testing. The ASC noted the unduly restrictive conditions that limit reimbursement to patients with advanced cancer and highlighted the important role that cytology plays in providing tissue for NGS testing. The restrictive proposal would exclude cytology specimens from reimbursement, because these require laboratory-developed procedures (LDP) for validation of ancillary tests performed. This would bar a large proportion of oncology patients from critical diagnostic and therapeutic/prognostic tests if cytology specimens are obtained.

Not Just Anyone Can Do Cytology…

The ASC is currently working in cooperation with several pathology organizations to formulate a response to a recent CMS call for public comment regarding Clinical Laboratory Act Amendment (CLIA) changes to laboratory testing and technical supervisory personnel. Briefly, the CMS is asking whether a nursing degree (Bachelor of Science in Nursing) qualifies individuals to perform laboratory testing and/or act as technical consultants. They also invite other proposed changes to existing CLIA personnel requirements. The Government Affairs and Economic Policy Committee provided me with an in-depth outline of the issues and background supporting data and our response is in development. Fortunately, CLIA protects cytotechnologists with very stringent personnel requirements and we all agree not to disturb that soil.

Self-Collected Pap tests?

Along other regulatory lines, the ASC was represented at a January 11th meeting of the FDA seeking public comment on the feasibility of introducing self-collection devices for Pap testing. Paul Staats, MD gave an astute presentation on the issues, problems and risks of self-collection devices for cytology, and Dorothy Rosenthal, MD provided insight on logistics and the potential chemical dangers to patients. I issued an ASC statement at the end of the meeting emphasizing our concerns that women might opt-out of clinical visits in favor of self-testing, with the potential ill effect of increasing the rates of cervical cancer in previously well-screened populations through extended delays in follow up. Although the FDA specifically did not address self-testing for primary HPV testing as a cervical cancer screening test, this is certain to be soon on the docket for discussion.

Digging in

A little soil disruption can go a long way: the ASC voted to remain neutral in the ongoing discussion about Maintenance of Certification (MOC) and the requirement by many Specialty Boards for a re-certification examination every 10 years. However, pathology is fortunate in that the American Board of Pathology (ABP), the last specialty to introduce MOC, remains on the cutting edge of exploring reasonable alternatives to document competency of its diplomates. As a step towards easing the pain of reporting, the ABP is collaborating with the Accreditation Council for Continuing Medical Education (ACCME) to create automated reporting of a diplomate’s educational and practice improvement activities for MOC to the ABP. The registration of educational activities and reporting of diplomates’ completion data to the ABP is done by CME accredited providers, using the ACCME’s Program and Activity Reporting System (PARS).  PARS is a web‐based system that collects data about educational activities. Beginning in 2018, PARS will be available for CME accredited providers, such as the ASC, to register their educational activities for MOC and report diplomate completion data to the ABP.  CME accredited providers will also be able to identify and categorize their CME, SAMs, and Part IV activities that will be searchable by diplomates in ACCME’s CME Finder.

ASC’s Most Supportive Microbe

There is always a “most prevalent” organism (organization) that supports a microbiome, and for the ASC, it is the CETC. The Cytopathology Education and Technology Consortium is a comprised of representatives from the American Society of Cytopathology (ASC), American Society for Clinical Pathology (ASCP), American Society for Cytotechnology (ASCT), College of American Pathologists (CAP), International Academy of Cytopathology (IAC) and the Papanicolaou Society of Cytopathology (PSC). The consortium has been very active lately with multiorganizational responses to suggested guidelines or governmental calls for information. In October 2017, CETC submitted a succinct, coordinated response to the United States Preventive Service Task Force cautioning on their recommended guidelines to introduce primary HPV screening for cervical cancer without sufficient longitudinal evidence. Similarly, they outlined laboratory concerns about Pap test self-collection devices for submission to the FDA. Ritu Nayar, MD, an ASC former President, is the CETC’s representative on the American Society for Colposcopic and Cervical Pathology (ASCCP)- National Cancer Institutes (NCI) working group for risk-based guidelines to follow up abnormal cervical cancer screening tests. The CETC has been the watchdog for our organization; quickly bringing important issues to our attention and coordinating solutions. It is truly a symbiotic relationship and highly valued.

The sun is setting, my hands are dirty, but I can’t go wash up without mentioning one other critical partner- the College of American Pathologists. Through the CAP Center, the ASC and 7 other societies have published guidelines for the appropriate collection and handling of thoracic specimens for laboratory testing, soon to be published. Sinchita Roy-Chowdhuri, MD, a molecular and cytopathologist, is the Co-Chair of this critical consortium. Cytology specimens play a central role in reducing the morbidity and mortality of lung cancer diagnoses, and our seat at this table was critical to ensure that patients continued to have a cytology alternative for diagnosis.

The soil is prepared…Next up- planting seeds.

Message from the ASC President – Welcome to the Garden

Barbara A. Crothers, DO, ASC President Joint Pathology Center Silver Spring, MD

I aspire to be a farmer. I’m already a gardener who enjoys the fruits and flowers of my labors and now you, the members of the American Society of Cytopathology, have entrusted me with a great landscape to sow the seeds of change. It is a great privilege! I am honored to serve you, the profession of cytopathology, and our patients. I am sincerely grateful for your vote of confidence. But I will need your help.

Farming and gardening are cooperative activities that rely on an interconnected ecosystem for success, so I will use that analogy this year to chart our way. New gardeners and farmers plan for the future, but also evaluate the present and reflect on the past. The ASC grows stronger and more stable each year; a thick trunk springing from a strong root system.

During my 30 years as an ASC member, I have been constantly amazed at how the Annual Scientific Meeting improves every year, and at the growth and outreach of our organization. Most of all, I am  impressed with the welcoming warmth of the members and the Executive Board. Our organization is like a family that continues to embrace new members and get them involved. Without the encouragement and opportunities provided to me as a member, I would never be standing in these shoes as your President. You are the organization, and each of you has a significant role to play.

 

THEME: Grow Your Garden with 100 Years of Color 

Every incoming President selects a theme or focus for the year, and I chose “Grow Your Garden.” Gardeners focus on their own habitat, their own little worlds of color; a patchwork of gardens endows the world with beauty. Gardeners tend to work alone (aren’t most pathologists and cytotechnologists introverts?), looking at the big picture, but also getting down in the dirt and details. You are gardeners every day; we all influence things in our environment and impact outcomes, no matter how small our actions or how small our sphere. When you are a gardener, you go around looking at what is in your garden, what is doing well, what is not, and make some changes:  Weed-pull it out! Flourishing- plant more! Languishing- relocate! I ask each of you to work within your sphere of influence – whether that is in your workplace, on an ASC committee, in your community or internationally – to forward our goals as a profession.

This year we celebrate “100 years of color,” George Papanicolaou’s research based on Papanicolaou staining to color cervical epithelial cells. Without color, Dr. Papanicolaou would not have been able to differentiate between cellular changes. The foundation of cytopathology is morphology, the examination of colored cells. Our gardens thrive on color, and there are innumerable cell blossoms that we view daily. It works well with a garden theme, don’t you think?

The ASC has already laid the groundwork for many changes we’ll be working this year. We have a strategic plan in alignment with the quality and safe practice principles of the Institute of Medicine, thanks to Dr. Eva Wojcik. I can’t say enough good things about the ASC/ASCP Working Group for the Future of Cytopathology spearheaded by Kalyani Naik, MS, SCT(ASCP), Maria Friedlander, MPA, CT(ASCP)CMIAC, Lynnette Pineault, SCT(ASCP), Amy Wendel-Spiczka, MS, SCT, MP, HLT(ASCP)CM, Sandra Giroux, MS, SCT(ASCP)CFIAC, and A. Janie Roberson, BS, SCT(ASCP)CMIAC, focused on emerging cytopathology roles and re-invention of the profession, particularly the transformation of cytotechnology. They’ve done a lot of heavy lifting to move us forward towards team-based cytopathology practice. Most importantly, we continue to collaborate with our sister organizations towards common goals: the College of American Pathologists, the American Society for Clinical Pathology, the American Society of Cytotechnology, the Papanicolaou Society of Cytopathology, the International Academy of Cytopathology, and the United States and Canadian Academy of Pathology.

But sometimes you have to do some weeding. Looking at our committee list, I “pulled up” the Continuing Education Oversight Committee, Position Statements and Guidelines Review Committee, Website Committee, and the Paris System Website Task Force to make room in the garden for some new initiatives. Committees should have a lifespan too – that’s a good thing; it means they have achieved their purpose. Two other committees are soon to see a shovel come their way – The ASC/IAC Milan System for Salivary Terminology and the Milan System Website Atlas Committee, but they still have a bit of work to do this year.

PLANTING NEW SEEDS

Once you make a space in the garden, you are inspired to fill it in. The ASC/ASCP Working Group will be restructuring to work through some of their recommendations for future growth. I’ve transplanted many members of the Website Committee to the Product Innovation Committee to conceptualize and design new products to help sustain us financially. There are two new Task Forces – CELL and CLIA – to work on special projects I’ve chosen to focus on this year. There are 69 new committee member “seeds” to help with these efforts. After you appoint and plant, it’s important to nurture the seeds, so… I have maintained or appointed seasoned leaders to act as advisors for these efforts. They include Mohidean Ghofrani, MD for the Product Innovation Committee; Kara Hansing, BS, SCT(ASCP) and Robert Goulart, MD for the CELL Resources Committee; David Wilbur, MD, George Birdsong, MD, Carol Filomena, MD and Swati Mehrotra, MD  for the Government Affairs and Economic Policy Committee; Lydia Howell, MD for the Public Affairs and Advocacy Committee; and Patricia Wasserman, MD for the Social Media Committee. I want to recognize, in particular, the critical work that they have all done in the past and continue to do for the Society. It doesn’t happen without all of you; all of you who volunteer, who attend Annual Scientific  Meetings, or even who advocate for cytology on a daily basis at your places of work – your sphere. YOU make the difference.

What is this meant to grow? Every President can only accomplish a few things during his or her year, and I chose the following areas of emphasis.

Transform, Re-energize and Recruit for New Cytology Professional(s)

I am deeply concerned about our dwindling cytotechnology schools and workforce. We cannot function effectively without cytotechnologists. They are the canaries in the coal mines – where they go, cytopathologists follow. We all must reinvent ourselves, and help each other do it. I’m asking the ASC to consider sponsoring an ASC University to develop a Master’s Program in Cytology for a new Mid-level Practitioner. It may involve a consortium of universities. In addition, we’ll double our contributions to the Cytopathology Education and Learning Laboratory (CELL) Website through the CELL Task Force to provide on-line education both nationally and abroad. The Cytotechnology Programs Review Committee (CPRC) and the Cytopathology Program Director’s Committee will collaborate on curriculum for a mid-level pathology professional Master’s program. The Social Media Committee and others have been charged to invent new ways to recruit and retain individuals in our profession.

Improve underserved US population access to cervical cancer screening with Pap tests

To this day, it is still primarily unscreened and under-screened women who get cervical cancer. We’re in a climate where healthcare is becoming unaffordable, more confusing, and less accessible, while at the same time we are advocating less screening with a molecular test that doesn’t detect dysplasia. We have to reach these women with an understandable message of the importance of screening, and preserve the Pap test as a scientifically valid screening test. The Public Affairs and Advocacy Committee is charged with coordinating with local patient advocacy groups and other organizations to create and investigate ways to make the messages clearer, and the ASC has begun discussions with the College of American Pathologist’s See, Test and Treat program to become a sponsor.

Prepare for changes in government regulations for cytology laboratories

We currently have a President, Donald Trump, who has stated that for every regulation passed, two must go, and we should be prepared. I’ve created a CLIA Task Force under the Government Affairs and Economic Policy Committee to partner with sister organizations and to examine current regulations for scientific validity and draft “ideal” regulations that consider the changes in cytology and technology.

Ensure financial solvency of the ASC through development of new products

The new Product Innovations Committee is charged with taking ideas from an ASC Executive Board Task Force, headed by Dr. Liron Pantanowitz, and coming up with new products that can help boost our revenue. In addition, the Budget and Finance Committee will be performing a 5-year review of the financial health of our organization and determine future projections for solvency.

Support cytopathology research through continued grants

The Scientific Program Committee, ASC Foundation, and Research and Current Concepts Committees will collaborate to foment new research in cytopathology.  That may include perpetuating the Shark Tank or finding other inventive ways of encouraging new investigators.

Not everything in the garden is beneficial–we are faced with many threats, primarily our diminishing workforce, the changing medical climate, and currently, loss of our vote at the AMA in the House of Delegates. We require 20% of our medical members to be AMA members to have a seat, and we rely solely on this position for influence in billing and reimbursement in Congress, so it is a critical position. I urge you, as a member, become an AMA member as well.

However, we are a strong organization, and we are capable of anything. What did President Barack Obama say? Yes, we CAN. And next year in Washington, DC, at this time, I hope to be able to tell you about the fruits of your labor and dedication. So the theme, “Grow Your Garden,” is an appeal for each of you to work within your garden, your sphere of influence; to grow your garden. Look around you. Evaluate your garden, your environment. That means capitalizing on what works, avoiding what doesn’t, and planting new ideas into the soil. You are a little dot, a grain of soil, in a large garden called the ASC. We are your support network- your soil, your nutrients, and your opportunity for growth. It’s easy to start small, coming to the ASC Annual Meeting, volunteering to sit on a Committee, posting to the blogosphere. I’m going to call on you, in the words of President John F. Kennedy, to ask not what ASC can do for you, rather ask what you can do for ASC!

You have my heartfelt thanks for all you have done in the past, present and future. GARDENING IS A HAPPY EXPERIMENT. This is your garden – go and play in it!

When Worlds Collide or What’s Music Got to Do With It?

This blog is for everyone who is passionate about Cytology but knows that our work doesn’t entirely define us. This blog is also confessional: I’m revealing something about myself that many of you don’t know. During high school and college, I dreamed of a career as a classical pianist. My parents arranged for piano lessons for me and my sister when we were young, and from my earliest years I loved playing. I performed extensively and loved it (mostly), but when push came to shove I realized that the life of a musician was not for me. Even though I ended up studying medicine, I never stopped playing. And to this day one of my favorite things is getting together with friends for an evening of chamber music.

Sometimes, my two worlds collide in surprising and delightful ways. In May 2013, I was invited to play a short program of music for piano four hands at the International Congress of Cytology in Paris. My partner in crime was Dr. Felipe Andreiuolo, a Brazilian pathologist living in Paris and a superb musician. An evening I’ll never forget!

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And now, surprisingly, my two worlds are colliding again: a few months ago I was at a retreat with the ASC Foundation, the purpose of which was to brainstorm about fundraising. During the retreat, to facilitate bonding among the participants, we all shared something personal about ourselves. Of course, I brought up my passion for music. I mentioned to the group that some live recordings of concert performances from my college and medical school years had been recently transferred from cassette to CD format to preserve them from extinction. Aha – a fundraising idea was born!

If you enjoy classical music, and if you’re at all curious to see this other side of me, you can own a copy of the CD by simply making a $50 (or greater) contribution to the ASC Foundation. Your contribution will go towards furthering the mission of the ASC – its commitment to education, research, and advocacy. The CD includes live performances of the Chopin Ballade in g minor and a couple of pieces by Brahms (from Op.118), all from my college years, as well as Jeux d’eaux by Ravel, recorded when I was a medical student.

A big thank you, in advance, for considering making a contribution to our very precious and worthy ASC!

Cytology Shark Tank Finalists Announced!

Cytology Shark Tank – ASC Young Investigator Grant
Saturday, November 11, 2017
5:30 PM – 6:30 PM

I’m pleased to announce that the members of the Research and Current Concepts Committee have reviewed 12 highly meritorious proposals and selected the three finalists for the ASC Cytology Shark Tank:


Eric Huang, MD, PhD
University of California, Davis
Sacramento, CA

Proposal: Diagnostic Utility of Raman Spectroscopy in Differentiating Thyroid Nodules and Identifying Thyroid Cancers


Sinchita Roy-Chowdhuri, MD, PhD
The University of Texas MD Anderson Cancer Center
Houston, TX

Proposal: Mutational Profiling of Centrifuged Supernatant Fluid from Fine Needle Aspiration of Thyroid Nodules


Vivian Weiss, MD, PhD
Vanderbilt University Medical Center
Nashville, TN

Proposal: The Use of Next Generation Sequencing to Identify the Molecular and Immunologic Mechanisms of Thyroid Cancer Invasion to Develop Improved FNA-based Testing


With 3 minutes for their pitch, followed by questions from four judges (“sharks”), each finalist will do his/her best to convince the judges (and the audience) that their proposal is the most deserving of the $50,000 grant.

The Cytology Shark Tank Aquarist (moderator) for the evening will be Dr. Liron Pantanowitz (University of Pittsburgh), and the Sharks (judges) will be Dr. Douglas Clark (University of New Mexico), Dr. Martha Pitman (Massachusetts General Hospital and Harvard Medical School), Dr. Celeste Powers (Virginia Commonwealth University), and Dr. David Rimm (Yale University).

Mark your calendars now (Saturday, November 11 at 5:30 PM). Be there to support and encourage our three finalists as they dive into the ASC Cytology Shark Tank!