Evolving Paradigms in NSCLC: EGFR Mutation Detection in Tumor and Plasma Samples
Date: Friday, September 15th, 2017
Title: Evolving Paradigms in NSCLC: EGFR Mutation Detection in Tumor and Plasma Samples
Time: Presentation to begin at 7:15 am, sharp
Location: The Waterhouse Ballroom, 1-3
Speakers:
Bekim Sadikovic, PhD DABMG (Cyto; Mol) FACMG
Section Head, Molecular Genetics
Associate Professor, Western University
Pathology and Laboratory Medicine
Christopher Howlett, MD, PhD, FRCPC
Assistant Professor, Department of Pathology and Laboratory Medicine,
London Health Sciences Centre and Western University
At AstraZeneca we strive to deliver great medicines to patients through innovative science. But managing disease can’t be done with medicines alone. Together we can develop creative solutions to help tackle the challenges of effectively preventing and treating disease.
AstraZeneca is proud to support the Annual Meeting of the Ontario Association of Pathology as part of our commitment to making a difference and improving the lives of Canadians.
Hospital Mergers – Simon Raphael
Objectives:
By the end of the talk the audience will be able to
- List reasons why hospitals and laboratory leadership consistently pursue mergers. Name some situations in terms of the development of hospitals and labs where mergers are often seen as a solution.
- What are the steps that usually are necessary to effect a hospital merger.
- What factors lead to a successful or unsuccessful merger
- Describe in general terms the record of mergers in North America over the past 50 years.
- What is the outlook for mergers in the future?
Session Description:
Mergers are a constant feature of Hospitals and Laboratories in Ontario. In this talk Dr. Raphael will discuss the features that will continue to impel hospital administrators and medical leaders to pursue mergers or takeovers as solutions to very real problems for Hospitals and Laboratories. We will examine what features characterize both successful and unsuccessful mergers and some of the evidence as to whether mergers produce the solutions to the problems that make them such as constant feature in the Medical landscape.
The Pathologist’s Assistant and the Dermatopathologist: We’re a Team – James J Limacher
Objectives: By the end of the talk the audience will be able to:
- Describe the role of pathologist’s assistants and their interaction with pathologists in handling skin specimens;
- List the different types of skin specimens and their handling requirements;
- Describe the dermatologists’ expectations of the laboratory handling their tissue specimens
Pathologist’s assistants have a unique and important role in the examination and ultimate diagnosis of skin biopsies and excision specimens. Most of these specimens are small and are processed in their entirety; as a result, the pathologist’s assistant may well be the last person to see the specimen in its intact state and their recorded observations are critical.
Dermatologists are experts in the morphology of skin disease and therefore are themselves sophisticated gross skin pathologists. They have specific reasons for submitting different types of skin specimen as well as specific expectations for the report content for each specimen type. This presentation highlights these different specimen types and how the pathologist’s assistant and pathologist working together can provide the submitting physician with the most informative diagnostic report.
The session will be of value to PAs, pathology residents and general and anatomic pathologists.
Ontario Regional Blood Coordinating Network (ORBCoN) Symposium
Transfusion Medicine Update and Case Discussions – Allison Collins
Objectives: By the end of the talk the audience will be able to:
- Explain the rationale for limiting the use of group O negative red cells.
- List the indications for the use of irradiated blood products.
- Summarize the findings of the PATCH study.
Session Description:
Through case discussions, several topics in transfusion medicine will be reviewed, and information provided about resources for further learning. After this talk, attendees will listen to at least one podcast about transfusion medicine
Gross Examination of Pancreaticobiliary Cancer Specimens – Vlad Maksymov
Objectives: By the end of the talk the audience will be able to:
- Review issues related to the surgical anatomy and gross examination of the pancreaticoduodenectomy pancreaticobiliary cancer / specimen.
- Review and discuss existing terminology for margins and the need for standardized assessment of these specimens (as well as, discuss the role of standardized terminology amongst pathologists, radiologists, surgeons and oncologists in the optimal care of patients with pancreaticobiliary cancer).
- Discuss how gross examination of pancreaticoduodenectomy/pancreaticobiliary cancer specimen affects synoptic reporting.
At the end of the session, the participants will be able to answer following questions:
- Which anatomical structure (s) is facing to the Uncinate process (retroperitoneal) margin in the human body? (A) Superior Mesenteric Artery and Superior Mesenteric Vein;
B) Vena Cava Inferior;
C) Superior Mesenteric Artery;
D) Superior Mesenteric Vein). - Which term is best in the description of the Superior Mesenteric Vein margin? (
A) Resection margin;
B) Surface /Dissection margin;
C) Retroperitoneal margin). - Which term is suggested by AJCC (Cancer Staging Manual, Eight and Seven Editions) to be used instead of Uncinate process margin? (
A) Posterior pancreatic margin;
B) Superior Mesenteric Artery margin;
C) Retroperitoneal margin.
Study questions and Points:
- Surgical anatomy of the head of the pancreas and relationship to adjacent vascular structure (Superior Mesenteric Artery (SMA), Superior Mesenteric Vein (SMV)/portal vein (PV) and Vena Cava Inferior (VCI).
- Whipple’s procedure (pancreaticoduodenectomy (PD): basic knowledge (what do we have to know before start gross examination):
a) Standard PD
b) Pylorus preserving PD
c) Total PD - Frozen section (potential pit fall during handling of the specimen and sampling of tissue):
A) Pancreatic neck (distal) margin
b) Uncinate process (SMA) margin
c) Other issues
d) Role of pathologist assistant/pathologist in the handling and sampling specimen during frozen section (pit falls) - Margins in pancreaticoduodenectomy specimens:
a) Definition of resection margin versus surface/dissection margin
b) Terminology: do we understand each other? - Pancreatic neck (distal) resection margin
- Uncinate process (SMA) resection margin
- SMV/PV dissection margin versus medial margin
Anterior margin/surface - Posterior margin/surface (posterior surface of the uncinate process dissection margin)
- Gross examination protocols:
a) Leeds protocol
b) How PD specimens grossed in North America (approaches in different institutions) and other countries:
c) An anatomical based mapping of margins in PD specimens - Urgent need for standardized assessment of the PD specimen (how different approaches to the assessment and reporting of the margins can change results and adversely affect the final statistic used in pancreatic cancer studies and clinical trials)
- Why does it matter or could be results of gross examination of PD specimen margins used as quality assurance and powerful tool to provide feed back to Hepato-Pancreato Billiary (HPB) surgical oncologists and radiologists? (Pathologic evaluation and reporting margins in PD specimens in correlation with multimodality imaging).
- Canadian proposal to grossing and reporting of PD specimen/Changes to reporting margins in PD specimens (proposal submitted to the College of American Pathologist (CAP) in 2013 by V Maksymov, M Khalifa, D Divaris and D Driman and discussed by CAP in 2013): review of the results of discussion by leading USA GI pathologists.
- Reporting of the margins in pancreaticoduodenectomy specimens (as part of collaboration of radiologists and HPB surgical oncologists).
- How gross examination could improve collaboration between pathologists, HPB surgical oncologist and radiologist for benefits of the patients?
The session will be of value to: pathology residents, Pathologist assistant, general and anatomic pathologists.
Challenging Mesenchymal Lesions of the Gynecologic Tract – Jelena Mirkovic
Objectives: By the end of the talk the audience will be able to:
- Identify morphologic variants, immunohistochemical and molecular features of endometrial stromal tumors
- Identify features of primary ovarian endometrioid stromal sarcomas
- Identify features of entities in the differential diagnosis of low-grade endometrial stromal sarcomas
This is a case based presentation which includes several diagnostically challenging cases of predominantly uterine mesenchymal neoplasms. The topics covered are endometrial (or endometrioid) stromal tumors and entities in their differential.
QMP – An Update – Kathy Chorneyko & Annette Ellenor
Objectives: By the end of the talk the audience will be able to:
- Summarize the activities of the QMP over the past year
- Explain upcoming QMP activities Discuss quality in the context of the QMP
- Explain successes and challenges of the programme
- Discuss barriers to implementation
This presentation will provide and update on the implementation activities of the pathology QMP over the past year. The work of the Provincial Pathology Quality Committee will be summarized with additional reference to work done by the standards and indicator working groups. A summary and explanation of the pathology reports which will be sent to facilities in November 2017 will be provided. There will be an update on the learning module which will be rolling out in the fall. The session will be of value to anatomical and general pathologists, pathology residents and pathologist’s assistants.
Update on Reporting Prostate Cancer Pathology with an Emphasis on Needle Biopsies – Andrew Evans
Objectives: By the end of the talk the audience will be able to:
- Describe the evolution of the Gleason grading system for prostate cancer
- List the changes made to Gleason grading system in November 2014 including the introduction of grade groups
- Apply an grade group to sets of biopsies where individual cores have different Gleason scores
- List key prognostic factors that should be included in reports of cases containing prostate cancer
- Describe the implications of prostate biopsy findings for patient mangagement
- Identify key resources and guidelines to assist with proper reporting of prostate biopsies containing cancer
Since 2005, the reporting of prostate cancer by pathologists has undergone numerous changes in concert with changes to the management of this disease. Most notably, the International Society of Urological Pathology (ISUP) convened consensus conferences in 2005 and 2014 where significant changes were made to Gleason grading system. In addition to Gleason grade, the list of histopathologic features with clinical implications in the management of prostate cancer continues to expand. This presentation will review the evolution of the Gleason grading system, including the concept of grade groups which were formally introduced in November 2014. It will also review the growing list of histopathologic features with clinical implications that all pathologists reporting specimens containing prostate cancer should be aware of. Finally, the presentation will provide pathologists with a list of key resources and current guidelines to assist in the reporting of specimens containing prostate cancer.
Biobanking Melanoma: opportunities for high impact research – Dianne Chadwick
Objectives: By the end of the talk the audience will be able to:
- Define a research biobank
- Learn how to biobank from patients with melanoma
- Describe how banked samples may be used in research
The University Health Network (UHN) Biobank is a Core Facility that provides patient samples for research. Biobank Pathologists’ Assistants and Research Technicians process and store remnant surgical and autopsy tissue and research bloods from patients with melanoma and other diseases, The samples are distributed to research studies led by UHN investigators. Workflow for Biobanking specimens from patients with melanoma will be described. The use of banked samples in clinical, translational and basic research studies towards enhancing our understanding of melanoma as a disease and improving patient care will also be presented.
Challenging Mesenchymal Lesions of the Gynecologic Tract – Jelena Mirkovic
This is a case based presentation which includes several diagnostically challenging cases of predominantly uterine mesenchymal neoplasms. The topics covered are endometrial (or endometrioid) stromal tumors and entities in their differential.
The session will be of value to: pathology residents, anatomic pathologists, and pathologists with gynecologic pathology subspecialty.
Learning Objectives:
After this session, participants will:
- Identify morphologic variants, immunohistochemical and molecular features of endometrial stromal tumors
- Identify features of primary ovarian endometrioid stromal sarcomas
- Identify features of entities in the differential diagnosis of low-grade endometrial stromal sarcomas
Political and Economic Updates – Moderator – Russell Price
OMA Section on Lab Medicine Update – Cathy Ross
Learning Objectives:
After this session, participants will:
- inform OAP members about upcoelection period
- update oap members regarding negotiation
- share with oap members the past years activities of the lab medicine section
Harmonizing Reference Intervals and Result Uncertainty – Christine Collier
Learning Objectives:
After this session, participants will:
- Implement pediatric harmonized reference intervals in their own laboratories,
- Describe the use of adult harmonized reference intervals,
- Appraise the validity of current reference intervals,
- Develope ancillary result interpretation information,
- Address both the measurement uncertainty of an analytical result, and the expected result uncertainty of a patient result based on biological variation.
Session Description:
Not only are laboratory professionals responsible for standardizing and optimizing laboratory testing, but they also may contribute significantly to the appropriate interpretation of a result and thus ensure optimal patient care. Although providing valid reference intervals is an integral part of this process, unfortunately the current practices associated with determining reference intervals are not perfect, as they can be expensive, time-consuming, and difficult to do properly. An alternative approach that has been advocated for more than 10 years is the use of harmonized reference intervals. Collaborative approaches involving consensus, comparisons, and data mining initiatives have resulted in national recommendations for over 25 analytes in many countries including the UK, Japan, Australia and New Zealand. Impressively, it is the Canadian “CALIPER” initiative from the Hospital in Sick Children’s in Toronto, that is leading the way for the harmonization of pediatric reference intervals in many jurisdictions around the world.
Another important factor in result interpretation is consideration of result uncertainty which is based not only on analytical measurement uncertainty but also on the inherent biological variation of an analyte in a patient.
By providing physicians with as much information as possible, laboratory professionals can help optimize result interpretation, which ultimately culminates in appropriate patient care and test utilization with minimized risk.
OFPS – Michael Pollanen
The Evolving State of PD-L1 Testing
Date: Saturday, September 16th, 2017
Title: The Evolving State of PD-L1 Testing
Time: Presentation to begin at 7:15 am, sharp
Location: The Waterhouse Ballroom, 1-3
Speakers:
Ming S. Tsao, MD, FRCPC
Consultant Pathologist, University Health Network
Michelle R. Downes MBBCh, MRCSI, MD, FRCPC
Staff Urologic Pathologist, Sunnybrook Health Sciences Centre
Assistant professor, LMP, University of Toronto
At AstraZeneca we strive to deliver great medicines to patients through innovative science. But managing disease can’t be done with medicines alone. Together we can develop creative solutions to help tackle the challenges of effectively preventing and treating disease.
AstraZeneca is proud to support the Annual Meeting of the Ontario Association of Pathology as part of our commitment to making a difference and improving the lives of Canadians.
Diagnostic Slide Seminar Kidney Tumor Pathology Part 1 – Andrew Evans
Learning Objectives:
After this session, participants will:
- Explain the rationale and indications for performing needle biopsies of incidentally found renal masses
- State the expected diagnostic yield for these biopsies and how the results influence patient management
- Understand the current barriers to more widespread adoption of needle biopsies to characterize renal masses
- Describe an approach to classifying kidney tumours with immunohistochemistry that is based on specific panels of markers determined by H&E morphology
- List the most frequently encountered kidney tumours associated with familial syndromes and be aware of steps required for confirming these diagnoses and screening patient relatives.
Diagnostic Slide Seminar Kidney Tumor Pathology Part 2 – Andrew Evans
Learning Objectives:
After this session, participants will:
- Explain the rationale and indications for performing needle biopsies of incidentally found renal masses
- State the expected diagnostic yield for these biopsies and how the results influence patient management
- Understand the current barriers to more widespread adoption of needle biopsies to characterize renal masses
- Describe an approach to classifying kidney tumours with immunohistochemistry that is based on specific panels of markers determined by H&E morphology
- List the most frequently encountered kidney tumours associated with familial syndromes and be aware of steps required for confirming these diagnoses and screening patient relatives.
CCO Update – Aaron Pollett
Learning Objectives:
After this session, participants will:
- Describe the current key activities at Cancer Care Ontario (CCO).
- Evaluate the impact of current activities at their institution.
- Plan for upcoming recommendations coming from CCO.
OMA Section on Lab Medicine Update – Cathy Ross
Learning Objectives:
After this session, participants will:
- inform OAP members about upcoelection period
- update oap members regarding negotiation
- share with oap members the past years activities of the lab medicine section
Pancreaticobiliary Cancer Synoptic Reporting. What do we need to report? – Jim Brierley
Gross Examination of Pancreaticobiliary Cancer Specimens – Vlad Maksymov
Learning Objectives:
After this session, participants will:
- Review issues related to the surgical anatomy and gross examination of the pancreaticoduodenectomy pancreaticobiliary cancer / specimen.
- Review and discuss existing terminology for margins and the need for standardized assessment of these specimens (as well as, discuss the role of standardized terminology amongst pathologists, radiologists, surgeons and oncologists in the optimal care of patients with pancreaticobiliary cancer).
- Discuss how gross examination of pancreaticoduodenectomy/pancreaticobiliary cancer specimen affects synoptic reporting.
- At the end of the session, the participants will be able to answer following question: Which anatomical structure (s) is facing to the Uncinate process (retroperitoneal) margin in the human body? (A) Superior Mesenteric Artery and Superior Mesenteric Vein; B) Vena Cava Inferior; C) Superior Mesenteric Artery; D) Superior Mesenteric Vein).
- At the end of the session, the participants will be able to answer following question: Which term is best in the description of the Superior Mesenteric Vein margin? (A) Resection margin; B) Surface /Dissection margin; C) Retroperitoneal margin).
- At the end of the session, the participants will be able to answer following question: Which term is suggested by AJCC (Cancer Staging Manual, Eight and Seven Editions) to be used instead of Uncinate process margin? (A) Posterior pancreatic margin; B) Superior Mesenteric Artery margin; C) Retroperitoneal margin).
Reporting pancreaticobilliary cytology – Updates – Celia Marginean
The session will be of value to: pathology residents, cytopathologists and anatomic pathologists
Learning Objectives:
After this session, participants will:
- Be familar with the cytologic diagnostic categories of pancreaticobilliary cancer
- Use the Bethesda terminology and nomenclature for pancreaticobiliary disease
- Be familiar with the current diagnostic methods in pancreaticobilliary cancer
EUS FNA of Pancreas & Bile Ducts – Avijit Chatterjee
Recognizing the Unrecognizable : At the Gross Bench – Jasmin Radhi
At the end of the session, delegates will be able to:
- Recognize the unrecognizable , or at least include them in your differential
- Identify the features that can aid in the correct interpretation
- Differentiate between malignant and benign