Loading...

SATURDAY JUNE 22

0830-1730

0830-1200

Preconference Workshops W2211, W2212, W2213, W2214, W2215, W2216

1200-1400

Lunch

  • Residents’ Networking Lunch

1400-1730

Preconference Workshops W2241, W2242, W2243, W2244, W2245, W2246

1800-2000

Pathologists’ Assistants Reception and PA Poster Presentations

1800-2100

Residents’ Symposium and Dinner

 

 

SUNDAY JUNE 23

0730-0830

Sponsored Breakfast Symposia

0845-1000

Opening Keynote: Human Pathology Revisited Through Clinical Genomics

1000-1030

Refreshment Break & Exhibit Viewing

1030-1200

Concurrent Symposia & Workshops

1200-1330

Lunch & Exhibit Viewing

Digital Pathology Theatre in the Exhibit Hall:

  • 1215-1245 Aurora mScope
  • 1300-1330 Sectra: Be prepared, digital pathology will come sooner than you think!

1330-1500

Concurrent Symposia & Workshops

1500-1530

Refreshment Break & Exhibit Viewing

1530-1700

Concurrent Symposia & Workshops

1700-1800

CAP-ACP Award Lectures

1900-2200

President’s Reception at Peller Estates (transportation provided)

MONDAY JUNE 24

0730-0830

Sponsored Breakfast Symposia

0845-1015

AstraZenecaCam Coady Symposium: Current Applications of Molecular Testing in Ovarian and Endometrial Tumour Pathology Part I

MerckCo-developed by CAP-ACP, AstraZeneca Canada, and Merck Canada

1015-1045

Refreshment Break & Exhibit Viewing

1045-1215

Concurrent Symposia & Workshops

1215-1345

Lunch & Exhibit Viewing

 

Digital Pathology Theatre in the Exhibit Hall:

  • 1230-1300 Roche: VENTANA DP 200, uPath and our vision for Digital Pathology
  • 1315-1345 Philips

1345-1515

Concurrent Symposia, Workshops, and Platform Presentations

1515-1545

Refreshment Break & Exhibit Viewing

1545-1715

Concurrent Symposia & Workshops

1715-1930

Exhibitors’ Wine & Cheese Reception

Poster Presentations

1900-2100

Saskatoon Health Region Dinner for Residents

TUESDAY JUNE 25

0730-0830

Sponsored Breakfast Symposia

0830-1030

Symposium: PSQA: Pan Canadian Molecular Biomarkers Quality Framework for Reporting

1030-1045

Refreshment Break

1045-1215

Concurrent Symposia & Workshops, and Platform Presentations

1215-1345

CAP-ACP Annual General Meeting Lunch

1315-1445

HologicSymposium: Who, What, When, Where, and How? HPV Testing in the Era of Molecular Pathology

Co-developed by CAP-ACP and Hologic

1445-1615

Concurrent Symposia, Workshops

1615-1630

Refreshment Break

1630-1830

Concurrent Symposia & Workshops

1900-2300

Conference Banquet Overlooking the Falls (transportation provided, or walk from the conference hotel)

Back to top

 

 

Opening Keynote: Human Pathology Revisited Through Clinical Genomics
Sunday June 23, 0845-1000

 

Fowzan Sami Alkuraya, Alfaisal University

 

Learning Objectives:

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

  • Describe how clinical genomics can reveal novel pathological mechanisms of known human diseases.
  • Associate how the discovery of novel disease genes and syndromes will provide novel insights into the structure and function of the human body.
  • Restate how clinical genomics can define the “druggable” genome to accelerate the development of novel therapeutics for human diseases.

Understanding mechanisms of diseases is at the core of the discipline of pathology. Although studying diseases at the molecular level has been carried out for decades, the ability to link diseases to their underlying molecular etiology in an unbiased fashion represents a very recent trend that forms the foundation of clinical genomics. Such an unbiased approach has lived up to its promise of revealing novel pathologies that defy predictions based on prior knowledge, thus expanding the horizons of human pathology at an unprecedented pace. This revolution in our understanding of the molecular underpinning of human physiology and pathology through clinical genomics also promises to revolutionize our approach to therapeutics with the druggable genome being the latest trend in target discovery and validation. Importantly, the implications of such developments are far from limited to Mendelian diseases. Indeed, the concept of druggable genome is primarily conceived for the treatment of common disorders.

Back to top

 

 

Multi-Headed Scope Workshop: Practical Approach to Skin Adnexal Tumors with Clinicopathological Correlation – An Interactive Microscopy Experience (CME Section 3 Credits)
Sunday June 23, 1030-1230

 

Salem Alowami, McMaster University

 

Learning Objectives:

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

  • Confidently approach and discuss the clinical and pathological features of the entire spectrum of benign and malignant adnexal tumors of the skin.

Adnexal skin tumors are uncommon and their malignant counterpart are extremely rare. General surgical pathologists and residents are not consistently exposed to these tumors. The course will provide a case based , interactive presentation of different types of adnexal tumors including eccrine, apocrine, hair follicle and sebaceous differentiation. The interactive microscopy session will focus on their morphological criteria and how to differentiate them from mimics of cutaneous origin tumors.

Back to top

 

 

Symposium: Biobanking: The Question That Shall Not Be Named – Should Patients Be Told? The Controversy About Return of Results
Sunday June 23, 1030-1200

 

Sidney Croul, Dalhousie University

 

Learning Objectives:

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

  • Explain the major issues involving return of results to patients who have donated specimens to biobanks.
  • Explore the return of results polices in place worldwide.
  • Provide meaningful input into a return of results policy for their biobanks.

Some biobanked specimens used for research will generate clinically actionable results. Should these results be returned to the donors? This session will examine the current policies and controversy about return of results with particular focus on the associated ethical and practical issues. Participants will be asked to share their on these issues. At the conclusion of this session, we will compare and contrast several approaches to this critical question. This session will be of value to: Biobankers, Pathology Residents, PAs, general and anatomic pathologists.

Back to top

 

 

Symposium: Pediatric and Perinatal Pathology: The Placental and Fetal Microbiome
Sunday June 23, 1030-1200

 

Jefferson Terry, BC Children’s Hospital

 

Back to top

 

 

Symposium: The Canadian Society of Cytology (CSC) & Kulcsar Lecture: Milan System of Salivary Glands
Sunday June 23, 1030-1200

 

Mark Pusztaszeri, McGill University

 

Learning Objectives:

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

  • Describe the Milan system for reporting salivary glands cytopathology.
  • Discuss the diagnostic criteria set forth in the Milan system for reporting salivary gland cytopathology, and review the clinical implications and outcome (risk of malignancy) of each diagnostic category.
  • Review the most commonly used ancillary tests, and their utilization in diagnosis of salivary gland cytology within the framework of the Milan system.

Salivary gland cytopathology is challenging due to the large number of non-neoplastic and neoplastic conditions that can affect salivary glands, and the extensive overlap between entities. Until recently, the reporting of salivary gland FNA specimens was inconsistent among different institutions throughout the world, leading to diagnostic confusion among pathologists and clinicians. This presentation is based on the Milan system for reporting salivary gland cytology, an international effort to unify and standardize the reporting terminology of salivary gland cytology, which culminated with the publication of an Atlas in 2018. The presentation is designed to address the salient morphological/diagnostic criteria and the reporting terminology. The clinical implications and the associated risk of malignancies of individual diagnostic categories will be covered. Finally, the indications, judicious utilization, and practical integration of ancillary tests (IHC, FISH, etc.) to improve the accuracy of salivary gland FNA within the framework of the Milan system will be discussed as well.

The session will be of value to: pathology residents, general and anatomic pathologists as well as cytopathologists.

Back to top

 

 

Symposium: Breast Pathology
Sunday June 23, 1030-1200

 

Unusual Breast Pathology Cases

Penny Barnes, Queen Elizabeth II Health Sciences Centre

 

Learning Objectives:

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

  • Describe a recently recognized breast infection.
  • Identify two recently recognized variants of breast carcinoma.
  • Discuss the clinical relevance of these entities.

This session is a review of three unusual and recently recognized breast diseases. The session will be case-based with a review of the clinical histories, pathologic features, work-up, differential diagnoses and recent literature for each case.

This session should be of value to pathology residents, general and anatomical pathologists with an interest in breast pathology.

 

Everyday Challenges Related to Breast Biomarkers Testing

Sharon Nofech Moses, Sunnybrook Health Sciences Centre

 

Learning Objectives:

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

  • Select optimal blocks for biomarkers testing in special circumstances (multiple tumors, post NAT, retest excisions).
  • List the changes made to HER2 testing in 2018.
  • Recognize pitfalls in biomarkers assessment.

The changes made in the 2018 HER2 guideline recommendations for testing HER2 in breast cancer most importantly elimination of equivocal FISH category will be reviewed. Everyday dilemmas regarding testing breast biomarkers will be discussed, starting from selection of cases for testing core biopsies (specifically when not to attempt testing core biopsies), when to re-test an excision after testing a core, when to test more than one block. Selected unusual cases from the desk of breast biomarkers reader in a large volume lab will be presented. Trend analysis as an internal QA measure for biomarkers will be presented. The session will be of value to: pathology residents and anatomic pathologists.

 

Rad-Path Correlation

Supriya Kulkarni, University of Toronto

 

Learning Objectives:

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

  • List commonly seen imaging findings in high risk lesions.
  • Compare imaging features in context with pathological findings.
  • Summarize radiological recommendations based on rad-path correlation.

The presentation will be a case based session of commonly encountered atypical and high risk lesions on imaging with their imaging presentations along with pathological correlation. The cases will demonstrate the specific challenges in management of these lesions as well as their future follow up implications. The presentation will also touch upon aspects of high risk screening strategies.

The session will be of value to radiologists, pathology residents, PAs, general and anatomic pathologists.

Back to top

 

 

Multi-Headed Scope Workshop: Forensic Histopathology (CME Section 3 Credits)
Sunday June 23, 1300-1500

 

Christopher Milroy, University of Ottawa

 

Learning Objectives:

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

  • Assess histology of multiple organs in sudden death.
  • Differentiate autopsy histology artefacts from true pathology.
  • Integrate histology into the determination of cause of death.
  • Select appropriate sections for examination.
  • Utilize appropriate special stains in autopsy cases.

The workshop involves the demonstration of histology cases seen in the presenter’s autopsy practice. The presenter is an experienced forensic pathologist who deals with cases that all autopsy pathologists may encounter. The cases are sudden deaths with a wide range of pathology of interest to all residents and staff pathologists.

Back to top

 

 

Workshop: Placental Pathology Essentials: Common and Rare Lesions Encountered in General Surgical Pathology Practice
Sunday June 23, 1330-1500

 

Rose Chami,

Catherine Chung,

Anna Lee,

 

Learning Objectives:

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

  • Approach the gross and microscopic placental examination in a systematic and informative manner.
  • Identify common and rare placental lesions and understand their clinical significance.
  • Improve the completeness and the quality of placental reports.
  • Improve the management of subsequent pregnancies by identifying conditions known to have recurrence risks or which may be treatable and/or preventable.

The placenta is a commonly encountered specimen, yet most pathologists have little to no formal training in its examination. The placenta is a unique organ in that it reflects diseases that may occur in the mother and/or fetus. Its examination provides important insights into certain maternal and fetal disorders that may have significance for subsequent pregnancies. For the fetus, it reflects the inutero milieu and often gives useful insights into the diagnosis and treatment of the sick neonate. In the setting of fetal or neonatal demise, the placental exam frequently provides answers to the cause of demise thereby providing closure for the family, as well as providing useful information for the management of future pregnancies. The workshop will start with an introductory discussion of 1) when placentas should be examined (indications for placental examination), 2) how they should be examined (placental handling, transport, and grossing), and 3) how placental histology changes with gestational age.

The introduction will be followed by a presentation of the more common placental lesions with a focus on their clinical relevance, such as abnormalities of the umbilical cord, pathology of the fetal membranes (including meconium), infectious diseases, villitis of unknown etiology, maternal and fetal vascular disease, placental hematomas (e.g. abruption), and villous dysmaturity.

The workshop will conclude with a demonstration of the rare or less common, but clinically significant, placental lesions (e.g. massive perivillous fibrin deposition, and chronic histiocytic intervillositis).

The workshop will be structured around clinical scenarios in both liveborn and stillborn settings.

Back to top

 

 

Symposium: Canadian Society/Network of Dermatopathology: The JANUS and the HYDRA of Dysplastic Nevi
Sunday June 23, 1330-1500

 

1330-1400

Criteria of Dysplastic Nevi

Margaret Redpath, McGill University

 

Learning Objectives:

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

  • Describe the criteria for evaluating dysplastic melanocytic lesions (ranging from low grade to high grade dysplastic nevi to melanoma in situ).
  • Identify common pitfalls that can lead to over, or under, diagnosing dysplastic melanocytic lesions.
  • Summarize the current treatment recommendations for the management of dysplastic melanocytic lesions.

This session will provide a practical approach to the diagnosis and management of dysplastic melanocytic lesions. The histology of low grade dysplastic nevi, high grade dysplastic nevi and in situ melanoma will be described in detail using cases that illustrate the morphology of the cells, and the patterns of growth, that can be observed in this spectrum of lesions. There will be a thorough explanation of the criteria that are used to assess the degree of architectural and cytologic atypia in dysplastic lesions. Insight into immunohistochemical stains and molecular techniques that can be used as adjunct tests for difficult melanocytic lesions will also be provided. Common pitfalls that can lead to over, or under, diagnosing dysplastic melanocytic lesions will be shared along with the current treatment recommendations for the management of dysplastic melanocytic lesions.

This session will be of value to pathology and dermatology residents, practicing general and anatomic pathologists and dermatologists.

 

1400-1415

Atypical Acral Nevi

Zaid Kamil, University of Toronto

 

Learning Objectives:

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

  • Identify atypical features of acral nevi.
  • Recognize site specific features of acral nevi.
  • Discuss dysplastic-like features seen in acral nevi.

This session will focus on the atypical features of acral nevi with approach to diagnosis. I will also discuss the differentiating features from acral melanomas.

The session will be of value to pathology residents, community pathologists and pathologists with interest in melanocytic lesions.

 

1415-1435

Nevi of Special Sites – Criteria, Pitfalls, and Management

Karen Naert, University of Calgary

 

Learning Objectives:

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

  • Define “special site” nevus in the context of melanocytic pathology.
  • Identify typical histologic features of special site nevi.
  • Describe features that distinguish special site nevi from melanoma occurring at special sites.

 

1435-1450

Combined Melanocytic Lesions

Shachar Sade, Sunnybrook Health Sciences Centre

 

Learning Objectives:

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

  • Recognize the potential phenotypic heterogeneity of melanocytic lesions.
  • Recognize some common combinations for melanocytic lesions.
  • Describe features that may portend malignancy or malignant transformation in such lesions.

This session will follow a case-based approach to expose viewers to a number of the more common combined melanocytic lesions and reflect the general concept of phenotypic heterogeneity in melanocytic lesions. Some emphasis will be spent on recognizing features that may portend malignancy or malignant transformation in such lesions.

This presentation will be useful to residents or staff pathologists who may be exposed to cutaneous specimens.

 

1450-1500

Q & A

Back to top

 

 

Workshop: CMPA Shifting the Focus From Professional Liability To Accountability
Sunday June 23, 1330-1500

 

Tino Piscone, Canadian Medical Protective Association

 

Learning Objectives:

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

  • Distinguish between professional liability and accountability.
  • Explain how demonstrating professional accountability may mitigate risk of patient harm and medical-legal liability.
  • Design a personal action plan that incorporates principles of professional accountability and patient safety.

Reframing Canadian Pathology Practice in the Era of Patient-Centred Care: This course addresses professional accountability and physician-to-physician communication in the Pathology practice setting. It will take place during the CAP-ACP Annual Scientific Meeting as two independent 90-minute facilitated, interactive workshops. Educational activities will be case-based and engage learners in large and small group discussions as well as individual reflection. Learning objectives aim at aligning attitudes and behaviours of pathologists with the model of patient-centred care. As part of the learning experience, learners will be asked to complete pre- and post- course assignments.

Case-based discussions examining: a) the relationship between liability, accountability, and patient harm; and b) attitudes and/or behaviours modelling professional accountability that may mitigate patient harm and liability. Individual and group reflective exercises to identify opportunities for improving actions and behaviours reflecting professional accountability in one’s own practice setting.

As a result of attending this workshop, the learner will have gained personal insight into the significance of professional accountability and communication in delivering safe patient care which might also mitigate medical-legal liability.

Back to top

 

 

Symposium: General Pathology: A Day in the Life of General Pathology
Sunday June 23, 1330-1700

 

1330-1410

The Role of General Pathologists in the Choosing-Wisely Campaign

Christopher Naugler, University of Calgary

 

1410-1440

How to Best Prepare Yourself for Life in an Administrative Role (1410-1430)
Tips and Tricks for Financial (Budget) Planning (1430-1440)

Russell Price, Royal Victoria Hospital

 

Learning Objectives:

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

  • Discuss the roles and responsibilities of the Laboratory Medical Director.
  • Summarize strategic planning concepts.
  • Discuss laboratory budgeting concepts.
  • Summarize the laboratory accreditation process.

 

1440-1500

Panel Discussion, Q & A

 

1500-1530

Refreshment Break

 

1530-1605

Microbiology in Day-to-Day Practice

Steven Drews, University of Alberta

 

Learning Objectives:

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

  • Identify three key characteristics of multiplex panels for the identification of pathogens in clinical specimens.
  • Compare and contrast benefits and drawback to the use of these panels.
  • Propose laboratory settings where multiplex panels may be most effectively used.

This session will be of value to: pathology residents, general pathologists, administrators, and general pathologists; especially those who are directing a medical microbiology laboratory.

 

1605-1630

Overcoming Challenges in Signing Out Bone Marrow in Community Settings

Hubert Tsui, Sunnybrook Health Sciences Centre

 

Learning Objectives:

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

  • Refine their morphologic approach to bone marrow, with a focus on potential morphologic subtleties of relevance to classification.
  • Recognize limitations of the ‘blast’ % from flow cytometric reports.
  • Appraise their current workflow regarding molecular/cytogenetic send outs.
  • Demonstrate the importance of clinical-pathologic integration in quality bone marrow reporting.

With laboratory medicine increasing in complexity, maintaining confidence in subdisciplines such as hematological pathology may be a challenge, especially in general community practice. Dr. Tsui will discuss bone marrow reporting from a community setting with emphasis on three main themes: 1) reviewing morphologic features with implicit connotations on the underlying diagnosis/classification (e.g. megakaryocytic morphology in myeloproliferative neoplasms, reticulin grading and ring sideroblasts); 2) limitations of the bone marrow blast differential by flow cytometry; and 3) taking a wholistic quality approach to bone marrow sign out – appreciating clinical context, triaging molecular/cytogenetic send outs and the importance of active communication between pathologist-hematologist/medical oncologist. This session will be of value to general and anatomic pathologists working in community environments.

 

1630-1700

CAP-ACP General Pathology Section Annual General Meeting

Back to top

 

 

Multi-Headed Scope Workshop: Difficult and Not So Difficult Cases in GI Pathology (CME Section 3 Credits)
Sunday June 23, 1530-1730

 

Sara Hafezi-Bakhtiari, University Health Network

 

Learning Objectives:

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

  • Evaluate primary vs metastatic lesions in the GI tract.
  • Identify some of the changes in GI tract associated with extra luminal diseases.
  • Identify histologic changes associated with new treatments.
  • Differentiate different types of dysplasia in GI tract polyp.

Through reviewing different set of slides, the participant would be able to improve their ability to evaluate primary vs metastatic lesions in the GI tract, identify some of the changes in GI tract associated with extra luminal diseases, get familiar with some of the histologic changes associated with new treatments as well as improve their ability in diagnosing different types of dysplasia in GI tract polyp specially gastric polyps.

Back to top

 

 

Symposium: Informatics, Digital Resources & Social Media: Navigating Through an Era of Digital Pathology – Opportunities and Challenges
Sunday June 23, 1530-1700

 

1530-1600

Deep Learning for Pathology

Phedias Diamandis, University Health Network

 

Learning Objectives:

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

  • Discuss the principles of computer vision for image analysis.
  • Design a project that applies deep learning for image analysis.
  • Discuss the limitations of deep learning in image analysis.

Precision diagnostics in pathology continues to demand stratification of patients into smaller and more personalized subgroups. While genomic technologies have largely led this movement, turnaround times can be slow and diagnostic costs unsustainable when these technologies are used in isolation. Histopathologic image analysis while provides more cost-effective, prompt and flexible results, a persistent reliance on the subjective qualitative interpretation of morphologic findings has recently demanded improved approaches. New and emerging technological advances in artificial intelligence (AI) now facilitate much needed objective and precise outputs. In particular, one specific form of artificial intelligence, known as deep learning, is achieving expert-level disease classifications in many areas of pathology. Here, concepts of deep learning, and convolutional neural networks (CNNs) are reviewed to highlight their transformative potential for diagnostic histopathology. Understanding the opportunities and challenges of these quantitative machine-based decision support tools is critical to their widespread introduction into routine diagnostics.

The session will be of value to pathology residents, PAs, general and anatomic pathologists.

 

1600-1615

Social Media and Digital Resources in Pathology Survey: Current Attitudes and Future Perspectives for Implementation

Arsani Yousef, University Health Network

 

1615-1630

Should Pathology Exams Go Digital?

Susan Armstrong, University of Toronto

 

Learning Objectives:

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

  • Identify examples of computer-based educational materials being used in medicine and pathology.
  • Discuss the advantages and disadvantages of computer-based exams from the perspective of pathology residents and examiners.
  • Describe how computer-based exams may be created and used using different platforms.

In a technology-driven world, pathology, along with other medical fields, is striving to keep pace with the changes. Resident training and evaluation must do the same. While the Royal College slide exam has gone digital, paper-based written exams remain. In this session, we will examine the use of online platforms to administer pathology exams. Different platforms will be compared and the exams will be discussed from the perspective of the residents who take them as well as the staff who administer them.

The session will be of value to: pathology residents, PAs, general and anatomic pathologists, and any trainees or people with an interest in the evaluation of trainees.

 

1630-1645

Social Media in Pathology: Connecting a Global Community of Pathologists

Matthew Cecchini, Western University

 

Learning Objectives:

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

  • Utilize social media platforms effectively.
  • Discuss important privacy and ethical regulations.
  • Implement social media into their pathology practice.

There is a global network of pathologists connected via social media that share cases, expertise and networking opportunities. Social media can be utilized effectively for education, research, and promotion. However, there are important ethical and privacy regulations that must be considered when sharing information in an online forum. This presentation will outline the benefits to the use of social media in pathology practice while considering key ethical and privacy regulations.

The session will be of value to pathology residents, PAs, and pathologists.

 

1645-1700

General Discussion About Digital Pathology in Canada

Back to top

 

 

Symposium: Anatomical Pathology: Gastrointestinal Tract Fine Needle Aspiration/Core Biopsies: A Needle in Time Saves 9 Further Procedures
Sunday June 23, 1530-1700

 

Catherine Streutker, St. Michael’s Hospital

Christopher Teshima, St. Michael’s Hospital

 

Learning Objectives:

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

  • Recognize the typical clinical/endoscopic findings of pancreatic lesions such as intraductal papillary mucinous neoplasms, adenocarcinomas and neuroendocrine tumours.
  • Discuss the current methods for endoscopic tissue acquisition.
  • Review the pathologic/cytologic findings for these entities.
  • Express the importance of clinical discussions between gastroenterologists and pathologists needed for optimum diagnosis.

Back to top

 

 

Workshop: CMPA How to Resolve Diagnostic Disagreement Between Physicians
Sunday June 23, 1530-1700

 

Tino Piscone, Canadian Medical Protective Association

 

Learning Objectives:

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

  • Discuss the impact of diagnostic disagreement on safe patient care.
  • Provide examples of how to communicate disagreement professionally with other pathologists and physicians.
  • Apply effective communication strategies to resolve diagnostic disagreement in Pathology practice.

Reframing Canadian Pathology Practice in the Era of Patient-Centred Care: This course addresses professional accountability and physician-to-physician communication in the Pathology practice setting. It will take place during the CAP-ACP Annual Scientific Meeting as two independent 90-minute facilitated, interactive workshops. Educational activities will be case-based and engage learners in large and small group discussions as well as individual reflection. Learning objectives aim at aligning attitudes and behaviours of pathologists with the model of patient-centred care. As part of the learning experience, learners will be asked to complete pre- and post- course assignments.

Case-based discussions eliciting factors that contribute to disagreement between physicians and which may directly lead to patient harm; Debriefing on a video presentation illustrating ineffective, unprofessional communication between physicians, followed by a discussion of professional communication behaviours; Small group breakout activity using case vignettes depicting scenarios relevant to Pathology practice to identify effective physician-to-physician communication strategies.

As a result of attending this workshop, the learner will have gained personal insight into the significance of professional accountability and communication in delivering safe patient care which might also mitigate medical-legal liability.

Back to top

 

 

Junior Scientist Award Lecture: Game of Clones: Origins and Impacts of Age-related Clonal Hematopoiesis on Hematological and Non-hematological Diseases
Sunday June 23, 1700-1730

 

Michael Rauh, Queen’s University

 

Learning Objectives:

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

  • Discuss the origins of a novel and common phenomenon of aging, called clonal hematopoiesis (CH, CHIP or ARCH), characterized by expansion in peripheral blood of clonal leukocyte progeny of a stem/progenitor cell carrying a single driver mutation.
  • Explain the interactions of CH cells with an environment of “inflamm-aging”.
  • Compare the impacts of CH on risks for hematological malignancies (i.e. de novo, relapsed, or therapy-related myeloid neoplasms) and non-hematological disease (i.e. unexpected associations with cardiovascular and pulmonary disease).
  • Consider the potential rewards and risks associated with future CH surveillance and intervention.

Normal hematopoiesis is polyclonal, with circulating blood cells arising from the contributions of at least 20,000 hematopoietic stem cells (HSC) in the bone marrow. However, increasingly with age, HSC acquire somatic mutations. Occasionally these mutations impart a selective advantage such that clonal progeny of a mutant HSC expand to detectable levels in the peripheral blood, measurable by a variant allele fraction (VAF) of at least 2%. This common state (i.e. affecting >15% of adults >65y) has recently been called clonal hematopoiesis of indeterminate potential (CH or CHIP) or age-related clonal hematopoiesis (ARCH). CHIP is a pre-malignant state, usually with normal complete blood cells counts, but is associated with risk of transformation to a hematological malignancy of approximately 0.5 to 1% per year. We and others have found unexpected associations between CHIP and cardio-pulmonary disease. This phenomenon is related to infiltrative and hyper-inflammatory monocytes/macrophages carrying CHIP mutations (especially in the epigenetic regulators, TET2 and DNMT3A). It is becoming increasingly possible to predict, years in advance, which people with CHIP are likely to develop acute myeloid leukemia (AML). Moreover, promising research is underway to target TET2- and DNMT3A-mutant CHIP clones and the possibility of myeloid neoplasm surveillance and prevention may be on the horizon. Finally, of potentially wider appeal to anatomical pathology, somatic clonal expansions are being discovered across normal tissues with age, and CHIP may serve as a paradigm for disease surveillance and earlier intervention. For these reasons the session may be of value to pathology residents, pathology assistants, and hematological, general and anatomical pathologists.

Back to top

 

 

William Boyd Award Lecture: Mistakes Made, Lessons Learned
Sunday June 23, 1730-1800

 

Blake Gilks, University of British Columbia

 

Learning Objectives:

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

  • List three huge mistakes made by the presenter in the course of his career.
  • Reduce their chances of making the same mistakes in their own professional life.
  • Acknowledge one major mistake they have made, professionally.

“No one is perfect”. We all hold this to be true, with the corollary that we all make mistakes i.e. being wrong is an inevitable part of human existence. While we freely acknowledge this general truth, we find it difficult to discuss specific instances of our being wrong. The reasons for this will be discussed, illustrated by examples from the presenter’s own career in pathology, in the areas of research, diagnostic surgical pathology, administration and teaching, with the goal of encouraging a more thoughtful approach to being wrong. This session will be of value to: pathology residents, PAs, general and anatomic pathologists.

Back to top

 

 

AstraZenecaCam Coady Symposium: Current Applications of Molecular Testing in Ovarian and Endometrial Tumour Pathology
Co-developed by CAP-ACP, AstraZeneca Canada, and Merck Canada
MerckMonday June 24, 0845-1215

 

Diagnosing High Grade Serous Carcinoma of Ovary and Fallopian Tube; Implications for Genetic Screening and Therapy

Robert Soslow, Memorial Sloan Kettering Cancer Center

 

Learning Objectives:

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

  • Recognize different morphological patterns of adnexal high-grade serous carcinoma.
  • Apply ancillary testing for diagnostic use.
  • Describe the genomic heterogeneity of adnexal high-grade serous carcinoma.
  • Discuss morphological/genomic correlations in adnexal high-grade serous carcinoma.
  1. Introduce concept of adnexal high-grade serous carcinoma; what does a diagnosis of adnexal high-grade serous carcinoma convey to the patient and the gynecologist?
  2. Morphological spectrum of adnexal high-grade serous carcinoma.
    1. Ancillary diagnostics.
  3. Genomic heterogeneity of adnexal high-grade serous carcinoma, with emphasis on homologous recombination deficiency.
    1. Homologous recombination deficient adnexal high-grade serous carcinoma.
    2. Genomic heterogeneity within the homologous recombination deficiency (HRD) group.
    3. Morphological correlations between HRD phenotype and genotype.

 

Germline Genetic Sequencing (Using Multi-gene Panels)

Dianne Mandelker, Memorial Sloan Kettering Cancer Center

 

1015-1045

Refreshment Break

 

Most Current Update on BRAC Somatic Reflex Testing in HGSC (BRCA Consortium)

Alice Lytwyn,

 

Learning Objectives:

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

  • Summarize the burden of ovarian cancer in Canada.
  • Discuss the National BRCA Collaboration: a multidisciplinary effort to ensure universal access to testing, treatment and prevention of BRCA related ovarian cancer.
  • Summarize the status of somatic tumour testing in Canada.
  • Discuss issues for pathologists to consider when establishing somatic BRCA testing.

 

Mismatch Repair Immunohistochemistry / Microsatellite Instability Testing in Endometrial and Ovarian Cancers – An Update of the Canadian Landscape

Aaron Pollett, Mount Sinai Hospital

 

  • Explain the role of MMR / MSI testing for gynecologic malignancies.
  • Discuss the interpretation of MMR immunohistochemistry.
  • Compare the implementation of MMR / MSI testing in different provinces.

Mismatch repair immunohistochemistry (MMR-IHC) and microsatellite instability (MSI) testing has become a standard biomarker for endometrial cancers and a specific ovarian carcinomas. As routine, reflexive immunohistochemistry becomes more common there are issues related to gynecologic tumours which are emerging. This session will review the role and interpretation of MMR-IHC, including how to deal with difficult cases and how MMR-IHC can be implemented as part of a provincial program.

The session will be of value to: pathology residents, geneticists, genetic counselors and pathologists handling gynecologic tumours.

Back to top

 

 

Symposium: Neuropathology: The Past, Present, and Future of Molecular Diagnostics in Brain Tumors
Monday June 24, 1045-1215

 

Craig Horbinski, Northwestern University

 

Learning Objectives:

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

  • Explain the importance of advanced molecular testing in the workup of brain tumors.
  • Interpret the results of next-generation sequencing when applied to brain tumors.
  • List the assays, and specific molecular targets, currently recommended for the workup of brain tumors.
  • Discuss the future of methylation profiling on pathology in general, and neuropathology in particular.

Accurate pathologic diagnoses, and informed treatment decisions for brain tumors, depend on robust clinical molecular testing that uses genomic, epigenomic, and transcriptomic-based tools. This is demonstrated by the incorporation of molecular criteria into the 2016 World Health Organization classification of nervous system tumors and the updated official guidelines of the National Comprehensive Cancer Network.

In this presentation, we will discuss the current molecular tools recommended for the clinical evaluation of pediatric and adult brain tumors, and learn how molecular data are integrated into patient care.

This session will be of value to all pathology trainees and pathologists who handle brain tumors in their practices.

Back to top

 

 

Multi-Headed Scope Workshop: Diagnosis of Infectious Diseases from the Peripheral Blood Film (CME Section 3 Credits)
Monday June 24, 1315-1515

 

Ruth Padmore, University of Ottawa

 

Learning Objectives:

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

  • Identify infectious organisms on the peripheral blood film.
  • Differentiate the morphology of 4 malaria species and Babesiosis.
  • Recommend ancillary testing for viral infections based peripheral blood lymphocyte morphology.

The workshop will consist of the review of peripheral blood films from approximately 20 different cases of infectious diseases which manifest characteristic peripheral blood morphological findings.

Back to top

 

 

Symposium: Gynecological Pathology
Monday June 24, 1345-1515

 

1345-1415

Diagnosing Endometrial Precancers in 4 Easy Steps

C. Matthew Quick, University of Arkansas for Medical Sciences (UAMS)

 

Learning Objectives:

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

  • List the 4 major steps in diagnosing endometrioid precancer.
  • Describe common pitfalls and difficulties in the diagnosis of EIN/AH.
  • Define cytologic demarcation and it’s importance in the diagnostic criteria.
  • Compare and contrast non-atypical and atypical hyperplasia.

This lecture addresses recent changes to the rubric used to diagnose endometrial precancers and hyperplasia as described in the most recent WHO Blue Book “Tumors of the Female Reproductive Organs” (IARC, 2014). Changes in terminology and criteria put forth in the new system will be elaborated on and pitfalls and areas of difficulty will be discussed. Need for this topic is based on personal experience training residents and fellows, recent publications in the area as well as personal consult cases and QA case review.

This session will be of value to pathology residents and general anatomic pathologists.

 

1415-1445

Recent Advances in Adenosquamous Lesions of the Cervix

Simona Stolnicu, University of Medicine and Pharmacy of Targu Mures, Romania

 

Learning Objectives:

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

  • Describe morphology and diagnostic criteria of cervical adenosquamous carcinoma, precursor lesions and mimics.
  • Discuss useful tools for differential diagnosis.
  • Provide information on etiology, clinical features and outcome of cervical adenosquamous lesions in comparison with other cervical malignant tumors.

Cervical adenosquamous carcinoma (AS) is a relatively uncommon tumor, classified by the World Health Organization Classification of Tumors of Female Reproductive Organs (WHO) 2014 as a separate entity distinct from both squamous and glandular malignant tumors of the cervix. Historically, glassy cell carcinoma and mucoepidermoid carcinoma were considered malignancies lying within the spectrum of AS. Although WHO 2014 criteria require unequivocal glandular and squamous differentiation for a diagnosis of cervical AS, in practice, AS is a spectrum of lesions and the diagnoses are often made in tumors that lack unequivocal squamous and/or glandular differentiation. Recent work provides new information about AS and mimics. Comparing to invasive squamous carcinoma or cervical adenocarcinoma, AS differ in etiology (associated rate with HPV infection), precursor lesions, morphology, immunohistochemical profile, clinical outcome and management. Mimics such as invasive stratified mucin-producing carcinoma (iSMILE), a newly recognized subtype of endocervical adenocarcinoma and HPV-associated adenocarcinomas with benign-appearing squamous metaplasia should not be diagnosed as AS based on distinguishing morphological features and some immunohistochemical differences, despite the fact that clinical outcomes appear similar. Also, since glassy carcinomas do not meet the criteria for AS and lack evidence of squamous differentiation with immunohistochemistry, one should reconsider whether these tumors should be categorized as adenosquamous carcinomas. Moreover, cervical tumours defined as mucoepidermoid carcinoma by strict morphological criteria harbour genetic aberrations involving the genes rearranged characteristically encounter in mucoepidermoid carcinoma of the salivary glands suggesting that cervical mucoepidermoid carcinoma is an entity distinct from conventional adenosquamous carcinoma.

 

1445-1515

An Update on Uterine Sarcomas

Robert Soslow, Memorial Sloan Kettering Cancer Center

 

Learning Objectives:

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

  • Describe the historical context of uterine sarcoma classification and its evolution.
  • Recognize histologic and immunohistochemical features of the main sarcoma types (endometrial stromal, leio- and undifferentiated sarcomas).
  • Discuss the range of recently described entities.
  • Apply ancillary tests to diagnose these new entities.
  • Explain the clinical significance of the new entities.

Uterine sarcomas used to be classified as endometrial stromal sarcomas, leiomyosarcomas or undifferentiated sarcomas. Use of technology to identify somatic mutations and gene fusions along with refinements in interpretation of morphology and immunophenotype have engendered the idea that the spectrum of uterine sarcomas encountered is significantly broader that what was appreciated previously.

 

1515-1545

Refreshment Break

 

1545-1615

Small Cell Carcinoma of the Ovary of Hypercalcemic Type: New Developments

Anna Plotkin, Trillium Health Partners

 

Learning Objectives:

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

  • Describe morphological and immunohistochemical features of the SCCOHT.
  • Discuss genetic markers for diagnosis of SCCOHT.
  • Summarize clinical implications of the new data.

Small cell carcinoma of the ovary of hypercalcemic type (SCCOHT) classified as miscellaneous tumor in WHO 2014. Recent data suggested that SCCOHT could be classified as rhabdoid rumor and is a part of genetic syndrome.

The session will be of value to: pathology residents, PAs, general and anatomic pathologists.

 

1615-1715

Panel Discussion: Application of Current Recommendations in Endometrial Carcinoma Diagnosis into Your Routine Practice

Back to top

 

 

Workshop: Gastrointestinal Infections, for Those with a Strong Stomach
Monday June 24, 1345-1515

 

Sara Hafezi-Bakhtiari, University Health Network

Catherine Streutker, St. Michael’s Hospital

 

Learning Objectives:

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

  • Evaluate subtle signs indicative of infections of the GI tract.
  • Detect uncommon organisms.
  • Identify the subtle signs indicating a malignancy associated with infectious causes.
  • Identify some of the common differential diagnosis for an infectious etiology.

This workshop will be a review of common and uncommon luminal GI tract infections. The specific topics that will be covered include:

  1. Esophagus (i.e. CMV, Herpes, Candida)
  2. Stomach (i.e. Helicobacters, strongyloides, parasites)
  3. Small Bowel (i.e. Parasites, CMV, other)
  4. Colon (i.e. TB, syphilis, chlamydia, others)
  5. Differential diagnosis of an infectious etiology in GI tract
  6. Infection associated malignancies in GI tract

Back to top

 

 

Symposium: Workload & Human Resources
Monday June 24, 1345-1715

 

Assessment of Canadian Pathology Workload and Human Resources

Raymond Maung, Chair, CAP-ACP Workload and Human Resources Committee

 

Learning Objectives:

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

  • Summarize current pathology human resources.
  • Discuss current pathology workload.
  • Describe how the information is gathered and analyzed.

This session will be useful to all anatomic and general pathologists and residents who are wondering the workload and pathology human resources in their particular province. They will understand where and how the information was gathered and analyzed.

 

Comparison of Workload Measurement Guidelines in Anatomic Pathology

Fawaz Halwani,

 

Learning Objectives:

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

  • Compare the similarities and differences of 4 different workload systems.
  • Compare the pros and cons of 4 different workload systems.
  • Compare the data generated by 4 different workload systems.

EORLA is an association of all the laboratory and pathology departments of Eastern Ontario that includes 18 facilities in 16 regional hospitals of different sizes. Pathologists require a mechanism to ensure proper staffing and a workload that is reasonable, safe and practical but not excessive. There are several published workload measurement systems that are available. We chose to evaluate four commonly used workload measurement systems: CAP, W2Q, RCP and CPT. We developed software that automatically calculates the workload for all these systems simultaneously to evaluate which one was most appropriate for our practice at EORLA. The session will be of value to anatomic pathologists and residents.

 

CAP-ACP Workload Model 2018 Update

Raymond Maung, Chair, CAP-ACP Workload and Human Resources Committee

 

Learning Objectives:

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

  • Summarize the CAP-ACP model – history and principles.
  • List the pros and cons of the CAP-ACP model versus other models.
  • Discuss how to use the model.

Pathologists unlike others specialties do not control the work that lands on their desks, thus a need for a workload model to keep the workload appropriate. CAP-ACP workload and Human Resources committee has representation from all the provinces and has updated the model every 3-4 years to improve and keep it current. No model is perfect, but the 2018 update is mature and reflects the work/value related to each case. The “9 rules” makes coding easy and intuitive. It is the only model that is all inclusive of the work done by pathologists. It includes consultation, QA activities, teaching and mentoring, research, administrative and medical oversight activities.

Back to top

 

 

Workshop: OMPRN: Diagnostic Devils and Rogue Results in Molecular Pathology
Monday June 24, 1345-1515

 

This workshop, developed through the Ontario Molecular Pathology Research Network, will focus on technical and interpretive challenges that arise in the application of molecular assays that are used broadly and increasingly in diagnostic cancer pathology.

 

1345-1430

Molecular Testing (HER2) and Guidelines for Breast Cancer (ASCO-CAP and NCCN)

John Bartlett, Ontario Institute for Cancer Research

 

Learning Objectives:

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

  • Summarize changes relating to diagnosis of HER2 status recommended by recent update to ASCO-CAP guidelines.
  • Discuss the diagnostic approaches to “rogues”.
  • Describe the role of molecular prognostic testing in staging – AJCC 8th Edition on breast cancer staging.

 

1430-1515

PCR-based Assays for the Detection of Sequence Variants and the Quantification of Aberrant Transcripts

Peter Sabatini, University Health Network

 

Learning Objectives:

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

  • Describe pre-analytical considerations relevant to molecular testing of nucleic acids from formalin fixed paraffin embedded (FFPE) tissues.
  • Summarize challenges associated with use of FFPE tissue-derived nucleic acids in PCR-based molecular diagnostic assays.
  • Identify approaches that may be used to optimize the pre-analytic phase of PCR-based molecular diagnostic testing.

 

1515-1545

Refreshment Break

 

1545-1715

Massively Parallel Sequencing (MPS): An Overview and Applications for the Clinical Labs

Harriet Feilotter, Queen’s University

 

Learning Objectives:

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

  • Discuss the general theory of massively parallel sequencing (MPS, also known as next-generation sequencing; NGS) and its applications in molecular diagnostic testing.
  • Summarize the pre-analytical, analytical, and post-analytical metrics that help guide interpretation of MPS results for solid tumour investigations.

 

Choose the Right Molecular Diagnostic Assay – Interactive, Case-based Exercises

Harriet Feilotter, Queen’s University

David LeBrun, Queen’s University

Peter Sabatini, University Health Network

Back to top

 

 

Symposium: Canadian Network of Uropathology: Prostate Biopsies: Traditional and Advanced Diagnostic Approaches
Monday June 24, 1545-1715

 

Selected Diagnostic Challenges in Prostate Biopsies: Poorly Formed Glands and Intraductal Carcinoma

Fadi Brimo, McGill University

 

Learning Objectives:

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

  • Apply qualitative and quantitative criteria to the diagnosis of Gleason pattern 4, poorly formed glands.
  • Recognize the morphological features of intraductal carcinoma of the prostate.
  • Employ an approach to malignant intraductal cribriform lesions of the prostate.

The diagnosis of invasive prostatic adenocarcinoma,Gleason grade 4, the poorly formed glands pattern is the source of a non-negligible proportion of discrepancies between pathologists.Similarly, intraductal carcinoma of the prostate and cribriform high-grade PIN can show overlapping morphological features despite their widely different prognostic impact. This lecture will present a systematic morphological approach to such lesions and will highlight clear morphological criteria that can be of use to practicing pathologists.

This session will be of value to general and anatomic pathologists, pathology residents and urologists.

 

Tumour Volume Estimation in Prostate Core Biopsies, How a Pathologist Can Guide the Management

Farshid Siadat, University of Alberta

 

Learning Objectives:

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

  • Identify importance of tumour volume estimation.
  • Estimate tumour volume in challenging scenarios.
  • Formulate a plan to standardize tumour volume reporting.

This session will lay out the importance of tumour volume estimation in prostate core biopsies and role of pathologist in guiding management of prostate cancer. Different scenarios will be discussed with examples and best method of reporting tumour volume will be discussed.

The topic will be of value to pathologist signing out prostate core biopsies as well as pathology residents and PAs.

 

AI-Based Decision Support Tools for Gleason Scoring: Progress, Opportunities and Challenges

Andrew Evans, University Health Network

 

Learning Objectives:

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

  • Define artificial intelligence, machine learning and convolutional neural networks.
  • Discuss how AI algorithms are developed and validated and their role as decision support tools in pathology.
  • Summarize the promise and limitations associated with these tools as applied to Gleason grading of prostate cancer.
  • Describe the current state of development of AI-based tools for Gleason grading.

Gleason grading is the most important histopathologic factor used in risk stratification and treatment planning for men diagnosed with prostate cancer by needle biopsy. Interobserver variability between pathologists is a well-known issue for Gleason grading, which can have a major impact on treatment planning following biopsy. The development of artificial intelligence (AI)-based tools represents an active area of translational research in prostate cancer. These tools hold great promise with respect to quality assurance in the diagnosis and grading of prostate cancer in needle core biopsies. This presentation will provide an overview of the current state of this technology as applied to Gleason grading, including its promise, limitations and challenges. The session will be of value to residents, fellows and anatomic pathologists. It is hoped that attendees will understand that these tools will eventually reshape the profession by augmenting (as opposed to threatening) the way pathologists practice.

 

Prostate Cancer: Moving Beyond Gleason Grading

George Yousef, University of Toronto

 

Learning Objectives:

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

  • Discuss the evolving role of the pathologists in the active management of patients with prostate cancer.
  • Describe the role of molecular testing in reaching a new era of precision medicine in prostate cancer.
  • Identify some of the current commercially available and emerging molecular testing that can aid to the management of prostate cancer.

With the introduction of PSA testing, we ran into the problem of over diagnosis and over treatment of prostate cancer. The Gleason grading system served as an excellent tool for assessment of prognosis and guiding the treatment decision, however recent research has shown that Gleason grade is not without its limits. Discrepancies exist among pathologists in assigning certain morphological patents to specific Gleason grades. There is also a discrepancy between the grading of biopsy and resection of a specimen in addition to inter-observer variability. A number of emerging biomarkers based on the analysis of the biology of prostate cancer are now emerging to help different purposes from deciding to biopsy or re-biopsy patients for the presence of cancer, to guide treatment decisions, and to assess the prognosis of cancer which can have significant implication on management.

Back to top

 

 

Multi-Headed Scope Workshop: Common Problems and Solutions in Practical Breast Pathology (CME Section 3 Credits)
Monday June 24, 1530-1730

 

Anna-Marie Mulligan, University of Toronto

 

Learning Objectives:

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

  • Recognize common diagnostic issues in breast pathology practice in non-specialize or semi-specialized settings.
  • Develop logical and common sense approach to the problem solving in daily breast pathology.
  • Utilize limited resources effectively – learn how to safely avoid overtesting.
  • Gain confidence in assessing proliferative non-neoplastic breast lesions.
  • Build a network with clinical colleagues through participation in multidisciplinary team work.

There will be 20 cases representing a spectrum of difficulties in general surgical pathology breast practice. The cases and the themes for deliberation are based on experience of consulting in breast pathology. Exotic, controversial and exceeding rare pathology will not be included. The focus will be on daily issues in a busy community practice and their practical solution with limited resources.

Back to top

 

 

Symposium: PSQA: Pan Canadian Molecular Biomarkers Quality Framework for Reporting
Tuesday June 25, 0830-1030

 

PSQA Section Chair / Symposium Moderator:

Monalisa Sur, McMaster University

 

Overview and Update from CPAC

John Srigley, Trillium Health Partners

 

Learning Objectives:

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

  • Review collaborations between the Canadian Partnership Against Cancer (CPAC) and CAP-ACP over the last decade.
  • Discuss the importance of national quality initiatives in the context of a federated provincial system.
  • Present a draft pan-Canadian framework for high quality molecular cancer biomarker testing.

 

National CAP-ACP initiative on CIQC

Catherine Ross, McMaster University

 

Learning Objectives:

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

  • Review the CIQC and Committee on high complexity testing.
  • Inform attendees of the initiatives being undertaken within the CAP-ACP, to advance quality initiatives for Canadian pathology.
  • Discuss the possibilities of other potential national collaborations.

Attendees at the meeting will learn of current CAP-ACP quality initiatives, and the CIQC program. Additionally, ongoing work and new developments with CIQC for quality initiatives will be discussed, including a new competency based assessment tool and an external quality assessment for molecular biomarker testing.

 

National Proficiency Testing and Local Experiences in the West with Synoptic Biomarkers Test Reporting

Blake Gilks, University of British Columbia; Vancouver General Hospital

 

The templates for synoptic reporting of those biomarkers used for endometrial carcinoma molecular subtype assessment (mismatch repair and p53), as used in British Columbia, will be presented, along with information about national and international quality assurance and proficiency testing results, demonstrating the potential of these markers to serve as surrogate markers of molecular subtype. Comparison will be made to the established biomarker synoptic reports used for breast cancer.

 

Overview of Canadian Landscape with Hereditary Tumours Testing (Quality Indicators for Reporting)

Tracy Stockley, University Health Network

 

The session will present the Canadian current status for testing of hereditary tumors, and our increasing awareness of the utility of tumor-first testing for simultaneous identification of somatic and germline variants. Examples will be provided from testing of high-grade serous ovarian cancer and Lynch syndrome.

Back to top

 

 

Multi-Headed Scope Workshop: Recognizing Inherited Cancer Syndromes (1045-1245) (CME Section 3 Credits)
Tuesday June 25, 1045-1215

 

Cheryl Mather, University of Alberta

 

Learning Objectives:

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

  • Identify histologic features associated with Lynch syndrome associated GI and GYN cancers.
  • Interpret immunohistochemical stains for mismatch repair proteins and appropriately triage specimens for additional studies to determine whether mismatch repair deficiency is due to inherited or somatic mutations.
  • Integrate the histologic and clinical data that should raise consideration that a renal tumor is associated with an inherited syndrome.
  • Describe the constellation of tumors that suggest a patient has congenital mismatch repair deficiency Li Fraumeni syndrome and SDH deficiency.
  • Express the necessity of recognizing inherited cancer syndromes for the purposes of surgical and clinical management.

This workshop is designed to be an overview of inherited cancer syndromes, focusing on clinical and histologic features that should raise consideration of these syndromes. The workshop should also assist the participants to triage cases to appropriate studies to rule in or exclude such syndromes, and it will improve the participants’ understanding of the clinical implications of identifying these syndromes using surgical specimens.

Back to top

 

 

Workshop: The World of Ocular Pathology, Intraocular and Periocular Neoplastic and Non-Neoplastic Lesions
Tuesday June 25, 1045-1215

 

Sabrina Bergeron, McGill University

Miguel Burnier, McGill University

Alexandre Odashiro, Hôpital Saint-Jérôme

 

Learning Objectives:

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

  • Review how to diagnose eyelid malignancies, sebaceous cell carcinoma and adenocarcinoma and image them by OCT.
  • Discuss the diagnosis and prognosis of conjunctival neoplasms and primary acquired melanosis (PAM).
  • Discuss the diagnosis and prognosis of intraocular and periocular melanomas.
  • Discuss the diagnosis and prognosis of intraocular tumors in adult and children.
  • Discuss the diagnosis and prognosis of orbital tumors in adult and children.

This workshop aims to familiarize pathologists, trainees and pathologist assistants with both routine and challenging cases in ocular pathology. Topics covered include, but are not limited to; eyelid tumors, conjunctival melanocytic lesions, intraocular melanoma, retinoblastoma and orbital tumors.

This workshop will on macroscopic and microscopic features of ocular specimens and give a thorough overview of clinicopathological correlations of these lesions. We plan to emphasize on the use of digital pathology in ocular pathology and describe techniques and programs employed by our laboratory. Connections between digital pathology and other imaging modes pertaining to ophthalmology, such as optical coherence tomography, will be presented.

Workshop material will be digitalized and made available to participants upon request after the workshop. Participants will be encouraged to participate in the workshop and bring cases they wish to share with other participants and the ocular pathology specialists hosting the workshop.

Back to top

 

 

Workshop: The Expert Witness
Tuesday June 25, 1045-1215

 

Christopher Milroy, University of Ottawa

Jacqueline Parai, University of Ottawa

 

Learning Objectives:

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

  • Plan how to give effective evidence in court.
  • Differentiate the role of the expert in criminal and civil cases.
  • Identify different ways lawyers examine witnesses.
  • Apply pathology knowledge in writing a report for the court.

The courts depend upon physicians to act as expert witnesses. Physicians may choose to practice in this area or may end up as an expert witness because of their everyday practice. Testifying at trial is most commonly done by Forensic Pathologists in criminal cases; surgical pathologists however can also be called as expert witnesses in civil litigation, as assessors and experts for medical licensing bodies or as witnesses in an inquest.

This workshop will provide practical experience on how to be an expert witness. The workshop will discuss the rules of evidence as they apply to witnesses and how they apply to civil as well as criminal cases. It will provide an analysis of report writing in both civil and criminal matters. The workshop will also include practical demonstrations of being a witness in court and how evidence in chief and cross examinations are conducted.

The presenters are experienced expert witnesses and have given evidence in many jurisdictions in criminal and civil cases, inquests and for medical licensing bodies.

Back to top

 

 

HologicSymposium: Who, What, When, Where, and How? HPV Testing in the Era of Molecular Pathology
Co-developed by CAP-ACP and Hologic
Tuesday June 25, 1315-1445

 

Mel Krajden, BC Centre for Disease Control

 

Learning Objectives:

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

  • List the benefits of HPV testing for cervical cancer screening.
  • Outline the lessons learned from the FOCAL Trial to assess primary HPV testing.
  • Compare the performance of different HPV tests.
  • Outline HPV testing implementation challenges.

The intention of this presentation is to describe the benefits of HPV testing as a cervical cancer screening tool. This will be achieved by outlining the lessons learned from the British Columbia FOCAL Trial to assess primary HPV testing. The presentation will also include a comparison of the performance characteristics of different HPV tests as well as summary of HPV implementation challenges including the impact of HPV vaccination. The session will be of value to: pathology residents, PAs, general and anatomic pathologists.

 

Joan Murphy, Trillium Health Partners

 

Learning Objectives:

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

  • Summarize the current status of cervical screening and cervical cancer in Ontario.
  • Cite the evidence to support HPV in cervical screening.
  • Discuss the implications for screening and colposcopy programs of HPV as the primary cervical screening test.

In this session I will summarize the need for changes in cervical screening including our challenge to meet the WHO Elimination Goals, the shortcomings of current screening practices and programs in Canada and the effect of HPV immunization. The high sensitivity, specificity and negative predictive value of HPV testing, together with triage tests including cytology, offer the opportunity for women in Canada to benefit from greater efficiency and effectiveness of cervical screening than have previously been possible. The experience and strategies of implementation projects in organized screening programs outside Canada, will be reviewed. The Ontario Cervical Screening Program’s guidelines which in 2011 recommended HPV as the primary screening test and which are currently under revision, will be reviewed. Engagement of the clinical and laboratory communities, the public and policy makers will be pivotal in achieving optimal identification and management of cervical cancer precursors and thus the elimination of cervical cancer in Canada. There are challenges and unanswered questions that remain to be addressed in all jurisdictions, including Canada, as new evidence and technology become available.

Back to top

 

 

Multi-Headed Scope Workshop: Dermpath for Non-Dermpaths: Name That Rash (CME Section 3 Credits)
Tuesday June 25, 1415-1615

 

Catherine Shiau, Royal Columbian Hospital

 

Learning Objectives:

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

  • Differentiate between eczematous dermatitis and psoriasis.
  • Identify the histologic criteria for an interface/lichenoid process.
  • Correlate the provided clinical history with the pathology findings.

This workshop will be a series of cases showing the different and common histologic patterns of superficial inflammatory dermatoses. There will be particular focus on differentiating between the most common patterns, including eczematous/spongiotic dermatitis, psoriasiform dermatitis, interface dermatitis, and lichenoid inflammation. Basics of clinical-pathology correlation will be done through a discussion of the clinical features with corresponding histologic features. Practical examples will be provided of how to write a final diagnosis that is clinically relevant despite not always being specific.

Back to top

 

 

Symposium: Education: Understanding and Adopting Competence By Design in Pathology Education
Tuesday June 25, 1445-1615

 

Education Section Co-Chairs / Symposium Moderators:

Nadia Ismiil, University of Toronto

Catherine Streutker, St. Michael’s Hospital

 

Learning Objectives:

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

  • Discuss the concept of competency by design (CBD) in pathology education, and contextualize its origins and application in Canada.
  • Describe the core elements of CBD and its major differences with traditional curricula.
  • Express the advantages of CBD education in pathology for both trainers and trainees.
  • Apply a CBD approach to their own training environments.

 

Competency by design (CBD) is an innovative model of education that has successfully engrained in many disciplines, including medicine. Post-graduate pathology training is transitioning into a CBD format in many institutions across Canada under the guidance of the Royal College of Physicians and Surgeons of Canada. In this session, the education section aims to share perspectives and experiences on CBD in pathology and foster a discussion about the advantages, opportunities and obstacles of CBD implementation in pathology. After this session, attendees will have a better understanding of CBD and their implications in postgraduate training, and will be able to better adopt a CBD approach to their teaching/learning experience.

 

Part 1 – Panel Introductory Remarks

 

1445-1455

History of CBD internationally and in Canada. Origins and rationale. Brief description of CBD and its differences from traditional curricula

Martin Bullock, Dalhousie University

 

1455-1505

Understanding and adopting Competence by Design in Pathology Education

Elenore Latta,

 

1505-1515

Lessons learned from CBD implementation and adoption; benefits and challenges

Christopher Davidson,

 

1515-1525

Learner perspective on CBD

Dalila Villalobos,

 

1525-1615

Part 2 – Panel Discussion

1. Questions by moderators

Nadia Ismiil, University of Toronto

Carlos Parra-Herran,

 

2. Questions by audience

Back to top

 

 

Symposium: Advanced Diagnostics
Tuesday June 25, 1445-1615

 

1445-1520

Precision Oncology in Canada


David Malkin
, University of Toronto

 

Learning Objectives:

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

  • Describe the pediatric precision oncology programs in Canada.
  • Discuss the unique aspects of next generation sequencing approaches in childhood cancer.
  • Explain the challenges to implementing precision therapies generated from NGS data for children with cancer.

Cancer is the most common cause of disease-related death in children, adolescents and young adults (CAYA) in Canada. One-third of patients exhibit refractory, metastatic or relapsed disease, and 20% of CAYA with cancer will die of their of disease. The advent of next generation sequencing (NGS) together with identification of an ever-increasing armamentarium of novel molecular-targeted compounds and immunomodulators points to the promise to incorporate these into ‘new generation precision medicine’ for the CAYA cancer population. In Canada, three NGS programs (pedsPOG (Vancouver); KiCS (Toronto); TRICEPS (Montreal)) have supported the cancer sequencing capacity for patients. The Terry Fox PROFYLE (PRecision Oncology For Young PeopLE) was created in 2017. This multi-institutional, multi-disciplinary program is designed to accelerate and facilitate enrollment of patients with ‘hard-to-treat’ cancers anywhere in the country to NGS as well as discovery-based research programs in proteomics and modeling, to identify molecular targets for novel therapeutics developed through innovative clinical trial designs. This presentation will summarize the structure of the PROFYLE and KiCS (SicKKids Cancer Sequencing) programs, as well as present data generated from these programs that inform the future opportunities and challenges in precision oncology, and precision medicine, programs.

 

1520-1525

Questions

 

1525-1550

NGS and Beyond: Current and Upcoming Approaches in Molecular Pathology

George Yousef, University of Toronto

 

1550-1610

The Importance of Context-Dependent Genomics

Alan Spatz, McGill University

 

1610-1615

Questions

Back to top

 

 

Workshop: Doing More with Less: Effusion Cytology – a Significant Resource to Guide Therapy in the Era of Personalized Medicine
Tuesday June 25, 1445-1615

 

Omar Al-Nourhji, University of Saskatchewan

Harmon Sekhon, University of Ottawa

 

Learning Objectives:

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

  • Describe a practical diagnostic approach to pleural, pericardial and peritoneal effusion specimens with an emphasis on challenges and pitfalls of effusion cytomorphology.
  • Discuss the systematic and algorithmic approach utilizing current ancillary studies in effusion cytology.
  • Summarize the role of cytopathologists in specimen optimization for molecular testing (preanalytic variables, specimen processing, tissue conservation).
  • Discuss molecular testing: Why is testing needed? When to order?
  • Discuss tissue selection: Which tests to order (prioritize)?
  • Discuss test protocols: How to test?.

Pleural, pericardial, and peritoneal effusion specimens may provide the first diagnosis of malignancy or be the first sign of disease recurrence in patients with previous malignancy. Despite being a common specimen in the cytology laboratory, these specimens may present diagnostic challenges to the practicing pathologist. This session will detail the diagnostic features of benign and malignant effusions encountered in daily practice. Importance of integration of cytological and clinical correlation will also be incorporated. A practical approach to immunohistochemical workup with an emphasis on new immunostains will be outlined. Effusion cytology specimens are more frequently being utilized for molecular testing, avoiding the need for further invasive procedures to acquire additional tissue. A detailed outline of the cytopathologist’s role in molecular testing will be addressed (preanalytic variables and specimen optimization, indications for and methods of molecular testing including IHC, DNA and RNA targeted tests).

Back to top

 

 

Symposium: Forensic: The Shafia Murders
Tuesday June 25, 1445-1615

 

Christopher Milroy, University of Ottawa

 

Learning Objectives:

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

  • Describe the pathology of drowning.
  • Describe honour killings.
  • Identify the integration of pathology into a criminal investigation.

 

Back to top

 

 

Multi-Headed Scope Workshop: Challenging Intraoperative Consultation Cases (CME Section 3 Credits)
Tuesday June 25, 1630-1830

 

Fang-I Lu,

 

Learning Objectives:

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

  • Diagnose and manage selected challenging intraoperative consultation scenarios.
  • Recognize the importance of clinical, radiologic and pathologic correlation in the intraoperative consultation setting.
  • Establish quality control/quality improvement activities relevant for intraoperative consultation.
  • Identify technical issues related to intraoperative consultation.

A total of 15 cases highlighting various challenges one could encounter during intraoperative consultation will be presented. Each case will take about 10 minutes with at least 1/3 of the time reserved for questions and comments from the participants. The topics that will be covered include challenging diagnostic entities one could encounter in various organ systems and how to best diagnose and manage them intraoperatively, cases that highlight the importance of clinical radiologic and pathologic correlation, technical issues one could encounter during intraoperative consultation and how to best manage them, and quality control/quality improvement activities relevant to intraoperative consultation. The material to be presented will include frozen section, cytology (smear and touch prep) and permanent H&E section slides.

Back to top

 

 

Symposium: Humanities and International Health
Tuesday June 25, 1630-1830

 

1630-1730

The Fake Princess

Christopher Milroy, University of Ottawa

 

Learning Objectives:

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

  • Describe the pathology of bodies preserved in peat bogs.
  • Describe the pathology of natural and artificial mummification.
  • Apply the role of carbon dating of modern bodies.

 

1730-1800

Tribute to Harry Letts, Former CAP-ACP Archivist

James Wright, University of Calgary, presented by Laurette Geldenhuys, Dalhousie University

 

1800-1830

CAP-ACP Humanities and International Health Section Annual General Meeting

Back to top

 

 

Symposium: Hematological Pathology: A Practical Approach to the Diagnosis Of Myeloid Neoplasms Using Next Generation Sequencing
Tuesday June 25, 1630-1830

 

Philip Berardi, The Ottawa Hospital

Bryan Lo, The Ottawa Hospital

 

Learning Objectives:

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

  • Explain how congenital/germline mutations can influence cancer predisposition.
  • List some common acquired/somatic mutations encountered in a clinical molecular oncology laboratory.
  • Summarize strategies to somatic and germline mutation testing and understand how this impacts the patient journey.
  • Discuss best practices associated with identifying and reporting genetic lesions in cancer.

This interactive session will include broad themes in molecular oncology including key differences in somatic and germline mutation assessment. It will be presented by medical directors of a molecular oncology laboratory that focuses on ‘somatic’ mutation testing for complex malignant hematology and solid tumours in a large academic center. With the advent of comprehensive genetic testing using NGS gene panels, identification of various mutations in cancer has become more common in clinical practice. It is increasingly being recognized that testing tumor DNA alone may lead to sub-optimal administration of cancer therapies, resulting in patient safety concerns and possibly increased healthcare costs.

Clinical laboratories may need to more clearly state in their reports that NGS tumour-only assays cannot always differentiate somatic versus germline variants and further testing may be necessary if a patient’s clinicopathologic and/or family history are suggestive of a hereditary cancer syndrome. Hitherto, running a second matched normal-tumor test for all patients has added additional cost to the healthcare system without significantly improving testing accuracy. This may need to be reconsidered as the recognition of germline mutations in the context of cancer predisposition becomes more readily available. In addition, germline variant interpretation is not without difficulty and over-interpretation of germline alterations can potentially harm patients.

This session will highlight these and other emerging issues in the realm of more routine comprehensive genetic testing in a clinical molecular laboratory. There will be case descriptions throughout the session and adequate time for audience participation and discussion.

Back to top