CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Kaitlin E. Sundling, MD, PhD
January 2019—The evolution of minimally invasive techniques and new diagnostic modalities have placed new demands on medical laboratories. Cytotechnologists find themselves uniquely poised to take on these new responsibilities, using their morphologic and analytical skills. In this article, I summarize potential roles for cytotechnologists that go beyond screening cytology slides to add value and improve quality in the clinical laboratory.
Prescreening slides for potentially rare microorganisms uses morphologic and locator skills. Groups at Massachusetts General Hospital and Mayo Clinic report cytotechnologist prescreening for microorganisms using immunohistochemical stains for H. pylori, AFB stains for mycobacterial organisms, and GMS stains for fungus.1,2 This prescreening has the potential to add value by increasing the sensitivity of detection for rare organisms as well as saving pathologists time.
Cytotechnologists’ rigorous approach to screening and attention to detail may help standardize the interpretation of prognostic and predictive immunohistochemical stains. For example, a Canadian group reports that cytotechnologist counting of Ki-67 index for gastrointestinal and pancreatic neuroendocrine tumors showed a significant time savings for pathologists and more accurate tumor grading.3 Similarly, cytotechnologists may be involved in HER2, estrogen receptor, and progesterone receptor quantification.1 The potential value of cytotechnologist pre-scoring of immunohistochemical stains could be extended to any biomarker with a clinical decision based on a quantitative result, such as PD-L1.
Digital pathology has the highest probability of success when trained microscopists review the whole slide images. In our laboratory, cytotechnologists perform the scanning, review the images, and re-scan slides that are poor quality. Cytotechnologists at Mayo Clinic additionally perform digital image analysis.1 Cytotechnologists can help ease the digital transition and provide needed quality assurance for these tools.
Evaluation of blood specimens for circulating tumor cells requires the use of strict morphologic criteria to evaluate multichannel fluorescence signals of rare tumor cells. Circulating tumor cell enumeration results are FDA cleared for breast, prostate, and colorectal cancers; however, they are most commonly used in the context of clinical trials. Kane and colleagues of Mayo Clinic report cytotechnologist screening of these data prior to pathologist review.1 It is expected that cytotechnologists’ involvement would improve the reproducibility of this test compared with pathologist review alone, although studies to this effect have not been identified.