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Cytopathology Rotation

Faculty: Nancy Joste, M.D. (Division Chief), Thèrése Bocklage, M.D., Edgar Fischer, M.D, Ph.D., Lesley Lomo, M.D., Von Samedi, M.D., Ph.D.

Length: one 3-month rotation

Rotation Structure: Shall we say, spontaneously invigorating? (Explained below)

Annual UNM Pap smears reviewed by residents: approximately 5800

Annual FNAs: about 600

Annual Other Non-gynecologic cases: about 1700

In contrast to the stately cadence of the University of New Mexico (UNM) surgical pathology rotation, the structure of the cytology rotation is more like a carnival experience: you wander from booth to big ring to sideshow in admittedly a less orderly fashion. On any given day, you will sign out about 25 Pap smears, about 20 Non-gyn specimens, 2-5 Fine needle aspirations (FNA), run off and check for adequacy of an endoscopic ultrasound (EUS) guided FNA of a pancreatic tumor in the Gastrointestinal (GI) Procedures Suite, participate in the quarterly required correlation review of Pap smears and follow-up cervical biopsies, and then perform an FNA of a plum-sized thyroid mass without requiring the aid of the friendly radiologists performing nearby and occasionally requesting your presence. The idea is to provide you steadily less amateur participation in the various aspects of cytopathology while also allowing your stomach to occasionally settle long enough to review teaching sets, on your own or with an attending, study from cytology texts, review cytology teaching materials online, prepare for your end of rotation case presentation conference, and partake, if you so desire, in a small cytology research project.

The College of American Pathologists (CAP) periodically issues collations that relate how pathology is practiced in the United States. The most recent edition notes that cytopathology is the second most common daily anatomic pathology (AP) activity for private practice pathologists. If in physical quantity it tends to be small, in aggregate it is a big deal.

In three months, you will need to learn how to perform and evaluate FNAs competently, align your cervico-vaginal diagnoses with those of your attendings, and become at least generally familiar with the basics of other non-gynecologic specimens. You will also learn about CAP cytology laboratory regulations, Clinical Laboratory Improvement Amendments (CLIA) rules, and will spend time in the lab observing how cytology specimens are processed and stained. Our lab also uses state of the art neural network machines that preview the cervico-vaginal cases, exceedingly helpful for an annual combined volume of about 80,000 Pap “smears” (now almost all are in the form of Surepath monolayer slides).

You sign out with one cytopathologist daily, perform FNAs with another cytopathologist daily, and may even have the opportunity to work with a cytopathology fellow. There are plenty of performers, a bit like a carnival’s chaos, which is actually well-planned and well executed. In addition to the teaching associated with the daily workload, cytopathology education also includes an annually repeated didactic lecture series covering the major diagnostic categories. Admission is free.

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