Course Objectives:

Sunday:

Welcome and Opening Remarks [Yaziji]

  1. Overview of general course goals
  2. Summary of topics
  3. Introduction of ISIMM of partnership with ISIMM
  4. Housekeeping remarks

Pre-Test [Yaziji]

  1. To be familiar with a sample of presented material at the course
  2. To gauge the participants’ level of ‘baseline’ knowledge prior to attending the course
  3. To learn on specific testing items that are of particular interest
  4. To have an opportunity for focused discussion of some or all of the test questions and the correct answers

Interpreting FISH Assays by The Practicing Pathologist – General Principles  [Yaziji]

  1. To provide an overview of basic physics principles of fluorescence and how it applies to fluorescence in situ hybridization (FISH) testing
  2. To learn advantages of oligonucleotide probes over BAC probes
  3. To learn the FISH procedure of directly conjugated probes on both tissue specimens and liquid specimens
  4. To learn the general principles of interpretation of amplification, gain/loss, deletion, and translocation assays
  5. To be familiarized with the specific applications of FISH testing and FISH targets as they relate to the practice of anatomic and clinical pathology

Best of USCAP 2017: IHC Applications [Eisen]

  1. To learn of the new and promising immunohistochemistry (IHC) markers that were presented at the 2017 United States-Canadian Academy of Pathologists (USCAP) as part of large research studies
  2. To apply new IHC applications in various differential diagnostic settings
  3. To appropriately utilize specific new markers/applications that may become significant in the near future

Developing Fit-For-Purpose IHC Assays [Cheung]

  1. To discuss classification of IHC assays; types vs classes
  2. To discuss “Fit-for-purpose” concept in IHC; purpose vs. use
  3. To discuss phases of IHC assay; readout vs. Interpretation

Validation vs. Verification of IHC Assays:  The Clue is in the Test Performance Characteristics [Torlakovic]

  1. To discuss quantitative vs. qualitative laboratory tests
  2. To learn cell-based vs. liquid-based laboratory assays
  3. To learn the list of IHC test performance characteristics
  4. To learn the difference between validation and verification; process of building evidence for “fit-for-purpose”

Tissue Tools are Power Tools for the IHC Laboratory.  [Cheung]

  1. To learn tissue tools for validation
  2. To learn tissue tools for QC
  3. To learn tissue tools in the life cycle of IHC assays; putting the fit-for-purpose in IHC QA

Controlling the Controls in IHC – a Path to Standardization [Torlakovic]

  1. To learn the role of controls in IHC assays; linking purpose to evidence
  2. To learn the descriptive sensitivity and LOD in IHC assays
  3. To learn the pros and cons of using archived diagnostic tissue vs. excess diagnostic tissue vs. other; the role of pre analytical conditions for IHC control materials
  4. To learn the use of reference standards in IHC

Monday:

Malignant Mesothelioma and Other Diffuse Pleural Tumors [Myers]

  1. To apply current criteria to histopathologic diagnosis of malignant mesothelioma,
  2. To appropriately apply immunohistochemistry to separate mesothelioma from its mimics, and
  3. To appropriately apply immunohistochemical stains and molecular tests helpful in separating benign from malignant mesothelial proliferations.

Role of the Pathologist in Diagnosis and Management of Patients with NSCLC [Myers]

  1. To apply current criteria to histopathologic diagnosis and classification of non-small cell lung carcinomas (NSCLC),
  2. To appropriately apply immunohistochemistry to subclassification of poorly differentiated NSCLCs, and
  3. To appropriately utilize immunohistochemical stains and molecular tests that drive therapeutic algorithms for NSCLC patients.

Interpreting FISH Assays: Common Assays & Specific Scenarios  [Yaziji]

  1. To learn interpretation of ALK, ROS1 and MET assays in non-small cell lung cancer
  2. To learn interpretation of HER2 assay in breast and gastric cancer (discussed in more detail in a dedicated talk)
  3. To learn interpretation of 1p/19q assay in brain glioma
  4. To learn interpretation of some of the lymphoma assays (panels or individual ones)
  5. To learn interpretation of some of the leukemia assays (panels or individual ones)
  6. To learn interpretation of urine FISH assay panel
  7. To learn the utilization of protein-based techniques for co-localization of FISH targets (rare cells, distinction of in-situ from invasive tumors, tumor nests in vascular spaces, etc.)

Molecular Genetics of Colon Cancer, what a practicing surgical pathologist needs to know [Greenson]

  1. To understand the various pathways involved in colorectal cancer pathogenesis, the histology of the precursor lesions of each pathway, the histology of the carcinomas of each pathway and molecular alterations found in each pathway.
  2. To learn the various therapies for colorectal cancer and how they vary depending on the underlying pathway involved.
  3. To learn which molecular tests are available and about how molecular testing integrates into precision medicine and targeted therapy for colon cancer.

Specimen Considerations for Solid Tumor Molecular Testing [Brown]

  1. To appreciate the importance of pre-analytic variables for solid tumor molecular testing
  2. To recognize what steps can be taken to ensure the accuracy of molecular testing while minimizing rejected specimens and testing failures
  3. To understand how the specimens received for molecular testing impact the appropriate testing methodologies

PD-L1: Interpretation Pitfalls & Update on Utility as a Companion Diagnostic Assay [Yaziji]

  1. To understand the biological pathways of Programmed Cell Death-1 (PD1), PD-L1 and PD-L2 in cancer and inflammatory cells
  2. To learn the commercially available PD1 and PD-L1 IHC assays in non-small cell lung cancer (NSCLC) and their association with specific targeted therapy agents
  3. To learn interpretation of PD-L1 testing by immunohistochemistry
  4. To learn pitfalls in PD-L1 interpretation, how to avoid them, and how to resolve them

Tuesday:

HER2 Testing: 2018 ASCO/CAP Guidelines – What’s New and Why [Yaziji]

  1. To recognize the new revisions in the 2017/2018 ASCO/CAP guidelines in breast cancer
  2. To learn in depth the background of each of the new revisions in the guidelines
  3. To recognize the impact of such changes on the practice of HER2 testing and interpretation
  4. To correctly apply specific tumor characteristics (tumor grade, histopathologic type, specific histomorphology and cytomorphology) to reliably predict HER2 status, and to apply this method as a quality control method

Troubleshooting Diagnostic Immunohistochemistry [Cartun]

  1. To recognize the causes of possible false negative and/or false positive IHC studies
  2. To review and apply real-life examples of inadequate pre-analytical or analytical IHC assay that lead to false negative or false positive results
  3. To correctly recognize potential pre-analytical and analytical pitfalls (including pitfalls related to microtomy)

Open Mic: Bring Your Own Questions – Part I  [Yaziji]

  1. To troubleshoot particularly difficult or procedures in IHC and FISH
  2. To apply post-analytical scoring criteria of various immunohistochemistry markers
  3. To learn obstacles related to interpretation of FISH slides, and to provide solutions
  4. To learn specific techniques in slide preparation for IHC and FISH studies
  5. To discuss specific concerns raised by general pathologists regarding pre-analytical, analytical and post-analytical phases of IHC, that are not specifically discussed above

Best “Specialized” Markers (Myoepithelial, Cytokeratins, Neuroendocrine, Endothelial, Histocytic, Megakaryocitic, Erythroid, ETC) in IHC [Yaziji]

  1. To recognize the difference between organelle markers and lineage markers
  2. To recognize how the selection of specific lineage markers can enhance the sensitivity and specificity of these markers in diagnostic settings
  3. To correctly apply optimal neuroendocrine markers combination in diagnostic immunohistochemistry
  4. To correctly apply optimal screening cytokeratin markers combination in diagnostic immunohistochemistry
  5. To correctly apply optimal myoepithelial markers combination in diagnostic immunohistochemistry
  6. To correctly apply optimal endothelial markers in diagnostic immunohistochemistry
  7. To correctly apply optimal histiocytic markers in diagnostic immunohistochemistry
  8. To correctly apply optimal megakaryocytic markers in diagnostic immunohistochemistry
  9. To correctly apply optimal erythroid markers in diagnostic immunohistochemistry
  10. To learn specific antibody clones, and pretreatment that are optimal for each of the aforementioned settings

Surgical Pathology Case Presentations – Session 1 [Faculty]

  1. To discuss de-identified, actual patient’s tumors and lesions
  2. To recognize specific morphologic and immunophenotypic characteristics of unusual/uncommon tumors/lesions, or common tumors/lesions with unusual presentations
  3. To learn how to formulate a panel of markers based on a morphology-driven differential diagnosis
  4. To learn how to apply a tier-based approach as an algorithm that initially focuses on higher sensitivity then shifting to higher specificity in later phases of the diagnostic IHC and FISH/ISH workup

Surgical Pathology Case Presentations – Session 2 [Faculty]

  1. To discuss de-identified, actual patient’s tumors and lesions
  2. To recognize specific morphologic and immunophenotypic characteristics of unusual/uncommon tumors/lesions, or common tumors/lesions with unusual presentations
  3. To learn how to formulate a panel of markers based on a morphology-driven differential diagnosis
  4. To learn how to apply a tier-based approach as an algorithm that initially focuses on higher sensitivity then shifting to higher specificity in later phases of the diagnostic IHC and FISH/ISH workup

Wednesday:

The Evolution of IHC for Soft Tissue Tumors in the 21st Century: From Differentiation to Molecular Genetics [Hornick]

  1. To provide a brief overview of conventional lineage markers for soft tissue tumors and limitations
  2. To discuss the use of IHC as surrogates for molecular genetic alterations: MDM2/CDK4, SMARCB1 (INI1), H3K27me3, PRKAR1A
  3. To discuss the use of IHC to detect protein products of gene fusions: TFE3, STAT6, and CAMTA1
  4. to discuss diagnostic markers identified through gene expression profiling: MUC4, NKX2-2, and ETV4

Immunohistochemistry in Kidney Tumors: The New WHO Classification and Beyond [Troxell]

  1. To review immunohistochemical panels to aid in subtyping of renal cell carcinoma
  2. To learn newly characterized renal entities
  3. To discuss immunomarkers in new/emerging renal tumor subtypes
  4. To learn molecular correlation of these markers and subtypes

Beyond Lineage: Diagnostic and Predictive Molecular IHC for Surgical Pathologists [Hornick]

  1. To provide a brief overview of the conceptual revolution in IHC
  2. To learn abnormal protein localization: beta-catenin
  3. To learn protein correlates of tumor suppressor genes: BAP1, SMAD4
  4. To discuss the use of IHC as a replacement for FISH in predictive testing: ALK, ROS1
  5. To discuss the use of IHC to detect mutant oncoproteins: BRAF V600E, IDH R132H, H3F3A K27M
  6. To learn screening for familial predisposition syndromes: MMR, SDH, FH

Immunohistochemistry in Transplant Pathology [Troxell]

  1. To discuss the role of C4d and other immunostaining in evaluation of antibody mediated rejection
  2. To evaluate the application of macrophage, B- and T-cell markers in transplant pathology
  3. To weigh the utility of viral immunostains in transplant and immunocompromised patients

Surgical Pathology Case Presentations – Session 3 [Faculty]

  1. To discuss de-identified, actual patient’s tumors and lesions
  2. To recognize specific morphologic and immunophenotypic characteristics of unusual/uncommon tumors/lesions, or common tumors/lesions with unusual presentations
  3. To learn how to formulate a panel of markers based on a morphology-driven differential diagnosis
  4. To learn how to apply a tier-based approach as an algorithm that initially focuses on higher sensitivity then shifting to higher specificity in later phases of the diagnostic IHC and FISH/ISH workup

Surgical Pathology Case Presentations – Session 4 [Faculty]

  1. To discuss de-identified, actual patient’s tumors and lesions
  2. To recognize specific morphologic and immunophenotypic characteristics of unusual/uncommon tumors/lesions, or common tumors/lesions with unusual presentations
  3. To learn how to formulate a panel of markers based on a morphology-driven differential diagnosis
  4. To learn how to apply a tier-based approach as an algorithm that initially focuses on higher sensitivity then shifting to higher specificity in later phases of the diagnostic IHC and FISH/ISH workup

Thursday:

Essential Coding & Compliance: 2018 Update – Part I [Cox]

  1. To understand and implement CPT 2018 changes of interest to pathologists and laboratories
  2. To learn recently discovered ICD-10-CM revisions and updates of major importance to pathology coders

Essential Coding & Compliance: 2018 Update – Part II [Cox]

  1. To become aware of 2018 Medicare physician fee schedule changes impacting pathologists and laboratories
  2. To provide update on MACRA and the Medicare clinical laboratory fee schedule regulations

Open Mic: Bring Your Own Questions – Part II  [Yaziji]

  1. To troubleshoot particularly difficult or procedures in IHC and FISH
  2. To apply post-analytical scoring criteria of various immunohistochemistry markers
  3. To learn obstacles related to interpretation of FISH slides, and to provide solutions
  4. To learn specific techniques in slide preparation for IHC and FISH studies
  5. To discuss specific concerns raised by general pathologists regarding pre-analytical, analytical and post-analytical phases of IHC, that are not specifically discussed above

Open Mic: Bring Your Own Questions – Part III  [Yaziji]

  1. To troubleshoot particularly difficult or procedures in IHC and FISH
  2. To apply post-analytical scoring criteria of various immunohistochemistry markers
  3. To learn obstacles related to interpretation of FISH slides, and to provide solutions
  4. To learn specific techniques in slide preparation for IHC and FISH studies
  5. To discuss specific concerns raised by general pathologists regarding pre-analytical, analytical and post-analytical phases of IHC, that are not specifically discussed above

Surgical Pathology Case Presentations – Session 5 [Faculty]

  1. To discuss de-identified, actual patient’s tumors and lesions
  2. To recognize specific morphologic and immunophenotypic characteristics of unusual/uncommon tumors/lesions, or common tumors/lesions with unusual presentations
  3. To learn how to formulate a panel of markers based on a morphology-driven differential diagnosis
  4. To learn how to apply a tier-based approach as an algorithm that initially focuses on higher sensitivity then shifting to higher specificity in later phases of the diagnostic IHC and FISH/ISH workup

Surgical Pathology Case Presentations – Session 6 [Faculty]

  1. To discuss de-identified, actual patient’s tumors and lesions
  2. To recognize specific morphologic and immunophenotypic characteristics of unusual/uncommon tumors/lesions, or common tumors/lesions with unusual presentations
  3. To learn how to formulate a panel of markers based on a morphology-driven differential diagnosis
  4. To learn how to apply a tier-based approach as an algorithm that initially focuses on higher sensitivity then shifting to higher specificity in later phases of the diagnostic IHC and FISH/ISH workup