Abstracts

POSTER PRESENTATIONS

Posters and abstracts are electronic and available here: http://clmc.multilearning.com/clmc/#!*menu=6*browseby=3*sortby=2*getpage=1

 

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ORAL PRESENTATIONS

Abstracts are below. Oral presentations will take place on Monday, June 22 at 1100-1230. Orals O101-O106 will be presented in Montreal A, Orals O201-O206 will be presented in Montreal C.

 

 

O101 Towards competency by design: establishing a ‘transition to pathology’ rotation for PGY1 residents
Chelsea Maedler1, Livia Florianova1, Pylyp Zolotarov1, Linnea Duke1, Milene Gonzalez-Verdecia1, Richard Fraser1, Jason Karamchandani1, Zu-Hua Gao1, Ramila Amre1, Chantal Bernard1. 1Department of Pathology, McGill University, Montreal Quebec Canada.

The Royal College of Physicians and Surgeons of Canada has initiated the implementation of competency-based medical education (CBME). CBME is an outcome-based approach to the structuring, execution and evaluation of a medical education program in order to meet defined competencies of a medical specialty.

Objective: To design and implement a competency-based pilot rotation for first-year (PGY1) anatomic pathology residents that facilitates transition into core pathology training.

Methods: The residency training committee along with the current PGY1 residents reviewed the training program’s current rotation objectives in order to define key competencies that first-year residents should achieve prior to beginning their core anatomic pathology training. Given the varied academic backgrounds of residents, these competencies were selected to standardize certain essential concepts in anatomic pathology. Senior residents and staff pathologists offered their knowledge and skills to teach the different competencies, and a formal curriculum was drafted.

Results: Five key competencies were identified. These included laboratory safety, workflow in a pathology laboratory, basic grossing principles, normal histology and intra-operative consultations. A rotation was implemented at McGill over a two-month period (March-April 2015) which included a structured learning plan and exit oral and histology examinations.

Conclusions: Both staff and residents viewed CBME as a useful framework for structuring the new ‘transition to pathology’ rotation at McGill. PGY1 residents were able to shape their training through their involvement in the new curriculum design. All PGY1 residents involved in the process appreciated this unique customized experience.

Keywords: competency-based medical education, residency training committee, training,, first-year.

 

O102 Learning and networking opportunities at a resident-led multidisciplinary academic day: how social media has helped
Deepti M Ravi1,3, Laura Morrison2,3, Winnie Chan2,3, Alex Chorley2,3, Christine Orr2,3, Teresa Chan2,3. 1Department of Pathology, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5. 2Department of Medicine, McMaster University, Hamilton, ON, 3McMaster Multidisciplinary Academic Day Organizing Committee.

Introduction: At McMaster University we have a bi-annual multidisciplinary academic day (MAD) where residents from all specialties, including pathology, come together providing a pan-disciplinary experience and a platform for knowledge sharing and networking. The organizing committee comprises of residents from different specialties (pathology, medicine and surgery) and one staff delegate. With the increasing popularity of social media, it has the potential to become a powerful tool in residency education. In 2013-2014, we launched a coordinated social media plan for MAD. Our goal was to use social media to increase networking and shared learning amongst all residents at McMaster.

Method: A facebook group for MAD was created by the resident organizing committee in 2012. This platform facilitated bidirectional communication between the organizing committee and residents who joined the group. Prior to the MAD session, we communicated: 1) announcements concerning events, 2) details about speakers (e.g. biography), 3) videos, 4) photographs, and 5) other print material. During the session, we launched a contest where residents posted and communicated through this page.

Results: Within two years, our facebook page accrued 224 resident followers, 50 of whom actively participate in online discussion. Via our session evaluations, residents noted the MAD Facebook page as a clear information access point.

Conclusion: The introduction of social media into our branding campaign has helped the MAD committee increase visibility with residents. This has led to an increased resident’s involvement and interaction with the McMaster MAD program.

 

O103 Autopsy education in Canada: assessing need for competency-based education through survey of educators
Stephanie L. Reid1,2, Carolyn M. Morris-Larkin1,2, Vernon R. Curran1. 1Memorial University of Newfoundland, St. John’s, NL; 2Discipline of Laboratory Medicine, Eastern Health, St. John’s, NL.

Objectives:  Competency-based education (CBE) approaches are at the forefront of undergraduate and postgraduate medical training in Canada.  Given that autopsies are an essential part of education and practice in anatomical pathology, essential competencies have to be developed.  The purpose of this study is to determine the current state of autopsy education practices in Canada and the attitudes towards competency-based education.

Methods: Autopsy educators in English speaking pathology programs in Canada completed an 18 item  questionnaire regarding their current autopsy education practices and opinions regarding competency-based autopsy education.  Questionnaire responses were compared to determine variability and trends in autopsy education and attitudes towards CBE.

Results: Questionnaire results show that autopsy education within and across programs varies.  This is seen in introductory courses offered, formal safety courses, rotation length, use of competencies, required techniques, staff coverage and evaluation.   The majority of educators felt that a competency-based education approach would improve autopsy education and would be useful in evaluating resident learning.  However, there was some skepticism as to the effectiveness of CBE approaches. Suggested essential competencies varied and examples included: techniques, medico-legal reporting, evaluation of histological slides, ancillary testing, and proper and concise reporting. 

Conclusions:  Autopsy education and exposure in Canada is variable. The majority of autopsy educators in Canada feel that CBE would improve training.  Competencies suggested for inclusion are varied and will have to be modified and finalized by committees within the Royal College of Physicians and Surgeons of Canada.

Keywords: competency-based education, autopsy, anatomical pathology

 

O104 An Interactive Computer Based Model for the Standardization of Oral Examinations in Anatomical Pathology
Elena D. Diaconescua, Alex O. Salagean, Hala Faragallaa,b, Andrea Grina,b, Vladimir Iakovleva,b, Adriana Krizovaa,b, George M Yousefa,b. aLaboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada; bDivision of Pathology, St. Michael’s Hospital, Toronto, Ontario.

Objectives: Our objective is to develop a computer-based application to standardize the administration of oral examinations in anatomical pathology. Current limitations of traditional oral examinations include examiner bias, variability in question timing and inability to test certain areas of practice. Our design provides an effective assessment of competencies essential for patient care by evaluating practical and theoretical knowledge.

Method: The web application was scripted in PHP. Virtual microscopic slides were imported into the application. To emulate real practice conditions, the examinee was requested to interact in real-time with digital simulations of the virtual histological slides, and digitalized maps of grossing specimens. To increase standardization, time constraints were imposed on each case.

Data and Results: The oral examination simulator we have developed is a reliable, easy-to-use web based tool that standardizes oral examination administration and evaluation. Unique features of our model include the incorporation of interactive images of histological and immunohistochemical slides, photographs of gross specimens, radiological images, and molecular pathology results. In addition to eliminating bias, it broadens the scope of the exam by assessing skills that cannot be evaluated in the setting of the traditional oral examination. Its structured design increases efficiency and facilitates the interaction between examiners and examinees. We have tested this application on a select number of senior residents, and their feedback was obtained through a post-examination survey.

Conclusion: By standardizing exam administration and facilitating the objective evaluation of competency, this web-based oral examination simulator provides an accurate measure of proficiency and an enhanced examination experience.

Keywords: digital pathology, computer-based, examination

 

O105 CanMEDS OSCE in Anatomical Pathology residency program
Syed M. Abedia, Jeremy Danielsa, Snezana Popovica. aDepartment of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario.

Background:  CanMEDS framework is a group of core competencies that medical trainees are expected to achieve during residency training. To the authors’ knowledge, no Canadian pathology residency programs offer PGY2-5 residents standardized examinations to evaluate CanMEDS competencies.

Method:  McMaster University anatomical pathology residents were involved in an objective structured clinical examination (OSCE) to evaluate CanMEDS competencies of Professionalism, Communicator, Collaborator, Manager and Health Advocate.  Residents were either examinees (PGY2&3) or evaluators (PGY4&5), depending on their level of training. The examination was conducted as 5 stations of 15 minutes each.  Each station involved a clinical encounter followed by a written questionnaire and was scored against a standardized answer sheet. The standardized answer sheet included specific objectives or actions that need to be performed and was scored on a 0-5 rating scale (0= not preformed, 1= poor, 2= borderline, 3= good, 4= very good and 5= excellent).

Results:  Nine McMaster University anatomical pathology residents participated in the CanMEDS OSCE.  Six of the residents were examinees and the remaining three residents were evaluators. Resident overall scores ranged from 73-95% (mean 86%).

Conclusion:  We showed that OSCE can be used as an evaluation tool in the anatomical pathology residency program expanding beyond Medical Expert role and based on specialty-specific objectives. We also showed that learners vary in their proficiency in CanMEDS competencies and can be engaged in facilitating both education and evaluation. Pathology residents could also be involved in writing specialty-specific CanMEDS OSCE scenarios contributing to curriculum development and delivery.

 

O106 Remediation of pathology residents in difficulty: the University of Toronto experience
Julia Keitha, Nadia Ismiila, Shachar Sadea, Simon Raphaela, Susan Glover Takahashib, Matthew Cesaria. aLaboratory Medicine and Pathobiology, University of Toronto, Toronto, ON; bPostgraduate Medical Education, University of Toronto, Toronto, ON.

Objective: To describe the process, successes and challenges encountered in our experience remediating residents in the Laboratory Medicine and Pathobiology program (LMP) at the University of Toronto (U of T).  

Methods: A retrospective review of residents enrolled in LMP at U of T between 2007 and 2015 to identify residents undergoing formal remediation; their remediation programs and outcomes were described.  Educators heavily involved in these remediation experiences reflect on the process and compare our experience with other residency programs at U of T.

Data and results: During this 8 year period there were 9 LMP residents who underwent a remediation rotation out of 133 total residents enrolled at LMP during this time (7%).  Residents entered remediation at an average level of PGY3.5, 6/9 had difficulties flagged in their PGY1 ITERS, residents starting remediation in their PGY4 or 5 years often transferred within LMP programs beforehand, and the average duration of remediation was 10 months.  Every resident had major deficiencies in more than one CanMEDS role; most frequent deficiencies being medical expert (8/9) and professionalism (6/9).  Outcomes included i) passing both remediation and RCPSC exams (3/9), ii) failure of remediation and resignation (2/9), and iii) pending (4/9). The content of the remediation programs, including the relevant University of Toronto infrastructure, will be discussed.  

Conclusions: Resident remediation in LMP is relatively comparable to the overall resident remediation experience at U of T.  The remediation process has become more robust over the study period and is frequently successful.

Keywords: resident remediation, residents in difficulty, pathology, laboratory medicine

 

O201 The prognostic value of immune biomarkers in leiomyosarcoma
Samantha Burugua, Matt van de Rijnb and Torsten Nielsena. aDepartment of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC; bDepartment of Pathology, Stanford University Medical Center, Stanford, CA.

With the emergence of successful cancer immunotherapy agents for some tumor types, the cancer research field is increasingly studying tumor immunology. The presence of specific tumor infiltrating lymphocytes such as cytotoxic T cells and T regulatory cells has been associated with good or bad prognoses in different tumor types. The prognostic value of immune markers in leiomyosarcoma, one of the most common type of sarcoma, has not been studied extensively. Leiomyosarcoma is an aggressive cancer with a 64% 5-year survival rate. Our objective was to survey potential prognostic immune biomarkers in leiomyosarcoma primary tissues.
126 leiomyosarcoma primary tissues represented on a tissue microarray were stained with CD4, CD8, FOXP3 and PD-1 antibodies by immunohistochemistry and positive cells were counted. Presence of CD4+, CD8+, FOXP3+ and PD-1+ cells was observed in 47.6%, 79%, 49.5% and 8.5% of cases, respectively. Among the markers tested, significant positive correlations were observed between the presence of CD8+ cells and tumor size (r=0.220, P=0.035) and between the presence of FOXP3+ cells and age (r=0.203, P=0.038). In survival analyses, there were negative correlations between the presence of immune markers (CD4+, CD8+, and FOXP3+) and disease-specific survival but these did not reach statistical significance.
Overall, to our knowledge, this is the first study assessing the prognostic value of CD4+, CD8+, FOXP3+ and PD-1+ cells in leiomyosarcoma. Future directions will involve analyzing prognostic value of additional immune biomarkers such as PD-L1.

Keywords: leiomyosarcoma, tumor immunology, T cell

 

O202 Cooling colorectal cancer with TRPM8 agonists
Liena Zhao1, Stefan Urbanski1, Rithwik Ramachandran2. 1Department of Pathology, University of Calgary, Alberta, Canada; 2Department of Physiology and Pharmacology, University of Calgary, Alberta, Canada.

Introduction: It has been established that TRPM8 is a cold temperature-sensing channel. Recently, we identified TRPM8 to be a regulator of inflammatory response in inflammatory bowel disease (IBD). We also noted an upregulation of TRPM8 expression in patients with IBD. Since TRPM8 has previously been detected in colon cancer, we hypothesize that inflammation associated changes in TRPM8 expression contribute to the development of colon cancer. The aims of this study were to examine the expression of TRPM8 in colorectal adenocarcinomas and to investigate whether activation of TRPM8 can cause tumor cell apoptosis.

Methods: Immunohistochemistry with antibody to TRPM8 was performed on human colorectal adenocarcinomas (n=66). Caco2 and HT-29 colonic adenocarcinoma cell lines were used to assess TRPM8 function in vitro. In ongoing work development of colorectal adenocarcinoma will be monitored in wt and TRPM8-/- mice in the azoxymethane (AOM) and dextran sodium sulfate (DSS) colitis associated colorectal cancer model.

Results: TRPM8 expression was increased in colorectal adenocarcinomas compared to normal colonic tissue. Colonic adenocarcinoma cell lines treated with icilin showed increase in apoptosis. We have also established that AOM-DSS administration results in the development of adenomas that lead to adenocarcinoma in the colon and this model will be used to further investigate a role for TRPM8 using genetically engineered mice.

Conclusion: TRPM8 is upregulated in colorectal adenocarcinoma and activation of TRPM8 with icilin cause apoptosis in cultured colon cancer cells. Agents that activate TRPM8 channels may represent novel therapeutics for colorectal cancer.

Keywords: TRPM8, colorectal cancer, inflammatory bowel disease

 

O203 Reappraisal of immunohistochemistry in the diagnosis of ovarian mucinous neoplasms: the added value of SATB2 and the relevance of biomarker discovery through proteomic database mining
Sarah Stricklanda, Jason Wassermana, Bojana Djordjevica, Ana Giassia, Carlos Parra-Herrana. aDepartment of Pathology, University of Ottawa. Ottawa, Ontario.

Objective: The utility of immunohistochemistry to classify mucinous neoplasms involving the ovary as primary or metastatic is limited. Through bioinformatic exploration, we identified two novel markers and compared their performance to traditional markers.

Methods: Structured language queries of the Human Protein Atlas database identified the immunomarkers SATB2 and POF1B as having a differential expression between gastrointestinal (GI) and ovarian adenocarcinomas. Immunohistochemistry was performed on tissue microarrays consisting of 30 lower GI tumors, 36 upper GI tumors and 56 primary ovarian mucinous neoplasms (OMN) including 19 benign, 20 borderline, 17 malignant tumors.

Results: The results are summarized in Table 1. SATB2 was virtually negative in primary OMNs and upper GI tumors. Thus, it was sensitive and specific for lower GI origin, outperforming CK20 and CDX2. PAX8 was sensitive and specific for primary OMNs with higher expression rates than previously reported. Nuclear POF1B expression was similar in all categories. A panel including CK7, SATB2, PAX8 and B-Catenin showed the best diagnostic performance.

Conclusions: In the work-up of an OMN, SATB2 is a better colorectal marker than CK20 and CDX2, whereas PAX8 is highly specific of primary OMN.  Exploration of proteomic data is a valuable biomarker discovery tool for applications in anatomical pathology.

Keywords: Ovarian mucinous neoplasms, immunohistochemistry, SATB2, POF1B

 

O204 Novel KI67 IHC assessment in breast cancer with high inter-observer reproducibility
Gilbert Bigrasa, Judith Hughb, Wei-Feng Donga, Richard Berendta, Hua Yangc. aLaboratory Medicine and Pathology Cross Cancer Institute, University of Alberta, Alberta Canada; bLaboratory Medicine and Pathology, University of Alberta, Alberta, Canada; cDepartment of Laboratory Medicine and Pathology, University of Calgary, Alberta, Canada.

Objective: 1) Assess breast cancer (BC) proliferative activity using double staining (cytokeratin/Ki67) and unbiased stereological parameter with image analysis. 2) Demonstrate clinical interest of new parameter.

Method(s): Currently BC Ki67 assessment rely on percentage of cells that stain positively for Ki67 using routine IHC. Recent international attempt to increase concordance in Ki67 scoring failed to diminish sufficiently inter-observer variation in order to use Ki67 scoring in clinical practice. Inherent subjectivity in manual counting is one explanation. It is not well known but number estimation in histological sections is intrinsically biased without utilization of complex stereological method like the disector. We suggest a novel approach in Ki67 assessment involving 1) double staining technique (Ki67 with cytokeratin); 2) an unbiased stereological method that is Vv (V = Ki67 positive nuclear volume; v = tumoral volume) with operator-driven image analysis. 100 samples were provided to three pathologists with instruction to acquire three areas with maximum Ki67 staining. Clinical significance was studied by obtaining Vv of 33 patients with bad outcome and 59 with good outcome. All patients were ER positive, Her2/neu negative, pT1 or pT2 and pN0, overall histological grade 2/3 and mostly chemo-naive. Statistical assessment (coefficient of determination and Chi-square tests) were performed with R.

Data and results: Strong linear relationships were found among the three observers with the following r2: 83%, 86% and 96%. Vv values classify patients in three thirds of increasing percentage of bad outcome: 12%, 38% and 53%. Statistical significance was demonstrated with Chi-square test.

Conclusions: A new highly reproducible BC proliferative assessment could replace current Ki67 scoring.

 

O206 Expression of thyroid hormone alpha receptor (THRα) isoforms in triple negative breast cancer (TNBC)
Katarzyna J. Jerzaka, Jessica G. Cockburnb, Gregory R. Pondb, Robin Hallettc, John A. Hassellc, Kathleen I. Pritcharda,d, Sukhbinder K. Dhesy-Thindb, Anita Baneb,e. aDepartment of Medicine, University of Toronto, Toronto, ON. bDepartment of Oncology, Juravinski Cancer Centre, Hamilton, ON. cDepartment of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON. dDepartment of Public Health Sciences, University of Toronto, Toronto, ON. eDepartment of Pathology and Molecular Medicine, McMaster University, Hamilton, ON.

Objective: To assess expression of THRα isoforms in a TNBC cohort and assess its prognostic relevance.

Methods: 158 formalin fixed paraffin embedded TNBCs were collected from the Juravinski Cancer Center from November 2002 to September 2009. TMA sections of tumors were analysed for the expression of THRα splice variants (THRα1 and THRα2) by immunohistochemistry using the Allred scoring method and assessed in triplicate. The association of THRα1 and THRα2 expression with pathological features and clinical outcomes was evaluated using Spearman correlation coefficients and Cox regression models. 

Data and results: The average age of patients was 64.4±14.9 years; 77% (n=122) were grade 3, 22.8% (n=33) were node positive and 12.3% (n=19) had stage 3 or 4 disease. 5-year OS was 80.6(95%CI 72.6-86.5) and 5-year recurrence-free survival (RFS) was 73.7(95%CI 65.2-80.4). Treatment consisted of chemotherapy alone (20.3%, n=31), radiation alone (11.8%, n=18), chemotherapy and radiation (55.6%, n=85) or neither (12.4%, n=19).
THRα2 was expressed (Allred score ≥5) in 78.0% of patients (n=117); its expression was associated with improved 5-year OS [HR 0.36(95%CI 0.16-0.83), p=0.017] and RFS [HR 0.24(0.12-0.47), p<0.001] univariably. THRα1 was expressed (Allred score ≥5) in 93.4% of patients (n=142) but it was not associated with 5-year clinical outcomes. After adjusting for stage, nodal status and treatment, neither THRα1 nor THRα2 was significant for OS.

Conclusions: THRα isoforms are expressed in the majority of TNBCs. THRα2 expression (Allred score ≥5) was associated with improved 5-year OS and RFS, but it was not independently prognostic.  

Key words: Breast cancer, thyroid hormone receptors