Scientific Workshops

Scientific Workshops will be held on Saturday June 20 and Sunday June 21.

 

PATHOLOGY WORKSHOPS

Saturday June 20 Morning – 0800-1130

Saturday June 20 Afternoon – 1300-1630

Sunday June 21 Morning – 0800-1130

CLINICAL CHEMISTRY WORKSHOPS

Sunday June 21 Morning – 0830-1130

Sunday June 21 Afternoon – 1300-1600

 

 

W2011 Kidney Cancer: a Whole New Look in 2015
Saturday June 20, 0800-1130

 

Andrew Evans, University Health Network; University of Toronto

George Yousef, St. Michael’s Hospital; University of Toronto

 

Objectives:

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

  • Recognize the updated consensus ISUP recommendation for handling and reporting kidney tumors and the proper use of IHC.
  • Describe the significance and limitations of biopsy specimens for small renal masses.
  • Describe the potential role of molecular analysis in improving patient management in kidney cancer.

Kidney cancer is one of the top 10 prevalent cancers in North America. The incidence of kidney cancer is increasing in the last few decades. Recently, the International Society of Urological Pathology (ISUP) identified a number of significant inconsistencies and discrepancies between pathologists regarding the reporting of kidney cancer. Furthermore, accumulating research in the field identified a number of new clinical and molecular parameters that can improve disease management. A number of international work groups were assembled to address the recent advances in this field, and in 2012, the annual meeting of the ISUP was focused on developing consensus recommendations for handing and reporting kidney cancer specimens that are consistent among pathologists. These recommendations will be published in the next few months. Moreover, a number of new entities are officially recognized during that meeting. The purpose of this workshop is to highlight the recent changes that were implemented by the ISUP especially the new and modified items that will help to reach much higher levels of consistency and uniformity among pathologists in reporting a kidney cancer.

Approximately 60-70% of renal masses < 4 cm in size are found incidentally when ultrasound examinations are performed for reasons other than signs/symptoms referable to the kidneys. As the use of ultrasound examinations by primary care physicians increases, there will be an expected increase in the incidental detection of these small renal masses (SRM). Autopsy and partial nephrectomy data demonstrate that 20% of SRM’s will be benign (typically oncocytoma or angiomyolipoma) requiring no immediate treatment. Slow growth and low progression rates of most low grade renal cancers make active surveillance with delayed intervention a viable management option, particularly for elderly patients with multiple co-morbidities. As such, needle core biopsies of these lesions can be extremely helpful in developing a management plan for the incidentally found SRM. Pathologists faced with such biopsies appreciate that there is a learning curve associated with reporting them. The objectives for this portion of the course are: to review the success rates for needle biopsies of SRM’s in terms of diagnostic yield and concordance with the final pathology in nephrectomy/partial nephrectomy specimens, to understand the pitfalls associated with limited sampling provided by needle biopsies and to understand the appropriate use and limitations of immunohistochemistry when attempting to classify renal neoplasms in needle biopsies.

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W2012 Teaching and Assessing the Non-Medical Expert CanMEDS Competencies in Pathology & Laboratory Medicine
Saturday June 20, 0800-1130

 

Marcio Gomes, The Ottawa Hospital; University of Ottawa

Ruth Padmore, The Ottawa Hospital; University of Ottawa

 

Objectives:

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

  • Develop a framework of teaching activities for the implementation of the CanMEDS competencies in their programs.
  • Develop a framework of evaluation tools for assessing the CanMEDS competencies in their programs.
  • Implement new teaching activities to develop the non-medical expert roles in their program.
  • Implement easy-to-apply evaluation tools to assess the non-medical expert roles in their program.

The Royal College of Physicians and Surgeons of Canada (Royal College) developed the CanMEDS framework of competencies. The framework became a mandatory requirement for accreditation. The residency programs of the different disciplines were required to implement the CanMEDS framework within their institutions. The implementation process started with the development of CanMEDS-based learning objectives. The next steps of implementation will require fully competence-based training programs, in which teaching activities and evaluation tools should be mapped to the framework, and resident’s progression along the program will depend on the acquisition/demonstration of such competencies.

Most of the Royal College documents and support material were developed for the purely clinical disciplines, and the patient-doctor relationship is in the heart of the discussions around the non-medical expert roles. Hence the application of the CanMEDS framework to pathology and laboratory medicine became a challenge to most of the residency programs, which still struggle to meet the Royal College requirements with time-consuming in-house developed solutions. This workshop intends to address some of the issues common to laboratory medicine, providing tools for immediate application by medical educators, program directors, coordinators, rotation directors, and clinician teachers.

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W2013 Pathological Assessment of the Pancreaticoduodenectomy (Whipple’s) Specimen
Saturday June 20, 0800-1130

 

David Driman, London Health Sciences Centre; University of Western Ontario

Vlad Maksymov, Grand River Hospital; McMaster University

 

Objectives:

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

  • Review surgical anatomy of the head of the pancreas and relationship to adjacent vascular structures.
  • Describe types of surgical specimens received.
  • Define frozen section issues.
  • Review margins in pancreaticoduodenectomy specimens.
  • Review grossing protocols.
  • Recognize the need for standardized assessment of specimens.
  • Review quality assurance issues and interdisciplinary collaboration.

In this workshop, we will review the important issues around pathological assessment of pancreaticoduodenectomy specimens including terminology, gross protocols and the need for a standardized and multidisciplinary approach to these cases. This workshop will be of value to pathologists who assess these cases, residents and pathologists’ assistants.

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W2014 A Guide to Total Quality Improvement: How to Choose, Track, and Act on Relevant Quality Metrics
Saturday June 20, 0800-1130

 

Terri Jean Murray, Eastern Health Authority; Memorial University

Stephen Raab, Eastern Health Authority; Memorial University

 

Objectives:

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

  • Utilize a simple framework for selecting which quality metrics to track.
  • Acquire a QI toolkit to close gaps between target and current performance including understanding concepts such as Root Cause Analysis, Fishbone diagrams, Learn-Plan-Do-Study-Act.
  • Describe the different ways QI projects can be identified (reactive vs. proactive).
  • Describe how quality control and quality assurance are different from quality improvement.

Targets of quality improvement efforts are typically identified via adverse events (the reactive method) or via ongoing tracking of quality metrics (the proactive method). Frequently, anxiety following discovery of errors or near-misses can lead to a fire-fighting type of approach in quality management. Crucial decisions are made about workflow change without real data or thoughtful and targeted improvement efforts. Little is known about whether interventions were successful, or simply created more work for providers and staff. From a proactive standpoint, quality metrics collected and analyzed often relate mainly to accreditation, or simply to what data is easily available. In this course, we provide a clear framework participants can use to understand vulnerabilities and build successful Quality Improvement initiatives.

The course format will include a combination of didactic teaching and illustrative exercises involving simulation activities. Each section of the course will involve an introduction and discussion of specific quality concepts and then a simulation exercise that depicts real pathology work. This course is intended for both practicing surgical pathologists and pathologists-in-training.

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W2021 Evidence Based Medicine for the Practicing Pathologist
Saturday June 20, 1300-1630

 

Alice Lytwyn, Juravinski Hospital; McMaster University

 

Objectives:

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

  • Describe basic concepts in evidence based medicine and how to apply them to pathology practice.
  • Recognize where to obtain guidelines and tools for assessing studies.
  • Recognize bias and how this affects study validity.
  • Recognize concepts in randomized trials, diagnostic testing, prognostic marker and prediction studies, systematic reviews, and guideline development.
  • Describe basic statistical concepts.

This course will provide the pathologist with a working knowledge of evidence based medicine both for direct application to pathology practice and for clinicopathologic interactions.

Pathology diagnoses impact on patient care, and for that reason pathologists need to know to how to assess the literature and how to determine when studies are valid and are ready for application to practice. There are also increasing demands upon pathologists to incorporate new tests and to report potential prognostic indicators; therefore there is a need for pathologists to determine which demands are appropriate and will have a positive impact on patient care. With increasing multidisciplinary decision making, pathologists need to know not only to assess their own literature but also the results of clinical trials and studies.

This course will cover basic concepts in study methodology, discuss study designs pertinent to pathology, and provide the framework for assessing studies. Using practical examples from pathology practice, this course will discuss randomized controlled trials, diagnostic testing, prognostic factor studies, prediction, systematic reviews and guideline development. Basic statistical issues will be addressed in the context of these studies.

The course will be a lecture format, but with practical examples throughout, and interactive questions and comments are encouraged at any time. At the end of the course the audience will be polled by electronic format for their answers and opinions. This course is suitable for all pathologists and residents who wish to gain knowledge of applying evidence based medicine to pathology.

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W2022 T Cell Lymphoproliferative Lesions: Trials and Tribulations, Traps and Tips: Diagnostic Pitfalls and Potential Clinical Impact
Saturday June 20, 1300-1630

 

Catherine Ross, McMaster University

Monalisa Sur, McMaster University

 

Objectives:

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

  • Utilize a rational, cost effective strategy combining clinical history, morphologic, phenotype and genetic data to approach T cell malignancies and or reactive lesions.
  • Diagnose nodal and extranodal T cell lymphomas and distinguish them from reactive processes.
  • Analyze the current status of lymphoma classification as per the WHO 2008 classification with emphasis on some newer and unusual entities.
  • Critique the clinical implications of the diagnoses.

Being relatively uncommon, T cell lymphoproliferative lesions present a considerable diagnostic challenge to the practicing pathologist. Nodal and extranodal T cell lymphomas have a morphologic spectrum that overlap considerably with reactive lymphoid hyperplasia, B cell lymphomas and Hodgkin’s lymphoma. Some T cell lymphoid neoplasms also show immunohistochemical overlap with myeloid neoplasms and can prove to be diagnostically challenging. This practically oriented course will focus on major categories of nodal and extranodal T cell lymphoproliferative lesions recognized by the WHO classification of Tumours of the Lymphoid Tissues: Representative index cases, which have significant potential to be missed or misdiagnosed, will be presented within the WHO classification. The emphasis will be on cases which may often be confused with non-hematopoietic neoplasms and or reactive conditions. In addition, cases in which the appearances and sometimes the ancillary studies can present confusion both in diagnosis and classification will be discussed. The utility of both immunohistochemistry and other studies (flow cytometry and molecular studies) as aids to diagnosis will be highlighted with emphasis on the role of flow cytometry in the diagnostic workup. Examples of newer entities within the WHO classification will be shown and discussed. The workshop will be constructed by a series of case presentations with routine H&E stains and full immunohistochemical panel and/or flow cytometry and molecular studies. Discussion will center on the differential diagnosis with highlighted points to avoid diagnostic pitfalls. Additionally, the clinical importance of these diagnoses and the impact of proper diagnosis on treatment and outcomes will be addressed.

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W2023 Top 10 Consultations in Gynaecologic and Obstetric Pathology
Saturday June 20, 1300-1630

 

Martin Chang, Mount Sinai Hospital; University of Toronto

Carlos Parra-Herran, The Ottawa Hospital; University of Ottawa

 

Objectives:

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

  • Cite a variety of common scenarios where consultation with a gynaecologic pathology expert is requested.
  • Develop a deeper understanding of the process by which the consultant evaluates cases sent for second opinion.
  • Identify the key clinical and pathologic elements that must be provided when a case is sent for external consultation in gynaecologic and obstetrics pathology.

Specific learning objectives:

  • Summarize the diagnostic criteria of differentiated vulvar intraepithelial neoplasia and the most common diagnostic pitfalls.
  • Describe useful diagnostic principles to accurately estimate extent of cervical stromal invasion in challenging situations (cervical intraepithelial lesions with superficial invasion, multifocal invasion).
  • Diagnose preinvasive endometrial neoplasia (“endometrioid intraepithelial neoplasia” / “atypical endometrial hyperplasia”) in the setting of hormonal therapy, and distinguish it from benign mimickers (including simple and complex endometrial hyperplasia).
  • Formulate a practical approach to the diagnosis of uterine mesenchymal lesions with endometrial stromal and smooth muscle differentiation.
  • Apply histopathologic criteria and immunohistochemistry in the diagnosis of ovarian mucinous neoplasms. List the limitations of pathologic evaluation in classifying these tumours.
  • Compare the clinicopathologic features of the most common ovarian sex cord stromal tumors.
  • Describe the spectrum of non-carcinomatous epithelial “atypias” of the fallopian tube mucosa, and their differences with tubal intraepithelial carcinoma.
  • Differentiate between molar and non – molar aneuploid gestations based on histopathologic evaluation of immature placental tissue.

This course is directed to pathologists in training and practicing general pathologists who frequently encounter diagnostic challenges in gynaecologic and obstetric surgical pathology. The activity will go over the process by which the consultant approaches cases for second opinion and will reinforce practical take-home points for the general pathologist. The goal of the course is to give attendants useful information to solve diagnostic dilemmas in gynaecologic pathology from the expert pathologist perspective. In addition, the course intends to provide guidance to determine when an expert opinion is required and what information needs to be communicated to the expert in order to achieve an optimal diagnosis.

The course has a case-based format. Ten difficult cases in gynaecologic pathology, including lower genital tract, upper genital tract and placenta, will be presented. Cases exemplify common diagnostic challenges where a second (expert) opinion is usually warranted. Although this will not be a hands-on microscopy session, digital image content will be made available to workshop participants in advance.

Presentation of each case includes relevant clinical history and imaging, main macroscopic and microscopic findings and results of ancillary studies (immunohistochemistry, special histochemistry). A list of differential diagnoses will be formulated, and dialogue regarding the best diagnosis may be opened to the audience if possible. Discussion of the correct diagnosis will follow with review of the current terminology, definition and diagnostic criteria, as well as an overview of the most important mimickers and confounders. Practical points summarizing the expert’s recommendations will be listed at the end of each case.

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W2024 Fine Needle Aspiration Cytology of the Thyroid
Saturday June 20, 1300-1630

 

Manon Auger, McGill University Health Center; McGill University

 

Objectives:

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

  • Recognize The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).
  • Employ an organized approach to the diagnostic interpretation of fine needle aspirates of the thyroid.
  • Distinguish the wide range of cytological presentations of benign and malignant thyroid lesions.
  • Recognize potential diagnostic pitfalls and be able to resolve major differential diagnoses.

This workshop includes a comprehensive didactic portion (lasting approximately 1 hr 30 min) followed by a slide session with a projecting microscope (lasting approximately 1 hr 30 min), with focus on the demonstration of the spectrum of cytological features/variants of specific benign and malignant thyroid lesions. Emphasis will be placed on the recognition of diagnostic pitfalls and on approaches to resolve differential diagnostic dilemnas. Many examples of cytological mis-diagnoses will be shown, with emphasis put on the illustration of the cytological clues that could have led to the correct diagnoses in most cases. Updates on The Bethesda System for Reporting Thyroid Cytopathology will be given.

A comprehensive handout will be distributed to each registrant.

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W2111 Effective Laboratory Utilization: Challenges and Strategies
Sunday June 21, 0800-1130

 

Laurette Geldenhuys, QE II Health Sciences Centre

David Kinniburgh, Centre for Toxicology; University of Calgary

Christopher Naugler, Calgary Laboratory Services; University of Calgary

Catherine Ross, McMaster University

 

Objectives:

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

  • Identify factors which influence laboratory utilization.
  • Identify resources, tools and approaches to promote appropriate utilization.
  • Discuss examples of effective strategies.
  • Demonstrate the development of laboratory utilization strategies in their own institution.

Appropriate Laboratory Utilization has become an area of intense focus as laboratory professionals, health care administrators and governments continue to search for efficiencies and improved quality and safety of patient care. The workshop will review the factors which drive and influence laboratory utilization. Potential resources, tools and approaches that can be used to promote effective utilization will be discussed. Examples of effective strategies employed will be presented, including opportunities and lessons learned in the areas of: governance, test costing information, informatics (data collection, extraction and analysis), behaviour modification (through CME, clinical pathways, pre-printed orders, practitioner and test utilization profile reports) and clinical program operational impact assessments.

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W2112 Pathological Muddiness: Reflective Practice and the Art of Intraoperative Consultation in Gynecologic Pathology
Sunday June 21, 0800-1130

 

Matthew Cesari, Sunnybrook Health Science Centre; University of Toronto

Nadia Ismiil, Sunnybrook Health Science Centre; University of Toronto

 

Objectives:

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

  • Describe the principles of reflective practice.
  • Apply a reflective approach to the resolution of difficult/complex intra-operative consultations.
  • Describe pitfalls and their solutions in the performance of intra-operative consultations.
  • Demonstrate collaborative learning as part of a performance improvement strategy for intra-operative consultations.

Intra-operative consultation is a high-level representative task of the anatomical pathologist, requiring integration of numerous CanMEDS roles in any given situation. The consultative process is most often complicated by several, usually co-existing factors (i.e. sampling issues, inadequate clinical information, preparation artefacts, time restrictions, etc.) When combined with the limitations of individual knowledge, these factors render the consultative process muddy; that is, a situation where worldly realities conflict with the controlled science of pathology. Using real-life cases in gynecologic pathology, this workshop will invoke the principles of collaborative learning and engage participants to: 1.”reflect in action” for resolution of an intra-operative consultation scenario, and (2) “reflect on action” as a means of analyzing past performance to better prepare for future consultative efforts. These skills are transferable to intra-operative consultation in all sub-specialty areas.

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W2113 Best Practice Guidelines for Hospital Pathologists Performing Medicolegal Autopsies
Sunday June 21, 0800-1130

 

Kristopher Cunningham, Ontario Forensic Pathology Service; University of Toronto

Jayantha Herath, Ontario Forensic Pathology Service; University of Toronto

Michael Pollanen, Chief Forensic Pathologist of Ontario; University of Toronto

 

Objectives:

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

  • Explain the stepwise process for managing and conducting a medicolegal autopsy.
  • Describe injuries.
  • Use laboratory testing beyond toxicology.
  • Construct a professionally independent and impartial opinion on the cause and mechanism of death.
  • Construct a final medicolegal autopsy report.

Medicolegal postmortem examinations are not the same as hospital postmortem examinations. Medicolegal postmortem examinations are performed to advance a death investigation in the interest of the public. In Canada, medicolegal autopsies are primarily conducted by a Forensic Pathologist. However in certain circumstances, a hospital pathologist may be called upon to perform a routine medicolegal postmortem examination. Through the use of case studies involving hangings, motor vehicle collisions and sudden cardiac deaths, this 3.5 hour workshop will review the stepwise process followed by a Forensic Pathologist when performing a routine medicolegal autopsy. Following the Ontario Forensic Pathology Service Practice Manual for Pathologists, this workshop will focus specifically on: case history, describing injuries, using laboratory testing beyond toxicology, formulating the cause of death, and producing a final report.

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W2114 What ISUP with Prostate Cancer? Grading, Variants, and New Developments
Sunday June 21, 0800-1130

 

David Berman, Queen’s Cancer Research Institute; Queen’s University

Theodorus Van Der Kwast, Toronto General Hospital; University Health Network

George Yousef, St. Michael’s Hospital; University of Toronto

 

Objectives:

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

  • Apply the latest ISUP grading system for prostate cancer in daily practice.
  • Distinguish Gleason grade 3 patterns from Gleason grade 4 / 5 patterns in prostate needle biopsies.
  • Identify and report the presence of intraductal carcinoma in prostate needle biopsies.
  • Recognize unusual variants of prostate cancer in prostate needle biopsies.
  • Describe the potential clinical importance of large scale genomic profiling studies in prostate cancer.

The management of patients with prostate cancer is mainly dictated by the biopsy Gleason score. Currently, most men with a low risk prostate cancer are managed by active surveillance and in these men the presence of any amount of Gleason grade 4 constitutes an important trigger for active therapy. A recent survey among pathologists after the introduction of the ISUP 2005 modified Gleason grading system showed a tendency to over-grade prostate biopsies. The importance to distinguish high grade PIN from intraductal carcinoma has also attracted recent interest, because of its potential clinical implications. Through very active management by the International Society of Urologic Pathologists (ISUP) diagnostic and grading criteria for urologic malignancies have undergone several changes addressing these issues. Indeed, an overhaul of the Gleason grading system was the subject of a day-long ISUP meeting in the fall of 2014. Additional changes in the field are arising through increasing activity in cancer genomics, which are linking an increasing number of genomic changes with prognosis and with response to targeted therapies.

The workshop, entitled “What ISUP with prostate cancer? Grading, variants and new developments” will address these challenges in an engaging and interactive format. Using scanned images and multiple choice questions, the organizers will provide participants with a pre-workshop assessment to orient them to critical comparisons between entities and grading systems. Participatory exercises will be utilized throughout the workshop to engage the audience and to elicit and address knowledge areas that need additional exploration and explanation. At the end of the sessions, participants will be recruited to utilize knowledge from prior portions of the workshop to diagnose scanned slide images and to answer multiple choice questions. These active learning experiences will reinforce learning that occurred during the workshop.

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W2116 Practical Strategies for POCT Challenges: Managing the 3 R’s (Relationships, Records and Risks)
Sunday June 21, 0830-1130

 

Christine Cursio, University Health Network

Julie Shaw, The Ottawa Hospital

Paul Yip, University of Toronto

 

Objectives:

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

  • Employ strategies to build successful relationships for compliance in the POCT environment.
  • Describe approaches to improve documentation in the training, test order and results reporting of POCT users.
  • Apply risk management techniques to identify and control sources of error in POCT.

This workshop is designed for Laboratory professionals who oversee the POCT programs in their institution. A nation-wide survey recently conducted by the CSCC POCT interest group found that the scope of POCT performed in Canada has greatly expanded including the availability tests as well as the diversity of environments using POCT. While accreditation standards may provide some guidance, POCT programs are structured and governed according to local resources.

The workshop dedicates a session on the importance of and strategies for building successful relationships between the POCT team, the laboratory and the clinical areas towards achieving compliance and understanding challenges from the clinical perspective.

Subsequent content cover the requirements for a Quality Management program for POCT with focus on two major areas: documentation and quality control. The recent CLSI guideline EP23-A on Laboratory Quality Control based on Risk Management will be used as a framework. Approaches to identify risks and evaluating their components when performing a risk assessment are applied to designing QC plans for POCT.

The workshop section on documentation will encompass discussions on documentation of POCT orders, results, training/recertification, operators and non-conformances. We will examine practical strategies for overcoming documentation challenges and share approaches that have been successful.

This workshop is designed to be interactive and hands-on with contributions from attendees based on their experiences. At the end of the workshop, the aim is for each attendee to take with them a set of practical ideas for dealing with challenges they face in their own POCT programs.

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W2117 Understanding the Challenges of Anti-nuclear Antibody Testing
Sunday June 21, 0830-1000

 

Ivan Blasutig, University Health Network

Alex Chin, Calgary Lab Services

 

Objectives:

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

  • Describe the basics of anti-nuclear antibody (ANA) testing in diagnosing autoimmune diseases.
  • Recognize current methods of ANA testing.
  • Summarize the advantages and disadvantages of the different ANA testing techniques.
  • Describe the challenges associated with validating new ANA methods based on real-life data.

This session is intended to discuss the utilization of anti-nuclear antibody (ANA) assays. The presence of autoantibodies is a key feature of systemic autoimmune diseases. For over 50 years, the detection of ANA by indirect immunofluorescence assays (IFA) using cellular substrates followed by the interpretation of the staining patterns has been the favoured method and has been labelled as the “gold standard” method by the American College of Rheumatology. However, the increasing incidence of autoimmune diseases worldwide and the consequent increase in diagnostic testing are posing challenges to the clinical laboratory. Furthermore, an aging workforce and budgetary constraints have reduced the pool of qualified technical personnel that can perform ANA testing by the IFA method. To address these challenges, recent advances in technology such as multiplex solid-phase immunoassays and interpretive digital software have improved workload capacity, reduced costs, minimized the technical expertise required for the interpretation of patterns and eliminated interindividual interpretation biases. Nevertheless, these new methods also have limitations. Solid-phase immunoassays are prone to false negative results potentially leading to missed diagnoses while IFA methods are prone to false positive results potentially leading to over diagnosis and unnecessary interventions. These differences can lead to uncertainty in selecting the most suitable method for ANA testing in your laboratory and difficulties in validating new methods for use. A review of the advantages and disadvantages of different ANA detection techniques and representative examples using real-life data will be presented to help attendees make informed decisions and navigate complex ANA method evaluations.

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W2118 How to Implement LC/MS/MS into Your Laboratory
Sunday June 21, 1000-1130

 

Jessica Boyd, Calgary Lab Services

Hossein Sadrzadeh, Calgary Lab Services

 

Objectives:

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

  • Develop a business case to justify getting LC/MS/MS.
  • Describe the basic requirements for implementing LC/MS/MS technology in their labs.
  • Choose the most appropriate system for their labs.

Liquid chromatography Tandem Mass Spectrometry (LC/MS/MS) has become an important part of new modern clinical laboratories. Within the next 5-10 years, almost all the clinical labs in western countries need to implement this technology. LC/MS/MS technology offers the most sensitive and specific approach to measure most analytes in clinical chemistry laboratory. Although the cost to purchase a LC/MS/MS system is relatively high, the operational cost is significantly lower compared to that of immunoassays. In addition to high original cost, the sophisticated nature of LC/MS/MS, may prevent laboratorians to adopt this technology. The main focus of this short workshop is to introduce LC/MS/MS technology to the participants, explain how to prepare a business plan and get their laboratories and technologists, ready. The speakers share their experiences in successful LC/MS/MS implementation in their laboratory.

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W2126 Control of Nonconformities in the Clinical Laboratory
Sunday June 21, 1300-1600

 

Lynn Allen, University of Toronto

Stephen Hill, McMaster University Medical Centre

Edward Randell, Health Sciences Centre St. John’s

 

Objectives:

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

  • Differentiate corrective and preventive actions, and describe an approach to documenting them using corrective or preventive action reports (CARs or PARs).
  • Describe different corrective and preventive action models for control of nonconformities.
  • Describe root-cause analysis and identify some tools that aid in root-cause analysis investigations.
  • Describe how to conduct a root-cause analysis for a discordant patient result or a proficiency testing failure.

Nonconformities represent non-fulfilled requirements or failures to meet accepted standards. They create significant costs for the healthcare system and lead to many patient safety issues. This workshop will describe proactive and reactive approaches to controlling nonconformities in the clinical laboratory. This will involve definition and description of corrective and preventive actions; and a description of documentation and reporting of these activities based on laboratory standards. The session will review corrective and preventive action models involving “plan-do-check-act”, LEAN, Six Sigma, and Root Cause Analysis (RCA). The session will provide an overview of preventive action approaches like Failure Mode and Effect Analysis (FMEA) and Hazards and operability studies, as well as a detailed description of RCA as a corrective action model. The presentation on RCA will involve a description of various tools used to identify, understand, accumulate and analyze data, and implement solutions to nonconformities. The use of RCA will be illustrated using practical examples including investigating discordant patient results and proficiency testing failures.

This interactive workshop will provide content in the form of oral presentations and discussions to go towards the “Control of nonconformities” module of the Leadership in Quality Management Certificate Program being developed by CSCC. The session will help the laboratory professional to recognize nonconformities, develop tools to analyze them and create strategies to eliminate them.

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W2127 Biomarkers for Diabetic Kidney Disease – Established and New Practices
Sunday June 21, 1300-1430

 

Andrew Don-Wauchope, Juravinski Hospital and Cancer Centre

Patrick Twomey, UK National Quality Assurance Advisory Panels (NQAAP)

 

Objectives:

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

  • Explain the appropriate interpretation of biomarkers for diabetic kidney disease.
  • Advise clinicians on physiologic or measurement conditions that may affect interpretation of laboratory tests for diabetic kidney disease.
  • Implement best practices for urine albumin testing.
  • Advise clinicians on the new diabetic kidney disease marker sTNFR1.

This session will address the current evidence base, from both a laboratory and clinical perspective, for the assessment of diabetic kidney disease. The current standard of urine albumin will be discussed along with a new biomarker, sTNFR1, that is showing some potential in the area of diabetic kidney disease. With the worldwide incidence of diabetes increasing, it is now the leading cause (44%) of End Stage Renal Disease in Western Countries, requiring treatment through dialysis or kidney transplant. Each year in the United States alone, more than 44,000 people with diabetes are diagnosed with kidney failure. With up to 40% of patients with diabetes developing Diabetic Kidney Disease, there is a need for early and accurate identification of patients at the highest risk of progression from Diabetic Kidney Disease to End Stage Renal Disease. Albuminuria values >3.5 mg/mmol creatinine [and lower values if the eGFR is <60 mL/min] have prognostic significance. In type 2 diabetes, only 20%–40% of patients with stage A2 albuminuria progress to overt nephropathy, and by 20 years after overt nephropathy, only around 20% develop end-stage renal disease. Circulating levels of sTNFR1 are independently associated with the incidence of ESRD. For patients with sTNFR1 levels in the highest quartile, the risk of progression to ESRD is about 80% over 12 years. While the use of sTNFR1 will enable the early initiation of protective renal therapies, clinical studies are needed to show that this improves patient outcomes and/or a subsequent reduction in costs to healthcare systems.

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W2128 Improving Utilization of Biochemistry Endocrine Testing
Sunday June 21, 1430-1600

 

Connie Prosser, University of Alberta Hospital

 

Objectives:

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

  • Discuss an approach to utilization management.
  • Recognize barriers to implementing lab driven protocols aimed at optimizing test usage.
  • Assess the impact of implementing such protocols.

The interpretation of endocrine tests is complex as levels of circulating hormones respond to changes in the concentration of the compounds they regulate. Understanding the biochemistry of these systems allows one to define criteria or conditions when the test result is likely to provide useful information. The laboratory can influence utilization of these tests by implementing such criteria to either restrict or recommend testing. An audit of results after the protocol has been in use will confirm its effectiveness. Examples of successes realized by using this approach will be discussed. In all cases the protocol was implemented before test volumes had escalated. Participants will be encouraged to discuss other approaches they have used, the roadblocks they have encountered and possible new tactics.

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