Successes and Shortfalls of the Cytopathology Service 

In the Middle‐East Region

Nael M. Soudi, MS, CT(ASCP)(MIAC),CPHQ, LSSGB.Chief Quality Officer

MedLabs Consultancy GroupAmman‐Jordan

My Cytology Journey:

1

Saving The Best For Last

2

Outline

3

Recognition

What  Did Not Work

My CytologyJourney What Worked

Open ForumThe World of Cytology

Cytology In The Middle East

4

Timeline In The Middle East

IranJHH @ Tehran

1969

Lebanon : AUB

Pap Smears 60s & 70s

Jordan:MOH/JUHKHMC

Pap Smears60’s & 70’s

Saudi ArabiaKFSH/Aramco70’s & 80’s

KHMCFluid Cytology

Cell BlockIHC

80 & 90’s

KHMC1st Local Cytology Workshop:Dr. Erozan

1998

KHCC2nd Local CytoConference:Dr. Sayed Ali

2008 

5

Pioneers In The Middle EastLandmarks

6

Recognizing Landmarks

AUB KFSH7

Recognizing Landmarks

JHAH

81st & only Cytotechnology School 2006

NGHA

Recognizing Pioneers

9

Recognizing PioneersMiddle East

10

•Dr. Janin Tomb: Pap SmearLebanon

•Dr. Mohammad Akhtar•Dr. Ashraf Ali •Dr. Samir Amr

KSA

Recognizing Pioneers  Jordan

Dr. RaghebAl Khalidi

• 1st to introduce cytology

Dr. AsmaTarazi

• Ist trained Cytopathologist

Dr. Salah Al Jitawi

• Cytology Service:

• Gyn/NonGyn• FNA

11

My Cytology Journey1985 ‐ Present

12

My Road To: The School of Cytotechnology

@ Johns Hopkins

13

My Application ProcessSupporting Letters

Mine Dr. Salah Jitawi

Johns Hopkins  Cytotehnology

Program

Dr. AquilTutunji

Dr. TheodoreBaramki

Conditional Acceptance 14

Cytopathology Lab

15

Frost         Erozan Gupta          Staff

Taught By The Giants

16

Cytotchnologist’s Work Kit

17

Graduation‐1987

18

My Career

19

Best of Both Worlds

20

KHMC/JHH

21

NYMC/Quest Diagnostics 

22

LabCorp/KHCC

23

JHAH/MedLabs

24

Achievements

Interesting Cases:Slides/Kodachromes

Established CytoSection @ KHMC

FNA ClinicUS/CT Guided FNAs

TeachingCross Training

TBNA @ KHCC

Conferences:Local/International

Invited Speakers:Erozan/Ali

High SchoolCancer/SmokingCareer Days

Interesting Cases:EHE‐PleuralCrypto‐CSF

PCP & CMV‐BALReactive Atypia‐ESWL‐ Urine 

ASCP/IACMS: Ovarian Cyst 

Cytology

CAP Accreditation:Inspections

25

Education for High School Students

26

Cancer/SmokingCareer Day

ASCP‐Dubai/Abu Dhabi

27

CAP Inspections

28

Challenges

29

Challenges

Absence of Cytotechs in Jordan

Shortage of Cytotechs/local in 

the Region

Lack of understanding & appreciationFor Cytotechs

* Valuable in all phases  of testing

Letting go of H&E stain

Acceptance by Pathologists

30

What Worked

31

What Worked

Recognized as a field

Volume keeps increasing

Clinician’s buy‐in Diagnostic value is appreciated

32

Jordan & King AbdullahUniversity Hospitals

8574 88659327

2292 22763005

2015 2016 2017

Histo Cyto

Cyto Ratio: 22%

JUH10123

10742 11021

2815 2650 2724

2015 2016 2017

Histo Cyto

Cyto Ratio: 20%

KUH

33

King Hussein Cancer & Medical Centers

1213211332

13892

40504933 5234

2015 2016 2017Histo Cyto

Cyto Ratio: 27%

18864 1904620399

7127 72098321

2015 2016 2017

Histo Cyto

Cyto Ratio: 29%

KHCC KHMC

34

MedLabs

14285

15643 15756

46775375 5104

2015 2016 2017

Histo Cyto

Ratio: 25%35

What Did Not Work 

36

What Needs To Improve

Increase # of local Cytotechs

Establishing a School of 

Cytotechnology

Cytology Fellowship

Cooperation among 

institutions

Utilize Cytology for national programs

Cytology Days:Discuss 

interesting cases 

37

From The World of Cytology What Did I Learn ? 

38

Team

Leadership Commitment

Support

Break Silos

Openness

Team Approach

39

What do you see ?What the mind cannot think of 

the eyes can not see

40

Diagnostic: Algorithm Approach

Organ

NegAtypPos

41

Look For Patterns

42

Look for Patterns

43

More Common, Then Less Common

44

Road MapScreening from one end to the other.

• Up & down then overlapping.• Use 10x for cruising before the actual screening.• Get an overall feeling: 

• satisfactory ?.• abnormal cells ?.• microorganisms ?.• other changes ?

CC-1961-05

45

Road Map

Evaluate

Background

clean

dirty

other: mucus, colloid

Cell types

normal

abnormalarrangement:single, group

microbes

46

Normal Vs. Abnormal

47

Normal Cells

48

Abnormal Cells 

49

Faces of Malignant Cells

50

Faces of Malignant Cells 

Innocent

Follic Neo Melanoma

Ugly

51

Faces of Malignant Cells

Muc Ca

SubtleObvious52

HCC

Faces of Malignant Cells

HDCarc

53

Clues are found in nature

Microorganisms

bacteria

fungi

viruses

parasites

54

Cryptococccus neoformans

55

Cytomegalovirus: 1 cell

56

Proper Smearing Technique

57

Proper Collection & Fixation

58

HD Clarity

Take Home Message

59

What is Cytology ?

60

Art & Science of Interpreting Cells

61

What Does A Cytotech Do?

762

1963‐200946

I have A Dream

63

School of Cytotechnology

64

65

nsoudi@medlabsgroup.com66