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
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