Symposia/Lectures/SIGs

SATURDAY JULY 12

 

SUNDAY JULY 13

 

MONDAY JULY 14

 

TUESDAY JULY 15


 

Residents’ Symposium Part I
Saturday, July 12, 1200-1300

 

Co-Chairs:

Nadia Ismiil, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario

Sydney Card, University of Toronto, Toronto, Ontario

Carlo V. Hojilla, University of Toronto, Toronto, Ontario

 

Fellowship Training in the US on Highlighting the Different Options in the US and the Requirements for Application

Kay Park, Program Director for the Oncologic Surgical Pathology Fellowship at Memorial Sloan-Kettering Cancer Center, USA

 

Objectives:

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

  • Summarize the fellowship options available in the US for Canadian Anatomic Pathology residents.
  • List the requirements for Canadian Pathology trainees wishing to pursue further training in the US.
  • Compare US pathology training programs to Canadian training programs.

Description:

This symposium will describe the various types of Pathology fellowship training programs available in the United States; from small to large, ACGME accredited to non-accredited and the various subspecialties offered. It will also describe what the requirements for application are specifically for Canadian residents (e.g. visa requirements, board certification, USMLE, etc). This lecture will be of value to: Canadian Pathology residents wishing to pursue further post-graduate training in the United States.

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Patient Safety and Quality Assurance Symposium
Saturday, July 12, 1700-1900

 

Chair:

Laurette Geldenhuys, Queen Elizabeth II Health Science Centre, Dalhousie University, Halifax, Nova Scotia

 

1700-1800

The Implementation of Medical Revalidation in the UK – How Histopathologists Do It

Peter N. Furness, University Hospitals of Leicester NHS Trust, London, UK

Objectives:

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

  • Discuss the basic format and requirements for medical revalidation (a.k.a. recertification, relicensing etc.) in the UK since 2013.
  • Recommend how those requirements may vary, depending on a doctor’s specialty and scope of practice.
  • Distinguish what information histopathologists must provide to achieve revalidation, including the provision of information from interpretive external quality assessment (EQA) schemes.
  • Discuss how histopathology EQA schemes function in the UK.
  • Discuss the relevance, if any, of this information for practice as a histopathologist in Canada, now and in the future.

Description:

At the end of the 20th Century, the General Medical Council (GMC) in London—prompted by a number of high-profile cases of medical incompetence—was trying to develop a scheme to ensure that doctors were keeping their skills and knowledge up to date. Plans were based largely on the documentation of participation in educational activities, or ‘CPD’ – making the perhaps-unjustified assumption that participation in CPD always has the desired effect.

Then came a high-profile case of a doctor who was not incompetent, but evil. Dr Harold Shipman, a general practitioner, was ultimately found to have murdered several hundred of his patients, without detection over a period of many years. The subsequent public inquiry into his crimes was scathing about the inadequacy of the GMC’s plans. Next, the Government’s Chief Medical Officer produced a white paper and plans for medical revalidation were re-started, with considerably more urgency. Paradoxically, the resultant scheme is not well designed to catch ‘the next Harold Shipman’; but it nevertheless does have some benefits.

Initial suggestions that regular examinations should be passed were rapidly dismissed, on the grounds that postgraduate medical specialization is now so diverse that to sustain an adequate diversity of examinations would be unsustainable. It was agreed that every doctor should be assessed on the basis of their own practice.

Refined by a series of large pilot studies, the process is now based on formal annual appraisals of all doctors, undertaken by trained appraisers and complying to a format defined by the GMC. Every doctor must supply a portfolio of information to their appraiser before they meet. Appraisals are expected to confirm that a doctor is fit to practice, but if no such concerns are identified they should concentrate on the formative task of helping a good doctor to perform even better. Each doctor has a relationship defined in law to a ‘Responsible Officer’ (RO) – typically the medical director of the hospital where they work. The RO has access to all appraisal records and to any other relevant sources of information about a doctor’s performance. The RO is expected to make a recommendation to the GMC, once every five years, as to whether each individual doctor’s license to practice should be revalidated. The GMC makes the final decision. The potential for challenge through the courts has been thoroughly considered.

The system ‘went live’ in 2012, with the earliest revalidation dates being set in April 2013. It has not been without its critics, but so far it seems to be working as planned.

One of the problems recognized in establishing this system was the need for doctors to provide evidence of the quality of their practice, and the extent to which the nature of that evidence has to vary between different specialties. Each medical Royal College provided specialty-specific guidance on this matter, in a consistent format.

In this context, histopathologists in the UK were fortunate in already having a well-established system of external quality assessment (EQA) schemes. These are, in effect, proficiency testing schemes. Their function is largely educational, but they generate numeric scores that are related to a pathologist’s performance and their relevance to medical revalidation has been accepted. It is recognized that EQA schemes test what a pathologist is capable of doing, rather than what that pathologist actually does, so audit is an essential complementary element.

 

1800-1900

Interpretive Quality Assurance In Pathology: Where Are We Going In Canada?

John Srigley, McMaster University, Hamilton, Ontario and The Credit Valley Hospital, Mississauga, Ontario

Gunita Mitera, Canadian Partnership Against Cancer

Objectives:

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

  • Describe a case study highlighting the issued related to quality in the interpretive phase pathology.
  • Provide an overview of the landscape of interpretive pathology quality in Canada.
  • Discuss the work of the quality initiative in interpretive pathology (QIIP) project and its role in improving the quality of interpretive pathology.

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Education Special Interest Group Meeting

Saturday, July 12, 2000-2200

 

Chair:

Danny Salloum, Hematopathologist

 

For many pathologists, education is a vital part of our clinical and academic work. This group provides an opportunity for pathologists to communicate and share ideas about how to improve pathology education. As you know, there are many types of education which pathologists are involved in, including teaching preclinical and clerkship medical students, pathology residents and residents in non-pathology fields, subspecialty fellows both within and outside pathology, and peers in the form of Continuing Medical Education. The CAP-ACP Education Group addresses all of these types of pathology education, as well as other topics such as forms of educational delivery, education as academic scholarship, and more. Our group is open to pathologists, residents, students, pathology assistants, technologists, medical educators, and anyone interested in pathology education.

 

2000-2025

Canadian Laboratory Medicine Education: The Undergraduate “Exposure”, Variety of RCPSC Postgraduate Specialties and Sub-specialties, and Emerging Niches in Pathology

Danny Salloum, Hematopathologist

 

2025-2105

Imaging and Pathology Education: The Potential Value of Whole Slide Imaging in Self-Assessment, Proficiency Testing, Obtaining Expert Second Opinions, and External Peer Review of Interpretive Pathology

Diponkar Banerjee, Eastern Ontario Regional Laboratory Association (EORLA) and The Ottawa Hospital, Ottawa, Ontario

 

2105-2135

Canadian PGME Numbers: Why Vacancies, and How Can We Streamline Recruitment Efforts?

Danny Salloum, Hematopathologist

 

2135-2200

The Future of Pathology Teaching and Learning: Keeping Up with Change including Classification, Biomarkers and Personalized Medicine; What Should We Be Thinking About?

Danny Salloum, Hematopathologist

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Informatics Special Interest Group Meeting

Saturday, July 12, 2000-2200

 

Chair:

Christopher Naugler, University of Calgary and Calgary Laboratory Services, Calgary, Alberta

 

The informatics SIG provides a forum for pathologists and laboratory professionals interested in information technology, computers in medicine, digital imaging, laboratory information systems and associated topics in research and education.

 

2000-2015

Integrated Genomics: the Start of a New Era in Cancer Research

George M. Yousef, St. Michael’s Hospital and the University of Toronto, Toronto, Ontario

 

2015-2030

Analysis of Laboratory “Big Data”

Christopher Naugler, University of Calgary and Calgary Laboratory Services, Calgary, Alberta

 

2030-2100

The RCPCS is Moving Digital

Lorna Mirham, Sunnybrook Health Sciences Centre, Toronto, Ontario

Christopher Naugler, University of Calgary and Calgary Laboratory Services, Calgary, Alberta

George M. Yousef, St. Michael’s Hospital and the University of Toronto, Toronto, Ontario

 

2100-2200

Pathology Wiki

Michael Bonert, University of Toronto, Toronto, Ontario

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Nephropathology Special Interest Group Meeting

Saturday, July 12, 2000-2200

 

Chair:

Laurette Geldenhuys, Queen Elizabeth II Health Science Centre, Dalhousie University, Halifax, Nova Scotia

 

The Development and Benefits of the UK National Renal Pathology External Quality Assessment Scheme

Peter N. Furness, University Hospitals of Leicester NHS Trust, London, UK

Objectives:

At the end of this session, participants will:

  • Understand the underlying principles of histopathology interpretive external quality assessment (EQA) schemes in the UK.
  • Be aware of the history and current form of the UK National Renal Pathology EQA Scheme.
  • Understand the benefits and limitations of the UK National Renal Pathology EQA Scheme.
  • Be able to consider the advantages and disadvantages of establishing a similar scheme in Canada.
  • If so required, be able to establish such a scheme.

Description:

The principles of external quality assessment schemes in the analytical laboratory disciplines were established in the 1950s and 60s. A central laboratory sends identical test samples to all participating laboratories; each laboratory analyses their samples as they would routine specimens; the results are returned to the central laboratory and compared against the ‘ideal’ result, which may be identified by some specialist reference method or by consensus, depending on the analyte.

Extending this approach to interpretive disciplines such as histopathology did not happen until the 1980s and 90s. It required an agreed approach to delivering numeric scores for the free-text conclusions of histopathologists. The generation of such scores in turn demanded a pre-planned course of action if a participant’s scores fell to a level that raised concerns about patient safety.

From the start, it was agreed that ‘full marks’ should be awarded not for what an expert might regard as a correct diagnosis, nor for a diagnosis that the subsequent clinical course proved to be correct. Full marks would be awarded for a response to a case that represents what a competent diagnostic histopathologist ought to make of the material provided. This is defined by the consensus of the whole group of participants. As a result, ‘expert opinion’, while invaluable for training, became largely irrelevant to scoring responses in these schemes.

Initially, many argued that the clinical impact of an incorrect diagnosis should carry weight in assessing responses. This superficially appealing approach was rapidly discredited, as it was recognized that in some difficult cases a large proportion of participants might miss a handful of malignant cells in a large section; whereas some errors with no clinical impact whatsoever can identify a truly alarming lack of competence.

The UK National Renal Pathology EQA Scheme was established in 1990 and has functioned ever since. Despite initially being entirely voluntary, it rapidly gained close to full participation of the UK’s specialist renal pathologists. In part this was a result of its educational benefits, but it was also valued by renal pathologists who, as specialists, worked in a degree of professional isolation, so who had no other way to confirm, in confidence, that their skills remained up to the expected national standard.

A small number of pathologists have triggered the first ‘action point’ as a result of persistently low scores. In every case the result has been either rapid self-correction, or a decision to refer all renal biopsies to another specialist. No-one has triggered the second action point, at which confidentiality would be broken in the interests of patient safety.

The scheme has provided an educational resource, not only from its routine circulations, but also from the archive of cases which has developed; also by identifying the sort of cases that pathologists find difficult, thereby guiding the provision of CPD.

With the introduction of revalidation in the UK, appropriate participation in EQA schemes now provides one of the most important items of ‘supporting information’ that histopathologists in the UK must deliver in order to retain their license to practice medicine.

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Residents’ Symposium Part II
Sunday, July 13, 1300-1400

 

Co-Chairs:

Nadia Ismiil, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario

Sydney Card, University of Toronto, Toronto, Ontario

Carlo Hojilla, University of Toronto, Toronto, Ontario

 

An Environmental Scan for Pathologists across Canada as well as Financial, Tax, Negotiation and Other Advice for Those Both In and Finishing a Pathology Residency and/or Fellowship

Brian Cummings, Grand River Hospital, Kitchener, Ontario

Objectives:

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

  • List their individual negotiation points in regard to a practice opportunity.
  • Describe the present practice environmental for pathologists in Canada, including remuneration and other practice benefits.
  • Identify financial intact tissue that pathologists evaluate when opening a practice.

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Guillermo Quinonez Seminar on the Medical Humanities and International and Global Pathology Combined Symposium
Sunday, July 13, 1400-1700

 

Co-Chairs:

Hallgrimur Benediktsson, University of Calgary and Calgary Laboratory Services, Calgary, Alberta

Laurette Geldenhuys, Queen Elizabeth II Health Science Centre, Dalhousie University, Halifax, Nova Scotia

Indrojit Roy, St. Mary’s Hospital and McGill University, Montreal, Quebec

 

1400-1500

Towards an Ethico-onto-epistemology of Science, Medicine, and the “Developmental Infection Called Love”

Rebecca Scott Yoshizawa, Queen’s University, Kingston, Ontario

 

Objectives:

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

  • Identify and describe the basic premises of a number of approaches to the study and philosophy of science and medicine.
  • Summarize the arguments for ethico-onto-epistemology and transdisciplinary research.
  • Ruminate upon developmental infections called love.

Description:

This talk will advocate the necessity of doing science, sociology, ethics, and philosophy together, a project broadly termed ‘transdisciplinarity.’ Using empirical examples from biomedical ethics in international contexts, placentology, and the developmental origins of health and disease, this talk will tour various approaches in the sociology and philosophy of science and medicine. It will then attempt to dismantle some of the ‘great divides’ between sciences and social sciences, which include differing ethical, ontological, and epistemological commitments – where ethics refers to what we should do, ontology to what exists, and epistemology to how we know what exists. This talk argues that only by considering action, being, and knowing as one and the same – that is, only by practicing ethico-onto-epistemology – can we as researchers address the most urgent problems of contemporary life.

 

1500-1530 – Refreshment Break

 

1530-1630

Pathologist Goes To Work: Affordable Automation of the Pap Test for Cervical Cancer Screening in Developing Countries

Soufiane El Hallani, The Ottawa Hospital, Ottawa, Ontario

 

Objectives:

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

  • Appreciate the primordial role of the pathologist in cervical cancer screening and management.
  • Know the means of cervical cancer prevention and screening in the setting of low and middle resource countries.
  • Learn about an innovative, automated and affordable technology, based on DNA-assisted image cytometry, to help implement a cervical cancer screening program locally or nationally.
  • Engage different actions and strategies of health advocacy for cervical cancer screening at the individual, community and society level.

Specific Objectives:

  • Review the key role of the Pap smear as a basic tool for cancer screening and early detection
  • Recognize the barriers in implementing a nation-wide cervical screening program based on Pap smear
  • Acquire knowledge on the basic and newest methods to overcome the limitation for a Pap smear program
  • Acquire knowledge on the automation of Pap smear based on DNA-cytometry and its application in the setting of low and middle resource countries
  • Discuss the framework of health care advocacy for the fight against cervical cancer
  • Develop a health advocate leadership and engage specific actions for the promotion of cervical cancer screening
  • Collaborate with academia, civil society, media and private sector to fuel the public and/or government sector with the necessary means to promote a long term screening program
  • Discuss the success story of implementing a national cervical cancer screening program in the country of Morocco, based on affordable automation of the Pap test

1630-1700

Update on WASPaLM Activities

Hallgrimur Benediktsson, University of Calgary and Calgary Laboratory Services, Calgary, Alberta

 

Update on Available Volunteering Opportunities in Pathology

Indrojit Roy, St. Mary’s Hospital and McGill University, Montreal, Quebec

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CAP-ACP Junior Scientist Award Lecture

Sunday, July 13, 1700-1745

 

A Two-stage, Single-arm, Phase II Study of EGCG-enriched Green Tea Drink as a Maintenance Therapy in Women with Advanced Stage Ovarian Cancer: This Started from Tissue

Award Recipient/Speaker:

Dominique Trudel, University Health Network – Toronto General Hospital, Toronto, Ontario

Objectives:

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

  • Discuss how tissue studies can be brought into clinical trials.
  • Describe how NGS-based technology has transformed molecular profiling of cancer.
  • Identify at least one of the strengths and limitations of an intention-to-treat design.

Description:

A concentrated form of green tea has been tested in women with ovarian carcinoma after obtaining preliminary results from tissue studies. During this talk, we will discuss the tissue studies underlying the design of this clinical trial, then discuss how this design impacted the interpretation of the final results.

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CAP-ACP William Boyd Award Lecture

Sunday, July 13, 1745-1830

 

A Change of Heart: Metabolic Remodelling in Cardiac Hypertrophy

Award Recipient/Speaker:

Mike Allard, University of British Columbia, Vancouver, BC

 

Objectives:

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

  • Describe myocardial in response to altered workload.
  • Compare metabolic remodeling in hearts adapted to pathologic and physiologic workloads.
  • Summarize the functional implications and potential mechanisms of metabolic remodeling in cardiac hypertrophy.

Description:

The heart of remodels in response to prolonged or repetitive elevations in workload resulting in alterations at many levels that ultimately lead to changes in size, shape, and function of the heart. The outcome of remodeling, including metabolic remodeling, is influenced substantially by the pathologic or physiologic nature of the stimulus. The resultant distinct metabolic phenotypes may, in part, explain the differing functional outcomes of pathologically and physiologically adapted hearts, especially notable following and ischemic stress. The lecture will be of value to residents, general and anatomic pathologists, and investigators.

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Hematopathology Symposium
Monday, July 14, 0800-1030

 

Chair:

Catherine Ross, Hamilton Health Sciences, Hamilton, Ontario

 

Making Sense of Molecular Mayhem in Myeloid Malignancies

Adam Bagg, Hospital of the University of Pennsylvania, Philadelphia, USA

Description:

The diagnosis and classification of myeloid neoplasms requires, in addition to the integration of clinical features, an array of laboratory studies that include morphology, histology, immunophenotyping (both flow cytometry and immunohistochemistry) and genetic analysis. The genetic studies include classical metaphase analysis, fluorescence in situ hybridization (FISH) and an increasing number of molecular approaches. Molecular analysis provides tremendous new tools for diagnosis and classification, and at the same time helps to unravel the biology of these neoplasms so that patients may benefit from personalized therapeutic approaches. To highlight the relevance of genetic studies in myeloid malignancies, this lecture will briefly review some of the recent (and not so recent) clinically-relevant discoveries in the myeloproliferative neoplasms, and then focus on contemporary genetic approaches in the evaluation of acute myeloid leukemia.

 

The Diagnosis and Classification of Myeloid Neoplasms

Robert P. Hasserjan, Massachusetts General Hospital, Harvard Cancer Center, Boston, USA

Objectives:

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

  • Describe non-neoplastic conditions that may mimic myelodysplastic syndromes on bone marrow morphology.
  • Employ morphologic findings and supportive ancillary information to distinguish myelodysplastic syndromes from non-neoplastic mimics.
  • Apply information obtained from morphology, cytogenetics, and blood counts to accurately classify myelodysplastic syndromes.

Description:

Establishing a diagnosis of myelodysplastic syndrome (MDS) in a cytopenic patient can be challenging, particularly in patients with comorbidities that may cause cytopenia or in situations with unusual morphology, such as bone marrow hypoplasia or fibrosis. Close attention to morphologic detail in the aspirate smear and trephine biopsy, as well as knowledge of clinical information and results of supporting ancillary studies, are critical in making an accurate diagnosis of MDS. This lecture will focus on the practical aspects of diagnosing MDS in challenging situations, including its potential overlap with aplastic anemia, autoimmune conditions, reversible/reactive causes of cytopenia, and other myeloid neoplasms that may present with cytopenia.

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Canadian Society of Cytopathology Symposium and Kulcsar Lecture
Monday, July 14, 0800-1030

 

Chair:

Janine Benoit, Saskatoon City Hospital, Saskatoon, Saskatchewan

 

0800-0930

Kulcsar Lecture: Recent Changes in Cervical Cancer Screening in Canada

C. Meg McLachlin, London Health Sciences Centre, London, Ontario

Objectives:

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

  • Summarize the current status of cervical screening in Canada.
  • Discuss the potential impact of HPV vaccination of screening performance.
  • Explain the potential use of primary HPV testing and the implications for screening practices.

Description:

This symposium will focus on cervical cancer screening in Canada present and future. Major changes to screening practices are already occurring with provincial cytology screening guidelines. The first HPV vaccinated cohort is approaching screening age and further changes must be considered to deal with decreasing prevalence of cervical precancerous lesions. A shift to primary HPV testing is being studied in Canada and internationally. The cytology community needs to play an active role in these changes by understanding the pros and cons of proposed screening algorithms. The lecture will be of value to: pathology residents, cyotechnologists, general and anatomic pathologists.

 

0930-0945 – Refreshment Break

 

0945-1030

The Impact of Advances in Cervical Cancer Screening on the Cytotechnologist

Sharon Crafter, Ct., Mount Sinai Hospital, Toronto, Ontario

Objectives:

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

  • Describe what we know about the current and evolving environment of the practice of cytopathology.
  • Identify issues as they relate to cytotechnologists as a result of changes to gynecological screening practices.
  • Describe what we know about the current skill sets of those who support the practice of cytopathology today.
  • Assess the skills needed in the cytotechnologist of the future.

1030-1100

This symposium is followed by the Annual General Meeting of the Section of the Canadian Society of Cytopathology.

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Advanced Diagnostics Symposium
Monday, July 14, 1400-1700

 

Chair:

David Berman, Kingston General Hospital, Queen’s University, Kingston, Ontario

 

1400-1410

Introduction

David Berman, Kingston General Hospital, Queen’s University, Kingston, Ontario

 

1410-1450

Molecular Diagnostics for Targeted Cancer Therapy

Suzanne Kamel-Reid, University Health Network, Toronto, Ontario

Objectives:

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

  • Evaluate emerging molecular technologies for use in cancer based diagnostics and therapeutics.
  • Describe the decision-making criteria used for developing these new tests and their limitations.
  • Discuss informatics tools used in variant data analysis.
  • Distinguish how these technologies can be used practically in the clinical setting; their advantages and their limitations.

Description:

Dr. Kamel-Reid’s talk will focus on new and emerging technologies and their use for clinical molecular diagnostics. She will discuss how to develop and validate panel based testing for multiplex and next generation sequencing, as well as how to use current publicly available databases for variant analysis. She will also discuss informatics pitfalls that diagnosticians should be aware of when interpreting data. Finally she will show application of these technologies for both solid tumors and hematological malignancies.

 

1450-1530

Next Generation Sequencing – Transformation of the Practice of Pathology and Translating Discoveries into Clinical Practice

Stephen Yip, University of British Columbia, Vancouver, BC

Objectives:

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

  • Describe the limitations in current molecular assays in oncology.
  • Describe how NGS- based technology has transformed molecular profiling of cancer.
  • Distinguish how this technology uncovers cancer subtleties and how these lead to transformation of the traditional view in oncology.

Description:

Genomic medicine and lab medicine, especially pathology, are natural and symbiotic partners in the future of patient care. In many cases, molecular diagnostic assays complement rather than supplement “glass-based” pathology. For example, correct identification of tumor cells and estimation of tumor fraction facilitates downstream analysis. In an era of personalized medicine, understanding of the genomic and epigenomic makeup of a disease lesion, via the appropriate application of advanced molecular tests and bioinformatic analytic tools, represents a logical progression from special stains to epitope- specific antibodies to genetic tests, for making an accurate and informative diagnosis. This presentation will explore how 2nd generation sequencing will transform the practice of pathology with examples of actual cases from the current BC Cancer Agency Personalized Oncogenomics (POG) initiative.

 

1530-1545 – Refreshment Break

 

1545-1630

Targeted Cancer Therapy: Lessons from Exceptional Responders

David Solit, Memorial Sloan-Kettering Cancer Center, New York, USA

Objectives:

The lecture will enhance the ability of participants to:

  • Recognize molecular mechanisms of sensitivity and resistance to targeted therapeutics.
  • Discuss how tumours with a given targeted mutation can sometimes respond differently to targeted therapeutics.
  • Recognize characteristics of “exceptional responders” to targeted therapeutics.
  • Develop a more sophisticated understanding of the term “actionable mutation” with regard to cancer.

Description:

This lecture will discuss the use of next generation sequencing methods to prospectively identify patients for oncology clinical trials. Newer clinical trial designs to accelerate the development of targeted kinase inhibitors will also be discussed.

 

1630-1700

Questions and Discussion

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Forensic Pathology Symposium
Monday, July 14, 1400-1630

 

Chair:

Michael Pollanen, University of Toronto, Toronto, Ontario

 

1400-1500

Death Certification Reform in the UK; When is a Death ‘Natural’ and Who Will Decide?

Peter N. Furness, University Hospitals of Leicester NHS Trust, London, UK

Objectives:

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

  • Summarize of the history of death certification in England and Wales.
  • Discuss the pressures for change over the past century, notably the crimes of Dr Harold Shipman, and why those pressures have so far altered little.
  • Describe the proposals for change in the UK Coroners and Justice Act 2009, and the pilot schemes that were established to test those proposals.
  • Discuss the advantages and disadvantages of a non-coronial medical examiner system, as implemented in the pilots.
  • Participate in a discussion of the interface between a system for investigating potentially unnatural deaths and a separate system for investigating apparently natural deaths.

Description:

A requirement for ‘registration’ of a death did not exist in UK law until 1836, at which point the ancient office of the Coroner was also given specific responsibilities relating to the registration of unnatural deaths. By 1893, a Parliamentary Select Committee described the system as ‘dangerously defective’ and said it played into the hands of the ‘criminal classes’. The system was subsequently amended by the Cremation Act of 1902 and the Births and Deaths Registration Act of 1926, but subsequent reports (notably by Wright in 1936, Broderick in 1971 and Luce in 2002) repeatedly and explicitly stated that fundamental flaws had not been rectified.

A general practitioner, Dr Harold Shipman, took advantage of those flaws to murder several hundred of his patients, going without detection for many years. His crimes led to a lengthy inquiry by Dame Janet Smith. Her report led to the provisions in the Coroners and Justice Act 2009.

This Act—subject to the final approval of the Secretary of State, which regrettably still has not been given—introduces ‘medical examiners’ who will provide independent scrutiny of all deaths that are not investigated by a coroner. (The term ‘medical examiner’ therefore differs markedly from the North American usage).

Pilots of the new approach have now been running for five years. Confirmed benefits include improved accuracy of certified causes of death, a large reduction in inappropriate referrals to the coroner and an increase in appropriate referrals to the coroner – one of the pilots has seen an increase of 25% in the number of deaths subjected to inquest. There is a very useful flow of information about the quality of local healthcare provision. Doctors value the availability of expert advice. All concerned—especially the relatives of the bereaved, who are consulted in every case—regard the new system as a major improvement.

Previously, many coroners encouraged doctors to refer numerous deaths to them, because they recognized that most doctors are not well trained to recognize the situations where a coroner should investigate. The introduction of medical examiners, who are specifically trained to do that, justifies a re-evaluation of how the sometimes indistinct interface between ‘natural causes’ and ‘unnatural causes’ of death is handled. This is complicated by the fact that medical examiners and coroners are the responsibility of different Government departments. That interface will be discussed.

 

1500-1530 – Refreshment Break

 

1530-1630

The Role of Advanced Imaging in Death Investigation

Evan Matshes, Office of the Medical Investigator, University of New Mexico, Albuquerque, USA

Objectives:

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

  • Review the concept of modern death investigation from a medical examiner’s perspective.
  • Describe the New Mexico Office of the Medical Investigator.
  • Review modern forensic radiology including:
    • Postmortem radiography
    • Postmortem computed tomography
    • Postmortem magnetic resonance imaging

 

1630-1700

This symposium is followed by the Annual General Meeting of the Section of Forensic Pathology.

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Competency Based Education Symposium

Monday, July 14, 1400-1700

 

Chair:

Marcio Gomes, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario

Moderator:

Laurette Geldenhuys, Queen Elizabeth II Health Science Centre, Dalhousie University, Halifax, Nova Scotia

 

1400-1430

What is CBME, why CBME?

Linda Snell, McGill University Centre for Medical Education, Royal College of Physicians and Surgeons of Canada, Montreal, Quebec

 

Objectives:

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

  • Define competency, and competency-based medical education.
  • Contrast the curriculum model and planning cycle for CBME vs a
    traditional curriculum.
  • Describe how to identify and define competencies.
  • Define milestones and describe how to develop them.
  • Discuss why our current system should change, and why The
    Royal College’s Competency by Design is needed.
  • Address criticisms of CBME.
  • Describe the changes for CanMEDS 2015.

 

1430-1500

University of Toronto Orthopedics Experience

Peter C. Ferguson, Mount Sinai Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ontario

 

Objectives:

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

  • Discuss the practical implementation of CBME in a postgraduate training program.
  • Present the initial results of a pilot stream in CBME in orthopaedic surgery.
  • Discuss the challenges of implementation of CBME on a wide-scale level.

1500-1530 – Refreshment Break

 

1530-1600

CanMEDS 2015 and Competence by Design

Linda Snell, McGill University Centre for Medical Education, Royal College of Physicians and Surgeons of Canada, Montreal, Quebec

 

Objectives:

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

  • Define competency, and competency-based medical education.
  • Contrast the curriculum model and planning cycle for CBME vs a
    traditional curriculum.
  • Describe how to identify and define competencies.
  • Define milestones and describe how to develop them.
  • Discuss why our current system should change, and why The
    Royal College’s Competency by Design is needed.
  • Address criticisms of CBME.
  • Describe the changes for CanMEDS 2015.

1600-1630

What Would CBME Look Like in Lab Medicine?

Marcio Gomes, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario

Objectives:

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

  • Debate about entrustable professional activities in Lab Medicine.
  • Propose milestones for different professional activities.
  • Visualize a competency-based education program in Lab Medicine.

The Royal College is preparing for the launch of “CanMEDS 2015” and “Competency by Design”, which will require considerable changes to current post-graduate training programs. Although competency based medical education (CBME) has been in the radar for a while and many disciplines have already begun to give it a try, its application in laboratory medicine is still very incipient. In this session, the practical application of concepts such as CBME, entrustable professional activities and milestones to pathology and laboratory medicine will be explored.

 

1630-1700

Panel Discussion with Audience

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General Pathology Special Interest Group Meeting – Forum Discussion on the Future of General Pathology in Canada

Monday, July 14, 2030-2230

 

Chair:

Christopher Naugler, University of Calgary and Calgary Laboratory Services, Calgary, Alberta

 

Presenters:

Christopher Naugler, University of Calgary and Calgary Laboratory Services, Calgary, Alberta

Allam Shawwa, QEII Health Sciences Centre, Halifax, Nova Scotia

 

Description:

General pathologists fill many roles in Canadian laboratories related to community practice, administration, teaching and research. This SIG is open to anyone with an interest in general pathology practice or training in Canada.

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Anatomical Pathology Symposium: Recent Advances in Thoracic Pathology

Tuesday, July 15, 0800-1130

 

Chair:

Golnar Rasty, University Health Network, Toronto, Ontario

 

0800-0850

Updates on Lung Cancer Diagnosis and Classification

Ming Tsao, University Health Network, Toronto, Ontario

Objectives:

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

  • Discuss upcoming changes to the WHO classification on lung cancer
  • Describe recent advances in molecular pathology of lung cancer
  • Discuss molecular testing in non-small cell lung cancer

 

0850-0930

Interstitial Lung Disease

Marcio Gomes, The Ottawa Hospital, Ottawa, Ontario

Objectives:

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

  • Differentiate acute and chronic interstitial lung diseases (ILD).
  • Apply a simple algorithm for the classification of ILD.
  • Recognize pathognomonic findings in ILD.
  • Criticize the use of different types of biopsy for the diagnosis of ILD.

Interstitial Lung Diseases (ILD) are relatively uncommon but comprise over a hundred different entities. Therefore, they are considered a complex topic in medicine and anatomical pathology. In this session, a practical approach is proposed, using simple and straightforward clinical, radiological and pathological findings, which can be applied by general and in-training surgical pathologists. A case-based demonstration will also provide a few tips from the trenches and highlight the take home messages.

 

0930-0945 – Questions and discussion

 

0945-1010 – Refreshment Break

 

1010-1040

Mesothelioma

Andy Churg, University of British Columbia, Vancouver, BC

Objectives:

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

  • Discuss the diagnostic criteria for malignant mesothelioma.
  • Describe problem areas, including the choice of immunohistochemical stains and the separation of benign and malignant mesothelial proliferations.
  • Discuss new techniques such as p16 FISH.

Description:

This lecture will cover the diagnostic criteria for mesothelioma. Problem areas, including the choice of immunohistochemical stains, the separation of benign and malignant mesothelial proliferations, and new techniques such as p16 FISH will be emphasized.

 

1040-1115

Thymic Neoplasia

David Hwang, University Health Network, Toronto, Ontario

Objectives:

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

  • Discuss the classification of thymic epithelial neoplasms.
  • Describe recent consensus recommendations for differentiating thymoma subtypes.
  • Present a practical approach to the diagnosis of these tumours.

Description:

This session will overview concepts and controversies in the classification of thymic epithelial neoplasms, with primary focus on thymoma and thymic carcinoma, and present a practical approach to the diagnosis of these tumors.

 

1115-1130 – Questions and discussion

 

1130-1200

This symposium is followed by the Annual General Meeting of the Section of Anatomical Pathology, which will include a discussion about workload with Raymond Maung

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Pediatric/Perinatal and Neuropathology Symposium

Tuesday, July 15, 0800-1130

 

Co-Chairs:

Fergall Magee, Saskatoon City Hospital, Saskatoon, Saskatchewan

Robert Macaulay, Capital District Health Authority, Halifax, Nova Scotia

Placental Predictors and Correlates of Fetal Neuropathology and Neurological Outcome

David Grynspan, Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, Ontario

Objectives:

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

  • Review placental correlates of adverse fetal neurological outcomes.
  • Discuss the mechanism of intrauterine and perinatal asphyxia and how they may be reflected in the placenta.
  • Critically review the literature on this topic, contemplate what we really know and consider next steps.

Brain Injury Acquired in Utero: Patterns and Correlates

Patrick Shannon, Mount Sinai Hospital, Toronto, Ontario

Objectives:

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

  • Discuss how tissue studies can be brought into clinical trials.
  • Describe how NGS- based technology has transformed molecular profiling of cancer.
  • Identify at least one of the strengths and limitations of an intention-to-treat design.

Description:

To review the basic morphology and clinical correlates of brain injury in the fetus, and its utility in establishing clinical pathological correlation for the perinatal autopsy.

 

Congenital and Infant Brain Tumours

Cynthia Hawkins, The Hospital for Sick Children, Toronto, Ontario

Objectives:

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

  • Review the most common brain tumours of infancy.
  • Review the differences in clinical presentation, genetics, and approach to treatment of infant brain tumours vs those of later childhood and adulthood.
  • Appreciate those infant brain tumours which may suggest an underlying inherited cancer syndrome.

Description:

Children younger than three years present with a different spectrum of brain tumours than older children and are particularly challenging to diagnose and treat. With the advent of high throughput sequencing and microarray profiling we are beginning to understand some of the molecular differences which underlie brain tumours arising in these young children. In this talk we will review the common brain tumours arising in children under the age of three including their distinct clinical presentation, genetics and treatment. Brain tumours which may indicate an underlying familial cancer predisposition syndrome will be highlighted.

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Dr. Cam Coady Slide Seminar: Gynecologic Pathology
Tuesday, July 15, 1400-1700

 

NEW! Click here to download the advance slides for the Coady Seminar

 

Gynecologic Pathology

Robert Soslow, Memorial Hospital for Cancer and Allied Diseases, Memorial Sloan-Kettering Cancer Center, Weill Medical College Cornell University, New York, USA

 

Objectives:

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

  • Discuss biological and clinical underpinnings of BRCA1 and BRCA2 dysfunction and PARP function
  • Describe the current models of serous carcinogenesis
  • Assess for hereditary ovarian cancer risk- importance of genetic counseling and the use of pathology and family history as risk assessment tools
  • Evaluate ovarian cancer risk reduction strategies, including chemoprevention, surveillance and risk reducing surgery
  • Calculate proper grossing techniques for prosecting risk reducing (i.e. prophylactic) salpingo-oophorectomy specimens
  • Discuss criteria for the diagnosis of intraepithelial serous carcinoma of the fallopian tube and the distinction of this purported precursor lesion from mimics
  • Describe strategies for diagnosing both grossly visibly and clinically inapparent lesions in salpingo-oophorectomy specimens
  • Evaluate current concepts of the morphologic phenotype of BRCA1 associated ovarian, tubal and peritoneal carcinoma
  • Discuss biological and clinical attributes of BRCA1 inactivated ovarian, tubal and peritoneal carcinoma, including an introduction to the rationale for targeted therapy
  • Assess biological and clinical underpinnings of Lynch syndrome in endometrial and ovarian cancer
  • Interpret the rationale behind assessment for hereditary cancer risk in patients with endometrial cancer
  • Discuss the risk assessment for Lynch Syndrome – genetic counseling, family history and pathology
  • Assess the techniques used to determine Lynch syndrome risk in patients with endometrial cancer, including morphologic, immunohistochemical and molecular diagnostic examination
  • Calculate the algorithms used to determine Lynch syndrome risk
  • Discuss ethical and regulatory issues concerning screening patients for heritable syndromes
  • Describe the genetic basis, clinical presentation and morphologic features of tumors associated with uncommon gynecologic cancer syndromes: Peutz Jeghers, Cowden, Muir Torre, Hereditary leiomyomatosis/renal cell carcinoma, Tuberous sclerosis

Description:

This symposium will provide registrants an overview of inherited gynecologic cancer syndromes with emphasis on BRCA-associated and Lynch syndromes. Specific topics include: Biological and clinical underpinnings of BRCA1 and BRCA2 dysfunction and PARP function; Current models of serous carcinogenesis; How to assess for hereditary ovarian cancer risk- importance of genetic counseling and the use of pathology and family history as risk assessment tools; Ovarian cancer risk reduction strategies, including chemoprevention, surveillance and risk reducing surgery; Proper grossing techniques for prosecting risk reducing (i.e. prophylactic) salpingo-oophorectomy specimens; Criteria for the diagnosis of intraepithelial serous carcinoma of the fallopian tube and the distinction of this purported precursor lesion from mimics; Strategies for diagnosing both grossly visibly and clinically inapparent lesions in salpingo-oophorectomy specimens; Current concepts of the morphologic phenotype of BRCA1 associated ovarian, tubal and peritoneal carcinoma; Biological and clinical attributes of BRCA1 inactivated ovarian, tubal and peritoneal carcinoma, including an introduction to the rationale for targeted therapy; Biological and clinical underpinnings of Lynch syndrome in endometrial and ovarian cancer; Rationale behind assessment for hereditary cancer risk in patients with endometrial cancer; Risk assessment for Lynch Syndrome – genetic counseling, family history and pathology; Techniques used to determine Lynch syndrome risk in patients with endometrial cancer, including morphologic, immunohistochemical and molecular diagnostic examination; Algorithms used to determine Lynch syndrome risk; Ethical and regulatory issues concerning screening patients for cancer predisposition syndromes. The genetic basis, clinical presentation and morphologic features of tumors associated with uncommon gynecologic cancer syndromes will also be covered. The target audience is general pathologists, gynecological pathologists, residents and fellows.

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Emerging Trend Session

Tuesday, July 15, 1715-1815

 

A Placental Molar Disease Diagnostic Service: Let’s Improve the Management of Women with Suspected Placental Molar Disease!

Terence J. Colgan, Mount Sinai Hospital, University of Toronto, University Health, Toronto, Ontario

 

Goal:

To understand how a new lab diagnostic service for suspected hydatidiform moles improves pathologic diagnosis and leads to optimal patient management.

 

Objectives:

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

  • Review the limitations of histopathology and immunohistochemistry in the diagnosis of hydatidiform moles.
  • Integrate the use of genotyping in the assessment of products of conception.
  • Appraise the value of a diagnostic service using formalin fixed paraffin embedded tissue that combines histopathology, immunohistochemistry, and genotyping.

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