the Voice - American Society for Cytotechnology · 2011-09-29 · Volume IX – Issue 5 Editorial Deadline: August 2, 2011 Available: mid-September Volume IX – Issue 6 Editorial

the VoiceThe American Society for

Cytotechnology, as the collective voice for the profession, is committed

to defining and promoting the profession of Cytotechnology.

In This Issue

2Summary of 2010

New York State Cytology Workforce Study

3Spotlight on Region 3

4When Pap Volumes Go Down,

Look Around

5Report from the Budget and

Finance Committee: The State of ASCT Finances –

Sound and Secure

5Upcoming Webinars

62012 Annual

Scientific Conference

Volume IX Issue 5

September 2011continued on page 7

2012 Annual Scientific Conference

April 13-15 • Hyatt at Olive 8 • Seattle, WashingtonFor more information, see page 6 or visit www.asct.com

and click on the Annual Conference tab.

Moving Towards a Consensus in Quality-Practice Guidelines for Quality Assurance in Gynecologic CytopathologyLeigh Ann Cahill, BS, CT(ASCP), CMIAC Kalyani Naik, MS, SCT(ASCP) Lynnette Savaloja, SCT(ASCP)

This past June a group of stakeholder organizations that included the ASCT, the federal government, and individ-ual cytotechnologists and cytopathologists convened in Rosemont, Illinois at the CAP Gynecologic Quality Practices Consensus Conference. The conference was part of a cooperative agreement between the CAP and the Centers for Disease Control and Prevention (CDC) to perform an “evaluation of current practices in reporting gynecologic cytology test results and cytology proficiency testing.” The purpose of the conference was to discuss various current and potential “best practices” for gynecologic cytopathology quality assurance (QA) in order to develop a consensus quality-practice guideline for QA in gynecologic cytopathology.

Leigh Ann Cahill Kalyani Naik

Lynnette Savaloja

2 Volume IX • Issue 5 • September 2011

ASCT Executive Council

President Joan Rossi, MA, CT(ASCP)CM

President-Elect Sonya Griffin, MS, SCT(ASCP)CM, IAC

Past President Sandra Giroux, SCT(ASCP), CFIAC

Treasurer Kalyani Naik, MS, SCT(ASCP)

Legislative Consultant Lynnette Savaloja, SCT(ASCP)

Regional Directors

Region 1 Timannie Ames, CT(ASCP)

Region 2 Courtney Robinson, CT(ASCP)

Region 3 Hector Garcia, MS, SCT(ASCP), CMIAC

Region 4 Vivian Thompson, PhD, CT(ASCP)

Region 5 Susan Warren, SCT(ASCP), IAC

Editorial Board

Editor-in-ChiefEliza Enstine, BS, CT(ASCP)

Associate EditorsMichele Smith, BS, SCT(ASCP) Karen Chau

Editorial AssistantBeth Denny

Graphic DesignerLaura Comer

Publication Schedule

Volume IX – Issue 5Editorial Deadline: August 2, 2011Available: mid-September

Volume IX – Issue 6 Editorial Deadline: October 3, 2011 Available: mid-November

ASCT1500 Sunday Drive Suite 102Raleigh, NC 27607800-948-3947 phone919-787-4916 [email protected]

Summary of 2010 New York State Cytology Workforce Study(original article published in the American Journal Clinical Pathology - Am J Clin Pathol. 2011 Jul;136(1):108-18.)

Indra Balachandran PhD, SCT(ASCP), CFIAC Maria Friedlander MPA, CT(ASCP), CMIAC

Cytology practice is experiencing significant changes from traditional screening and morphologic interpreta-tion. With the enhanced understanding of changes at the molecular level for various pathologic entities including cancers and new tests for specific molecular changes, cytology is gradually incorporating molecu-lar-based diagnostic testing with the hopes of target-ing specific therapies for various cancer diseases and improving patient care. At the same time, the introduc-tion of image-assisted Papanicolaou (Pap) test devices, Human Papilloma Virus (HPV) DNA testing, changes in cervical cancer screening guidelines and HPV vaccina-tion have introduced anxiety over the decline of Pap tests and possibly a reduced need for cytotechnologists in the future. Unfortunately, this speculation has contributed to misperceptions about the need to continue traditional training and the premature closure of many cytotechnology training programs.1-7

MethodologyAn on-line survey was conducted by the Program Directors of the 2 remaining New York State (NYS) cytotechnology training programs to obtain accurate data concerning the current and future direction of cytology practice in the state. The survey consisted of 22 questions related to classification of laboratory facility, number and position of cytotechnologists (CTs) and cytopreparatory staff employed, number of years experience of employed CTs, current and anticipated case volume (including gynecologic, nongynecologic, and FNA), use of thin layer cytology or automated-assisted imaging, additional CT responsibili-ties beyond traditional screening practices, CT workload expectations, time spent on nontraditional responsibilities, cytotechnology training history, training related to nontraditional responsibilities, CT vacancy data and hiring practices. Invitations to participate in the survey were com-municated via phone and e-mail to all laboratory directors from 130 NYS laboratories holding a NYS Department of Health permit as of November 27, 2009. Laboratories with a NYS cytopathology permit but located out-of-state were not included in this study. The survey was open for a period of 7 weeks. Demographic information and survey results are summarized below and compared to other similar studies. Some survey participants did not answer every question.

CT Employment DemographicsType of facilityOf 130 laboratories, 67 responded, representing a 51.5% response rate. The majority of respondents represented hospital/medical center–based

continued on page 8

Volume IX • Issue 5 • September 2011 3

Spotlight on Region 3(Arkansas, Illinois, Indiana, Louisiana, Michigan, Mississippi, Ohio, Oklahoma, Texas)

By Hector Garcia

I can’t believe my second year as regional direc-tor is almost over! With your sup-port I’m looking forward to the year to come. So

far it has been a very busy year for our region. Here is the latest news from Region 3:

OhioThe Ohio Society of Cytology will hold their annual meeting on Sat-urday, September, 24th at Good Samaritan Hospital in Dayton Ohio. Some of the topics to be covered are: use of cytology specimens for flow cytometry in the diagnosis of B cell lymphomas, an update on CAP LAP inspections, lymph node FNAs, the cytology of body cavity fluids, and yoga for the cytotech-nologist. For further information please contact Agnes Alexander at [email protected]

IndianaThe Cytology Society of Indiana held their spring meeting at the Hilton North in Indianapolis, on March 6th. The meeting featured presentations by Dr. Darron Brow on HPV, and Jennifer Young from the ASCP, discussing the new inter-national certification program.

Texas

MD Anderson, HoustonMD Anderson held their 17th An-nual Cytopathology Conference in May. They also offered a 2-day conference to help cytotechnolo-gists prepare for the Molecular Biology board examination on August 12th and 13th.

Student Laura Corgey received the prestigious Geraldine Colby Zeiler Award for Students of Cy-totechnology for 2010-2011. She was also a recipient of the ASCP National Student Honor Award along with fellow students Lisa Garcia and David Tebong. Steph-anie Hamilton, Program Director, is happy to report another student success story, Siabhon Swann will be returning to her employer in the Bahamas, but will be now working as a cytotechnologist!

In other good news, Kristy Ven-able, a cytotechnologist at MDACC, passed the examination for Molecular Biology certification and is also the recipient of the Outstanding Faculty Award for the Cytotechnology Program.

Texas Society of CytologyThe Texas Society of Cytology will hold their 40th annual meeting on October 8th at the Omni Hotel at Austin, Texas. Program topics will include the new Bethesda System for reporting thyroid cytopathol-ogy by Ann Marie West, CT(ASCP), a practical approach to glandular cell abnormality by Dr. Luis Diaz-Rosario, the current role of ancil-lary techniques in the diagnosis of urothelial carcinoma by Dr. Eva Wojcik, and an overview of the history of Human Papilloma virus (HPV) detection in Pap smears by

Dr. Vicki J. Schnadig. In addition, Dr. Phillip Valente will discuss the potential impact of HPV vaccina-tion and testing on Pap screening frequency and women’s health, as well as how molecular tech-niques and imaging technologies will alter the practice of cytology. The meeting will conclude with a talk explaining the process of implementing an imaging system in a reference laboratory setting.

IllinoisThe Illinois Society of Cytology (ISC) will be holding its Fall Meet-ing on Saturday October, 22nd. Dr. Corliss from the University of Wisconsin Medical Center, in Madision, WI will be the featured speaker. Dr. Corliss is a forensic pathologist and an excellent speaker!

The ISC has tried its very best to present excellent speakers and relevant topics, such as molecular programs and the future of cyto-technology. This year’s program will be no exception. They are excited and thrilled to present this fabulous speaker to their members and friends!

For more information visit the ISC web site at www.illinoissocietyof-cytology.com for the latest infor-mation

WSC Fall MeetingFriday, October 7 and Saturday, October 8, 2011

Stoney Creek Inn Onalaska, WI

www.wiscytology.org


continued on page 7

When Pap Volumes Go Down, Look AroundBy Gail Mueller, M.S., CT(ASCP)DLM, Cytology Supervisor, Ketchum, Wood & Burgert Pathology Associates, Tallahassee, FL

With the rise in HPV testing, the nation is experi-encing a down turn in the num-ber of traditional Pap specimens. The adherence

to recommendations for co-testing and less frequent Paps has also contributed to the decrease. This certainly gives cause for cyto-technologists to be apprehensive about the future of cytology as we have known it.

Cytotechnologists are highly skilled professionals with college degrees. Our education, coupled with on-the-job experience, has allowed us to develop knowledge and skills that can be applied to many health and laboratory related jobs. We know about Quality Assurance, Quality Control, CAP inspections, safety, and the basics of histol-ogy. Along with the patience that comes from working at micro-scopes, this background qualifies us for a myriad of related activities.

One Laboratory’s ExperienceKetchum, Wood and Burgert Pathology Associates is a private anatomic pathology laboratory serving the Tallahassee area and several surrounding counties. The cytology staff consists of 6.3 FTE cytotechnologists and 3 cytoprep technicians. Our annual cytology volume consists of approximately 61,000 gynecologic specimens and over 4,000 non-gynecologic specimens, including 700 fine nee-dle aspiration specimens. Over the last three years, we have experi-enced a Pap volume decrease of 4 to 5% per year. Fortunately, our cytotechnologists have also had opportunities to spread their wings within the laboratory.

Three of the cytotechnologists assist the cytopathologist with FNA’s performed at the labora-tory. Previously, a cytoprep tech assisted. This is not a high volume activity, but it does offer variety to the cytotechnologists. Also, now that there is less pressure to screen slides continuously, two cytotech-nologists can visit offices that need some assistance with obtaining adequate FNA’s. This activity has helped to improve the quality of specimens received from these sites, and has enhanced the per-sonal communications with these facilities.

When a vacancy occurred in the Quality Assurance/Safety/Training area at our laboratory, we met with the administrator to discuss some interim solutions to the va-cancy. One of our cytotechs was recommended to take over the laboratory QA responsibilities. With a cytotechnologist’s attention to detail and organizational skills, this proved to be a perfect solution for our situation.

I offered to review the training ma-terials with the histology supervisor, and we were able to trim down the new employee and annual safety training materials. As a result we have a more concise program which continues to meet all guide-lines and requirements. I now have a monthly training review schedule that coincides with the employ-ees’ annual reviews. Even though the material is repetitious, I enjoy visiting with all the employees from different departments.

Responsibility for the safety sec-tion was eventually assumed by the QA cytotech. Other cytotechs are asked to accompany her on the quarterly safety inspections. Varying the participation can lead to increased awareness of safety issues.

Because we have very good tis-sue correlation and archive data, we have been able to do some small research projects with the support of our pathologists. Two rapid prescreen (RPS) trials, and a retrospective thyroid review set involving all the cytotechnologists, have resulted in posters for the ASC meeting. Another project on HPV results grouped by patient age has also been accepted. The data crunching for these projects was done after work hours by will-ing personnel.

One of our cytotechnologists has had previous experience with grossing in histology, and has recently been able to use that skill again. We have seen an increase in fine needle aspiration speci-mens which include a tissue core as well as prepared slides and a needle rinse. The cytology pro-cessing time for these specimens is greatly enhanced when the gross descriptions can be handled by our cytotechnologist. He also provides back-up coverage for routine grossing when needed.

In addition, one or two cytotech-nologists will soon be helping histology with an early morning computer task. They will be en-tering clinical and descriptive information for a particular set of specimens. This work was being done by a part time graduate stu-dent who will be graduating and moving on.

All of our cytotechnologists know the basics of cytology specimen preparation, and how to coverslip slides, so they can help out with specimen preparation when there is a need. There are some cytol-ogy lab tasks that can be done by non-cytotechs, but frequently a cytotechnologist has a better eye for daily patterns. For instance, the


Report from the Budget and Finance Committee: The State of ASCT Finances – Sound and SecureBy Kalyani Naik, Treasurer, Chair, Budget and Finance Committee

The Budget and Finance Com-mittee (BFC) is charged with continuously monitoring and analyzing the ASCT’s financial

status and resources. This commit-tee is one of the Society’s main mechanisms of ensuring a sound fiscal foundation that allows us to fulfill our mission today and in the future.

Towards this end, the BFC was tasked with evaluating and developing long term strategies to sustain financial stability and vi-ability. Working with our Executive Director and our financial advisor, the BFC developed a proposal to reallocate funds in our reserve account in a way that would

increase our returns while minimiz-ing risk. The proposal also included a provision to maximize dividends from ASCT Services, allowing the ASCT to strengthen its current op-erating budget, which has seen in-creased basic operating expenses over the years. Equally important, the proposal included a provision to further strengthen our reserves by funneling a defined percent-age of funds to our reserve ac-count on an annual basis. This proposal was approved by the Executive Council and supported by ASCT Services earlier in this first quarter of our fiscal year.

The BFC will focus the rest of the year on implementing the strategy laid out in the proposal. In addi-tion, the BFC will, as it does every year, monitor and analyze finan-cial statements to ensure that we

stay on track with our established budget.

While ASCT is financially sound for both the short and long terms, our 2011-12 budget is fairly tight. We will continue to work with other committees to identify and as-sess opportunities for reducing expenses and generating revenue streams. We will also work with ASCT Foundation to identify other opportunities to use Foundation funds to help us to meet our stra-tegic goals. These efforts, together with implementation of our strat-egy to increase our reserves on a consistent basis, will ensure that we continue to meet member-ship needs, maintain our viability and strengthen our future financial position.

Upcoming Webinars

Register online at www.asct.com!

November 15, 1:00pm ESTThe Era of Targeted Therapy in Lung Cancer – Role of Molecular Testing

By: Maureen F. Zakowski, MD

This program will introduce viewers to the concept of targeted therapy as it applies to lung cancer including:

• Use and limitation of cytology in lung cancer

• Review criteria to separate adenocarcinoma from squamous cell carcinoma

• Use of IHC staining and paradigm for usage

• Impact to patient care and treatment

January 10, 2:00pm ESTLicensure and the Cytotechnologists’ Scope of Practice: What You Need to Know Before you Say “No”

By: Lynnette Savaloja, SCT(ASCP)

• Discuss the definition of “Scope of Practice” and other licensure terms, and how they apply to cytotechnologists and state licensure

• Examine laboratory licensure position statements of professional organizations

• Review recommended Scope of Practice definitions that are approved and/or endorsed by professional organizations

• Present current national laboratory licensure regulations, as they apply to cytotechnologists, on a state-by-state basis

• Offer items for consideration for cytotechnologists’ active participation in licensure discussions


2012 Annual Scientific ConferenceApril 13-15 • Seattle, Washington

Seattle is anything but ordinary. It’s a place where bike messen-gers share elevators with world-renowned researchers and where fishermen have lunch alongside top surgeons. It’s a city where the extraordinary is commonplace and commonplace is anything but. And if you look closely, you just might discover that in Seattle there are amazing things happen-ing all around you.

From a jet engine to an espresso machine to grunge rock, Seattle’s world-changing events have all had a distinct sound. But the symphony doesn’t end there. Your visit to Seattle may bring you the sound of an orca blowing as it surfaces, the roar of the crowd at Safeco Field or the near silence of the Olympic rainforest. Come to Seattle and hear for yourself.

AccommodationsSleek modern design and environmental responsibility converge seam-lessly at Hyatt at Olive 8. The first LEED certified hotel in the city, Seattle’s newest hotel represents a new echelon for sustainability in the Pacific Northwest. Boasting an array of inno-vative energy and water sav-ing features, the hotel offers guests the abil-ity to continue their sustain-able lifestyle while traveling. A few blocks outside our glass doors are historic Pike Place Market and Puget Sound.

Eco-friendly dining and spa amenities present a resort atmosphere in a vibrant city setting. Exuding the best of the Pacific Northwest spirit, brilliant form is combined with environmental function to create a new definition of luxury in downtown Seattle. The ASCT has secured a special room rate of $167 for the nights of April 8-18.

Visit the 2012 Annual Conference page at www.asct.com for more information.


This conference was preceded by a survey developed by the CAP, with input from the CDC and other stakeholders. The survey was conducted in 2010 to collect infor-mation about laboratory quality assurance practices in gynecolog-ic cytology including prospective and retrospective rescreening, correlation of HPV positivity with Pap test results, utilization of PT results in assessment of screening personnel, and application of vari-ous quality monitors. The goal was to learn how these measures are routinely used in a QA program, how performance is monitored in relation to these measures, which measures are the most helpful, and what challenges and barri-ers are faced by laboratories in maintaining a QA program. The survey results from approximately 600 laboratories were posted on the CAP website with a request for comments. These survey results and comments, in addition to the results of follow-up web-based surveys, served as the foundation for discussion at the consensus conference.

Six workgroups, consisting of five pathologists (including at least one primary author of the grant and survey – Joseph Tworek, MD; Bruce Jones, MD; and Michael Henry, MD), a cytotechnologist, and a CAP support staff member, were charged with monitoring and leading website discussion, summarizing survey results and web comments, and developing consensus statements on one of six major topics:

1. Monitoring diagnostic rate categories, turn-around time, and concurrence of CT and MD diagnosis prior to sign out;

2. CLIA ‘88 mandated real time re-screening of cases initially iden-tified as NILM prior to reporting,

and monitoring retrospective review of NILM when prompted by a current HSIL+ Pap test;

3. Pap PT

4. Monitoring of Pap test and cer-vical biopsy correlation

5. Monitoring of HPV rates; and

6. General quality

As a contributor to the 2010 survey, ASCT was invited to have three cytotechnologists – Leigh Ann Cahill, Kalyani Naik, and Lyn-nette Savaloja – serve as represen-tatives on the workgroups.

During the conference, par-ticipants voted on the consensus statements developed by the workgroups. Individuals and or-ganizations were able to interact with the CAP and members of the CDC, offering opinions regarding the use of quality monitoring in gy-necologic cytopathology for the establishment of quality assurance guidelines. How powerful was this voice? Even as the conference proceeded, the workgroups re-fined the consensus statements in response to voting results as they were being reported, and pre-sented additional statements for consideration before the close of the conference.

Since the close of the confer-ence workgroup members have been working to create a sum-mary of their findings, which will be presented at the next CLIAC meeting. Each workgroup will then submit a paper developed from the findings of the survey, survey comments, and the results of the consensus conference. These pa-pers will be submitted for publica-tion in a peer-reviewed journal. ASCT will remain involved in this process and our representatives will be sure to keep you informed. Stay tuned!

Moving Towards a Consensus in Quality-Practice Guidelines for Quality Assurancecontinued from page 1

cytotechnologist who arrives at the lab first each morning unloads the FocalPoint instrument and selects the slides for review. She is aware of any minimal instrument irregularities that could become problematic. She also retrieves the priority cases for early reporting.

It is always good to build and maintain healthy relationships with other departments in one’s work-place. An offer to accompany the customer service representative on a few calls to large GYN prac-tices can be advantageous for all. It is great to put a face to a voice on the phone, and the medical personnel enjoy meeting us and having their technical questions answered. It is also very helpful for us to see the work flow in medical offices, and to listen to the staff concerns.

Even if you are not able to expand your skills into molecular work or FISH at your laboratory, you can thoughtfully appraise your work environment and offer to help or learn a related skill. This is where communicating with personnel in other departments can be valu-able. When there is a decrease in revenue from a specimen decline, administration usually looks to the most expensive personnel for cuts. However, the expense of hiring and training support positions must be considered, because the turnover among those employees is understandably higher than that of cytotechnologists. Creating a new niche as a forward-looking cytotechnologist can be the key to maintaining a secure position in the changing laboratory.

When Pap Volumes Go Down, Look Aroundcontinued from page 4


laboratories (51/67 [76%]), fol-lowed by private laboratories (11/67 [16%]), 2 commercial labo-ratories (3%), 2 college or universi-ty-based laboratories (3%), and 1 public health laboratory (2%). The majority of CTs are employed in hospital-based and large medical center–based laboratories (170) followed by private laboratories (89).

Type of position and professional experienceOne third of all reported CT staff positions represent managerial/supervisory and lead/senior CT po-sitions (115/656 [17.5%] and 84/656 [12.8%], respectively). Of all report-ed CT positions, 17.2% (113/656) and 12.3% (81/656) represent part-time and per diem positions, respectively. Similarly, 12% of CTs in the 2009 ASCT national survey reported working part-time or on-call/casual.8 While this survey did not solicit information about CTs holding multiple CT jobs, 8% of CTs in the ASCT national survey report-ed working more than 1 job.

About 33% (233/704) of all re-ported CT positions in the state are held by CTs with more than 20 years’ experience; about another 25% (179/704) of CTs have 11 to 20 years’ experience. The distribution of experience levels for staff-level CT positions was similar across all reporting facility types. Not surpris-ingly, the majority of manage-rial and supervisory CT positions are held by CTs with 11 to more than 20 years’ experience (78.2% [111/142]). While these results indi-cate an aging workforce, specific numbers and time frames for the actual number of CTs expected to retire or leave the profession remain uncertain. However, about 30% of responding laboratories reported that they expect to hire CTs within the next 3 years owing

to retirement of existing staff. Oth-er studies substantiate a shrinking laboratory workforce. Reports es-timate that an average of 13% of current laboratory staff is likely to retire within the next 5 years and a 6% retirement rate is expected in the northeast region.9 Accord-ing to the 2009 ASCT survey, about half (51%) of the CT respondents reported more than 20 years’ experience and one third (31%) reported more than 30 years in the field.8 Of these respondents, 74% indicated they were leaving the field for retirement. This is a larger percentage of respondents with intentions to retire than what was reported in the 2008 ASCT survey, in which 58% of CTs indicated they were leaving the field owing to retirement. The rate of retirement specific to different regions of the United States is unavailable in the ASCT survey results. Besides retire-ment, it has been reported that CTs leave the profession for other reasons, including career change; this further impacts the workforce available to meet cytology lab needs.8,10

Of all reported positions, 5.5% (36/656) involve CTs working in nontraditional roles. The major-ity of these positions are in large hospital medical centers and community hospital–based labo-ratories (14/17). All but 1 of the responding laboratories employ cytopreparatory technicians. The distribution of experience levels for CTs in nontraditional CT positions was the same across all reported ranges.

Cytology case volumes GynecologicA decrease in gynecologic test volume was reported by 41% (12/29) of large hospital/medical center–based laboratories at a reported rate of 1% to 10%; this

decrease is expected to continue in the next 2 years. Half of the community-based laboratories experienced stable gynecologic volumes, while a fairly equal num-ber of laboratories reported gyne-cologic volume decreases (6/22 [27%]) or increases (5/22 [23%]). Similar variability in gynecologic volume was reported by partici-pating private laboratories. While specific reasons for gynecologic test volume reductions were not collected in this particular study, contributing factors suggested in the literature include HPV testing and changes in screening prac-tices.11-15 It is interesting that few laboratories reported anticipated increases, although the reason for this trend is uncertain from this study. Consolidation of laboratory services, or redirection of Pap tests historically serviced in other facili-ties to laboratories experiencing growth, are possible reasons.

Non-Gynecologic and FNAIn this study, almost half (14/29 [48%]) of hospital/large medical center–based type laboratories reported an increase in non-gynecologic volumes; a slightly higher number of these labora-tories (18/29 [62%]) also reported an increase in FNA volumes. The rate of increase was reported at 1% to 10%. Approximately one third of these laboratories expect this trend to continue during the next 2 years at a similar rate of increase. In comparison, only 23% of smaller, community-based hos-pitals (5/22) reported an increase in nongynecologic and FNA vol-umes; 68% (15/22) reported stable volumes with no anticipated change in the next 2 years. Half of the responding private laborato-ries reported increasing nongyne-cologic volumes.

Summary of 2010 New York State Cytology Workforce Study continued from page 2

continued on page 9


A few other studies also cite grow-ing to stable non-gynecologic and FNA volumes.17-18 In 2008 and 2009, cytotechnology workforce surveys were sponsored and conducted by the ASCP to col-lect data on current trends in the field of cytotechnology. Overall, their survey results suggested de-creased Pap test volumes, stable to increased non-gynecologic volumes, and increased FNA vol-umes. These findings are consistent with the volume trends reported by participating large hospital– and medical center–based labo-ratories in this survey; although these trends were not necessarily observed in the majority of other facility types.

New Technologies and AutomationAlmost all responding laboratories (65/67 [97%]) used some form of liquid-based technology as their predominant method of Pap test preparation. The majority of labo-ratories (56/65 [86%]) use ThinPrep (TP; Hologic, Bedford, MA) prepa-rations for gynecologic specimens and 14% (9/65) use BD SurePath (SP; BD, Franklin Lakes, NJ). Thirty-eight percent of TP laboratories reported use of the TP Imaging System (TPIS; Hologic) for gyneco-logic specimen evaluation. Nine laboratories of varied facility types reported using SP. Only 3 private laboratories, however, reported use of BD FocalPoint Slide Profiler Intelligent Pap Imaging or the BD FocalPoint GS Imaging System.

These results illustrate the impor-tance for cytotechnology train-ing programs to train and certify students in the use and evaluation of these technologies so gradu-ates are marketable. Manufactur-ers of these technologies have historically been supportive of providing resources to assist CT programs with student training. It

is anticipated that such alliances will continue if employers demand that graduates be trained to use these products. In addition, alli-ances with laboratories currently housing such technology may be another way for training programs to have access to technology to appropriately train CT students.

ProductivityThe majority of laboratories (59/67 [88%]) reported gynecologic screening rates of less than 50 to 69 slides per day. It is interesting that half of the laboratories using the TPIS reported screening pro-ductivity of fewer than 50 slides per day, while only 3 laboratories reported rates of 90 to 100 slides per day. The majority of laborato-ries with CTs evaluating nongyne-cologic cases reported screening volumes of fewer than 50 slides per day. Reported hourly screen-ing rates varied evenly across provided categories.

Table 1 shows the number of laboratories in which employed CTs participate in additional responsibilities beyond micro-scopic screening. Not surprisingly, CTs participate in quality control and quality assurance activities in 85% of all responding laboratories

(57/67). In large medical center– and community hospital–based laboratories, smear preparation assistance (29/51 [57%]) and provision of specimen adequacy (27/51 [53%]) during FNAs were reported as additional CT respon-sibilities beyond screening. While all but 1 of the responding labo-ratories reported employment of cytopreparatory technicians, cytopreparation was noted as an additional responsibility for CTs across all facility types, but more notably in community- and hospi-tal/large medical center–based laboratories.

The survey also solicited informa-tion about how CT responsibilities have changed within the last 3 years beyond traditional responsi-bilities (Table 2). Use of laboratory information systems was reported by 20 laboratories of varying facility types. A few laboratories reported CT responsibilities con-sidered more histologic in nature. There was not enough information collected in this survey to discern whether CTs participating in these nontraditional activities had ad-ditional certification and licenses. However, it is likely that such per-sonnel have the necessary quali-


Table 1Number of Facilities Reporting CTs involved in Traditional Responsibilities

Type of facility Cytopreparation OA/OC FNA-Assist in FNA Assist-Provide slide preparation specimen adequacy

Hospital/large medical center (n=29) 14 22 17 17

Community hospitals (n=22) 15 20 12 10

Large commercial reference laboratory (n=2) 1 2 1 1

Private laboratory (n=11) 2 10 2 3

College/University (n=2) 2 2 1 1

Public health laboratory (n=1) 1 1 1 0

continued on page 10


fications, as NYS requires licensure of laboratory technologists, tech-nicians and cytotechnologists.

Immunohistochemical analysis, preparation or evaluation, was reported as an additional CT re-sponsibility by 4 laboratories. Five laboratories reported the involve-ment of CTs in molecular testing—Digene (Gaithersburg, MD) Hybrid Capture (n = 3), Cervista (Hologic, Bedford, MA; n = 1), BenchMark (Ventana, Tucson, AZ) analysis and interpretation only (n = 1). Three laboratories reported the involve-ment of CTs in FISH—UroVysion (Abbott Molecular, Abbott Park, IL; n = 2), epidermal growth factor receptor (EGFR; n = 1), and HER2-neu (n = 1) testing. One laboratory reported the possibility of adding HPV-Cervista testing in the future with histotechnologists and CTs likely to share test responsibilities. CTs involved in molecular diagnos-tics were trained on-the job by the employer (n = 4) or by the vendor (n = 2); 2 laboratories reported CTs as being trained in a cytology training program.

Change in Scope of PracticeWhile the majority of respondents to this survey (45%) did not think the CT’s scope of practice would expand in the near future or were unsure (39%), 16% of laboratories reported that CT responsibilities would expand and include mo-lecular testing. While NYS licensure laws do not specifically exclude CTs from performing molecular testing, laboratories performing HPV testing are required to hold a certificate of qualification in the area of virology from the NYS De-partment of Health. Licensure laws and regulations in other states may have a significant role in re-stricting the future scope of prac-tice for CTs. Recently, however, the California and Florida Depart-ment of Health initiated a review of CT scope of practice and licen-sure regulations, recognizing that industry supports expansion of the CT scope of practice to include microscopic evaluation of mor-phologic changes identified by molecular pathology techniques.

CT Vacancies and Hiring PracticesOf 67 laboratories, 36 (54%) have hired CTs within the last 3 years. One third of responding labora-tories reported plans to hire 1 or 2 CTs within the next 3 years ow-ing to retirement of existing staff (25/46 [54%]) or to meet an antici-pated increase in the laboratory workload (18/46 [39%]). Only 3 laboratories reported the inten-tion to hire CTs with an enhanced scope of practice. The CTs hired within the last 3 years represent a balance between experienced CTs (18/44 [41%]) and new gradu-ates (26/44 [59%]). The majority of new graduates were trained in-state (19/26 [73%]) versus out-of-state (7/26 [27%]). Half of the new graduates acquired their NYS licenses before employment, while the remaining graduates obtained licenses after starting their employment. Direct contact with NYS training programs (23/41 [56%]) and word of mouth among local CT professionals (24/48 [50%]) were reported as the most useful recruiting strategies. Vacan-cies were reportedly filled within 3 months in the majority of hiring laboratories (31/47 [66%]).

According to the 2008 ASCP sur-vey, the overall national vacancy rate (hospitals and private clinic/reference laboratories) for staff level CTs is estimated to be 4.8%. Vacancy rates for staff CTs seem to be higher in private clinic/refer-ence laboratories (7.3%) and large hospitals (6.9%).9 These findings are consistent with the findings of this study; about 50% of hospital/large medical center and private laboratories reported that they plan to hire 1 or 2 CTs within the next 3 years; the major reasons for hiring include retirement of existing staff and increase in laboratory


continued on page 11

Table 2Number of Facilities Reporting CTs involved in Non-Traditional Responsibilities

Type of facility Grossing Histology Immunohistochemistry Laboratory Molecular tissue activities (preparation or Information Testing* preliminary evaluation) Systems

Hospital/large medical center (n=29) 0 1 2 8 2

Community hospitals (n=22) 1 4 2 7 1

Large commercial reference laboratory (n=2) 0 1 0 1 0

Private laboratory (n=11) 0 0 0 3 2

College/University (n=2) 0 0 0 0 0

Public health laboratory (n=1) 0 0 0 1 0

*Types reported include human papillomavirus DNA testing (Digene Hybrid Capture, Digene, Gaithersburg, MD; Cervista, Hologic, Bedford, MA; and BenchMark, Ventana,Tucson, AZ) and fluorescence in situ hybridization (UroVysion, Abbott Molecular, Abbott Park, IL; EGFR [epidermal growth factor receptor], and HER2-neu).


workload. This is not consistent with decreased CT demand as report-ed by Roberson and Eltoum.4

ConclusionSurvey data suggests that the cur-rent CT scope of practice is not likely to change significantly in the immediate future within respond-ing NYS laboratories. Impending retirement of an aging workforce is anticipated. While a decrease in the gynecologic test volume is more significant in large hospital/medical center–based laborato-ries, 26% of all participating labo-ratories report gynecologic test volume increases. Nongyneco-logic volume is growing primarily in hospital/large medical centers and private laboratories, while the most significant FNA volume increase was reported by large medical center based–laborato-ries. This finding indicates a need for continuation and strengthen-ing of current curricular content within cytotechnology training programs to adequately train CTs for current cytology practice.

In addition, few laboratories report the gradual adoption of molecular testing in their laborato-ries. While this study showed these laboratories to be in the minority, the direction of laboratory test-ing is consistent with pathology practice reported nationwide. There is growing evidence that CTs in NYS are involved in this prac-tice, although the number is small. It would be advantageous for training programs to prepare CT graduates in the area of molecu-lar testing.

Because 30% of NYS laboratories report a continued demand for CTs in the next 1 or 2 years, the 2 remaining programs serve as valuable key staffing resources for CTs in NYS. The continued viability of these programs is essential to provide the necessary staff for NYS laboratories for cytopathol-ogy practice, including molecular pathology.

References1. ASC Multidisciplinary Steering Com-

mittee on the Future of Cytopathol-ogy . Facing the future of cytopa-thology: discerning the future needs of our profession. Wilmington, DE: American Society of Cytopathology; 2010. http:// www.cytopathology.org/website/download.asp?id=3467. Accessed November 30, 2010.

2. Goulart RA. Cytotechnologists today: much more than “pap-ologists” with schools in need of our support. Am J Clin Pathol. 2008;129:523-524.

3. Young NA, Greening SE, Gupta P, et al. The declining Pap test: an omen of extinction or an opportunity for reform? Acta Cytol. 2008;52:277-278.

4. Roberson J, Eltoum IA. Cytotechnol-ogy labor market: an update. Am J Clin Pathol. 2010;134:820-825.

5. Austin RM. Dismantling of the U.S. cytotechnology educational infra-structure is premature and carries significant risks. Arch Pathol Lab Med. 2008;132:154-158.

6. Eltoum IA, Roberson J. Impact of HPV testing, HPV vaccine development, and changing screening frequency on national Pap test volume: pro-jections from the National Health Interview Survey (NHIS). Cancer. 2007;111:34-40.

7. Eltoum IA, Roberson J. Impact of ex-pected changes in national papani-colaou test volume on the cytotech-nology labor market: an impending crisis. Am J Clin Pathol. 2007;128:665-670.

8. Riding M, Savaloja L. 2009 Cytotech-nology Wage and Vacancy Survey; 2010:1-7.

9. Bennett A, Thompson AA, Holladay EB, et al. ASCP wage and vacancy survey of US medical laboratories. Lab Med.2009;40:133-141.

10. Savaloja L, Wendel A. 2008 Cytotech-nology Wage and Vacancy Survey; 2009:1-7.

11.Austin RM, Benstein B, Bentz J, et al. Market survey predictions on the future of US Pap testing. Cytojour-nal. 2009;6:17. doi:10.4103/1742-6413.55885.

12. Ronco G, Giorgi-Rossi P, Carozzi F, et al. Efficacy of human papillomavirus testing for the detection of inva-sive cervical cancers and cervical intraepithelial neoplasia: a random-ized controlled trial. Lancet Oncol. 2010;11:249-257.

13. Wright TC, Massad S, Duntun CJ, et al. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gyne-col.2007;197:346-355.

14. Noller KL, Bettes B, Zinberg S, et al. Cervical cytology screening practic-es among obstetrician-gynecologists. Obstet Gynecol. 2003;102:259-265.

15. Saint M, Gildengorin G, Sawaya GF. Current cervical neoplasia screening practices of obstetrician/gynecolo-gists in the US. Am J Obstet Gynecol. 2005;192:414-421.

16. Holladay EB. The Future of Cytotech-nology: A Peek Behind the Curtain. ASC 56th Annual Scientific Meeting. Orlando: ASC; 2008.

17. Facik M. Transformation in the Cytopathology Laboratory at the University of Rochester Medical Center. American Society of Cytopa-thology Bulletin. September 2010;XL-VII:126-128.

18. Holladay EB. Patterns and Trends in Cytology. Available at: http://www.cytopathology.org/website/static-download.asp?id=2975. Accessed November 30, 2010.


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the Voice - American Society for Cytotechnology · 2011-09-29 · Volume IX – Issue 5 Editorial Deadline: August 2, 2011 Available: mid-September Volume IX – Issue 6 Editorial