Sabato 27 ottobre 2012 - Pacini Editore

244
Anatomia patologica e citopatologia:
distribuzione nazionale dei servizi, qualità del
referto citologico e ruolo della citoassistenza.
Osservatorio nazionale siapec sul contenzioso
L. Resta
Paper not received
Cytopathology: pathologist and
cytotechnologists traning in european union
and Italy
A. Fassina1 , L. Resta2 , L. Alessandrini1 , M. Tötsch3 1 Department of Medicine, Pathology & Cytopathology; University
of Padova, Italy; 2 Department of Emergency and Organ Transplantation,
Pathology & Cytopathology, University of Bari; 3 Institute of
Cytology, University Hospital Graz, Medical University of Graz, Austria
In Pathology, the traditional division between “surgical pathology”
and “cytology” led to attitudes and feelings, which
in the past caused debates and incomprehension among the
different actors of the same discipline. Recent advances in
cytology performance and new technology application to the
scant cytological material justify the new awareness for a
diverse approach to cytology 1 . Cytopathology is regarded as
integral part of pathology and well-trained pathologists must
be able to cover basic diagnosis in gynaecological and nongynaecological
cytology.
In 2010, the Editorial Advisory Board of the journal Cytopathology
carried out a survey of medical training in cytopathology,
aimed to explore the current situation in undergraduate
and postgraduate training in different European countries 2 .
The results demonstrated serious deficiencies in cytopathology
training, in manpower and resources, also in institutions with
otherwise adequate programmes. The main deficiencies were
the time variability of training, the lack of specifically trained
cytopathologists, the lack of training to a high level of competence
and the work overload and shortage of training facilities in
the centres with adequate schools and potentially good training
programmes. It was evident that training in cytopathology was
more likely to involve screening slides than gaining hands-on
experience with FNA and rapid on-site assessment and less than
a third of trainees gained sufficient experience to be allowed to
sign out reports. Moreover, another relevant point was that nonmedical
staff signed out negative cervical cytology according
to 48.1% of responses, particularly in large laboratories, while
rarely they signed out non-gynaecological cytology, except
for negative sputum and urine. In that survey conclusions, it
was clear that cytopathology training was overly dependent on
local centers of excellence and that training varied too much.
Cytopathology practice varies so much from country to country
in Europe that a common definition of cytotechnologists’ and
pathologists’ education and their role was mandatory 2 .
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
Sabato, 27 ottobre 2012
Sala Giotto – 08.30-10.30
Citologia 1
Il ruolo della citodiagnostica nell’attuale Sistema Sanitario nazionale
Moderatori: Paolo Dalla Palma (Trento), Ambrogio Fassina (Padova)
In 2011, in Split, delegates of the European Union of Medical
Specialists (EUMS) were invited from all over Europe to
discuss the harmonization of pathology in Europe, and they
considered gynaecological and non-gynaecological cytology
an integral part of the pathology common trunk, and that cytology
required a special and defined training, as a mandatory
obligation to guarantee standardized high quality cytology
diagnoses to patients and referring doctors. Cytopathology
is an integral part of Pathology and cannot be left to other
disciplines, and non-medical practitioners are not authorized
to sign out cytological diagnoses. It was finally concluded
that well-trained pathologists should be able to cover all the
‘fields’, ‘branches’ or ‘ramifications’ of cytopathology, in order
to avoid the dangerous situations where clinicians prepare
and read slides and smears themselves 3 .
In June 2012, in Paris, UEMS members voted and accepted
the Split conclusions with the obligation to set standards
for the pathology training, to allow young pathologists to
be trained and ⁄or work all over the European Union, and to
re-integrate disciplines such as neuropathology, dermatopathology
and cytopathology in pathology. This charter will
not provoke significant changes to cytology training in the
large part of European countries, where pathologists already
practice cytology, whereas few countries, such as Greece and
Croatia, where cytology is practiced as a separate discipline,
need time to re-assess their statutory profiles 4 .
In Italy, the cytopathology board of SIAPEC regularly gathered
and discussed the problems regarding work organization
and training, encouraging regional correspondents to intervene.
In particular, all over Italy one can find excellent courses
either in diagnostic or in molecular cytopathology, courses
for Residents in training (Accademia Nazionale di Medicina),
as well as International Tutorials (Trieste) and Congresses.
As an open question still remains the cytotechnologist position
in the present and future of Pathology departments. In
view of the training that Bio-Medical Techniques laureates
will undergo to play a new role to definitely assess sample
adequacy, disease characteristics, HPV and II-level cervical
cytology, FNA and molecular cytology, we all Pathologists,
Academics, and active Technicians along with the political
authorities, must re-think their formal and practical training
as well as their professional profiles.
references
1 Schmitt F, Vielh P, Zeppa P. Cytology for pathologists: two sides
of the same coin or different views of the same side? Cytopathology
2012;23:345-6.
2 Anshu HA, Cochand-Priollet B, et al. Survey of medical training in
cytopathology carried out by the journal Cytopathology. Cytopathology
2010;21:147-56.
3 Totsch M, Vass L, Fassina A. The UEMS training charter for pathology:
a common trunk and a challenge ahead for EFCS. Cytopathology
2011;22:349-51.
4 Tötsch M, Cuvelier C, Vass L, et al. On behalf of the participants of
the UEMS Section ⁄Board of Pathology meeting in Paris 2012. The
UEMS Section ⁄Board of Pathology, Chapter 6: Requirement for Rec-