During the course of residency training in Pathology, both AP and AP/CP resident are required to rotate 2~4 weeks as a single bock or in 2 different blocks depending on the interest of each resident. Cancer cytogenetics is a busy service with roughly 3000 accessions per year, which include hematologic malignancies and solid tumors. The cytogenetics work up include G- (Giemsa) banding karyotype analysis and fluorescence in situ hybridization (FISH) using a variety of probes on various types of tissues, including formalin fixed paraffin-embedded tissue sections.
In this rotation, each resident is expected to familiarize with the application of
cytogenetic testing in diagnosis and management of cancer. Electronic evaluations are
performed by the Cytogenetics director immediately after the rotation for each resident to
assess the goals and objectives set by the cytogenetics laboratory.
The goals and objects for the Tumor Cytogenetics rotation linked to the core
competencies as defined by the ACGME are the following:
DIAGNOSTIC AND PATIENT CARE ACTIVITIES:
To understand the quality control measures in proper collection, preparation and
transportation of samples for cytogenetic analysis from peripheral blood, bone marrow, lymph
nodes, solid tumors, and other relevant tissues/fluids. Solving problems arising from these
issues and obtain all the clinical information needed for processing the specimens by
contacting the concerned clinicians and pathology attendings.
To understand the clinical and pathological indications to choose specific requirements of
handling each type of tumor tissue.
To familiarize with the laboratory procedures of culturing and preparing chromosomes from
each tissue type, G-banding and FISH procedures, microscopy and karyotyping.
To familiarize with International System for Human Cytogenetics Nomenclature (ISCN),
specifically how to write and interpret tumor karyotypes.
To familiarize how to analyze simple and complex karyotypes, and interpretation of the
To learn how to choose the type of FISH testing based on the clinical history and pathology
findings. Reading of FISH signals on the microscope and their interpretation. Understand the
sensitivity and specificity associated with each FISH probe in use and apply this knowledge in
interpretation of the results.
To be able to prepare tumor cytogenetics reports and write interpretation for the major types
of chromosome abnormalities encountered in cancer.
To familiarize with the cytogenetic changes associated with specific types of malignancies,
and their diagnostic and prognostic implications.
To understand the role of pathology findings and other molecular tests in relation to
cytogenetics results in arriving at appropriate diagnosis and management of the disease
MEDICAL KNOWLEDGE AND ITS APPLICATION:
Residents must demonstrate knowledge about the evolving developments in clinical and
biological (cytogenetic and molecular) areas in cancer and its application to the daily cancer
To review the literature on specific topics on cancer provided by the director in relation to
cytogenetic and other molecular genetic alterations.
To become familiar with database resources currently available on cancer genetics testing
and their application in daily use in diagnostic testing.
To review recent abnormal and interesting cases and understand how these cases
revealed important diagnostic and prognostic information.
To understand how the cytogenetic changes have revealed the molecular mechanisms of
tumorigenesis in specific types of tumors.
PRACTICE BASED LEARNING AND IMPROVEMENT:
To understand the regulatory requirements for quality assurance and quality control
limitations (CAP/New York State/American College of Medical Genetics), biological hazards
(JCAHO) in the cytogenetic laboratory.
To understand the appropriate laboratory practices that may have direct impact on quality
and turn around time of reporting.
To know the appropriate uses for special testing such as FISH, and to be aware of the costbenefit aspects of cytogenetic testing.
To know how to trouble-shoot problems arising from specimen submission, lack of clinical
information, or mislabeling.
To become familiar with the interactions between the cytogenetics laboratory, molecular
diagnostic laboratory, clinical/anatomic pathology services and the clinicians treating the
INTERPERSONAL AND COMMUNICATION SKILLS:
Residents are required to develop skills to effectively exchange the information related to
tumor cytogenetics in getting all the clinical details needed and provide results to the
To communicate with referring physicians regarding the information needed in performing
the appropriate tests.
To be able to communicate and discuss the cytogenetics results to physicians and other
related diagnostic services. Obtain information if any follow up testing is needed in specific
To review selected abnormal cases representative of interesting cytogenetic abnormalities
and discuss with the lab director.
To present abnormal cases and review the related literature in appropriate weekly interdivisional
To know how well to use the pathology laboratory and clinical information systems (e.g.,
COPATH, WebCIS) in gaining knowledge to interpret the cytogenetics findings.
To develop skills to communicate in a professional manner towards all laboratory personnel
and clinical staff.
To attend all laboratory and inter-laboratory meetings and complete assignments in a timely
To preserve patient confidentiality at all times, including presentations at conferences,
removing patient identifiers from teaching materials, proper discarding of documents, and
reporting results to outside clinicians/patients by following HIPPA regulations.
To be sensitive to the feelings of colleagues and other professionals.
SYSTEMS BASED PRACTICE:
To understand the limitations of cytogenetic analysis and the laboratory problems that may
interfere with timely diagnosis.
To know the appropriate use of diagnostic codes (ICD) and billing procedures (CPT) in
reporting the cytogenetics test results.
To be aware of testing requirements mandated (Federal and State] for each type of test
performed in the cytogenetics laboratory.
To be aware of the cost-benefit aspects of special tests, especially FISH testing.
To be familiar and practice the quality assurance issues in cytogenetics laboratory practice
mandated by the regulatory agencies (CAP, New York State and the American College of
Coordinator, Residency Training Program Department of
Pathology & Cell Biology Columbia University College of
Physicians & Surgeons
630 W. 168th Street
New York, NY 10032 Tel: 212 305-5697 e-Mail:firstname.lastname@example.org