Welcome to MSH!

Tri-State has Gone Green!

In an effort to be more green we have decided not to print handouts again this year. If you would like a copy of the presentation prior to the event, please see the linked documents below. You are more than welcome to print a copy and bring it with you to the presentation.

Wednesday, May 16th

3:00-4:00 Chromogenic Multiplex Immuno-Staining: A Clinically Useful Procedure That Hasn’t “Caught On” and Why  

Joseph D. (Joe) Myers, MS, CT(ASCP)QIHCcm **Sponsored by Biocare

This workshop is intended to provide participants with a comprehensive overview of chromogenic multi-antigen (‘Multiplex’) immuno-staining procedures and will address issues of procedural design, commercially available reagents, and performance on automated slide-staining systems. Handout material, including schematic diagrams, sample protocols, reference tables and cost-analysis/comparison spreadsheets will be provided.

3:00-4:30 The Role of Histopathology in the Translation Study of Gene Therapy for Congenital Muscle Disease

Hui Meng, PhD, HTL(ASCP)

Duchenne Muscular Dystrophy and Myotubular Myopathy are congenital muscle disease due to mutations in genes that are necessary for muscle structure and function. Both diseases have characteristic pathological manifestation and reliable animal disease models.  In recent years, AAV-mediated gene replacement for these diseases has rapidly transferred from basic research to clinical studies and trials. Histopathology study on muscle specimens from animal model and human plays a very important role for evaluating the efficacy of the gene therapy. This presentation mainly focuses on how histopathological techniques help the translation from animal studies to clinical trials of gene therapy.

4:14-5:15 Chromogenic In Situ Hybridization Procedures

Joseph D. (Joe) Myers, MS, CT(ASCP)QIHCcm **Sponsored by Biocare

This presentation is intended to provide a comprehensive review of chromogenic in situ hybridization (ISH) procedures, from primarily a technical standpoint. Particular emphasis will be placed on the notable similarities and differences between ISH and immunohistochemistry (IHC). Performance of these procedures on automated slide-staining procedures will also be discussed. Participants are encouraged to participate in a ‘question-and-answer’ session at the conclusion of the presentation, as a means of soliciting different opinions and personal preferences. Handout material, including comparison tables, ‘flow-diagrams’ and sample protocols will be provided.

5:00-6:30 Paraffin: What Histologists Need to Know and Understand for Histological Success

Debbie Siena HT (ASCP) QIHC and Gary Wiederhold BS, HTL **Sponsored by StatLab Medical Products

Paraffin infiltration and embedding are essential functions in the everyday activities of the histology laboratory.  The quality and consistent formulation of the paraffin is essential to achieve optimal tissue processing and sectioning of tissue specimens.  There are many types of base paraffin used in the industry and just as many, if not more, additives and polymers that give paraffin its unique and distinguishable features.  Such features allow for thin tissue sectioning and efficient paraffin infiltration during the tissue preparation process.  This workshop will discuss and cover all of the physical and chemical properties of a wide range of paraffin products and their relationship to expected results.  Group discussion and troubleshooting will be included as well as some historic perspectives.  The audience is encouraged to participate and bring their questions and discussion topics involving paraffin observations for the group to discuss.

5:30-6:30 Troubleshooting Immuno-staining Procedures

Joseph D. (Joe) Myers, MS, CT(ASCP)QIHCcm **Sponsored by Biocare

This presentation is intended to provide a comprehensive review of the one of most important issues in the field of immuno-cyto-histo-chemistry – which is only possible when one possesses a thorough understanding of the underlying scientific principles. The primary topics of this seminar include reagent manufacturer’s validation and quality control efforts, proper preparation of antibody solutions, creation/selection of positive and negative control material, pretreatments to improve antigen ‘exposure’ and ‘block’ endogenous enzyme and/or endogenous immunoglobulins, proper selection of detection reagents, and automated staining system performance issues. One of the key concepts that will be discussed is the need, at all times, to take systematic approach to troubleshooting – meaning that potentially problematic variables within a given staining protocol should be eliminated through careful scientific evaluation, not haphazard experimentation. Handout material, including algorithms, flow diagrams, and ‘question & answer’ tables will be provided.

Thursday, May 17th


Part 1: Evaluating Minimally Invasive Cervical Biopsy samples for Cervical Cancer Precursor Lesions 

Juan C. Felix, MD **Sponsored by Newcomer Supply

Minimally invasive biopsies of the cervix are becoming more widely accepted and are being more widely obtained by gynecologists and nurse practitioners. The method is quite simple. Disposable devices that have either stiff bristles or a Velcro-like fabric are gently pressed against the area of the cervix that is targeted for sampling and then rubbed firmly. The design of the device is such that it obtains trans epithelial fragments of cervical tissue for examination. Studies have shown that the biopsies obtained using these devices are diagnostically equivalent to conventional forceps biopsies but have the advantage of being relatively painless to the patient and not causing significant bleeding. Although the techniques for processing the sample are not difficult, they are novel and would be an excellent addition to a Histotechnologists armamentarium of skills.

Part 2: Human Papillomavirus (HPV): The Story of a Disease

Juan C. Felix, MD **Sponsored by Newcomer Supply

This lecture traces the history of discovery of Human Papillomavirus (HPV) induced diseases from the first accounts in antiquity until the present day. Through the lecture the participant will discover how physicians first identified the diseases caused by HPV and through the generations made the associations and discoveries to uncover their cause. From antiquity to modern time, discoveries will be highlighted as the true nature and mechanisms of HPV are elucidated. The sequence of events from discovery of the virus to its detection to its eventual prevention will be highlighted.

1:00-2:30 Intro to Transmission Electron Microscopy (TEM)

Robert Goodwin, BS

The journey of a muscle biopsy.

1:00-2:30 Chemistry of Buffers in the Histology Laboratory

Jason A. Ramos, PhD **Sponsored by Biocare

As every histotech knows, the accuracy and consistency of your clinical results depends upon the quality   and reliability of your reagents. Most reagent solutions are based on a buffer system, which is a critical feature in providing consistent and accurate results. This workshop will provide a thorough understanding of buffer systems, including why buffers are an important component of histology reagents and how buffers work to control pH, as well as an understanding of “buffer capacity.” Principles for selecting an appropriate buffer and methods to prepare a custom buffer solution will be discussed. The proper methods for measuring pH and its limitations, and tricks for adjusting pH, will be described. A summary of the properties and features of the most common histology buffer systems will be provided, focusing on the role of buffers in antibody diluents, retrieval solutions, detection systems, chromogens and wash buffers. The workshop will include numerous examples and real-world problems, laboratory math, as well as a handy reference guide for future use.

1:00-2:30 The Wonderful World of Nucleic Acids 

Valerie Salato, MS, and Barbara Wimpee, MS

This presentation dives into the history of nucleic acid discovery and development of RNA and DNA experimental technologies.  Who would have predicted that the discoveries made decades ago by cell biologists and then coupled by information revealed by physical chemists at that time would result in figuring out the huge puzzle of life?  The discoveries of DNA and RNA structures and functions have led to revealing the secrets of heredity, cellular processes, and disease.  In present day histology, researching these molecules can give answers to what pathways are involved in disease and this knowledge can lead to the discoveries of new medicines.  In the second half of the presentation, we will talk about common molecular biology techniques which utilize nucleic acids from tissue samples.  The initial step for any experiment requiring RNA or DNA from tissue samples is proper tissue procurement.  We will discuss methods for preserving the integrity of nucleic acids from tissue samples, extraction methods for RNA and DNA, and quality assessment of extracted materials.  Next, we will talk about different downstream methods, mainly polymerase chain reaction (PCR), for analysis of extracted nucleic acids.  We will then walk you through the design and execution of a typical molecular biology experiment.

3:00-4:30 Histology Laboratory Hazards and Safety

Tami A. Maier, PhD, RBP

Do you know the hazards present in your laboratory? It is very important that staff know and understand the risks associated with their work. Based on a risk assessment, the proper work practices need to be implemented. Hazardous materials should be eliminated or replaced with an alternative whenever possible. Inherent hazards need to be controlled by using engineering controls that isolate the worker from the hazard, through work practices and/or by using personal protective equipment (PPE). Work in a histology lab requires attention to hazards such as chemicals, biologicals, sharps, ergonomics and many others. Behavioral safety is an essential element that results in the control of hazards. Only YOU can prevent injuries in a histology laboratory!

3:00-4:30 Introduction to Immunohistochemistry

Robert A. Brunner, BA, HT (ASCP) **Sponsored by Leica Biosystems

Immunohistochemistry has come a long ways since its inception.   With advancements in technology the quality and consistency of the results have been vastly improved.   Most labs are now performing IHC on site, but, sometimes there is a lack of knowledge needed by the histology staff to perform the technical portions of the procedure in a competent and confident manner. This session will cover the introduction to Immunohistochemistry.  There will be a review of Cell structure and immunology in preparation to discuss antibodies and detection systems.  Other topics covered will be pre-analytical issues and epitope recovery. Participants will learn how IHC is used by the Pathologist to render a diagnosis.  There will be an introduction to some common staining patterns seen with IHC.

3:00-4:30 IHC Troubleshooting: When Things Go Wrong

Jason A. Ramos, PhD **Sponsored by Biocare

This troubleshooting overview is designed to ensure all students have a concrete understanding of the basic tenets of IHC, how commercial IHC reagents are used, and the implications of that knowledge on work in an IHC laboratory. Typical technical support scenarios will be discussed, so the participants may better appreciate the importance of each of the individual steps in the IHC protocol. The focus on IHC troubleshooting will allow the participants to understand where procedures go awry, how to identify a problem, and how to systematically go about correcting issues. All of the topics covered will be tied back to the IHC laboratory to improve basic knowledge and IHC skills.

Friday, May 18th

8:00-10:00 The Use of Large format Cassettes in the Routine Diagnosis of Clinical Specimens

Neil Haine, Ph.D, BSc., (Hons) and Phil Bryant, PhD, MRSB, CBiol, CSci, FIBMS **Sponsored by Cell Path

In Europe and the United Kingdom, the application of large format histology in routine clinical diagnosis is well established. In North America however, large tissue specimens such as bowel, breast and prostate are sliced in the grossing room and usually processed in multiple smaller, conventional-sized tissue cassettes. Consequently at microscopy, the whole specimen needs to be pieced together like a jigsaw since the stained sections are presented over many slides. The use of large format cassettes alleviates this problem by aiding diagnosis and turnaround times through improvement in visibility as the entire tissue sample can often be viewed on a single slide. This is particularly important in cancer diagnostics since in the early stages, tumor development is often so involved that conventional histology sampling is seldom sufficient to document its complexity. Easily adapted to the needs of the routine diagnostic laboratory, large format histology has become the established method for not only assessing tumor characteristics such as size, extent and distribution but also for identifying the involvement of surgical margins. The large format technique can be adopted for all tissue types and tumors and the production of digitalized whole slide images is also possible using available scanners. Large format histology has proven to be a cost effective method that is able to meet the needs of the modern histology laboratory, particularly in the multidisciplinary approach to cancer diagnosis.

8:00-10:00 From Dream to Reality: Building a Fine Needle Aspiration (FNA) Service

Lauren N. Parsons MD and Nicole Anne Leon, BS, HTL(ASCP)

In most hospital laboratories, Fine Needle Aspiration procedures and their associated specimens are performed, prepared, and interpreted by the Cytology department-specifically cytotechnologists and cytopathologists. But what happens when your Histology department is responsible for Cytology prep and you have no cytotechnologists? What happens when your Medical Director tells you in January that a Cytopathology Director has been hired and that you need to be ready to go-live with a new FNA service for patients on July 1st? This workshop will focus on how a dream of providing an FNA service in a pediatric facility becomes a reality in six short months. We will detail the process from idea to implementation and review all of the elements needed to provide an FNA service for patients focusing on billing, equipment, supplies, procedures, LIS systems, and associated CAP regulations. Additionally, we will share our successes and our challenges, as well as strategies for confronting these challenges. The workshop will conclude with real-life FNA cytology case studies with histologic correlation from our service.

8:00-10:00 The “S.M.A.R.T” Way – Efficient, Easy and Reduce Errors

Julie Trejo, BS, HT(ASCP)cm **Sponsored by LabStorage Systems

You want to do a good job but they are barking for a fast turnaround. Should I cut some corners to make it faster even if the cell morphology isn't up to par? Now I am cutting corners every day and they still want it faster. What do I do? Who hurts who? This can be understood as this can be a daily occurrence in a Pathology lab but it is always the patient that can get hurt. This can cost them more money, more time to wait for a diagnosis or more testing. How can I do my job well, for me and the patient and without taking too long for the pathologist? Emphasizing doing a job correctly rather than quickly. Once this has been established, it becomes more efficient, reduces errors and improves the quality. It can improve its own turnaround time in the long run. Taking an extra minute up front can end up with less -re-processing, re-embed, re-cut and re-stain. Planning ahead can sidestep problems, be cost effective and opening up time for new ideas. Employee empowerment cancels the feeling as a factory worker. Every employee can become a better problem solver and decision maker.

10:30-12:00 Digital Pathology: Advantages of Having a Digital Workflow

Christopher Hospidales, BS, MS

This discussion is designed to highlight some points to think about when deciding to purchase a digital pathology system.  It is not as simple as plug and play.  The presentation will outline many of the considerations to take into account when looking at systems, from capacity and scanning speed to storage required.

10:30-12:00 Histology Hiring Hot Topics, Resume Writing, Histology Job Search, and Histology Staffing

Melissa F. Owens, BS, CHP **Sponsored by Allied Search Partners

10:30-12:00 Introduction to the MCW Tissue Bank Medical College of Wisconsin

Allia Nelson, CCRC

The Medical College of Wisconsin Tissue Bank is a collaboration resource to facilitate research. Learn about the functions of the bank, how we procure specimens and current ongoing studies. Ask questions about your potential research.

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