How do cytopathologists learn fine needle aspiration techniques? An international survey.

INTRODUCTION: Fine needle aspiration cytology (FNAC) is a widely accepted diagnostic technique, but performance varies according to expertise. Little is known about variation in FNAC training practices worldwide. We surveyed pathologists using social media networks to determine FNAC training practices internationally. DESIGN: Pathologists were surveyed on questions related to FNAC simulation training using direct messaging on the Twitter and WhatsApp platforms. Survey responses over a period of 2 weeks were collected. RESULTS: In total, 149 pathologists participated (96.1% response rate). The respondents came from 24 countries and 87 institutions. The majority of the pathologists (63.8%) performed FNAC directly on patients for the first time. Only 36.2% of them had simulation instruction during their training. It was performed on food items such as fruit (64.8%), surgical specimens (37.0%), autopsies (13.0%) and others (9.3%), including commercially available phantom simulators for ultrasound-guided FNAC (US-FNAC) (two pathologists). DISCUSSION: Most pathologists did not receive formal training in a simulated environment, and of the pathologists who had simulation instruction, food items were commonly used for education. A few participants used a commercial US-FNAC simulator, but since most pathologists perform FNAC by palpation, this method of simulation training is not applicable to many practices. Social media is an effective and efficient way to perform survey research, yielding a very high response rate.

Chronic follicular pancreatitis: a space occupying lesion with spontaneous resolution.

Follicular pancreatitis (FP) is an extremely odd entity characterized by the presence of a pseudotumor that histologically presents lymphoid aggregates and germinal centers. The authors present the case of a 67-year-old woman with epigastric pain and jaundice. Endoscopic ultrasonography (EUS) was performed, revealing a 14x15 mm hypoechoic area with irregular edges in the head of the pancreas. The in situ cytological study showed polymorphic lymphoid cellularity, without atypia suggesting neoplasia. The cell block and the immunohistochemical study showed a polyclonal population with a pattern suggestive of FP. The patient presented spontaneous clinical improvement. The EUS follow up three months later shown pancreatic parenchyma with homogeneous echogenicity and no space occupying lesions were indentified. Since the diagnosis of FP has been reached after surgery in most cases, the treatment is not well established. However, no recurrences have been reported after surgery and spontaneous resolution has been observed in incomplete resections, which suggests the indication for conservative management. Diagnostic EUS has a fundamental role in the differential diagnosis between FP and pancreatic neoplasms, two entities with very different prognosis, and makes it possible to avoid, in the case of FP, unnecessary surgeries with the associated morbidity and mortality.

The utility of a gross dissection anatomical model for simulation-based learning in pathology.

INTRODUCTION: The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators. METHODS: Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3). RESULTS: The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1-5) (range 3.4-4.7, σ0.89). The categories 'knowledge of resection margins' and 'macroscopic diagnosis' received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by 'understanding of handling and gross examination of the surgical specimen' (4.5, σ0.49), 'prognosis' (4.3, σ0.67) and 'understanding of a tumor resection' (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15'39″ (σ2'12″), 16'50″ (σ3'45″), and 17'52″ (σ2'12″), respectively (p<0.05). Gross dissection marks (0-5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8). CONCLUSIONS: This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.

The utility of a gross dissection anatomical model for simulation-based learning in pathology

Introduction: The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators. Methods: Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3). Results: The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1–5) (range 3.4–4.7, σ0.89). The categories ‘knowledge of resection margins’ and ‘macroscopic diagnosis’ received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by ‘understanding of handling and gross examination of the surgical specimen’ (4.5, σ0.49), ‘prognosis’ (4.3, σ0.67) and ‘understanding of a tumor resection’ (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15′39″ (σ2′12″), 16′50″ (σ3′45″), and 17′52″ (σ2′12″), respectively (p<0.05). Gross dissection marks (0–5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8). Conclusions: This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.(AU)

Introducción: En Anatomía Patológica el examen macroscópico y la disección resultan fundamentales para alcanzar un diagnóstico correcto. Los métodos tradicionales de enseñanza de esta habilidad presentan limitaciones, como el riesgo de enfermedad transmisible, la exposición al formol y la disponibilidad de especímenes. Describimos aquí un método de enseñanza en disección utilizando simuladores anatómicos. Material y métodos: Se usaron modelos anatómicos neoplásicos artesanales que utilizan silicona líquida. Ochenta y cinco estudiantes de medicina participaron en una experiencia de examen macroscópico y disección y cumplimentaron un cuestionario sobre su percepción de aprendizaje adquirido. Además, se organizó un taller para comparar 3 metodologías distintas: imágenes estáticas (Grupo 1), vídeo (Grupo 2) y observación directa de un patólogo tallando (Grupo 3). Resultados: El cuestionario de conocimientos adquiridos mostró una valoración media de 4,4 sobre 5 (1-5) (rango 3,4-4,7, σ=0,89). Las categorías de «conocimiento sobre márgenes quirúrgicos» y «diagnóstico macroscópico» obtuvieron las mejores valoraciones (4,8, σ=0,11 y 4,7, σ=0,32, respectivamente), seguidas del «manejo de una pieza quirúrgica y su disección» (4,5, σ=0,49), el «pronóstico» (4,3, σ=0,67) y la «comprensión de una cirugía tumoral» (3,9, σ=0,96) (p<0,05). En relación con el método de enseñanza, el Grupo 3 realizó la disección en menos tiempo que el Grupo 2 y el Grupo 1, con unos tiempos medios de 15′39″ (σ=2′12″), 16′50″ (σ=3′45″), y 17′52″ (σ=2′12″), respectivamente (p<0,05). Por otra parte, se encontraron resultados estadísticamente significativos en función de la metodología utilizada (0-5) (p<0,05). El Grupo 2 obtuvo mejores resultados (3,7; σ=0,54) comparado con el Grupo 3 (3,4; σ=0,94) y el Grupo 1 (3,1; σ=0,8). Conclusiones: Este estudio preliminar demuestra que es posible implementar un módulo de simulación en disección en el Grado en Medicina, permitiendo esta metodología adquirir la habilidad en un entorno seguro.(AU)

Comparison of muscle activity while using different input devices in digital pathology.

INTRODUCTION: The high prevalence of musculoskeletal disorders in pathologists, together with the current trend towards the digitization of pathology, prompted us to study the different types of input devices employed during the revision of whole slide images, in order to investigate the pattern and extent of muscle activity involved in their use. MATERIAL AND METHODS: A comparative study was made of 10 input devices (conventional and vertical mouse, three trackballs, the Ergopointer™, the Rollermouse™, an optical pen mouse, a touchpad, and the Leap Motion™). Six medical students performed a standardized circuit using a Fitts' Law based tissue array, digitized. The electrical activity of seven upper limb muscles (adductor pollicis, extensor pollicis longus, extensor digitorum, flexor digitorum, middle deltoid, upper trapezius, and middle trapezius) was measured using surface electromyography. RESULTS: Statistically significant differences in the overall electrical activity among the different input devices, both absolute values in mV as well as normalized values to the upper limb at rest, were observed (p<0.001); the Rollermouse™ (0.1027mV; 139%), Logitech M570 trackball (0.1053mV; 145%), Ergopointer™ (0.1151mV; 167%), conventional mouse (0.1251mV; 191%), and vertical mouse (0.1312mV; 205%) required less activity, while the optical pen mouse (0.1717mV; 299%), Leap Motion™ (0.1803mV; 319%), Expert Mouse trackball (0.1845mV; 329%), EIGIIS trackball (0.2442mV; 468%) and the touchpad (0.2560mV; 496%) required greater muscle mobilization. CONCLUSION: We designed a system based on Fitts' Law to compare input devices in digital pathology. Variability between compared devices and muscle activity was found. Long-term use could result in different muscular fatigue patterns. Even though the selection of an input device is a matter of personal preference, its impact on ergonomics should be considered.

COVID-19 pandemic impact on cytopathology practice in the post-lockdown period: An international, multicenter study.

BACKGROUND: In a previous worldwide survey, the authors showed a drastic reduction in the number of cytological specimens processed during the coronavirus disease 2019 "lockdown" period along with an increase in malignancy rates. To assess the continued impact of the pandemic on cytological practices around the world, they undertook a second follow-up worldwide survey collecting data from the post-lockdown period (2020). METHODS: Participants were asked to provide data regarding their cytopathology activity during the first 12 weeks of their respective national post-lockdown period (2020), which ranged from April 4 to October 31. Differences between the post-lockdown period and the corresponding 2019 period were evaluated, and the authors specifically focused on rates of malignant diagnoses. RESULTS: A total of 29 respondents from 17 countries worldwide joined the survey. Overall, a lower number of cytological specimens (n = 236,352) were processed in comparison with the same period in 2019 (n = 321,466) for a relative reduction of 26.5%. The overall malignancy rate showed a statistically significant increase (12,442 [5.26%] vs 12,882 [4.01%]; P < .001) during the same time period. Similar results were obtained if both malignancy and suspicious for malignancy rates were considered together (15,759 [6.58%] vs 16,011 [4.98%]; P < .001). CONCLUSIONS: The data showed a persistent reduction in the cytological specimen volume during the post-lockdown period (2020). However, the relative increase in the cytological workload in the late part of the post-lockdown is a promising finding of a slow return to normality.

Comparison of muscle activity while using different input devices in digital pathology

Introduction: The high prevalence of musculoskeletal disorders in pathologists, together with the current trend towards the digitization of pathology, prompted us to study the different types of input devices employed during the revision of whole slide images, in order to investigate the pattern and extent of muscle activity involved in their use. Material and methods: A comparative study was made of 10 input devices (conventional and vertical mouse, three trackballs, the Ergopointer™, the Rollermouse™, an optical pen mouse, a touchpad, and the Leap Motion™). Six medical students performed a standardized circuit using a Fitts’ Law based tissue array, digitized. The electrical activity of seven upper limb muscles (adductor pollicis, extensor pollicis longus, extensor digitorum, flexor digitorum, middle deltoid, upper trapezius, and middle trapezius) was measured using surface electromyography. Results: Statistically significant differences in the overall electrical activity among the different input devices, both absolute values in mV as well as normalized values to the upper limb at rest, were observed (p<0.001); the Rollermouse™ (0.1027mV; 139%), Logitech M570 trackball (0.1053mV; 145%), Ergopointer™ (0.1151mV; 167%), conventional mouse (0.1251mV; 191%), and vertical mouse (0.1312mV; 205%) required less activity, while the optical pen mouse (0.1717mV; 299%), Leap Motion™ (0.1803mV; 319%), Expert Mouse trackball (0.1845mV; 329%), EIGIIS trackball (0.2442mV; 468%) and the touchpad (0.2560mV; 496%) required greater muscle mobilization. Conclusion: We designed a system based on Fitts’ Law to compare input devices in digital pathology. Variability between compared devices and muscle activity was found. Long-term use could result in different muscular fatigue patterns. Even though the selection of an input device is a matter of personal preference, its impact on ergonomics should be considered.(AU)

Introducción y objetivos: La alta prevalencia de trastornos musculoesqueléticos entre patólogos y el cambio hacia la digitalización de la Anatomía Patológica, nos ha hecho plantear un estudio comparativo de dispositivos de entrada al manejar preparaciones histológicas digitalizadas, evaluando el patrón y la actividad muscular durante su uso. Material y métodos: se realizó una comparación entre 10 dispositivos: ratón convencional y vertical, 3 trackballs, Ergopointer™, Rollermouse™, lápiz óptico, touchpad, Leap Motion™. Seis estudiantes de medicina realizaron un circuito estandarizado empleando una matriz tisular digitalizada, basada en la ley de Fitts. Se registró con electromiografía superficial la actividad eléctrica de 7 músculos del brazo dominante (aductor y extensor largo del pulgar, extensor y flexor común de los dedos, deltoides medio, y trapecios superior y medio). Resultados: se encontraron diferencias estadísticamente significativas en la actividad muscular, absoluta y relativizada (respecto al reposo), entre los dispositivos (p<0,001); Rollermouse™ (0,1027mV;139%), trackball Logitech M570 (0,1053mV/145%), Ergopointer™ (0,1151mV/167%), ratón convencional (0,1251mV/191%) y ratón vertical (0,1312mV/205%) fueron los que demandaron menor actividad, mientras que el lápiz óptico (0,1717mV/299%), Leap Motion™ (0,1803mV/319%), trackball Expert Mouse (0,1845mV/329%), trackball EIGIIS (0,2442mV/468%) y touchpad (0,2560mV/496%) fueron los que mayor movilización muscular requirieron. Conclusiones: Hemos diseñado un sistema basado en la ley de Fitts para comparar dispositivos de entrada. Se encontró variabilidad entre los dispositivos comparados y la actividad muscular demandada, lo que podría traducirse en diferentes patrones de fatiga muscular a largo plazo. Aunque la elección de un dispositivo es una cuestión de preferencia personal, es importante analizar su impacto desde el punto de vista ergonómico.(AU)

A rare cause of intra-abdominal cysts: pancreatic cystic lymphangiomas.

Echenique et al. described a lymphangioma as a rare cystic neoplasm of the pancreas. We present a similar intra-abdominal lesion diagnosed by endoscopic ultrasound (EUS)-fine-needle aspiration (FNA) cytology.

Head-tracking as an interface device for image control in digital pathology: a comparative study / Reconocimiento facial como interfaz de usuario para el manejo de la imagen en patología digital: un estudio comparativo

BACKGROUND: Inasmuch as the conventional mouse is not an ideal input device for digital pathology, the aim of this study was to evaluate alternative systems with the goal of identifying a natural user interface (NUI) for controlling whole slide images (WSI). DESIGN: Four pathologists evaluated three webcam-based, head-tracking mouse emulators: Enable Viacam (eViacam, CREA Software), Nouse (JLG Health Solutions Inc), and Camera Mouse (CM Solutions Inc). Twenty WSI dermatopathological cases were randomly selected and examined with Image Viewer (Ventana, AZ, USA). The NASA-TLX was used to rate the perceived workload of using these systems and time was recorded. In addition, a satisfaction survey was used. RESULTS: The mean total time needed for diagnosis with Camera Mouse, eViacam, and Nouse was 18'57", 19'37" and 22'32", respectively (57/59/68seconds per case, respectively). The NASA-TLX workload score, where lower scores are better, was 42.1 for eViacam, 53.3 for Nouse and 60.62 for Camera Mouse. This correlated with the pathologists' degree of satisfaction on a scale of 1-5: 3.4 for eViacam, 3 for Nouse, and 2 for Camera Mouse (p < 0.05). CONCLUSIONS: Head-tracking systems enable pathologists to control the computer cursor and virtual slides without their hands using only a webcam as an input device. - Of the three software solutions examined, eViacam seems to be the best of those evaluated in this study, followed by Nouse and, finally, Camera Mouse. - Further studies integrating other systems should be performed in conjunction with software developments to identify the ideal device for digital pathology

INTRODUCCIÓN: Considerando que el ratón convencional no es el controlador ideal en patología digital, el objetivo del estudio fue evaluar sistemas alternativos y tratar de identificar una interfaz natural de usuario para controlar preparaciones digitalizadas. MATERIAL Y MÉTODOS: Cuatro patólogos evaluaron tres emuladores de ratón con reconocimiento facial a través de webcam: eViacam, Nouse y Camera Mouse. Se seleccionaron 20 casos digitalizados de dermatopatología aleatoriamente para su diagnóstico, empleando el software Image Viewer (Ventana, AZ, USA). Se utilizó el sistema NASA-TLX para registrar la carga de trabajo percibida y se grabaron los tiempos. Adicionalmente, se empleó un cuestionario de satisfacción. RESULTADOS: El tiempo medio requerido para diagnosticar con Camera Mouse, eViacam y Nouse fue de 18'57", 19'37"y 22'32", respectivamente (57/59/68 segundos por caso, respectivamente). La carga de trabajo NASA-TLX, donde registros menores implican menor carga, fue de 42,1 para eViacam, 53,3 para Nouse y 60,62 para Camera Mouse, correlacionándose con el grado de satisfacción de los patólogos en una escala de 1-5: 3,4 para eViacam (3,4), Nouse (3) y Camera Mouse (2) (p < 0,05). CONCLUSIONES: El reconocimiento facial posibilita a los patólogos el control del cursor y las preparaciones virtuales sin utilizar las manos, empleando únicamente una webcam como dispositivo de entrada. - De los tres sistemas, eViacam es el mejor software evaluado en este estudio, seguido de Nouse y, finalmente, de Camera Mouse. - Deben ser desarrollados estudios adicionales, integrando otros sistemas, en conjunción con el desarrollo de software para alcanzar el sistema ideal en patología digital

Global impact of the COVID-19 pandemic on cytopathology practice: Results from an international survey of laboratories in 23 countries.

BACKGROUND: To the authors' knowledge, the impact of the coronavirus disease 2019 (COVID-19) pandemic on cytopathology practices worldwide has not been investigated formally. In the current study, data from 41 respondents from 23 countries were reported. METHODS: Data regarding the activity of each cytopathology laboratory during 4 weeks of COVID-19 lockdown were collected and compared with those obtained during the corresponding period in 2019. The overall number and percentage of exfoliative and fine-needle aspiration cytology samples from each anatomic site were recorded. Differences in the malignancy and suspicious rates between the 2 periods were analyzed using a meta-analytical approach. RESULTS: Overall, the sample volume was lower compared with 2019 (104,319 samples vs 190,225 samples), with an average volume reduction of 45.3% (range, 0.1%-98.0%). The percentage of samples from the cervicovaginal tract, thyroid, and anorectal region was significantly reduced (P < .05). Conversely, the percentage of samples from the urinary tract, serous cavities, breast, lymph nodes, respiratory tract, salivary glands, central nervous system, gastrointestinal tract, pancreas, liver, and biliary tract increased (P < .05). An overall increase of 5.56% (95% CI, 3.77%-7.35%) in the malignancy rate in nongynecological samples during the COVID-19 pandemic was observed. When the suspicious category was included, the overall increase was 6.95% (95% CI, 4.63%-9.27%). CONCLUSIONS: The COVID-19 pandemic resulted in a drastic reduction in the total number of cytology specimens regardless of anatomic site or specimen type. The rate of malignancy increased, reflecting the prioritization of patients with cancer who were considered to be at high risk. Prospective monitoring of the effect of delays in access to health services during the lockdown period is warranted.

Head-tracking as an interface device for image control in digital pathology: a comparative study.

BACKGROUND: Inasmuch as the conventional mouse is not an ideal input device for digital pathology, the aim of this study was to evaluate alternative systems with the goal of identifying a natural user interface (NUI) for controlling whole slide images (WSI). DESIGN: Four pathologists evaluated three webcam-based, head-tracking mouse emulators: Enable Viacam (eViacam, CREA Software), Nouse (JLG Health Solutions Inc), and Camera Mouse (CM Solutions Inc). Twenty WSI dermatopathological cases were randomly selected and examined with Image Viewer (Ventana, AZ, USA). The NASA-TLX was used to rate the perceived workload of using these systems and time was recorded. In addition, a satisfaction survey was used. RESULTS: The mean total time needed for diagnosis with Camera Mouse, eViacam, and Nouse was 18'57", 19'37" and 22'32", respectively (57/59/68seconds per case, respectively). The NASA-TLX workload score, where lower scores are better, was 42.1 for eViacam, 53.3 for Nouse and 60.62 for Camera Mouse. This correlated with the pathologists' degree of satisfaction on a scale of 1-5: 3.4 for eViacam, 3 for Nouse, and 2 for Camera Mouse (p<0.05). CONCLUSIONS: Head-tracking systems enable pathologists to control the computer cursor and virtual slides without their hands using only a webcam as an input device. - Of the three software solutions examined, eViacam seems to be the best of those evaluated in this study, followed by Nouse and, finally, Camera Mouse. - Further studies integrating other systems should be performed in conjunction with software developments to identify the ideal device for digital pathology.

Metástasis pancreática de carcinoma de células de Merkel: una rara neoplasia del páncreas / No disponible

No disponible

Pancreatic metastasis of Merkel-cell carcinoma: a rare neoplasm of the pancreas.

Only 2-3.9% of pancreatic malignancies represent metastases from other sites, the most common origins being the lungs, kidneys, and gastrointestinal tract. Differentiating between primary and secondary lesions may be challenging with imaging techniques but EUS-guided FNA is a safe, accurate procedure for obtaining a tissue diagnosis. We report the case of a 70-year-old male who, following satisfactory treatment for a Merkel-cell carcinoma in the right groin, presented with jaundice and an indurated, vascularized, adherent nodule on the right thigh. Endoscopic ultrasound identified a mass at the pancreatic head as well as a perilesional adenopathy with no evidence of vascular involvement. FNA revealed cell proliferation, which was immunohistochemically positive for CD56, synaptophysin, and chromogranin, these findings being consistent with poorly-differentiated neuroendocrine carcinoma. Given the patient's history we considered this lesion to be a pancreatic metastasis of Merkel-cell carcinoma, which represents a rare finding.

#FNAFriday: How cytopathologists learn, teach, and share knowledge on Twitter.

BACKGROUND: Twitter is an expanding social media network among cytopathologists to share knowledge. Tweets are made up of text which may also include images or video. All tweets labeled under a hashtag can be tracked. The #FNAFriday hashtag was created in 2015 by one of the authors (X.J.) to build a community of individuals, to educate and share interesting cases, and highlight a variety of diagnoses with FNA specimens. METHODS: We retrospectively extracted all tweets labeled with #FNAFriday from April 2015 to mid-February 2019 (47 mo) using the Twitter search engine. The data point included: author, number of figures, type of cytology-stain, use of immunocytochemistry, histochemistry or molecular techniques, and the subspeciality. The educational content was categorized as: live-tweeting, training activities, and publication references. The number if comments, retweets and likes was also recorded. RESULTS: A total of 349 original tweets using #FNAFriday were tracked with an average of 7.43 tweets/month. We describe the "top three" countries with most tweets, active users and subspecialties. The most frequent stain was Papanicolau and part of the content of the tweets was using cellblock (14.04%), histologic correlation (10.03%), immunocytochemistry (8.60%), molecular tests (2.01%), gross pictures (4.58%), and radiologic pictures (3.4%). CONCLUSION: The presence of cytopathologists on Twitter who want to share their cases has increased. The weekly FNAFriday label with other cytology hashtags is a specific keyword for those interested in the field.

A novel simulator model and standardized assessment tools for fine needle aspiration cytology training.

OBJECTIVES: Fine needle aspiration (FNA) is an invaluable diagnostic procedure for evaluation of lesions; however, acquisition of diagnostic material is dependent on the skill of the practitioner. We report a novel patient simulator for teaching the FNA procedure and structured assessment tools for educators and learners. METHODS: We created a novel simulator model for FNA training, employed a standardized teaching module, and assessed procedure utility in medical students. Groups of students completed training using a commercial version of the model, and underwent structured evaluation using an Objective Structured Assessment of Technical Skills (OSATS) form, and the Debriefing Assessment for Simulation in Healthcare (DASH) tool. RESULTS: In the initial phase, 178 students rated the training workshop between valuable and essential (4.2 on a 5-point Likert scale). In the second phase, for students evaluated with the OSATS form, the mean overall score was 33 out of 50 (range 26-43). The areas of weakness for the participants were: (a) compression after the FNA procedure, (b) completion of the informed consent, and (c) correct explanation of the procedure to the patient. For the group of students that completed the DASH questionnaire, the results were: 6.2 (assessment by students) and 6.7 (assessment by instructor) out of a maximum of 7. CONCLUSION: A realistic simulation model, in combination with a standardized training program with formal assessment methods is a valuable tool to teach FNA. We here describe a process for teaching the FNA procedure to interested educators and learners.

La Anatomía Patológica en las redes sociales. Campaña de reclutamiento / Pathology in social media networks. Recruitment campaign

Introducción. La Anatomía Patológica sigue siendo desconocida, no solo para el público en general, sino también para nuestros compañeros de profesión. El uso generalizado de las redes sociales permite difundir nuestra labor. Por ello, se planteó generar un grupo de trabajo. Material y métodos. Se emitió una convocatoria a los socios de la Sociedad Española de Anatomía Patológica a través de su Vocalía de Comunicación y Proyección Social titulada #IWantYouForSEAP, para conformar una red de trabajo en la red social Twitter. El periodo de reclutamiento fue de un mes (agosto del 2016). Se registró la actividad desarrollada durante el XXVIII Congreso de la SEAP-IAP de 2017 utilizando las herramientas analíticas Symplur y Tweet Binder. Resultados. Se recibieron 32 solicitudes (29 patólogos, 2 técnicos de Anatomía Patológica, un administrativo), con una distribución geográfica dentro del territorio español que incluyó a participantes de 14 de las 17 comunidades autónomas, perteneciendo a 22 ciudades y 25 centros distintos. La actividad en relación con el hashtag #SEAP2017V utilizado en el congreso incluyó a 685 participantes, 6.704 tweets y 8.837.435 impresiones; 28 de los 32 reclutados por la campaña #IWantYouForSEAP participaron, contribuyendo con 2.410 tweets y generando 2.090.423 impresiones (el 36 y el 24% del total, respectivamente). Conclusiones. Es posible promover y motivar el trabajo en grupo dentro de nuestra disciplina a través de las redes sociales. Se trata de una fase inicial, pero los resultados experimentados son alentadores y existen grandes expectativas por parte de los participantes. Un uso adecuado de las redes sociales podría acercar la figura del patólogo a la sociedad (AU)

Introduction. Pathology is a speciality that is often poorly understood, not only by the general public, but also by clinicians. However, the recent widespread use of social media provides an opportunity to increase the visibility and comprehension of our profession. A working group was formed to carry out this task. Material and methods. The members of the Spanish Society of Pathology were contacted through its Communication and Social Projection Subcommittee to engage in the campaign #IWantYouForSEAP, to form a network on Twitter. The recruitment period was one month (August, 2016). The resulting project, developed during the XXVIII Congress of the SEAP-IAP, was registered using the analytical tools Symplur and Tweet Binder. Results. 32 applications (29 pathologists, 2 histotechnicians, 1 administrative personnel) were received from all over Spain, including participants from 14 of the 17 Autonomous Regions, from 22 cities and 25 medical centres. The activity in relation to the hashtag #SEAP2017V used in the congress included 685 participants with 6704 tweets and 8,837,435 impressions. 28 of the 32 recruited by the #IWantYouForSEAP campaign participated, contributing with 2410 tweets, and generating 2,090,423 impressions (36% and 24% of the total, respectively). Conclusions. It is possible to promote and motivate teamwork within our discipline through social media networks. This preliminary experience of the use of social media networks in our scientific community has had encouraging results which have raised high expectations among participants. An appropriate use of social media networks could help to narrow the gap between pathologists and society (AU)

[Pathology in social media networks. Recruitment campaign]. / La Anatomía Patológica en las redes sociales. Campaña de reclutamiento.

INTRODUCTION: Pathology is a speciality that is often poorly understood, not only by the general public, but also by clinicians. However, the recent widespread use of social media provides an opportunity to increase the visibility and comprehension of our profession. A working group was formed to carry out this task. MATERIAL AND METHODS: The members of the Spanish Society of Pathology were contacted through its Communication and Social Projection Subcommittee to engage in the campaign #IWantYouForSEAP, to form a network on Twitter. The recruitment period was one month (August, 2016). The resulting project, developed during the XXVIII Congress of the SEAP-IAP, was registered using the analytical tools Symplur and Tweet Binder. RESULTS: 32 applications (29 pathologists, 2 histotechnicians, 1 administrative personnel) were received from all over Spain, including participants from 14 of the 17 Autonomous Regions, from 22 cities and 25 medical centres. The activity in relation to the hashtag #SEAP2017V used in the congress included 685 participants with 6704 tweets and 8,837,435 impressions. 28 of the 32 recruited by the #IWantYouForSEAP campaign participated, contributing with 2410 tweets, and generating 2,090,423 impressions (36% and 24% of the total, respectively). CONCLUSIONS: It is possible to promote and motivate teamwork within our discipline through social media networks. This preliminary experience of the use of social media networks in our scientific community has had encouraging results which have raised high expectations among participants. An appropriate use of social media networks could help to narrow the gap between pathologists and society.

Simulación médica en punción aspiración con aguja fina utilizando maniquíes. Experiencia docente universitaria / Medical simulation training in fine needle aspiration cytology using phantoms. University teaching experience

Introducción. La punción aspiración con aguja fina (PAAF) es un procedimiento diagnóstico mínimamente invasivo y extremadamente útil para tipificar lesiones. La limitación de medios en las prácticas de anatomía patológica ha dificultado su enseñanza. Describimos la incorporación de maniquíes diseñados para realizar PAAF en nuestro centro. Material y métodos. Los maniquíes consisten en 2 simuladores de tareas, artesanales y a tamaño natural, de las regiones facial/cervical (modelo de utilidad U201500372) y de torso, respectivamente, revestidos por silicona, simulando piel, con áreas tumorales. Permiten realizar PAAF (palpación, punción, aspiración, obtención de material y extensión sobre portaobjetos) y son reutilizables. La práctica se realizó durante 3 cursos académicos (2013-2016) y consistió en realizar PAAF de manera individualizada sobre contexto clínico, con ulterior correlación citológica. Resultados. Un total de 178 estudiantes de medicina de la Universidad de Murcia de tercer curso realizaron la práctica (28 grupos: 105 mujeres, 73 hombres). La tasa de acierto (punción, aspiración de material y extensión en portaobjetos) fue del 97,2% con la primera punción. Además, 13 estudiantes procedentes de otras 10 universidades (nacionales e internacionales) llevaron a cabo la práctica, refiriendo la no existencia en sus centros de procedencia. Fue considerada como de gran valor sobre encuesta anónima. Discusión. Las prácticas de PAAF son fácilmente implementables y potencialmente incorporables a los formatos evaluativos tipo examen clínico objetivo estructurado (ECOE). No existe una adecuada estandarización en las prácticas de diferentes centros universitarios. Las prácticas de PAAF mejoran la formación del estudiante y proporciona un mayor conocimiento y una mejor consideración de nuestra especialidad (AU)

Background. Fine needle aspiration cytology (FNAC) is a minimally invasive and extremely useful procedure. The characteristics of the practice of pathology, together with limited equipment, make teaching this technique difficult. We therefore have introduced phantoms designed to perform FNAC as part of the medical education programme in our hospital. Material and methods. Phantoms are two life-sized hand-made reproductions of an adult head & neck (utility model ES1140059) and a trunk, respectively, coated with silicone simulating skin and with inserted tumor areas. They allow the whole FNAC process (palpation, puncture, aspiration, placement of material on slide and smear preparation) to be performed and, furthermore, are reusable. During 3 academic years (2013-2016) FNAC samples have been obtained in this way by each student individually, in a clinical context and with subsequent cytological correlation. Results. A total of 178 third year medical students from the University of Murcia, Spain, took part in the FNAC training programme (28 groups: 105 women, 73 men). The success rate in the first attempt (puncture, aspiration of material, placing and extending the obtained material on slides) was 97.2%. Furthermore, 13 students from 10 other universities (national and international) also took part, not having such a programme in their medical schools. In an anonymous survey the consensus was that it was valuable practical training. Discussion. Training in FNAC techniques is easy to include in the undergraduate curriculum and also in the Objective Structured Clinical Examination (OSCE) evaluation format. There is no proper standardization in training among different universities. FNAC simulation provides students with greater knowledge and appreciation of our specialty (AU)

Problemas músculo-esqueléticos en patólogos españoles. Prevalencia y factores de riesgo / Musculoskeletal disorders in Spanish pathologists. Prevalence and risk factors

Los patólogos son médicos especializados en el diagnóstico morfológico de las enfermedades a través del estudio de muestras citotisulares para lo cual hacen uso, entre otras cosas, del microscopio óptico. Dicho uso se ha visto relacionado con la aparición de problemas músculo-esqueléticos. Se envió un cuestionario anónimo online a los miembros de la Sociedad Española de Anatomía Patológica con el fin de conocer la prevalencia de los mismos en los patólogos que trabajan en España. Se incluyeron preguntas relacionadas con defectos visuales y sobre patología digital. Completaron la encuesta un total de 557 patólogos. Se describen y discuten los resultados (AU)

Pathologists are physicians who specialize in the morphological diagnosis of diseases through the study of cytotissular samples, for which they use, among other things, the optical microscope. This has been associated with musculoskeletal complaints. In order to determine the prevalence of these in pathologists working in Spain, an anonymous online questionnaire was sent to members of the Spanish Society of Pathology. Questions about visual defects and digital pathology were also included. A total of 557 pathologists completed the survey. Results are described and discussed (AU)