Cytopathology

Perhaps due in part to the closure of cytotechnology schools across the US, employment challenges can include a shortage of staff—cytologists, cytology preparatory staff, and particularly cytotechnologists. Additionally, changes in cervical cancer screening guidelines and the possibility of reduced gynecological cytology volumes may have an impact. However, since cytopathology deals with both gynecologic and non-gynecologic samples, and with the availability of tissue for ancillary testing, many labs have dedicated cytopathology services, which can make finding a job a little easier.

The standard fellowship is one year.

It depends on where you’re practicing. For some, cytopathology requires on-call time, but usually not after hours or on the weekends. Some may need to perform Rapid On-Site Evaluation (ROSE) to assess the adequacy of FNA samples procured by an endoscopist (pulmonologist and gastroenterologist) as well as the interventional radiologist. Most cytopathologists’ on-call assignments are limited to weekday work hours and are over the weekend only for emergencies.

The case volume for cytopathologists varies widely, with some labs seeing 25–40 cases per day and others up to 50–100. There can be approximately 8,000 non-gyn and 35,000 gyn cases over the course of a year (not all gyn cases are reviewed by pathologists, just the abnormal). Ancillary testing, such as IHC and molecular testing, is common on cell block material that accompanies many cases and can include selecting cases for molecular/PD-L1 testing, correlating with HPV results, and sending out for thyroid molecular testing. Some labs prefer to run tests on corresponding paraffin-embedded tissue. Overall, there is a great deal of variability in case volume and ancillary testing depending on the place of employment.

Cytopathologists interact with a variety of specialties. In fact, cytopathologists at any given time interact with any and all specialties—including, but not limited to, pulmonologists, otolaryngologists, interventional radiologists, hematopathologists, surgeons, oncologists, endocrinologists, gastroenterologists, urologists, and obstetric/gynecological specialists.

Yes. The American Society of Cytopathology (ASC), the Papanicolaou Society of Cytopathology (PSC), and the International Academy of Cytology (IAC).

Cytopathology pairs well with many pathology subspecialties, particularly genitourinary, gynecologic, otolaryngologic, and gastrointestinal—basically anything except autopsy. So that also includes thoracic, head and neck, molecular, general surgical pathology, hematopathology, and soft tissue. Additionally, due to FNA cases and Pap smear cases in cytology, it can also pair with breast and pancreatic pathology.

Cytopathologists can interact with patients through pathologist-performed FNA clinics where history is taken and FNA is performed. Some labs have integrated FNA clinics with ENT physician clinics where they perform FNAs at the clinician's request. During ROSE, patients are awake and can interact with the cytopathologist. However, not all cytopathologists interact with patients, and many have no interaction at all.