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Introduction/ Background Clinical training at the European level requires flexible ways to provide education across borders with the goal of a unified way to teach and assess quality. The CyTest project focuses on Cytological Training at European Standard through Telepathology. The project (2014-1-IT01-KA202-002607) has been approved and funded in 2014 by EU within the ERASMUS+ Program. The project consortium is composed of 4 leading university Institutions (COREP and University of Turin, University of Padua, Imperial College of London, IPATIMUP/University of Porto and University of Graz) with technological development and support provided by CRS4. In addition, it benefits from the collaboration of International Organizations (EFCS, Eurocytology, OME) and is open to contributions from additional groups and Societies. Aims Our aim was the establishment of a platform for the sharing of digital pathology images and of an auxiliary system that will use the latter platform for the distribution of cytologist training courses with an integrated virtual microscopy capability. Methods The CyTest platform is based on the integration between Moodle, an e-learning platform designed to create personalized learning environments, and OME OMERO, a well known open source software for visualization, management and analysis of biological microscope images. The former is used to provide access to a database of questions produced by specialized trainers and the latter provides access to digital pathology images and related metadata. We chose to base our infrastructure upon Moodle because it is one of the top leading platform for online education with a large community of users across both academic and enterprise level, highly customizable and modular. OMERO was chosen because of its compatibility with a large number of image formats for digital pathology images, its handling of image metadata (i.e., TAGs and Regions of Interest) and its easily extensible web platform. Results The web platform can be used with a wide range of devices, it is compatible with most of the image formats produced by digital slides scanners and it can scale to a wide student body. Teachers can create courses, populate the Question Bank and aggregate questions in quizzes, while students can take classes and tests. When creating questions, teachers can choose images previously loaded and annotated. We provide two new types of questions: multiple choice, focused on an image and its ROIs, and interactive, where students identify areas on the image by markers that will be automatically compared to instructor’s specified ROIs. The currently deployed system holds already a set of several hundreds of images classified by categories (e.g., tissue type and diseases) with associated ROIs identified by pathologists. The CyTest platform provides a full technological solution for a more homogeneous training and testing of cytotechnicians and cytopathologists with uniform quality level assurance mechanism. The system could be easily extended to support the teaching of histopathological diagnosis. Moreover, the CyTest platform paves the way to an e-QUATE test, thus providing an efficient and economical way to replicate the test at European scale. The sustainability of the platform and the supported educational material (images, questions and evaluation algorithms) will be guaranteed by its integration in EFCS activities. We expect to distribute the CyTest System for validation by October 2016, for further information contact infocytest@corep.it., Diagnostic Pathology, Vol 1 No 8 (2016): 13. European Congress on Digital Pathology

Background: In the present work, we evaluated the possibility of introducing ultrasonographic (US) examination in association to fine needle aspiration cytology (FNAC) before sentinel lymph node biopsy (SLNB) as a useful diagnostic tool in the pre-surgical management of patients with MCC and we also assessed the negative predictive value and false negative rate of combined cytological (US+FNAC) and histological (SLNB) procedure compared to the literature values obtained from different SLNB procedures. Design: US examination was performed in 53 patients with diagnosed MCC and in 11 patients it was followed by FNAC of US suspicious lymph node. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry with a combination of anti-cytokeratin antibodies (CK 20, CAM 5.2). Results: All FNAC were informative (10 LNs were positive for metastases, 1 was negative). Of all others 42 MCC cases, with nonsuspicious lymph nodes on US, in which no FNAC examination was performed, 6 carcinomas (14.3%) turned out to be lymph node positive on histological examination. One of the 11 (9.1%) negative cytological diagnoses was false negatives since lymph node metastasis of 5 mm of diameter was found by SLNB on histology. Based on these data, US+FNAC are endowed with high sensitivity and accuracy (both of 90.9%) and absolute specifi city (100%) and we suggest that US examination should be performed in all patients with MCC adding immunocytochemistry-supported FNAC only on US-suspect lymph node. Besides, the negative predictive value for our combined cytological and histological procedure was 94.7% (36/38) and the false negative rates in our series was 10.5% (2/19). Conclusions: The present preoperative protocol (US+FNAC and SLNB) is reliable for screening patients with lymph node metastases, thus avoiding sentinel lymph node biopsy in 18% (10/53) of MCC cases.

Background: Prediction of clinical evolution in Merkel cell carcinoma (MCC), a rare and potentially aggressive tumor, is notoriously uncertain. In our previous experience, p63 expression in MCC represented an independent predictor of poor prognosis. In addition, recently it has been suggested that the presence of Merkel cell polyomavirus (MCPyV) is an indicator of adverse prognosis. Thus, to investigate on significance of the co-expression of p63 and MCPyV, we examined a series of MCC from different Institutions. Design: We collected data on 72 MCCs; 27 cases were tested for p63 expression by immunohistochemistry (IHC) alone, while the remaining 45 were studied for p63 status by IHC, RT-PCR and FISH and for the presence of MCPyV by PCR. Results: p63 expression, detected in 52.7% of cases by IHC, was associated with decreased OS (p=0.041) and DFS (p

Background. The diagnosis of follicular lesions is a grey zone in thyroid fine-needle aspiration (FNA) cytology. Our study aims to verify if staining with Emerin is a helpful marker of the follicular variant of papillary thyroid carcinoma (FVPTC) in the differential diagnosis of follicular-patterned lesions. Methods. We designed both a prospective study on smears and Thin Prep specimens to prove the feasibility of the procedure and a retrospective study on 78 FNA cell-blocks from cases which, after surgery, turned out to be either benign (34 cases) or malignant lesions (44, of which 31 PTC). From each sample, we obtained two slides, one stained with Hematoxylin and Eosin (H&E) and the other with immunohistochemistry (IHC) for Emerin. In Thy3 cases, HBME-1 and Gal 3 stains were also done. Two observers gave a judgement in Thy categories (British Thyroid Association) on H&E, Emerin, HBME-1 and Gal 3 stained slides. Results. The prospective study demonstrated that Emerin staining is an effective tool for nuclear membrane decoration and amplification of nuclear irregularities. In the retrospective study, inter-observer agreement proved higher in Emerin-stained slides (K of Cohen-Fleiss = 0.6890) than H&E-stained slides (K of Cohen-Fleiss = 0.4878). Sensitivity and overall accuracy were higher for Emerin (respectively, 77.27% and 84.61%) than H&Estained slides (respectively, 36.36% and 62.82%). Emerin staining proved able to identify all cases of PTC, including all cases of FVPTC. In Thy3 cases, Emerin’s sensitivity and specificity (64% and 96%) proved higher than HBME-1’s (60% and 88%), and Gal3’s (61% and 68%). Conclusions. Emerin stain, is a useful tool in the cytological diagnosis of thyroid lesions. It enhances detection of nuclear irregularities typical of PTC, thus helping to solve inconclusive FNA cases, mainly in those cases of FVPTC with a reduced expression of nuclear irregularities in the traditional stains (H&E).

WHO publications on tumours are classical references on updated data of specific tumours. This book deals with breast tumours and has a worldwide spread.