Inside the Lab

Although molecular testing offers promising opportunities for diagnosis and targeted treatment of cancers, prostate cancer has lagged behind other types of cancer. Recently, homologous recombination repair testing in prostate cancer has provided a means to achieving targeted treatments for patients as well as opening new avenues of collaboration between pathologists and oncologists.

On this episode of Inside the Lab, hosts Ms. Kelly Swails, MLS(ASCP), and Dr. Ali Brown, MD, FASCP are joined by Heather Cheng, a medical oncologist and associate professor of hematology and oncology at the University of Washington and Fred Hutchinson Cancer Center, and Colin Pritchard, molecular pathologist and professor of laboratory science and director of the Genetics and Solid Tumors Laboratory at the University of Washington Medical Center.

Our panelists discuss the current treatment landscape for prostate cancer and how HRR testing can improve patient outcomes in this context.

Topics Covered  

• An introduction to metastatic prostate cancer testing, and what types of tests are standard of care, and the rationale for targeting prostate cancer using PARP
• Key findings from recent phase III randomized clinical trials
• Standards for optimal testing in prostate cancer, particularly concerning sample sources and the choice between next-generation sequencing (NGS) and polymerase chain reaction (PCR) methods
• common pitfalls or challenges in the arena of accurately reporting and interpreting findings from HRR tests
• Practical tips for optimal coordination among a multidisciplinary, cross-departmental team of healthcare providers and laboratory professionals when utilizing HRR testing in prostate cancer management.

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Dr. Cheng on LinkedIn 

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Dr. Pritchard 

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Ms. Swails on Twitter
Dr. Brown on Twitter 

Resources
ASCP Membership 2024
Proposed FDA Regulation of Laboratory Developed Tests
Public Comment on the FDA’s Proposed Rule
Inside the Lab in the ASCP Store 

As CRC affects younger and more diverse populations, emerging tests for CRC biomarkers provide enormous utility for diagnosis. However, misdiagnosis of CRC, shifting demographics of those afflicted with CRC, and patient unfamiliarity with symptoms create challenges in identifying CRC. In this episode of Inside the Lab, hosts Dr. Ali Brown and Lotte Mulder are joined by Dr. Melissa Taggart, a board-certified pathologist at MD Cancer Center and Karla Valencia, a laboratory manager at MD Anderson Cancer Center to discuss the utility of biomarker testing for CRC.  

The hosts are also joined by Sarah Claeys, who was diagnosed with Stage I CRC in 2020 and is now actively fighting Stage IV recurrence with metastatic disease primarily in the liver, and ASCP Patient Champion Heather Tucker, who suffered from misdiagnosis for years before being diagnosed for CRC. She completed treatment 5 years ago. Sarah and Heather share their experiences with seeking both diagnosis and treatment, and provide insights on what information related to biomarkers were most valuable to them. 

Topics Covered in this podcast include:  

• How have tests for CRC evolved recently, and which biomarkers they test for; 
• How laboratory quality control is used to ensure the accuracy and reliability of colorectal cancer biomarker test results; 
• Factors involved with validating and implementing new biomarker assays for CRC in the laboratory; 
• Handling pre-analytical variables and potential interferences that may affect the interpretation of biomarker test results for colorectal cancer; 
• How pathologists integrate molecular and biomarker findings into pathology reports; 
• What information related biomarkers was most valuable from a patients’ perspective was most valuable when seeking treatment for CRC, as well as patient advice for healthcare professionals, including pathologists and laboratory professionals, regarding laboratory testing, including biomarker testing. 

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ASCP 

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Connect with Ms. Bartosh, Ms. Courtright & Mr. Bowman 

University Health Laboratory Services 

Ms. Bartosh on LinkedIn  

Connect with Ms. Swails & Dr. Brown 

Ms. Swails on Twitter 

Dr. Mulder on Twitter 

Resources 

CAP Inspection Checklists 

ASCP Patient Champions Program 

Inside the Lab in the ASCP Store 

Recent developments in disease modifying therapies have been proven to slow the progression of cognitive decline associated with Alzheimer’s disease. 

And yet, we can only confirm a diagnosis of AD after a patient’s death. 

But what if we could use biomarkers to identify preclinical stage Alzheimer’s and step in long before a patient exhibits dementia? 

On this episode of Inside the Lab, your host, Ms. Kelly Swails, MT(ASCP) introduces us to Dr. Shih-Hsiu Jerry Wang, MD, PhD, Assistant Professor of Pathology and Assistant Professor of Neurology at the Duke University School of Medicine, and shares his talk on emerging biomarkers for the assessment of Alzheimer’s disease from the ASCP 2023 Annual Meeting. 

Dr. Wang explains how we measure AD right now and why there’s discordance between the clinical presentation and pathology of Alzheimer’s. 

Dr. Wang walks us through the core biomarkers for identifying AD per the AT(N) framework, describing the pros and cons of current detection methodologies and offering recommendations around when to use blood biomarkers versus PET imaging or CSF. 

Listen in for insight into the ongoing search for better AD biomarkers and learn what we are doing to diagnose Alzheimer’s in its early stages and intervene accordingly. 

Topics Covered  

· The clinical definition of Alzheimer’s disease and how it impacts cognitive function
· How we measure Alzheimer’s in pathology by amyloid plaques and neurofibrillary tangles
· Why there’s discordance between the clinical presentation and pathology of AD
· The core biomarkers for identifying Alzheimer’s disease per the AT(N) framework
· Identifying the stages of AD based on amyloid plaque, pathologic tau and neurodegeneration
· Examples of PET imaging for the different stages of AD and how imaging biomarkers predict cognitive decline
· The limitations of fluid biomarkers vs. imaging biomarkers to detect Alzheimer's disease
· Some of the emerging ultrasensitive biomarker detection methods in development for AD
· Using cerebral spinal fluids (CSF) vs. plasma biomarkers to identify Alzheimer's disease
· A comparison of the mass spectrometry vs. SIMOA methods of analyzing p-tau biomarkers
· Why Dr. Wang suggests blood biomarkers for AD screening (with confirmation by PET or CSF)
· Why SNAP-25, NfL and GFAP are not considered core biomarkers for Alzheimer’s disease
· The ongoing search for better biomarkers and ultrasensitive detection methods for AD 

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Connect with Dr. Wang
Dr. Wang at Duke University 

Connect with Ms. Swails
Ms. Swails on Twitter

Resources
Dr. Wang’s Slides from the ASCP Annual Meeting 2023
‘NIA-AA Research Framework: Toward a Biological Definition of Alzheimer’s Disease’ in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association
Inside the Lab in the ASCP Store 

The availability of targeted therapies has changed the landscape of cancer treatment in the last few years.  And two types of cancer particularly affected by these advances are melanoma and non-small cell lung carcinoma or NSCLC. What role does the laboratory play in the diagnosis and treatment of these cancers? How can pathologists and lab professionals work with oncologists to optimize biomarker testing and improve patient outcomes?  

On this episode of Inside the Lab, your hosts, Ms. Kelly Swails, MT(ASCP), and Dr. Ali Brown, MD, FASCP, are joined by Dr. Sanjay Mukhopadhyay, MD, Director of the Lung Pathology Service at the Cleveland Clinic, Ms. Lynnette Pineault, MBA, SCT(ASCP), Operations Manager for Laboratory and Genetic Services for Health Partners, and Mr. Jim Ondick, ASCP Patient Champion and IT Associate at The University of Kansas Health System, to discuss advancements in biomarker testing to improve NSCLC and melanoma cancer care.  

Listen in for insight on ensuring equitable patient access to biomarker testing and learn how to register for ASCP’s Immuno-Oncology Microlearning Courses for pathologists and laboratory professionals.  

Topics Covered   

• How targeted therapies and immunotherapies have improved treatment for melanoma and lung cancer in the past few years 
• Mr. Ondick’s success story of being treated with immunotherapy for metastatic melanoma and why he had little interaction with laboratory professionals during his diagnosis and treatment
• How pathologists can work with oncologists and surgeons to improve care for patients with cancer 
• The obstacles to providing laboratory services or support for biomarker testing 
• Dr. Mukhopadhyay and Ms. Pineault’s advice on designing workflows to optimize biomarker testing and ensuring equitable access for patients 
• Mr. Ondick’s take on what cancer patients should know about the laboratory team  

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ASCP
ASCP on Facebook 
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Connect with Dr. Mukhopadhyay 
Dr. Mukhopadhyay at Cleveland Clinic
Dr. Mukhopadhyay on LinkedIn  

Connect with Ms. Pineault
Ms. Pineault on ResearchGate
Ms. Pineault on LinkedIn  

Connect with Mr. Ondick
Mr. Ondick on LinkedIn
Mr. Ondick’s Story on ASCP Patient Champions  

Connect with Ms. Swails & Dr. Brown
Ms. Swails on Twitter
Dr. Brown on Twitter  

Resources
ASCP Patient Champions
ASCP Immuno-Oncology Microlearning Courses
Inside the Lab in the ASCP Store   

Sponsor
Bristol Myers Squibb 

Tests that are designed in-house to fulfill a clinical need (but aren’t FDA approved) qualify as laboratory developed tests. And these LDTs are currently regulated by CLIA. But the FDA is proposing a new rule that would give them oversight of the design and development of laboratory developed tests. So, what does that mean for us? How would this new legislation impact everyday practice inside the lab? 

On this episode of the podcast, your hosts, Ms. Kelly Swails, MLS(ASCP), and Dr. Ali Brown, MD, FASCP, are joined by Dr. Gregory Sossaman, MD, Clinical Pathologist and Service Line Lead for Pathology and Lab Medicine at Ochsner Health, Dr. Jonathan Genzen, MD, Clinical Pathology Professor at the University of Utah and Chief Medical Officer and Senior Director of Government Affairs at ARUP Laboratories, and Mr. Matthew Schulze, Senior Director for the Center for Public Policy at ASCP, to discuss the implications of the proposed FDA regulations for LDTs. 

Our panelists share their anxiety around the labor and costs involved in complying with the new rule and describe how lab professionals might be forced into situations where we deny care due to regulations. Listen in to understand why public opinion favors the proposed rule and learn how to share your concerns with the FDA during the public comment period from October 3rd to December 4th, 2023. 

Topics Covered  

· How tests that are not FDA approved but designed in-house to fulfill a clinical need fall into the category of laboratory developed tests
· Examples of common LDTs used in academic medical centers + large community health systems
· The current regulations re: performance standards for LDTs under CLIA
· Dr. Sossaman, Dr. Genzen & Mr. Schulze’s concerns around the labor and costs involved in complying with the proposed FDA rule
· The lack of clarity re: what modifications to FDA approved tests would be allowed under the proposed regulations
· How direct-to-consumer testing, the pandemic and technological advances influenced the proposed FDA rule and why the general public is in favor of it
· How the proposed FDA regulations would affect our ability to respond in future pandemics

Connect with ASCP
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Dr. Sossaman on LinkedIn 

Connect with Dr. Genzen
Dr. Genzen on LinkedIn 

Connect with Mr. Schulze
Mr. Schulze on LinkedIn 

Connect with Ms. Swails & Dr. Brown
Ms. Swails on Twitter
Dr. Brown on Twitter 

Resources
ASCP Membership 2024
Proposed FDA Regulation of Laboratory Developed Tests
Public Comment on the FDA’s Proposed Rule
Inside the Lab in the ASCP Store 

Working on the bench can feel like being in a black box. And as important as it is to advocate for patients, pathologists and laboratory professionals rarely have direct access to them. 

So, what can we do to encourage patient-centered care in the medical laboratory? 

On this episode of Inside the Lab, your hosts, Ms. Kelly Swails, MLS(ASCP), and Dr. Lotte Mulder, PhD, are joined by three members of the laboratory staff at University Hospital in San Antonio, Ms. Carrie Bartosh, MLS(ASCP), SV, Laboratory Supervisor in the Microbiology Department, Ms. Claudia Courtright, MLS(ASCP), Technical Supervisor in Microbiology Services, and Mr. Scott Bowman, MLS(ASCP), Bench Technologist, to discuss patient advocacy in the laboratory. 

Our panelists describe what laboratories can do to promote a culture of patient-centered care, sharing examples of situations when they advocated for patients from the bench and what they wish people knew about the value of the work done in the medical laboratory.  

Listen in for Ms. Bartosh, Ms. Courtright, and Mr. Bowman’s advice for laboratory professionals on avoiding burnout and learn how your laboratory can establish processes that support patient-centered care.  

Topics Covered 
· How frontline laboratory professionals can advocate for patients from the bench
· Instances of advocating for patients and how working in a culture of safety empowered those situations
· What the University Health laboratory does to continuously evaluate and improve its patient-centered care practices
· What laboratories can do to promote a culture of patient-centered care
· Why a punitive culture in the laboratory is not conducive to patient-centered care
· Examples of processes that support patient-centered care
· Advice to laboratory professionals on how to avoid burnout
· How Ms. Bartosh, Ms. Courtright, and Mr. Bowmanstay motivated to focus on advocacy
· Why laboratory professionals rarely have an opportunity to involve patients in the decision-making process around laboratory testing and results interpretation (and how impactful it is when they do)
· What our panelists wish patients knew about the value of the work we do in the medical laboratory 

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ASCP on Facebook
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Connect with Ms. Bartosh, Ms. Courtright & Mr. Bowman
University Health Laboratory Services
Ms. Bartosh on LinkedIn 

Connect with Ms. Swails & Dr. Brown
Ms. Swails on Twitter
Dr. Mulder on Twitter

Resources
CAP Inspection Checklists
ASCP Patient Champions Program
Inside the Lab in the ASCP Store 

We know that diverse teams perform better. In laboratory medicine, diversity, equity, and inclusion in leadership not only inspires young professionals, it also promotes retention in a profession that struggles with staffing shortages. 

So, what’s stopping us from increasing representation and equity in laboratory leadership?  

What can we do to recruit a more diverse pool of job applicants and then support them in growing into lab leadership and management roles? 

On this episode of Inside the Lab, your hosts, Ms. Kelly Swails, MLS(ASCP), and Dr. Lotte Mulder, PhD, are joined by Ms. Lona Gordon Small, MLS(ASCP), MBA, Quality Specialist at the Johns Hopkins Hospital Core Lab and coach and Founder of LabOPEX Training and Consulting, Dr. Marissa J. White, MD, FASCP, Surgical Pathologist and Deputy Director for Diversity, Equity and Inclusion at Johns Hopkins, and Mr. Mohamed Abdelmonem, MBA-HCM, MSc, MLS(ASCP)SBB, Blood Bank Specialist and Transfusion and Reference Lab Supervisor at STEM Healthcare, to discuss diversity, equity and inclusion strategies for the medical lab. 

Our panelists explain the common barriers to expanding representation among laboratory leadership and explore effective strategies for mentoring underrepresented groups in management roles. 

Listen in for Ms. Small, Dr. White, and Mr. Abdelmonem’s insight on establishing equity around pay and promotion and learn what educational institutions and professional organizations can do to promote representation at all levels of the laboratory workforce! 

Topics Covered 
· The crucial need to increase representation in laboratory leadership and management positions
· Common barriers to expanding representation and equity in laboratory leadership
· What educational institutions and professional organizations can do to promote representation and equity in the laboratory workforce
· The benefits of equity around pay and promotion in the medical lab
· Effective strategies for mentoring and supporting underrepresented groups in laboratory leadership roles
· Strategies to identify and recruit a more diverse pool of job applicants for roles in the medical laboratory  

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ASCP on Facebook
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Connect with Ms. Small
Ms. Small on LinkedIn

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Dr. White at Johns Hopkins 

Connect with Mr. Abdelmonem
Mr. Abdelmonem on LinkedIn

Connect with Ms. Swails & Dr. Mulder
Ms. Swails on Twitter
Dr. Mulder on Twitter 

Resources
eLABorate Topics Podcast
Mass General Brigham’s Mentoring Across Differences
Positive Intelligence by Shirzad Chamine
ASCP Mentorship Program
Inside the Lab in the ASCP Store 

Would you benefit from having a mentor to help you grow as a pathologist or laboratory professional? How might you benefit from becoming a mentor yourself? 

We get further, faster, with support, and having the right mentor accelerates your personal and professional development. 

But how do you find a good mentor? And what can you do to make the mentor-mentee relationship successful?  

On this episode of Inside the Lab, your hosts, Ms. Kelly Swails, MT(ASCP), and Dr. Lotte Mulder, PhD, are joined by Dr. Nathan Johnson, PhD, FACHE, MASCP, DLM(ASCP), Chair of Laboratory Sciences at the University of Arkansas for Medical Sciences in Little Rock, Arkansas,Ms. Tywauna Wilson, MBA, MLS(ASCP)CM, System Technical Director of Chemistry for CompuNet Clinical Laboratories and President of Trendy Elite Coaching, and Dr. Russell Broaddus, MD, PhD, Chair of Pathology and Laboratory Medicine at the University of North Carolina School of Medicine at Chapel Hill, to discuss mentorship in the laboratory. 

Our panelists explore the characteristics of a good mentor, explaining why mentorship is important at ALL levels of your career and where to look for mentorship as a pathologist or laboratory professional. 

Listen in for examples of how Dr. Johnson, Ms. Wilson, and Dr. Broaddus have benefitted from serving as mentors and learn how to maximize the benefits of a mentor-mentee relationship in the medical lab. 

Topics Covered
· What inspired Dr. Johnson, Ms. Wilson, and  Dr. Broaddus to become mentors
· Why our panelists look to mentor in the areas of leadership and career development
· How experienced laboratory professionals can learn from their younger colleagues
· The characteristics of a good mentor
· What makes the mentor-mentee relationship work
· What questions you should ask yourself before saying YES to mentoring someone
· Insight on where to look for a mentor
· Common  mistakes people make in looking for a mentor
· Why mentorship is important at ALL levels of your laboratory career
· How our panelists have benefited from serving as mentors
· What you can do to maximize your mentor-mentee relationships in the lab

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ASCP
ASCP on Facebook
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Connect with Dr. Johnson
Dr. Johnson at the University of Arkansas
Dr. Johnson on LinkedIn

Connect with Ms. Wilson
Trendy Elite Coaching
Ms. Wilson on Twitter
Ms. Wilson on LinkedIn

Connect with Dr. Broaddus
Dr. Broaddus at UNC School of Medicine
Dr. Broaddus on LinkedIn 

Connect with Ms. Swails & Dr. Mulder
Ms. Swails on Twitter
Dr. Mulder on Twitter 

Resources
Inside the Lab in the ASCP Store 

What inspires a doctor to pursue pathology?  

Dr. Elvio Silva, MD, was drawn to pathology because it’s the only specialty in medicine where you can SEE the disease. And his patient-centered approach to studying tumors has led to breakthrough research.  

On this episode of Inside the Lab, Dr. Silva, Professor in the Department of Pathology at MD Anderson Cancer Center, joins our hosts, Ms. Kelly Swails, MLS(ASCP), and Dr. Ali Brown, MD, FASCP, to discuss his storied career as a gynecologic pathologist. 

Dr. Silva explains the two kinds of pathology research, describing what inspired his revolutionary work in grading endocervical adenocarcinomas and why it’s crucial for medical journals to make room for new ideas. 

Listen in for insight on deciding between a career in academics versus private practice and find out what Dr. Silva learned from his most challenging cases in the diverse field of gynecologic pathology. 

Topics Covered 
· Dr. Silva’s accidental journey to becoming a gynecologic pathologist
· How pathology is the only specialty where you can SEE the disease and why Dr. Silva views that as the best part of pathology
· Dr. Silva’s response to people who say pathologists aren’t real doctors
· How Dr. Silva thinks about deciding between academics vs. private practice
· The two kinds of pathology research and what draws people  to research that involves understanding a disease
· What Dr. Silva says to people who are intimidated by the diversity in gynecologic pathology
· Why it’s challenging for pathologists to recognize when we’re wrong
· The publications Dr. Silva is most proud of (and why those papers were initially rejected)
· Examples of challenging cases and how they illustrate pitfalls pathologists should avoid
· Why it’s crucial for societies and journals to make room for people with new and unusual ideas
· Concerns around the training of pathology residents

Connect with ASCP
ASCP
ASCP on Facebook
ASCP on Instagram
ASCP on Twitter 

Connect with Dr. Silva
Dr. Silva on Twitter
Dr. Silva on LinkedIn 

Connect with Ms. Swails & Dr. Brown
Ms. Swails on Twitter
Dr. Brown on Twitter

Resources
Dr. Silva on ResearchGate
Inside the Lab in the ASCP Store 

Are you dreaming of moving up the ladder and transitioning to a management position in the laboratory? Or maybe even a leadership role outside the lab? 

What can you do to learn the leadership skills you need to take that next step in your career? 

On this episode of Inside the Lab, your hosts, Ms. Kelly Swails, MLS(ASCP), and Dr. Lotte Mulder, PhD, are joined by Dr. Gary Procop, MD, MS, CEO of the American Board of Pathology, Ms. Anne Walsh-Feeks, MS, PA(ASCP), FACHE, Assistant Dean and COO for Ambulatory Operations at Stony Brook Medicine in Stony Brooke, New York, and Ms. Carol Gomes, MS, FACHE, CPHQ, MASCP, MT(ASCP)HTL, DLM, CEO and COO at Stony Brook University Hospital, to discuss the transition to leadership outside the laboratory. 

Our panelists discuss their journeys to leadership roles, sharing the resources they found helpful in making the transition and offering advice for laboratory professionals considering management positions in or outside the lab. Listen in for our panelists' insight on building leadership experience through volunteering and learn to leverage the skills you’re honing in the lab to advance your career! 

Topics Covered 
· Career advice for laboratory professionals who wish to move into a management position
· Why it is important to maintain your clinical role during the transition to management
· Leadership skills learned from volunteering with professional associations
· How to take advantage of tuition reimbursement programs to further your education
· Skills learned working in the lab that can contribute career progression
· The pivotal events responsible for our panelists' transition to leadership outside the lab
· Advice for clinicians who want to make the leap to leadership roles outside the lab
· Certifications and degrees our panelists found helpful in making the transition to leadership
· What our panelists would do differently in their careers given the opportunity
· What our panelists miss about working in the lab 

Connect with ASCP
ASCP
ASCP on Facebook
ASCP on Instagram
ASCP on Twitter

Connect with Dr. Procop
Dr. Procop at the American Board of Pathology
Dr. Procop on LinkedIn 

Connect with Ms. Walsh-Feeks
Ms. Walsh-Feeks on Twitter
Ms. Walsh-Feeks on LinkedIn 

Connect with Ms. Gomes
Ms. Gomes at Stony Brook University
Ms. Gomes on LinkedIn

Connect with Ms. Swails & Dr. Mulder
Ms. Swails on Twitter
Dr. Mulder on Twitter 

Resources
American Association of Pathologists’ Assistants
NYU’s Advanced Management Program for Clinicians
NAHQ’s CPHQ Certification
ACHE’s FACHE Certification
Inside the Lab in the ASCP Store