Valerie Neff Newitt
July 2024—The CAP’s hematopathology online education program, HPATH, is now in its 10th year, with real-world cases for which there’s real-time feedback and hundreds enrolled each year.
Interesting cases, ones every hematopathologist should have experience with or be familiar with, are what the expert authors of the cases provide, says Kyle Bradley, MD, chair of the CAP Hematopathology Committee and associate professor of hematopathology at Emory University School of Medicine. Each case includes laboratory data, whole slide images, images of ancillary studies, feedback about the case and test results, and self-assessment questions. “And some of the high quality comes from brevity,” Dr. Bradley says. “We whittle down a lot of information into something very manageable and high yield for busy pathologists.”
More recently, the cases the experts select for the program reflect the two hematopathology classification systems from the World Health Organization (fifth edition) and the 2022 International Consensus Classification, says Megan Nakashima, MD, vice chair of the CAP Hematopathology Committee and staff hematopathologist at Cleveland Clinic. “We’ve been highlighting cases that show how best to apply the two classification systems,” she says, “and we use the terminology of both throughout.”
Five cases are made available two times yearly, for a total of 10. “One of the comments we get is that people wish we would do more cases every year,” Dr. Nakashima says. (The images appearing with this story are from 2020–2023 cases.)
The interactive program covers a variety of case types and resembles what happens in everyday practice, where multiple ancillary tests may be needed to arrive at a diagnosis. “Everything is typical of how a hematopathologist will work up a case,” Dr. Bradley says.
“When first going through the case,” Dr. Nakashima says, “the whole slide images are not annotated at all. You have to approach the case the way you would a live case that comes across your desk. Once you’ve gone through the morphology that way, you go to the next screen,” where a list of tests appears and the user has to decide which tests to order.
“If, for example, you decide yes, you want to do flow cytometry, then you click in the ‘yes’ box,” she says, and then you’ll be able to review the dot plots and receive immediate feedback about the study. “We prefer that the person who’s doing the exercise make the interpretation,” Dr. Nakashima explains. For tests that are less relevant to the case, the user will be told it wasn’t performed in this case because it would not add much and why.
Users synthesize the information taken from the morphologic review of the whole slide image and the results of the ancillary testing and move to the next page, where they’re asked to select the correct diagnosis from a list of about five entities that may enter the differential diagnosis. If the wrong diagnosis is selected, users receive a brief explanation about why it’s not correct but are not told what the diagnosis is. “You get to keep guessing,” Dr. Nakashima says, and users can go back and forth within the cases.
The aim of the program is not to present rarities, Dr. Bradley says. “It’s not meant to be case reports or rare entities you won’t see in practice. It’s meant to be practical, common things as well as some that are less common. And users get up-to-date information not only about how hematopathologists diagnose the entity but also what is important for subtyping,” including what “cutting-edge, novel testing is used.”
These are cases that are seen regularly in practice, he says, but accompanied by the latest known information according to the expertise of the case authors. “And the idea is that the user can feel comfortable knowing that the same approach is being done in their practice” or, in some instances, alerted to where their practice might not be performing what has become the standard of care.
Cases also teach optimal test ordering and thus cost control. “Usually, we put in a few ancillary study choices that are not as relevant as others or are unnecessary for the case,” Dr. Bradley says, “and this gets at effective ordering of tests to target what you need.”