Paula Cardoso Técnica Coordenadora do Serviço de Anatomia Patológica Instituto Português de Oncologia de Lisboa Francisco Gentil Window on Europe: II° European Hysto-Cytotechnicians meeting. Coordinatori: A. Bondi, S. Simonazzi

PORTUGAL  University course of 4 years with bachelor with honors degree – 240 ECTS  One course specific for clinical pathology and another course specific for anatomic pathology  Anatomic pathology includes histology, cytology and thanatology BIOMEDICAL LABORATORY TECHNICIAN 1

 University school from Lisbon: “Lisbon Health Technology University School”  12 different courses (e.g.: radiology, physiotherapy, pharmacy)  Anatomic pathology and clinical pathology courses: - First year generalist - Specialization in each laboratory area begins in second year - Training of 60 ECTS, usually in hospitals, predominates in the last year of the course BIOMEDICAL LABORATORY TECHNICIAN 1

 The anatomic pathology technicians can work in all the clinical and research laboratories with histology (including histochemistry, immunocytochemistry, in situ hybridisation), cytology, electron microscopy, flow cytometry, molecular biology and autopsy activity. 2

BIOMEDICAL LABORATORY TECHNICIAN 2 Histopathology

BIOMEDICAL LABORATORY TECHNICIAN 2 Cytology

BIOMEDICAL LABORATORY TECHNICIAN 2 Immunocytochemistry

BIOMEDICAL LABORATORY TECHNICIAN 2 In situ hybridization

BIOMEDICAL LABORATORY TECHNICIAN 2 Flow cytometry Electron microscopy

BIOMEDICAL LABORATORY TECHNICIAN 2 Autopsy Molecular Biology

BIOMEDICAL LABORATORY TECHNICIAN  Most of the anatomic pathology technicians are employed in public Hospitals. However, many technicians work in private laboratories. Public or private laboratories may belong to clinical or research entities:  In Portugal is not usual to work as a freelancer. 3

 To be able to work, technicians need a professional declaration from the Health Ministry that recognizes the professional title obtained in the university: BIOMEDICAL LABORATORY TECHNICIAN 4

 For anatomic pathology: “Portuguese Association of anatomic pathology technicians” –  For clinical pathology: “Portuguese Association of clinical analysis and public health technicians” – 5

 Continuous education is done autonomously  For some places or for specific functions, technicians need to gain specific knowledge. They can do it through post- graduate courses, Bsc and phD’s in:  Management and administration  Macroscopy  Cytology  Immunocytochemistry  Electron microscopy  Molecular biology  Flow cytometry  Forensic medicine BIOMEDICAL LABORATORY TECHNICIAN 6

 In public entities the technicians have a career with 5 steps:  2 nd class technician  1 st class technician  Principal technician  Specialist technician  1 st class specialist technician  To move up in the career, technicians need to stay at least 3 years in each step with good evaluation and their curriculum needs to be evaluated too by a jury. To go to the last step, they need to do a project too. BIOMEDICAL LABORATORY TECHNICIAN 7

LABORATORY FEATURES  The technician who is responsible for the laboratory is called coordinator technician. To be a coordinator it’s necessary to have the category of principal technician, and have a post-graduate course in management and administration. 8

LABORATORY FEATURES  The coordinator technician working in a small department, can do laboratory work together with other technicians. If it’s a big department, he may only manage and do work laboratory quality control. 9

 During diagnostic activity, technicians only cooperate with other hospital professionals during fine needle aspirative punction in eco-endoscopies of gastro-intestinal tract and lung. In research activity, technicians cooperate with other professionals during the research project, like biologists, biochemistries, medical doctors or mathematicians. LABORATORY FEATURES 10

 Laboratories develop methods and procedures to improve the results or to reduce diagnostic time.  Also, the technicians can integrate research teams or develop research in their laboratory area. This projects can be seen in our National Congress or read in our magazine called “Micron” or other national and international meetings and magazines. LABORATORY FEATURES 11 Appl Immunohistochem Mol Morphol Mar;17(2): HER2/neu detection by immunohistochemistry: optimization of in-house protocols. Lourenço HMLourenço HM, Pereira TP, Fonseca RR, Cardoso PM.Pereira TPFonseca RRCardoso PM Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisboa, Portugal.

LABORATORY FEATURES 12  For safety support, usually hospitals have a specific department. Nevertheless, laboratories usually have a technician who is more dedicated to that area.  For equipment, companies do the maintenance and usually all the technicians can solve the basic problems with support of user instructions.

 Usually some technicians are dedicated to a specific laboratory area and if is big enough, the other technicians spend some time in that area, on rotation. LABORATORY FEATURES 13

LABORATORY FEATURES  The evaluation of technicians is done every 3 years. This includes self-evaluation and interview to discuss desagreement points. 14

LABORATORY FEATURES  In Portugal, all the public anatomic pathology laboratories work only during the day and not include weekends and holidays, except the hospitals performing solid organ transplantation where a technician is on call. 15

 The hospital laboratories have their own budget, but the hospital administration needs to authorize each expense for instruments or staff. LABORATORY FEATURES 16

 Most of the Portuguese laboratories use neutral buffered formalin to fix all the tissues.  During the last years more laboratories are changing from in-house prepared reagents to commercial kits. The bigger reproducibility of the results with commercial kits, the automation and the laboratory certification and accreditation requisites are transforming the laboratory work methods.  Some laboratories use xylene substitutes but the majority is still using xylene LABORATORY TOOLS

 Laboratory average running time in the Lisbon Institute of Oncology: -Biopsies  next day of reception before 13:00 -Routine fragments  next day of macroscopy before 16:00 -Cytological preparations  Same day laboratory processing and screening next morning 20 LABORATORY TOOLS

 In Portugal, usually technicians don’t sign the report but their name is included in the report. 21 LABORATORY TOOLS

 The Lisbon Institute of Oncology has a specific department for the health workers wish include risk and safety. My laboratories have sufficient personal protective equipment available, like gloves, goggles, masks, eye wash and shower. Nevertheless we don’t have compensating payment for the risk exposure. 22 LABORATORY TOOLS

 We have a personal insurance for technicians who works outside of the public administration. The public administration workers have a specific social safety. 23 LABORATORY TOOLS

24  Tools for internal quality management: 1. Histopathology 1.1. Registration, in each exam, the date and the technician who is responsible for each procedure (reception, macroscopy support, embedding, cutting and staining) 1.2. All the slides are confirmed with blocks to detect label errors and incomplete sections before delivery to the pathologist 1.3. Microscopic control of all biopsies and random control of surgical specimens LABORATORY TOOLS

24  Tools for internal quality management: 2. Cytopathology 2.1. Registration, in each exam, the date and the technician who is responsible for reception and processing 2.2. Rapid review: partial review of all cervical smears reported as negative or inadequate by the primary screener

LABORATORY TOOLS 24  Tools for internal quality management: 3. Immunocytochemistry and in situ hybridization 3.1. Positive control for each antibody and probe 3.2. Tissue microarray (TMA) control for HER2 (with negative, 1+, 2+ and 3+ tissue), ER and PgR (with negative, medium and high expression tissue) and p16 (with negative and positive tissue) 3.3. Microscopic control of all slides prior to delivery to the pathologist

 Our external quality assessment service is done by UKNEQAS: 1.Histopathology  Cellular Pathology Technique (H&E and Histochemistry) 2.Immunocytochemistry  General pathology + Lymphoma + Breast (ER and HER-2) + Cytopathology + HNPC (hereditary non polyposis colonic cancer) 3. In situ hybridization  HER-2 25 LABORATORY TOOLS

GREETINGS 26 17º Corso Nazionale per Tecnici di Laboratorio Biomedico