The Daily Scan

Biologic Differences in Breast Cancer: An Expert Interview With Dr. Lisa Carey

Medscape: Biologic Differences in Breast Cancer: An Expert Interview With Dr. Lisa Carey.

"Clinicians who treat women with breast cancer have long recognized wide variations in tumor behavior. Initial attempts to characterize differences among breast tumors and to use them as a basis for determining appropriate treatment strategies focused on hormone expression (ie, estrogen and/or progesterone) and later on overexpression of HER2/neu.  However, it was not until genomic technology developed sufficiently to examine thousands of molecular markers simultaneously that a more granular approach to such research became possible.

Interesting interview.  Understanding the genetic basis for differences in tumor behavior will provide great insight into successful treatments.

the ScienceRoll search engine

Bertalan Meskó has added a spiffy search engine to his ScienceRoll site.  It deserves a better URL :) but this is a really fantastic tool.  You can search ClinicalTrials, DrugInfo, eMedicine, Medscape, PubMed Central, WebMD, etc. - all at once, or selectively.

Naturally to test it out I did a search for "Aperio", and found a lot of papers where people have used Aperio equipment for digital pathology!  That is so cool.

The search results are catagorized, so you can see the "clumps" of search results, and choose among them.  This is a great tool, I can see myself using it all the time.

Update: As a public service I have registered ScienceRollSearch.com and forwarded it to Bertalan's search engine.  This will make it a bit easier for all of us to remember :)

Researcher Issued Patent for Virtual Telemicroscope

Newswise Medical News reports Researcher Issued Patent for Virtual Telemicroscope.

"Virginia M. Anderson, MD, associate professor of pathology at SUNY Downstate, and Jiang Gu, MD, PhD, dean and chairman of pathology at Peking University, developed the virtual microscope system, the only one of its kind capable of emailing electronic slides. Using their patent, the Chinese company Motic – a global leader in microscope manufacturing -- created a microscope with a robotic stage that scans whole slides at various magnifications and then creates compressed images that can be emailed all over the world.

“The Motic telepathology system utilizes a computer and microscope, which enables interactive communication on a user network. A robot scans the whole tissue sample on the microscope. Subsequent images corresponding to the selected area of the specimen are linked at higher magnifications. The patented software turns an ordinary computer into a virtual microscope. High magnification images are compressed and linked to the low power scanned glass slide that is stored as a virtual slide file. Images can then be emailed and analyzed by pathologists at remote locations. Once received, Internet independent images can be stored and viewed as part of the electronic medical record or medical student teaching file.

“The virtual telemicroscope is designed the way pathologists think and work,” Dr. Anderson says, adding, “A pathologist would never scan an entire histopathologic section at high power. This is inefficient and unnecessary. Slides prepared by an experienced pathologist will focus on important areas to make a diagnosis.”

Interesting...  My own view differs from the statement I've highlighted in green; our experience at Aperio has been that scanning the whole slide at high resolution is better than using a valuable Pathologist's time to identify the regions which are significant, and then scan just those regions. 

bringing Digital Pathology to life

Tonight I was reading a detailed report from one of Aperio's channel managers.  Included was a link to a demo site hosted by Nippon Roper, our Japanese distributor:

http://aperio.dip.jp:82/

Naturally I poked around a bit, and was pleased to note the remote viewing performance was quite good.

As I was sitting here viewing these slides from some server in Japan, I suddenly got chills. These are actual Japanese Pathology slides, real data, scanned on the other side of the Earth using our instruments, hosted on the other side of the Earth using our software, and I’m able to view these images right here, at my desk in my house. How cool is that?

This is really incredible. This is the vision that drove Aperio from the beginning, and we are making it a reality.

Matching and Choosing a Specialty

The fascinating Medicine from the Trenches blog features a nice post: Matching and Choosing a Specialty.

"Pathology tends to appeal to individuals who love to study tissues and medical problems. Pathologists do not treat inpatients and pathologists perform few procedures other than those pathologists who subspecialize in tissue banking and transfusion medicine. If study and evaluation of tissues and medical problems are appealing to you, look into pathology.

Sounds right to me.  Also if you want the priviledge and responsibility of making the majority of diagnosis and really directing patient care for many serious diseases such as cancer...

Digital Pathology Blog hosting Medicine 2.0

Keith Kaplan's Digital Pathology blog is hosting the Medicine 2.0 Blog Carnival on April 13, and is soliciting your suggestions... 

"Web 2.0, the new generation of web services, will (and already is playing) play an important role in the future of medicine. These web tools, expert-based community sites, medical blogs and wikis can ease the work of physicians, scientists, medical students or medical librarians.

"We believe that the new generation of web services will change the way medicine is practiced and healthcare is delivered.

If you have anything interesting for him, please let him know!

Canadian Association of Pathologists - Case of the Month - Take the Challenge!

My colleague Doug Tkachuk at Objective Pathology in Canada just emailed about the post below regarding the high error rates of IHC interpretation in Canadian pathology labs.  He comments:

"We are getting front page news like this almost weekly in Canada about lack of QA in pathologic diagnosis of common cancers (H&E, ihc, fish) with several high profile legal cases going on across the country. This news is one reason our programs in continuing medical education are booming both here and in other countries. We have data showing miscalls approaching 25% among board-certified pathologists in Canada in prostate cancer and neoplastic colonic polyps.

It's all about bringing the word "Objective" into the diagnosis of cancer!

Objective Pathology hosts a "Case of the Month" for the Canadian Association of Pathologists.  Here's this months' cases: Colonic Polyps.  Click through and see if you can diagnose them!

Oh Canada: Hospital labs need major fix, medical groups say

The Canadian Globe and Mail reports: Hospital labs need major fix, medical groups say.

"Major Canadian medical organizations and pathologists from the country's largest hospitals are calling for an immediate overhaul of the way laboratories handle medical tests to prevent more patients from dying unnecessarily.

"Their urgent call for action is being issued in the wake of a breast cancer screening scandal in St. John's that is the subject of judicial inquiry set to begin this week.

"Critical shortages of staff, inconsistent methods of interpretation and the absence of provincial or national standards are compromising the ability of some pathologists in labs across the country to catch mistakes or recognize incorrect diagnoses before it's too late, according to physicians leading the charge for change.

This is a key issue worldwide; standardizing on a rigorous quantitative application to perform IHC scoring would be a great step in the right direction.

Master protein for tumor growth

The Scientist reports Master protein for tumor growth.

Researchers have identified a master protein that regulates some 1,000 genes controlling for tumor growth and metastasis in breast cancer, according to a paper published today in Nature.

The researchers, led by Terumi Kohwi-Shigematsu at Lawrence Berkeley National Laboratory, stumbled upon SATB1's heightened expression while screening aggressive human breast cancer tumor samples. Surprisingly, they found that SATB1 is only expressed in aggressive tumors. "SATB1 is a gene organizer, a regulator of a large body of genes," Kohwi-Shigematsu told The Scientist. "Almost 1,000 genes changed expression with SATB1 expressed."

Fascinating and very promising.

P.S. It's cute the way paper 'zines like The Scientist are taking baby steps to the web.  They are confused between blog and post - they call individual posts "blogs" - but they're trying...  And in the meantime we get this kind of information more often than monthly.

Bigger monitors = more productivity

The Wall Street Journal: Bigger monitors = more productivity.

"Researchers at the University of Utah tested how quickly people performed tasks like editing a document and copying numbers between spreadsheets while using different computer configurations: one with an 18-inch monitor, one with a 24-inch monitor and with two 20-inch monitors. Their finding: People using the 24-inch screen completed the tasks 52% faster than people who used the 18-inch monitor; people who used the two 20-inch monitors were 44% faster than those with the 18-inch ones."

This applies equally to digital pathology and software development; in my experience bigger better monitors are a cheap way to help people be more productive...