The Daily Scan

Stumbling Toward Personalized Medicine

TheScientist's editor Richard Gallagher wrote an interesting editorial in the December issue: Stumbling Toward Personalized Medicine.

Let’s remind ourselves of the three-part promise of personalized medicine. First, everyone’s genome will be sequenced cheaply and the sequence will be interpretable, and predictive. Second, the bulk of a person’s anticipated medical problems, discerned by analysis of the sequence, will be avoided by genetic, lifestyle or therapeutic means. And third, where a disease has to be treated, it will be done with medicines that are exquisitely tailored to both patient and ailment. No risk, no mess, no problem.

The reality (to date) has been dramatically different.

Of course these things never take hold as quickly or thoroughly as we'd like, but there has been progress; numerous companion diagnostics and screens have been developed, and genomic and cellular tests for a wide range of disease states are becoming available (and increasingly they make use of digital pathology, enabling accurate quantification).  The editorial does end on a more positive note:

So far we’ve stumbled forward a little on the road to personalized medicine, but it looks like the pace towards Nirvana is about to pick up.

Indeed!

CAP Today recap of FDA panel discussion on whole-slide imaging

CAT Today has a nice recap story on page one about the FDA panel discussion on whole-slide imaging.

Digital pathology recently took center stage in an FDA panel hearing on how best to regulate whole-slide digital imaging systems used for primary pathologic diagnosis. The Hematology and Pathology Devices Panel hearing on Oct. 22 and 23, in fact, tackled a number of issues the lab industry has been grappling with as digital imaging moves into the clinical realm.

The impetus for the panel meeting, surmises Yale pathologist and panel member John Sinard, MD, PhD, is that the FDA realized that the number of whole-slide digital imaging vendors, as well as pathology groups using the technology or looking into it, had reached a “critical mass.”

It's a nice balanced article which tees up many of the interesting issues which were discussed, and quotes many of the participants and Pathology thought leaders.  And me :)

Ventana to teens: Study, then come work for us

The Arizona Star has an interesting article about Ventana, who are located in Tucson, and who recently hosted a Young Scientist's Day: Ventana to teens: Study, then come work for us.

Students from Amphitheater, Canyon del Oro and Ironwood Ridge high schools in the Amphitheater Public Schools district, along with Marana and Mountain View high schools in the Marana Unified School District, attended the event. It took place at Ventana Medical Systems, 1910 E. Innovation Park Drive.

Among other things, Ventana develops and manufactures medical instruments used to diagnose cancer, such as automated devices to prepare tissue samples for microscopic analysis.

Students rotated through six hands-on activities in which they interacted with Ventana professionals. Chemistry, engineering, pathology and histology (study of tissue structure) were among the topics covered during Young Scientists Day.

How cool is that?  What a great way to get kids excited about science as a career, and maybe get some new employees in the bargain...

Webicina: PeRSSonalized Pathology

If you're looking for online resources about medicine, be sure to check out Webicina ("Practicing Medicine in the Web 2.0 Era"), and especially their listing of PeRSSonalized Pathology. 

I'm not sure how web technology will end up being used to treat patients, but it is already an invaluable way for physicians and patients to communicate and learn.

Needle biopsies safer and just about as good at diagnosing breast cancer

The LATimes has an interesting story: Needle biopsies safer and just about as good at diagnosing breast cancer, say authors of mammogram advice:

The federal government's Agency for Healthcare Research and Quality, apparently undaunted by the controversy it kicked up last month over mammograms, has waded back into the breast-cancer thicket with new advice on how best to distinguish benign breast lumps from possible malignancies. 

In a report released today, the arm of the Health and Human Services Department that is charged with comparing the effectiveness of competing medical interventions said that core-needle biopsies are just as good as the method long considered the "gold standard" of evaluating suspicious breast lesions: open surgical removal.

...

In addition to being roughly as accurate and less risky, core-needle biopsy is less costly than surgical removal and "generally is preferred by patients." And because about one in 10 women who have suspicious lumps in their breast biopsied proves to have breast cancer, the less invasive, less costly core-needle biopsy seems the better choice in most cases, the group concluded.

Huh, interesting.  An increasing number of Aperio customers are using digital pathology as a way to capture and view core needle biopsies.

"this is your cancer"

I liked this post from Keith Kaplan on pathtalk.org, "this is your cancer".  About once a year one of Keith's patients visits him and wants to see their slides.  They aren't necessarily pathologists so the images don't necessarily tell them anything specific.  And in most cases, they don't doubt the diagnosis.  Still there is something about seeing your cancer, seeing your enemy, that makes it real.  I am not a pathologist, but if I ever have cancer I would want to see mine.

I'm particularly interested in this because we've been studying the usefulness of digital pathology images for patient communications.  Of course most patients are not able to interpret slides, even less so than they are able to interpret X-rays.  But patients often like having their radiology images and sometimes carry them around with them on a disc.  You can imagine the same thing could happen in future with pathology images.  There is an attraction to the immediacy and sense of control this information gives you, even if you aren't able to interpret it yourself.

What do you think?  Will pathology images be useful to patients?

chalk tip #33: bookmarking digital slide views

I'm back with another chalk tip!  (pauses to let applause subside :)

Today's tip is simple and useful: did you know, you can easily bookmark digital slide views?  Yes, indeed, any view of a digital slide can easily be saved as a URL bookmark.  Here's a digital slide we can use as an example:

By default the slide is displayed "zoomed out" to fit the entire slide in the window.  But let's say there's a particular view we want to bookmark, like this one:

  

Position the slide to the view you want, and then click the checkmark on the toolbar.  This opens a new window which has exactly the URL needed to bookmark this view, like this:

The following link can be used as a "bookmark" for WebScope: http://images2.aperio.com/H_E 40x.svs/view.apml?X=-0.0182238266781054&Y=-0.228077872826575&zoom=25 Options for display of the bookmarked slide view: Display navigation window (thumbnail) Display toolbar Display menubar Display annotations The following link can be used as a "bookmark" for ImageScope: http://images2.aperio.com/H_E 40x.svs/is.sis?X=-0.0182238266781054&Y=-0.228077872826575&zoom=25&chost=images2.aperio.com

Go ahead and click the link, it works!

Bonus tip: this window also has a link which bookmarks the slide view for the Aperio ImageScope viewer.  Yes that's right, you can bookmark any view of any digital slide with a single URL.  How cool is that?

TheScientist reviews 2009

TheScientist present their 2009 in review (+as a PDF file) an interesting and eventful year!

It's hard to pick the most significant event, but it might well be the first; in January the FDA approved the first-ever clinical trial of a human embryonic stem cell-based therapy.  (They subsequently held it in August, but still.)  Then in February the U.S. Congress approved the $789B recovery bill, including a number of provisions for improving health care and grants to the NIH and NSF.  Wow.

And who knows what 2010 will bring? 

(my vote would be - ever increasing adoption of digital pathology :)

University Health Network for Telepathology wins innovator's award

Congratulations to the University Health Network (Toronto), and Dr. Andrew Evans and his team for winning the Cancer Council of Ontario's Innovator's Award for their implementation of telepathology.  The University Health Center uses telepathology for all their frozen sections, enabling pathologists to be across town and still deliver immediate results to surgeons. 

Another benefit of digitizing the frozen sections is that pathologists can easily consult with each other on borderline cases, even when they aren't colocated.  A great example of the value of digital pathology in clinical settings.

A paper on this implementation was published earlier this year in Human Pathology.

H. M. Recollected

The San Diego Union Tribune reports H.M. Recollected: Famous amnesic "H.M." (Henry Gustav Molaison) launches a bold new brain project at UCSD:

As best he could remember, Henry Gustav Molaison never visited San Diego, spending his entire life on the East Coast.  When he died late last year at the age of 82, Molaison was a man almost entirely unknown except by his initials H.M. and the fact that experimental brain surgery had erased his ability to form new memories.  He forgot names, places, events and faces almost immediately.  Half an hour after lunch, he couldn’t recall what he had eaten, or that he had eaten at all.  His face in the mirror was a constant surprise because he remembered only what he looked like as a young man.  Every question was new, even those asked just minutes before. 

Yet Molaison bore this strange and unimaginable burden with grace and stoicism, allowing scores of scientists to study, probe and ponder his condition for decades, each seeking to better understand the mysteries of the human brain, memory and personal identity.

Molaison died of respiratory failure on Dec. 2, 2008, but his story — and his legacy — does not end in that Connecticut nursing home. Within hours of death, Molaison’s brain would be scanned, removed and placed in the preservative formalin, the first steps on a journey to San Diego and a new kind of immortality.

Jacopo Annese (pictured above), Director of the UCSD Brain Observatory, has launched an ambitious project to slide, scan, and reconstruct H.M.'s brain in microscopic detail, enabling researchers to compare the physical structure with what is know from over 50 years of behavioral research on the same brain.

The UCSD Brain Observatory is in the process of scanning and reconstructing the entire brain as a 3D object, and is planning to use Aperio's visualization software to serve and display the results online.  We're excited to be a part of this incredible project.  Please stay tuned!