College of American Pathologists
Printable Version

  At Molecular Summit, mix and match diagnostics


CAP Today



January 2008
Feature Story

Anne Ford

The current buzz about integrating in vitro and in vivo diagnostics raises questions for laboratorians: Can radiology and pathology departments join forces and, if so, how? Will the role of surgical biopsy and other traditional anatomic pathology tools diminish? Just how will the integration of molecular imaging, molecular diagnostics, and informatics take place, anyway?

But the question uppermost in the minds of the patients who come in for breast imaging under the auspices of Heidi Umphrey, MD, chief resident in radiology at the University of Alabama, Birmingham, is: How long will I have to wait for my biopsy results?

That’s where the dual expertise of Dr. Umphrey, who is already boarded in anatomic pathology, comes in handy—and where the integration of in vitro and in vivo plays out at the patient level. She can give mammography patients “sort of a preview of what to expect,” she says. “When patients are in the clinic, we can go ahead and give the patient a rapid interpretation of their cytology, and that gives the patient a preview of what their biopsy may show, which can alleviate some of the anxiety of waiting two to three days for biopsy results.”

Dr. Umphrey will discuss this and other ways that her pathology training has enhanced her radiology residency, and how she plans to integrate the two fields in her academic career, at a new conference, “Molecular Summit 2008: In Vivo and In Vitro Integration.” About 150 attendees are expected to gather in Philadelphia Feb. 5–6 to hear her and more than two dozen other radiologists, pathologists, and laboratory industry leaders from around the world speak on the future of in vivo and in vitro diagnostic integration.

In her talk, “Generation X Integrates Radiology and Pathology in Dual-Specialty Practice,” Dr. Umphrey plans to convey her enthusiasm for the new technology and improved imaging techniques that are helping to merge the fields. “As our imaging has improved and continues to improve, we can incorporate our pathologic knowledge better, thereby integrating the two fields,” she says.

“For example, we’re no longer just measuring size or volume changes to determine tumor response to neoadjuvant therapy. Now we’re integrating MR enhancement and plan to evaluate the roles of MR spectroscopy, microbubble ultrasound contrast, and diffusion imaging to determine whether someone has a rapid response to therapy.”

In addition, she’ll discuss cases in which she has combined her pathology and radiology skills to come up with better diagnoses: “While I think surgical pathology contributes tremendously, imaging advances in radiology are rapidly progressing and may eventually lead to integration of these fields, and I think you really need to have a good understanding of both to be successful.”

Dr. Umphrey became interested in imaging during her neuropathology training. A neurosurgical biopsy revealed gliosis, yet the targeted tissue was a ring-enhancing lesion. The imaging findings were discordant with the biopsy results, and a repeat biopsy revealed a cerebral abscess. She says, “It was this case that solidified my belief that an excellent knowledge of imaging and pathology would provide the best patient care.” She also felt that the advancements in imaging and proteomics would lead to imaging techniques that make it possible for physicians to accurately diagnose and determine extent of disease, monitor therapy delivery, and evaluate patient response.

Of course, the length of time it would take to train in both fields, as Dr. Umphrey has, is a problem. She suggests designing a program that integrates both fields but can be completed within five years. “It might require developing a training program that incorporated more proteomics into radiology or more radiology into anatomic pathology—or maybe a directed molecular imaging fellowship that is organ system specific,” she says.

Presented by The Dark Report, the conference is the brainchild of the newsletter’s editor, Robert Michel. It sprang, he says, from a question he’s been asking pathologists around the country for the last few years: “Is there a pathology group in the United States that is working with the radiology group in its hospital to provide integrated reports that show imaging and pathology results, at least for certain kinds of cases?”

“I’ve never yet found someone [in the U.S.] who says, ‘Oh yeah, we’re doing that,’” Michel says. But he’s holding out hope that at the Molecular Summit, he’ll hear a different answer. “What happens with a meeting like this is, people register and show up, and they’re doing things in their own lab that no one knew about,” he says. “They raise their hands and say, ‘Hey, I’ve been doing this for five years.’”

To Michel’s knowledge this is the first meeting that will bring radiologists and pathologists together to talk about how they’re using molecular technologies in their specialties. When inviting speakers, Michel’s chief objective was to “identify radiology groups and pathology groups that would be considered first movers in their respective use of molecular imaging and molecular diagnostics.”

One of those first movers is Jose Marcelo A. de Oliveira, MD, PhD, the diagnostic center director of Laboratorio Fleury, Sao Paulo, Brazil, who will present a case study on his organization’s integration of radiology, pathology, and informatics. Laboratorio Fleury, Michel says, “is an outstanding example of how a clinical laboratory can meld imaging and radiology services into an integrated, unified diagnostic report. They’ve been doing this for 10 years in a variety of clinical procedures. Fleury’s largest blood collection center in downtown Sao Paulo draws 2,000 patients per day. This same collection center includes a full range of imaging diagnostics, such as X-ray, PET, CAT scans, mammograms, sonograms, and ultrasounds, because Fleury is offering patients and their physicians a one-stop opportunity for diagnostic procedures. “This will be a great case study for pathologists and laboratorians who would like to see how a laboratory can put integration of imaging and laboratory medicine together,” he says.

Another hot topic, Michel says, will be addressed by Thomas Miller, a member of Siemens AG Medical Solutions Group’s executive management board, who will discuss his company’s vision for how the integration of molecular imaging, molecular diagnostics, and informatics will lead to presymptomatic diagnosis and treatment. “This will be the first time an executive of this level within Siemens lays out the integration story in detail,” Michel says. An additional industry representative, Caroline Kovak, PhD, managing director of San Francisco-based Burrill and Co., will present a talk titled “Strategic Directions for Genomic Medicine and Molecular-Based Diagnostics.”

Among the other speakers will be Bruce Friedman, MD, professor emeritus of pathology at the University of Michigan Medical Center, Ann Arbor; Daniel Farkas, PhD, executive director of the Center for Molecular Medicine, Grand Rapids, Mich.; Daniel Chan, MD, PhD, professor and director of the Biomarker Discovery Center at Johns Hopkins Medical Center; and King Li, MD, the M.D. Anderson Distinguished Chair in Radiology and Imaging Sciences and chair, Department of Radiology, The Methodist Hospital, Houston.

The conference is likely to reveal how far the field has to go, Michel says. “At the conclusion of Molecular Summit 2008, we’re likely to have a very good idea of where some obvious opportunities exist for radiology and pathology to collaborate in molecular medicine. We’re also likely to have a great appreciation of how little progress has been made. Nobody’s very far into this.” Then again, he finishes, “we may have some surprise outcomes.”

Anne Ford is a writer in Chicago.