Category Archives: Advocacy

Why Digital Pathology?

Digital pathology is a dynamic environment by which glass pathology slides are converted into a digital format for viewing, sharing and archiving for later use.

Before my cancer diagnosis and trying to retrieve my pathology slides, tissue cassettes and pathology reports for second and third opinions, I, like most patients had no idea how cancer diagnoses were made and where treatment algorithms are derived from.

As a patient advocate, I was asked to speak at a Key Opinion Leader dinner for a large healthcare company involved with digital pathology. In the course of my research on pathology, histology and digital pathology technologies, I came across Dr. Keith Kaplan’s widely read and respected Digital Pathology Blog at tissuepathology.com. At the time of my research last Summer, there were 100s of articles dealing with different technologies, companies and use cases for digital pathology in both clinical and research settings in addition to a mix of Dr. Kaplan’s own observations and lessons learned being involve with digital pathology for 15 years.

They say in research “go to the source”- so I did. Through Dr. Kaplan’s blog, we originally connected on Twitter, then by phone and within a week, in person at the annual College of American Pathologists meeting in Chicago last Fall. Dr. Kaplan was speaking at the meeting on digital pathology for a luncheon seminar and invited me to listen to a presentation sponsored by Leica Biosystems.

I met representatives from Leica Biosystems, toured their booth and saw several digital pathology products, that go by the name Aperio ePathology Solutions. Attending my first pathology meeting and exhibit floor, I was impressed by not only the dedication pathologists have to their specialty but the personal stories shared by those who are in healthcare industry.

I also recognized pathologists are very much “behind the scenes” not being at the bedside, but have a very direct and important impact on patient outcomes.

Many of the people I met have a personal reason for producing, distributing, marketing and selling what they do – a close relative who had cancer, a personal battle, or the recognition they could help millions of people with their products and services.

I am honored and grateful to have this opportunity to help share information about technology that positively impacts the work of pathologists, globally, from companies such as Leica Biosystems that are providing solutions to help patients everywhere. People just like me.

What is Digital Pathology?

kjccancerCancer is evil and very inconvenient! For patients who travel to other hospitals for second and third opinions, many wish to bring or are asked to have their pathology slides with them for tumor board reviews and case discussions with the healthcare team .

As a two time breast cancer survivor, I know first-hand the difficulty with getting your pathology slides from one hospital to another for timely reviews and back to the referring hospital.

When I had to request my slides to be sent between hospitals, they were lost, which caused my case to be delayed for discussion at a tumor board, and impacted the treatment plan being devised. I found out later that with a technology called, digital pathology, this mishap was preventable and my family and I would not have experienced unnecessary stress and anxiety.

Digital pathology is the process by which glass pathology slides are converted into a digital format for viewing, sharing, and archiving for later use. It eliminates the need to physically move glass slides from one pathologist to another or from the laboratory to a pathologist. Furthermore, pathologists from all over the country can share cases together to help ensure the best outcomes for patients.

Digital pathology has been shown to be 94% faster than courier systems alone. Have you ever had to call FedEx and ask “Do you have my tumor?”

How is it possible that I have all my other medical records and imaging studies but perhaps the most crucial piece of the puzzle – my pathology slides – are not where they need to be? And potentially the slides are lost, never sent or never received!

Companies such as Leica Biosystems with their Aperio ePathology Solutions have developed digital pathology to break down these obstacles, creating images that are replicates of the glass slides for easier shared viewing and allowing the primary hospital to retain their glass slides in their files. This is good news for referring doctors, consulting doctors, other healthcare providers and most of all US. Patients can now have access to specialists regardless of where they live and the time of dayallowing minimizing the anxiety and uncertainty during this initial reviewand suggested treatment recommendations.

Digital pathology is essential for patients and their families. The time is now for us to educate patients, and to allow this vision to move forward to benefit all parties involved. I will continue to advocate for this leading-edge technology and encourage you to ask your healthcare team how you can take your pathology slides and have them digitized. Please follow my subsequent posts to better understand the value and benefit of digital pathology for patients and families.

Second Look Alters 20% of Breast Biopsy Conclusions

second-opinionMedscape Medical News recently published an article with the above title about a study from Roswell Park Cancer Institute showing that 20% of cases examined there resulted in a change from the prior diagnosis.

This comes on the heels of a recent JAMA study that has been widely discussed in the pathology and popular press about the discordance among practicing pathologists in primary breast diagnosis.

I think the bottom line here is that review of pathology slides can have a significant impact on patient care and you owe it to yourself to insure that a breast specialist or second opinion from an individual/institution with expertise reviews your slides.

The second opinion about a suspected breast cancer should be in the form of an “interinstitutional pathology consultation” (IPC) that includes a review by a specialized breast pathologist, the authors say.

“Specialized pathology is very important these days because there are so many advances in the field of pathology, and if you are not specialized, you will miss many of the new technologies and morphologies, new entities, etc, etc,” author Thaer Khoury, MD, from Roswell Park Cancer Institute, Buffalo, New York, told Medscape Medical News.

In his study, a second look at the pathologic samples from needle biopsies that were sent to Roswell Park by outside institutions resulted in a change in 20% of the cases that were examined.

“These results underscore the need for a second review of the original pathologic material by a pathologist who specializes in breast cancer prior to the implementation of breast cancer therapy,” he said.

The study was published online April 15 in the Breast Journal.

“At Roswell Park Cancer Institute, it is a routine practice to review the outside pathology slides and reports of all patients referred from different health institutions for further treatment,” Dr Khoury said.

“This type of review is a required part of our quality assurance policy, but it has never been formally evaluated in terms of the discordance rate and the subsequent clinical impact on patient care.”

Consequently, Dr Khoury and colleague Yousef Soofi, MD, sought to evaluate the impact of IPC for breast core needle biopsies received at their institution.

They retrospectively reviewed 502 breast core biopsy cases provided by referring institutions during a 1-year period (2012).

Surgical pathology follow-up was available for 25 (62.5%) cases with major discordance and for 13 (20.3%) cases with minor discordance.

The resulting interpretation changed management in 15 patients (3%); 25 patients (5%) had a potential of management change.

The most common reason for major discordance was in interpreting biomarkers, such as the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor type 2 (HER- 2).

Breast J. Published online April 15, 2015. Abstract

Diagnosis in Eye of Beholder and the ‘Rita Wilson’ Effect

Since Angelina Jolie’s public statements about her testing for BRCA and subsequent surgeries including bilateral mastectomies and removal of her fallopian tubes and ovaries, many oncologists and laboratories have mentioned reports of an increase in BRCA testing across North America. Her awareness of her personal health and potential risk combined with her celebrity status raised awareness of need for early diagnosis and treatment. This is part of the ‘Angelina Jolie’ effect.

Another star, Rita Wilson, has also made headlines recently with her own call to action about the need for second opinions in breast pathology if you have a biopsy. According to one pathology blog, Dr. Keith Kaplan mentions the need for some form of second opinion in questionable cases to ensure patient safety and quality. Pathologists have many quality assurance processes in place and collaborate with one another on challenging cases. Check out this resource on Understanding Your Pathology Report.”

Yesterday I read a post from Dr. Susan Love on The Huffington Post that detail a little more than initial reports about Rita Wilson’s own breast cancer journey.

The takeaway message from Ms. Wilson’s situation is this: Individuals read pathology slides. And the diagnosis is often in the eye of the beholder. We encourage second opinions about treatment, but most people don’t realize that when they ask for a second opinion on the diagnosis, the opinion should be based on examination of the actual biopsy slides, not simply the original pathology report. Some cases are clear-cut but if there is any question, the more eyes looking at the tissue, the more accurate the diagnosis, and the more confident a woman can feel in the decisions she makes.

Too often, celebrities who publicly share their health stories leave out key information, which in turn can cause confusion and sometimes stimulate people to take action that may not be necessary or advised. We applaud Ms. Wilson’s willingness to include the details of her specific situation so that other women can better understand the rationale that drove her personal treatment decision.

Having traveled to many hospitals and cancer centers, I know this process all too well with many delays by both the referring and receiving hospitals to get my slides for review. I would also like to leverage the future vision of digital pathology that can help all of us ensure that our slides are read accurately and in a short amount of time by many pathologists. This technology can make the diagnostic process much easier for patients as well. The time is now for second opinions enabled by digital pathology.

Who is ready to stand alongside of me to make it happen?

Is My Breast Biopsy Being Read Accurately?

This might be a question several patients find themselves asking in light of a recent study published in a recognized prestigious medical journal.

The accuracy of pathology diagnoses of breast biopsy results was recently called into question in the study published in the March 17, 2015, issue of the Journal of the American Medical Association (JAMA). Researchers reported that practicing pathologists incorrectly diagnosed nearly 25% of breast biopsies presented to them in a test study.

These findings did not go unnoticed by the national media. On the same date the study was published, The New York Times ran a headline referring to “room for doubt” among breast biopsies with a PBS NewsHour video by the same name.

I think that it is important for patients and the public to know that by design, the study itself is not an accurate reflection of what happens in “real world” clinical practice of pathology. It is a very common practice for pathologists to obtain second opinions in difficult cases such as ductal carcinoma in-situ (DCIS) and atypical hyperplasia to avoid both under- and over-interpretation. The participating study pathologists were only presented a single glass slide without the ability to “show the case” to others or obtain stains that are sometimes used to diagnosis breast biopsies accurately.

If a woman (or man) receives a diagnosis of DCIS or atypia, they may consider getting a second opinion to ensure there is no invasive cancer. Because DCIS and atypical ductal hyperplasia do not represent invasive cancer, patients have time to make informed decisions about their health, including time to obtain a second opinion.

There are several options patients can take to help ensure their breast biopsy is read accurately. Here a few:

  • Ask if the laboratory that will examine your tissue sample is accredited by the College of American Pathologists (CAP). The CAP accredits thousands of laboratories worldwide and provides an online directory for patients.
  • Make sure the pathologists who are examining your tissue sample are board-certified.
  • Find out if the hospital has a multidisciplinary breast conference or “breast tumor board”. These are teams of physicians and other health care professionals that meet regularly to discuss diagnosis and management of patients with breast disease, guaranteeing more consultation about the best approach for your care.
  • If your hospital doesn’t have a multidisciplinary breast conference, consider getting a second opinion. Have your doctor send the biopsy slides to another laboratory and request they be read by a pathologist who specializes in breast pathology.
  • As you seek out additional clinical opinions be sure to request your slides be reviewed at the other hospitals. Pathologists can use technologies such as digital pathology to make available your slides to be viewed with several pathologists in many hospitals for timely and accurate diagnoses.
  • Seek out accurate and credible resources to help you understand your pathology report and diagnosis, such as the CAP’s resource, “How to Read Your Pathology Report“.

If you have questions, pathologists are willing to speak and meet with patients about your diagnosis and how your biopsy sample is processed and reviewed.

As with any biopsy sample, be sure to get a copy of your pathology report and use resources such as those from CAP to insure your laboratory and pathologist have the resources to provide you the best possible care.

Understanding Your Pathology Report: A Patient’s Story

Honored to share my story in this video produced by the College of American Pathologists (CAP) to help advise patients on engaging with their pathologists and the importance of understanding their pathology reports. Drs. Carey August and Keith Kaplan, practicing pathologists, describe how pathologists generate a pathology report and interact with the patient’s care team, such as Dr. Rosalinda Alvarado, to formulate a treatment plan. Be sure to ask for a copy of your pathology report and ask for the opportunity to review it with your pathologist. These doctors do amazing work everyday and the reports they generate are critical to formulating your treatment plan. Be your own best advocate!