Pathologists Pay Heed! New Spectroscopy Technique May Make Prostate Biopsy Obsol

[Unty]

Mass General researchers use metabolomic imaging to accurately diagnose tumors

Pathology laboratories may soon find it possible to identify prostate cancer without a biopsy. A new technology under development at Massachusetts General Hospital demonstrates the potential to improve the accuracy of prostate cancer diagnosis. Some studies have demonstrated that nearly a quarter of initial biopsies of the prostate gland may generate false-negative results because the biopsy specimen failed to extract cells from existing cancerous tumors.

To improve the detection of prostate cancer, researchers at Massachusetts General Hospital (MGH) are investigating a new technique that may give doctors a way to locate even small tumors and to provide an accurate determination of a prostate tumor’s prognosis without using a biopsy.



These are prostate cancer cells as imaged with electron microscopy and artificial colors. (© Cancer Research UK, Electron Microscopy Unit)
In a report published in the January 27 online issue of Science Translational Medicine, the MGH researchers say they are using spectroscopic analysis of the biochemical makeup of prostate glands to map the location and size of prostate tumors. Though the technique is still in the developmental stage, they hope to move the technique to clinical trials within two years.

The study’s senior author is Leo L. Cheng, M.P.P., Ph.D., who is Assistant Professor of Radiology and Pathology at Harvard Medical School. He works in the MGH Imaging and Pathology departments.

In the published study, researchers described how metabolomic imaging utilizing a clinical magnetic resonance scanner helped them locate tumors in prostate glands previously removed from cancer patients.

The research builds on a 2005 study in which Cheng and his colleagues found that magnetic resonance spectroscopy could distinguish prostate cancer from benign tissue. Using a malignancy index extracted from the spectroscopy information, researchers were also able to more accurately forecast of a tumor’s prognosis than traditional pathology studies.

According to an abstract of the new study on the Science Translational Medicine website, “This calculated malignancy index is linearly correlated with lesion size and demonstrates a 93 to 97% overall accuracy for detecting the presence of prostate cancer lesions, suggesting the potential clinical utility of this approach.”

An article in the February 1 issue of Science Daily quoted Cheng, saying, “Collectively analyzing all the metabolites measurable with a 7-Tesla MR scanner maps out prostate cancer in a way that cannot be achieved by any other current radiological test or by analyzing changes in a single metabolite. It detects tumors that cannot be found with other imaging approaches and may give us information that can help determine the best course of treatment.”

Pathologists will recognize how this technology may radically change the way prostate cancer is diagnosed. It could significantly reduce the need for a prostate biopsy and perhaps eventually make the procedure obsolete. Current estimates are that about one million prostate biopsies are done each year in the United States. Prostate biopsies represent a significant part of the test volume for many clinical pathology laboratories. A significant decline in the number of prostate biopsies collected annually would dramatically alter the work flow and revenue base for many pathology laboratories.

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[Sulfinator]

Well, I'm not sure how quickly this kind of approach would be applied, even if it does eventually prove to be superior to current methods. But if it does, and if it really translates into "better patient care," then I'm all for it. These are the kind of diagnostic innovations that pathologists need to be spearheading themselves.

 

[pathstudent]

Well, I'm not sure how quickly this kind of approach would be applied, even if it does eventually prove to be superior to current methods. But if it does, and if it really translates into "better patient care," then I'm all for it. These are the kind of diagnostic innovations that pathologists need to be spearheading themselves.

Yeah but this sounds like it will be a new revenue source for radiologists and academic radiology departments. But at least it will screw over urologists who have been making up to 1000 per case for pathology TC/PC.

 

[Sulfinator]

Yeah but this sounds like it will be a new revenue source for radiologists and academic radiology departments.

Which is why pathologists and pathology departments need to be more proactive about developing these new technologies on their own turf before other medical entities beat them to it.

 

[NoMystery]

People said the same about molecular pathology, just a decade ago, that "it is not practical, etc etc..." One way or another, these new technologies will change our practice. Say this procedure gives you a risk-assessment with a confidence value of only 90%, you combine that with patient's age, general health status, expectation, risks associated with treatment, you will end up with a good number of patients with whom a biopsy won't matter. So of course, the number will go down.

 

[Parts Unknown]

If I had a nickel.

The literature is loaded with "best thing since sliced bread" research. Given that researchers have to justify/sell their work, they have an interest in pumping up cutting edge technologies and techniques.

Of course, over time the downsides will gradually emerge. Perhaps it's not even remotely cost effective, or the real world sensitivity/specificity isn't quite what they are billing, or the findings generated by the new technology won't significantly change treatment patterns or outcome data. Five years ago it sounded like MALDI-TOF or SELDI-TOF was going to make us all obsolete, but we're still here.

I'm sure we have all seen when a new highly sensitive and specific immunostain gets reported, and then over time people begin to discover cross-reactive staining, or lesions that should stain but don't, and the figures have to be revised. Eventually the utility of the new stain settles wherever it should be. So it will be with metabolomic imaging.

 

[2121115]

Honestly, if prostate biopsies were made obsolete many community pathologists wouldn't notice the difference since they don't see them now anyway right? Urologist incomes would take a big hit though... that is unless they find a way to employ their own radiologist.

 

[Gene_]

I would love for prostate biopsies to go away. They are tedious. But, for the reasons mentioned above, I'm not getting my hopes up.

 

[yaah]

Wasn't there something about a new spectroscopic technique that could visualize dysplastic nevi and melanomas as accurately as biopsy, that was going to eliminate the need for pathology? And new super endoscopy cameras that allow clinicians do diagnose polyps and inflammatory conditions without biopsy? And of course all the molecular tests that obviate the need for cytology?

OF COURSE it is possible that new technologies will replace biopsy eventually, it is actually probable. But changes are slow to come and when they do they will be integrated with traditional methods for many years. People are still doing bone marrow biopsies for CML, after all.

It is in the pathologist's interest to be very aware of these new techniques and tests and help implement them and integrate them if they become clinically useful. But biopsies are not going to suddenly go away.

FYI when you quote something or repost it as above in the OP, you should indicate the source. This is from the Dark Report.