Quicker Biopsy Results with New Tissue-Scanning System
Jane Erikson · Oncology Times · 2005
TUCSON, AZ—In a state of vast rural areas, a higher-than-average rate of uninsured, and a lower-than-average rate of physicians per capita, the Arizona Telemedicine Program has earned national recognition for bringing state-of-the-art care to people who otherwise would go without. For the past five years, for example, the University of Arizona (UA)-based program began offering same-day digital mammogram reports—usually within one or two hours—to Native American women in the northern part of Arizona, where significant numbers of people live without phones. Now scientists with the telemedicine program and the UA Optical Sciences Center have developed a way to provide faster, better care for women undergoing breast biopsy: A new tissue-scanning system that has shortened the time from biopsy to diagnosis to four hours or less. The DMetrix Virtual Slide Imaging System was first used here in a proof-of-concept demonstration in May, when UA doctors used it to give a 37-year-old Tucson woman the good news that she did not have breast cancer—four hours and 13 minutes after she walked into the clinic where her surgical biopsy was performed. The system—used in combination with existing microwave tissue processors—can be used as part of a local operation or linked through telemedicine to remote sites. ‘Disassociate Lab from Pathologist’ “We can disassociate the lab from the pathologist,” said Ronald S. Weinstein, MD, who is the UA head of pathology and a founder of both the Arizona Telemedicine Program and DMetrix. “The pathologist no longer has to run downstairs or drive across town. All you need is access to the Internet.” Of the estimated one million women in the United States who undergo breast biopsies each year, most typically wait several days for their doctors to get back to them with the results. And the usual time it takes from the day a woman discovers a lump in her breast to the day she learns whether or not she has cancer ranges from 21 to 30 days, Dr. Weinstein said. “Unfortunately, the stress the patient goes through has not been identified as a metric for quality in our health care system. But for a patient waiting for a result, if it's not immediate then it might as well be impossibly long.” DMetrix, founded in 2001, bases its new imaging system on its DX-40 Array Microscope, an assembly the size of a stack of four 25-cent coins, Dr. Weinstein explained. The assembly holds 80 “nano-microscopes,” as he calls them, each about 7 mm in height, which together are capable of recording a 900-megapixel image in less than 60 seconds. The digital images can be viewed right away, stored for future viewing, or transmitted for remote viewing through a system such as the Arizona Telemedicine Program. While about 17 companies offer virtual slide imaging systems, DMetrix's “imaging in parallel” capability makes it five to 60 times faster than competing technologies, said the company's co-founder and President, Michael Descour, PhD, Director of the UA Optical Sciences Center's Biomedical Imaging and Microscopy Laboratory. R&D Magazine named the system one of the 100 most technologically significant products introduced to the marketplace during the past year. Ana Maria Lopez, MD, MPH, a women's cancer specialist with the Arizona Cancer Center and medical director of the Arizona Telemedicine Program, said she sees “great potential” for the DMetrix diagnostic system. In its first two months, it had been used to evaluate breast biopsy tissue from four women, one of whom was found to have cancer, Dr. Lopez said. Over the next year, Drs. Weinstein and Lopez said they hope to use the DMetrix system to evaluate prostate and cervical tissue samples, as well as dermatological biopsies. Question of Reimbursement John W. Craft Jr., MBA, Vice President of Prevention and Early Detection for the American Cancer Society's Great West Division, was optimistic about the technology, but noted: “In the interim, the one question I would pose has to do with reimbursement for the procedure. Like most new—and initially expensive—technologies, it may be difficult to get insurance companies to pay for this coverage initially. If it becomes a matter of the patient having to pay out-of-pocket for this service, we'll still be missing the underserved and uninsured patients.” The Arizona Telemedicine Program was started in 1996 and now connects UA doctors to more than 130 sites across the state, as well as nine regional sites in Utah, Nevada, and New Mexico and six sites in Panama. UA radiologists, for example, perform tele-radiology services for 22 hospitals in rural Arizona, including 92,000 cases last year. Significant cost savings have been documented. In 1998, the Whiteriver Hospital on the Apache Indian Reservation in eastern Arizona found that it saved more than $180,000 on air transports on 27 patients whose cervical CT scans were read by radiologists based at the University of Arizona. Additional savings have been reported by the state's corrections and behavioral health systems, which use telemedicine to provide care at local sites.