The

Laboratory Report Spring 2012

A Publication of the Department of Pathology and Genomic Medicine

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Drs. Mary Schwartz and Philip Cagle Named Texas Super Doctors

Methodist Pathology Leads Medicine with New Gene Sequencing Instrumentation

Department and College of American Pathologists Help Women in Need

New Diagnostic Test Offerings

In Focus: The Hematopathology Team

Lab Stats: Methodist Willowbrook Hospital

Department Trainees Win Awards at Texas Society of Pathologists Annual Meeting

Trainee Spotlight

Table of Contents

T he Department of Pathol-

ogy and Genomic Medi-

cine will implement new

digital pathology technology into

specific Department clinical

services in 2012.

“Digital pathology is one com-

ponent of the next generation of

pathology, and Methodist is one

of the first hospital systems in

the region to implement it,” said

Dr. Michael Thrall, medical direc-

tor of digital pathology for the Depart-

ment. “This technology presents a valu-

able tool and will assist the Department

not only in patient care, but also with

teaching our residents and fellows.”

The many current uses for digital

Department Launches Digital Pathology in 2012

images in pathology include making

primary diagnoses, consulting for second

opinions, facilitating telepathology

(teleconferencing with images), archiv-

ing, education, and image analysis.

The Department has acquired iScan

Coreo Au brightfield scanners

and related Virtuoso application

software. Under the direction of

Dr. Thrall, whole slide imaging

(WSI) technology will be imple-

mented between January and

March of this year. WSI involves

the digitization of glass slides

into high-resolution images. The

WSI capabilities will initially be

used to facilitate consultations

between pathologists at our Texas

Medical Center hospital and the outlying

hospitals. For more information on digital pathol-ogy at Methodist, please contact Dr.

Michael Thrall at mjthrall@tmhs.org.

Dr. Michael Thrall using the iScan Coreo Au brightfield scanner.

Houston Lung Symposium The Methodist Hospital Research Institute

April 28-29, 2012

Have you registered yet? Spaces for the

symposium and the Harlan J. Spjut Award

Dinner are limited! Click here to register now.

Save the Date: Dr. Donna Hansel of The Cleveland Clinic will

present at the Department of Pathology and Genomic Medi-

cine Grand Rounds on April 3, 2012. She will speak about the

molecular correlates of bladder cancer variants. For more in-

formation on Department Grand Rounds, visit method-

isthealth.com/pathologygrandrounds.

Donna E. Hansel, M.D., Ph.D.

CAP ‘12 THE Pathologists’ Meeting:

The annual meeting of the College of

American Pathologists will be held

from September 9-12, 2012 at the

Manchester Grand Hyatt in San

Diego, California. Register now at

cap.org/annual_meeting/2012.

The

LABORATORY REPORT

2

Methodist Pathology Leads Medicine with New Gene Sequencing Instrumentation

T he Molecular Diag-

nostics Laboratory

of The Methodist

Hospital System has ac-

quired three new next-

generation sequencing in-

struments: the Ion Torrent

Personal Genome Machine

(PGM) from Life Technolo-

gies, the MiSeq Personal

Sequencer from Illumina,

and the MassARRAY

Analyzer 4 from Sequenom.

“These are game-changing

diagnostic instruments,” said

Dr. Randall Olsen, medical director of the

Molecular Diagnostics Laboratory. “This

technology enables us to rapidly generate

accurate diagnoses and provide crucial

prognostic and therapeutic information.

These instruments will significantly im-

pact patient care in The Methodist Hospi-

tal System and other institutions served

by our reference laboratory.”

The molecular diagnostics team, includ-

ing our molecular genetic pathology fel-

low Dr. Amanda Peterson and clinical

chemistry fellow Dr. Irene Shu,

Drs. Mary Schwartz and Philip Cagle Named Texas Super Doctors

“It is an honor to be on the list with my

good friend and long-time colleague, Phil

Cagle,” said Dr. Schwartz, medical direc-

tor of anatomic pathology for the

Department and the 2010 Lifetime

Achievement Award recipient of the Col-

lege of American Pathologists.

“I am proud to be on the list with Mary

and so many others from Methodist,”

said Dr. Cagle, medical director of pul-

monary pathology for the Department

and editor-in-chief of Archives of Pathology

and Laboratory Medicine. “I hope to see

more of our pathologists on the list in

2012.”

Key Professional Media employs a rig-

orous multi-step process designed to

identify physicians, usually in consumer-

D rs. Mary Schwartz and Philip

Cagle were both selected as

Super Doctors for the Texas list

published in the December 2011 issue of

Texas Monthly Magazine. The Super

Doctors list identifies top doctors as se-

lected by their peers and the independent

research of Key Professional Media, Inc.

underwent intensive training for these

instruments.

The Ion Torrent PGM brings semicon-

ductor technology to DNA sequencing. It

is the fastest benchtop sequencer avail-

able and ideally suited for rapid, whole-

genome sequencing of individual strains

of bacteria. In comparison, the MiSeq

instrument uses sequencing by synthesis

technology and is capable of sequencing

the genomes of multiple strains of bacte-

ria in a single run. Both can be used for

highly multiplexed amplicon sequencing.

The MassARRAY Ana-

lyzer uses mass spectrome-

try for genetic analysis. It

is capable of high-

throughput genotyping of

patient samples and will

be used to develop a com-

prehensive tumor muta-

tion panel.

For more information on

genetic testing at Method-

ist, please contact

Dr. Randall Olsen at

rjolsen@tmhs.org. Dr. Olsen (far right) trains residents, fellows, and technologists on the new Sequenom.

oriented medical specialties, who have

attained a high degree of peer recognition

and professional achievement.

For more information on Dr. Mary

Schwartz, visit methodisthealth.com/

Schwartz. For more information on Dr.

Philip Cagle, visit methodisthealth.com/

Cagle.

Mary R. Schwartz, M.D. Philip T. Cagle, M.D.

The Ion Torrent PGM.

The

LABORATORY REPORT

results could be transmitted

back to the community center

the same day. Bilingual faculty

and residents presented health

information sessions to the

patients in both English and

Spanish as they waited for

their test results. In total, the

Department performed 187

Papanicolaou tests and 5

breast fine-needle aspiration

biopsies.

The College of American

Pathologists’ See, Test, and Treat

program is unique in that it offers

same-day screening, diagnoses,

and follow-up care. To date, the

program has screened more than

1,000 women at sponsored events across

the country.

For more information on the See, Test,

and Treat program, visit founda-

tion.cap.org.

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Department and College of American Pathologists Help Women In Need

T he Methodist Depart-

ments of Pathology

and Genomic Medi-

cine and Obstetrics and Gyne-

cology partnered with the

College of American Patholo-

gists and Dia de la Mujer

Latina on January 21st for the

College’s See, Test, and Treat

program event in Houston.

The program, which provides

free cervical and breast cancer

screening to uninsured and

underinsured women, is in its 11th

year.

“See, Test, and Treat is an impor-

tant program,” said Dr. Dina

Mody, medical director of cytopa-

thology for the Department. “There are

thousands of women in the greater Hous-

ton area that don’t have medical insur-

ance or access to these testing and con-

sult services. Through this event, they get

it all in one day.”

Sixteen volunteers from the Depart-

ment of Pathology and Genomic

Medicine, including faculty, trainees, labo-

ratory technologists, and family members,

participated in the day-long event at the

Southwest Multi-Service Center in south-

west Houston and the Cytopathology

Laboratory at The Methodist Hospital.

Patient specimens were immediately deliv-

ered to the Cytopathology Laboratory at

Methodist for evaluation so that the

Serum Beta-Hydroxybutyrate Assay

A s of February 1, The Methodist

Hospital Core Laboratory re-

placed the semi-quantitative

serum acetone test with a quantitative

enzymatic serum beta-hydroxybutyrate

assay. Due to a national shortage of re-

agents, the acetone test will no longer be

performed. Please order the beta-

hydroxybutyrate (synonyms Ketone and

Serum Ketone) for diagnosing or moni-

toring diabetic ketoacidosis.

Beta-hydroxybutyrate is the most abun-

dant ketone body in the blood; acetoace-

tic acid and acetone are produced in

Department volunteers at See, Test, and Treat. From left, Laboratory

Technician Cassandra Miles, Dr. Dina Mody, Senior Cytotechnologist

Liza DiFilippo, Chief Cytotechnologist Deborah Smith, and Cytotech-

nologist Specialist Bakula Dhurandhar.

New Diagnostic Test Offerings:

smaller amounts. Please note that the old

nitroprusside dipstick method does not

react with beta-hydroxybutyrate, there-

fore, the results of the acetone test do not

always correlate with the results of the

beta-hydroxybutyrate assay. Normal beta

-hydroxybutyrate levels are ≤0.3 mmol/L

and are typically >2.0 mmol/L in patients

with ketoacidosis. The beta-

hydroxybutyrate test is available 24/7.

If you have any questions or concerns,

please call Dr. Ping Wang at 713-441-

3294 or Toni Emmott at 713-441-1861.

Molecular structure of beta-hydroxybutyrate.

The

LABORATORY REPORT

4

In Focus: The Hematopathology Team

H ematopathology is the subspe-

cialty of pathology that studies

the diseases of hematopoietic

cells. These diseases can be hereditary

(bone marrow failure syndromes, pri-

mary immune deficiency syndromes) or

acquired (nutritional deficiencies, infec-

tions, cancers). The Department of Pa-

thology and Genomic Medicine has a

team of four board-certified hematopa-

thologists with a combined 94 years of

professional training and experience

Youli Zu, M.D., Ph.D.

Co-Medical Director, Hematopathology

Dr. Zu received his medical degree

from the Jilin Medical College of Beihua

University in Jilin City, China, and his

Ph.D. in Immunology and Pathology

from the Kyoto University School of

Medicine in Kyoto, Japan. He completed

his pathology residency at New York

University Medical Center and a hemato-

pathology fellowship at the National

Cancer Institute in Bethesda.

In addition to providing clinical

Abdus Saleem, M.D.

Associate Medical Director, Hematopathology

Dr. Saleem received his medical degree

from the King Edward Medical School in

Karachi, Pakistan. Having obtained his

original subspecialty certification in 1977,

he is the most experienced member of the

Hematopathology Team. He has trained

numerous local hematopathologists, in-

cluding Dr. Jacquelin O’Hare, Dr. Munir

Shahjahan, Dr. Choladda Curry, Dr. Ran-

dall Olsen, Dr. Thu Ngo, and Dr. Chris-

tine Finch. Dr. Saleem enjoys his role as

the primary educator of residents and

fellows in bone marrow and peripheral

blood pathology.

For more information on Dr. Saleem,

visit methodisthealth.com/Saleem.

services, Dr. Zu is the director of the Can-

cer Pathology Laboratory at The Method-

ist Hospital Research Institute. His re-

search focuses on the development of

novel diagnostics and treatments for he-

matopoietic and lymphoid disorders. His

current studies, funded by the National

Cancer Institute, involve development of

an aptamer probe nanocomplex to diag-

nose and administer targeted treatment

for anaplastic large cell lymphoma.

For more information on Dr. Zu, visit

methodisthealth.com/Zu.

Arthur W. Zieske, M.D.

Co-Medical Director, Hematopathology

Dr. Zieske received his medical degree

from the Louisiana State University

Health Science Center (LSU-HSC) in New

Orleans, where he also completed his

pathology residency. He received his

hematopathology fellowship training at

the Yale University School of Medicine in

New Haven, CT. Training the next gen-

eration of pathologists is one of Dr. Zi-

eske’s key interests; he received several

teaching awards while on the faculty at

LSU-HSC.

For more information on Dr. Zieske,

visit methodisthealth.com/Zieske.

in hematopathology.

The team brings this

extensive expertise

to all facets of the

hematopathology

patient service that

encompasses supe-

rior clinical care,

education, and

ground-breaking

translational re-

search. The hematopathology team: from left, Drs. Arthur Zieske, April Ewton,

Abdus Saleem, and Youli Zu.

Fluorescent microscope image of the aptamer probes identifying cancer cells.

April A. Ewton, M.D.

Associate Medical Director, Hematopathology

Dr. Ewton obtained her medical degree

and completed her residency training at

the Baylor College of Medicine. She

received her hematopathology fellowship

training at the University of New Mexico

in Albuquerque. As associate director of

clinical pathology resident training, Dr.

Ewton is especially involved with hema-

topathology education.

For more information on Dr. Ewton,

visit methodisthealth.com/Ewton.

Dr. Ewton mentoring a trainee. Dr. Zieske teaching flow cytometry.

For more information on the hematopa-

thology service at Methodist, please con-

tact Dr. April Ewton at aewton@tmhs.org.

The

LABORATORY REPORT

5

“This is an outstanding laboratory in a superb hospital. As the north Houston communities continue to grow, our hospi-tal and laboratory grow with them. Our relationships with our patients and their communities are very important.”

Hazel L. Awalt, M.D.

Lab Stats: Methodist Willowbrook Hospital Medical Director: Hazel L. Awalt, M.D.

Dr. Awalt received her medical degree

from the Baylor College of Medicine in

Houston, and held a faculty appointment

there until she joined the laboratory at

Willowbrook as the medical director in

2005. She is also the president-elect of the

medical staff at Methodist Willowbrook

Hospital.

Faculty: Tracie J. Koen, M.D.

Dr. Koen obtained her M.D. degree

from The University of Texas Medical

Branch in Galveston and is a graduate of

the pathology training programs at

Methodist. She has subspecialty certifica-

tion in cytopathology.

Yingchao Piao, M.D., Ph.D.

Dr. Piao received a M.D. degree from

the Yanbian Medical School in Yanji,

China and a Ph.D. in Molecular Biology

from the University of Paris VI in Paris,

France. She has subspecialty certification

in both hematopathology and cytopa-

thology.

Pictures from top: Dr. Awalt retrieving blood for a transfusion patient; Dr. Koen examining slides; Dr. Piao in the Histology Laboratory; Ms. Farr in her office at the Willowbrook Laboratory; and Ms. Skodack-Jones

(right) with Medical Technology Coordinator, Madelaine Vinueza.

“I just love working with Drs. Awalt and Piao and the rest of the laboratory. We all work well together and really keep things moving along.”

Tracie J. Koen, M.D.

“The Willowbrook laboratory is ideal because we get to see interesting cases, in a smaller, community setting. It’s the best of both worlds.”

Yingchao Piao, M.D., Ph.D.

Director: Anita G. Farr, M.H.A.

Ms. Farr received her Master of Health-

care Administration from Texas

Woman’s University. She has been labo-

ratory director at Willowbrook since

2009.

“It is very exciting to watch the response of the laboratory team to the challenges that new service lines bring. The team never disappoints.”

Anita G. Farr, M.H.A.

Manager: Lisa Skodack-Jones, M.S.

Ms. Skodak-Jones received her Master

of Science in Medical Technology Man-

agement from California State Univer-

sity. She recently joined the management

team at Willowbrook after spending 6

years as a group manager at ARUP Labo-

ratories in Salt Lake City, Utah.

“I am delighted to be a member of the Methodist family, and look forward to the opportunity to get to know everyone.”

Lisa Skodack-Jones, M.S.

Staff:

The laboratory currently employs 39

staff members that include supervisors,

technologists, histologists, processors,

and technicians. These employees work

as a cohesive team to allow the labora-

tory to operate efficiently and provide

the best possible care to the patients at

Methodist Willowbrook Hospital. “This is a busy laboratory, and we help each other out. That’s how it works.”

Madelaine Vinueza, MT

The

LABORATORY REPORT

Department Trainees Win Awards at Texas Society of Pathologists Meeting

require a more aggressive course

of therapy.

Dr. Nelles, a PGY2 resident,

presented on IgA mesangial

deposition among kidney do-

nors. Her study found that 12%

of donor kidneys were positive

for IgA. Since one-third of these

kidneys are procured from liv-

ing donors, more aggressive

screening for hypertension and

proteinuria may be warranted.

Twelve department trainees

are presenting their research

results this month at the United States

and Canadian Academy of Pathology

Annual Meeting in Vancouver, British

Colombia, Canada.

For more information on Department

training programs, visit method-

isthealth.com/pathologytraining.

D rs. Haijun “Steve”

Zhou and Nicole

Nelles won 2nd and 3rd

place, respectively, for their

abstract presentations at the

Texas Society of Pathologists

Annual Meeting held January

13-14 in Dallas.

“We are very proud of Steve

and Nicole and our other train-

ees who presented in Dallas,”

said Dr. Suzanne Powell, vice

chair of education for the De-

partment. “Scholarly activity is

an important part of our training pro-

grams and something we strongly

support.”

Dr. Zhou, a PGY1 resident, presented

on whether LSIL-H (low-grade squamous

intraepithelial lesion-cannot exclude high

-grade squamous intraepithelial lesion)

should be a distinct cytology category.

6

D r. Haijun “Steve” Zhou, a PGY1 resident, is the recipient of the Department’s Trainee

Leadership and Innovation Award for the first quarter of 2012. Dr. Zhou received the

award specifically for his academic accomplishments; he recently received a second place

award for his abstract presentation, “Should LSIL-H be a Distinct Cytology Category? A Study on

Frequency and Distribution of 40 HPV Genotypes in a Cohort of Underserved Women,” at the

Texas Society of Pathologists Annual Meeting on January 13 and 14 in Dallas. He also received an

Excellence in Urologic Pathology Award from the International Society of Urologic Pathology for

his abstract entitled “1,078 Intraoperative Frozen Section Evaluations of Ureteral and Urethral Mar-

gins: Studies of 212 Consecutive Radical Cystoprostatectomies for Men with Bladder Urothelial

Carcinoma.” Dr. Zhou received his medical degree and Ph.D. in Biochemistry and Molecular Biol-

ogy from the Peking Union Medical College in Beijing, China.

Trainee Spotlight:

Haijun Zhou, M.D., Ph.D. PGY1 Resident

Haijun “Steve” Zhou, M.D., Ph.D.

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8

Editor-in-Chief

April A. Ewton, M.D.

The Laboratory Report

Editorial Committee

Hazel L. Awalt, M.D.

Christopher Leveque, M.D.

The Methodist Hospital

Clare Rose, M.B.A.

Manuel Hinojosa, M.H.A.

Editorial Coordinator

Philip Randall

Department Chair

James M. Musser, M.D., Ph.D.