the laboratory report winter 2011
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The
Laboratory Report Winter 2011
A Publication of the Department of Pathology and Genomic Medicine
Methodist, The University of
Texas M.D. Anderson Cancer Cen-
ter, the Mayo Clinic, Harvard
Medical School, and the Memorial
Sloan-Kettering Cancer Center.
Lectures on April 28th will involve
various topics in diagnostic pul-
monary pathology, while those on
April 29th will cover the current
status and future directions of
lung cancer diagnosis and treat-
ment. Seating for the Houston
Lung Symposium will be limited,
registration is required, and ad-
vance registration is highly recom-
mended.
To register for the symposium or ob-
tain the speaker agenda, visit houston-
pathologists.org/upcomingevents.
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3
4
5
Laboratory Outreach Grows with The Methodist Hospital Reference Laboratories
New Faculty Join Department
New Diagnostic Test Offerings
Sugar Land Laboratory Supports Breast Center Expansion
Trainee Spotlight
Dr. Adriana Rosato Leads Methi-cillin-Resistant Staphylococcus Aureus Research Effort
Dr. Bogdan Czerniak to Present Chair’s Lectureship
Dr. Wayne Chandler Leads Test Utilization Improvement Effort
Table of Contents
Dr. Michael Thrall is leading the De-
partment’s efforts to implement digital
pathology technology into specific clini-
cal services in 2012. This cutting-edge
technology will allow for more rapid di-
agnoses for our patients and will enhance
education programs.
Look for a complete article on digital
pathology at Methodist in the spring 2012
issue of The Laboratory Report!
The Laboratory Report—Issue Archives
Would you like to view past issues of The Laboratory Report? All 2011 issues can be
viewed by visiting our Department website at methodisthealth.com/TheLaboratoryReport.
T he Department of Pathol-
ogy and Genomic Medi-
cine is collaborating with
the Houston Society of Clinical
Pathologists (HSCP) to host a
major symposium at Methodist
in 2012. The Spring Symposium
of the HSCP and the Depart-
ment’s Seminar on Advances in
Lung Cancer will combine for a
two-day event on April 28th and
29th in The Methodist Hospital
Research Institute auditorium.
The event, the Houston Lung
Symposium, is the brainchild of
Dr. Philip Cagle, medical director of pul-
monary pathology for the Department
and editor-in-chief of Archives of Pathol-
ogy and Laboratory Medicine.
“This symposium will convene some of
the most accomplished pathologists,
Department and Houston Society of Clinical Pathologists to Host Major Symposium
Dr. Cagle in the Research Institute auditorium.
oncologists, and bioinformatics experts
from Houston and around the world,”
said Dr. Cagle. “This is an excellent op-
portunity for physicians, scientists, and
trainees at all levels.”
The symposium will feature 20 speak-
ers from institutions including
In Our Next Issue...
The
LABORATORY REPORT
2
Laboratory Outreach Grows with The Methodist Hospital Reference Laboratories
interface software. A website will be
launched in early 2012.
For more information on TMHRL,
please contact Phuong Nguyen at
713-441-3484 or [email protected].
subscribing non-Methodist
hospitals, multi-specialty
provider groups, and aca-
demic and commercial re-
search groups.
“The Methodist reputa-
tion for excellence in patient
care is strong, our depart-
ment faculty members are
renowned in their specialty
and subspecialty fields, and
we have great facilities,”
said Phuong Nguyen, out-
reach specialist for TMHRL.
“While the program has
done well, it has the poten-
tial to be much bigger and better.” New
infrastructure for the program is in the
final stages of development, and a state-
of-the-art test ordering and results deliv-
ery system is being implemented with the
latest generation of operating system
T he Department of Pathology and
Genomic Medicine and The Meth-
odist Hospital are further devel-
oping and expanding their laboratory
outreach program with the formation of
The Methodist Hospital Reference Labo-
ratories (TMHRL). TMHRL will provide
expanded clinical testing for The Method-
ist Hospital patients, additional testing
volume for esoteric tests, and method
development and teaching opportunities
for residents and fellows.
“This is a tremendous opportunity for
the Department and the hospital,” said
Dr. Wayne Chandler, vice-chair of clinical
innovation for the Department. “In addi-
tion to helping our institution, our pro-
gram can provide a service that helps
other institutions and providers improve
their standard of care. It’s a win-win
situation.” TMHRL extends the Depart-
ment’s clinical services and expertise to
Dr. Chandler and Phuong Nguyen.
New Faculty Join Department
T he Department of Pathology and Genomic Medicine continues to grow. Two new physicians have recently joined our faculty:
Lauri B. Campagna, M.D.
Staff Pathologist, Methodist West Houston Hospital
Dr. Campagna joins the Department from The University of Texas Southwestern Medical Center in
Dallas, TX where she was an assistant professor of surgical pathology and cytopathology. She re-
ceived her medical degree in 1991 from the University of Colorado School of Medicine in Denver,
CO. She completed an anatomic and clinical pathology residency and a cytopathology fellowship at
Methodist and the Baylor College of Medicine in Houston, TX. Dr. Campagna will primarily provide
anatomic and clinical pathology services at Methodist West Houston Hospital.
For more information on Dr. Campagna, visit methodisthealth.com/Campagna.
Bisong Haupt, M.D.
Staff Pathologist, Methodist Sugar Land Hospital
Dr. Haupt is an alumna of the pathology training programs here at Methodist where she completed
both an anatomic and clinical pathology residency and a surgical pathology fellowship. She rejoins
the Department from St. Louis University in St. Louis, MO where she was an assistant professor of
pathology. Dr. Haupt received her medical degree in 1982 from the Southeast University School of
Medicine in Nanjing, China. She will primarily provide anatomic and clinical pathology services at
Methodist Sugar land Hospital.
For more information on Dr. Haupt, visit methodisthealth.com/Haupt.
The
LABORATORY REPORT
3
Triage TOX Drug Screen
The Triage TOX Drug Screen (Triage
Drugs of Abuse Panel) from Alere now
also tests for the presence of metham-
phetamines and methadone. The assay
has also changed from a visually inter-
preted chromogenic immunoassay to an
automated fluorescence immunoassay.
The panel is highly accurate and
screens for up to 10 distinct classes of
abused drugs (illicit and prescription)
with results obtained in approximately
15 minutes. The screen includes assays
for the presence of amphetamines,
methamphetamines, barbiturates, benzo-
diazepines, cocaine, methadone, opiates,
phencyclidine, tetrahydrocannabinol,
and tricyclic antidepressants.
This screen is especially useful in ob-
taining a differential diagnosis for emer-
gency medicine cases that may or may
not involve drug abuse as a primary
cause or contributing factor. It is recom-
mended that preliminary positive results
from the screen be confirmed with gas
chromatography-mass spectroscopy. At
Methodist, acetaminophen/paracetamol
is assessed using a quantitative serum
measurement assay run on the Vitros
Fusion platform.
For more information on the improved
Triage TOX Drug Screen, contact Dr.
Ping Wang at [email protected] or Toni
Emmott at [email protected].
New Diagnostic Test Offerings:
Adenovirus Real-Time PCR Assay
The Molecular Diagnostics Laboratory
of The Methodist Hospital System has
implemented a new real-time PCR assay
to detect adenovirus. Adenoviruses are
DNA viruses that cause several infec-
tious manifestations, including gastroen-
teritis, pneumonia, conjunctivitis, and
skin rashes. Importantly, adenovirus
infection can lead to graft failure and life
threatening disseminated disease in
transplant patients.
Real-time PCR is a highly sensitive and
specific method to detect the presence of
DNA from pathogens in clinical speci-
mens. The adenovirus real-time PCR
assay is the latest in a series of new mo-
lecular tests instituted by the Molecular
Diagnostics Laboratory. This test, which
was previously performed at a reference
laboratory, was introduced in-house on
November 1. Performing the test at
Methodist will improve patient care by
increasing quality, decreasing costs, and
minimizing turnaround times.
For more information on this assay or
other tests offered by the TMHS Molecu-
lar Diagnostics Laboratory, please con-
tact Dr. Randall Olsen at 713-441-6802
([email protected]) or Brant Hilson at 713-
441-5725 ([email protected]).
BinaxNOW Malaria Test and Helico-
bacter pylori Stool Antigen Test
The Clinical Microbiology Laboratory
of The Methodist Hospital System will
be offering two new antigen detection
assays in December: the BinaxNOW ma-
laria test by Inverness Medical and the
Helicobacter pylori Stool Antigen (HpSA)
test by Meridian Biosciences, Inc.
The BinaxNOW malaria test is an im-
munochromatographic assay for the
qualitative detection of Plasmodium anti-
gens. It targets the histidine-rich protein
II (HRPII), which is a specific antigen
common to all four malaria species capa-
ble of causing human infection - P. falci-
parum, P. vivax, P. ovale, and P. malariae.
The BinaxNOW assay is to be used in
conjunction with a malaria peripheral
blood smear. Although the BinaxNOW
assay is less sensitive than the malaria
BreathTek C-13 Urea Breath Test
The Outpatient Laboratory in Smith
Tower (Room 523) now offers the
BreathTek C-13 urea breath test to aid in
the initial diagnosis and post-treatment
monitoring of active Helicobacter pylori
infection. H. pylori is a Gram-negative,
microaerophilic bacterium found in the
stomach which causes duodenal and
gastric ulcers, and has been linked to the
development of stomach cancer. Several
studies have reported that initial antim-
icrobial therapies can fail in as many as 1
in 4 patients, so post-treatment monitor-
ing is important.
The BreathTek test from Otsuka Amer-
ica Pharmaceuticals is an easy, conven-
ient non-invasive and non-radioactive
test and can be administered in about 15
minutes. Patients should fast for at least
one hour and refrain from using antim-
icrobials, proton pump inhibitors, or bis-
muth preparations for two weeks prior to
testing.
For more information on the BreathTek
C-13 urea breath test, please contact Dr.
Ping Wang at [email protected] or Tammy
Lefevers at [email protected].
BinaxNOW cont.
smear, it can provide results in 15 min-
utes. The advantage of this assay is that
it allows for rapid identification and
quicker implementation of therapy.
The HpSA test is an enzyme immuno-
assay that detects Helicobacter pylori pro-
teins in human stool. This assay has
demonstrated higher sensitivity and
specificity than serology or the urea
breath test, and thus is an important op-
tion in the non-invasive diagnosis of H.
pylori.
For more information on the Binax-
NOW malaria test or the HpSA test,
please contact Dr. James Davis at 713-441
-2437 or Pat Cernoch at 713-441-0333.
MALDI-TOF Mass Spectrometry
The Bruker BioTyper is now being used
in the Microbiology Laboratory. This
new MALDI-TOF mass spectrometer
rapidly identifies bacteria based on their
MALDI-TOF cont.
unique protein fingerprints. Validation
studies for Gram-negative organisms
were completed in December. Additional
validations for identifying yeast and
Gram-positive bacteria are ongoing. Im-
plementation of this exciting new tech-
nology at The Methodist Hospital will
significantly improve patient care by
increasing sensitivity and reducing turn-
around times.
For more information on the BioTyper
MALDI-TOF mass spectrometer, please
contact Dr. James Davis at 713-441-2437
or Pat Cernoch at 713-441-0333.
The
LABORATORY REPORT
4
Dr. Adriana Rosato Leads Methicillin-Resistant Staphylococcus Aureus Research Effort
Sugar Land Laboratory Supports Breast Center Expansion
T he Breast Center at Method-
ist Sugar Land Hospital has
undergone a significant
expansion to meet the needs of the
growing Fort Bend County commu-
nity. The new facility is larger and
provides the full continuum of care
– from screening through treatment
and survivorship – all in one inte-
grated and multidisciplinary set-
ting.
“Tissue diagnosis is a critical part
of the multidisciplinary treatment
plan of breast cancer,” said Dr.
Seema Mullick, medical director of Labo-
ratory Services at Methodist Sugar Land
Hospital. “Our goal is to provide an
accurate and timely biopsy report to
facilitate the personalized care that
each of our patients receive here at
Methodist Sugar Land Hospital.”
Breast biopsies and related anat-
omic pathology volumes have risen
considerably since the Breast Center
moved to its new location in Febru-
ary. The laboratory is expected to
assess more than 800 breast biopsies
in 2012.
For more information on Methodist
Sugar Land Hospital, visit method-
isthealth.com/sugarland.
Dr. Mullick in the Sugar Land laboratory.
Trainee Spotlight:
Elizabeth B. McQuitty, M.D. PGY4 Resident
Elizabeth McQuitty, M.D.
D r. Elizabeth McQuitty, a PGY4 resident, received a first place award for her oral
abstract presentation, “CD8-positive CD30-positive lymphomatoid papulosis and
its differential diagnosis: a review of 20 cases”, at the 48th Annual Meeting of the
American Society of Dermatopathology (ASDP) in Seattle, WA. She is also developing a text
book with Dr. Jae Ro on evidenced-based approaches to cancer diagnosis.
Dr. McQuitty received her Master of Architecture degree from Rice University in 2002. She
then pursued a medical degree from the Baylor College of Medicine where she was a mem-
ber of the Alpha Omega Alpha Honor Medical Society. She graduated in 2008 and joined
the pathology residency program at Methodist that same year. Dr. McQuitty will complete a
fellowship in molecular genetic pathology at Methodist in 2012.
D r. Adriana Rosato, a research
scientist in the Center for Mo-
lecular and Translational Hu-
man Infectious Diseases Research, is
leading the Department’s efforts to inves-
tigate the pathogenesis of multidrug-
resistant bacteria. With a five-year R01
grant from the National Institute of Al-
lergy and Infectious Diseases, her re-
search aims to identify molecular genetic
causes of drug resistance in methicillin-
resistant Staphylococcus aureus (MRSA).
“MRSA strains with low-level antibiotic
resistance are a serious concern in hospi-
tal settings and, more recently, the com-
munity,” said Dr. Rosato. “Data from our
studies could identify new drug targets
for development of a novel class of anti-
biotics.”
Dr. Rosato is also investi-
gating the mechanistic bases
and molecular pathways in-
volved in resistance to dapto-
mycin, a new class of cyclic
lipopeptide antibiotic that is
effective against MRSA. Al-
though daptomycin-resistant
S. aureus infections are ex-
tremely rare, they pose a con-
siderable treatment challenge
when they occur as optimal
therapy remains undefined
and the infections commonly
appear in patients with com-
plicated preexisting, deep-
seated infections such as osteomyelitis,
septic arthritis, or endocarditis.
For more information on Dr. Rosato,
Dr. Rosato in the laboratory.
visit methodisthealth.com/Rosato.
The
LABORATORY REPORT
5
will present the Chair’s Lectureship at
the Methodist Department of Pathology
and Genomic Medicine Grand Rounds
on Tuesday, February 7, 2012. Dr. Czer-
niak, a renowned genitourinary pathol-
ogy expert, will speak on molecular pa-
thology as it relates to bladder cancer
development and detection.
“Understanding the molecular genetic
basis of bladder cancers has allowed us
to develop promising new non-invasive
tests that detect the cancers in their earli-
est stages,” said Dr. Czerniak. “Genomic
research will ultimately provide us with
the information we need to improve the
standard of care for this patient popula-
tion – and many others.”
Dr. Czerniak’s research focuses on
early events of carcinogenesis using hu-
man bladder cancer as a model disease.
His laboratory is credited with the devel-
opment of a strategy that combines
D r. Bogdan Czerniak, chairman
ad interim and deputy division
head for research in the Depart-
ment of Pathology at The University of
Texas M.D. Anderson Cancer Center,
whole-organ topographic histologic and
molecular mapping. This approach has
provided unique information on initiat-
ing cancer events and on the existence of
a novel class of genes, termed forerunner
genes, which contribute to early expan-
sion of intraurothelial neoplasia by their
loss of function.
The Department of Pathology and Ge-
nomic Medicine Grand Rounds program
was established in 2010 and is directed
by Dr. Geoffrey Land, medical director of
histocompatibility and transplant immu-
nology for the Department.
For more information on the Depart-
ment Grand Rounds or a list of speakers
with dates and topics, visit method-
isthealth.com/pathologygrandrounds or con-
tact Victoria Watson at vlwat-
Dr. Wayne Chandler Leads Test Utilization Improvement Effort
Dr. Bogdan Czerniak to Present Chair’s Lectureship
Bogdan Czerniak, M.D., Ph.D.
T est utilization management
programs aim to evaluate the
clinical and fiscal effects of
test ordering with the goal of im-
proving patient care, increasing effi-
ciency, and reducing costs. Dr.
Wayne Chandler, vice-chair for clini-
cal innovation in the Department, is
directing such an effort at Methodist.
“Laboratory testing should pro-
vide the necessary clinical informa-
tion to the physician and use labora-
tory services appropriately and effec-
tively,” said Dr. Chandler. “Advances in
medical research and testing technology
are continuously affecting evidence-
based guidelines for patient care. It is
imperative that Methodist continually
monitor these changes and manage test
utilization accordingly.”
Dr. Chandler and colleagues at the Uni-
versity of Washington and Johns Hop-
kins Hospitals have conducted several
studies on test utilization. Their 2009
study focused on ionized calcium testing
and their most recent study, published in
Blood Coagulation and Fibrinolysis, investi-
gated the overuse of coagulation test
panels. Dr. Chandler and colleagues
found that the common cycle of calcium
screening and supplementation in unse-
lected patients (patients without known
or suspected specific derangements
in calcium metabolism) had no posi-
tive effect on outcomes. They also
found that the automated total cal-
cium test was a clinically suitable
screening test to determine the need
for an ionized calcium test in this
patient population. Their most recent
study found that coagulation test
panels are significantly overused and
often not clinically indicated, and
that the prothrombin time test more
often diagnosed vitamin K deficiency
than bleeding risk. The latter study also
evaluated the most effective methods of
implementing change in clinical test utili-
zation. Implementation of new test utili-
zation practices at Methodist will begin
in 2012.
For more information on test utilization
management at Methodist, please contact
Dr. Wayne Chandler at wlchan-
Dr. Chandler meets with Laboratory Technologists, Heather Hendrickson (left) and Pam McShane (right).
The
LABORATORY REPORT
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Continued page 7
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RECENT PUBLICATIONS
The
LABORATORY REPORT
Ping Wang, Ph.D. Claudia P. Molina, M.D.
Seema Mullick, M.D.
Thu Ngo, M.D.
Steven Shen, M.D., Ph.D.
Paul Sumby, Ph.D.
The Laboratory Report is a publication
of The Methodist Hospital System
Department of Pathology and
Genomic Medicine.
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gical Pathology and Cytopathology From the College of American Pathologists and Association of Directors of Anatomic and Surgical
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Hwang, EA Graviss. 2011. Improving the Diagnosis of Pulmonary Tuberculosis in HIV-Infected Individuals in Ho Chi Minh City, Viet-
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RECENT PUBLICATIONS continued
7
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.