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Cytopathology consortium among nation's best by Michael Baker Public Relations The American Society of Cytopathology honored MUSC this month by awarding its centers of excellence status to the university's cytopathology consortium. Drs. Danielle Ripich, from left, dean of the College of Health Professions, Ray Greenberg, MUSC president, Blair Holladay and Marshall Austin, are among those celebrating the MUSC cytopathology consortium's national recognition as an American Society of Cytopathology Center of Excellence. Consisting of the College of Health Professions' Center for Quality Improvement in Cytopathology, the Department of Pathology and Laboratory Medicine, and Coastal Laboratories Inc., the consortium was named as one of only four centers of excellence in the U.S. MUSC’s consortium joins Harvard and Johns Hopkins universities and the University of Vermont in sharing this distinct honor. The four institutions were chosen amid the 3,200 cytopathology facilities in the nation. The three-year award cements the MUSC cytopathology consortium’s role as a mentor for other cancer diagnosis organizations across the nation. “The entire focus of the center is on cancer prevention and detection,” said Blair Holladay, Ph.D., director of the Center for Quality Improvement. Holladay credits his colleagues, such as Rana Hoda, M.D., director of the MUSC clinical cytopathology lab, and Marshall Austin, M.D., Ph.D., director of Coastal Pathology Laboratories, for the center’s success and continuing dedication to cancer research. More pointedly, Holladay’s cytopathology center performs two main research functions.  For its first service, the center analyzes genetic marker tests sent from the nation’s various biotechnology companies. The companies propose unique methods of testing DNA from biopsies and cellular samples, using genetic markers to determine whether the samples are benign, pre-cancerous (at risk of becoming cancerous) or cancerous.  The hotbed of cancer research attributed to the center is partially due to the state’s high incidence of the disease. Thus, when biotechnology companies need evaluations of their genetic markers as soon as possible, the companies contact Holladay and his colleagues.   The center’s speed in collecting data from cellular samples stems from access to a wide variety of high-risk patients in the region. The cytopathology center cooperates with a consortium of 12 hospitals in South Carolina. Through their collaboration, the hospitals can draw upon each other for assistance in recruiting patients for valuable cancer research. So ironically, a disease that plagues much of the South’s population actually makes South Carolina the nucleus for cancer research in the United States. Although the center works with large corporations, Holladay made it clear that cytopathology research at MUSC maintains an unbiased, patient-oriented approach. “We aren’t concerned which companies approach us with new markers,” he said, “as long as we can prove the markers are safe and effective in our clinical trials. We’re interested in testing the quality of these genetic tests.” He explained that as more testing methods appear on the market, the increasing number of alternatives actually drives down the cost of health care for cancer patients.  Of course, the cytopathology center isn’t interested in flooding the market and lowering costs simply for the sake of doing so; not every marker receives approval, Holladay stressed, and each new test undergoes a stringent evaluative process. “To receive our approval, each company must present a marker that is as sensitive—but preferably more sensitive—than those on the current market,” he said. “The goal of our research is to improve the standard of care for patients.” As another service to the medical community, the center also uses its own molecular markers to validate the requested markers presented by biotechnology companies. The process, called “reflex testing,” further aids Holladay and his colleagues in determining the inherent risk of cancer in the gene sample. For example, if a routine test yields uncertain results using analysis of the cells using the light microscope, the cytopathology center conducts more sensitive molecular tests on the individual patient’s sample. Specifically, the laboratory technologists might investigate high-risk genes related to the papillomavirus, a virus that causes cervical cancer. If the high-risk virus is proven by tests such as polymerase chain reaction (PCR), the marker will help the clinician determine the best course of therapy that needs to be instituted.  If the marker reveals that the genes have a high risk of creating cancer, then the affected cells or tissue need to be removed from the patient. However, if the genes are low-risk, the patient may undergo less drastic treatment. Typically, about 25 people work on projects within Holladay’s cytopathology center at any given time, although Holladay said that the number may reach 40 at times of peak activity. The researchers’ collected efforts have induced a rare paradigm shift in cytopathology. In the past, education was the driving force behind clinical practice. Students learned the same techniques and applied them in clinical situations.  Gradually, the center has shifted to a “hybridization” of the old methods. Now, Holladay says, the research conducted at the cytopathology center creates new knowledge; this knowledge drives education, which in turn drives clinical practice. But being named a center of excellence represents not the apex of cancer research, bur rather one more step in the process. “With what our center consortium has accomplished, it’s really limitless what we can do here,” Holladay said. “At the moment, cancer is not going away, but at least the center’s research can help prevent it. And if you want to cure cancer, one solution is to prevent it.”    Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.