Management & Operations

Integrating In Vivo and In Vitro Presents Interesting Challenges

How soon will in vivo and in vitro testing become an integrated clinical service? That was one of the important questions discussed last week in Philadelphia at Molecular Summit 2008. However, what captured and engaged the interest of most attendees was the rapid progress now unfolding in both molecular imaging and molecular diagnostics.

For example, new technologies just making their way into molecular imaging give radiologists new capabilities to see structures in greater detail, as follows:

a)   Radiology vendors are now shipping state-of-the-art imaging systems that allow radiologists to put the patient in a single imager, then scan the patient with two imaging methods simultaneously. Then, for each view selected by the radiologist for study, he/she can toggle that view between the images produced by the two methods, such as CT and PET. Because of the identical alignment of the images of the same body structures, the radiologist gains the ability to make more detailed conclusions about the nature of the tumor or other structure being studied.

b)   Using latest-generation imaging systems, radiologists can now look at tumors in vivo and discern differences in the tumor's tissue. Speakers at Molecular Summit 2008 illustrated this point with images, and observed that this capability allows them to determine which areas of the tumor are more active, thus allowing them to identify the most appropriate area from which to biopsy a tissue sample to refer to pathology for analysis.

c)   These state-of-the-art imaging systems are also allowing radiologists to observe the activity of the tumor in real time. Several speakers, in explaining this capability, observed that they can now see changes in the tumor's activity from one moment to the next, and that tissue biopsied at both times would show significant differences when processed and studied by pathologists.

Give and take from the podium between the radiologists and pathologists was fascinating, particularly since there was a common recognition that both medical specialties use images to make their diagnoses. On that, point, pathologist Richard C. Friedberg, M.D., Ph.D., in his presentation, succinctly described why pathology and molecular diagnostics represents a fundamentally different way than imaging to produce diagnostic information.  This is a paraphrase of his remarks.  "Keep in mind that pathology, like radiology, has more than 100 years of clinical knowledge," he observed. "Pathology is a science organized around artifacts and these artifacts are fundamentally different than living tissue. Pathological analysis utilizes tissue that has been sliced, processed, stained, and manipulated in a variety of ways. The results allow pathologists to study slides of the tissue and discern clinically useful information about that tissue and the patient's disease. But, since this tissue is an artifact, there is little resemblance to the same tissue in vivo, as radiologists may see it. Friedberg is Professor and Deputy Chairman Department of Pathology, Tufts University School of Medicine , Springfield, Massachusetts.

Finally, Molecular Summit 2008 was well attended by both radiology and pathology press. This is another sign of the keen interest in the integration of in vivo and in vitro testing since Siemens AG made its $14 billion investment in recent years to become one of the world's largest in vitro diagnostics (IVD) manufacturers. Stay tuned to future Dark Daily e-briefings from more insights from Molecular Summit 2008.