HealthNews

I

he modern pathologist's
jobs are far more complex
than just determining if
body tissues are normal
or abnormal. If the tissue
is positive for cancer cells,
other questions need answering:
How aggressive is it? Has it spread
from somewhere else? From what
organ did it originate?
The answers to these questions
ultimately guide the patient's doc-
tor in choosing the best treatment
plan. Medical science has produced
a technical crystal ball to help the
modern laboratory answer these
questions.
"We use image analysis, a very
powerful technique," says Gilbert
E. Herman, Ph.D., M.D., Acting
Chairman of Sinai's Department
of Laboratory Medicine. Sinai
pathologists can assess the DNA
(genetic cellular information) con-
centration in tumors using a space-
age technique called DNA ploidy.
"We are also nationally known
for our expertise in immunohisto-
chemistry," Dr. Herman reports.
This particular laboratory test can
identify the original site of some
tumors which have metastasized
(spread to other areas of the body).

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SINAI HOSPITAL

Dr. Gilbert Herman,
Acting Chairman
of Sinai's Department of
Laboratory Medicine,
consults with Dr. Eduardo
Phillips, Chairman of the
Department of Surgery,
about the original site
of a tumor.

"Yesterday, for example, we
used immunohistochem-
istry on a tumor that was
removed from a lung. We
proved the tumor was from
the prostate." This avoided
a CAT scan and MRI stud-
ies which would normally
be required during a search
for tumor origin.
Besides being extremely
cost-effective, immunohis-
tochemistry saves the
patient from a lot of un-
necessary tests that can be
very time-consuming and
stressful.
Sinai maintains a team
of board-certified anatom-
ic and clinical pathologists,
each of whom specialize in
a particular organ system,
such as reproductive or
digestive. "What sets us apart,"
Dr. Herman says, "is the quality
and the stability of the pathology
group along with our conscien-
tiousness and our rapport with the
staff doctors.
"We are not confined to the lab-
oratory at Sinai. Pathologists are
in the operating rooms to help the
surgeon determine where the

tumor begins and ends, if it is ma-
lignant or benign, and the proba-
ble point of origin."
Dr. Herman and his colleagues
are constantly teaching and learn-
ing. By checking diagnoses against
the final surgical data, pathologists
keep their skills finely tuned. The
correct diagnosis dictates the en-
tire treatment of the patient.

New Alternative for Cancer Therapy Available at Sinai

Elayne Arterbery, M.D., came
to Sinai from the fulltime fac-
ulty at Johns Hopkins Oncol-
ogy Center. She completed her medical
training at the University of Michigan
and did a radiation oncology residency
at Memorial Sloan-Kettering Cancer
Center in New York City. Dr. Arter-
berry was attracted to Sinai specifical-
ly because Sinai is performing the
ultimate state-of-the-art radiation
treatment with very high-tech equip-
ment. "Sinai's approach and technolo-
gy are comparable to the major cancer
centers such as Memorial Sloan-
Kettering, M. D. Anderson, and the
University of Michigan, but in a com-
munity rather than an academic
setting."
Like some of these major cancer cen-
ters, Sinai is using low-dose radiation

SPRING 1995 ISSUE

implants to treat prostate and sever-
al other types of tumors. New technol-
ogy allows doctors to place tiny
radioactive seeds (smaller than grains
of rice) into a tumor without need for
surgery. The amount of radiation in
each seed is very low , so it presents
little threat to the normal tissue and
organs surrounding the tumor. But,
because it is located right at the sight
of the tumor cells, it is deadly to those
cells.
Precision is the key word in this type
of therapy. Ultrasound, CAT scans, and
MRI tests can measure tumor size and
location with amazing accuracy. Corn-
puter analysis determines exactly
where to place all of the seeds through-
out the tumor so that there are slight
overlaps in the effective range of each
seed. Ultrasound is used during the

implantation procedure to guide the
physician to the exact placement posi-
tions. This way there will not be any
areas of the tumor which go unaffect-
ed by the radiation.
Some advantages of low-level radi-
ation implants are the lowered risk
of damage to healthy tissues, the
procedure does not require surgery,
and more radiation can be delivered
in concentrated form when compared
to external radiation therapy. This
procedure is especially well suited to
older patients who are not good can-
didates for surgery and would not
fare well from extensive exposure to
radiation.
Medical science is making significant
advances in treating cancer. That tech-
nology is available at Sinai.

The teaching occurs in many
fields. Dr. Herman has taught in-
ternational classes on immuno-
histochernistry. Many members of
the department have published re-
search and teach at Wayne State
University's School of Medicine. Dr.
Herman has lectured at the Na-
tional Institutes of Health and the
Food and Drug Administration.
Dr. Herman is proud that Sinai's
Department of Laboratory Medi-
cine has a national reputation for
expertise in high-tech automation
in pathology. But, he hastens to
note, that's not the only reason it
is an excellent department.
`The strength of the pathologist's
knowledge is vital to the quality of
the department. It's the education,
training, continuing education, ac-
tive participation in case manage-
ment (including tumor boards or
other clinical forums), teaching,
and research activities which ex-
pand that knowledge."
Add to all of that the specialty
expertise and new high-tech equip-
ment, and you have a superior De-
partment of Laboratory Medicine.
It is all available at Sinai.

SPECIAL ADVE RTISEM ENT

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