Giving Biopsies Another Look Before Cancer Treatment Begins

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By Ilan Danieli

As in every area of medicine, and in cancer care as well, ensuring the best possible outcome requires an accurate diagnosis at the outset; this guides the treating physician in selecting the correct course of therapy. Oncologists conventionally map a course of treatment based on a biopsy analyzed by a pathologist, but there is now an additional option available to provide reassurance of the correct diagnosis. The oncologist and/or their patient may choose to send the biopsy to an academic expert with sub-specialized expertise in the specific subtype of cancer for an additional review and confirmation.

Thanks to an innovative platform developed by Precipio, a patient can now have their biopsy shipped directly to the company, where the biopsy is reviewed and a second opinion diagnosis delivered within (on average) three to five days by a specialist pathologist from a world-renowned academic center, with the relevant sub-specialized expertise. This can provide oncologists and their patients with more information—either validating the original diagnosis, or providing an alternative, perhaps more accurate one—so that all treatment approaches can be considered before the patient embarks on the treatment course. This is particularly useful as more personalized medicine approaches become available.

There are clear advantages to this approach. First, the importance of obtaining the correct diagnosis as the precursor to any cancer patient’s treatment plan cannot be overstated. When an incorrect course of treatment is administered, the chances of adverse effects rather than improved outcomes increase. The wrong treatment can cause unnecessary downstream outcomes that could result in additional hospital visits, various scans, and other steps that waste valuable treatment dollars while the patients themselves pay the ultimate price: increased morbidity and mortality.

A second advantage of Precipio’s approach is that if the new diagnosis happens to match the original diagnosis that was delivered by the initial pathologist, then the patient, the patient’s family, and the oncologist alike can all be further reassured that the course of treatment on which they are embarking, is the correct one. It is important to note that as a result of their own research, academic pathologists may be able to discern specific patterns presenting in the slides and other materials that they are given, that correspond to specific cancer subtypes. Since the findings of all pathologists reviewing the biopsy depend largely on their pattern recognition skills, their prior experience and expertise is critical to their review of the components of the case; the academic pathologists’ analysis can complement the analysis of the initial pathologist and be invaluable in arriving at the right diagnosis. Given the potential complexity involved in analyzing any sample, a second opinion can increase the likelihood that the patient will be diagnosed correctly.

Premier academic institutions are one of the few places where such subspecialized expertise resides. However, historically, only patients treated directly at these academic institutions have benefited from that expertise. The construction of a platform that harnesses that expertise and makes it accessible to patients anywhere, can provide a higher level of care to those patients by ensuring that the most important step in the battle against cancer—the diagnosis—is done right. 

While oncologists typically have a network of peers working at academic institutions, various hurdles have traditionally made it a very problematic and slow process to submit a sample to them and obtain an analysis back. No university has a 24/7 customer service line; none have logistics set up; none deliver results electronically; and billing is problematic as well. The result is that oncologists are usually reluctant to pursue these academic consultations and may do so only in the very toughest cases. For oncologists, the biggest appeal of Precipio’s services may be how this process has been streamlined—coupling the available academic expertise with the commercial level of results to which the oncologists are accustomed from working with their usual reference labs.   

Perhaps the most vivid way to convey the advantages of Precipio’s approach is to envision specific scenarios in which a diagnosis is changed as a result of a biopsy being evaluated by an academic expert. Imagine, for example, a 58-year-old male who undergoes five years of chemotherapy for what is believed to be lympho-plasmacytic lymphoma. A diagnosis of the man’s biopsy by pathologists affiliated with Precipio determines that the man has been suffering from T-cell lymphoma instead, which warrants an entirely different treatment course. Or envision a 25-year-old male initially diagnosed with Hodgkin lymphoma who requests a consult through Precipio and is subsequently diagnosed correctly with grey-zone lymphoma, entailing a different treatment plan and a substantially better outcome.

There is an obvious need to diagnose cancer subtypes correctly in order to ensure the highest standard of care for patients. By tapping into the expertise of the academic community—and utilizing an accessible platform through which oncologists and their patients can draw on that expertise—the path to better potential outcomes can be made considerably smoother than ever before. 

Ilan Danieli is CEO of Precipio, a specialty cancer diagnostics company.