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Whether Gwendolyn Pollard will get to teach her students math again this year was determined in about a half-hour in a lab at Medical College of Georgia. The answer came in a small green box that popped up on a computer screen, which read "negative."

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Dr. Yun Mei (left) and Dr. Zixuan Wang use a computer to check the results of a test on a sample of lymph node tissue.  Michael Holahan/Staff
Michael Holahan/Staff
Dr. Yun Mei (left) and Dr. Zixuan Wang use a computer to check the results of a test on a sample of lymph node tissue.

Ms. Pollard, 61, is one of the first in the area to benefit from a new test for breast cancer that looks at the genetic material from her lymph nodes to see if her cancer had spread.

Instead of simply relying on a visual examination to look for cancerous cells, the GeneSearch Breast Lymph Node Assay looks for proteins specifically related to breast cancer, which potentially makes for a more accurate exam.

Because it is done real-time during surgery, it could keep some women from having to return for a second surgery to remove lymph nodes and possibly avoid chemotherapy and its sometimes severe side effects.

The GeneSearch test yields results in as little as 25 minutes, instead of the hours or days associated with other testing methods.

"It's just an exponential advance in terms of the time," said Scott Lind, chief of surgical oncology at MCG, which is the first in Georgia to offer it and one of only 21 facilities offering it in the United States. Not everyone is convinced it is useful. University Hospital declined to use it because it doesn't fit with the way its surgeons usually operate.

GeneSearch is a new technology that could soon be used for other types of cancer, such as melanoma, Dr. Lind said.

"This test is really the beginning of the use of molecular technology to apply clinically" to the patient, he said. "It's the beginning and we're trying to do further studies here to look at molecular detection of other types of tumors."

In Ms. Pollard's case, the negative report on her lymph node biopsy, and some subsequent tests, mean she can skip chemotherapy and just get radiation therapy.

With chemo "I couldn't work," said Ms. Pollard, who teaches math at a middle school in Mobile, Ala., where she chose to go teach to be close to her granddaughters.

For years, doctors have tried to determine the spread of breast cancer by using a biopsy of the sentinel lymph node, which is the one closest to the tumor and the first place cancer cells would likely show up. In the past, a thin slice of the lymph node was examined microscopically to look for cancer cells, sometimes during surgery and sometimes after. No cancer cells meant there was no need to remove the lymph nodes.

The drawback to the previous routine was that the pathologist doing the test during a surgical operation only viewed a small fraction of the tissue, where the cancer cells might not have shown up, said Zixuan Wang, scientific director of the Georgia Esoteric and Molecular Labs.

With the GeneSearch test, half the sentinel node is prepared for microscopic examination while the other is ground up and extracted of genetic material for analysis using a real-time polymerase chain reaction, or real-time PCR. Pathologists search for genes called mammaglobin and cytokeratin 19 that are most commonly associated with breast cancer, Dr. Wang said.

"The method itself is more sensitive and we're looking at more tissue specimen," she said.

Not everyone is sold on the GeneSearch test. University Hospital was approached about the technology but declined it, pathologist Randy Hamill said.

While MCG often does node analysis during an operation, University only does that selectively, and it only rarely results in a patient needing additional surgery, Dr. Hamill said.

University does use a gene test called Oncotype DX, where a tumor sample is sent to a lab to see if contains 21 genes that would put the patient at higher risk for cancer recurrence. A low score on the test means the patient likely could skip chemotherapy treatment.

Even though the GeneSearch test was approved last year by the Food and Drug Administration, Dr. Lind said MCG is one of the sites still gathering data for the manufacturer, Veridex, on how often it changes the diagnosis and how quickly the information can be gathered.

Ms. Pollard's belief in research is one reason she wanted to do it.

"Not just for myself but for my daughter and my grandchildren," she said. "I have four granddaughters, so hopefully it will help them too down the road."

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.

IT'S IN THE GENES

Genetic testing after breast cancer surgery is now routinely done to help women assess their risk of recurrence and help them to determine whether they should get chemotherapy. One of the more widely used tests is Oncotype DX. One of the newest is the GeneSearch Breast Lymph Node Assay.

ONCOTYPE DX

WHAT IS IT: A test for recently diagnosed women with stage 1 or 2 breast cancer whose lymph nodes are negative for cancer and whose tumors are estrogen-receptor positive. A tumor sample taken during surgery or biopsy is analyzed in a lab using reverse transcriptase polymerase chain reaction, or RT-PCR, to look for the activity of 21 genes. The results, usually available within 10-14 days, give a risk score that can help to determine whether chemotherapy would be beneficial.

BENEFITS: Can help some women avoid unneeded chemotherapy.

DRAWBACKS: Initial problems with insurance coverage are now largely resolved, but it is not appropriate for some breast cancer patients.

WHERE CAN YOU GET IT? University Hospital, Medical College of Georgia Hospital and Clinics, Trinity Hospital of Augusta, Aiken Regional Medical Centers.

WHAT DOES IT COST? Roughly $3,000; many insurance carriers and Medicare now cover the test.

GENESEARCH BREAST LYMPH NODE ASSAY

WHAT IS IT? A test of the sentinel lymph node biopsy done in early stage breast cancers to detect if the cancer has spread. During surgery, a biopsy is sent to a lab for real-time PCR testing for two proteins strongly associated with breast cancer. Negative results would allow the surgeon to avoid removing the lymph nodes and limiting the side effects from the surgery.

BENEFITS: Faster diagnosis, can be done during surgery; potentially eliminates need for a second surgery to remove lymph nodes.

DRAWBACKS: Unclear if the cost will be covered by insurance or Medicare, could potentially lengthen surgery time and time under anesthesia

WHERE CAN YOU GET IT? Currently, Medical College of Georgia Hospital and Clinics.

COSTS: About $300. Coverage for the test will probably vary by insurance carrier, said Linda Fedow, vice president of communications for the manufacturer, Veridex. While there are some technical issues about Medicare coverage, those patients should not face any costs from the tests, she said.

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He_Who_Must_Not_Be_Named 02/22/08 - 07:18 am
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Answer this fast...if you

Answer this fast...if you bounce a check for a prostitute..is that rape?

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