Friday, April 26, 2013

Annual AANP meeting is two months away

The Charleston Place Hotel in Charleston, South Carolina
Neuropathologists across the country are starting to make plans to attend the 89th Annual Meeting of the American Association of Neuropathologists, which will be held June 20-23, 2013 in Charleston, SC at the Charleston Place Hotel. The meeting with commence on Thursday the 20th with two half-day courses. There will be a morning course directed by Dr. Charles L. White entitled Practical Issues and Challenging Diagnoses in Forensic Neuropathology. The afternoon course is called Update in Frontotemporal Lobar Degenerations and is directed by Dr. Elizabeth J. Cochran. Other highlights later in the weekend include the return of Dr. Stanley Prusiner, Nobel laureate, who will talk about prion disease. (Dr. Prusiner last spoke to the AANP in 2006, when the meeting was paired with the International Society of Neuropathogy conference in San Francisco.) The inimitable Dr. Harry Vinters will speak on vascular diseases of the CNS. Looks like another great line-up of topics and speakers!

Tuesday, April 16, 2013

A Rich Focus

The grey arrow is pointing to a Rich focus that has hemorrhaged into the subarachoid space
A Rich focus is a tuberculoma in the cerebral cortex. Rich foci become particularly significant when they rupture into the subarachnoid space and cause tuberculous meningitis. This entity is named for Johns Hopkins pathologist Dr. Arnold Rice Rich (1893-1968), who first described it.

Tuesday, April 9, 2013

Best Post of September 2012: DecisionDx-GBM: Should every glioblastoma patient be getting this test?




The next in our Best of the Month Series is from September 12, 2012. It's worth revisiting the question of whether or not genetic testing of brain tumors is appropriate in patients who are not on research studies:

What does the neuropathology community think of DecisionDx-GBM? This is a product offered by Castle Biosciences, based in Phoenix, AZ. DecisionDx-GBM is a gene expression profile test developed at The University of Texas M. D. Anderson Cancer Center for the purpose of increasing the accuracy of the prognosis and predicted responsiveness of glioblastoma multiforme to first line radiation plus temozolomide. The test is able to distinguish GBM tumors with a proneural phenotype (tumor signature) from those with a mesenchymal / angiogenic phenotype. Patients with a proneural phenotype tumor who are treated with first line radiation plus temozolomide experience a significantly longer median survival (over 7 years) compared to those patients with a mesenchymal / angiogenic phenotype tumor (approximately 1 year). According to the company website, the assay has been fully validated and has been available for clinical use since 2008. A study is ongoing to determine whether the tumor molecular profile conferring a mesenchymal/angiogenic phenotype is associated with a selective increase in benefit from the addition of bevacizumab to temozolomide and radiotherapy. DecisionDx-GBM is also currently being incorporated into a number of other prospective and retrospective studies.

Is DecisionDx-GBM covered by insurance? Castle Biosciences states that the test receives reimbursement from a number of commercial insurance companies, and appeals to the Administrative Law Judge level for Medicare have resulted in favorable decisions for full payment. Should a patient need to pay out-of-pocket for this test, I could not find on the website what the cost would be.

Should we as neuropathologists recommend the use of this profile? Here is a an example of the kind of report that is generated when one orders the panel of 12 genes (3 of which are for control) upon sending a block of paraffin-embedded fixed tissue to the company. I would be interested in hearing people's opinions regarding this product, and whether there are others on the market which might be comparable. Please post!