Pioneering progress in spotting disease

Better Diagnosis, Better Care

nvestigators in a variety of specialties at the Miller School of Medicine are finding better ways to stalk their prey. Finding malignancies early or clearly spotting cardiovascular disease can mean the difference between life and death. If along the way scientists can make tests easier and more affordable, more people will have them done. And more lives will be saved.

Bladder Cancer Test

ladder cancer strikes about 63,000 Americans every year and kills more than 13,000. Physicians have known for years which patients were at high risk—smokers and people whose jobs expose them to chemicals or particles in the air.

The trouble is bladder cancer presents a lot like a urinary tract infection.

“That’s important because too often we see men and women who have blood in the urine or symptoms that could be bladder cancer treated for infections for several months before they’re diagnosed,” says Mark S. Soloway, M.D., chairman of the Department of Urology at the Miller School of Medicine.

“Unfortunately, those months can make a significant difference in the ability to cure those cancers.”

Traditionally, there are two tests that are used together to diagnose this disease—a visual examination of the bladder and urethra with a small viewing tube called a cystoscope, and a urine test in which a pathologist looks for cancer cells under a microscope, called cytology.

But a study co-authored by Soloway in the February 16 issue of the Journal of the American Medical Association showed a simple protein test was more than three times as sensitive as traditional cytology in detecting the presence of cancer in the urine.

The nuclear matrix protein, or NMP-22 test, isn’t perfect. It detected false positives slightly more often. But with cancer, too much information trumps not enough.

“This test is very simple, it’s very fast, it’s affordable—much cheaper and faster than cytology,” says Soloway. Results are available in the office in minutes.

Gene Screening

esting gene expressions has already led to the discovery of new types of non-Hodgkin’s lymphoma. Increasingly, gene screening is making it possible to diagnose not only exactly which lymphoma subtype a patient is suffering from but also how they’ll respond to therapy.

Izidore Lossos, M.D., a hematologist oncologist at UM/Sylvester, has been leading research for years to identify prognostic genes in lymphatic cancer. “One of the top predictors of outcome in diffuse large B-cell lymphoma was this unknown gene,” says Lossos. “We had a piece of this, but we didn’t know what the gene was.”

They suspected it originated in normal germinal center B cells, which are white blood cell lymphocytes. Lossos and his colleagues created a monoclonal antibody to target the mystery protein, which led to the cloning of a new gene—Human Germinal center-Associated Lymphoma (HGAL) gene.

Patients with HGAL expression had a better chance at survival. The latest work on this gene by Lossos and his collaborators was published in the May 15 issue of the journal Blood.

Sound Medicine

edicine has seen dramatic improvements in imaging technology since the dawn of X-rays 100 years ago, including PET scanning, digital mammography, and ever-better magnetic resonance imaging.

But sometimes the best tool is a familiar one.

That’s why the Joseph Applebaum Diagnostic Imaging Center now offers ultrasound alongside MRI in a single outpatient facility. “The community had a need for expanded access to ultrasound,” says Berta M. Montalvo, M.D., medical director of ultrasound and medical director of the Comprehensive Vascular Lab. “This new facility serves that need.”

This tool is used to diagnose and assess a variety of conditions, including hepatitis, renal and kidney disease, liver disease, gynecologic disorders, and heart and vascular conditions like arteriosclerosis.

UM is also introducing musculoskeletal ultrasound. “In certain areas ultrasound is as accurate as MR, and in some cases it’s better,” says Paul Clifford, M.D., chief of musculoskeletal radiology.