Number 3 2003
Distinguished Pathologist Award
Distinguished Pathologist Award
Prof. ANTHONY LEONG
During his two-year term of office, the President of the Australasian division of the International Academy of Pathology has the opportunity of recognising an outstanding pathologist of our division by the bestowing of the Distinguished Pathologist Award.
Prof. Anthony Leong has made a unique contribution to the practice of
pathology in the Australasian region. Tony was born in Singapore and gained
his MBBS at the University of Malaya. His pathology residency was undertaken
at the University of Washington, in the early 70’s. He moved to
Adelaide in 1976, gaining an FRCPA, and an MD. His thesis was entitled
“The spalling and migration of silicone from blood pump tubings”.
I think that it was through this work, published also in the New England
Journal of Medicine in 1982, that I first became aware of Tony’s
work. “Spall” means to “splinter”, “chip”,
according to the concise Oxford dictionary, and his thesis dealt with
the migration of debris from tubes used in haemodialysis. This work led
to changes in the composition of the tubing used in haemodialysis.
On the way he has collected Fellowships of Colleges of Pathology in
the United Kingdom, the United States, Hong Kong and Thailand.
Our division is the Australasian Division. The name puts Australia together
with Asia. The vast majority of the membership practice in Australia or
New Zealand, but our membership includes significant numbers of pathologists
in Asia or who are of Asian origin. Tony’s career is an example
of a career that is exquisitely Australasian. He grew up and trained in
South Asia, and has practiced in three States of Australia, as well as
in East Asia. As a pathologist he is equally well known, respected and
sought after as a consultant and lecturer in Australia and Asia. Wherever
he has practised, he has trained and nurtured pathologists from all areas
of Australia and Asia. He has gone to great lengths to appoint trainees
from Asia to his pathology programmes in Australia, and maintain professional
links with them after their return to their home countries.
2003 was a great meeting. Robert Kurman led an outstanding series on gynaecological pathology, followed by Sylvia Asa’s presentations of endocrine pathology. Both presentations, but particularly Sylvia’s, changed the way we approach pathology in that field.
In August 2003, the world’s attention turned to Athens and the 2004 Olympics, and that it was only twelve months to the Olympic Games. Would Athens be ready in time? When were the venues going to be finished? What was the program? Was it all going to work? But all this fades into insignificance compared to what follows.
In October 2003, the world’s attention (well,
the pathology world’s attention) turned to Brisbane and the 2004
International Academy of Pathology Meeting. Would Brisbane be ready in
time? When were the venues going to be finished? What was the program?
Was it all going to work? Well, the answer (with apologies to Optus) is
“yes”. The venues are finished, the hotels ready, the program
finalised and it is all going to work.
Thanks to the remarkable efforts of an organising
committee headed by Robin Cooke, it is all happening. The scientific program
has been organised by Robert Eckstein and is complete. A large team of
session convenors are bringing the speakers together. The social and companion
programs will be amazing and exciting. It promises to be one of the best
Invitation to The“Trends”
“TRENDS in Surgical Pathology” is an annual Anatomical Pathology Slide Seminar held in Sydney by the Royal College of Pathologists of Australasia.
At this seminar, representatives from various teaching hospitals and major private pathology practices, mainly from NSW and ACT, present about 10 or so interesting cases.
The slide sets are $77 per set inclusive of GST. All proceeds go to the College. This year the seminar will be held at 7.30pm on 26th November 2003 at the Scot Skirving Lecture Theatre, Royal Prince Alfred Hospital, Camperdown. All are welcome.
Commentaries are available at the seminar on the night. If you are from outside the metropolitan Sydney region, another State or overseas, a commentary will be posted to you with the slide set.
For more details and/or an order form for the slide
sets, please phone or email me as below.
25th Congress of The International Academy of Pathology
The first announcement booklet is almost completed and it should be ready for mailing at the end of November. The final touches are being added to the scientific programme. The social programme and the accompanying persons programme have been finalised. The RCPA-funded visiting professor for 2004 is Professor Randy Gascoyne. He is co-convening the lymphoma programme.
The Queensland Cancer Fund Lecturer is Prof. Vincenzo Eusebi
As you see in the accompanying flyer, most of the seminars will be done in the form of a CD rom to be sent to participants before the meeting. A book with the images in full colour plus diagnoses and commentaries will be given to subscribers at the registration desk.
Convenors of the various slide seminars are preparing photographs of their cases and some of the cases have already been finalised.
You will notice that two pathologists have donated money towards the expense of running the Congress. Would other individuals or groups be willing to contribute money for this purpose? Donations to the Congress are tax deductible. May I suggest the following:
- Would individuals or groups of pathologists like to pay the registration fee for one or a number of pathologists coming from less affluent countries in our region. The registration fee for the congress is $1,240. This sponsorship would encourage such pathologists to attend the meeting.
- Would individuals or groups of pathologists like to present colleagues who cannot attend the Congress, educational material from the Congress, for example the Slide Seminars consisting of CD plus a book in full colour with all the images from the discs, plus comments on each of the images by the experts presenting the cases. ( These comments are really what they will say about each of the images they present during their lectures. ) As well, the book will contain detailed Commentaries on each case as in the past.
Each slide seminar costs $110. They would be an ideal present for pathologists from less affluent countries.
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Pathology in PAPUA NEW GUINEA
About the time of World War 2, a small Pathology Laboratory was established in the rather primitive Port Moresby Hospital which was built on stilts over the sea, in a similar fashion to that of the houses occupied by the local villagers. In 1958 the hospital and the Pathology Department moved to new buildings in the suburb of Boroko. From 1962 the pathology service in Port Moresby was extended and strengthened and began to contribute to teaching of undergraduate medical students in what was called the Papuan Medical College. As modern hospitals were built in the provincial towns, the Port Moresby department was responsible for establishing Pathology Services in these hospitals.
The Papuan Medical School became a Faculty of the University of Papua
New Guinea in 1969, and since then it has taken an active role in the
teaching of pathology.
The present younger generation of Pathologists is building on the efforts
of previous staff members, and they are providing effective leadership
within the medical fraternity. The Master of Medicine program is attracting
good quality medical graduates and their educational courses are being
attended by M.Med trainees from other disciplines.
In Newsletter 2/2003 the Editor inadvertently wrongly named our only lady member of the Board, Jenny Ma Wyatt. I hope that Jenny will excuse this lapse as nominal aphasia of an ageing Editor.
Sponsorship Donations for Congress
Commonwealth Dept. of Health & Ageing
QEII Hospital, Brisbane
Brisbane City Council Office of Economic Development
The Lord Mayor of Brisbane
Winners from the 29th ASM
HER2 Staining and Reporting Educational Activity
A follow-up to the article by Michael Bilous, Newsletter 3/2002
Margaret Cummings Royal Brisbane Hospital
The testing of breast cancers for HER2 is currently being performed in a number of laboratories as the drug Herceptin is now available for treatment of advanced disease. The result of such testing has very important implications both for the patient with breast cancer and for the federal health budget as funding for Herceptin is directly linked to the HER2 test result.
HER2 testing by immunohistochemistry has problems both in the technique used and in the assessment of the stained slides and ensuring the accuracy of results can be difficult. With this in mind, a staining and reporting educational slide circulation exercise was planned to specifically address HER2 testing in breast cancer. The HER2 staining exercise was voluntary, free and administered by the RCPA Quality Assurance Program in Brisbane.
A preliminary questionnaire was sent to 200 Australian anatomical pathology
laboratories and 146 replies were received. Sixty-seven of the laboratories
requested the staining exercise and of those, 58 laboratories returned
the test cases.
Summary of HER2 immunohistochemical scoring:
Summary of results:
to interpret. In some examples of Case A, there was an artefact, seen
as large cytoplasmic deposits in cells. While also making interpretation
difficult, no membrane staining was ever identified when this artefact
negative or very weak. One laboratory scored Case C as 3+, as they were unaware that only the invasive component should be assessed with regard to scoring and the potential use of Herceptin therapy.
In the study, most (37) laboratories used the Dako AO485 antibody. Thirteen used the CB11 antibody and 4 used HercepTest. As the numbers are so small, it is difficult to draw accurate conclusions about staining using the different antibodies. Staining with HercepTest performed well. With CB11 there was a slight trend towards underscoring the staining, while with AO485, there appeared to be a slight trend towards overcalling the staining.
As a summary of the scoring, the 58 examples of Case B (3+) were performed
well. Combining Cases A and C, there were 116 examples of 1+ staining.
The laboratories results overall, compared with how the panel scored these
cases overall is given in Tables 4 and 5.
Overall, when the results of the 58 laboratories were compared with the “true results” (ie Case A = 1+, Case B = 3+ and Case C = 1+), the kappa level was 0.39 (fair). Showing that part of the discrepancy relates to interpretation and not just staining technique, all 58 panel results for the three cases was k=0.46 or moderate.
Ongoing quality assurance testing for HER2 is clearly important and until results are more standardised it may be worth considering centralising testing of HER2 immunohistochemistry. Laboratories staining and reporting fewer than 250 cases per year may find it difficult to achieve accurate scoring, unless there is substantial and ongoing FISH validation of their results.