Pathology, Patient Biospecimens and Disease Processes

Q1: What was your path towards pathology, ultimately at Toronto’s University Health Network, and what’s the environment there like for conducting research and handling biospecimens?

During my postgraduate training I became interested in pathology because it was the one place where a clinician could spend time studying the structure and function of disease. Clinical medicine was my primary interest, but I quickly realized that to be a good clinician, one had to have a strong understanding of the fundamentals of normal and abnormal tissues, cells and subcellular processes. Pathology seemed to be the right place for me to be able to understand how diseases develop and progress.

Tissue-based research has always been at the heart of pathology. The discipline was developed by clinicians who were curious and wanted to investigate disease processes; as knowledge emerged from their studies, they began to apply the new information to make diagnoses and predict outcomes. The massive growth in genomic and proteomic information has led to an explosion in pathology as almost every patient sample is probed for new markers of more precise diagnosis, prognosis and response to therapy.

Q2: You were the head of Canada’s largest academic pathology department, and the innovations you’ve made to pathology practices emphasize biobanking, automation, subspecialization, electronic initiatives and digital pathology. What other advances do you foresee in the next decade for biospecimen management, and what obstacles have to be overcome to get there?

Biospecimens are increasingly valuable as we move towards personalized and precision medicine. The technical challenges will be to collect the highest-quality samples, and to ensure that they are accurately annotated. This includes appropriately identifying and validating information that is known at the time of collection, and ensuring that new information emerging from the study of those samples is available for further annotation and analysis. Equally as important as those technical issues are the ethical challenges of ensuring tissue retention for patient care, appropriate definition of ownership and rights to tissue, determination of the monetary value of biospecimens, and the implementation of mechanisms to share the results of research studies with patients and their families.

Q3: Your presentation on July 14 is part of the keynote session “It Takes a Village”. When you discuss “The Complexity of Pathologist Responsibilities as Custodians of Biospecimens”, what’s your takeaway message for the audience regarding pathology’s contribution to biobanking?

Pathologists have responsibility for handling patient biospecimens; they implement rigorous quality assurance of processes that determine how specimens are collected, processed, examined, reported and either destroyed, biobanked or retained on file. Pathology is ideally positioned to develop and oversee biobanks and because of its capacity for data generation, generally provides the greatest amount of information for specimen annotation. Pathology also is subject to mandatory requirements for retention of clinical records, including tissue blocks and slides, for legal and accreditation purposes, emphasizing the importance of collecting and documenting biospecimens for research.

Speaker Information:

Sylvia L. Asa, M.D., Ph.D., Laboratory Medicine Program, University Health Network; Senior Scientist, Ontario Cancer Institute; Professor, Laboratory Medicine & Pathobiology, University of Toronto

Dr. Sylvia Asa is Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto and recently completed 15 years as the Pathologist-in-Chief and Medical Director of the Laboratory Medicine Program at the University Health Network. A Clinician-Scientist with a focus on Endocrine Pathology, her research aims to identify the basis for development of endocrine tumors, to improve diagnostic tests and to identify targets for therapy of those diseases. She has published more than 400 scientific articles, written four books, co-edited five books and written more than 100 book chapters. As head of the largest academic pathology department in Canada, Dr. Asa made innovative changes to the practice of the discipline, with emphasis on subspecialization, automation, biobanking, electronic initiatives and digital pathology.

Presentation: Tuesday, July 14 during the Keynote Session: It Takes a Village