New Technologies in Gynecology
By Donald Aulds, M.D.
During the past couple of years there has been an introduction of new technologies for diagnosis and prognosis in gynecology. These new techniques are giving new means for diagnosis and prognosis of diseases. I will try to give you an overview of the new technologies so you can discuss this with your physician if problems arise.
Cervical DNA Test
The testing for specific DNA that can be altered by human papilloma virus (HPV) was first reported in 2003, but the development of a test that can accurately predict risk of cervical cancer from HPV has taken several years to develop. The cervical DNA Dtex test is the first type of test that looks for three specific types of markers on the DNA that are altered by the HPV. The test is indicated when there have been two low-grade results on the Pap smear and a positive test for HPV. The test is done on liquid-based cytology samples, which are the same samples used for the Pap smear. Research done at Johns Hopkins University Medical Center showed that the HPV-altered chromosome increase the risk of the development of cervical cancer. If the Dtex test is positive – meaning that there is an increased number of cells showing the altered DNA – further evaluation is needed to rule out the risk of cervical cancer. If the Dtex test is negative, the patient will not need extensive testing and biopsies. The positive predictive value of the test is greater than 95 percent.
Breast Specific Gamma Imaging
The newest technology now available at Huntsville Hospital’s Breast Center is breast specific gamma imaging (BSGI). It is considered the next step in the evaluation of questionable or non-specific areas evaluated by mammogram. It evaluates the metabolic activities of areas of the breast. With cancer cells, the metabolic function is increased and the areas of increased activity lights up in comparison to the surrounding normal tissue. It can be used to determine the extent of disease in a patient with confirmed breast cancer, evaluate for lobular carcinoma which does not easily show on other modalities, check areas that are suspicious on mammogram or ultrasound, check for spread of the disease, and evaluate areas that have a large amount of calcification and could potentially hide areas of concern. It is an accurate, safe, easily tolerable procedure with a low-radiation exposure. Studies have shown it to have a high resolution that improves the ability to detect a cancer at an earlier stage of development. BSGI has been shown to complement mammogram for patients that have dense breast tissue, palpable lesions not seen on mammogram, suspicious lesions or clusters of calcification, implants, and difficult-to-read mammograms. It has been helpful in evaluating the breast in pre-biopsy evaluation, identifying areas needing biopsy, and post-surgical or post-therapy evaluation. Studies have revealed that it improves the management of difficulty to diagnose areas of the breast and aids in determination of the extent of the disease.
DNA Testing for Infectious Diseases
Until recently, DNA testing for bacteria, fungi and viruses had not evolved to be able to do panels of tests in a rapid and reliable manner. A Huntsville company now has the capacity to provide this service in a reliable, rapid and cost-effective manner. The testing gives panels of different infectious agents that can be done in 24 hours as compared to standard cultures which usually take 72 to 96 hours. The panels include evaluation for chronic bacterial vaginosis and chronic urinary tract infections as an aid to help the gynecologist diagnose these problems. Other panels can include the intestinal tract, pulmonary system, panels for staphylococcus including the severe methicillin resistant staph aureus, and others. The technology checks the DNA patterns for each of the bacteria most commonly known to occur and cause infections in these systems. Hospital studies have shown a decrease in hospital-acquired infections when the evaluation is rapid and required medications is delivered quickly.