Role of the Cancer Registry and Pathology Informatics in the Cancer

Role of the Cancer Registry and P athology Infor m atics in the Cancer Center

N A A C C R Cancer Infor m atics Sy m posiu m: Essential Technologies & M ethodologies for Registries Toronto, Canada; Sunday, June 9th, 2002 Michael J. Becich, M D Ph D - becich@ pitt.edu C hair m an of Pathology, UP M C-Shadyside & Hillm a n Cancer Center Associate Professor of Pathology and Infor ma tion Sciences & Teleco m m u nications U niversity of Pittsburgh School Medicine Director, Center for Path ology Inform atics http://path.up mc.edu/cpi Director, Benedu m Oncology Infor matics Center (Hill m an Cancer Center) http:// w w w.upci.up mc.edu/internet/benedu m /index.ht ml Advancing Pathology Infor matics, Imaging and the Internet (APIII) - http://apiii.up mc.edu Association for Pathology Infor matics (API) -

http:// w w w.pathologyinforSlide 1 matics.org Benedu m Oncology Informatics Center / Center for Pathology Infor matics 1 OO utline utline

•• Introduction to Oncology & Pathology Informatics R esearch at Hillman Cancer Center •• Linkages Between Pathology and Cancer Registries •• Research Use of Pathology Data and Cancer Registries •• Co m prehensive Prostate Cancer Tissue Resource (C P C T R) an d Tissue B a n k Inform ation Syste m s [Clinical, Pathology & Cancer Registry Data] •• The Shared Pathology Informatics Network (SPIN) - Cancer Registry and Anato mic Pathology Data •• Conclusions •• Future Directions – T h e N ee d for Electronic C o m m u nication Strategies

Slide 2 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 2 HillmanHillman CancerCancer CenterCenter

University of Pittsburgh Cancer Institute and UP M C Cancer Centers Co m prehensive Cancer Center 12 patient care centers, each focusing on a specific typ e or treatm e nt of can cer N ationally a n d Re gion ally Co m p etitive In stitutio n siz e 600+ physicians/researchers N u m b er of ne w cancer patients per year: 10,00 0 + P a rticip atio n in clinic al trials Number of open protocols by sponsor type 247 active protocols (48 phar m aceutical, 28 cooperative group, 45 internal) Number of patients accrued in 2001: 1028

Slide 3 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 3 HillmanHillman CancerCancer CenterCenter

P athology Infor m atics 1 8 hospitals – one anato mic laboratory infor m ation syste m (LIS) 1 2 of 1 8 ho s pitals on o n e clinic al path olo g y LI S One tissue banking plan (5 major tissue banks) and no w linked to our Organ Specific Database progra m O ncology Infor matics 1 4 of 1 8 ho s pital on o n e C a n c e r R e gistry (I m P at h, for m erly M R S) N u m ber of ne w index cancer patients per year: 10,000+ Clinical Trials Inform ation Syste m (develope d in house) Organ Specific Databases (research infor mation syste ms)

Slide 4 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 4 OO utline utline

Slide 5 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 5 PP at at h h olo olo g g y y InforInfor m m atics atics

Grade • Seventy percent of the data in Stage the U P M C Electronic Me dical Progression PSA Record is Pathology Data Therapy Type D e m o graphics • Eighty percent of the data us e d Pathology by the UPMC decision support Clinical Genetic syste m is Pathology Data Morphologic G ene Expression• Seventy-plus percent of the Genotype queries against the UPMC EMR Anatomy involve Pathology Data Phenotype • Ti m e P athologists analyze blood and tissue for the prese nce a n d nature of disease

• M u c h of this analysis is based or relies on morphology Slide 6 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 6 MM erging erging PathologyPathology && OncologyOncology DataData forfor ValueValue Creation Creation • Pathology & Oncology Data and Value Creation: – Tissue In B ased Archives » Paraffin – Tu mor classification, staging & grading (stored in anato mic pathology lab info syste m or A P LIS) are critical to the Molecular ReClassification (NCI Director’s Challenge) » Cancer Registry (CR) records treat m ent, progression and outco mes critical to res e arc h efforts (S PI N gra nt) » I m p orta n c e of res e arc h m a t erials (tissues) for geno mics » Pathology + O utco mes + Tissue = unprecedented new value – Clinical Data (and Seru m) Archives » Chemistry profiles and tumor markers many times qualify a patient or define success or failure of therapeutic intervention in clinical trials (clinical pathology lab info syste m or CPLIS) » Aggregates of longitudinal medical records in Oncology and for hospital syste ms (clinical infor m ation system s or CIS) has new perceived value for bench marking change Slide 7 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 7 CoCo mponent mponent TechnologyTechnology –– PP athology athology && OO ncology ncology InforInfor m m atics atics

•• PathologyPathology InformInform atics atics •• OncologyOncology InformInform atics atics •• AA n n ato ato mic mic PatholoPatholo gy gy •• CancerCancer RegistryRegistry •• ClinicalClinical PathologyPathology •• ClinicalClinical TrialsTrials •• HH e e m m atopathology atopathology && •• OO r r ga ga n n SpSp ecific ecific MM olecular olecular DiagnosticsDiagnostics PrograProgra m m SupportSupport •• LILI M M S S forfor GenoGeno mics mics ••Prostate, andand ProteoProteo mics mics M elano ma, etc.. • •• TissueTissue BankingBanking • TelemedicineTelemedicine (for(for •• oncology)oncology) TelepathologyTelepathology •• •• WW e e b b SiteSite SupportSupport WW e e b b SiteSite SupportSupport •• EE--HealthHealth

Slide 8 InitiativesInitiatives Benedu m Oncology Informatics Center / Center for Pathology Infor matics 8 ProposedProposed InforInfor mation mation RR el el atio atio n n s s hi hi p p s s

Version 1.0 Synoptic Form s Cancer Pathology R e gistry LIS

Nomenclature

HL7 R esearch Infor m a tion Tissue B a nk System

Slide 9 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 9 RR esearch esearch InforInfor mation mation Syste Syste m m

• This syste m acts as an integrator, verifier and honest Cancer Pathology R e gistry LIS broker N o m enclature Synoptic Forms • Version 1.04 of this syste m is Tissue Bank imple mented for prostate with Tissue Bank Infor m ation funding from CP CT R, CaPC U RE System and National Medical Test De identification Beds (NMTB) which is a DOD/TATRC (Telemedicine Organ Specific Research Dataset and Advanced Technology Research Center) funded effort.

Intran et N CI interface, collaborator interfaces

Slide 10 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 10 Clinical Environ m ent (Id e ntified Data) AP-LIS CP-LIS

Clinical Tissue Sources Clinical Infor m ation Sources Clinician Direct Data Entry

Fire w all

Tissue Bank Honest Tissue Bank Infor mation Syste m Planned Broker Environ ment Cancer Registry (Clinical, Pathology & Outco mes)

O ne way interface Fire w all De-identified Data O nly R e s e arch E nviron m e nt (De-identified Data) Organ Specific Research Database

R esearch Infor m ation Sources Syste ms Interface

cD N A Microarrays Tissue Microarrays Imaging Data (not com pleted)

Research Data Server

Intra n et A n alysis an d Visualization S ervers (years 2 - 3) Figure 1: Overall architecture OO utline utline

Slide 12 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 12 Current Funding and AP-LIS CP-LIS Areas of Influence Clinical Environ m ent (Id e ntified Data)

Clinical Tissue Sources Clinical Infor m ation Sources Clinician Direct D ata E ntry

De-ID (Clinical Research Infor m ation Service or CRIS) SPIN – Shared Pathology U M LS Based Parser and Autocoder – SPIN Infor m atics Network

T w o W ay Hashing for Non-Consented Clinfo and Biosa mples Fire w all

Tissue Bank Honest Tissue Bank Infor mation Syste m Planned C P C T R – Cooperative Prostate Broker Environ ment Cancer Registry (Clinical, Pathology & Outco mes) Cancer Tissue Resource

One way interface Fire w all De-identified D ata O nly R e s e arch E nviron m e nt Director’s Challenge – Molecular (De-identified Data) R e Classification of Diseas e Organ Specific Research Database

R esearch Infor m ation Sources Syste ms Interface Prostate Research Dataset

cDNA Microarrays Tissue Microarrays Imaging Data (not co m pleted)

Research Data Server

Intra n et A n alysis an d Visualization Servers (years 2 -3) Figure 2: Tissue Cube Director’sDirector’s ChallengeChallenge –– MM olecular olecular RR e e Classificatio Classificatio n n ofof CaCa nc nc er er • N CI Sponsored U01 (Collaborative Consortium) • See http://grants.nih.gov/grants/guide/rfa-files/RFA-CA-98- 027.html – Grand Geno mic and Proteo mic “Fishing Expeditions” funded by NCI – O urs is focuse d on (you guesse d it) Prostate Cancer – Requirement: Hi g h lev el of clinic al a n n o tatio n o n tissue sam ples an d interesting clinical cohorts (age, race, aggressiveness, etc …) – Affy m etrix platfor m R N A expression data – Collaborations with Ken Buetow to share data p u blicly at N CIC B’s (N CI Center for Bioinfor m atics) Gene Expression Data Portal http://gedp.nci.nih.gov/dc/ – Basis for our Organ Specific Database Progra m Slide 14 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 14 Current Funding and AP-LIS CP-LIS Areas of Influence Clinical Environ m ent (Id e ntified Data)

Clinical Tissue Sources Clinical Infor m ation Sources Clinician Direct D ata E ntry

De-ID (Clinical Research Infor m ation Service or CRIS) SPIN – Shared Pathology U M LS Based Parser and Autocoder – SPIN Infor m atics Network

T w o W ay Hashing for Non-Consented Clinfo and Biosa mples Fire w all

Tissue Bank Honest Tissue Bank Infor mation Syste m Planned C P C T R – Cooperative Prostate Broker Environ ment Cancer Registry (Clinical, Pathology & Outco mes) Cancer Tissue Resource

R esearch Infor m ation Sources Syste ms Interface Prostate Research Dataset

cDNA Microarrays Tissue Microarrays Imaging Data (not co m pleted)

Research Data Server

Intra n et A n alysis an d Visualization Servers (years 2 -3) Figure 2: Tissue Cube OO utline utline

Slide 16 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 16 TissueTissue BankingBanking InforInfor mation mation SystemSystem (TBIS)(TBIS)

Table 5. Total Paraffin Archived Prostate Specimens Available from the PA GU TB to the Resource

Banked Specimen Type Actual Projected Accrual at UPMC-HS 1991-8/99 9/99-12/99 2000 2001 2002 2003 2004 Totals Universal Consent PUH Prostates 736 31 92 92 92 92 92 1227 Universal Consent PUH Prostate Biopsies 1000 41 125 125 125 125 125 1666 Routine PUH Surgical Prostate Biopsies 1100 277 553 553 553 553 553 4142 Outreach Prostates 148 148 148 148 148 740 Outreach Prostate Biopsies 495 495 495 495 495 2475 1982-98 PUH Archived Prostates 1760 1760 1982-98 PUH Archived Prostate Biopsies 8800 8800 1982-98 Outreach Prostate Archives 2368 2368 1982-98 Outreach Prostate Biopsy Archives 9472 9472 Total Prostates 4864 31 240 240 240 240 240 6095 Total Prostate Biopsies 20372 318 1173 1173 1173 1173 1173 26555 Total Prostate Specimens 25236 348 1413 1413 1413 1413 1413 32649

Slide 17 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 17 RR esearch esearch InforInfor mation mation Syste Syste m m

Intran et N CI interface, collaborator interfaces

Slide 18 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 18 Slide 19 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 19 Slide 20 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 20 TissueTissue BankBank InformInform ation ation SysteSyste m m

Slide 21 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 21 TissueTissue BankBank InformInform ation ation SysteSyste m m

Slide 22 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 22 Slide 23 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 23 TissueTissue BankBank InformInform ation ation SysteSyste m m

Slide 24 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 24 TissueTissue BankBank InformInform ation ation SysteSyste m m

Slide 25 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 25 Slide 26 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 26 TissueTissue BankingBanking InforInfor mation mation SystemSystem (TBIS)(TBIS) Data Warehouse Query Results

Slide 27 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 27 Slide 28 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 28 OO utline utline

Slide 29 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 29 Current Funding and AP-LIS CP-LIS Areas of Influence Clinical Environ m ent (Id e ntified Data)

Clinical Tissue Sources Clinical Infor m ation Sources Clinician Direct D ata E ntry

De-ID (Clinical Research Infor m ation Service or CRIS) SPIN – Shared Pathology U M LS Based Parser and Autocoder – SPIN Infor m atics Network

T w o W ay Hashing for Non-Consented Clinfo and Biosa mples Fire w all

Tissue Bank Honest Tissue Bank Infor mation Syste m Planned C P C T R – Cooperative Prostate Broker Environ ment Cancer Registry (Clinical, Pathology & Outco mes) Cancer Tissue Resource

R esearch Infor m ation Sources Syste ms Interface Prostate Research Dataset

cDNA Microarrays Tissue Microarrays Imaging Data (not co m pleted)

Research Data Server

Intra n et A n alysis an d Visualization Servers (years 2 -3) Figure 2: Tissue Cube SPINSPIN –– SharedShared PathologyPathology InforInfor m m a a t ticsics NN etw etw ork ork • N CI Sponsored U01 (Collaborative Consortium) • See http://grants.nih.gov/grants/guide/rfa-files/RFA-CA-01- 006.html – Data Mining Software Develop ment for Laboratory Inform ation System s (LIS) and Cancer Registries (CR). » T o transfor m fre e text into de-identified, coded data that can be searched, mined » T h e pipeline con sists of the Lab oratory Infor m ation Syste m or Ca ncer R e gistry, De-identification E n gine, Parser, Autocoder, and Data Mining Software – Critical Needs: » De-Identification Soft w are » Autocoding and Parsing “Chunks” of Textual Data » T w o W ay Hashing for “Linked” De-Identified Data – Based on Minimal Essential Data Ele m e nts • R ole of the C a n c er R e gistry – Supply critical staging, treatment, progression and outco me data – Coupled with pathology data is a very po werful tool – Add “lead” Cancer Registrars to focus on key areas – breast, colon, lung, melano ma and Slidehead 31 & neck Benedu m Oncology Informatics Center / Center for Pathology Infor matics 31 OO utline utline

Slide 32 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 32 M aintaining the Cancer Registry, Pathologic and Morphologic Data in the Context of Gene Expression

Gene Expression - Microdissection -Advanced Fixatives - Microarrays Digital Morphology [Imaging] - Imaging Syste ms -Image Analysis Laboratory Results -CBIR Pathology Reports - Lab Info Syste ms - Cancer Registry Clinical History & Outco mes (Cancer Registry)

Slide 33 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 33 Pathology,Pathology, Oncology,Oncology, ImagingImaging andand thethe FutureFuture

• Geno mics and Proteo mics • Clinical Info and Outco m es fro m C a n c er R e gistry • P atho-bioinfor m atics: U nderstanding and m a pping g e n e expression in th e context of morphology

Slide 34 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 34 PP A A CancerCancer AlAlllianceiance DataData MM o o d d el el

1b 1a, 2a, 2c Cancer Center 1c D e-identification Bundling

2b Data Mapping Tissue Data Model Clinical Data Model 3b Bio-infor matics Data Model 3c

Data Linking R eceiver A bility to S h a r e D ata an d Biorep ositories ictionary Data Warehouse 3a is the Most Important A s pect of this W ork

Me t a dat a D Query Engine

Slide 35 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 35 UU P P M M C C CC a a n n c c er er CC e e nters nters ReRe gistry gistry GrowthGrowth ThroughThrough ResearchResearch

U PM C C ancer Centers Cancer Registry After: Before: S haron W inters 1 Director Director 1 Director 4 Leads 8 Leads Presbyterian H ospital Shadyside H ospital 25 Registrars Cancer Registry Cancer Registry 26 Registrars Lead - 1 FTE Lead - 1 FTE Total FTE = 30 Cancer Registrars - 4 FTEC ancer R egistrars - 5 FTE Total FTE = 35 Increase = 17 % M agee W om en's H ospitalC h ild re n 's H ospital Cancer Registry Cancer Registry Lead - 1 FTE Lead - 1 FTE Cancer Registrars - 4 FTEC ancer R egistrars - 4 FTE

C om m unity H ospitals 1 C om m unity Hospitals 2 Cancer Registry Cancer Registry Cancer Registrars - 4 FTEC ancer R egistrars - 4 FTE Benefits: B etter Visibility Prostate Program Melanoma Program C areer Ladder Before: O rgan Specific D atabaseO rg a n S p e c ific D a ta b a s e Lead R egistrar - 1 FTE L e a d R e g is tra r - 1 F T E Isolation Cancer Registrars - 1 FTE New Funding C ost Center C oordination Lung Program Head & Neck Program 6-12 m os. lag O rgan Specific D atabaseO rg a n S p e c ific D a ta b a s e Better Care Lead R egistrar - 1 FTE L e a d R e g is tra r - 1 F T E Delivery

Slide 36 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 36 OO utline utline

Slide 37 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 37 TheThe NeedNeed forfor ElectronicElectronic CommunicationCommunication StrategiesStrategies • Cancer Registry software co m panies need to be able to use HL7 – I m P at h (for m erly M R S ) lo o ki n g for alp h a p artn ers … little actio n to dat e – C net, R M S, Others ??? – City of Hope Initiative to link Clinical Trials & N C C N O utco m es is very important • A n ato mic P a thology LIS C o m p a nies n e e d to m e s sa g e to C a n c er Registries – Co Path (Cerner for merly DH TI) has a form s based relational data m a p ping tool (called syno p tic reports) » T o transfor m fre e text into code d data that can be searched, mi n e d – Critical Needs: » Data Warehouse and Data Mining Tools Based on Minimal Essential Data Ele m ents » Linkage of imaging data to textual data (beyond the scope of this lecture), but visit APIII(see subsequent slide) • Clinical Trials, Outco m e s Research an d Bioinform atics Initiatives will supply the funding for doubling your Cancer Registry staff.

Slide 38 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 38 Clinical Environ m ent (Id e ntified Data) AP-LIS CP-LIS

Clinical Tissue Sources Clinical Infor m ation Sources Clinician Direct D ata E ntry

Fire w all

Tissue Bank Honest Tissue Bank Infor mation Syste m Planned Broker Environ ment Cancer Registry (Clinical, Pathology & Outco mes)

One way interface Fire w all De-identified D ata O nly R e s e arch E nviron m e nt (De-identified Data) Organ Specific Research Database

R esearch Infor m ation Sources Syste ms Interface Prostate Research Dataset

cDNA Microarrays Tissue Microarrays Imaging Data (not co m pleted)

Research Data Server

Intra n et A n alysis an d Visualization Servers (years 2 -3) Figure 2: Tissue Cube VersionVersion 2.02.0

• It is incre a sin gly cle ar that high throughput research Cancer Pathology facilities will beco m e R e gistry LIS Clinical Services operationalized and therefore should be able to Tissue Bank provide very useful data to Tissue Bank Infor m ation this syste m System • Facilities include Affy m etrix De identification F acility, Tissue Microarray, High Throughput High Throughput Imaging Research Facilities • These facilitie s will likely Standards, conventions, interfaces b e p o w er users of the O S R D • Clinical investigators may Organ Specific also want to include their Research Dataset o w n data elem e nts.

Slide 40 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 40 AssociationAssociation forfor PathologyPathology InforInfor m m a a t ticsics http:// w w w.pathologyinfor matics.org

• Officers: – President - Mike Becich – President Elect - Bruce Fried m an – VP - Ron Weinstein – Secy/Treasurer - Joel Saltz – Membership -M ark Tuthill • Mission: – S upport research, education, scientific meetings through electronic and printed co m m u nications. – Develop standards for reporting, tra n sferrin g, storin g, a n d m e r gin g confidential and other pathology- related infor m ation. – Play active role in legal, ethical, social, regulatory, and govern m ental issues related to pathology infor m atics. – Develop relationships with other professional societies an d industry partners.

Slide 41 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 41 27 Scientific A bstracts-Peer Review e d 50 http://apiii.upmc.edu Electronic Posters -Live De mos Published in Arch Pathol Lab Med

This Year’s Meeting (October 2-4th, 2002) will have focus sessions discussing: a) Leveraging the Value of AP Data Warehousing b) The Role of Pathology in the Post-Geno me Era - Tissue and cDN A Microarrays in Diagnostics c) Recent Advances in Pathology Infor m atics - Wireless/Handhelds in Pathology Practice d) New Opportunities for Acade mic Pathology - Tissue Ba n king an d Bioinfor m a tics e) C o nfide ntiality, HI P A A an d Post- Ge no m e Era Breakout Sessions will include: a) W ar Stories - H a n d held/ Wireless Devices b) Telepathology/Reporting o n the WWW c) Cost Effectiveness and Outco mes Research d) Virtual Glass Slide and Robotic Technology e) New Career Opportunities in Pathology f) “Boot C a m p ” for R eside nts inclu din g a Pathology Infor matics Training Track Featuring: (Courtesy Cisco, Co mpaq, Dell and Verizon) O C 3 Backbone and 100 Networked Devices 1996- 2002 APIII site 3.5 M Hits & 375,000 Users Slide 42 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 42 R ecent Publications by our Tea m in the Areas of Tissue B a n king an d Prostate Ge no mics

• Becich, M.J. Th e role of the P atholo gist as tissu e refiner an d data miner: The impact of functional geno mics on the m o dern pathology laboratory and the critical roles of P ath ology Infor m atics an d Bioinfor matics. Molec Diag. 5( 4): 2 8 7-299, 2000. • Land m a n A, Yagi Y, Gilbertson J, Da wson R, Marchevsky A, Becich MJ. Prototype w e b-based continuing medical education using FlashPix images. Proc A MIA Sy mp. 2000; 462-6. • Y u, Y. P.; Lin, F.; Dhir, R.; Krill, D.; Becich, M.J.; Luo, J. H. Lin e ar A m p lification of G e n e-Specific c D N A e n d s to Isolate Full-length of a c D N A. Anal Bioche m. May 15;292(2):297-301, 2001. • Y u, Y. P.; Lin, F.; Bisceglia, M.; Krill, D.; Dhir, R.; Becich, M.; Luo, J-H. Short Co m m u nication: Identification of a novel gene with increasing rate of suppression in high grade prostate cancers. A m J Pathol Jan;1 5 8(1):1 9-24, 2001. • Krill, D., Tho mas, A., Wu, S-P., Dhir, R., Becich, M.J. E-cadherin expression and PSZ secretion in hu m a n prostate epithelial cells. Urol Res. Aug 29(4):28 7-92; 2001. • Krill, D.; DeFlavia P.; Dhir, R.; Luo, J.; Becich, M.J.; Leh man, E.; Getzenberg, R. Expression patterns of Vita min D Receptor in Hu m a n Prostate. J Cell Bioch e m. 82(4):566-72, 2001. • Lin, F.; Y u,Y. P.; W o o d s,J.; Cie ply,K.; Go o ding, W,l Fink elstein, P.; Dhir, R.; Krill, D.; Becic h, M.J.; M ichalopoulos, G.; Fink elstein S.; Lu o, J. H. Myo po din, a novel synaptopodin ho mologue, is frequently deleted in invasive prostate cancers. A m. J. Pathol, Nov; 159(5):1603-12, 2001. • Luo, J.H..; Yu, Y.P.; Cie ply, K.; Lin, F.; Deflavia, P.; D h ir, R.; Fi n k el stei n, S.; Mi c h al o p o ul o s, G.; Becich, M.J.. Gene Expression Analysis of Prostate Cancers. Mol. Carcinog, Jan;33(1): 25-35 2002. • Zheng. L., W etz el, A., Gilb erts o n, J., Becich, M.J.; Design an d Analysis of a Content-Based Pthology Image Retrieval Syste m, IEEE January 3, 2002 • Schubert, E., Gross, W., Gilbertson, J., Harrison, J., Becich, M.J. Anatomic Pathology Laboratory Infor mation System s. (in press, Mod Surg Pathol) • Becich, MJ. Inform ation Manage m ent: Moving fro m Test Results to Clinical Infor m atio n. 2000. Clinical Lab Manage m ent Review (in press).

Slide 43 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 43 EndEnd ofof TalkTalk –– ee--mailmail meme at at becich@becich@ pitt.edu pitt.edu ifif youyou havehave questions/clarificatquestions/clarificationsions notnot coveredcovered inin thethe discussion.discussion.

Thank you for the invitation to this N A A C C R C ancer Inform atics Sy m posiu m.

Slide 44 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 44