Scrammer anyone?

February 20, 2009

If all you’ve got is a hammer, everything looks like a nail. Add a screwdriver, and the world is a much different place. The same can be said for MR and CT, ultrasound, nuc med, and x-ray. For much of our modern age of imaging, we have been screwing in nails, then hammering them…or vice versa. This is much better than the previous approach, exploratory surgery, but it could be better.

If all you've got is a hammer, everything looks like a nail. Add a screwdriver, and the world is a much different place. The same can be said for MR and CT, ultrasound, nuc med, and x-ray. For much of our modern age of imaging, we have been screwing in nails, then hammering them…or vice versa. This is much better than the previous approach, exploratory surgery, but it could be better.

More often than not, medicine must contend with disease entities that are not the pathological analogs of nails or screws but have attributes of both. For lack of a better word, let's call them scrails. And what better to handle a scrail than a scrammer.

It's personalized medicine but not the kind usually talked about that genetically fine-tunes therapies to individual patients. This one is a lot nearer at hand and would match therapies to the needs of the patient using currently available diagnostic technologies.

Dr. Ilan Tsarfaty, a researcher at Tel Aviv University's Sackler School of Medicine, is a scrammer advocate, although I'm willing to bet he wouldn't recognize the name. His idea doesn't have a name yet, but he claims that, by using a combination of MR and ultrasound, he can measure the metabolic rates of cancer cells. Doing so allows him to identify at an earlier stage than ever cells that are metastasizing. This, in turn, helps determine how patients should be treated.

"By the time results are in from a traditional biopsy, the cancer can already be radically different," he said. "But using our technique, we can map the tumor and its borders and determine with high levels of certainty right away which patients should be treated aggressively."

Research so far has focused on breast cancer, but Tsarfaty said he believes the approach might be applied to any solid tumor, including those resulting from lung and brain cancer.

Increased blood flow, determined by ultrasound, and an increase in oxygen consumption, measured with MR, indicate cancer metastasis, he said. Tsarfaty says this can be done with unprecedented levels of sensitivity. We'll see. Results are still preliminary. A full-blown clinical trial of his idea won't begin until 2010. But, in the meantime, the principle is worth considering.

Why not mix and match the capabilities of different modalities to home in on the subtle nature of different diseases?. The human body is full of scrails. We need to start looking for scrammers.