Appendix 5: Survey of Specialised Molecular Pathology Services in Scotland
Column A | Column B | Column C | Column D | Column E |
|---|
Description of Specialised Laboratory Service
E.g. Test, Examination or Interpretation | Laboratory Provider | Annual Workload | Funding Source | Comments on specialised service
E.g. Turnaround, Expertise, Equipment |
|---|
FLUORESCENCE IN SITU HYBRIDISATION ( FISH) | | | | |
HER2 in breast cancer | Lothian | 176 | NHSL | Expertise, equipment and turnaround |
HER2 in breast cancer | Glasgow | 427 | NHSGGC | Expertise, equipment and turnaround |
HER2 in breast cancer | Grampian | 60 | NHSG | Expertise, equipment and turnaround |
HER2 in breast cancer | Tayside | 160 | NHST/ NSHH | Expertise, equipment and turnaround |
*Bone Marrows | Glasgow | 611 | NHSGGC | Expertise and equipment |
# Other applications | Lothian | 15 | NHSL | Expertise and equipment |
Other applications | Glasgow | 482 | NHSGGC | Expertise and equipment |
Other applications | Grampian | 153 | NHSG | Expertise and equipment |
Other applications | Tayside | 40 | NHST | Expertise and equipment |
Other applications | Highland | 28 | NHSH | Expertise and equipment |
COLOURIMETRIC IN SITU HYBRIDISATION ( CISH) | | | | |
§ Range of applications | Lothian | N/A | NHSL | Expertise and equipment |
Range of applications | Glasgow | 492 | NHSGGC | Expertise and equipment |
Range of applications | Grampian | N/A | NHSG | Expertise and equipment |
Range of applications | Tayside | N/A | NHST | Expertise and equipment |
Range of applications | Highland | 28 | NHSH | Expertise and equipment |
LOSS OF HETEROZYGOSITY IN BRAIN TUMOURS | | | | |
PCR testing | Glasgow | 1492 | NHSGGC | Expertise and equipment |
GENE REARRANGEMENT IN LEUKAEMIA / LYMPHOMA | | | | |
? PCR Testing - several specific applications | Lothian | 1193 | NSHL | Expertise and equipment |
PCR Testing - several specific applications | Glasgow | 2391 | NHSGGC | Expertise and equipment |
PCR Testing - several specific applications | Grampian | 740 | NHSG | Expertise and equipment |
PCR Testing - several specific applications | Tayside | 130 | NHST | Expertise and equipment |
PCR Testing - several specific applications | Highland | 323 | NHSH | Expertise and equipment |
Microsatellite instability (colorectal cancer) | Tayside | 180 | NSD* | |
* These tests include diagnosis and classification of lymphomas and leukaemias by specific recurrent genetic abnormalities, data available on request. This genetic approach to classification is now recommended by the World Health Organisation.
# These tests include diagnosis of translocations, deletions and other mutations in lymphomas, leukaemias, sarcomas and brain tumours; also detection of chimaerism after transplant, data available on request.
§ These tests include diagnosis of infections (eg human papilloma virus [ HPV], herpes Virus, Epstein Barr virus), chimaerism, and expression of messenger RNAs that characterise specific types of tumours, data available on request.
? These tests include diagnosis of translocations, deletions and other mutations in lymphomas and leukaemias, data available on request. This genetic approach to classification is now recommended by the World Health Organisation.
Funding Body Abbreviations
NHSG - NHS Grampian
NHSH - NHS Highland
NHSGGC - NHS Greater Glasgow & Clyde
NHSL - NHS Lothian
NHST - NHS Tayside
NSD - National Services Division
Notes on Specialised Molecular Pathology Services
- Some funding for the FISHHER2 service was provided to health boards by the Scottish Cancer Group
- While turnaround has not been flagged as an issue in most of these tests, this will change. When HER2 testing started, there was no pressure on turnaround, as patients would only be treated with Herceptin if their tumour recurred in future. This changed with the publication of the results of large clinical trials that supported the use of Herceptin in the adjuvant setting, and also indicated that a positive test might influence the patient's response to other drugs used in early treatment. This is highly likely to happen with other tests.
- The major focus of activity will in future be in relation to histopathology as testing in solid tumours increases. There will also be additional requirements in haemato-oncology. The exact model of delivery of service may differ in each centre, depending on the interactions between these two disciplines, and between them and genetics.
- Without national oversight it is very difficult to identify the resources required to introduce these new specific applications. Additional investment in equipment, scientific skills and training is required. A proposal has been made, and is widely supported, that this be achieved by the establishment of a Scottish Molecular Diagnostics Consortium, based on the model of the Molecular Genetics Consortium. This would see testing taking place in a defined small number of centres with appropriate infrastructure in terms of equipment and skilled staff. It would allow the coordinated introduction of tests throughout the country, the most efficient use of expertise and equipment and the development of training and quality assurance programmes.