The Pathology Report 2020 Duke Pathology Annual Magazine
Testing the System
Clinical Labs During Covid 19
The Action of Learning A Lifetime Journey
2020
The Pathology Report 2020 Duke Pathology Annual Magazine
3 Letter From Our Chairman 4 F EATURE
The Action of Learning Maria Angelica Selim, MD
8 FEATURE
Preventing One Cancer from Becoming Another Jung Wook Park, PhD
12 F EATURE
The Hackels’ Big Heart
16 A I FEATURES 16 At Duke, the Future of Pathology Lies in AI Division of Artificial Intelligence and Computational Pathology 19 A New Division, an Exciting Addition Improving Patient Care
22 COVER FEATURE
Annual Magazine 2020 (published July 2021) Editor in Chief Susan Reeves Consulting Editor Anne Buckley MD PhD Writers Whitney J. Palmer Susan Reeves David Howell, MD PhD Morgan Pope Photography Susan Reeves Steven Conlon PhotoPath Archives
Testing the System Clinical Labs During COVID-19
Art Direction Pam Chastain Design
30 Development News
For questions, comments, or to add your name to our mailing list, please contact us by any means below, and thanks for your interest!
Legacies of Learning
32 Meet Our New Faculty
Additions to our Clinical and Research Staff
34 Count and Amount
An illustrated guide to the numbers
36 Current Faculty and Administration 38 Around the Department 42 COVID-19 Memories
Department of Pathology Attn. Newsletter 40 Duke Medicine Circle DUMC 3712 Durham NC 27710 Email: pathnews@duke.edu Phone: 919-684-4862 Copyright 2021 © Duke Department of Pathology With gratitude to all who helped make this magazine and all of my endeavors possible over 40 years ~ Susan
PLEASE VISIT our extensive website at pathology.duke.edu
LETTER FROM OUR CHAIRMAN Dear Friends: We are very pleased to present the 2020 edition of our Annual Report, in which we share some exciting news about the department as well as tales of our rich history. Of course, 2020 was a most unusual and challenging year. The report would not be complete without highlighting the heroic acts of our faculty and staff in fighting the COVID-19 pandemic. This magazine will introduce you to new members of the Duke Pathology family, and highlight the treasured colleagues whom you may have worked with in the past. I hope you enjoy both the stories and the photographs within. Credit goes to our talented Susan Reeves and faculty advisor Anne Buckley. We invite you to visit the department’s website (https://pathology. duke.edu/), which is constantly being updated, and to stop by the department whenever you are in the area. As always, please email us if you have something to share. Warm regards,
Jiaoti Huang MD PhD Chairman, Department of Pathology Duke University School of Medicine
FEATURE 4
THE ACTION OF LEARNING
Unlike most scientists or doctors, MARIA ANGELICA SELIM, MD didn’t have an “Aha!” moment when she knew, beyond a shadow of a doubt, that she would be a physician. Medicine was just simply around her—her father is an internist; her mother, a pediatrician. So, she grew up assuming being a doctor was her future. Identifying a specialty, though, was harder. To find what best fit her interests, Selim’s father coordinated times for her to shadow his colleagues who worked in areas of medicine most related to images—radiology, dermatology, and pathology. For her, pathology, with its opportunities to examine shapes and colors, hit the mark. “My father asked me if I felt I could be the person behind the microscope all day,” she said, recalling her excitement at what she saw on the slide.
by WHITNEY J. PALMER
SHAPES AND COLORS The aesthetic appeal of skin tissue helped determine Dr. Selim’s career choice. She created this art wall in the DermPath sign-out room; the monitor shows tissue with lichen sclerosus.
“I said yes. I found what his colleague did to be fascinating, and I could easily see myself in that role.” Today, Selim, Professor of Pathology and Dermatology, serves as the Chief of the Division of Dermatopathology at Duke University Medical Center and is considered a leading international voice in vulvar pathology. She is also a highly respected and sought-after educator who has spent more than 20 years at Duke cultivating the next generation of pathologists.
are familiar with it, but at the time a multi-specialty approach was not a frequent practice,” she explained. “Then people started to understand that whatever skin disorder affects the body extra-genitally also has a high probability of also manifesting on the vulva.”
The Journey
What followed was an explosion of knowledge, she said, with gynecologists, dermatologists, and pathologists all beginning to work together to provide better care for women. Not only did collaborations increase, but so did the number of vulvar dermatoses included in classifications. In the 1970s, lichen sclerosus was the only inflammatory process recognized in the ISSVD classification, but by 2011, dozens of dermatoses were recognized as part of the classifications for vulvar dermatologic disorders.
After shadowing her father’s pathologist colleague, her trajectory was set. Following medical school graduation at the Universidad Nacional de La Plata in Argentina, Selim completed her residency in pathology at New England Deaconess Hospital, now Beth Israel Deaconess Medical Center, and her dermatopathology fellowship at The Harvard Medical School Dermatopathology program. It was the sheer volume of skin biopsies that caught her eye, and soon her colleagues were bringing her cases for evaluation. Thus, her expertise began to grow. “With so many cases, my co-workers would see me reading and trying to figure things out by myself,” she said. “They started to bring me cases to look over and help them. They naturally started to select me as the go-to person for asking skin biopsy questions.” But her journey had just begun. The next stop on her career path brought her to Duke in 1999 when she accepted Assistant Professorships in Pathology and Medicine. For nearly two decades, she was integral to coordinating and supervising the combined dermatopathology residency education program from both the pathology and dermatology departments. In 2013, her work led to her promotion to dual professorships. One of Selim’s clinical contributions has been integrating multi-disciplinary study of vulvar disorders. Vulvar pathology has, historically, been a conundrum both for patients and doctors. The associated disorders are poorly understood, and there was little-to-no collaboration between specialties, leaving countless women to suffer without answers or treatment. But for Selim, with her lifelong fascination with colors and images, diagnosing these disorders is like solving a puzzle. And with each puzzle she completes, another woman gets clarity for her painful questions. “The vulva is an organ with a very significant skin component. Both gynecologists and dermatologists
“Women with these conditions had been very, very upset because they were going from one specialty to another without receiving an answer,” she said. “I got involved because I saw there was a need for more interactions between the specialties—if we brought in skin pathology, we may be able to give these women better service.”
The Journey for the Next Generation It is the quest for knowledge that pushed Selim to go beyond her clinical work. She wanted to make connections with others in her field and participating in international conferences was a prime avenue for having broader conversations and learning from others’ experiences. And Duke’s reputation as an international leader with its
“My career, for me, has been a journey. It has been something that never ends,” she said. “It is not something that is permanent, but rather filled with movement, action, and learning.” Maria Angelica Selim, MD
5 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
“My career, for me, has been a journey. It has been something that never ends,” she said. “It is not something that is permanent, but rather filled with movement, action, and learning. At Duke, I have always felt that there was something next—it is what has kept me here at this institution.”
FEATURE
campus in Singapore helped open those doors for her. She likened it to standing on the shoulders of a giant. “Duke has a very large international presence, and for many people it creates the perception that the University doesn’t have boundaries,” she said. “It is an institution that welcomes other people, ideas, philosophies, and cultures.” Attending these conferences fed Selim’s intense love of travel, and it also broadened her impact on the specialty. By learning, sharing ideas, and networking at these events, she cemented her own reputation as a leader and positioned herself as a valued teacher. Consequently, she was chosen as Duke’s Dermatopathology Fellowship Program director, a position she held from 2001 until 2019. During that time, she trained more than 20 fellows, giving her the opportunity to launch the next generation of pathologists on their own journey. Today, many of them work as her colleagues at institutions across the country. “I now have the pleasure of working with my friends that have trained with me when we go to
conferences because they also embrace the idea of collaboration,” she said. “When you train, you pass your knowledge on to your fellows, and you connect people.”
“Many of my fellows told me they knew my voice would be in their head, and I responded that I hoped it would only be for a short time.”
Maria Angelica Selim, MD It’s this approach that has earned her several accolades over the years. In 2017, she received the American Society of Dermatopathology’s annual Walter R. Nickel Award for Excellence in Teaching of Dermatopathology for contributions to education in the field. She is also the four-time recipient of Duke’s Dr. J. Lamar Callaway Teaching Award for outstanding contributions in teaching the art of dermatology, as
Photo: Submitted
6
Fellows from the Duke Dermatopathology Fellowship program gather around Dr. Selim at the 2017 ASDP Annual Meeting.
She credits her success as an educator to her approach in selecting the fellows she trains. It’s not about only choosing individuals with the greatest technical skill—it’s about nurturing students who will add to the field in a variety of ways. “You are looking for individuals who you want to be your next colleague, someone who reflects what you want the specialty to be, someone who embraces the institution and has ethical standards for the specialty,” she said. “You want people who have the confidence to jump in, be leaders, and be someone you can be extremely proud of whether they opt for academic or private practice.” Although she trained and provided guidance, it was never her intent to create cookie-cutter versions of herself. Her hope was that her fellows would internalize the experience and knowledge she imparted and parlay it into their own philosophy and approach to practice. “Many of my fellows told me they knew my voice would be in their head, and I responded that I
COMING OUT FROM DRIVING THE 10-HEAD SCOPE TO TEACH Dr. Selim conceived the prototype for our sign-out rooms with multi-monitor computer and scope camera screens for group viewing.
hoped it would only be for a short time,” she said. “I only gave them the tools they needed to find their own voice and naturally develop their own style of practice.” Armed with those skills, they can not only serve patients and potentially teach others, but they can also enjoy their own lifelong learning pursuits. Doing so is something that continues to drive Selim on a daily basis. “I am still creating my style and discovering myself, and I am still able to share with my fellows and colleagues,” she said. “It is all about the action of learning. I am still on that journey.”
7 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
well as a two-time recipient of the Bernard F. Fetter Teacher Award given by the pathology house staff to the faculty member whose skills, knowledge, and attitude have most influenced their education.
8
FEATURE
PREVENTING ONE CANCER
FROM BECOMING ANOTHER by WHITNEY J. PALMER
“At that time, my definition of cancer was just a big ball that had grown in her body,” said Park, assistant professor of pathology. “I asked why he couldn’t just give her a new pancreas to fix it. He said it was impossible and that the cancer had already spread.” As Park grappled with the puzzle of his grandmother’s disease, he was also introduced to DNA manipulation via Jurassic Park. Dinosaurs aren’t related to cancer, he said, but seeing characters work with genes to revive prehistoric lizards put his mind to work. “That’s how I got started with cancer research. I wanted to see how I could change the genes, alter the DNA,” he said. “How could I fix it? Could I make it normal?” And with those queries, his journey to investigate how cancer cells develop—and to determine whether it is possible to detect malignancies earlier—was set. Today, he leads a lab in Duke’s Department of Pathology and focuses on the progression, changes, and treatment resistance of prostate cancer. But, to fully understand what’s going on, he studies the healthy tissue surrounding the cancer cells as well.
“Most men with prostate cancer have adenocarcinoma, but in 20 to 30 percent of those cases, the cancer cells will change to block or avoid treatment— they will become small cell cancer,” he said. “But why? By looking at the benign, normal adjacent tissue, and changing the gene in the normal cell, I can see how that cell becomes cancer.”
The Path to Pathology
“There are a lot of smart people out there who are going to fix cancer, but I want to detect it early and block the transformation of cells, preventing one type of cancer from becoming another.”
The road to studying prostate cancer cells, Jung Wook Park, PhD however, wasn’t direct. While he applied himself academically in middle and high school in South Korea, by the time he reached college, Park was mentally exhausted—and his GPA reflected it. After his sophomore year, he took a step back to complete his three years of mandatory military service. Upon his return to school, he followed a friend’s suggestion and pursued working in a lab for the remainder of his undergraduate and master’s degrees. It was a far more attractive opportunity than sitting in the classroom, Park said. “It was very fun to do the research and not have to study the same way. Papers were being published every week or month, so there was always new knowledge coming. Reading about how people figured things out was strong motivation.”
9 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
For JUNG WOOK PARK, PHD, the spark to study and better understand how cancer works came early when, as a middle schooler, he questioned his grandmother’s oncologist about whether replacing her pancreas could cure her cancer.
FEATURE
Imaged under the inverted microscope, genetically engineered human cells are growing in an organoid. The red color indicates that cells were infected by viruses expressing cancerdriving genes.
Dr. Park explains: “Normal human cells are transforming into cancer cells in a dish. Normal human cells grow with viruses delivering cancerdriving genes in a threedimensional culture system called an organoid culture. Each alphabet letter—C, A, P, or H—is indicating specific cancer-driving genes. Also denoting different human cell types are + and - symbols. Cells in yellow color wells are growing faster than in pink. These cells will be implanted into immune-deficient mice to functionally demonstrate their status of malignancy.”
10
When the time came for doctoral work, Park opted for a drastic change of venue, choosing to apply to numerous PhD programs in the United States. From his many offers, he selected the University of Wisconsin-Madison to study human papillomavirus (HPV). For this research, he used a mouse model to study how the virus—not genetics—led to cancer.
“Being part of the Duke Pathology Department is great because I can get samples of both diseased and healthy tissue from the doctors who are mainly focused on a patient’s disease,” he said. “With those samples, I can add the cancer-driving gene into the normal cell and watch how it changes into a cancer cell while in a Petri dish.”
With his post-doctoral work at the University of California-Los Angeles, though, Park pivoted to working with human tissue samples, investigating how cancer cells mutate from normal cells to cause disease. It was this move that led him to the work he does today, considering and comparing the healthy cells that surround malignant ones.
Working at Duke
To better illuminate how cancer cells work, he uses a novel ex vivo 3D organoid culture system that both identifies the origin cells for the disease and defines the genetic drivers behind the development and differentiation.
Eventually, his work shifted from HPV to prostate cancer, and, as a result of his accomplishments, Park was named as the first recipient of Duke’s new professorship in pathology—the Rollie Endowed Assistant Professor for Correlative Pathology. It quickly became clear that Duke was a natural fit for Park’s research home. Not only does the University have a reputation for both national and international excellence, but the Medical Center also serves patients from Durham, a
“Duke has a good mix of African American, Hispanic, and white patients,” he said, “so, as a scientist, I have good access to patient tissue samples that can support my research.” But, when it comes to unearthing what makes cancer work the way it does, the partnership and collaborative opportunities Duke presents are equally—if not more—valuable than the chance to evaluate tissue samples. At every turn, Park said, he sees an avenue to work with colleagues. “Here, I can find easy collaboration not just with cancer biology, but with other scientists, as well,” he said. “For example, the chair of my department is a world expert in small cell prostate cancer. So, if I have a question, I can easily come to him and ask.” Ultimately, Park said, he sees his role and his research as being part of a much larger cancer effort. The fight to conquer cancer has been decades long, and the road ahead is still fraught with obstacles. But, if he can be integral in
Dr. Park with his lab team, (L-R) Yunsol Jo, Jongchan Hwang, and Chanjin Yoon
helping uncover how cancer develops for earlier identification, he said, it will be a goal fulfilled. “I want to find out how we can detect cancer at the earliest time. If we can find the cancer as early as possible, then the patient has more of a chance to be cancer free,” he said. “There are a lot of smart people out there who are going to fix cancer, but I want to detect it early and block the transformation of cells, preventing one type of cancer from becoming another.”
11 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
racial and ethnic melting pot. That diversity is critical because African American and Hispanic men have a higher prevalence of prostate cancer than white men.
FEATURE 12
THE HACKELS’
BIG HEART
by DAVID HOWELL, MD PHD
Army Medical Corps. He completed pathology residency at Western Reserve (now Case Western Reserve) School of Medicine in Cleveland, and subsequently joined the faculty there, working with Dr. Thomas Kinney, then Chief of Pathology. When Dr. Kinney came to Duke as the second chair of the Department of Pathology, he recruited Dr. Hackel as Professor of Pathology in 1960. Dr. Hackel became Professor Emeritus in 1989, but continued to be active in the department for several more years.
For much of the past year, the Department of Pathology has been celebrating the lives and contributions of Dr. Donald Hackel and his wife, Irene Hackel. Dr. Hackel died in 1994, and Mrs. Hackel passed away on August 18, 2020, but the couple left a major legacy founded on his research and teaching, her support of Medical Center philanthropy, and their joint contribution to a fellowship for Duke medical students: the Donald B. Hackel Fellowship in Cardiovascular Pathology. (The Fellowship bears Dr. Hackel’s name, but is clearly intended by his family to honor both members of the pair.) Donald Hackel hailed from Boston. He received his undergraduate and medical degrees from Harvard before interning at Beth Israel Hospital, where he met Irene; he then served in the U.S.
Dr. Hackel is best known in the scientific community for his foundational work on cardiac ischemia, but he is perhaps best remembered by his students for his enthusiastic teaching, particularly in small group or one-on-one settings, always bestowed with patience, kindness, and a wry sense of humor. Several current Pathology faculty members recall him spending hours demonstrating the dissection of tiny pediatric hearts with congenital disorders. He continued to participate in “heart cutting” late in his career, when Parkinson disease robbed him of much of his manual dexterity. He typically used an Olympic-sabre-size knife; trainees looked on with concern, but there’s no record of him ever cutting himself. He never tired of teaching, even if it involved repeating the same lesson for a new audience. He was particularly revered by medical students, who honored him with three Golden Apple Awards for excellence as an educator, followed by a Lifetime Golden Apple near the end of his career. (Winners of this award aren’t eligible for consideration for the next five years, so he basically won it each time his name was on the ballot.) He also received a Distinguished Teaching Award from the Duke Medical Alumni Association in 1989. For all his prowess as a communicator, Dr. Hackel was a gentle, unassuming man who almost never expressed overt disgruntlement. When a promising trainee indicated, during examination of a heart, that he was going into surgery rather than pathology, his response was a smile, a sigh, and a
Opposite: This portrait hangs in the Pathology Library
soft, “Oh, that’s OK too.” (That trainee ultimately became a cardiovascular pathologist, so the seed had been successfully planted.) Once, when a coworker was struggling to catch a bus that was pulling away from the curb, a junior colleague saw Dr. Hackel stick two fingers into his mouth and emit a sweet, piercing, boyish wolf whistle that stopped the driver in his tracks. Beyond that, exceptions to his quiet approach were exceedingly rare. Though an expert in cardiovascular pathology, he was fascinated by anything medical. During his time in Cleveland, he served as a pathology consultant to the local zoo. He recounted this experience to the department in a wonderful Grand Rounds; his escapades included crawling into the chest cavity
of a deceased elephant with what turned out to be tuberculosis during a macro-necropsy. Even toward the end of his life, when he was coping with two debilitating illnesses, he continued to come to the department, motoring around on a small electric scooter (commonplace nowadays but something of a novelty at the time). During that time, he made a point of seeking out young colleagues and giving them a memento (often an old manuscript about a problem of mutual interest). Irene Hackel was born in Bangor, Maine. She met and married Donald Hackel while she was studying nursing and working in the blood bank at Beth Israel Hospital in Boston, and accompanied him on his academic journey
The Fellowship bears Dr. Hackel’s name, but is clearly intended by his family to honor both members of the pair.
13 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
Above: Irene and Donald Hackel at the Cardiovascular Awards Dinner, ca. 1989
FEATURE
who have committed themselves to an extra year of training, will have a high probability of choosing pathology as their life’s work. The first two Hackel Post-Sophomore Fellows have just successfully completed their fellowship year, and two new successors have replaced them. Donald and Irene Hackel served and honored the Duke community for decades through their scholarship, teaching, and philanthropy. We in turn remember and honor them with great respect and affection.
Duke cardiopathologist Louis DiBernardo MD, once a student of Dr. Hackel, summarizes these contributions from his assiduous work:
14
to Western Reserve and Duke. In addition to raising three children (Connie Katz, Dr. Andrea Hackel, and Richard Hackel), she was an active member of her community and synagogue, a champion of just causes (including women’s voting rights), and a strong supporter of Duke Medical Center. In particular, she played a major role in the establishment of the Nearly New Shoppe, a thrift store created by the Duke Faculty Wives that sold clothing and household items donated by faculty and staff and channeled the proceeds into millions of dollars in scholarships for Duke medical students. The Hackel Fellowship was initiated in 1990 with funding from the Departments of Pathology, Medicine, and Surgery; dozens of individual donors; and a Charitable Giving Annuity (CGA) created by Donald and Irene Hackel themselves. With Irene Hackel’s passing, the CGA infused more than a quarter of a million dollars into the fellowship endowment. The fellowship was initially used to provide stipends for third-year medical students pursuing a research year in the laboratories of faculty members with primary appointments in the Department of Pathology. Of five Hackel Fellows in this category to date, three have chosen a career in pathology. More recently, the scope of the fellowship has been expanded to include students taking a “post-sophomore” year in pathology, where they serve in a role similar to that of first-year residents. It is anticipated that these individuals,
“Dr. Hackel focused on the way the heart and its cells reacted to various forms of injury. He identified the multifactorial nature of cardiac injury and dysfunction during hemorrhagic shock. His research on myocardial ischemia looked at functional and structural changes in the myocardium during and after ischemia. He focused on the conduction system’s response to ischemia, an important aspect given that many myocardial infarct patients die from arrhythmias that can occur within seconds to minutes. In the area of interventional cardiology, Dr. Hackel performed one of the early studies comparing cardiac catheterization and angiography to gross examination—the true gold standard.”
Cutting heart sections with lab technician Pat Cruz, and intern Rex Bentley MD, ca. 1989. Also shown is an x-ray of the injected heart arteries, and at the back, the photographic stand where they documented heart sections on 4x5” B&W film.
DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
15
AI FEATURE
AT DUKE, THE FUTURE OF PATHOLOGY LIES IN
AI
Duke Engineering and the Department of Pathology in the School of Medicine have joined forces to create a new Division of Artificial Intelligence and Computational Pathology.
16
Among these niches, however, there is one in which Duke researchers have always been at the leading edge: image analysis, with a broad team of researchers teaching computers to analyze images to unearth everything from various forms of cancer to biomarkers of Alzheimer’s disease in the retina. To keep pushing the envelope in this field by cementing these relationships into both schools’ organization, Duke’s Pratt School of Engineering and Department of Pathology have launched a new Division of Artificial Intelligence and Computational Pathology. “Machine learning can do a better job than the average person at finding the signal in the noise, and that can translate into better outcomes and more cost-effective care,” said Michael Datto, Associate Professor and Associate Vice President for Duke University Health System Clinical Laboratories. “This is one of the most exciting times I’ve seen in Pathology, and it’s going to be exciting to see what we can do.” The new division will support translational research by developing AI technologies for image analysis to enhance the diagnosis, classification, prediction and prognostication of a variety of diseases, as well as train the next generation of pathologists and scientists in the emerging field. The division is led by Carolyn Glass, Assistant Professor of Pathology, and Laura Barisoni, Professor of Pathology and Medicine, and operates with the partnership of AI Health, directed by Lawrence Carin, Professor of Electrical
and Computer Engineering (ECE) and Vice President for Research at Duke, and Adrian Hernandez, Professor of Medicine and Vice Dean for Clinical Research. “Duke has taken the lead at the national level in establishing a division in the Department of Pathology in partnership with AI Health with the goal of developing and establishing new models and protocols to practice pathology in the 21st century,” said Barisoni, who is also Director of the Renal Pathology service at Duke. AI Health is also a new initiative, launched as a collaboration between the Schools of Engineering and Medicine and Trinity College of Arts & Sciences, with units such as the Duke Global Health Institute and the Duke-Margolis Center for Health Policy, to leverage machine learning to improve both individual and population health through education, research and patientcare projects. “For what everyone has envisioned for AI Health, we see Pathology paving the way,” said Hernandez. “AI Health is a catalyst and spark for putting cutting-edge machine learning development and testing into realworld settings. In Pathology, we have imageintensive data streams, and COVID-19 has really emphasized the need for the timely processing of patient samples.” Applying machine learning image analysis to pathology processes, however, is easier said than done. Figuring out how to process extremely large image files and train AI algorithms on relatively few examples is part of the focus of Carin’s laboratory, in partnership with Ricardo Henao, Assistant Professor of Biostatistics and Bioinformatics as well as ECE. Current AI algorithms, such as convolutional neural networks (CNN), were originally designed for the analysis of natural images, such as those captured on phones. Adapting such algorithms for the diagnosis of biopsy scans, however, is challenging due to the large size of the scans—typically of tens of gigabytes—and the sparsity of
“In Pathology, we have imageintensive data streams, and COVID-19 has really emphasized the need for the timely processing of patient samples.” Adrian Hernandez, MD
17 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
R
esearchers at Duke University have been merging artificial intelligence (AI) with health care to improve patient outcomes for the better part of two decades. From making cochlear implants deliver purer sounds to the brain to finding hidden trends within reams of patient data, the field spans a diverse range of niches that are now beginning to make real impacts.
by KEN KINGERY
AI FEATURE
In a virtual kickoff meeting this fall, the new division’s leadership spoke to the potential it holds to improve patient health outcomes.
18
abnormal diagnostic cells they contain. Led by David Dov, a postdoctoral researcher in Carin’s laboratory, Duke engineers are working to overcome these challenges to design AI algorithms for the diagnosis of various conditions, such as different types of cancers and transplant rejection. “Designing algorithms that make a real impact on clinical practice requires close collaboration between AI researchers and pathologists,” said Dov, who joined Duke after completing his PhD in electrical engineering at The Technion - Israel Institute of Technology. “A key challenge in these collaborations is gaining a deep understanding of the gaps in medical practice, and then ensuring that clinicians fully understand the capabilities and limitations of AI in bridging these gaps. The new Division of Artificial Intelligence and Computational Pathology plays an important role in facilitating such collaborations.”
In a virtual kickoff meeting this fall, the new division’s leadership spoke to the potential it holds to improve patient health outcomes and several researchers delved into projects they already have underway in the field. For example, Danielle Range, Assistant Professor of Pathology, spoke of efforts to use AI in diagnosing cancer; Roarke Horstmeyer, Assistant Professor of Biomedical Engineering, described his efforts to create a “smart microscope” to better diagnose disease; and Glass detailed her work on the use of machine learning in diagnosing transplant rejection. “In the last couple of years, we have seen an exponential increase in AI pathology interest from Duke undergraduates to medical students applying for Pathology residency positions,” said Glass. “I think continued development of a solid, integrated curriculum and educational program will be critical to train these future leaders.”
A NEW DIVISION, AN EXCITING ADDITION
I
n early 2020, the newly-formed Duke Division of AI & Computational Pathology (DDAICP) hit the ground running. Their accomplishments already span a wide swath: under the leadership of pathologists Dr. Laura Barisoni and Dr. Carolyn Glass, the team built interdisciplinary collaborations between Duke University, the School of Medicine, industry, and other academic institutions. These collaborations have resulted in presentations at national and international meetings, manuscripts in high-impact journals, and federal grant submissions. Research projects are supported by internal grants including the Duke Coulter Translational Award and a donation by the Nephcure Foundation. In addition, Duke pathologists Dr. Rajesh Dash
Artificial intelligence (AI) does not subtract human input or eliminate doctors. Rather, it multiplies the knowledge doctors have to address diseases and provide treatment options, creating an equation that improves patient care.
and Dr. Glass, members of the DDAICP, were selected for leadership positions in the College of American Pathology AI Committee, which shapes AI policy at the national level. Future AI leaders are already in the education system. Recognizing that computational pathology and image analysis will be integrated in patient care, Duke Pathology strives to be at the forefront, modernizing the curriculum for pathology trainees with the introduction of formal lectures that cover the basic aspects of digital pathology, image analysis, regulatory issues, and clinical applications. Growing interest in computational pathology among the new generation of pathologists is reflected by the high level of pathology residents’ participation in image
Dr. Will Jeck is working with AI to detect epithelial structures, shown here in green, in a small bowel transplant biopsy. This is a preliminary step in the detection of apoptotic cell density, a diagnostic feature of transplant rejection.
DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
Photo: Submitted
19
AI FEATURE
“I thought there would be projects out there, but not to this scale or degree of collaboration with our colleagues in different departments. I feel the opportunities are very unique to Duke.” Richard Davis, MD MSPH
20
analysis projects, providing exposure to interdisciplinary collaborations and the opportunity to present their findings at national scientific meetings. Gina Sotolongo, MD, a second-year Duke resident and new Chief resident, has explored tools for the automatic detection of inflammatory cells in biopsies. She describes her experience working with the pathology AI team: “I learned that AI is not magic; if it is difficult for a pathologist to visually tell the difference (without the help of molecular or stains), AI will have difficulty as well. When working on AI projects, patience, good communication and a willingness to learn from your computer engineering colleagues are all important for success.” She intends to do more work with AI. “AI is the future of Pathology. Duke is ahead of the curve by having an AI division — it makes Duke stand out.” Dr. Sotolongo’s project is in partnership with Duke undergraduate engineering student Jihyeon Je; both are co-mentored by Drs. Lafata and Barisoni. Richard Davis, MD MSPH, a third-year resident who has contributed to three analytics projects, describes his image analysis project on donor kidney biopsies: “We have been trying to quantify glomeruli and determine whether they are nonsclerotic or globally sclerotic, as part of the treatment decision for whether or not a kidney is going to be implanted into a recipient. Our research manuscript is now under review for publication.” He is co-first author with Xiang Li, a graduate in Duke’s Electrical and Computer Engineering (ECE) program. The close cross-disciplinary collaboration with Xiang and Kyle Lafata, PhD, Assistant Professor of Radiology, Radiation Oncology, and ECE, has been essential for the success of this project. “I thought there would be projects out there, but not to this scale or degree of collaboration with our colleagues in different departments. I feel the opportunities are very unique to Duke.”
Bangchen Wang, MD PhD, a first-year Pathology resident, is working in close collaboration with computer scientists at Duke and Case Western Reserve University to develop protocols for automatic detection of tubules in kidney biopsies. “I’m interested in both kidney diseases and AI, so this project is a perfect combination,” he said. “By integrating clinical, histological and molecular data, AI can also provide valuable insights to the diagnosis, prognosis, and treatment of diseases. In a sense, Pathology is data science.” Other projects include the work of Neuropathology Fellow Patricia Pittman, MD, with COVID diagnostics analytics. Another exciting development is the creation of a fellowship. The DDAICP, in partnership with AI Health, has recruited its first AI Pathology Fellow for the two-year training program. Starting in spring 2021, Akhil Ambekar, MS will conduct research on three projects, including kidney transplant, lung cancer, and gastrointestinal pathology. The Duke Division of AI and Computational Pathology has already achieved recognition regionally and nationally in thyroid cancer, prostate cancer, cardiac, lung and kidney transplantation, non-neoplastic renal disease, infectious disease (COVID) and hematologic disorders. Future investigations will include immunology, lung cancer, mesothelioma, liver disease, gastrointestinal disease and melanoma. The Division extends an invitation for new faculty members and looks forward to nurturing ideas and collaborations, multiplying the options in the equation to improve personalized patient care. Please see https://pathology.duke.edu/ patient-care/anatomic-pathology/aiand-computational-pathology for more details and updates.
Photo: Submitted
Annotations made by a cardiac transplant pathologist to train the algorithm to detect between myocyte damage or non-damage. (Orange: likely damage; Yellow: likely no damage)
A heat map shows how glomeruli from frozen sections of donor kidney biopsies can be clustered based on common pathomic signatures.
DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
Photo: Submitted
21
COVER FEATURE
TESTING
22
THE
SYSTEM by WHITNEY J. PALMER and SUSAN REEVES
IT’S BEEN A WHIRLWIND YEAR FOR DUKE CLINICAL LABORATORIES with no precedent or road map for guidance. In 2020 the group moved from being behind the scenes to being front-and-center in North Carolina’s fight against the COVID-19 pandemic. “It’s been an amazing journey,” summarized
From interviews on March 4, 2021 and December 2020
Christopher Polage, MD, Director of Clinical Microbiology, who along with Michael Datto, MD PhD, Medical Director and Associate Vice President, Duke Health Clinical Laboratories, recounted the tale of the roller coaster ride through COVID-19.
Nelea Roscot, Medical Lab Scientist, handles tubes with COVID specimens for testing in the COBAS 6800 instrument.
DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
23
COVER FEATURE
The Early Days News of the first case in the United States, identified in Washington state, hit on January 19, 2020. It wasn’t long before the virus spread nationally, with North Carolina identifying its first patient on March 3. Duke’s clinical lab leaders knew they needed to prepare, but they had no way of knowing the avalanche of testing that would soon inundate them, starting with Duke’s first case on March 13. Fortunately, the Clinical Labs were part of the planning from the start. Datto explains, “Our senior laboratory leaders were part of Duke Health’s COVID incident response team and were helping create Duke’s strategy to manage the COVID pandemic. Labs were not just involved, but in many ways we were driving the discussion with key pieces of information around infection rates, testing capacity and testing strategies.” “Very early in the pandemic, our labs understood that testing was going to be one of the main mechanisms used to get the pandemic under
24
Michael Datto, MD PhD Medical Director and Associate Vice President Duke Health Clinical Laboratories
control,” he said. “Within weeks, our hospitals shut down to all but the sickest patients with the most urgent needs. Elective care was put on hold and our clinics, ORs, and the University were closed to routine business. All research had stopped. We were out of PPE and we required patients to have a negative COVID test to receive care that could put them or their providers at risk. In short, restarting the health system was completely dependent on our ability to start testing patients.” Just a little pressure. The Labs started planning for in-house testing in January 2020, while sending the first tests to the NC Department of Health and Human Services State Lab and Viracor. “The first month was a giant puzzle with a number of different possible solutions and no one clear best answer. Unfortunately our sendout partners quickly became overwhelmed with testing requests and could no longer support our Duke patients,” Datto said. The first in-house test was offered March 23, but this was a highly manual CDC assay, and the need for higher volume testing became evident.
Polage says the number of samples the lab could process on any given day was too low, between 66 and 150 tests. “In hindsight, it was ridiculously few.”
A Team-Based Effort Test supplies were low and hard to come by, lab staff were being pushed to capacity, and at any given point, they were within 24 hours of being unable to handle any more samples. So they created the Clinical Labs COVID Response Team on March 19, 2020, bringing together all the laboratory expertise Duke had to offer. (See List of Team Members at right.) The team connected every day over Zoom to touch base, identify needs, and brainstorm solutions. They divided responsibilities, reducing the pressure on Polage’s team and allowing individual members and their teams to focus on their specific areas of expertise and delegated responsibility. This allowed Polage and the Clinical Microbiology Laboratory the time to focus on bringing new test platforms on line and operationally running the tests. “Each person involved with the crisis management team had a role. With each call, we went around the virtual room—how were our swab supplies, our transport, our kit supplies?” Polage explained. “We
Team Members In addition to Datto, Polage and Lobaugh, other key members of the Response Team include: Chad McCall Director, Hematology Laboratory Services Corrie Simons Manager, Clinical Microbiology Diana Cardona Associate Director, Duke Health Laboratories Diane Butler Administrative Specialist Judy Fleming Director, Quality Management Kari Ryan Director, Business Operations Kathryn Winston Manager, Referral Laboratory, Client Services Kathy Grant, Mary Smith Global Operations, Operations Director AP/ Operations Director CP Mark Lee Associate Director, Clinical Microbiology, Lead for COVID Assay Development Nancy Henshaw Associate Director, Clinical Microbiology Penda Jones Supervisor, Referral Laboratory
Rita Winsor Chief of Laboratory HR Tyler Welch Diagnostic Services Lead, Performance Services
Christopher Polage, MD Director of Clinical Microbiology
“Also essential to our success have been the members of the Microbiology Laboratory, Molecular Diagnostics Laboratory, Referral Laboratory, Specimen Management, Phlebotomy, Couriers, and every tech who stood at the bench and did the work to keep our health system open and to care for our patients in the face of the fear and uncertainty of the raging pandemic.”
25 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
Raj Dash Director, Laboratory Information Systems
COVER FEATURE
tracked each test platform on a daily basis. We set up communication chains to monitor the testing volume we had to get done each day and we reviewed it multiple times during the day. It became a strategy to help us manage our workload.” “There was a time when we literally had just a few hundred nasopharyngeal collection swabs left for all of Duke Health and that was it,” remembers Datto. “In an attempt to address supply chain issues, we diversified our testing options and validated every platform we could. This provided us with the ability to fully meet Duke’s needs.”
Mark Lee, PhD, Assistant Director of Clinical Microbiology, was the lead for COVID assay development.
Throughout the summer the lab brought more assays and platforms online. With the second test, processing volume doubled to 300 samples a day, and by the time seven assays were up and running at the height of the first wave last summer, the lab was routinely handling up to 1600 COVID tests daily. The maximum processing capacity was even higher, though. In March 2021, with 10 platforms, and more than 5 distinct types of covid test orders, the lab could analyze more than 3000 specimens daily if needed. The lab’s workload increased enormously. Prior to the pandemic, the Clinical Microbiology Laboratory
26
Lab Technician Darius Smith receives cartridges from the pneumatic tube system, which is connected throughout the clinics to transport samples for testing.
“We basically created a COVID-19 test factory to allow us to manage the daily tsunami of testing,” Polage said.
Duke Clinical Laboratory Clinical Research Center During the pandemic, the Clinical Labs established a Clinical Research Center (CRC) to enable and lead in COVID research. “The Duke Clinical Laboratory CRC’s mission is to leverage our scientific and medical knowledge, state of the art operations, and millions of clinical lab specimens to deliver tomorrow’s health care today,” states Datto. “This
Duke Health’s Point of Care Testing (POCT) Program also played a major role. Under the direction of Dr. Bruce Lobaugh, Administrative Director of Duke Health Labs and Director of the DUHS POCT, the Program developed a comprehensive POCT solution for Duke patients. Lobaugh and his team managed the supply chain and distribution of hundreds of tests daily to multiple locations across Duke Health, to enable real-time decisions based on the result of a COVID test. Approximately one-third of all COVID tests performed at Duke were performed using tests supplied by the POCT Program.
center banked over 14,000 COVID specimens
Datto’s role as the liaison between the lab and Health System leaders and providers contributed to the success of our laboratory response. He listened to Health System requests, managed their expectations, and brought their concerns back to the team. It was often a delicate dance and negotiation, but it kept everyone informed of the Health System’s needs and what the laboratories could do to meet them.
ability to change the way we practice laboratory
Beyond Duke The team’s immediate concern was helping and managing Duke patients, but infections were rampant in the surrounding region, popping up in community clinics, skilled nursing facilities, prisons, and other hospitals without local testing resources. The virus was rapidly blanketing the population, and tests were needed everywhere. Duke’s leaders rose to the occasion. Instead of restricting testing to Duke patients or people who were sick enough to seek care at Duke, they reached out to community partners and offered assistance. “Very early on, we had capacity, and we were helping out with investigations of skilled nursing facilities,” Datto said.
in the first six months of operation (serum for understanding antibody responses, whole blood to understand genomics indicators of outcome, and the virus itself). I truly believe that these are the specimens that hold the key to fully understanding the virus and how it effects patients—why some do better and some do worse or die. With this understanding will come better outcomes and saved lives for this and future pandemics. Our medicine is ultimately why we choose to practice in an academic environment. We are driven by our desire to help thousands of patients each day take their next step on the path to being healthy.“
That aid soon extended to both the Duke County Public Health Department and the prison in Butner, NC. To streamline those efforts, the COVID Response Team turned to testing kit assembly. Team members shared the responsibilities of ordering and tracking supplies, as well as putting together ready-to-use tests that could make it easier to identify infected individuals who were not coming to the hospital. “Every day we would report out on how the team was doing on assembling these kits that would go out to the clinics, ready for a nurse or medical assistant to pull them out of the box,” Polage said. “Often representatives from these groups would come by the Lab, and I would give them boxes of COVID swab collection kits or carry them out to a car in the round-about [of the hospital].”
27 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
ran approximately 500,000 tests on roughly 350,000 samples each year. With the pandemic, test volume ballooned by 50 percent—and every additional case was a COVID test. As of March 2021, the lab was receiving between 600-1000 tests for the virus daily and processing 5000-6000 cases weekly with three high-throughput pieces of equipment which can each handle more than 1000 tests in a 24-hour period.
COVER FEATURE
Diane Butler, PACE, (Supply Chain and Administrative Support) ordered and received a total of 294,100 swab kits in 2020. Per Dr. Datto, she was “the master of the nasopharyngeal swab supply chain. There was never a nose without a swab when needed.“
28
The team also provided training for point-of-care testers on how to correctly collect, handle, and test the swabs, as well as how to keep themselves safe from infection.
and the testing ensured rapid quarantine of anyone who became positive.”
And in April, Datto was called on to co-chair Governor Cooper’s COVID-19 Testing Surge Working Group for the state of North Carolina.
Managing the COVID workload alongside the normal clinical workload has been challenging. But, in partnership with Duke’s Informatics group, the clinical team developed a prioritization system that categorizes tests into multiple population buckets. The system pinpoints the reason for the test and a due date, helping them process the most urgent cases first.
The Clinical Labs were also part of the success of Duke University’s Fall Semester, which was held on campus. Members of the Molecular Diagnostics Lab team ran the M2000 platform along with Tom Denny’s group at the Human Vaccine Institute (DHVI). “Our labs did the confirmatory testing for the positive pools. DHVI did the pooled testing in their CLIA laboratory. They are a fantastic team and one good outcome from the pandemic was bringing our groups together,” Datto said. “We are fortunate that the positivity rate on campus was very low last semester. The students were good about being safe
Finding a Rhythm
For example, if a patient needs a negative COVID test to be cleared for surgery, that cases rises to the top of the list. “This has allowed us to manage our workload. It’s like looking at homework with your kids—this homework is due tomorrow, this on Thursday, and this in two weeks,” Polage said. “In the beginning,
we were blind. We didn’t know what homework was due tomorrow and what was due later. We only knew we had a mountain of homework, and if we didn’t get it done, we were in trouble.” Now, though, it’s much easier to divide the case load into daily digestible bites, and the workflow is streamlined. And that’s critical because there’s a strong indication that COVID isn’t going anywhere and could be seasonal much like the flu. As of March ’21, the lab had processed 223,303 tests. Fortunately, the positivity rate has been a fraction of that amount: 22,897 (roughly 10%) have returned a positive COVID diagnosis. And thanks to proper safety protocols and personal protective equipment, there have been no COVID outbreaks among lab staff. Duke’s Clinical Labs and staff are now well equipped to not only meet the needs of patients with active disease, but to also help keep the wheels of the community turning. “We were used to a situation where every sample came from a sick patient, and we were trying to diagnose that sick patient. Now, we were testing people so we could get things open, employees back to work, patients into surgeries. It was a different job than we were used to,” Polage said. “It’s been an amazing journey.”
Jodine Zane, MLS works with specimen testing for infections on the GeneXpert
DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
29
Yelena Timmons, Medical Lab Scientist (MLS) aliquoting (splitting ) COVID19 samples
LEGACIES OF
DEVELOPMENT NEWS
LEARNING
30
I
t was a time in the Department of Pathology when esteemed faculty members such as Dr. Bernard Fetter and Dr. Donald Hackel walked the halls of the Davison Building, and Dr. Ed Bossen and Dr. John Shelburne were just starting out in their laudable careers. Following in the footsteps of such powerful mentors and scientists, Dr. Joe Sommer had just turned 50 when a young James Junker joined his lab with a freshly minted undergraduate degree from Muhlenberg College in Allentown, PA. Inspired by coursework in microanatomy and histology, James came to Duke to pursue a PhD in Pathology. He specifically sought out a program where he could work with an electron microscope, and good fortune landed James in the lab of a worldwide leader in the field of cardiac muscle. With Dr. Sommer as his graduate advisor, James’ thesis aimed to biochemically isolate and anatomically localize a calcium binding protein in heart muscle. He focused on calsequestrin, which helps internal organelles store calcium during relaxation and release calcium during contraction. Looking back on his time with Dr. Sommer, James remembers that his mentor wanted his students to be self-motivated. He encouraged his students to find an inspiring topic of study and then enabled them to pursue their best work. Dr. Sommer also had a quirky sense of humor, James recalls with laugh. “A degree in pathology is very versatile and gives you a lot of flexibility,” James remarked. “The Duke Pathology Department gave me the opportunity to find what I wanted to do and pursue it. Dr. Sommer allowed his students such freedom that I was able to craft my own, broadly-based biomedical curriculum that served me very well in my career.” Upon graduating with his doctoral degree from Duke in 1980, James pursued two research fellowships. First, a post-doctoral position at the University of Pennsylvania’s Muscle Institute, followed by four years as a staff fellow at the National Cancer Institute. James then went on to teach comparative animal physiology for two years at Bayero University Kano in Nigeria. He credits his success in this
by MORGAN POPE
particular teaching position to a class on animal physiology taken at Duke’s Marine Lab. James joined the faculty of Campbell University’s Pharmacy School in 1989 as an assistant professor. Because Dr. Sommer had not yet retired from Shown here in 1993, Dr. Duke, James had Joachim Sommer worked in the opportunity to Pathology from 1958 to 2011. rejoin the lab and continue publishing important research papers. One such first-author paper propelled James’ career even further, helping him secure a promotion to associate professor of pharmaceutical sciences in 1994. In total, James spent 20 years teaching first year pharmacy students at Campbell, a joy he remembers fondly. “I had the 8:00 am anatomy and physiology class for the first-year pharmacy students, which meant I got to launch around 2,000 pharmacists into their career. It gives me a great deal of satisfaction to know that I gave so many students their academic start.” After retiring from Campbell in 2009, James went to University of Maryland Eastern Shore to help start a new pharmacy school. While there, James was named the chair of the Pharmaceutical Sciences Department and later moved into academic affairs in an associate dean position, retiring in 2016. James’ notable career and legacy will live on at Duke through a generous bequest that will be split evenly between the Chapel music program and the Department of Pathology’s educational initiatives. When asked why he chose to include Duke Pathology as part of his estate planning, James said, “I am indebted to Duke. Leaving an estate gift is one way I can express my appreciation for the excellent academic and research foundation that I received from the Duke University Department of Pathology.”
The Department is grateful to James and the many individuals who choose to provide such thoughtful philanthropic support. If you would like to learn more about leaving a legacy gift to the Department of Pathology, please reach out to DIRECTOR OF DEVELOPMENT, MORGAN POPE, at 919-451-5093 or morgan.pope@duke.edu.
Crop from Staff Photo in 1978: 1. Dr. William Johnston; 2. Dr. Donald Hackel; 3. Dr. Joachim Sommer; 4. Dr. James Junker; 5. Dr. John Shelburne. See the whole photo and names list linked on our website Newsletter Archive.
Edward Bossen, MD
James Junker, PhD
31 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
Joe, as everyone referred to him, was unfailingly cheerful, despite the demands of his work. His advice to those, like myself, who were working with him, was always thoughtful and delivered in such a way that you felt as if the whole idea was yours. He encouraged intellectual growth in his co-workers. He was a perfect research mentor for me.”
“I am indebted to Duke. Leaving an estate gift is one way I can express my appreciation for the excellent academic and research foundation that I received from the Duke University Department of Pathology.”
Photo: Jim Glovier
“Dr. Sommer’s research interest was comparative ultrastructure of the heart with animals including humans, mice, birds, and others. One of the techniques he employed was serial electron microscopic sections, a painstaking way of examining tissue.
NEW FACULTY 32
Chelsea Landon, DVM PhD
Chanjuan Shi, MD PhD
Beth Shaz, MD
Medical Instructor
Professor of Pathology
Professor of Pathology
Dr. Landon earned her PhD in the Department of Pathology in 2013 under the mentorship of Dr. Mark Dewhirst. Her graduate research focused on the use of hyperthermia to enhance drug delivery and anti-tumor efficacy. After earning her PhD, Dr. Landon attended North Carolina State University College of Veterinary Medicine and earned her DVM in 2017. She then returned to Duke as a Laboratory Animal Resident/ Postdoctoral Associate in the Division of Laboratory Animal Resources (DLAR). Dr. Landon was recently awarded an NIH K01 career development award titled “Utilizing intranasal immunization to induce a cytotoxic T lymphocyte response and reduce metastatic burden in the lung.” She focuses 75% of her effort on her laboratory research and 25% as a laboratory animal veterinarian in the DLAR. Dr. Landon performs her research in the laboratory of Dr. Herman Staats.
Dr. Shi’s primary duties are in GI and liver pathology; she was recently appointed Chief of Gastrointestinal Pathology. Dr. Shi obtained her MD at Zhejiang Medical University in Hangzhou, China. She initially trained in general surgery and colorectal surgery at Zhejiang Medical University and was an attending surgeon there for two years before she moved to Nova Scotia to obtain a PhD at Dalhousie University in Halifax, with research focused on regulation of chloride channels in ciliary body cells of the eye. Her transition to pathology began with a research fellowship at Johns Hopkins, followed by pathology residency and fellowship in GI and liver pathology there. She joined the faculty at Vanderbilt University Medical Center in 2010, where she rose to the rank of Professor. Her academic activity has been wide ranging, but has focused on the area of GI neuroendocrine tumors and pancreatic neoplasms.
Dr. Shaz joined our department as Professor of Pathology and became the Deputy Director of the Marcus Center for Cellular Cures in 2020. She received a BS in Chemical Engineering from Cornell University and then completed her MD at University of Michigan. Subsequently, she completed a surgical internship at Georgetown University followed by training in anatomic and clinical pathology and transfusion medicine at Beth Israel Deaconess Medical Center/ Harvard Medical School. Dr. Shaz then remained at BIDMC as Associate Medical Director of the Transfusion Services and Medical Director of the Transfusion/ Pheresis Unit. In 2006, she relocated to Grady Memorial Hospital/ Emory University as Director, Transfusion Services and Associate Professor. Most recently, she served as Chief Medical and Scientific Officer and Executive Vice President of New York Blood Center. In addition, Dr. Shaz is the president of AABB Board of Directors, a scientific member of Biomedical Excellence for Safer Transfusion, and an Associate Editor of Transfusion.
Rebecca Varley, MD
Associate Professor
Assistant Professor
Dr. Reynolds has served for over 30 years in laboratory animal medicine in industrial and academic settings. He obtained his undergraduate degree, veterinary medical degree, and master’s degree in physiology from North Carolina State University. Dr. Reynolds is a diplomate of the American College of Laboratory Animal Medicine. His postgraduate training included a residency in laboratory animal medicine at Duke University Medical Center and research in reproductive and molecular toxicology. Dr. Reynolds then spent over 12 years in pharmaceuticals and biotechnology, including service as an Attending Veterinarian before returning to Duke University as Deputy Director of the Division of Laboratory Animal Resources (DLAR) in 2004.
Dr. Varley rejoined our department as Assistant Professor of Pathology in 2020. She obtained her undergraduate degree at Butler University in Indianapolis, Indiana, and MD at the University of Texas Health Science Center in San Antonio, Texas. She completed anatomic and clinical pathology residency at Duke University Medical Center and cytopathology fellowship training at the University of North Carolina in Chapel Hill, North Carolina. In 2012, she joined Laboratory Corporation of America (LabCorp) in Burlington, NC where she served as Medical Director of Anatomic Pathology in the Atlantic Division and various LabCorp clinical labs in the North Carolina Piedmont region. Her responsibilities include serving as a pathologist and Medical Director of anatomic and clinical laboratories at Duke Raleigh Hospital.
Dr. Reynolds is an internationally recognized expert on how sound and vibration are often overlooked research variables. Previous areas of research included animal model development, molecular toxicology, and carcinogenesis. His current research is on environmental factors affecting laboratory animal welfare and research reproducibility.
“We are pleased to introduce you to the talented new faculty who have recently joined us, and to give you a glimpse into their incredible achievements.” Jiaoti Huang, MD PhD, Chairman
33 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
Randall Reynolds, DVM, MS
NUMBERS 34
Autopsies: 256 Gross specimens in 2020 included lungs from COVID-19 patients. This lung slice shows irreversible severe fibrotic damage, in this case with only a small area of relatively spared lung tissue at the base. Lung transplantation has emerged as an important treatment option for COVID-related ARDS.
Covid tests: 268,824
Swab kits received: 294,100
10,223,832 Annual Grant Funding Federal
Non-Federal
2020 2019
0
1
2
3
4
5
Millions
6
7
8
9
10
35 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
Number of Laboratory Tests:
Julika Powell, MLS making up reagent for the TOPS Analyzer in the Coagulation Lab
PRIMARY FACULTY IN THE DEPARTMENT OF PATHOLOGY 36
Faculty Leadership
Genitourinary Pathology
Jiaoti Huang MD PhD Chair, Department of Pathology Distinguished University Professor Johnston and West Endowed Chair David N. Howell MD PhD
Sr. Vice Chair and AP&T Chair
Rex Bentley MD Vice Chair and Director of Surgical Pathology; Director of PA Program Diana Cardona MD Vice Chair and Director, DUHS Anatomic Pathology Labs Thomas Cummings MD Vice Chair and Director of Residency Program Rajesh Dash MD
Vice Chair for Pathology Informatics
Michael Datto MD PhD Vice Chair and Director of Clinical Pathology Claudia Jones MD Shannon J. McCall MD Herman Staats PhD Elizabeth Boswell MD
Vice Chair for Faculty Vice Chair of Translational Research Vice Chair for Research Chief, Pathology and Laboratory Medicine, Durham VA
Autopsy Pathology Carolyn Glass MD PhD
Assistant Professor, Director Assistant Professor
Louis R. DiBernardo MD
Assistant Professor
William Jeck MD PhD
Assistant Professor
Elizabeth N. Pavlisko MD Kyle Strickland MD PhD
Professor Associate Professor Assistant Professor
Associate Professor, Section Head
Sarah M. Bean MD
Professor
Rex Bentley MD
Professor
Rajesh Dash MD
Professor
Cardiovascular Pathology Carolyn Glass MD PhD
Assistant Professor, Section Head
John Carney MD
Assistant Professor
Louis R. Dibernardo MD
Assistant Professor
Elizabeth N. Pavlisko MD
Associate Professor
Cytopathology/FNA Claudia K. Jones MD
Associate Professor, Director; Director Cytopath Lab
Danielle Elliott Range MD Associate Professor, Associate Medical Director Sarah M. Bean MD
Professor
Raj C. Dash MD
Professor
Wen-Chi Foo MD
Associate Professor
Xiaoyin “Sara” Jiang MD
Associate Professor
Avani Pendse MD PhD
Assistant Professor
Kyle Strickland MD PhD
Assistant Professor
Dermatopathology Maria Angelica Selim MD
Professor, Section Head
Rami Al-Rohil MBBS
Assistant Professor
Kenneth Ellington MD
Assistant Professor
Gastrointestinal Pathology Chanjuan Shi MD
Professor, Section Head
Diana M. Cardona MD Associate Professor; Director, DUHS Anatomic Pathology Labs Cynthia D. Guy MD
Professor
John F. Madden MD PhD
Associate Professor
Avani Pendse MD PhD
Assistant Professor
Gynecologic Pathology Rex Bentley MD Sarah M. Bean MD
Professor, Section Head Professor
Allison H.S. Hall MD PhD
Associate Professor
Kyle Strickland MD PhD
Assistant Professor
Head, Neck & Endocrine Pathology Xiaoyin “Sara” Jiang MD
Associate Professor, Section Head
John F. Madden MD PhD
Associate Professor
Danielle Elliott Range MD
Associate Professor
Hematopathology Ken He Young MD PhD
Professor, Section Head
Jadee Neff MD PhD Assistant Professor; Assistant Director MPGG Endi Wang MD PhD
Professor
William Jeck MD PhD
Assistant Professor
Shannon J. McCall MD
Associate Professor
Avani Pendse MD PhD
Assistant Professor
Professor
Infectious Pathology John F. Madden MD PhD
Associate Professor
Liver Pathology Cynthia D. Guy MD
Breast Pathology Allison H.S. Hall MD PhD
Associate Professor, Section Head
Anand S. Lagoo MD PhD Professor; Director, Flow Cytometry Lab
John Carney MD
Laura Hale MD PhD
Wen-Chi Foo MD Jiaoti Huang MD PhD
Professor, Section Head
Diana M. Cardona MD
Associate Professor
William Jeck MD PhD
Assistant Professor
Shannon J. McCall MD
Associate Professor
Chanjuan Shi MD Avani Pendse MD PhD
Professor Assistant Professor
Neuropathology Thomas J. Cummings MD
Professor, Neuropath Director
Anne F. Buckley MD PhD
Assistant Professor
Giselle López MD PhD
Assistant Professor
Roger McLendon MD
Professor
Shih-Hsiu “Jerry” Wang MD PhD Assistant Professor; Associate Director Autopsy
Nerve and Muscle Pathology Anne F. Buckley MD PhD Assistant Professor, Section Head; Director EMICL Thomas J. Cummings MD Shih-Hsiu “Jerry” Wang MD PhD
Professor Assistant Professor
Ophthalmic Pathology Thomas J. Cummings MD
Professor, Section Head
Anne F. Buckley MD PhD
Assistant Professor
Alan D. Proia MD PhD Shih-Hsiu “Jerry” Wang MD PhD
Professor Assistant Professor
Pulmonary /Thoracic Pathology Elizabeth N. Pavlisko MD Associate Professor, Section Head; Director Image Cytometry; Associate Director IPT John Carney MD
Assistant Professor
Carolyn Glass MD PhD
Assistant Professor
Victor Roggli MD
Professor
Renal Pathology Laura Barisoni MD
Professor, Section Head
Anne F. Buckley MD PhD
Assistant Professor
David N. Howell MD PhD
Professor
Diana M. Cardona MD
William Jeck MD PhD
Assistant Professor
Rami Al-Rohil MBBS
Assistant Professor
Rex Bentley MD
Professor
Thomas J. Cummings MD
Professor
Associate Professor, Section Head
Transplant Pathology
David N. Howell MD PhD
Laura Barisoni MD
Anne F. Buckley MD PhD
Assistant Professor
Diana M. Cardona MD
Associate Professor
John Carney MD
Assistant Professor
Louis R. DiBernardo MD
Assistant Professor
Carolyn Glass MD PhD
Assistant Professor
Elizabeth N. Pavlisko MD
Associate Professor
Professor, Section Head Professor
Undergraduate Medical Education
Andrea Deyrup MD PhD
Professor, Director of Undergraduate Medical Education
VA Faculty
Elizabeth Boswell MD
Assistant Professor, Chief
Christopher Alley MD
Assistant Professor
Maureane Hoffman MD PhD
Professor
Professor
David N. Howell MD PhD
Duke Regional Pathology
Michael Waugh MD Assistant Professor, Chief and Medical Director
Maureen Bauer MD
Assistant Professor
Kenneth Ellington MD
Assistant Professor
Duke Raleigh Pathology
Rebecca Varley MD
Assistant Professor, CLIA Director
Maggie Stoecker MD Assistant Professor; Director Morris Building and Bone Marrow Transplant Labs Huiwen Bill Xie MD PhD
Assistant Professor
Research Faculty
Soman Abraham PhD Grace Kerby Distinguished Professor; Director of PhD Program
Ming Chen PhD
Assistant Professor
Zhong Chen PhD
Assistant Professor
Jeffrey Everitt DVM
Udhayakumar Gopal PhD
Laura Hale MD PhD
Yiping He PhD
Professor Medical Instructor Professor Associate Professor
Maureane Hoffman MD PhD
Professor
Distinguished University Professor
Jiaoti Huang MD PhD
Chelsea D. Landon, DVM PhD
Medical Instructor
Giselle López MD PhD
Assistant Professor
Everardo Macias PhD
Assistant Professor
Sara Miller PhD
Professor
John Norton DVM PhD
Professor
Qianben Wang PhD
Zijun Yidan Xu-Monette PhD
Hai Yan MD PhD
Professor Assistant Professor Professor
Retired from Clinical Practice
Edward Bossen MD
William Bradford MD
Professor
Patrick Buckley MD PhD
Professor
Professor Emeritus
Robert Jennings MD James B Duke Distinguished Professor Emeritus
Barth Reller MD
John D. Shelburne MD PhD
Professor Professor Emeritus
Directors Duke University Hospital Labs
Michael Datto MD PhD Associate Professor; Associate Vice President and Medical Director of DUHS Laboratories Nicholas Bandarenko MD Associate Professor; CLIA Director Transfusion
Dongfeng Chen PhD
Associate Professor; Director CTIL
Kristen Deak PhD Assistant Professor; Associate Director Molecular Pathology, Genetics and Genomics (MPGG)
Nancy Henshaw PhD Assistant Professor; Assistant Director Clinical Microbiology
Mark Lee PhD Assistant Professor; Assistant Director Clinical Microbiology
Bruce Lobaugh PhD Professor; Director Central Automated Lab; Reference Lab; POCT
Jessica Poisson MD Assistant Professor; Director Transfusion Christopher Polage MD
Associate Professor; Medical Director Clinical Microbiology
Catherine Rehder PhD Assistant Professor; Director MPGG
Beth Shaz MD
Professor; Co-Director Stem Cell Lab
Siby Sebastian PhD
Professor; Associate Director MPGG
John Toffaletti PhD Professor; Dir. Blood Gas Lab; CHCL; CPED
Administration
Amy Orange BS CFM
Chief Department Administrator
Jeff Thomasson MBA
Director of Finance
Pamela Harris MBA
Kelly Macklin BS
Director of Administrative Operation HR Director
Debra Andersen C-TAGME GME Coordinator, Residency/Fellowships
Pamela Vollmer BHS PA(ASCP)
Associate Director, PA Program
Program Coordinator, PhD Program
Meg Atchison BA
Services
BioRepository & Precision Pathology
Research Animal Services
Research EM
Research Immunohistology
Shannon J. McCall MD, Director Jeffrey Everitt DVM, Director Sara Miller PhD, Director Shannon J. McCall MD, Director
PhotoPath Susan Reeves BA, Supervisor; Website Director
Jung Wook Park PhD Rollie Assistant Professor of Correlative Pathology
Christopher Pirozzi PhD
Medical Instructor
Salvatore Pizzo MD PhD
Distinguished Professor
Randall Reynolds DVM
Associate Professor
Stanley Robboy MD
Professor
Herman Staats PhD
Professor
Mary Sunday MD PhD
Professor
Ken He Young MD PhD
Professor
See our website photo directory and contacts
37 DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
Soft Tissue & Bone Pathology
AROUND THE DEPARTMENT
Dr. Monica Abdelmalak, PGY2, takes photos in PhotoPath for use in an online chapter for pathologyoutlines.com.
38
Brittani Thornton, Autopsy Technician, with samples of the Pathology Museum Specimen Collection. Known as “The Road Show,” these specimens are used to teach medical students gross pathology. The collection was started in the early years of our Department in the 1930s, initially in buckets with “odiferous” formalin on shelves lining the hallways, as Dr. William Bradford recalls. These were later encased in Plexiglas containers and the collection expanded to include neuropathology rarities.
Photo: Submitted
Members of the Surgical Pathology Team in December 2020
DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
39
First-year resident Bangchen Wang, MD PhD studies at his desk.
AROUND THE DEPARTMENT
Corey Bailey, Staff Specialist, keeps the flow of reports and papers moving.
40
Dr. Kasey McCollum, PGY1, reviews slides in the Residents’ Room.
Berta Bumphus, a retired Electron Microscopy employee, is shown in 1990 during her 25th year of service to the Department. Berta worked with several lab directors over the years, and her role included processing and printing thousands of large-format B&W negatives taken for the service to enable diagnoses.
Don’t miss the article in our Fall 2020 Newsletter about Dr. Alice Coogan, former Duke Pathology resident and fellow, who is now the Chair of Pathology, Microbiology, and Immunology at Vanderbilt! https://pathology.duke.edu/ newsletter-archive
DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
Photo: Susan Urmy/Vanderbilt Photography
41
REMEMBRANCES OF OUR COVID-19 EXPERIENCES 2020’s new unit of measure: bentleys
42
The Pathology Graduate Program continued its classes remotely once the stay-at-home orders were enacted in March 2020. Lab spaces were closed temporarily but reopened in May for researchers and students to return to work; distancing and shift work were put in place to allow continued studies. Vaccinations in 2021 have allowed more interactions to resume, with full resumption in the fall 2021 semester.
DUKE PATHOLOGY 2020 ANNUAL MAGAZINE
43
40 Duke Medicine Circle DUMC 3712 Durham NC 27710 pathology.duke.edu
This staff photo from 1961 shows Dr. Jane Elchlepp, far left; front row: Dr. Joachim Sommer, Dr. Thomas Kinney, Dr. Donald Hackel, Dr. Roger Baker, Dr. Nathan Kaufman, Dr. J.V. Klavins, Dr. Bernard Fetter. Photo and names list are at: https://pathology.duke.edu/newsletter-archive
