Profile: Janet Bruner, M.D.
Conquest - Fall 2007
By Mary Jane Schier
Janet Bruner, M.D., was a new pharmacist planning to conduct drug research when a mentor suggested she study medicine. Following that advice would propel her to a productive career as a neuropathologist at M. D. Anderson.
While taking a medical school course in pathology, Bruner got hooked and remembers, “I was fascinated to learn about the disease processes and how crucial pathologists are to the medical care team, starting with making definitive diagnoses for hundreds of diseases and continuing through to determine the causes of death. I knew right away this field was for me.”
Bruner was encouraged by several pathology instructors at the Medical College of Ohio at Toledo. She considered specializing in forensic pathology, but then a neuropathologist inspired her to follow in his footsteps.
“Studying the intricacies and special language of the human brain introduced me to a whole new world. The brain is distinctly different from all other organs because it’s the center of our intelligence, memory and emotions, and it controls movement and speech. The more I understood the brain’s unique anatomy, the more intrigued I was,” Bruner explains.
Now, three decades after first examining pathology slides with brain tumor tissue, Bruner is professor and chair of the Department of Pathology and deputy head of the Division of Pathology and Laboratory Medicine at M. D. Anderson. She also holds a joint appointment in the Department of Neuro-Oncology.
“M. D. Anderson has afforded me with more opportunities than I ever could have dreamed,” she says.
Clinical Histology Technician Davis Parambil checks on tissue being frozen quickly to minus 50 degrees.
Bruner received a bachelor’s degree in pharmacy and a master’s in pharmaceutical sciences from the University of Toledo before earning her medical degree at the Medical College of Ohio at Toledo. After completing a residency in anatomic and clinical pathology and being chosen chief resident at the Medical College of Ohio Hospital, she came to Houston in 1982 for a two-year fellowship in neuropathology at Baylor College of Medicine.
“I always planned to return to Ohio,” Bruner recalls, “but during my fellowship I had the good fortune to spend time at M. D. Anderson working with an expert in electron microscopy and to meet neurologists developing a neuro-oncology program.”
Upon finishing the fellowship, she was invited to join M. D. Anderson, where for awhile she was the only neuropathologist. Bruner thrived as the Departments of Neuro-Oncology and Neurosurgery expanded to offer innovative therapies for an increasing number of patients with brain and spinal cord tumors. She was chief of the Section of Neuropathology and directed the Diagnostic Hybridization Laboratory for 14 years, during which she began conducting laboratory research and taking leadership courses that prepared her for management positions.
Histology Laboratory Assistant Angela Calhoun helps Pathology Fellow Christopher Vinh Nguyen, M.D., prepare and stain slides.
In 1998, Bruner became the first woman faculty member to chair a clinical department, the initial holder of the Ferenc and Phyllis Gyorkey Chair in Pathology and the deputy head of the new Division of Pathology and Laboratory Medicine. She immediately polled the pathology faculty about organizing into subspecialties that would align them with the disease-site centers and clinical research initiatives while strengthening the department’s educational programs. Since then, the department has expanded in parallel with the institution’s growth in patients served.
“We’ve nearly doubled our faculty — from 29 in late 1998 to 56 today — and are divided into 11 subspecialties that allow us to interact more effectively with the surgical and medical specialists and keep up with their patient increases,” Bruner notes.
This year, the pathology faculty and support staff will provide diagnostic and staging evaluations on more than 60,000 surgical cases. At least one-half of that total will be for outside consultations (click here for more information).
Subspecialists include 11 devoted to breast pathology, seven for gastrointestinal and liver tumors, six gynecologic pathologists and six for soft tissue tumors. Others provide pathology services for surgeons who remove genitourinary, head and neck, skin, brain and spinal cord, orthopedic and thoracic (lung and endocrine) tumors.
In addition, there are 12 cytopathologists who annually process 20,000 cases, analyzing tissue removed during fine needle aspiration biopsies, cells scraped from the cervix for Pap smears and other cells extracted from fluids that shed into body cavities.
The department offers autopsy services and operates laboratories that provide highly specialized tissue analyses to support clinical and research programs. Pathology faculty work closely with colleagues in the Department of Hematopatholgy, which is responsible for evaluating bone marrow and lymph node specimens for clinicians who treat patients with leukemia, lymphoma and myeloma and who provide stem cell transplantation and cellular therapy.
Pathology Chair Janet M. Bruner, M.D., tells a neurosurgeon that the frozen section analysis shows his patient’s brain tumor can be removed.
Memories of wonderful mentors have motivated Bruner to set high standards for training the next generation of pathologists.
“I’m proud of our pathology fellowship program, which averages 25 clinical fellows a year and is the largest in the United States. Because M. D. Anderson sees every type and stage of cancer, we offer fellows the broadest training possible. Some will take part in more complex or rare evaluations in a few months than many community pathologists will see over a whole career,” Bruner says.
The fellows rotate through all areas of pathology and often hear Bruner remind them that “behind every single pathology slide is a patient depending on our expertise.”
One location where that phrase is most relevant is the frozen section laboratory on the fifth floor of Alkek Hospital. Surgeons in nearby operating rooms can count on rapid diagnoses of their patients’ biopsy tissue within 20 minutes.
An 11-headed teaching microscope helps Pathologist Hafeez Diwan, M.D., Ph.D., (center) discuss slides with pathology fellows before sending diagnostic reports to clinicians.
Bruner explains the process for analyzing brain tumor tissue, which often measures only 1 millimeter in size. An operating room nurse brings a tissue sample to the frozen section laboratory window and rings a bell. Within seconds, the tissue is placed in a custom-fabricated machine made at M. D. Anderson to freeze the tissue quickly to minus 50 degrees. The frozen tissue is sliced, placed on slides, stained so normal and malignant cells can be evaluated, and examined under the microscope by Bruner or another neuropathologist.
Any pathologist performing a rapid diagnosis will ask a fellow to view the slides while they discuss the findings, then the pathologist calls the surgeon on a special intercom to report the frozen section results. The best scenario for Bruner occurs when she can tell the neurosurgeon the tumor that had been considered inoperable can be removed or is not an aggressive cancer.
Other tissue samples not needing a rapid diagnosis are processed through the frozen section laboratory, placed in color-coded plastic holders and sent to the routine histology laboratory to be cut into sections for slides that are stained before going to pathologists and fellows for final analysis. Written pathology reports are sent to the surgeons within three days to share with their patients.
“You always hear on TV or read in the paper about some celebrity waiting for the results after being operated on for cancer, yet most people don’t know those results depend on pathologists,” Bruner says with a wry smile.
Speaking of results, she says new patients who have had biopsies before coming to M. D. Anderson are asked to send ahead or bring pathology slides with them.
“We provide an extensive review of their slides and actually change the diagnosis for at least 10% of patients, either finding they don’t have a malignancy or they may have a less severe disease that can be treated,” Bruner says.
Bruner’s research includes tissue-based and molecular analyses of human brain tumors to discover molecular markers that will better define prognosis and predict survival for patients. She contributes to the interdisciplinary Brain Tumor Program Laboratory that identifies and prepares primary brain tumor tissue for research studies.
Among accolades, Bruner is included in several “best doctor” lists, is a past president of the Houston Society of Clinical Pathologists and has received distinguished alumnus awards from her medical school, college and high school. She and her husband, Charles, a retired pharmacist, share their Houston home with their fifth miniature schnauzer, whose registered name is Bruners’ Live Long and Prosper, but who answers to Louis.
“We start our mornings walking an hour with Louis, who provides positive reinforcement that we expect to have a good day,” Bruner says.
Thousands of cancer patients who never come to M. D. Anderson are indebted to the institution’s pathology expertise provided through second opinions.
“Our outside consultation service prepares approximately 30,000 second opinions annually to help physicians elsewhere classify all types of cancer and choose the most effective treatments for their patients,” explains Janet M. Bruner, M.D., chair of the Department of Pathology.
Tissue samples on glass slides sent by overnight delivery are processed quickly and written reports are returned to the requesting physicians, usually in two to four days. The basic evaluation fee of $250 sometimes is covered by patients’ insurance or can be paid by the patients or their primary physicians.
Besides having pathologists in 11 cancer subspecialties, Bruner says additional diagnostic tests are available through specialized laboratories for image analysis, electron microscopy, diagnostic hybridization and immunocytochemistry.
In recent months, second opinions on pathology specimens have been sought by physicians for patients as far away as China, India and Iran.
Conquest - Fall 2007
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