Integrated diagnostic centers beyond focusing on breast

In response to my recent post on the The Dark Report audioconference that I hosted at my hospital, I have had the pleasure of a valuable and constructive exchange with Dr. Bruce Friedman from the LabSoftNews blog.  He posted about a point that I raised about a role for integrated lung diagnostics expanding from the "breast clinic" model.  I will summarize what I have been thinking about and highlight some key differences as points for future discussion.

How could the pulmonologists and bronchoscopy/mediastinoscopy be integrated with radiology and pathology into an integrated lung disease diagnostics center?  There seems to be a natural convergence that could really be beneficial for thoracic surgeons, oncologists and radiation therapists--and patients.  This occurred to me, especially after reading the recent study by Baumann et al in July 10, 2009 Journal of Clinical Oncology, showing in a phase II trial the amazing effectiveness of stereotactic body radiation in medically inoperable stage I NSCLC  patients.  Imagine the coordination and logistics of getting something like this to come off in a timely manner at this point!  Further, if we can sort out the avalanche of predictive and prognostic serum and tissue biomarkers and analysis of mutations emerging in lung cancer diagnostics and integrate these with histopathology and radiology, we might just have something approaching personalized medicine.  At this point, however, even if not performed "in-house," we pathologists should be considering how to integrate this information within the diagnostic stream and present it coherently and contextually to our colleagues. 

I do agree with Dr. Friedman that it doesn't seem likely that multidisciplinary integrated breast clinic will evolve into more broader clinics.  But the concept of an integrated diagnostic center (IDC) may just be the DNA for other location-/disease-specific integrated diagnostics that will have to be reintepreted and modified to fit the specific needs of that site or disease group.

Upon further reflection, lung "lesions" have crucial differences from breast "lesions" that I suspect would also impact the organization of IDCs and, moreover, implies that the "architecture" of an IDC revolving around breast may not be appropriate for another site/disease process. The decision-making point for a breast lesion is basically malignant vs benign; if the lesion is benign, then, in general, really not too much else happens with respect to additional therapy.  However, the decision-making around a lung lesion (or lesions) is more complex--clinically, radiographically and pathologically.  It's not a binary decision because the range of benign lesions is much greater with multivarious treatment options.  An ill-defined localized mass/infiltrate could be a drug reaction (stop drug), bronchioloalveolar-type adenocarcinoma (surgery), infection (anti-infectives), collagen vascular (steroid/cytotoxic), etc.   Yet the complexity of lung diagnostics emphasizes the need for the close collaboration between clinicians, radiologists, and pathologists, ideally in some sort of IDC.  It's just that this is not likely to simply evolve from the breast IDC.