Getting it right
by Tom O’Connor

            In the constantly changing world of pathology, Julia Bridge, M.D., stands out. Her unique skill set makes her a true Sherlock Holmes in her profession. She specializes in analyzing bone and soft tissue tumors, and she’s one of the best in the world.
            A professor of pathology and microbiology at UNMC, Dr. Bridge will be honored next year by Memorial Sloan-Kettering Cancer Center (MSKCC) in New York for her outstanding contributions in advancing knowledge of human cancer.
            She will receive the prestigious Fred W. Stewart Award, which honors a top pathologist each year. The award emphasizes the clinical significance of the honoree’s work, particularly in diagnosis and patient care.
            “Cancer cytogenetics is one of the foundations of our growing understanding of human cancer that is driving improved diagnosis and therapy,” said Marc Ladanyi, M.D., chief of MSKCC’s Molecular Diagnostics Service in the department of pathology.
            “Through her career-long effort in this area, Dr. Bridge has not only put UNMC on the map, she has made it a world capital in this field. She is one of the most highly respected figures in cancer cytogenetics and also is recognized as a great educator, using her combined expertise in pathology, cancer cytogenetics and research to spread learning and knowledge.”
            Bone and soft tissue tumors most often occur in children. Behind leukemia, they collectively represent the second most common form of childhood cancer.
            “There are more than 100 different types of bone and soft tissue cancers,” Dr. Bridge said. “Many types exhibit overlapping clinical, radiographic and microscopic features, so making the correct diagnosis is challenging.”
            New genetic findings – at least 40 of which have been discovered by Dr. Bridge and her laboratory team – allow pathologists to more precisely identify and classify these tumors.
            “These genetic discoveries shed light on key events occurring in a person’s tumor,” she said. “Many also serve as therapeutic targets, permitting arrest or slow down of the growth of the tumor.
            “Once we know the exact type of cancer, the clinician can provide the most appropriate therapy with the highest chance of delivering a successful outcome.”
            One tumor-specific genetic change identified by Dr. Bridge’s team is the 12;22 rearrangement in clear cell sarcoma. “This cancer may appear clinically and microscopically identical to the deadly skin cancer malignant melanoma,” she said.
            “In many cases, it is indistinguishable. Recognition of this molecular marker has become fundamental in diagnosing clear cell sarcoma and differentiating it from malignant melanoma.”
            But, in the new world of cancer treatment in which therapies are personalized for each person’s genetic scheme, it is absolutely essential for the pathologist to correctly distinguish between the two cancer types. Like other fields of medicine, genetics has many different subtypes. One of these subtypes is cytogenetics, which involves the study of the chromosomal makeup of tumor cells.             What sets Dr. Bridge apart from her peers is her broad scope of expertise. A fellow of the American College of Medical Genetics, she also is one of only about 40 pathologists in the country who is board certified in both anatomic pathology and cytogenetics. At UNMC, she serves on five different pathology and genetic services – a depth of knowledge almost unheard of in the profession.
            “The field of genetics is just exploding,” Dr. Bridge said. “It’s changing by the day.”
            Dr. Bridge’s team is trying to identify additional markers of diagnostic and prognostic importance and develop more rational classification schemes that will impact clinical management and therapy selection.
            “We’re looking at the underlying genetic changes and the molecular consequences of those changes,” she said. “Many tumors have a characteristic genetic change that is exclusive to that tumor. “Once we recognize this change, it’s like a domino effect. We can then specifically target these genes as well as other genes further down the pathway.”
            Her work has not gone unnoticed at UNMC.
            “Julia is recognized as an international leader in the molecular basis of certain cancers,” said Steven Hinrichs, M.D., professor and chairman of the department of pathology and microbiology. “Not only has Dr. Bridge identified characteristic chromosomal translocations, but her research group also has gone on to develop a wide variety of probes for use in diagnostic assays.”
            Word is quickly spreading on Dr. Bridge’s expertise outside UNMC. Her lab now receives tissue specimens from all over the country.
            It’s not surprising. After all, when a person’s life hangs in the balance, there is no margin for error.

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