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Appendix
B
r
Selecled
Essoys
for Anolysis
Were the
sites
independent or linked
to
one another?
Further
testing
was
required.
But
at
the end of
these
inquiries
it
remained the
opinion
of the team and
particularly
the clinic's pathologist that the
cancer
sites
involved identical
(metastasized)
cells.
Through this
diagnostic
process we
learned
that
the
judgment
of whether the cancer
had metastasized
was
based
on
judgments
of
visual
similarity.
There appeared to be
no
"gold
standard"-no
clear
means
to
check
the
reliability
of
the pathologist's
judgments.
In
addition,
we
learned
that lung
cancer
with multiple
sites
in
the
lung
was
quite
exceptional.
No
one was sure
that
such a
diagnostic
appearance
meant
metastasization.
Using
cancer
textbooks, Medline, and
an
article
in
the Scientific
Ameican,
we
came
to
the
conclusion that
the
initial
diagnosis
was
not well validated. We noted
that
the
pathologists
disagreed
about the
cell
type, though
the
new pathologist
assured
me
he
was
"90o/o
certain" that
the
cells
were
identical
and hence had the same source.
But
knowing
there
was
no
"gold
standard,"
I
was aware
that this
"90o/o"
figure
was
just
a
subjective
assessment
of confidence and
not
a
real
measure of
reliability.
Based
on
my wife's reading about
DNA
testing
in
a
colon
and
brain
cancer study
in
the
Sci-
entific
Americar
we
asked
why
DNA
testing
wasn't
being done
in
this
case.
For
rea-
sons
still
unclear, the doctors
at
the
cancer agency
had
not
used such
procedures
in
lung
cancer
cases.
They
now
do.
When
they
used
DNA
testing on
my sister-in-law's
lungs,
it
became clear
(to
the amazement
of
the
pathologist) that
the
separate sites
were
not
from
the
same
source,
but
independent.
The cancer had
not
metastasized
and the
risk
of
an
operation to
remove the
cancer
was
iustified-it
is
over
four
years
since
her
operation
and
my sister-in-law
remains cancer
free.
I
believe
that
the
above
story
is
(among other
things)
an educational
success
story.
Our
actions
and reflections embodied the
ideal
of
a
liberal education:
intel-
lectual
autonomy.

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- Summer '12
- CARAZZA
- Oncology, DNA testing, Goddess, Anolysis
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