‘You Don’t Know Me, But You Saved My Life’

Medication helped for a while. But after the symptoms came roaring back, Stacey and her doctor began talking seriously about surgery. A hysterectomy, they agreed, was the only real cure.

The procedure went smoothly. Everything looked good. Stacey began to recover, expecting to turn a corner.

A week later, her phone rang. The pathologist who examined her surgically removed tissue — a specialist she never met — found a lesion on the right fallopian tube. It was an early warning sign of ovarian cancer, largely invisible and almost never caught this soon.

Every test Stacey had undergone previously came back normal. The blood work. The ultrasounds. Even a tumor marker test. None of it pointed to danger ahead.

“The only way we found out,” Stacey says, “was through the work of the pathologist.”

The unseen engine

The vast majority of Cleveland Clinic’s patients are touched by the health system’s Diagnostics Institute, often without ever knowing it.

It entails a staggering scope of work. The institute’s imaging specialists perform and interpret more than 4.6 million exams annually. Its labs process more than 36 million tests. Altogether, nearly 5,000 caregivers — physicians, scientists, technologists and support staff — make up one of the largest and most sophisticated diagnostic operations in the world.

And yet for most patients, this world is invisible. A blood draw disappears into a pneumatic tube. A scan is taken in a darkened room. Then, later, a doctor delivers news. The vast, intricate machinery between those two moments — the microscopes and analyzers, the algorithms and specialists, the 40 miles of tube systems threading through Cleveland Clinic’s main campus alone — remains largely hidden from view.

“Without diagnostics, doctors are flying blind,” says Brian Rubin, MD, PhD, Chief of the Diagnostics Institute and Chair of the Department of Pathology and Laboratory Medicine. “We work with every other institute at Cleveland Clinic. They’re highly dependent on the services that we provide.”

The Diagnostics Institute operates across the interconnected disciplines of pathology, laboratory medicine and imaging. Together, they form the foundation on which every clinical decision is built.

“It all starts with the right diagnosis,” Dr. Rubin says.

The wrong diagnosis can cascade into unnecessary surgeries, missed treatments and profound harm. The right diagnosis, made with precision and speed, can mean the difference between a disease caught early and one that has already spread beyond reach.

The wrong diagnosis can cascade into unnecessary surgeries, missed treatments and profound harm. The right diagnosis, made with precision and speed, can mean the difference between a disease caught early and one that has already spread beyond reach.

Art of the diagnosis

Before he was a doctor, Dr. Rubin was a music major. It’s not just a fun fact. He lets it be known as a window into the kind of mind pathology attracts: one drawn to pattern, to interpretation, to finding meaning in what others might overlook.

“I always gravitated toward art and seeing things and being able to interpret images,” says Dr. Rubin, who holds the Robert J. Tomsich Institute Chair in Pathology and Laboratory Medicine.

“Taking visual information and turning it into a diagnosis was a challenge I loved,” he says. “There’s always been a huge overlap between art and medicine, and you find it a lot in pathology departments.”

What a pathologist actually does, though, is often misunderstood — even by other caregivers.

Dr. Rubin describes his team as “the doctors’ doctors”: the specialists whom clinicians rely on for the data, the interpretation and often the diagnosis itself. At Cleveland Clinic, pathologists and lab physicians participate in roughly 40 multidisciplinary conferences every week, sitting alongside surgeons, radiologists, oncologists and others to develop individualized care plans for patients they may never personally meet.

 “Patient treatment is a team sport,” Dr. Rubin says. “It takes a multidisciplinary team of doctors working together to diagnose and to treat — and diagnostics plays a critical role.”

The sheer volume of work is staggering. On Cleveland Clinic’s main campus, 7,000 to 8,000 tubes of blood arrive in the laboratory each day, where they’re sorted onto high-throughput analyzers capable of running a standard metabolic panel in minutes. In a single year, the lab processes 24 million tests.  

Seeing is believing

Peter Liu, MD, Chair of the Department of Imaging, came to medicine via engineering, drawn by what he calls “the interface of technology and biology.” In radiology, he found the perfect intersection of both.

In the past decade, that intersection has become one of the most consequential in modern medicine. Imaging has evolved from a tool of observation into a multilateral force. It guides therapies, replaces surgeries and, in some cases, delivers treatment directly to tumors.

Along the way, imaging has become faster, too. A CT scan that once took 30 minutes now takes under 30 seconds. And MRI exams that used to require patients to endure 35 to 40 minutes on a narrow table in a tight tube can now be completed in 8 to 10 minutes, with improved results.

“We see things not only better but faster, with greater detail, greater confidence and greater patient comfort,” says Dr. Liu, who holds the Thomas F. Meaney, M.D., Research Scholars Endowed Chair.

Beyond efficiency, imaging has become the decision point for entire categories of disease.

Liver cancer is just one example: “You don’t even have to biopsy liver cancer anymore,” Dr. Liu says, “because the imaging is so precise.”

For rectal cancer, MRI is the diagnostic cornerstone for treatment planning. It determines whether a patient proceeds to surgery, assesses the results of chemotherapy and radiation therapy and permits noninvasive surveillance of treated tumors.

Imaging also has moved decisively into treatment. Interventional radiologists now perform procedures that once required open surgery — threading catheters through tiny vessels with incisions no wider than a pinprick, draining abscesses through needles guided by CT, treating brain aneurysms from an incision in the groin.

“Surgery and interventional radiology offer complementary techniques to provide patients with the best treatment using the least invasive method,” Dr. Liu says. “In many cases, interventional radiology techniques are preferred, thereby preventing the higher morbidity associated with open surgery.”

The newest frontier is theranostics, a discipline that fuses imaging and therapy into a single, targeted intervention. Using radioactively labeled molecules that seek out specific cancer cells, physicians can both visualize disease and destroy it with the same agent. Patients come in, receive the therapy and go home — often the same day.

Sean Stauffer, PhD, Director of Medicinal Chemistry at Cleveland Clinic, is collaborating with Dr. Rubin’s lab to develop next-generation targeted therapies along similar principles, supported by a grant from the National Cancer Institute’s Experimental Therapeutics Branch.

Advancing alongside AI

Threaded throughout the Diagnostics Institute is the technology that is reshaping medicine at every level: artificial intelligence.

Andrei Purysko, MD, a diagnostic radiologist and Section Head of Abdominal Imaging, is pushing that frontier. His research integrates AI into prostate cancer diagnosis, combining MRI with PSA data and pathology findings to build multimodal models that improve detection accuracy — and reduce overdiagnosis of cancers that may never require treatment.

Elsewhere in the institute, AI analyzes blood cell smears with a consistency that human eyes cannot match while AI-assisted reporting tools are saving more than 12,700 hours of radiologist time each year by automatically summarizing reports in each physician's own voice and style.

In the imaging department, well over a dozen AI algorithms are already live — triaging stroke patients, flagging pulmonary nodules, identifying potential fractures and screening mammograms for early signs of cancer. The stroke detection system offers perhaps the most visceral example: An AI network continuously scans CT results from the emergency department, identifies patients showing signs of a stroke and elevates them immediately for radiologist review, compressing a process that once took precious minutes into seconds. 

Deeply indebted

Shortly after her hysterectomy, Stacey had a second surgery to remove her ovaries. The diagnosis that followed — stage 2a ovarian cancer — was serious. Catching it early, however, changed everything.

Earlier this year, she completed chemotherapy. Her prognosis is good. Ovarian cancer caught at stage 2a carries outcomes that stage 3 or stage 4 simply cannot match.

A Cleveland Clinic caregiver herself, Stacey is a clinical nurse specialist and manager of a nursing excellence program. Over her career, she has read hundreds of pathology reports. She never stopped to think about the names on those reports.

Until now.

When she was finally ready — she tried earlier, but tears kept welling up — she expressed her gratitude in an email to Andres Chiesa-Vottero, MD, the gynecologic pathologist who found the telltale lesion.

She also remains deeply indebted to Director of Gynecologic Pathology Amy Joehlin-Price, MD, who confirmed the ovarian cancer, as well as the other unsung heroes behind the scenes in the Diagnostics Institute.

“Everything else was telling me I was OK — except for their work,” Stacey says. “Not a day goes by that I don’t think about that.”

She wants to raise awareness and increase funding for ovarian cancer screening and research, in hopes that early detection will make a difference for more women. It made all the difference in the world for her. 
“You don’t know me,” she wrote to Dr. Chiesa-Vottero, “but you saved my life.”