This is an exciting time to do microscopy with the development of digital tools. Recently, digital microscopy has centered around whole slide imaging (WSI), a term that refers to devices that can digitize (scan) an entire glass slide.
For healthcare, digital microscopy manifests itself in the pathology department (digital pathology): it is important to get the right case, to the right pathologist, at the right time, to make the right diagnosis. Digitizing data eliminates the boundaries of time and distance.
Digital microscopy can enhance efficiency and improve quality for various use cases, including teaching, research, as well as clinical settings.
2. 14-11-2016 pag. 2
Financial disclosure
• Yves Sucaet and Wim Waelput are co-founders and
shareholders in Pathomation, an innovative company founded
in 2012. The company strives to offer the most
comprehensive software platform for digital pathology
possible. The focus is on integration, scalability, and user-
friendliness. Pathomation implements digital pathology in a
variety of use cases and scenarios.
3. 14-11-2016 pag. 3
Prelude
• In October 2016, I was honored at Troy University as one of
its 2016 “alumni of the year” during the annual homecoming
activities.
• In the following week, I gave several guest lectures in various
departments across campus.
• This is the lecture as presented for the Business department
on Thursday, October 20, 2016.
4. 14-11-2016 pag. 4
Topics for today
• How did I get here?
• Digital microscopy
• Digital pathology
• Companion diagnostics
6. 14-11-2016 pag. 6
Who am I (education)?
• 1998-2000: Hogeschool Gent (BE)
– BS Computer Sciences
• 2001-2005: Troy State University (US)
– Exchange program
• Developed an interest in using ComS to help (molecular) biologists
– MS Biological Sciences
• Research in yeast genetics with Dr. Christi Magrath (NSF fellowship)
• 2005-2010: Iowa State University
– PhD Bioinformatics & Computational Biology
Education
7. 14-11-2016 pag. 7
Who am I (professional)
Professional
• 2000-2001: Becton Dickinson
• 2010-2013: HistoGeneX
• Section head Data Management & Bioinformatics
• 2012-now: Pathomation
• Chief Technology Officer
• 2014-Q1 2017: VUB
• Digital Pathology Manager
• 2016-now: HistoGeneX
• Data scientist
27. 14-11-2016 pag. 27
Valorization of a biobank
• Without digital histopathology: • With digital histopathology:
I’m looking for breast
tumor tissue
Does the sample
contain cancer cells
Is it in situ or
invasive?
Is it hormone-
responsive?
I’m looking for breast
tumor tissue
Does the sample
contain cancer cells
Is it in situ or
invasive?
Is it hormone-
responsive?
Sure; glad to help
Just trust us
Just trust us
We don’t have that
information
Sure; glad to help
Have a look at the HE
Have a look at the HE and
the immunostains
(p63 – calponine)
Have a look at the
immunostains and the fluo
data (FISH)
Fidelity increases, confident about
requests, investments pay off
28. 14-11-2016 pag. 28
Market size
• Digital pathology is a $2 Billion market
– That’s actually small (it’s a niche market)
• GE is now dropping out of the race because of this!
• Medical imaging is a mature market
– Annual growth of about 5%
– Digital pathology: 14%
32. 14-11-2016 pag. 32
How do cancer drugs work?
• Rituximab, Rituxan:
– monoclonal Ab that attacks CD20+ B cells
– Leukemia, lymphoma
• Trastuzumab, Herceptin
– Interferes with Her2/Neu receptor
– Breast cancer
• Imatinib, Gleevec
– Tyrosine Kinase Inhibitor
– Chronic Myelogenous Leukemia (CML), Gastrointestinal
tumors (GITs)
• Everolimus, Afinitor
– HR+ (ER or PR), Her2 negative
– Breast cancer
33. 14-11-2016 pag. 33
To prescribe or not to prescribe?
• Expensive drugs only work in a subset of patients
– Herceptin: 20-30% of early stage breast cancer
• Only to be used in HER2/Neu positive patients
• Cost: $4,659 / month
– Affinitor: 35% of patients respond
• Only to be used in Her2 negative, HR positive patients
• Cost: $8,701 / month
– Ibrance:
• Only to be used in ER positive, Her2 negative
• Also for metastatic cancer
• Cost: $10,677 / month
– Avastin + Erbitux
• Triple Negative Breast Cancer (TNBC)
• Cost: $5,551 + $11,862
34. 14-11-2016 pag. 34
The need for personalized medicine
Cancer
therapy
Resection
Radio
therapy
Targeted
Immune
therapy
Research
Chemot
herapy
% patients responding: 25%
20-30% patients benefits
from ipilimumab
Epigenetics
Combinations
Lung cancer :
EGFR - gefitinib
ALK - crizotinib
35. 14-11-2016 pag. 35
So what do you do?
• Companion diagnostics are tests that are administered to assess
what treatment is suited for a particular patient
– Can save lots of resources (time, money), and therefore
lives
– cDX is usually done on a (liquid) biopsy or resection
• Which means a pathologist is involved
– Allows clinician to take shortcuts!
• Sometimes a 3rd line treatment can be opted for directly as a 1st
line treatment
– Paves the way for personalized medicine
• Get the right drug to the right patient at the right time
• (at the right price for the patient and for society)
36. 14-11-2016 pag. 36
How can digital microscopy help?
• In the future: Automatic assessment of stained slides
– Decision support systems
– Most importantly: help troubleshoot borderline
cases!
• Today: Training the pathologist for make the right assessment
– http://training.Pathomation.com
• Today: Facilitate discussion
– Tumor boards, multidisciplinary oncological consults
– Second opinions
42. 14-11-2016 pag. 42
Number of cancer cases, estimated total cost
• 1.6 million new cases are identified each year with a 5%
opportunity of improvement
– 80,000 cases annually
• Saving resources on 80,000 cases at $30,000 per case
– $2.4 Billion saving
48. 14-11-2016 pag. 48
Conclusions
• Digital pathology is ready for prime time
– Education and training,
– Research (including biobanking)
– Clinical research and drug development
• Business opportunities abound
– $2 B market size, $2.4B savings to be realized
– Hardware: scanners can still improve a LOT
– Software: needs to be more flexible, intuitive, user-
friendly (also programmer-friendly and MD-friendly)
– Consulting: team up with MDs!