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The advent of
digital
microscopy
Yves Sucaet,
Wim Waelput,
Peter In’t Veld
14-11-2016 pag. 2
Financial disclosure
• Yves Sucaet and Wim Waelput are co-founders and
shareholders in Pathomation, an i...
14-11-2016 pag. 3
Prelude
• In October 2016, I was honored at Troy University as one of
its 2016 “alumni of the year” duri...
14-11-2016 pag. 4
Topics for today
• How did I get here?
• Digital microscopy
• Digital pathology
• Companion diagnostics
PERSONAL BACKGROUND
14-11-2016 pag. 6
Who am I (education)?
• 1998-2000: Hogeschool Gent (BE)
– BS Computer Sciences
• 2001-2005: Troy State U...
14-11-2016 pag. 7
Who am I (professional)
Professional
• 2000-2001: Becton Dickinson
• 2010-2013: HistoGeneX
• Section hea...
WHAT IS DIGITAL MICROSCOPY?
14-11-2016 pag. 9
This is not it
14-11-2016 pag. 10
Digital microscopy on a budget
14-11-2016 pag. 11
Add a camera “port”
14-11-2016 pag. 12
Whole slide imaging (single slide)
14-11-2016 pag. 13
Hardware
14-11-2016 pag. 14
Whole slide imaging (clinical)
14-11-2016 pag. 15
Software
Very
large
image!
14-11-2016 pag. 16
How big are these images?
14-11-2016 pag. 17
Who does this?
14-11-2016 pag. 18
But the problem is that they don’t talk to each other!
14-11-2016 pag. 19
What’s the solution?
14-11-2016 pag. 20
Digital microscopy at the VUB
14-11-2016 pag. 21
What does the Pathomation software look like?
(DIGITAL) PATHOLOGY 101
14-11-2016 pag. 23
What does a pathologist do?
14-11-2016 pag. 24
Tools for pathologists
14-11-2016 pag. 25
Digital tools for pathologists
14-11-2016 pag. 26
Unique Selling Proposition and digital (r)evolution
14-11-2016 pag. 27
Valorization of a biobank
• Without digital histopathology: • With digital histopathology:
I’m looking ...
14-11-2016 pag. 28
Market size
• Digital pathology is a $2 Billion market
– That’s actually small (it’s a niche market)
• ...
14-11-2016 pag. 29
M&A activity
THE ECONOMICS OF CANCER
14-11-2016 pag. 31
The cost of cancer drugs
14-11-2016 pag. 32
How do cancer drugs work?
• Rituximab, Rituxan:
– monoclonal Ab that attacks CD20+ B cells
– Leukemia, ...
14-11-2016 pag. 33
To prescribe or not to prescribe?
• Expensive drugs only work in a subset of patients
– Herceptin: 20-3...
14-11-2016 pag. 34
The need for personalized medicine
Cancer
therapy
Resection
Radio
therapy
Targeted
Immune
therapy
Resea...
14-11-2016 pag. 35
So what do you do?
• Companion diagnostics are tests that are administered to assess
what treatment is ...
14-11-2016 pag. 36
How can digital microscopy help?
• In the future: Automatic assessment of stained slides
– Decision sup...
14-11-2016 pag. 37
Decision support
Tumour
DOCTORS DON’T ALWAYS GET IT
RIGHT FROM THE FIRST VISIT
But even so…
14-11-2016 pag. 39
What would you do?
14-11-2016 pag. 40
The cost of change in a diagnosis (Mark Priebe)
14-11-2016 pag. 41
The cost of change in a diagnosis (Mark Priebe)
14-11-2016 pag. 42
Number of cancer cases, estimated total cost
• 1.6 million new cases are identified each year with a 5%...
14-11-2016 pag. 43
The stakes are high (loser)!
128B market cap / 83B market cap
14-11-2016 pag. 44
The stakes are high (winner)!
IN CLOSING
14-11-2016 pag. 46
This is a global market
14-11-2016 pag. 47
Potential customers, partners, and re-sellers
14-11-2016 pag. 48
Conclusions
• Digital pathology is ready for prime time
– Education and training,
– Research (including...
14-11-2016 pag. 49
Learn more about digital pathology
14-11-2016 pag. 50
Continue the conversation
• Email: yves.sucaet@gmail.com
Thank you for inviting me!
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The Troy lectures: The advent of digital microscopy (business school edition)


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.

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The Troy lectures: The advent of digital microscopy (business school edition)

  1. 1. The advent of digital microscopy Yves Sucaet, Wim Waelput, Peter In’t Veld
  2. 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. 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. 4. 14-11-2016 pag. 4 Topics for today • How did I get here? • Digital microscopy • Digital pathology • Companion diagnostics
  5. 5. PERSONAL BACKGROUND
  6. 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. 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
  8. 8. WHAT IS DIGITAL MICROSCOPY?
  9. 9. 14-11-2016 pag. 9 This is not it
  10. 10. 14-11-2016 pag. 10 Digital microscopy on a budget
  11. 11. 14-11-2016 pag. 11 Add a camera “port”
  12. 12. 14-11-2016 pag. 12 Whole slide imaging (single slide)
  13. 13. 14-11-2016 pag. 13 Hardware
  14. 14. 14-11-2016 pag. 14 Whole slide imaging (clinical)
  15. 15. 14-11-2016 pag. 15 Software Very large image!
  16. 16. 14-11-2016 pag. 16 How big are these images?
  17. 17. 14-11-2016 pag. 17 Who does this?
  18. 18. 14-11-2016 pag. 18 But the problem is that they don’t talk to each other!
  19. 19. 14-11-2016 pag. 19 What’s the solution?
  20. 20. 14-11-2016 pag. 20 Digital microscopy at the VUB
  21. 21. 14-11-2016 pag. 21 What does the Pathomation software look like?
  22. 22. (DIGITAL) PATHOLOGY 101
  23. 23. 14-11-2016 pag. 23 What does a pathologist do?
  24. 24. 14-11-2016 pag. 24 Tools for pathologists
  25. 25. 14-11-2016 pag. 25 Digital tools for pathologists
  26. 26. 14-11-2016 pag. 26 Unique Selling Proposition and digital (r)evolution
  27. 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. 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%
  29. 29. 14-11-2016 pag. 29 M&A activity
  30. 30. THE ECONOMICS OF CANCER
  31. 31. 14-11-2016 pag. 31 The cost of cancer drugs
  32. 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. 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. 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. 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. 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
  37. 37. 14-11-2016 pag. 37 Decision support Tumour
  38. 38. DOCTORS DON’T ALWAYS GET IT RIGHT FROM THE FIRST VISIT But even so…
  39. 39. 14-11-2016 pag. 39 What would you do?
  40. 40. 14-11-2016 pag. 40 The cost of change in a diagnosis (Mark Priebe)
  41. 41. 14-11-2016 pag. 41 The cost of change in a diagnosis (Mark Priebe)
  42. 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
  43. 43. 14-11-2016 pag. 43 The stakes are high (loser)! 128B market cap / 83B market cap
  44. 44. 14-11-2016 pag. 44 The stakes are high (winner)!
  45. 45. IN CLOSING
  46. 46. 14-11-2016 pag. 46 This is a global market
  47. 47. 14-11-2016 pag. 47 Potential customers, partners, and re-sellers
  48. 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!
  49. 49. 14-11-2016 pag. 49 Learn more about digital pathology
  50. 50. 14-11-2016 pag. 50 Continue the conversation • Email: yves.sucaet@gmail.com Thank you for inviting me!

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