Personalised / Precision Medicine has revolutionized cancer treatment and, in parallel, is also deeply transforming the way we practice tissue pathology. The aim of this talk is to briefly review the status of molecular diagnostic tests applicable to tissues and cells, as well as the main technical and conceptual areas that, in my opinion, will be dictating the evolution of tissue pathology and its integration with the molecular era. These areas are, among others – a) digital pathology in the pipeline of therapeutic pathology; b) tissue-based NGS and its integration in routine diagnostics; c) the promise of liquid biopsy diagnostics and its necessary “partnership” with tissue molecular testing; d) Pathology IT, databases and bioinformatics; and e) the training of future tissue pathologists. In the process of this review, it may be apparent that a solid, integrated, morpho-molecular approach to pathology may serve our patients better.

1. Manuel Salto-Tellez, MD (LMS), FRCPath, FRCPI
Professor and Chair of Molecular Pathology
Clinical Consultant Pathologist
Deputy Director, Centre for Cancer Research and Cell Biology

4. MARCH 2011 – A MEETING OF MINDS
MARCH
2011

5. INTRODUCTION
2007
Salto-Tellez M. Clinical Chemistry 2007

6. •ANATOMICAL DIMENSION
•OF PATHOLOGY
ANATOMICAL / CLINICAL DIMENSION
OF PATHOLOGY (HISTOLOGY AND CYTOLOGY)
“… transforming pathology of the dead
into pathology of the living.”
Salto-Tellez M. Clinical Chemistry 2007

7. Paediatric
Sarcomas
Colorectal
Cancer
Lympho –
proliferative
Disorders
Lung Cancer Breast Cancer
TREATMENT AND/OR PROGNOSIS
Gastrointestinal
Stromal
Tumours
A N A T O M I C A L - C L I N I C A L D I M E N S I O N O F P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007

8. SURG PATH
Diagnosis of
Paediatric
Sarcomas
SURG PATH
Diagnosis of
Colorectal
Cancer
SURG PATH
Diagnosis of
Lympho –
proliferative
Disorders
SURG PATH
Diagnosis of
Lung Cancer
SURG PATH
Diagnosis of
Breast Cancer
TREATMENT AND/OR PROGNOSIS
SURG PATH
Diagnosis of
Gastrointestinal
Stromal
Tumours
A N A T O M I C A L - C L I N I C A L D I M E N S I O N O F P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007

9. •ANATOMICAL / CLINICAL DIMENSION OF PATHOLOGY
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

10. •ANATOMICAL / CLINICAL / MOLECULAR DIMENSION OF PATHOLOGY
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

11. DIRECTOR'S CHALLENGE: TOWARD A MOLECULAR
CLASSIFICATION OF TUMORS
Release Date: January 20, 1999 RFA: CA-98-027
P.T. National Cancer Institute
PURPOSE - The Director of the National Cancer Institute (NCI)
challenges the scientific community to harness the power of
comprehensive molecular analysis technologies to make the
classification of tumors vastly more informative. This challenge is
intended to lay the groundwork for changing the basis of tumor
classification from morphological to molecular characteristics.
Dr Harold Varmus, 1999
Research and the World of Tissue Pathology

12. Molecular biomarkers used in clinical standard-
of-care decision making in colorectal cancer
Biomarker Purpose
Diagnostic
APC mutation detection
MMR protein expression (MSH2, MLH1, MSH6,
PMS2)
MSI (microsatellite instability) analysis
MMR mutation detection (MSH2, MLH1, MSH6,
PMS2)
BRAF mutation detection
MYH mutation detection
LKB1, SMAD4, BMPR1A, PTEN mutation detection
Diagnosis of FAP
Diagnosis of HNPCC
Diagnosis of MYH-associated polyposis
Diagnosis of harmartomatous polyp syndromes
Prognostic/Predictive
KRAS mutation analysis
BRAF mutation analysis
Thymidylate synthase protein expression
MSI
Gene expression signature
Molecular stratification for treatment with epidermal
growth factor receptor (EGFR) inhibitors
Identification of response to 5-FU
Identification of response to 5-FU
Prognostication
Van Schaeybroeck S, et al (Salto-Tellez M). Abeloff's Clinical Oncology. 5th edition; in press.

13. Molecular testing in breast cancer
American Society of Clinical Oncology/College
of American Pathologists Guideline
Recommendations for Human Epidermal Growth
Factor Receptor 2 Testing in Breast
Cancer - Antonio C. Wolff AC et al.
JCO Jan 1 2007: 118-145.
Boyle DP, et al. (Salto-Tellez M). Biochim Biophys Acta 2013;1835:230–42.
AKT1 mut in 2% of patients
AKT1 inhibitor AZD5363
Activating ERBB2 mut in 3% of patients
plasmaMATCH
BRCA1 and BRCA2 mut
PARP inhibitors.
ESR1 mut
Oral SERDs.

14. Molecular classification of
lung adenocarcinoma
Pao W & Hutchinson KE.
Nat Med 2012;18:349–51.
Lindeman NI et al.
J Mol Diagn. 2013 Jul;15(4):415-53.

15. Molecular testing in sarcomas & lymphomas

16. Molecular testing in malignant melanomas

17. GLIOMA TESTING
DNA QPCR
1P
19Q
PTEN
EGFR Amplification
DNA Sanger Sequencing
IDH 1 & 2
DNA Methylation
RNA QPCR
BRAF Translocations
EGFR v.3
NI-MPL Validation Strategy

18. Selected target therapeutics in
clinical oncology practice
Salto-Tellez M. In: Tan & Lynch’s Principles of Molecular Diagnostics and Personalized
Cancer Therapy, Lippincott Williams & Wilkins, 2012.
16

19. Revolution in Oncology
New Drugs for Targeted Therapy
Discovery Medicine 2014
32

20. SURG PATH
Diagnosis of
Paediatric
Sarcomas
SURG PATH
Diagnosis of
Colorectal
Cancer
SURG PATH
Diagnosis of
Lympho –
proliferative
Disorders
SURG PATH
Diagnosis of
Lung Cancer
SURG PATH
Diagnosis of
Breast Cancer
TREATMENT AND/OR PROGNOSIS
SURG PATH
Diagnosis of
Gastrointestinal
Stromal
Tumours
A N A T O M I C A L - C L I N I C A L D I M E N S I O N O F P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

21. TREATMENT AND/OR PROGNOSIS
SURG PATH
Diagnosis of
Paediatric
Sarcomas
SURG PATH
Diagnosis of
Colorectal
Cancer
SURG PATH
Diagnosis of
Lympho –
proliferative
Disorders
SURG PATH
Diagnosis of
Lung Cancer
SURG PATH
Diagnosis of
Breast Cancer
SURG PATH
Diagnosis of
Gastrointestinal
Stromal
Tumours
Molecular
Detection
of
Translocations
Microsatellite
Instability
Analysis
KRAS/BRAF
Mutation Analysis
B & T cell
rearrangements
Specific
translocations Analysis
of
EGFR
Mutations
Analysis
of
C-kit
Mutations
HER2-neu
Status
A N A T O M I C A L - C L I N I C A L - M O L E C U L A R D I M E N S I O N
O F P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

22. TREATMENT AND/OR PROGNOSIS
Molecular
Detection
of
Translocations
Microsatellite
Instability
Analysis
KRAS/BRAF
Mutation Analysis
B & T cell
rearrangements
Specific
translocations Analysis
of
EGFR
Mutations
Analysis
of
C-kit
Mutations
HER2-neu
Status
Multiple Biomarker Analysis
SURG PATH
Diagnosis of
Paediatric
Sarcomas
SURG PATH
Diagnosis of
Colorectal
Cancer
SURG PATH
Diagnosis of
Lympho –
proliferative
Disorders
SURG PATH
Diagnosis of
Lung Cancer
SURG PATH
Diagnosis of
Breast Cancer
SURG PATH
Diagnosis of
Gastrointestinal
Stromal
Tumours
A N A T O M I C A L - C L I N I C A L – MO L E C U L A R D I M E N S I O N O F
P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

23. TREATMENT AND/OR PROGNOSIS
Molecular
Detection
of
Translocations
Microsatellite
Instability
Analysis
KRAS/BRAF
Mutation Analysis
B & T cell
rearrangements
Specific
translocations Analysis
of
EGFR
Mutations
Analysis
of
C-kit
Mutations
HER2-neu
Status
Multiple Biomarker Analysis
Pharmacogenomics
SURG PATH
Diagnosis of
Paediatric
Sarcomas
SURG PATH
Diagnosis of
Colorectal
Cancer
SURG PATH
Diagnosis of
Lympho –
proliferative
Disorders
SURG PATH
Diagnosis of
Lung Cancer
SURG PATH
Diagnosis of
Breast Cancer
SURG PATH
Diagnosis of
Gastrointestinal
Stromal
Tumours
A N A T O M I C A L - C L I N I C A L – MO L E C U L A R D I M E N S I O N O F
P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

24. TREATMENT AND/OR PROGNOSIS
Molecular
Detection
of
Translocations
Microsatellite
Instability
Analysis
KRAS/BRAF
Mutation Analysis
B & T cell
rearrangements
Specific
translocations Analysis
of
EGFR
Mutations
Analysis
of
C-kit
Mutations
HER2-neu
Status
Multiple Biomarker Analysis
Pharmacogenomics
SURG PATH
Diagnosis of
Paediatric
Sarcomas
SURG PATH
Diagnosis of
Colorectal
Cancer
SURG PATH
Diagnosis of
Lympho –
proliferative
Disorders
SURG PATH
Diagnosis of
Lung Cancer
SURG PATH
Diagnosis of
Breast Cancer
SURG PATH
Diagnosis of
Gastrointestinal
Stromal
Tumours
A N A T O M I C A L - C L I N I C A L – MO L E C U L A R D I M E N S I O N O F
P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

25. TREATMENT AND/OR PROGNOSIS
Molecular
Detection
of
Translocations
Microsatellite
Instability
Analysis
KRAS/BRAF
Mutation Analysis
B & T cell
rearrangements
Specific
translocations Analysis
of
EGFR
Mutations
Analysis
of
C-kit
Mutations
HER2-neu
Status
Multiple Biomarker Analysis
Pharmacogenomics
SURG PATH
Diagnosis of
Paediatric
Sarcomas
SURG PATH
Diagnosis of
Colorectal
Cancer
SURG PATH
Diagnosis of
Lympho –
proliferative
Disorders
SURG PATH
Diagnosis of
Lung Cancer
SURG PATH
Diagnosis of
Breast Cancer
SURG PATH
Diagnosis of
Gastrointestinal
Stromal
Tumours
A N A T O M I C A L - C L I N I C A L – MO L E C U L A R D I M E N S I O N O F
P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

26. TREATMENT AND/OR PROGNOSIS
Molecular
Detection
of
Translocations
Microsatellite
Instability
Analysis
KRAS/BRAF
Mutation Analysis
B & T cell
rearrangements
Specific
translocations Analysis
of
EGFR
Mutations
Analysis
of
C-kit
Mutations
HER2-neu
Status
Multiple Biomarker Analysis
Pharmacogenomics
SURG PATH
Diagnosis of
Paediatric
Sarcomas
SURG PATH
Diagnosis of
Colorectal
Cancer
SURG PATH
Diagnosis of
Lympho –
proliferative
Disorders
SURG PATH
Diagnosis of
Lung Cancer
SURG PATH
Diagnosis of
Breast Cancer
SURG PATH
Diagnosis of
Gastrointestinal
Stromal
Tumours
A N A T O M I C A L - C L I N I C A L – MO L E C U L A R D I M E N S I O N O F
P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

27. TREATMENT AND/OR PROGNOSIS
Molecular
Detection
of
Translocations
Microsatellite
Instability
Analysis
KRAS/BRAF
Mutation Analysis
B & T cell
rearrangements
Specific
translocations Analysis
of
EGFR
Mutations
Analysis
of
C-kit
Mutations
HER2-neu
Status
Multiple Biomarker Analysis
Pharmacogenomics
SURG PATH
Diagnosis of
Paediatric
Sarcomas
SURG PATH
Diagnosis of
Colorectal
Cancer
SURG PATH
Diagnosis of
Lympho –
proliferative
Disorders
SURG PATH
Diagnosis of
Lung Cancer
SURG PATH
Diagnosis of
Breast Cancer
SURG PATH
Diagnosis of
Gastrointestinal
Stromal
Tumours
A N A T O M I C A L - C L I N I C A L – MO L E C U L A R D I M E N S I O N O F
P A T H O L O G Y
Salto-Tellez M. Clinical Chemistry 2007 Jul;53(7):1188-90Salto-Tellez M. Clinical Chemistry 2007

28. MARCH 2011 – A MEETING OF MINDS
MARCH
2011

29. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH
2011
SEPT
2011
Salto-Tellez, James & Hamilton.
Molecular Oncology, 2014 Oct;8(7):1163-8
Salto-Tellez & Kennedy.
Drug Discovery Today, 2015, in press.

30. Manpower
Technology Samples
Manpower
Technology Samples
RESEARCH DIAGNOSTICS

31. SAMPLES
HYBRID LABORATORY OPERATION
TECHNOLOGY
MANPOWER

32. Northern Ireland Molecular Pathology Laboratory (NI-MPL)
End to End Diagnostic and Research Service
Cutting Across Technologies and Infrastructures
Salto-Tellez, James & Hamilton. Molecular Oncology, 2014
Salto-Tellez, James & Hamilton.
Molecular Oncology, 2014 Oct;8(7):1163-8

33. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH
2011
SEPT
2011
Salto-Tellez, James & Hamilton.
Molecular Oncology, 2014 Oct;8(7):1163-8
Salto-Tellez & Kennedy.
Drug Discovery Today, 2015, in press.

34. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
MARCH
2011
SEPT
2011
MARCH
2012

37. Salto-Tellez & Kennedy. Drug Discovery Today, 2015, in press.
100%
1%
Kern SE.
Why your new cancer biomarker
may never work: recurrent
patterns and remarkable diversity
in biomarker failures.
Cancer Res. 2012 Dec 1;72(23):6097-101

38. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
MARCH
2011
SEPT
2011
MARCH
2012

39. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012

40. NEXT GENERATION SEQUENCINGHT GE ARRAYS / METHYL / CNV
IMAGING SCANNING LT TESTING (SEQ, Q-PCR)AUT NA EXTR
AUTOMATED IHCAUTOM. FISHAUTOMATED H+E
MICROSCOPYSAMPLE PREPARATION

43. Level 1:
well-characterised
Level 2:
basic knowledge
Level 3:
hardly or no
knowledge
Full characterization (cell lines, KO models, WBs, etc)
REJECTYES NO
QUESTION 1: What is known about the AB?
QUESTION 2: Is there a good protocol
Technical: Antigen retreivals/Dilutions using Case controls and detecting expected expression
REJECTYES NO
QUESTION 3: Does it have the expected use – is it fit for purpose?
Diagnostic Genetic/molecular Therapeutic
Single? Panel?
Sensitivity and Specificity
against diagnostic target
Use of molecular
reference
standards
Follow strict
guidelines
REJECTACEPT AND INTRODUCE TO SERVICE
YES NO

45. Digital Pathology &
Molecular Diagnostics
Tissue Hybridization-based
Testing
Extracted Nucleic Acid-based
Testing

46. Bingham V, (Salto-Tellez M) McQuaid S. Human Pathology. 2015, In Press

47. Bingham V, (Salto-Tellez M) McQuaid S. Human Pathology. 2015, In Press

48. Bingham V, (Salto-Tellez M) McQuaid S. Human Pathology. 2015, In Press

49. Bingham V, (Salto-Tellez M) McQuaid S. Human Pathology. 2015, In Press
Gland-to-gland &
Intragland heterogeneity
QUANTITATION - ABSOLUTE AND RELATIVE
(HOUSE-KEEPING GENE)

50. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012

51. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
JAN 2013 - CPA MOLECULAR DIAGNOSTIC ACCREDITATION
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013

53. … to show our hospital that we are competent to perform diagnostics
… to show research agencies / charities that we perform research according to the
best standards
… to show industry our quality
S-CORT
(under review)
NATIONAL & EUROPEAN PROGRAMMES
€ 6M £2.5M £ 6M £3.5M £600K
ACCELERATOR
£3.9M TO BE CONFIRMED

54. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
JAN 2013 - CPA MOLECULAR DIAGNOSTIC ACCREDITATION
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013

55. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014

57. J Natl Cancer Inst. 2014 Jan;106(1):djt335. doi: 10.1093/jnci/djt335.

58. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014

59. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014

60. Genome Sequencing - FASTER
Sanger (capillary) sequencing
2015
? ~1day
?? $100
2005
~3 years
~$ 20million
2010
~1month
$9,500
(Illumina)
AML
Melanoma
Small-celllung
Breast
2008
~4 months
~$ 1.5million
Lung(NSS)
Cancer Genomics
2000
~10 years
~$ 3.5 billion
Myeloma
Hepatocellular
CLL
MouseAML
Next generation sequencing

61. Genome Sequencing - BROADER
102
104
106
108
1010
1012
1014
1016
Output
kbp / run
Capillary (Sanger)
Sequencing
Next Generation
Sequencing
(NGS)
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
454
pyroseq
Solexa/
Illumina
ABI
SOLID
Illumina
HiSeq
Technologies
Roche/454
Titanium
ABI
SOLID 3.0
ABI
capillary
Ion
Torrent

62. Genome Sequencing - CHEAPER

63. NGS Research Paradigm
Clinical samples
(best possible sample quality)
NGS ANALYSIS
(discovery – as broad as possible)
CONFIRMATION OF SELECTED FINDINGS
(orthogonal methods)
Selected Report of Results

64. Alvi (Salto-Tellez) et al. Oncotarget 2015 – Advanced Publication

65. Alvi (Salto-Tellez) et al. Oncotarget 2015 – Advanced Publication

66. Lawrence Ms et al. Nature. 2013 Jul 11;499(7457):214-8.

67. For most cancer types, this landscape consists of a small number of
“mountains” (genes altered in a high percentage of tumors) and a
much larger number of “hills” (genes altered infrequently).
To date, these studies have revealed ~140 genes that, when altered by
intragenic mutations, can promote or “drive” tumorigenesis. A typical
tumor contains two to eight of these “driver gene” mutations; the
remaining mutations are passengers that confer no selective growth
advantage.
Driver genes can be classified into 12 signaling pathways that regulate
three core cellular processes: cell fate, cell survival, and genome
maintenance.
Vogelstein et al. Science . 2013; 339(6127): 1546–1558.

68. NGS Research Paradigm
Clinical samples
(best possible sample quality)
NGS ANALYSIS
(discovery – as broad as possible)
CONFIRMATION OF SELECTED FINDINGS
(orthogonal methods)
Selected Report of Results
?

69. PLoS ONE 8(7): e69604. doi:10.1371/journal.pone.0069604
PLoS One. 2013 Jul 26;8(7):e69604. doi: 10.1371/journal.pone.0069604. Print 2013.

70. LUNG ADENOCARCINOMA
COLORECTAL CANCER
MALIGNAT MELANOMA
5 BIOINFORMATICS ANALYTICAL
SOFTWARES
CAN WE CONFIDENTLY DETECT WHAT IS CURRENTLY STANDARD
OF CARE? (EGFR, KRAS, BRAF)
CAN WE RELY ON THE INFORMATION GENERATED IN
OTHER KEY ONCOGENES (n=43)?
2 NGS PLATFORMS
PLoS One. 2013 Jul 26;8(7):e69604. doi: 10.1371/journal.pone.0069604. Print 2013.

71. J Pathol. 2014 Sep;234(1):5-10. doi: 10.1002/path.4365.

72. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
PREPARATIONS FOR 1ST
CLINICAL TRIAL

73. PTEN MAP2K1(MEK) EGFR KRAS
NRAS BRAF PIK3CA ERBB2
MET PIK3R1
Multiplicom - MErCuRIC specific MASTR assay:
257 amplicons in 4 plexes covering all coding exons of the 10 genes.
Of the 257, 21 are control amplicons to allow for gene deletions / amplifications.
The average length of the amplicons is 198 bp ranging from 124 to 255 bp.
The evaluation of the performance of the assay (MiSeq) resulted in 100% coverage of all targets, a
higher than 97% on target reads and higher than 99% of all amplicons within 20% of mean
coverage
PI – DR SANDRA VAN SCHAEYBROECK

74. Representation of uniform coverage of the MErCuRIC MASTR assay

75. Currently, only part of exon 9 of ERBB2 is covered suboptimally.
The low covered region is 30 bp in size located at the 5’ end of exon 9.
It is unlikely that this low coverage will lead to false negative results
since no mutations are reported in the COSMIC database for this DNA fragment.

76. Aiming to avoid amplification of the MAP2K1 pseudogenes on chromosome 8p21.
The MiSeq sequencing data showed that only MAP2K1 specific amplicons were
amplified and hence no pseudogene amplicons.

77. Schematic presentation of the complete workflow of the MErCuRIC
MASTR assay .
The resulting amplicon library can be sequenced on MiSeq and PGM.

79. SOLID TUMOURS - LEVELS OF TESTING
CLASS 4
HUMAN CANCER
COMPREHENSIVE
200-400
CLASS 1
ACTIONABLE
MUTATIONS
6-12
CLASS 3
Tumour
COMPREHENSIVE50-200
CLASS 2
CLINICALLY
RELEVANT
20-50
Dx DiscoveryClinical
Trials

80. Getting from raw sequencing data to accurate and timely curation
of clinically actionable variants and reporting in a user
friendly format for our ordering physicians continues to
be a significant challenge for complex molecular testing.

81. M O L E C U L A R O N C O L O G Y 8 ( 2 0 1 4 ) 8 5 9 - 8 7 3

82. M O L E C U L A R O N C O L O G Y 8 ( 2 0 1 4 ) 8 5 9 - 8 7 3
Is this an activating or inactivating mutation?
Does this mutation engender sensitivity to specific targeted therapeutics?
How to select therapy in case of multiple genomics alterations?

83. M O L E C U L A R O N C O L O G Y 8 ( 2 0 1 4 ) 8 5 9 - 8 7 3
“Managing levels of (un)certainty”

84. M O L E C U L A R O N C O L O G Y 8 ( 2 0 1 4 ) 8 5 9 - 8 7 3

85. The Need for Analytical Redundancy - Courtesy of – Dr Richie Soong, NUS

86. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014

87. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014

89. 2,000 CRC
transcriptomics
Validation of WES
& RNA-Seq
Validation of
WGS
Ion Torrent Illumina iScan Affymetrix Illumina MiSeq Illumina NextSeq
MOLECULAR PATHOLOGY PROGRAMME – GENOMICS

90. Ion Torrent Illumina iScan Affymetrix Illumina MiSeq Illumina NextSeq
MOLECULAR PATHOLOGY PROGRAMME – GENOMICS
Hamilton P (Salto-Tellez M). Oncotarget 2015 (advanced publication)

91. % Tumour cells is critical
Total number of cells is critical
Tumour cells ? Tumour cells ?

92. Breast Cancer % Tumour Estimates
PathXL – QUB – BHSCT internal assessment, 2015
PathXL – QUB – BHSCT internal assessment, 2015

93. Variation in % Tumor Cell
Evaluation in Lung Cancer
Smits AJJ et al. Modern Pathology 27, 168-174 (February 2014)

94. Variation in % Tumor Cell
Evaluation in Colorectal Cancer
Viray, et al. Arch Pathol Lab Med. 2013;137:1545–154

95. Oncotarget 2015, minor revisionsOncotarget 2015, advanced publication

96. Oncotarget 2015, minor revisionsOncotarget 2015, advanced publication

97. FIG 11. (A) COMPARISON OF AUTOMATED TUMOUR NUCLEI COUNTS AND PERCENTAGE
TUMOUR VALUES (Y-AXIS), AGAINST BENCHMARK DATA ON TUMOR % SHOWING STRONG
CORRELATION, MAPPING CLOSELY TO ACTUAL TUMOR CELL PERCENTAGE VALUES. (B) THE
SAME SCATTERPLOT AS (A) BUT SUPERIMPOSING THE RANGE OF PATHOLOGY ESTIMATES (RED
CIRCLES) AGAINST THE BENCHMARK DATA.
Oncotarget 2015, minor revisionsOncotarget 2015, advanced publication

98. Oncotarget 2015, minor revisionsOncotarget 2015, advanced publication

99. Initiation
Implementation
phase
*Led by Prof Louise Jones. Includes molecular pathology representation from
BRC-GMC centres. Consultation with Joint Molecular Pathology Group
Joint Molecular Pathology working group
Main program
WS 1: upstream tumour
handling
WS 2: tumour
processing, fixative,
embedding
WS 3: tumour
assessment
WS 5: DNA
quantification and
quality assessment
WS 4: DNA extraction
WS 6: Library
preparation and
sequencing
EXPERIMENTAL PATHWAY
SOPdevelopmentgroup

100. Initiation
Implementation
phase
*Led by Prof Louise Jones. Includes molecular pathology representation from
BRC-GMC centres. Consultation with Joint Molecular Pathology Group
Main program
WS 3: tumour
assessment
EXPERIMENTAL PATHWAY
SOPdevelopmentgroup
Joint Molecular Pathology working group

101. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014

102. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014

104. Flynn C, (Salto-Tellez M) .J Clin Pathol. 2014 Jul;67(7):632-6.

105. Flynn C, (Salto-Tellez M) .J Clin Pathol. 2014 Jul;67(7):632-6.

106. Flynn C, (Salto-Tellez M) .J Clin Pathol. 2014 Jul;67(7):632-6.

107. Flynn C, (Salto-Tellez M) .J Clin Pathol. 2014 Jul;67(7):632-6.

108. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014

109. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
JAN 2015: RENEWAL OF NI BIOBANK FUNDING
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015

110. Generators of DNA & RNA
clinical sample collections
Generators of archival
clinical tissue collection
( … )
Clinical Diagnosis Research Availability
Providers of samples
to tissue repositories
Research Availability
Frozen
Tissue
Repository
Clinical Diagnosis Research Availability
DNA RNA
( … )
Conventional Pathologist Molecular Diagnostician
Dr Jackie James

111. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
JAN 2015: RENEWAL OF NI BIOBANK FUNDING
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015

112. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
JAN 2015: RENEWAL OF NI BIOBANK FUNDING
APRIL 2015: CR-UK ACCELERATOR AWARD
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015
APR
2015

113. THE PROPOSAL
£3.9M
1.
To create a “common digital pathology language” across the members of the proposal
2.
To use digital pathology to describe tumour heterogeneity and cancer immunology
3.
To improve the efficiency of NGS through digital pathology pre-analytical interventions
4.
To develop “a common digital pathology platform” for the UK
5.
To create a structure of Clinical Fellowships /MSc in different aspects of Molecular Pathology
(Including liquid biopsy pathology, lung digital pathology and
the pathology of early-phase clinical trials)

114. Cancer immunology is a branch of immunology that studies
interactions between the immune system and cancer cells.
It is a growing field of research (and increasingly diagnostics)
that aims to discover innovative cancer immunotherapies
and immune companion diagnostics to treat and retard
progression of the disease.

115. $3.9M to develop Digital Pathology in the UK
BELFAST
Manpower, IT,
Instrumentation
EPITHELIAL
INTERROGATION
Training
SOUTHAMPTON
Manpower, IT
Instrumentation
CANCER IMMUNE
INTERROGATION
TrainingMARSDEN
Manpower
WGS QA/QC
Training
CRUK DIGITAL MOLECULAR PATHOLOGY & TRAINING NETWORK
UCL Neuro
Manpower
Training
Leicester
Lung Ca
Training
Newcastle
Clin Trials
Training
Manchester
Liq Bx
Training

116. Pagès (Galon) N Engl J Med 353;25, 2005 Galon. Science. 2006;313(5795):1960-4.

117. Fridman (Galon). Nat Rev Cancer 2012 Galon. J Pathol 2014; 232: 199–209

118. Cancer Immunology and
Tissue Hybridization Assays
Multiplexing
Subcellular localization
Spatial localization
(topography or
Immune contexture)
Quantitation
http://www.perkinelmer.co.uk/Catalog/Product/ID/VECTRA

119. CD3 quantitation – validation experiments

120. CD3 quantitation – validation experiments

121. CD3 quantitation – validation experiments

122. Time
PercentSurvival
CHEMOTHERAPY
GENOMIC TARGETED THERAPY
IMMUNE CHECKPOINT THERAPY
COMBINATION OF IMMUNE CHECKPOINT THERAPY
AND GENOMIC TARGETED THERAPY
Sharma & Allison. Cell 161, April 9, 2015

123. 14 1 26 7 17 24 1 15 19 18 2 16 13 22 11 3 3 12 5 28 9 8 4 27 6 23
TP53 1 3 2 0 0 1 1 2 1 0 2 1 0 0 0 2 2 1 1 0 2 1 1 2 3 0
APC 1 0 0 1 0 1 0 0 1 0 0 0 0 0 2 0 2 1 1 0 0 2 0 0 0 0
BRAF 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 1 1
KIT 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 1 1
MET 0 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0
SMD4 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0
FBXW7 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0
KRAS 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0
MSI S S S S H S S S S S S S S H S S H H H H H H H H
Alvi & Salto-Tellez. 2015, in preparation

124. Alvi & Salto-Tellez. 2015, in preparation
64%27%

125. PD-L1 IHC -- Test validation
PD-L1 Scoring
Cell type
(epithelial
vs
immune
vs
stromal)
Percentage of + cells
(in each type)
Subcellular localization
Topographic localization
(i.e. immune contexture)

126. Alvi & Salto-Tellez. 2015, in preparation

128. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
JAN 2015: RENEWAL OF NI BIOBANK FUNDING
APRIL 2015: CR-UK ACCELERATOR AWARD
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015
APR
2015

129. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
JAN 2015: RENEWAL OF NI BIOBANK FUNDING
APRIL 2015: CR-UK ACCELERATOR AWARD
OCT 2015: A REGIONAL, FULLY COMMISSIONED MOLECULAR DIAGNOSTIC SERVICE
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015
APR
2015
OCT
2015

130. REGIONAL, FULLY COMMISSIONED
MOLECULAR DIAGNOSTIC SERVICE

131. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
JAN 2015: RENEWAL OF NI BIOBANK FUNDING
APRIL 2015: CR-UK ACCELERATOR AWARD
OCT 2015: A REGIONAL, FULLY COMMISSIONED MOLECULAR DIAGNOSTIC SERVICE
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015
APR
2015
OCT
2015

132. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
JAN 2015: RENEWAL OF NI BIOBANK FUNDING
APRIL 2015: CR-UK ACCELERATOR AWARD
OCT 2015: A REGIONAL, FULLY COMMISSIONED MOLECULAR DIAGNOSTIC SERVICE
OCT 2015: PRECISON MEDICINE CATAPULT CENTRE OF EXCELLENCE
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015
APR
2015
OCT
2015

133. Creating the leading
Precision Medicine
Ecosystem in the world
Catapult.org.uk@PMCatapult

136. Salto-Tellez & Kennedy. Drug Discovery Today, 2015, in press.

137. INDUSTRIAL-ACADEMIC PARTNERSHIPS
PRE-CLINICAL
RESEARCH
PRODUCT /
TECHNOLOGY
DEVELOPMENT
Our mission is to improve patient care through the development of:
1. Biomarkers for prognosis, prediction and markers of response
2. Biologically determined targeted therapies.

138. INDUSTRIAL-ACADEMIC PARTNERSHIPS
CLINICAL & PRE-CLINICAL
RESEARCH
PRODUCT /
TECHNOLOGY
DEVELOPMENT
Our mission is to improve patient care through the development of:
1. Biomarkers for prognosis, prediction and markers of response
2. Biologically determined targeted therapies.

139. INDUSTRIAL-ACADEMIC PARTNERSHIPS
CLINICAL & PRE-CLINICAL
RESEARCH
PRODUCT /
TECHNOLOGY
DEVELOPMENT
Our mission is to improve patient care through the development of:
1. Biomarkers for prognosis, prediction and markers of response
2. Biologically determined targeted therapies.

140. INDUSTRIAL-ACADEMIC PARTNERSHIPS
CLINICAL & PRE-CLINICAL
RESEARCH
PRODUCT /
TECHNOLOGY
DEVELOPMENT
PRODUCT /
TECHNOLOGY
ADOPTION
Our mission is to improve patient care through the development of:
1. Biomarkers for prognosis, prediction and markers of response
2. Biologically determined targeted therapies.

141. INDUSTRIAL-ACADEMIC PARTNERSHIPS
CLINICAL & PRE-
CLINICAL RESEARCH
PRODUCT &
TECHNOLOGY
DEVELOPMENT
PRODUCT &
TECHNOLOGY ADOPTION

142. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
JAN 2015: RENEWAL OF NI BIOBANK FUNDING
APRIL 2015: CR-UK ACCELERATOR AWARD
OCT 2015: A REGIONAL, FULLY COMMISSIONED MOLECULAR DIAGNOSTIC SERVICE
OCT 2015: PRECISON MEDICINE CATAPULT CENTRE OF EXCELLENCE
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015
APR
2015
OCT
2015

143. MARCH 2011 – A MEETING OF MINDS
SEPT 2011 – A HYBRID, INTEGRATED MODEL
MARCH 2012 – NI-MPL1 BECOMES FULLY OPERATIONAL
FROM MARCH 2012: PUBLICATIONS (1) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
CPA MOLECULAR DIAGNOSTIC ACCREDITATION
JAN 2014: INDUSTRY (1) – ALMAC DIAGNOSTICS & DDRD TEST
FROM JAN 2014: PUBLICATIONS (2) – THE BROAD SPECTRUM OF MOLECULAR DIAGNOSTICS
2014: INDUSTRY (2) – PATH XL & TISSUEMARK TEST
2014: TEACHING IN MOLECULAR PATHOLOGY
JAN 2015: RENEWAL OF NI BIOBANK FUNDING
APRIL 2015: CR-UK ACCELERATOR AWARD
OCT 2015: A REGIONAL, FULLY COMMISSIONED MOLECULAR DIAGNOSTIC SERVICE
OCT 2015: PRECISON MEDICINE CATAPULT CENTRE OF EXCELLENCE
?
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015
APR
2015
OCT
2015

144. BIOBANKINGLGF
CCRCB - PM
BIOINF., DP (LAB), OFFICESGF
MOL PATH / MOL DX LAB1ST F
BIOMARKER DISCOVERY PROG.2ND F
TARG. DRUG DISCOVERY PROG.3RD F
MST, PH, JJ
RK
?
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015
APR
2015
OCT
2015

145. ?
MARCH
2011
SEPT
2011
MARCH
2012
FROM
MARCH
2012
JAN
2013
JAN
2014
FROM
JAN 2014
2014
JAN
2015
APR
2015
OCT
2015
INTEGRATION…
… OF TISSUE PATHOLOGY WITH MOLECULAR PATHOLOGY
… OF TECHNOLOGY PLATFORMS, IT SYSTEMS AND MATERIALS (BIOBANKS)
… OF TALENT, THROUGH TRAINING
… OF DIAGNOSTICS AND RESEARCH, THROUGH COMMON RESOURCES & LABS
… OF HEALTHCARE AND ACADEMIA WITH INDUSTRY, THROUGH QUALITY

146. NORTHERN IRELAND Inc.

147. 5 (4?) (2?) TISSUE PATHOLOGY SERVICES
REGIONAL MOLECULAR PATHOLOGY DX SERVICE
NI-MPL
PRECISION MEDICINE CATAPULT
INVEST NI
A SINGLE, INTEGRATED, HOLLISTIC INFORMATION
AND DIAGNOSTIC IMAGING SYSTEM FOR NI

148. Tom Simms Memorial Fund

149. Tom Simms Memorial Fund