Digital pathology promises to improve detection of disease, streamline pathology workflows and lower the overall cost of healthcare delivery. The Fifth Annual Digital Pathology conference will offer a range of topics that demonstrate the current activities and effectiveness of digital alternatives for pathology practices, and share insights from distinguished faculty. Technology developments and implementation strategies will be presented in a forum that encourages collaboration and knowledge sharing. The track is part of the 24th International Molecular Medicine Tri-Conference and allows synergy with concurrent tracks on molecular diagnostics, immunotherapy and informatics. With the advent of genomic information in managing health, learning how to manage big data is becoming paramount. The pathology workflow will benefit from access to massive amounts of digital imaging data and tools to manage the data overload.
Scientific Advisory Board
Eric F. Glassy, M.D., FCAP, Medical Director, Affiliated Pathologists Medical Group
Liron Pantanowitz, M.D., Professor, Pathology & Biomedical Informatics, University of Pittsburgh Medical Center (Conference Chairman)
David L. Rimm, M.D., Ph.D., Professor, Pathology, Yale University
David C. Wilbur, M.D., Professor, Pathology, Massachusetts General Hospital
Monday, February 20
10:30 am Conference Program Registration Open
11:50 Chairperson’s Opening Remarks
Liron Pantanowitz, M.D., Professor, Pathology & Biomedical Informatics, University of Pittsburgh Medical Center (Conference Chairman)
12:00 pm IT Standardization in Digital Imaging in Pathology
Marcial García-Rojo, Ph.D., Head, Pathology Department, Hospital de Jerez de la Frontera, Ronda de Circunvalación
The aim of this work is explaining the importance of standards and the process performed on proprietary image formats of histological and cytological slides in pathology to convert them the be compliant with the Digital Imaging and Communication in Medicine (DICOM) standard, according to 145 and 122 supplements, and their subsequent storage in a Picture Archiving and Communication System (PACS).
12:50 Q&A Discussion
1:00 Session Break
1:10 Luncheon Presentation (Sponsorship Opportunity Available) or Enjoy Lunch on Your Own
2:10 Session Break
2:30 Chairperson’s Remarks
Richard Levenson, M.D., Professor and Vice Chair, Strategic Technologies, Pathology & Laboratory Medicine, University of California, Davis Medical Center
2:40 Naked Eye to Nucleotide
Babar K. Rao, M.D., FAAD, Clinical Professor, Dermatology, Robert Wood Johnson Medical School, Rutgers University
Histology is an accepted “gold standard” to manage most diseases. Newer non invasive, in vivo technologies are gaining popularity and are becoming routine test in many specialities, especially skin. Confocal microscopy is one such tool which has potential to change dermatology practice drastically.
3:10 Ex vivo Microscopy: Better, Faster, Cheaper
Maria Shevchuk, M.D., Associate Professor, Pathology & Lab Medicine, Weill Cornell Medical College, Cornell University
Ex vivo microscopy (EVM) is the histologic evaluation of human tissues in real time, without processing, using light of various wave lengths. Uses of EVM include: 1. intraoperative assessments and selection of most significant tissue for frozen section; 2. intraprocedural adequacy assessment of needle biopsies; 3. tissue selection for molecular/genetic studies; and 4. documentation of histology of biobanked tissues. Prompt, definitive diagnosis facilitates patient care, saving the patient and the medical system money.
3:40 Breast Margin Assessment by ex vivo Microscopy: The Crucial Role of the Pathologist in Validation
Wendy A. Wells, M.D., MSc, The E. Elizabeth French Professor and Chair, Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth; Vice President, Pathology and Laboratory Medicine Service Line, Dartmouth-Hitchcock Medical Center
Clinical uses of real-time, rapid imaging of unprocessed fresh biopsy or excisional tissue by EVM include the intra-operative assessment of tumor margins or sentinel nodes, specimen triaging for tissue bank storage, and biopsy adequacy for molecular genomic studies. The validation of biologically-based image contrast with biomarkers linked to the tissue diagnosis “gold standard” made by pathologists is critical to the successful translation of optical imaging technology to the clinical arena.
4:10 Improving Patient Care through a Diagnostic Collaboration Workflow
Chrystal Adams, Associate Vice President, Product Line Management, Product Marketing, XIFIN, Inc.
David McClintock, M.D., Medical Director, Pathology Informatics, University of Chicago
Due to the disparate nature of current HIT systems, there are notable inefficiencies in care. In order to enable value-based care, these inefficiencies must be overcome. Collaboration and coordinated care involves communication among diagnostics specialists, most notably pathologists and radiologists, in an effort to provide better care at a reduced expense by providing clinicians with practical, actionable results. A key element to achieving collaboration is the ability to access all diagnostic information for a patient at the same time, seamlessly. Interoperable information solutions will address the needs of emerging collaboration centers, which provide services for diagnostics as a whole.
4:25 Sponsored Presentation (Opportunity Available)
4:40 Refreshment Break and Transition to Plenary Session
5:00 Plenary Keynote Session
6:00 Grand Opening Reception in the Exhibit Hall with Poster Viewing
7:30 Close of Day
Tuesday, February 21
7:30 am Registration Open and Morning Coffee
8:00 Plenary Keynote Session
9:00 Refreshment Break in the Exhibit Hall with Poster Viewing
10:05 A Hands-On Workshop
This interactive workshop will make use of web-based tools to provide a general survey to participants of contemporary approaches to common image classification and segmentation tasks, as made possible by the increasing availability of digital whole slide imagery. Equal emphasis will be placed on first-principles theory as well as practical considerations such as: workflow optimization, algorithm optimization and pipeline design. Those attendees bringing a laptop will be able to interactively apply the concepts presented by use of content and tools on a specifically-implemented workshop website.
Key aspects of this workshop will include:
- Actual hands-on use of web-based image segmentation and analytics tools (utilizing attendees’ laptops)
- Interactive exercises in image segmentation topics
- Interactive exercises in image classification topics
- Interactive exercises in creating streamlined compound image processing pipelines
Instructors:
Ulysses G. J. Balis, M.D., FCAP, FASCP, FAIMBE, Professor, Pathology; Director,
Division of Pathology Informatics; Director, Pathology Informatics Fellowship
Program, Pathology, University of Michigan Health System
Chris Williams, M.D., Senior Lecturer, Informatics, Department of Pathology,
University of Michigan
11:45 Unlocking Digital Pathology: Actionable Medical Assays are the Key
Mark Lloyd, Ph.D., MBA, Executive Vice President and Founder, Inspirata, Inc.
Pathology can make the transition from glass to digital but is that a significant enough value proposition? What is the killer app" for pathology? Using morphometric analysis of WSIs to quantify biomarkers, TIL distributions, intratumoral heterogeneity and grading standardization can provide prognostic and predictive indications, leading to better patient outcomes.
12:15 pm Session Break
12:25 Luncheon Presentation (Sponsorship Opportunity Available) or Enjoy Lunch on Your Own
1:25 Refreshment Break in the Exhibit Hall with Poster Viewing
2:00 Chairperson’s Remarks
David C. Wilbur, M.D., Professor, Pathology, Massachusetts General Hospital
2:10 Imaging Fluorescence Flow and Mass Cytometry; New Frontiers in Cellular Analyses
Frederic I. Preffer, Ph.D., Director, Flow Cytometry, Pathology, Massachusetts General Hospital; Associate Professor, Pathology, Harvard Medical School
Flow cytometry (FC) measures the light scatter and fluorescent emissions of conjugated monoclonal antibodies directed to cells in suspension. Imaging flow cytometry extends the utility of FC by adding the ability to simultaneously examine cellular morphology along with the spacial distribution of fluorescence staining. Mass cytometry substitutes metals for fluorescence and dramatically expands the capacity of measurements of cell suspensions and recently has evolved into the analysis of tissue sections.
2:40 Three-Dimensional Imaging of Individual Cells: Use of Cell-CT Has a Variety of Potential Applications in Morphology-Based Assays
David C. Wilbur, M.D., Professor, Pathology, Massachusetts General Hospital
Routine cytologic assays use 2-dimensional analyses either manually or in automated modes. The additional of high resolution 3-dimensional image capture adds fundamentally different information to both conventional morphologic and algorithmic-driven automated analyses, which has the potential to substantially increase the discriminatory power. This talk describes the Cell-CT technology and presents data regarding its potential use in a variety of clinically-relevant applications, most notably lung cancer screening.
3:10 Deep Learning for Computational Pathology
Andrew Beck, Ph.D., M.D., CEO, PathAI
Recent advances in computer vision and machine learning offer new opportunities for making the field of pathology more accurate and more predictive. We will present work from these emerging fields, with a focus on the development and application of deep learning technology for pathology.
3:40 Cost-Effective, Multiplex Fluorescent and Bright Field Scanning in the Cloud
Clive Taylor, M.D., Ph.D., Consulting CMO, OptraSCAN
3:55Unparalleled Multiplexing In Situ for Digital Pathology
Stephanie Walter, Ph.D., Research & Development Team Leader, Ultivue
Advances in research and diagnostic tools that combine high multiplexing with spatial information will open the door to discoveries with significant biological and clinical value. Ultivue’s InSituPlex uses DNA-mediated sequential imaging to enable unparalleled multiplexing of biomarkers in tissue samples.
4:10 Hollywood Oscar Dessert Reception in the Exhibit Hall with Poster Viewing
5:00 Breakout Discussions in the Exhibit Hall
These interactive discussion groups are open to all attendees, speakers, sponsors, & exhibitors. Participants choose a specific breakout discussion group to join. Each group has a moderator to ensure focused discussions around key issues within the topic. This format allows participants to meet potential collaborators, share examples from their work, vet ideas with peers, and be part of a group problem-solving endeavor. The discussions provide an informal exchange of ideas and are not meant to be a corporate or specific product discussion. Pre-registration to sign up for one of the topics will occur a week or two prior to the Event via the App.
In Vivo and Ex Vivo Microscopy in the Future of Pathology
Maria Shevchuk, M.D., Associate Professor, Pathology & Lab Medicine, Weill Cornell Medical College, Cornell University
- In vivo and ex vivo microscopy applications
- Benefits and barriers to ivm and evm practice by pathologists
- Future new innovative applications of this technology in pathology
6:00 Close of Day
Wednesday, February 22
7:00 am Registration Open
7:00 Breakfast Presentation (Sponsorship Opportunity Available) or Morning Coffee
8:00 Plenary Keynote Session
10:00 Refreshment Break and Poster Competition Winner Announced in the Exhibit Hall
10:50 Chairperson’s Remarks
John E. Tomaszewski, M.D., MASCP, Professor and Chair, Pathology and Anatomical Sciences, School of Medicine and Biomedical Sciences, State University of New York, Buffalo
11:00 3D Printing in Anatomy and Surgical Pathology
John E. Tomaszewski, M.D., MASCP, Professor and Chair, Pathology and Anatomical Sciences, School of Medicine and Biomedical Sciences, State University of New York, Buffalo
3D accretive printing is a rapidly evolving technology which offers multiple opportunities for the physical modeling of the complex biological structures. In pathology and anatomical sciences, applications of 3D printing include education, clinical care modeling, rapid prototyping of structurally based experimental systems, and in the not too distant future, tissue engineering. This session will examine some of the techniques, materials and uses of 3D accretive printing.
11:30 The Role of Micro CT in the Imaging of Surgical Pathology Specimens
James Michaelson, Ph.D., Director, Laboratory of Quantitative Medicine, Member, Pathology and Surgery, Massachusetts General Hospital; Associate Professor, Harvard University
The absence of rapid, detailed, 3D, information on surgical specimens is a challenge. We have found that a relatively new high resolution X-ray imaging method, Micro CT, can provide useful 3D images for many surgical specimens, including identifying margin positive breast cancer patents in 10 minutes, and locating lymph nodes. Thus, CT can provide rapid, accurate, actionable information on the surgical specimen while the patient is still in the OR.
12:00 pm Emerging Opportunities for Clinically-Deployed, High-Throughput WSI Analytics: Real World Use Cases Come of Age
Ulysses G. J. Balis, M.D., FCAP, FASCP, FAIMBE, Professor of Pathology, Director, Division of Pathology Informatics; Director, Pathology Informatics Fellowship Program, Department of Pathology, University of Michigan Health System
Prior to the advent of desktop-based high-throughput computing and immediately scalable cloud-based computing, high performance image analytics were effectively outside the realm of being feasibly deployed in real-world production settings. This presentation will explore and canvas recent developments in high-throughput computational approaches that effectively democratize the availability of real-time solutions in support of anatomic pathology diagnostic workflow, with examples being automated mitotic figure counting and unsupervised laser-capture microdissection image segmentation. Both didactic content and interactive examples will be included in this presentation.
12:30 Session Break
12:40 Luncheon Presentation (Sponsorship Opportunity Available) or Enjoy Lunch on Your Own
1:10 Refreshment Break in the Exhibit Hall and Last Chance for Poster Viewing
1:50 Chairperson’s Remarks
Liron Pantanowitz, M.D., Professor, Pathology & Biomedical Informatics, University of Pittsburgh Medical Center (Conference Chairman)
2:00 Digital Pathology: What Will the Regulations Bring
Esther Abels, Director, Quality and Regulatory and Medical Affairs; Emerging Businesses, Philips Digital Pathology Solutions
Primary diagnosis using digital pathology could become a reality in the United States in the near future. FDA may soon classify Whole Slide Imaging (WSI) systems intended for Primary Diagnosis as Class II devices, simplifying the pre-market process. This would be a big step forward in bringing these systems to market quickly and facilitating their lifecycle management, and could also speed innovation in the field, benefiting specialty of pathology and, most importantly, patients.
2:30 CAP Quantitative Image Analysis Guideline Update
Liron Pantanowitz, M.D., Professor, Pathology & Biomedical Informatics, University of Pittsburgh Medical Center (Conference Chairman)
Quantitative Image Analysis (QIA) has become increasingly popular in Anatomic Pathology for diagnostic, prognostic and predictive purposes. Drawbacks to employing QIA in clinical practice include lack of standardization. If not implemented, calibrated and used well QIA algorithms can generate misleading results. The College of American Pathologists (CAP) has accordingly assembled a committee to develop guidelines in order to perform consistent QIA. This talk will review these new evidence-based guidelines.
3:00 WSI Performance Assessment to Inform Digital Pathology Diagnostic Applications
Mark Simpson, Ph.D., Senior Scientist, Laboratory of Cancer Biology and Genetics, National Cancer Institute
Evaluation of safe replacement of conventional microscopy by whole slide image digital pathology systems, as a suitable method for primary clinical diagnosis, will help with wider adoption of the technology. Elements of instrument approvals for diagnostic tests include validations of hardware and diagnostic performance. Identification and enumeration of neoplastic mitotic activity serves as an objective and clinically relevant histopathological feature to analyze comparable abilities for diagnostic discrimination using digital pathology in a clinical paradigm. Detailed design, conduct and summary findings of intra- and inter-observer pathologist performance in a multi-center, multi-reader, multi-case clinical study employing a split-plot design to assess performance comparing stains and digital (virtual) and conventional microscopy modalities will be presented.
3:30 Session Break
3:40 Chairperson’s Remarks
David L. Rimm, M.D., Ph.D., Professor, Pathology, Yale University
3:45 Clinical Value of Studying the Tumor Immune Microenvironment Using Multiplex Quantitative Approaches
Kurt A. Schalper, M.D., Ph.D., Assistant Professor, Pathology and Medicine (Medical Oncology), Yale School of Medicine; Director Translational Immuno-oncology Laboratory, Yale Cancer Center
Understanding the tumor immune microenvironment could support the optimal use of novel anti-cancer immunostimulatory therapies. In situ detection of immune inhibitory molecules and immune cells in the tumor allows signal measurement with preservation of key contextual (morphological) information. We will discuss the clinical value of objective/quantitative assessment of actionable immune targets, immune cell subpopulations and functional markers in lung cancer specimens using multiparametric imaging and automated analysis.
4:15 Association of PDLs, Cytotoxic T Cells, and Mutational Load to Each Other and to Anti-PD-1
Janis M. Taube, M.D., Associate Professor, Dermatology, Pathology, and Oncology; Director, Dermatopathology Division and Fellowship, Johns Hopkins University School of Medicine
Multiple single immunologic and genetic biomarkers have been identified as both prognostic and predictive of response to PD-1/PD-L1 checkpoint blockade. We use multiplex immunofluorescence and gene expression studies from formalin-fixed paraffin-embedded tissue to explore the relationship between multiple immunoactive features in the tumor microenviornment to each other and to patient outcome. We will discuss prioritizing and combining biomarkers with a focus on patients with melanoma and Merkel cell carcinoma.
4:45 The Role of Digital Pathology in Assessing the Target for PD-L1 Immuno-Therapy
David L. Rimm, M.D., Ph.D., Professor, Pathology, Yale University
The PD-1 axis drugs are making history with dramatic responses in lung cancer and melanoma, but also with the need for, and the confusion around the diagnostic tests that select patients for these therapies. This talk will examine the problems with the existing assays and illustrate the role of digital pathology in finding solutions to these problems.
5:15 Close of Conference Program