The Daily Sign-Out

Pathology Visions 2012: Discounted registration opportunites

If you're thinking of attending the 2012 Pathology Visions Conference, please note the following opportunities for discounted registration fees.  Here's the info provided to me from the DPA--

Registration for Pathology Visions 2012, the Digital Pathology Association’s (DPA) annual conference, is now open. Pathology Visions 2012 is taking placing at the Hilton Baltimore in Baltimore, Maryland, October 28th-31st.There are a variety of discounted registration opportunities available for people affiliated with the DPA and professionals in the digital pathology field.

Anyone who registers for Pathology Visions prior to September 1, 2012 will receive the Early Bird registration rate and save $100 on all-inclusive registration. Registration provides admission to all sessions, the keynote presentation, workshops, meal functions, the Sunday evening welcome reception, and the Monday evening networking reception.

 Members of the DPA will save $200 on registration. When you become a DPA member you not only get a discount for Pathology Visions, but also free attendance at the DPA webinars and access to the new online DPA Member Community. To learn more about the other DPA member benefits or to join now click here.

 DPA members aren’t the only association members that will have the opportunity to receive a discounted registration for Pathology Visions 2012. A special affiliate rate has been negotiated for members of the following organizations: ACVP, ASCAP, CAP, CSP, STP, NSH, AACR, ASCO, API, DICOM and USCAP. The Affiliated Association & Society registration is all-inclusive as well. If you are a member of any of these associations look for an e-mail from your association with registration instructions and a discount code or contact the DPA staff for more information.

 If you are currently a Resident or PhD Candidate interested in the field of digital pathology, a special registration rate of $399 has been established for you. If you are a Resident you are also eligible to receive a Travel Award. The DPA will make available five Travel Awards of up to $2,000 each for Residents currently doing their fellowship to attend Pathology Visions. The Travel Award funding is intended to defray costs of registration and travel expenses. Applications for the Travel Awards are due August 3, 2012. Click here to apply today.

 A guest package and one-day registration is also available. For more details on any of the discount opportunities, Pathology Visions 2012, or to register now click here.

Abstracts and Posters Accepted Now for Pathology Visions 2012

As a courtesy to the Digital Pathology Association, I am passing along this information regarding the 2012 Pathology Visions conference in Baltimore, Maryland from October 28-31, 2012.  Please consider submitting an abstract for oral presentation and/or poster presentation.  This is a great conference to attend!

  

ABSTRACT SUBMISSION DEADLINE FOR PATHOLOGY VISIONS 2012 APPROACHING

What’s the best way to stay in the loop on the most pressing and intriguing topics in the field of digital pathology? By attending and speaking at the Digital Pathology Association’s (DPA) annual meeting, Pathology Visions.

Pathology Visions will be held October 28 – 31, 2012 at the Hilton Baltimore. The Pathology Visions Conference will give you the opportunity to present and learn about real world, practical applications in the ever evolving field of digital pathology. In addition, Pathology Visions will give you direct access to industry leaders, the opportunity to earn CME credits, your choice of cutting-edge workshops with distinguished trade visionaries, the chance to see the latest product solutions, and much more!

The DPA is currently accepting oral presentation abstracts and poster presentation abstracts. The oral abstracts, submissions which provide researchers the opportunity to present for 30 minutes on a topic related to digital pathology, will be due on June 1, 2012. The poster presentation abstracts, allowing attendees the opportunity to display a poster for two days during Pathology Visions, will be due August 1, 2012.

Submitted abstracts will be reviewed by the Pathology Visions Program Committee and chosen presenters will be provided a conference registration pass (valued at $699), economy class round trip airfare, and lodging expenses for a maximum of 3 nights (October 28 - 31) at the host hotel.

Accepted presenters will be notified by June 15, 2012. To submit your abstract please now please click here. For more information regarding Pathology Visions please click here.

 

About the DPA

The Digital Pathology Association, located in Indianapolis, IN, was founded in 2009. Its mission is to facilitate education and awareness of digital pathology applications in healthcare and life sciences. Members will be encouraged to share best practices and promote the use of technology among colleagues in order to demonstrate efficiencies, awareness, and its ultimate benefits to patient care.

 

Tweeting for 14th World Conference on Lung Cancer

I will be in attendance on Tuesday, July 5 at the 14th World Conference on Lung Cancer in Amsterdam and tweeting over the course of the day.  Please join me on Twitter.

Follow @dailysignout

Notes and impressions from CAP Futurescape '11

First, a disclaimer.  I was only able to attend CAP Futurescape on Saturday, April 16.  Although this was the majority of the conference, the Sunday morning session had a great lineup of speakers talking personalized/genomic medicine.

I tried my thumbs at "live" microblogging via Twitter @dailysignout in the morning and early afternoon (until my iPhone battery swooned).  This really made me focus on the presenters, quickly summarize their main points, and record particularly well-struck insights.  But I definitely should have been tweeting on my iPad or laptop--I'm way too slow on my iPhone.  A very cool thing was the synergy between the CAP folks tweeting and re-tweeting away @CAPDCAdvocacy (Julie McDowell) and @Pathologists.  It was also nice to meet my fellow Twitterians in person.

Suggestion to CAP: how about drafting pathologists attending conferences to do live webinar or just microblogging during the presentations to reach folks (those of us with kids, junior people on-call, etc.) who can't attend in person?  

Suggestion to CAP #2: Why can't a conference be held at a venue that offers free Wi-Fi?  Seemed logical for a "Futurescape" conference.

The theme of this year's iteration of Futurescape was innovation.  This term has almost become hackneyed but Dr. Jeffrey Myers (DIrector of AP at University of Michigan) provided Saturday's keynote address.  He provided clear, concrete examples of innovation rather than theoretical or poetical definitions.  One clear point is that innovation needs its own "space" outside of day-to-day operations to develop, fail, be tested, be refined, etc. before being put into production.  Dr. Myers stressed that PDCA is the essential link between innovation and operations/safety/quality.  The expectation that innovation will be as "productive" as processes already in operation is not only unrealistic but counter-productive to "innovation."  True innovations probably need to fail a few times before they become successful innovations.  One somewhat uncomforatble factule that Dr. Myers presented was the ageing of our specialty: 52.8% of pathologists are 55 and older (and I think this was from 2006).  I couldn't help but connect this with an article I recently read about the lack of succession plans in many private practice and academic groups.  Moreover, as I looked around the conference attendees, I couldn't help but notice the incongruity that the ovewhelming majority had to be over 55.  Yikes.

The digital pathology section was of most interest to me.  Dr. Sylvia Asa's presentation showed the possibilites of off-site telepathology but I wondered if this would be feasible in the U.S. without serious  corporate or venture capital funding.  I doubt there is sufficient willingness (or capital) for even large private groups, let alone academic practices or community hospitals, to invest in doing this.  But it would beat driving to small places to do a frozen.  Maybe I'm wrong but as long as there are hungry junior pathologists looking for employment, why invest in this stuff?

Dr. Rebecca Crowley's presentation on the SlideTutor project was really intriguing and challenging.  I would love to test myself on the system--would be a great way to continue learning and improving diagnostic skills.

Dr. Ken Bloom (Clarient, Inc.) always has more insights and ideas than I can write down or text but two things he said hit me upside the head like a 2x4.  First, the model of utilizing skill sets and specialized talents residing in community practice to essentially serve a network of consultants for his company.  Brilliant!  I think this will be even more wise as subspecialty-trainees find that their dream job of signing out pores of Kohn cases is (er) just a dream.  So they'll have to take a community practice job where pores of Kohn cases are sent to St. University Center for Inscrutable Excellence.  Ouch!  There goes that expensive training.  So why not tap into this source of expertise?  Second was his idea that innovation will happen not as the academic medical centers but at the community hospitals.  Evidence for this was provided by Dr. Edward Fody's presentation in the afternoon on how his lab at Holland (MI) Hospital uses barcoding and automation in surgical pathology.  One of the things I'm most proud of for my lab (if I may) is the Lean production system we implemented--almost 6 years ago.

Mr. Bob Gregory of Atlas Medical filled in as pinch-hit speaker and discussed the concept of a "diagnostic collaborative network."  Some of the IT bits were over my head but the key idea is that such networks cannot be rigid but must be open, have flexible rules, integrate multiple open and closed "communities," and also have a peer-to-peer capability.  I'd like to see people trying to put this together--really seems like it would be some powerful stuff.

Finally, Dr. Mike Becich provided his (intentionally so) provocative but incisive comments on informatics and digital pathology.  Other than Dr. Bruce Friedman (LabSoftNews), I can't think of another pathologist who has been as pioneering leader as Dr. Becich.  One intriguing point from him was regarding pathology overseas.  There has been swirling fears that once slides become digitized that all anatomic pathology will be outsourced to India, China, or some other place.  Dr. Becich opined that there is a huge opportunity to create consultative networks with developing countries in which telepathology could be used to support overseas pathologists and their patients.  Moreover, countries such as India, Pakistan, China have rapidly increasing middle class people who may be willing to pay cash-money for their biopsies to be read by red-blooded American pathologists.  Did I say cash?  Not the toilet paper specie the state of Illinois gives us but real $$$!

Thanks for your patience reading this post.  Archives of Path Lab Med usually publishes texts of the presentations from Futurescape--so stay tuned.

Abstracts solicited for Pathology Informatics 2010 Conference

Dr. Bruce Friedman at LabSoftNews blog has announced a call for abstracts for the Pathology Informatics 2010 Conference in Boston on September 19-22, 2010.

The conference Web site is up which has links for additional information about the conference, online registration, abstract submission, etc.  This really is a premier conference and well-worth the time and expense!  Please check out the Web site--it is pretty amazing what this conference has evolved into since I attended my first conference in 2000 (ouch!).

Molecular markers for targeted therapy in lung cancer: USCAP 2010

I attended the Special Course at USCAP 2010, "Basic Principles and Practice of Molecular Pathology in Cancer."  One of the talks was given by Dr. Marc Ladanyi from MSKCC and one of the leaders in the field of molecular pathology of lung cancer.  The title of his presentation was "Molecular Predictive Markers for Targeted Therapies in Lung Cancer."  Here's my "take-home" points from the talk:

• Term: "lung adenocarcinoma oncogenome"--(I like this) and he presented a pie chart illustrating the different (and (generally) mutually exclusive) mutations found so far in lung ACa
• •  KRAS
  • EGFR
  • BRAF
  • ERBB2 (HER2)
  • ALK fusions (especially, ALK-EML4)
  • MEK1
  • NF1
  • but still about one-third of lung ACa have an unknown mutation
• Although there are morphologic and clinical features associated with EGFR mutations, their predictive value are insufficient to exclude EGFR mutation testing.  Thus, every adenocarcinoma should be tested for EGFR mutation (with the exception of mucinous ACa/BAC which are always KRAS mutants).  Although uncommon or even rare, one does find EGFR-mutant ACa in former and current smokers and in men who could benefit from targeted therapy.  This is important for testing algorithms (see below).
• EGFR mutation versus EGFR amplication is difficult to tease out because they frequently occur together but--
• • The response rate to EGFR-TKIs is high in EGFR-mutated cases regardless of the EGFR copy number.
  • EGFR amplified cases lacking one of the mutations have a very low response rate to EGFR-TKIs.
• Why are some patients with EGFR-mutant tumors non-responders to EGFR-TKIs?
• •  Not all EGFR mutations confer sensitivity (dependent on type of mutation detection method, i.e., direct sequencing versus targeted approach to known sensitive mutations)
  • There may be concurrent "downstream" mutations, e.g. BRAF, PTEN loss, PIK3CA, etc.)
  • Not a well-studied group.
• Why do some patients with EGFR-wild type tumors respond to EGFR-TKIs?
• • Undetected sensitive mutations due to targeted detection method.
  • Poor sensitivity of direct sequencing methods
  • Not a well-studied group.
• KRAS mutations function better as a negative predictor of response to EGFR-TKIs than EGFR mutations do as a positive predictor.
• Dr. Ladanyi presented data from a MSKCC study of patients with EGFR-mutant tumors who initially responded to EGFR-TKI therapy but relapsed while on therapy and underwent re-biopsy.  Two-thirds of these patients developed acquired resistance due to the development of the EGFR T790M mutation; some also were shown to have MET amplification.
• BRAF mutations (most commonly exon 15 V600E) is also a negative predictor of response to EGFR-TKIs but does predict benefit from MEK-selective inhibition: PLX-4032, an experimental agent from Plexxikon which targets mutated BRAF (currently in trials for melanoma in which >50% of tumors show the V600E mutation).
• Very helpful point in discerning which type of EGFR/KRAS mutation detection testing will be serve your patients: Dr. Ladanyi distinguished between "diagnostic sensitivity" and "technical sensitivity."
• • Diagnostic sensitivity (the "comprehensiveness" of an assay): the percentage of all mutations that will be found with a given assay
  • Technical sensitivity: the percentage of tumor cells that need to be present in the specimen in order for a mutation being tested for to be identified
  • There is a trade-off between low technical sensitivity and the risk of false negatives and increasing comprehensiveness or high diagnostic sensitivity and the risk of false positives due to detection of rare mutations of unknown or no clinical significance.
• There are mutation-specific rabbit MoAbs that are commercially available for the detection of mutant EGFR in lung ACa and these could facilitate detection in an algorithm and perhaps eliminate the need for mutation detection testing in certain situations: Antibody 3197 against EGFR exon 21 L858R mutation and Antibody 2085 against the EGFR exon 19 E746-A750del--both from Cell Signaling Technologies.
• Dr. Ladanyi showed 95% sensitivity and 99% specificity for EGFR L858R Ab and 85% sensitivity and 99% specificity for EGFR exon 19 del Ab. (paper in press)
• EML4-ALK detection issues: RT-PCR requires multiple assays because of multiple possible isoforms, other ALK and other kinase fusion partners have been reported, new IHC antibody clone to detect ALK fusion (rabbit mAb #3633 D5F3, Cell Signaling Technologies) may be useful in screening for EML4-ALK detection.
• Dr. Ladanyi presented the testing algorithm used at MSKCC and contrasted with one published recently in J Clin Oncol 2009;27:4232-4235.
• A future post will include my merged algorithm, combining these and incorporating new IHC.

Using social networking for pathology teaching

I had the privilege of presenting yesterday at the "1st Annual Symposium on Teaching and Learning" at Southern Illinois University-School of Medicine in Springfield (my alma mater!).  I am uploading a pdf of the slides from the presentation.  This is my (very!) preliminary experience from last fall teaching the organ-specific  lung section of the second-year pathology course at Rush Medical College in Chicago using a course blog (Lung Sounds) and Twitter profile (@lungsounds) to enhance the traditional curricular format of textbook, lectures and course syllabus.

It is interesting that there was not more participation on either the blog or Twitter.  One of the comments in the discussion is that Twitter may not have yet caught on in the med-student age group.  Maybe.  Another was that the students may need more "hands-on" in-class development of groups before migrating to social networking groups.  One suggestion was to have break-out small groups discuss a simulated case prior to the formal lecture presentation.  This is a work-in-progress.  I am considering using a Facebook course page for a proposal next year that would incorporate the ideas behind the blog/Twitter.  An M2 student I spoke with has informed me about Google-Wave which has some interesting possibilities.  Anyone else using social networking sites in their teaching?

Download SIU presentation--Pool

Relationship between growth patterns and survival in NSCLC: news from AACR-IASLC

Medscape (registration required) reports a study presented at the joint American Association for Cancer Research-International Association for the Study of Lung Cancer (AACR-IASLC) in which Sardari Nia et al from University of Antwerp, Belgium in which researchers from the University of Antwerp, Belgium identify tumor growth patterns in lung cancer that are independent predictors of disease-free survival, disease-specific survival, and overall survival.

They report having previously identified three growth patterns--destructive, alveolar, and papillary.  These patterns do not describe histological subtypes (despite the confusing terminology).  The "papillary" type ("normal lung tissue is preserved in the presence of a new microenvironment") seems to be non-invasive bronchioloalveolar type adenocarcinoma.  "In the destructive pattern, the tumor is creates its own microenvironment for further growth  In the alveolar pattern, the tumor uses the microenvironment of the lung to grow."

This is a confusing description but it would be interesting to see pictures of exactly what these patterns are that the authors describe.

This is a retrospective study of 432 patients with stage IA to IIIB NSCLC who underwent complete resection and follow-up was about 50 months.  In this group, they report that 71.1% of the tumors showed a destructive pattern, 13.9% a papillary pattern, and 15% an alveolar pattern.  They find that the alveolar pattern was an independent predictor of poorer disease-free survival, disease-specific survival, and overall survival.

This sounds like an intriguing study and I wonder how their findings relate to recent research on epithelial-mesenchymal transformation (EMT) as well as using "comprehensive histologic assessment" to assess subtyping for adenocarcinoma.  If anyone sees where these findings are published, please leave a comment.

MicroRNAs as a predictive marker for stage 2 colorectal cancer

This is an interesting abstract presented at the recent 2009 Association for Molecular Pathology annual meeting which is highlighted in Medscape.  Finding the magic markers that will predict which stage 2 CRC patients will progress without chemotherapy is an intense area of research, as is research into the importance of microRNAs in various diseases.

This abstract by Dr. Elizabeth Mambo et al. from Asuragen, Inc. is a small case-matched paired study but demonstrates that 11 microRNAs could potentially be prognostic for CRC recurrence.  Interestingly, they found that most microRNAs associated with CRC recurrence were downregulated but microRNA-21 and microRNA-31 were significantly upregulated compared to tumor specimens from CRC stage 2 patients who did not experience recurrence. 

I wonder which cells are exactly showing these changes given changes in the tumor microenvironment, specifically, neoangiogenic endothelial cells, myofibroblastic cells, and inflammatory cells.  I don't know much specifically about this type of testing, but I think it is a leap to assume that the test is measuring purely the carcinoma compartment of the tumor.

Still following the miRNA story. . .

Recent lecture on role of KRAS mutation in management of colorectal cancer

I recently gave a Tumor Board presentation on the role of KRAS mutation testing in the management of colorectal cancer.  The PowerPoint file is attached for educational purposes.  I hope you will find it of interest.

Download K-ras lecture upload