Roche Tissue Diagnostics Ireland Meeting Report, Thursday 22nd September 2011

On September 22nd 2011, Roche Tissue Diagnostics formally launched their new organisation in Ireland with a one day meeting programme in the Radisson Hotel, Athlone, Co. Westmeath. Paul Weldon and Christian Paetzke opened the meeting with a welcome note and an introduction into how Roche Tissue Diagnostics came to be involved in the Ventana Histology Business in Ireland.

Dr Iris Nagelmeier gave a wonderful presentation on Her2 in situ hybridisation using DDISH; a dual colour, dual hapten (DNP and DIG) ISH, parallel hybridisation of Her2 and Chr17 probe that used shorter hybridisation time, therefore has less artefacts and gives much sharper red signal. Dr Nagelmeier discussed the advantages of DDISH over FISH and CISH testing for Her2 and demonstrated proposed analysis guidelines based on criteria for FISH. Signal enumeration and techniques to find the right area for counting were demonstrated using examples from both gastric and breast carcinoma samples. There is also a new Ventana probe that makes it possible to combine IHC and ISH signals on the same slide which makes it easier to deal with tumour heterogeneity. The various definitions of polysomy were explored and how to assess breast cancer and gastric cancer specimens that display polysomy when evaluating her2 status. Finally Dr Naglemeier went through some troubleshooting with regard to BDISH and DDISH testing.

Dr Manuel Salto-Tellez, Professor of Molecular Pathology at the Centre for Cancer Research, Queen’s University Belfast presented on Her 2 Testing, An evolving Paradigm for Personalised Medicine. Personalised medicine has transformed the way we practice oncology and pathology. For Her-2 testing in breast cancer, Her-2 amplification status is assessed by IHC and FISH testing, when there are discrepancies between IHC and FISH, it is FISH that carries the strong therapeutic significance. More recently Her-2 SISH testing is being implemented in routine Histopathology. Oncotype Dx testing by real-time PCR assesses the need for chemotherapy in non-invasive breast ductal carcinomas. Her-2 over-expression is also assessed in gastric cancer for patients’ suitability for Herceptin treatment. Molecular Diagnostics are used to select target therapeutics in the routine oncology practice;
Breast Cancer/Gastric Cancer: Her-2neu: Trastuzumab/Lapatinib
Gastric Intestinal Stromal Tumours: C-kit mutations: Imatinib
Lung Cancer: EGFR mutations: Erlotinib/Gefitinib
Colon Cancer: K-Ras mutations/B-Raf mutations: Cetuximab
Modern pathology must be a synergy of morphology, immunohistochemistry and molecular diagnostics; a single diagnostic opinion provided by those who can combine traditional and molecular pathology knowledge of the disease.

The next presentation was on Digital Pathology by Dr Krista Catlow, Business Development Manager at Roche Tissue Diagnostics. Dr Catlow discussed the advantages of the Digital Pathology System and its integration into the Histopathology department. Slide scanning and imaging instrumentation has become part of the routine Histopathology reporting in the UK. The Ventana Image Analysis System (VIAS) is a computer-assisted and interactive microscopy system intended for use as an aid to the Pathologist in the detection, classification and counting of cells of interest. Specifically, the algorithms standardise slide scoring through a quantitative assessment of marker intensity, size, and shape. Krista provides technical demonstration of digital pathology solutions to NHS pathologists and laboratory managers on a UK-wide basis. The digital pathology system supplied by Roche has shown excellent concordance between digital pathology and routine micorscopy in validation processes completed in Belfast and has proven to be time saving in Histopathology.

New Developments in Prostate Cancer by Roche Tissue Diagnostics was presented by Dr Heike Fiegler, Marketing Manager at Roche Tissue Diagnostics. Prostate cancer has a high incidence that increases steeply with age but a low mortality rate. A a result, many men will die with the disease but not because of it. Current diagnosis technique are H&E diagnosis followed by immunohistochemistry. Identification of most suited treatment options are limited by availability of appropriate diagnostic tests. New insights into how the disease arises at molecular level will enable clinicians to take into accout different patient sub-populations for personalised treatment. Sub-population include risk of progression, benefit of hormonal therapy and potential targeted therapies opportunities. Gene re-arrangements involving ERG occur in over 50% of prostate cancers resulting in overexpression of chimeric fusion transcripts encoding a truncated ERG product. Using the Ventana ERG antibody identifies early prostate cancer stages. Determining ERG rearrangement will act a prostate risk stratification and used to determine potential treatment options. Knowledge of the molecular subtype of prostate cancer will determine the most appropriate treatment.
Philip Merryfield, Workflow and IT specialist at Roche Tissue Diagnostics presented the Vantage Workflow Solution. The VANTAGE workflow solution from Ventana is the first of its kind in the industry. It is an operating system that promotes lean integrated processes and enables full visibility into lab operations any time, from anywhere. It is a complete solution for histology labs with hardware, software, and workflow consulting and offers a commanding view the total operation of tracking histology specimens from a single strategic perspective. It is an end-to-end product that automates, streamlines, and integrates lab work and information flow to provide maximum productivity and patient safety gains.

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