Pathology in Leeds – now and in the future

Dr Phil Wood

Clinical Director, Oncology, LTHT

(Formerly Clinical Director, Pathology)

Consultant Immunologist

What does pathology do?

Workload of NHS Pathology

Forensic pathology

1%

Other specialties

77%

Leeds Current workload

• 5,204,900 Blood tubes annually

• 155,455 Urine tubes annually

• 222,800 Histology samples annually

• 60,681,301 Blood tests annually

• 10,274,259 Microbiology tests annually

5,204,900

155,455

222,800

Blood Samples

Urine Samples

Histology Samples

Current Pathology Locations

Current Pathology Locations

Current Pathology Locations

Diagnostics in today's NHS

Pathology has a key role across ALL of these areas

What is changing pathology?

Leeds Pathology

The Old Medical School

• The original medical school dissection room

• Used for the study of visible human anatomy

• Limits of pathology at that time

Traditional Biochemistry Laboratory – Old Medical School

Leeds Pathology Managed Service

Leeds Managed Pathology Service

• State of the art automation

• Fully tracked system – allows single patient blood sample to have multiple tests

• Minimal staff involvement

• Electronic result transmission to the health professional

• One of the largest installations in the UK & Europe

The Grand Opening – March 2016

Traditional Microbiology lab

Microbiology automation – UK first

Digital Cellular Pathology

• Dr Darren Treanor • Slides are difficult to transport & store

• Expertise traditionally at the site of production

• Centres of excellence for e.g. Cancer becoming more focussed – LTHT centre of excellence

Providing services to patients across the Region

The next Frontier

The Genomic Revolution

We can now look at ALL a person's DNA – their GENOME

Unlocking a real understanding of our inheritance

Proper diagnosis for people with rare diseases

Transformational for cancer diagnosis & treatment

Technology driving change

• Manual DNA sequencing 1982

– Labour-intensive, research tool

• Polymerase chain reaction 1988

– Cheap, sensitive

– Genetic diagnosis, pathogens, forensics

• “Next-generation” sequencing (NGS) 2009

– Massive numbers of short DNA sequences

– Essentially unlimited data

– Biology (medicine) a computational problem

Traditional DNA sequencing

Next Generation Sequencing

Genomic Pathology

• Leeds is part of the 100,000 genome project

– Regional service working with Sheffield

• Already underway

– First patient's genome sent for analysis

– Aiming for 7000 samples overall

– Cancer & rare disease centre

Leeds Laboratory Genetics

• YRGS DNA lab – Single-gene testing

• High-throughput testing of cancer-susceptible families – 2010 – first in UK – Major cost saving – External income

• Rare recessive disorders

• Strong links with University of Leeds

The power of Genomics in Cancer

• Lung cancer

– Identified late

– Surgery as treatment option

– Very poor outcome

– BUT

Genomic Cancer Medicine

Treatment possible and different

• Squamous

– Surgery

– Radiotherapy

– No chemotherapy options

– Poor survival

• Adenocarcinoma

– ALK-mutation positive

– Novel treatments even for metastatic disease

– Target growth of cancer or immune response

– EGFR-mutation positive

– Novel treatments even for metastatic disease

Where next?

• Technology will get smaller, faster, cheaper

• Public expectation will increase

– Access to tests

– Self-tests

– Less uncomfortable

– More rapid answers

Common Diseases Diagnostics - future direction

• Point of Care Testing – Convenience

– Quality & reproducibility

• Growth in Self-Testing devices – Patient access to results

– Need to be accurate

– Put patient in control

The future is here

• Phillips Device

• Handheld

• Rapid results from finger-prick of blood

• Rapid diagnostics at the bedside or surgery

• OR home – cancer patients

Wearable diagnostics & beyond!

Customer Needs

• Timely, Precise and Relevant Laboratory Diagnostic Information

• Faster, Simpler, Cheaper

PATIENTS

Thank you