ACVP Recap 2024
Catching up with friends and research in Seattle
Dear Readers,
I can’t believe it’s already December! As we sprint towards the end of the year, my travel has only increased—In the past two weeks, I was in Seattle for the annual ACVP/ASVCP veterinary pathology conference, then flew to Italy for a trip with my wife. Later this week I will be in Southern California for 48 hours to speak at the DVM-360 Fetch conference in Long Beach, and then turn right around to locum for two weeks in Auburn 😅 After that, I’ll finally take some much needed holiday rest and relaxation with family and friends.
—Eric
Meeting Highlights
I thought I’d use this post to recap the ACVP meeting and share my highlights for folks who weren’t able to attend. I’ve used ChatGPT to create a couple data visualizations from the conference schedule to provide an overview of what was covered. First, here is a word cloud from session titles (filtering out common filler words and generic labels like “veterinary” and “pathology”):
That wasn’t as helpful as last year when it clearly highlighted the focus on digital pathology and artificial intelligence. So next, I had ChatGPT categorize lectures into broad themes/topics and illustrate them spatially by day of the conference:
This necessarily oversimplifies the meeting content and leaves out the specifics, so I’ll talk about a few sessions I found particularly interesting below.
Liquid Biopsy
There was a half-day session on “liquid biopsy,” a broad term for molecular tests that include cell-free and circulating tumor DNA (ctDNA), circulating tumor cells, microbial cfDNA, and donor-derived cfDNA (used for transplant monitoring). These tests are run off fluids like blood, urine, and CSF, so they are less invasive than traditional tissue biopsies and allow repeated monitoring. However, they face challenges such as variability in how samples are handled and stored, the small amount of analyte available, and the risk of false positives without highly specific testing.
Dr. Christina Lockwood works in human medicine at the University of Washington and runs their cancer genetics lab. Her talk discussed their current liquid biopsy applications like monitoring prostate and bladder cancer through urine and diagnosing cancer in effusions. One use case I found particularly compelling was diagnosing medulloblastoma—a common malignant brain tumor in children—in CSF; brain biopsies are extremely invasive and can have false negatives, so this is a great new tool.
The next speaker was the veterinary oncologist Dr. Andi Flory, formerly co-founder and Chief Medical Officer of the liquid biopsy company PetDx (now a Senior Director at Zoetis)1. She talked about the promise of liquid biopsy for broader uses like multi-cancer early detection (MCED) screening in healthy patients. However, both speakers discussed concerns about practicality due to false positives, inability to tell you where in the body the cancer is hiding, and high costs (tests like OncoK9 and GRAIL are often $700-1,000+). Dr. Brennen McKenzie at the blog SkeptVet has written about these liquid biopsy tests several times before:
“I have become a bit more positive in my view of these tests since I first wrote about them because the studies coming out suggests they are reasonably accurate. However, there is still no clear evidence that using these tests, at least in dogs with no other reason to suspect cancer, leads to longer life or delayed illness, and that is ultimately the point of screening.”
Leukemia Research
One of the areas I’m most interested in is hematopathology, or diagnosing problems with the blood, including lymphoma and leukemia. So I was stoked to see a number of great abstracts about acute myeloid leukemia (AML). Dr. Kaur from Cornell presented a small retrospective study about AML found in peripheral lymph nodes (aka “extramedullary” AML/eAML). Some of their key findings were:
eAML is not that uncommon and can be misdiagnosed as lymphoma on cytology
Lack of cytopenias does not rule out AML
eAML may have (slightly) longer survival than “classic” AML with heavy blood/marrow involvement
You can read the full study, which was recently published online, here.
Dr. Jillian Nolan at CSU presented a preliminary look at her research sequencing CD34+ acute leukemia cases for specific cancer mutations. In addition to similar findings for cases of eAML as above, she found that certain mutations were almost exclusive to AML versus lymphoid leukemia, and carried a difference in survival time. This suggests that mutations like NRAS + GATA2 could be useful both to diagnose poorly-differentiated blood cancers and potentially represent new drug targets.
Dr. Tracy Stokol at Cornell also presented her research showing that the flow cytometry marker CD80 was specific for AML versus acute lymphoid leukemia. It will be interesting to see if this antibody trickles into flow panels across the country in the future.
Artificial Intelligence
While AI was not as dominant as at last year’s meeting, it was still a prominent topic. Zoetis debuted a similar cartridge-based AI analyzer for blood called OptiCell that is similar to the IDEXX InVue analyzer announced at VMX in January. Zoetis also presented a number of late-breaking poster abstracts on AI applications for their Imagyst cytology scanner. There were several platform talks from the University of Florida about deep-learning models that could accurately differentiate between reactive lymph nodes and T-cell and B-cell lymphoma (97.5% overall accuracy), as well as “explainable AI” systems to show how the algorithm reached a decision in each case. And Dr. Candice Chu showed how she is integrating ChatGPT and other AI tools into her teaching at Texas A&M. You can see her workflow summary below and follow the QR code to find her AI articles and lectures:
Exploring Seattle
Monday morning, I played hooky from the conference to go explore the Museum of Pop Culture or MoPOP (formerly called the Experience Music Project). MoPOP is a mecca for anyone interested in the history of alternative/grunge rock, and Seattle musicians more broadly.
The magic begins with the building itself, which was designed by avant garde architect Frank Gehry. Like the Walt Disney Concert Hall in LA and the Guggenheim Museum Bilbao in Spain, MoPOP is a chaotic mix of materials that appear organic and curved, devoid of clean lines or typical building structures. Inside, the main exhibits ring the massive “Sky Church,” a huge IMAX-style screen that loops different live music performances from KEXP in Seattle. You can gaze upon the actual guitars owned by legendary artists like Buddy Holly, Kurt Cobain, Stevie Ray Vaughn, and Woody Guthrie. Stations with headphones let you sample music clips from dozens of iconic bands. There are even sound-proof rooms on the third floor where you can jam and learn to play instruments!
MoPOP also has a ton of interactive audiovisual exhibits and memorabilia from science fiction, fantasy, and horror movies, videogames, and more. It’s a true nerd paradise: Where else could you find movie props from The Lord of the Rings, Star Wars, and Hellraiser all under one roof??? There was also a temporary rotating exhibit featuring famous NYC pop artist Keith Haring. His simple street art that was inspired by graffiti culture became a world-wide phenomenon, and he used his platform to advocate for AIDS awareness, which he ultimately died from.
Besides exploring MoPOP, Pike’s Place market, and random eateries on my own, I got to catch up with my old resident mates and other friends from all over the world that I usually only get to see once a year at these meetings. We caught up about careers and family over drinks at the hotel bar every night. I also got to meet my ACVP resident mentee for the first time in person and we had a great lunch at the dim sum restaurant Din Tai Fung.
An Uncertain Future (Conference)
Finally, a bombshell dropped during the ASVCP business meeting: Future ACVP conferences may no longer be co-sponsored or planned with ASVCP 😧 Basically, after the long-term memorandum of understanding (MOU) between our two societies on organizing and paying for the annual conference expired a year ago, we have been unable to reach a new agreement. Only limited details were provided to the membership, but it sounds like a big part of the disagreement concerns finances and cost-sharing.
I certainly hope our two sister societies can find a way forward because holding separate meetings would be a disservice to both anatomic and clinical pathologists. There would likely be less clin path educational and research content for the APs to learn from, and CPs would have to pick between attending a smaller conference that interests them or a bigger, more expensive one that doesn’t cater to us just to fulfill our requirements to maintain board certification. This split would also hurt non-pathologist ASVCP members like the medical technologists who staff our labs and don’t have much to gain from the ACVP.
What can you do? Besides contacting ASVCP leadership with any thoughts, they will soon be sending out a survey to gather member feedback about the issue. I would encourage all ASVCP members to look for the email and fill it out. Our two societies have been inseparable for decades, I sincerely hope we can work things out 🙏
PetDx shut down in 2024 amid financial difficulties, and their OncoK9 test is no longer available. You can read more here: https://derickwhitley.com/a-tribute-to-petdx-pioneers-in-veterinary-oncology/
I LOVE Seattle! Terrific place.