Hello, it's Anthony Chadwick from the webinarett welcoming you to another episode of Vet Chat. I'm really pleased to have Gillian Dank on the line with me today. Welcome back Gillian, really enjoyed the last podcast we did.
But perhaps for those people who haven't listened to that first one, just would you like to introduce yourself and tell us a little bit about the the company that you're representing? Thank you so much for having me. So my name is Jillian.
I'm a veterinary oncologist. I went to vet school at Hebrew University in Israel and I did my internship there as well. And then I went to the University of California at Davis and did my residency there, and I'm an oncologist boarded both in at ACBIM and ACBIM.
And I now have the pleasure of working for a company called HTVett, which has a very exciting device which is called HT Vista. And this device is based on a technology called the thermal imaging, and so it's called, and also heat diffusion. So what happens is, is that there is a camera on the device, which actually kind of looks like an iPad.
And the camera and the device heat different tumours, and with that heating, the, the device actually looks at the image. So we have a an optical image. It heats it up and we have a thermal image.
And with that heating, the, the camera actually shows what happens to the tumour over time. So over time, the the tumour is heated and cools down, and based on the thermal images and the heating and the way that it cools down, The artificial intelligence looks at all that data and tries to understand whether the tumour is benign or requires a additional workup. So the purpose of this device is to let us know whether it's OK that an animal has a lump.
We can look at it and send it home and say that it's benign or whether we should recommend an additional workup. Gillian, that's great. I, I obviously did dermatology when I was practising and so I loved cytology, and I would pretty much .
Do cytology on any lump that came in because just looking at it, you can't know what it is, but I know you've had some survey results recently that you've done for different countries including the UK. And, and it seems that there's still a lot of vets who, who perhaps don't do cytology. And it's more of a guesswork thing so maybe talk us a little bit about what you found from the survey results that you, that you got.
So, so you're, you're absolutely correct. And actually, I taught at the university for over 20 years and I taught the students to aspirate every single lump that they see in the clinic just like you did. And, and then when I left, and then when I spoke with students that had finished, and I, and I understood that most people do not aspirate every single mass, I was kind of disappointed.
So if veterinarians aspirated every single mass that came to their clinics, there would be no need for this device, because the chances if you're going to aspirate a mass, the chances are about 75 to 80% that you'll succeed, you'll succeed in diagnosing the tumour. However, not everyone aspirates everything they see, and that's why we see the need for this device. And so we actually did surveys in the US and the UK after we had previously done a survey in Israel.
And in 80 general practitioners answered the survey. There were additional people from from academia, but we looked at the GPs and what they said was that 30, 30 of those 80s saw between 4 and 8 masses a week, 20 people saw under 4 masses, and 30 saw over 8 masses a week. So clearly, People are seeing lumps and bumps in general practise.
Of those lumps, they assumed based on palpation, that 3030 of them saw between 4 and 8 lipomas a week, 30 under 4 and 20 saw over 8 lipomas just based on palpation, and you and I know that there's no way to know that a mass is a lipoma just based on palpation. The fact that a mass is subcutaneous and soft and circumscribed could be. A number of different masses.
It could be mascle tumours, it could be a sarcoma, it could be a hemangioparacytoma. Palpation is is not enough. And of those masses, only under 50 about 40% of those cases, they, they recommended further investigation.
So most of those cases coming into the general practitioners based on palpation, they said, oh, we think it's a lipoma, and they sent them home. So we know that there are many cases of malignant tumours that should warrant further investigation that are not being treated. Something very interesting was that when we asked how comfortable you are just diagnosing a lipoma based on palpation, 55% of them said that they're comfortable just based on palpation.
There will be a a study coming out in the next 6 months from the US that actually looked at the ability to diagnose lumps and bumps just based on palpation, but we don't have the results of that yet. But, but we all know that it isn't enough. And then something else that was really interesting was when we looked at the correlation between how many years experience does someone have as a veterinarian and their confidence in diagnosing these lumps and bumps, it there actually turns out that the more experience they have, the less confident they were.
So it shows that with experience we understand that our hands are not good enough. So, so we learned a lot of interesting things about what the GPs think and feel. Gillian, the world isn't black and white, is it?
It's grey and so being able to, it would be a lovely skill to have it, but I must admit, if I went to a GP doctor with a lump and he said, oh, it's probably just a lipoma, you don't need to worry about it. I would probably change my GP because we have to do tests on these unless we have some sort of X-ray vision or a Superman or something, then . As you say, it's impossible to to say what a lump is, .
So It, it's really interesting and I, I definitely saw that in practise where I would have people coming in with referrals, sometimes for a skin problem. But I'd see a lump, and they'd say, oh, the vet's looked at that, it's not a problem. But I would nevertheless do cytology and the number of mass cell tumours I found.
And of course we don't want to miss something like that because a lipoma might grow a bit bigger at some point if it's in an awkward position, you may have to remove it. But if it's a mast cell tumour, that could be a death knell for the dog, couldn't it? Most definitely.
And it, and the the other issue with, with mast cell tumours and many other malignant tumours is if we catch them early, then we can send them for surgery and the surgery will not be a major surgery and the dog. We'll get over the surgery very quickly, but if the tumours are left to grow and grow, when we catch it, the, the ability for the surgeons to do a simple surgery will be much more problematic. So there is a huge, a huge advantage for early diagnosis.
Yeah, and I remember particularly just going off on a little bit of a tangent with with mast cell tumours, things like Mazivvet were useful when they were inoperable. But of course we've also now got steel Fonta, which has been a really interesting product, and I I actually really like the fact it's come from a botanical in a rainforest. It really shows why we should be protecting our nature because there's so many cures that are out there that we perhaps aren't even aware of.
I, I agree 100%. I think that that steelfonta is a, is a wonderful example of an amazing new drug that we that we that we can use. And for stelfonta too, the smaller the mast cell tumour that is diagnosed, the easier it is to use stelfonta because if the mast cell tumour is too big, then, then you can't use steelfonta.
So I think that everything leads to the fact that mask that a dog comes in with should be looked at. If you can use our device and see that it's benign, then the negative predictive value is around 97%, which means the benign is benign. And if it's positive, it needs to be diagnosed, and then the owners will feel comfortable and you'll feel comfortable that you're not missing.
I think, obviously people aren't doing cytology and we can train people to do cytology or know how to take a sample so that at least they can send it off to a histopathologist, to have it diagnosed. But if people haven't got that skill or are nervous about making, cos of course if we take a sample and we look at it and we're not sure, then that's also people have then spent quite a lot of money on a cytology sample and don't feel they've had the value for it, whereas obviously with the HDISA machine, if if the. Predictive value is, is that high, it is a great way of just, it's a rule out, isn't it?
It, you know, this is a benign tumour. You don't need to worry so much about it, or it's very likely to be a benign tumour, whereas, if there is some concerns with the scan, then as you say, we obviously either carry on the diagnosis work ourselves or we can refer. To specialists like yourself who can who can further characterise and then treat.
Exactly. So we actually did ask on the survey in the UK why are you not doing cytologies and the number one reason was cost because almost nobody does in-house. Most of the people are doing either in house and sending it away, or just sending it to an external laboratory, which costs much more, and they said we offer it to the owners and they say it's too expensive.
On the other hand, if you do the. Scan and the scan comes out positive, then you have the rationale do the cytology and spend that extra money because you need to make sure that it's OK. Other reasons are that people don't feel comfortable doing cytology, don't feel comfortable that they that they do good enough smears, so, so this is another way to, to not send home dogs and just say wait and see because wait and see is never good medicine.
And I think also, you know, you, what's really interesting is quite often vets will talk about cost a lot and will say, you know, it's too expensive to send off, etc. Etc. But actually, if clients are given an option.
It depends on clients circumstances. I always was told, and I used to say to people, please don't X-ray your client's pockets because you don't know what that that dog means to that client. And if that client goes home feeling a bit uncertain about a lump, but knows that for 50 pounds, 100 pounds, 150 pounds, they can have a diagnosis of it's benign or it's malignant.
Hopefully benign. I mean this is where you love to spend money and be told actually we didn't need to do that because it's a benign tumour. That's much more positive, isn't it?
So. When you see big surveys from clients and they you ask why did they choose that vet, cost isn't always number one. It, it is often about the client, the vet was nice to us, it's a clean surgery, etc.
Etc. So cost, I think we can get ourselves a bit tangled up as vets in cost, in my opinion. I agree 100%.
I think that one of the, one of the reasons that some veterinarians have, have been upset with me is because I don't tell owners what to do. And the way I was taught is never to tell owners what to do. I always give them options and the more options you give the owners, if you tell the owners, OK, your dog has a lump.
You can go home and wait and see, but you can also do HT Vista to see what it is, and then based on that either feel comfortable going home or decide to continue the workup, then then it's the owner's decision. And, and, and not take decisions for the owners because you never know what's going on in their mind and what other things are are affecting them and sometimes we have owners that'll say, you know, we came in, we did come in even into an oncologist, but we have no money, and, and then they understand it's their decision and it's not your responsibility that you're not working up a mass. And I'm sure you could tell us stories as I could, you know, where I would look at a lump and say just looks like a lipoma, but nevertheless I'm gonna go in and you find a mast cell tumour, you know, also with the HCISTA machine.
People who were just saying, oh, it's benign, they they get a surprise when they start using this machine and finding out actually there's more positives or, you know, . Positive tumours than than perhaps they thought or malignant tumours is the word I was looking for. Most definitely.
So we've had a couple of, of, of different stories lately from the UK and from Israel, and we've had dogs in Israel. We have one dog that came in with multiple masses, a 10-year-old beagle named Stella, and in the, in the, so she was checked. She had 3 different masses in the same.
Are we scanned all of the masses. Two of them were lipomas and one was a mass cell tumour. So eventually when she had surgery, she only had to have surgery on one mass and not all three, which is also critical to understand the fact that the dog has multiple masses.
It doesn't mean they're all the same type. You have to check every single mass. Yeah.
There was another very interesting case last week in the UK of a dog that was being treated by a physiotherapist, and she said, I don't like the feel of that tumour. And the owner said to her, Well, my vet felt it and said it was a lipoma, and she said, I don't like the feel of it. I think you should work it up.
So they went back to the vet, went to a clinic that had HT Vista. And got scanned. It came out as suspicious.
They didn't ask for it. It came back as a sarcoma, and this week they're going to go for a CT before removal at a different place. And, and based if that physiotherapist hadn't said you can't know what it is by feeling it needs to be worked up, the dog would have been left to have a sarcoma that was growing, growing, growing, and probably would have had a much more problematic surgery.
Now obviously big in the news at the moment all about AI and chat GPT but I presume one of the beauties of this machine is that it actually gets better the more it's used, so that there's a, a database of, When you get it right and when you don't get it right. But also you're able to then with the algorithm, the algorithm improves over time, is that, is that right as well? Most definitely.
So the algorithm is improving all the time. We also have validation studies that are giving even more information. So what we know now, we didn't know 6 months ago.
We now have, oncologists all over the world that are participating in the validation study. We have 3 different oncologists in the UK. We have oncologists.
All over Europe and the US that are participating, and we also know things now that that we didn't know, a year ago. So, so we now know that for soft tissue sarcomas, hopefully within the next year we'll be able to know not only that it's a soft tissue sarcoma based on the scan, but whether it's a grade 1 or grade 3. I mean grade 1 and grade 3s have completely have different biologic behaviours and their ability to metastasize is much higher.
It's a grade 3 and you need to know that, so hopefully we'll have much, much more information as we go. Gillian is one of our values at Web and our vet is about innovation, you know, we want to be an innovative company and of course being innovative, you start on something and people can say, oh well, I don't believe that a tumour can be scanned and worked out whether it's benign or malignant, . But I think this shows that this is why we have to innovate and sometimes innovation is about making mistakes and getting it wrong and going down a an alley where, you know, it's blocked at the end and so it it it wasn't the right way to go, but unless we innovate, I think it was Thomas Edison had thousands and thousands of attempts at making a light bulb before the light bulb actually worked.
So innovation is just so, so important, isn't it? And by doing that, we can then get to things which also one of the big problems we have, certainly in the UK is a shortage of vets. And if you are bringing a dog in and having to do cytology on 3 or 4 lumps, maybe the dog's a bit awkward, maybe they're in difficult positions, maybe you need to sedate that dog because you're sticking a needle in.
Whereas again with this machine, this is a machine that you could pass on to the vet technician, the nurse, to do the scanning and to come up with results and then for the vet to check it. So, again, it potentially is a time saving device, isn't it? You are 100% right.
So the beauty of this device is that you, that the vet technicians that have been taught to use it can do it without the veterinarian, so it saves the veterinarian time. And there are even places in the US next week. They're going to start a trial and they're going to actually have people make appointments for the vet technician, then come to the vet technician for the vet technician to clip the dog, look at scan the mass, and then come to the vet and say, these are the results.
How do you want us to proceed? So it'll just save them that much time and make everything that much more efficient. So I think that that's, that's a huge advantage.
Obviously there are technicians all over the world that also do aspits, but that's a little takes much more, understanding from them point of view, but we see this is something that obviously technicians can do and then and then help the owners and help the vets and then get them in for appointments even earlier. There are also places that kind of like to, to, to advertise on Facebook. We're having a tumour day tomorrow, scan your dog.
That one day on a Saturday, everyone can come in and, and scan their dogs and then decide how to continue. And Gillian, obviously there's, there's so much data now, so much information, data points coming in, but it's so important to take all of that data and to analyse it as, you know, it very much sounds like you're doing, we're, we're doing this podcast now at the beginning of July 2023 for those who are listening in the future, but I know that . Some of this data you're obviously hoping to bring together in studies that will actually be published or that you'll present at conferences.
So I, I believe you, you told me not that we need much encouragement, but you'll be in Barcelona in September at the European College of Veterinary Internal Medicine. It's one of my favourite cities. If people are listening.
Before September 2023, it's probably not a bad place to go and spend a few days, is it? Yes, so we're very excited that we just got the approval this morning that we'll be presenting a poster in Barcelona. So so far we have one study that's been published.
The second one is under review and hopefully we'll get an answer soon. And then in Barcelona, we'll be presenting the data that we have about the thermal images for soft tissue sarcomas. So other papers have been published on thermal imaging in osteosarcomas, in perineal tumours and masal tumours and memory tumours, and the devices that they use for that thermal imaging.
We're, we're much, we're, we're research devices, so not something that somebody could actually use in the clinic, and based on the images that we have so far in soft tissue sarcomas, we believe that we can diagnose soft tissue sarcomas and also hopefully in the future that we'll be able to deal with the grading and that's what we will be presenting there. And I know, I think it was last year at London Vet show I met your, your founders, and I think you'll be back as a company at London Vet Show in November this year, won't you? Yes, most definitely, so, so Shani Taliana will be there and, and also the the UK so there's an actual UK team that are in charge of everything that happens in the UK with with Leon Hirsch, the veterinarian, yeah.
Gillian, it sounds really exciting, it's great to see a machine sort of developing, becoming more precise in, in what it can do, but also, as I say, potentially a, a, a life saving, but also a time saving device, for the pets, but also for the vets who are, who are trying to make these diagnoses because I think also if we are in a busy practise, if we have appointments coming in every 10 minutes. The other side is the dog's got a lump. It doesn't look that serious.
I've got 5 other people in the waiting area. You want to push that person out to get the next person in, rightly or wrongly. So anything that helps save time that gives us better results, then this is something that we must be looking at seriously.
So thank you for all the hard work. That you're doing as a company, but also you individually to bring real science to this because I think there's always a danger. There's new machines out, how much can we trust them?
But it sounds like there's some really good evidence coming together now to show how effective the HCISTA machine can be. So thanks so much for coming on and and sharing that information with us. Thank you.
Thank you for having us and thank you for believing in us. Thanks Gillian, take care and thanks everyone for listening. This has been another episode of Vet Chat.
See you on another episode very soon. Bye bye.
