Veracyte, Inc. (VCYT) Earnings Call Transcript & Summary

Right. Thanks, everybody, for joining us. My name is Matt Sykes. I'm the life science tools and diagnostics analyst at Goldman Sachs. And today, we have the pleasure of hosting Veracyte, CEO, Marc Stapley; and Chief Financial Officer, Rebecca Chambers. Thank you. Marc and Rebecca, for being here today. Really appreciate it.

Thanks for having us.

Thank you for having us.

Maybe Marc, Rebecca, maybe will kind of set the -- help you set the stage for us, maybe some introductory comments about the year so far? And then maybe, Marc, this is probably about your 1-year anniversary, so maybe some highlights as you reflect back on your first year at Veracyte.

Yes. It's been -- actually, thanks for the question. And again, thanks for having us. It's been a really interesting -- oh actually, I'm sorry, I should start by just reminding everybody about our safe harbor statement to the extent we're making forward-looking statements. You can see the full text of the safe harbor on our website in our corporate deck at www.veracyte.com. Okay. So now, yes, reflecting back on the year, it's actually been a really interesting year. The company has very intentionally changed significantly over that year. As you know, last year, in March, we acquired Decipher. And then in August, we acquired HalioDx, all part of a deliberate strategy to put together the pieces to be able to deliver on our global approach to diagnostics that was really built on the 2019 acquisition of the diagnostic rights to the nCounter platform. So putting those 3 companies together, we've effectively created a diagnostics, a large diagnostics company that has global reach, is in 8 of the 10 top indications, over 750 employees globally based in the U.S. and largely in Marseille, France, and we're able to deliver our test to patients in the U.S. and around the world. And so you can imagine that, that's been a significant change for the company. We've had to build a talented management team on top of the team that came from each of the companies that we put together, including Veracyte. And that's been done extremely successfully with a reorganization at the beginning of this year to really focus our attention on our CLIA U.S. business and our IVD business. So I'm very happy with the progress that we've made over the last year. And yes, we're continuing to execute on our strategic plan here, and we're happy to talk more about the individual components of that.

Great. Thanks very much for that introduction. I have to think 2.5 years ago, I didn't think we'd still be talking about COVID today, but we are. And thankfully, it's -- we're hopefully seeing the other side of this. But because we are about 2.5 years into COVID, you've seen some impact in your business as a result of that, particularly in the hospital setting for test like Afirma and things like that, that have large presence in the hospital setting. Could you maybe talk about anything that impacts? And then also what you've learned during this time? And anything that you kind of feel you've improved from an operational or a strategy standpoint on a post-COVID basis?

Yes. It's a great question. There's a lot to kind of unpack then I'll try and do it as quickly as possible. But I think if you look back, because of our portfolio of products, as I mentioned today, of the 10 top cancers, we've had a very differentiated effect across our products from the pulmonology business that was clearly impacted by the fact that, that product is sold into a very strong hospital setting and is dependent on bronchoscopy procedures and other things that have to happen. And that community is a community positions that was most impacted by COVID, obviously, and then all the way through to decipher our urology business, which was surprisingly not impacted at all as far as we can tell or at least not materially by COVID, and we just continue to perform very well. Afirma sits somewhere in the middle there with about -- being about 70% in the institutional setting. And so the challenge there was more around access, not so much around procedures. So the impact has been varied. In terms of lingering impacts, I would say, very, very minimal at this point. I think Omicron was the last wave that really impacted us significantly. And since then, we started to see kind of a more of a normal pace as far as we can tell, relative to where we were pre-COVID, which was such a long time ago, as you said, it's almost hard to draw those comparisons. In terms of what we've learned, I think we've learned a lot about the resilience of our business and our team, the ability to manage our supply chain through the COVID impacts and really execute on our business during that time.

Great. Maybe shifting to ASCO, where you sort of believe 6 abstracts. Can you tell us a little bit more about the data you presented at ASCO and maybe the 30,000 foot view as to -- for those who haven't had the chance to dig into the data, what were some of the key takeaways?

Yes. So ASCO is always interesting for us and maybe highlight a couple of parts of the data that we talked about. I'm going to start with Decipher, our prostate test where we -- there was some data presented from looking at the SEA database and roughly 10,000 patients and analyzing that relative to our Decipher test and the Decipher score, which clearly showed that the Decipher score can be used to identify patients that should get active surveillance or patients that should go straight to RP right after prostatectomy. And so again, just yet another validation in an ongoing cadence and drumbeat of clinical evidence for the Decipher prostate test that I think is great to see. We had another abstract around Decipher, which has more to do with recurrence and again, using the Decipher prostate score or RP test in patients who had surgery and face a recurrence to really figure out which patients need more aggressive therapy than others. So that was great to see. The other area I want to highlight really is our immuno-oncology portfolio. So I'm not sure if investors really appreciate this, but we acquired an immuno-oncology portfolio with the HalioDx acquisition and some really interesting work that's being done there. And a couple of the abstracts that were talked about, 1 actually was a presentation around the use of immunoscore IC, which is a test that looks to biomarkers, CD8 and PD-L1 and there's some spatial analysis done as well to really determine for non-small cell lung cancer patients where immune checkpoint inhibitors might actually have a positive benefit or not. And so that was exciting. And we did a similar study, an abstract in colon cancer as well, which, as you know, I mean, for immune checkpoint inhibitors in colon that would be a really interesting area that needs more exploration for sure. The level of interest from biopharma in our immuno-oncology portfolio at ASCO was encouraging. And I think that's one of the things I'm really interested to see more, our immuno-oncology portfolio is really something that I think is going to be for many years to come, a big biopharma opportunity for us.

Great. And it's kind of sort of the second part of this first question on ASCO, but -- and maybe it's just last part on the biopharma interest in the immuno-oncology. But if investors were to walk away with one key point or one of the things that surprised you out of the feedback that you've got, what would that be as coming out of ASCO?

I think not really a surprise because, I mean, the level of interest in immunotherapy is so great by our pharma partners, but the utilization of biomarkers for ongoing immunotherapy development. And where I could go, I mean, I really think over the next 10 years, we're going to see some very interesting new developments there. And so being in the midst of that, I think, is very helpful to us. That was probably one of my biggest takeaways.

Got it. And then maybe moving a bit to financials. You have a revenue guidance of $265 million to $275 million for this year. What are some of the assumptions that you're making within this range in terms of the macro environment, it seems to change on a weekly basis? And curious on upside, you've highlighted Afirma, Decipher potentially biopharma some of the key drivers, where do you see the potential upside within some of these drivers?

Yes, absolutely. So with regard to the macro environment that we're operating within, the COVID assumption in our guidance is really neither here nor there, right? So we're expecting whether COVID is where it is today, where it was 2 months ago, to Marc's earlier comments, we're relatively indifferent, given, obviously, outside the humanitarian aspect of that portion of the question. But given the pulmonology portion of our revenue right now is relatively small. So the macro assumption in guidance is that we can operate within both environments. If we saw something akin to Q2 of 2020, that is definitely not in guidance, but surges here or there were relatively -- our business is relatively immune to at this point in time. With regard to upside, I do think we have laid out where -- what we believe Afirma to your point, Afirma revenue growth will be over the year. We haven't necessarily given all the bits and pieces, but historically, Decipher is where the outperformance has been and not saying the other portions of the portfolio can surprise us to the upside really just relying on historicals there. It's historically come from Decipher.

Got it. And then just on Decipher. It's been a great story for you guys since the acquisition. Maybe talk about the competitive differentiation of the bladder and the prostate test and how you see the growth trajectory for Decipher over the next few years and maybe the contribution from Decipher to the overall Veracyte growth story?

Yes. I mean starting with the Decipher prostate test. As you probably know, I mean, there's been other molecular diagnostics in this market for a while and decipher prostate came along. And the team did a very good job of driving evidence development and then getting reimbursement. And we acquired the company at a very key inflection point, which was obviously our intent, given what we saw in the value of that business. And I think really what sets decipher apart from the market is the continuous drumbeat of evidence. It might be trials that we're doing and other independent trials, but you can just see a regular cadence of new information, new data, supportive data coming out. That leads to a couple of things. It leads to KOL support for the product and make sure the product is top of mind. It gives our sales reps a lot of information to share with urologists. And then ultimately, it leads to guidelines, and varying degrees of guidelines, guidelines that say you should use a molecular diagnostic to you should look at the Decipher, you should use Decipher in this case. And I'm oversimplifying for effect. But that really makes a difference. And then I think another key point is Decipher can be used in -- well, close to 93% of prostate cancer cases given the coverage. The coverage of indications and then the coverage from a reimbursement standpoint is very high, and we're continuing to drive that even higher. So all those factors come together, and it's just -- it's a great test, and the Decipher team has done an incredible job developing that test. Adding bladder as a test while a smaller market, having that bladder in our menu so that when you're seeing the urologist practice, you're able to have a menu of tests even though the -- within the practice, you might be having different conversations with different specialists. And I think that just adds to the capabilities and the competitiveness of our product having a portfolio.

And to your question on growth, Matt, I think when it comes down to Decipher and Afirma and biopharma are our 3 growth revers in the near term, 2 of which are immensely profitable products as well. And so I'm sure based on the one-on-ones we've had today, we'll get to the profitability question, but a little preview, it's not a bad thing.

Got it. Yes, we will get to that. Just on growing the IVD menu on the nCounter platform. I was always very struck by how international Veracyte was as sort of a relatively in terms of a revenue base and for what you guys were able to do there. But could you talk about the potential for further international expansion of that revenue base? And how the HalioDx accelerates this and maybe the time line for expansion for Envisia, Decipher and then eventually in the swap on encounter platform, just kind of help us see how that plays out?

Yes. Thank you for asking. This is 1 of the key strategic elements that attracted me to the company, amongst others. But if you think about it, there aren't many diagnostic companies that can take their portfolio outside of the U.S. on their own platform. And that is a real bonus, I think, for us. And I think it needs to be a little better understood as well in terms of that opportunity over time. So the way that it works for us is we identify clinical unmet needs. We then have a robust scientific team that generates and creates these very high-performing tests. We rolled them out in our clear environment in the U.S., like you've seen us do with the tests that are on the market today that we've just spoken about. And then we put them over to the nCounter platform for selling as a distributed model to labs all around the rest of the world. Reason for that is the clear lab model works very well in the U.S., but we're seeing a trend where outside the U.S. sending samples over to CLIA labs in the U.S. to be processed: a, takes longer; and b, privacy concern moving people in the direction of doing that less. And then it's very cost prohibitive to set up a CLIA lab in every country we might want to do business in. So that is why we made the decision to acquire the platform, and that helps fuel this distributed kit model outside the U.S. Now we generate a lot of evidence for those kits that are on the market in the U.S., and that obviously helps us with the -- it's not the billing, but it certainly goes a long way to helping us to generate the evidence we need for the OUS markets. So that gives us a good step up. In terms of developing the test with the Halio acquisition, we acquired these incredible multiyear 15-year experiences in IBD development taking them all the way through to regulatory approval. And so that team is literally working with our scientific teams in San Francisco and San Diego to develop Envisia for next year to add to our existing Prosigna breast cancer test. So Envisia in '23, Decipher prostate in '24 and Percepta Nasal Swab in '25. So -- and that's really important. Launching a new IVD test with all the way through the regulatory approval every year for the next 3 years and we'll continue beyond that is an accelerated time line. If you look at other companies and how long it takes them to do that, it takes a lot longer and part of that is because of this model that we've got. The final point is, in addition to launching these tests on the platform, we will also be able to manufacture our own kits for those tests because alongside that IBD development capability came manufacturing capability. And so we're moving that to France, to Marseille. And so by the end of next year, we'll be making our own kits in Marseille as well, which enables us to control the whole end-to-end supply chain.

Great. And then Rebecca to you, talking about the profitability, I mean, obviously, it's been a big focus for investors just given the market environment, you have about $164 million in cash on the balance sheet, strong gross margins in the mid-60s. So are you're in a slightly different place. You also have wide reimbursement for your tests in the market. How do you feel Veracyte is positioned right now for the current market environment? And especially with investors so much focus below the line versus the prior couple of years?

Yes, thanks for the question and very well. In summary, I kind of hinted at it earlier, but we do have the benefit of 2 very profitable products in Afirma and Decipher that help us generate a decent amount of cash, which then we can invest into our strategic growth drivers currently Nasal Swab in the IBD business outside the U.S. And that model is obviously 1 that we really like. We have made offensive decisions to really invest in our long-term revenue growth but at a balanced rate and have plenty of cash on hand to fund this business to profitability. And in all honesty, flirt with profitability in any given quarter. When it comes down to it, we have smaller sales teams than the rest of the space given they're specialized in nature. And we have R&D spend that outside of clinical trial timing is relatively stable as well. So we're very pleased with our ability to generate cash, our ability to fund the investments we're making for long-term revenue growth. If anything were to change, we also have levers to pull such that we could we could positively from a cash perspective, influence the P&L structure. So net-net, I think we're very well positioned for this current market environment. And if we return to a world where revenue growth is king again, we're also well positioned for that. So I think we're very -- we're in a great spot from a business perspective on a go-forward basis.

Got it. Maybe digging a little bit into the expense side. I mean you had about $49 million in OpEx last quarter. And I think you've had about 3 quarters in a row with sales and marketing was kind of relatively flat. R&D also seems to be stabilizing. So do you feel from like an expense standpoint, you've kind of reached where you want to be? You mentioned the commercial side, and we'll get into that a little bit. But do you think you can keep these costs relatively stable and start to really generate some significant operating leverage versus kind of flipping back and forth?

If we choose to, I think, it's the right answer, right? So you do have timing of clinical trial spend that can flip flop in that in all honesty, those are the right investments we want to make, and they're very high-return investments. So we're happy to make them. And on the SG&A side, I think outside of maybe a program here or there, I see that absolutely continuing. So I think if we chose to do so, we absolutely could. But at this point in time, we're taking a more balanced approach of investing for long-term revenue growth and having a very disciplined cash generation/cash burn depending on the quarter approach.

Got it. Maybe on the commercial side, you talked about how some of your teams a little bit smaller due to specialization. How do you feel from the commercial side that you're positioned on sort of as you look out on a product-by-product basis, there are certain areas where you think you could flex a little bit more when you take some backlog? How much flexibility is actually comes from commercial investment?

Yes. I mean actually, in terms of the actual sales force itself, we feel we're really well positioned with the team we've got, and we're adding to that team where it makes sense. But again, there's an optimization curve here, you're not going to if you add too fast, then you start to disrupt territories and momentum. I'll give you an example of that and decide for our business. We're adding at a couple of sales reps a quarter or month and we'll flex that up and down as necessary. But it's -- if we went too fast, then we'd be realigning territories, yet this team has great momentum and has some of the best-in-class performance metrics. Same on the Afirma side, those territories are very well established. And so that team is performing very, very well. And then on the pulmonology side, we have the sales force that is ready for the launch of Nasal Swab and to drive the products that we currently have on market. And so that gives us a great benefit where those teams are able to work with existing physicians to talk about Percepta GSC and Envisia and so on, and then nasal swab for the clinical utility work and then obviously, in the future. So we feel very well positioned there. One of the benefits we've got is as we start to see the ramp of new products, then we can dial up the investment in commercial sales force. Outside of that, there's some discrete investments that we make in commercial that we can turn on or turn off as needed. So we have quite a lot of flexibility.

And effectively, it's a great source of leverage for us. Even with all the investments Marc's talking about, SG&A has been and will continue to be a source of leverage for us.

Got it. I'd like to throw, if the audience has any questions, please just raise your hand. We've got a microphone in the back, so feel free. I'll keep going. I have more questions. But if there's anybody who has a question, don't be shy, raise your hand, and we will get to you. Maybe shifting to Percepta, which I think I always thought it was a really interesting balance you've got for a company side, you have international exposure, you've got profitable segments. And then you've also got a really exciting pipeline in Percepta. So maybe talk a little bit about the Nasal Swab. And the smooth unit is sort of early detection and potentially a very large market. You've released some recent data that you highlighted around this test. Maybe talk a little bit about that and how you see from a competitive positioning standpoint where Percepta fits into this market?

Yes. And I think when you're saying Percepta and Nasal Swabs, in particular.

Yes.

Yes. It's really exciting, actually, what we can do with that product. So the way that product works is by any patient who's been identified with a lung module who's a current or former smoker with a simple noninvasive Nasal Swab test, we can -- we run our genomic assay on that to help classify those patients as low risk, and therefore, avoid unnecessary procedures or high risk, which means accelerate their path to treatment, which is obviously good and then intermediate as well. And that's really important because 15 million people here in the U.S. should be getting screened for lung cancer that fall in that category, and they're not, only a fraction of those people are actually getting screened today. And then there is about 1.6 million of incidental lung nodules found. So if you take those 2 sources where you've got a large number of patients identified with a lung nodule they could -- a large portion of them could be potential candidates for the Nasal Swab. Today, the screening paradigm for those patients is a low-dose CT, simple image, easy to get, low-cost, noninvasive, very highly sensitive, not very specific. A lot of those nodules that have found are benign. So you need something like the nasal swab test to really help to classify those patients. And so in conjunction with low-dose CT, it's the -- we think it's the perfect combination of screening and testing modality for those high-risk patients. I think where it's very different from some of the other tests that might be on the market or coming on the market is low-dose CT has demonstrated a mortality benefit. It has a demonstrated mortality benefit and that's been proven over 10 years. And that's important. And so we have a very targeted test if you're a patient who's high risk for lung cancer, the targeted test is probably where you're going to go as opposed to a more multi-cancer test that might be lower sensitivity, especially early stage. So that's the positioning. I think it's a really important opportunity for us, and we're looking forward to seeing it more broadly adopted as we continue to gather the clinical utility evidence that we're currently working on.

Got it. And then maybe help us frame either, I know it's an early stage, but the volume or revenue expectations you may have for nasal as we kind of look over the next few years. help kind of investors think about that trajectory?

I think the best way to think about it is in terms of that addressable market that I just talked about, the 15 million people, of which a portion of those, almost half could end up having a lung nodule, but depending on how successful we are with the evidence development, obviously, we're driving that to be the most optimized across the entire population that you could potentially see this test being run on. So patients who have a lung nodule that needs further work up and analysis. So as I say, it could be up to half of that population. Obviously, a big driver of that is getting more people screened, right? And so we need to make sure that both our test and a lot of other people who are working on driving more lung cancer screening in the U.S. are working effectively to drive that number higher. Don't forget also, as part of the addressable market. As I mentioned earlier, we're launching this test in 2025 on the nCounter platform. And so we'll be able to address the market outside the U.S. as well. So that gives you a good sense of how sizable this opportunity could be.

And all of that obviously is predicated on getting reimbursement, which as we've shared, we'll take a couple of years. We're working through the clinical utility study. It's on track. It's pacing well, but that is a predicate for getting out there and getting reimbursed and therefore, revenue.

And what kind of time line should investors be looking for in terms of data and then potential submission?

I think really to -- as we've talked about as Rebecca just said, it's going to be a couple of years to get the clinical utility data based on enrolling patients and then following up the patients to get to the ultimate end points here and then we'll publish that data and we'll go through the process that's somewhat out of our control for reimbursement. But the key is we're doing everything we can to drive that to happen as quickly as we possibly can with the things that are within our control, which is running the trial in a post-COVID environment where clearly, during COVID, it was much harder to get lung cancer or lung module trials going, but that's certainly less the case now.

And then from like -- and you talked a little bit about the compliance advantage. What's the feedback been from the oncologist that you speak to? I know you guys had like a lung cancer day a while back and received good feedback. But just in general, what kind of feedback have you gotten from the potential for this test and the need for it?

Yes. I mean I think what we're hearing, and of course, we developed this with a lot of KOLs as well. We hear consistently that this noninvasive approach to providing more clarity to physicians and patients in a world that, frankly, is very difficult to assess what's the appropriate treatment for the patients. And it is variable. We've researched physicians, and they've shared that with us. This will help drive more confidence in the next steps that they take with patients. So far, the feedback has been really good. From the clinical utility study so far, where ultimately, we're looking for the change in treatment pathway, we're seeing some early indications of that's going to happen the way we anticipated it would, but not significant enough yet early enough -- not enough data yet to say that's absolutely the case. But I'd say the early signs are encouraging.

Got it. And then how should we think about from a capital allocation standpoint? I mean, you guys have been very busy over the past couple of years. So I think your expectation is that, and particularly in this environment, you kind of have the offset of like probably more attractive valuations, maybe not realistic expectations from sellers, but probably the field has widened a little bit. At the same time, you've been very busy. You've been integrating, you all did at the same time when you came in. So how are you thinking about capital allocation? And how do you think about the business as it stands right now, how you're set up?

Yes. I mean I think from a capital allocation standpoint, our primary goal is to invest in our growth drivers, right? So from a first derivative impact, that's exactly where we're going. With regard to M&A opportunities, never say never, obviously, but the bar is high. We would like it to be accretive both from a strategic perspective as well as from a financial perspective over a reasonable period of time. And so we're obviously very cognizant of where different assets are at this point in time, but nothing on the horizon that we're planning on going after given the primary objective is to grow the core business.

You're in 8 of the top 10 cancer so you're busy enough. Any appetite to expand beyond that? Or do you feel like these are the places you want to be right now unless something obviously never say never.

Yes. I think there are really 3 levers for us. One is the indications and as you say, 8 of the 10 -- top 10 and a number of those are in early -- we have products that are in the early stages, okay? The second is across the care continuum. And you see us doing that with a Nasal Swab, which is much more upstream. And then we have products that help with diagnosis, prognosis, prediction and so on. So we're covering that middle part of the care continuum extremely well. And then the third lever is really going to be geographic and continuing to grow geographically. And I really like what we're doing with our nCounter platform and the approach we've taken there. We've identified the first 3 products to launch on that in addition to Prosigna based on kind of the market opportunity. We know there's a pent-up demand for decipher prostate outside the U.S., for example. We know that the nasal swab is going to be a significant market outside the U.S. And so that's really key to our focus on getting those developed.

Got it. And maybe back to you on the gross margin side, you're already at a pretty comfortable level in the mid-60s in terms of where you see some of the levers for upside there. I know price increases can often be a challenge and COGS is not the environment right now where we can improve that. But where do you see a potential upside for gross margin expansion moving forward?

Yes. Fair enough. So just taking it maybe revenue line by revenue line for us on the testing business, Decipher is accretive. So from a perspective of mix to the extent Decipher becomes a bigger contributor to mix, we will have a goodness on the gross margin line. And also, I do think we have some productivity opportunities with Afirma over the next, call it, 2 to 3 years, not maybe necessarily around the corner because those are longer duration type products -- projects. But I do think we can invest and those would be very reasonable projects for us to invest in. On the product side of the business, obviously, with the transition to our own manufacturing away from NanoString and in-house in Marseille, that, over time, will be meaningfully accretive to the product gross margin line. However, at scale, right? And so that will take a little bit of time. And then lastly, on the test -- on the biopharma and other business, that's highly dependent on the mix of revenue in any given period. I don't see meaningful gross margin opportunities there because it's a very human capital-driven revenue business. But I think to the extent you have more biopharma revenue versus contract IVD revenue, that will show and obviously, milestones slow down at 100%. So that's a good news. So that will be a little lumpier 1 way or the other. But I think we have great opportunity on testing and product. And over the next 5 years, we have a good horizon to expand our gross margins even from the R&D elevated -- respective relatively elevated level there currently.

Got it. And then Marc, one thing we talked about in the past is the significant biorepository you have, monetizing that data sometimes is harder than expected. Maybe talk about your expectations or time line of utilizing that biorepository?

Yes. And again, it goes back to the biopharma business that Rebecca was just talking about, that biorepository, which comes from the work that we're doing on clinical evidence development, and the work that we're doing in real-world evidence creation as we launch our test. And as you know, we focus very much on whole transcriptome. So we have a significant amount of data. We're building immuno-oncology assets. We're building an Atlas for pharma in immuno-oncology that will give them access to IO data for key biomarkers. So very, very excited to continue to build that large data set and work with our biopharma partners to provide them what they need. That's why we put the 3 businesses together, the 3 biopharma businesses together and created one biopharma organization that's run by one single general manager to really focus on maximizing the opportunity for our data set. But I don't find clinically relevant biomarkers for clinical trial work and ultimately for companion diagnostic development.

Great. And maybe in the time we have left, what do you feel is underappreciated about Veracyte? What do you think is misunderstood? And what would you like to talk about that?

Maybe a couple of things and Rebecca weigh in here as well. But one, I would say our opportunity outside the U.S. I think is, again, because it's a very unique model that we have and not many companies have chosen the path that we're treading. I think it's -- it can be a little hard to evaluate that opportunity, and we're doing it. We've evaluated it. And the time will tell. Secondly is, I think our path to profitability, you might want to talk about this again, but the fact that we do have 2 very important products that are generating cash for the investments that we're making that are very deliberate and discrete. The portfolio of products we have from very early stage to inflecting to later stage and still growing is misunderstood. I think those are probably the key points.

Agreed.

Finally, I might just say and just to wrap this up. I mean our team, our leadership team and our entire team at Veracyte that they gets up every day to think about patients and how to take care of patients by making diagnostic as accessible to them all around the world. We have assembled an incredible leadership team and they have assembled a fantastic organization and all of our colleagues all around the world are doing an amazing job. The culture is great, and we're doing more work on that to continue to focus on culture, which I think is critically important to receive -- to achieving these goals when we're moving at the pace we are. So very, very happy with how that's progressing.

Got it. Well with that, we'll end it there. Thank you very much, Marc and Rebecca, I appreciate it.

Great. Thanks, Matt.

Thank you.