Medical imaging plays a crucial role in cancer diagnosis and prevention. Read about the current oncology imaging landscape and recent advancements from Frost & Sullivan.
Medical Imaging Plays a Crucial Role in Cancer Diagnosis and Prevention
Imaging forms an essential part of cancer clinical protocols and is able to furnish morphological, structural, metabolic and functional information. It is used to screen, diagnose and stage cancer, guide cancer treatments, determine the effectiveness of cancer therapy and monitor cancer recurrence. Integration of oncology medical imaging with other clinical tools, such as in vitro tissue analysis, biomarker tests, and cancer screening, improves decision making. Early detection through screening based on imaging is the major contributor to a reduction in the number of deaths caused by certain types of cancers.
Oncology Imaging and Diagnosis Workflow
Oncology imaging and in vitro diagnostic biomarkers go hand in hand. While oncology imaging has used the conventional imaging modalities for quite some time, in vitro biomarkers is a relatively a new concept. Oncology imaging biomarkers are unique because they can examine and diagnose the exact tumor size and stage. Oncology imaging consists of two main procedures: imaging and diagnosis. Once a suspicious lump is detected through a scan, it has to be diagnosed as either malignant or benign. If malignant, the stage needs to be determined based on biomarker assay tests. During the imaging process, contrast agents are used to enhance the visibility of the softer tissues.
Key Innovations and Impact on Oncology Diagnosis
As researchers learn more about the mechanisms of cancer, new diagnostic tools are being developed and existing diagnostic methods are being further refined. Some types of cancer, such as lymphomas, can be difficult to classify even for an experienced oncologist. Accurate identification allows oncologists to choose the most effective treatment plan. Listed below are some of the key innovations for imaging and biomarker technology for oncology.
Philips Medical Systems’ Ingenia MR-RT Oncology Configuration is a comprehensive solution that allows radiation oncology departments to smoothly integrate magnetic resonance imaging into their computed tomography (CT)-based radiation treatment planning workflow. This solution provides clinicians with high-quality magnetic resonance images for defining tumor contours through excellent soft-tissue contrast.
The Centre for Probe Development and Commercialization (CPDC), a supplier of radiopharmaceuticals, is developing the next generation of molecular imaging probes. The company is evaluating 18F-fludeoxyglucose (18F-FDG), a radiopharmaceutical, in clinical trial for its ability to detect response to chemotherapy in breast cancer patients. CPDC has also started to manufacture 18F-fluoroazomycin arabinoside (18F-FAZA), a probe designed to identify hypoxic tumors.
Gamma Medica Inc.’s LumaGEM® digital molecular breast imaging system enables radiologists to detect early-stage cancers that can be missed in women with mammographic dense breast tissue.
Dune Medical Devices’ MarginProbe® System delivers real-time assessment of excised tissue in breast cancer surgery. MarginProbe uses electromagnetic “signatures” to identify healthy and cancerous tissue, and was found to be more than 3 times as effective in finding cancer on the margin during lumpectomy than intraoperative imaging and palpation assessment.
The UH Cleveland Medical Center indicated in a publication that a new form of imaging, PET/MRI, can be useful for detecting several types of cancer. The system combines the anatomic, biochemical and functional information from magnetic resonance imaging with the metabolic, molecular and physiologic information from PET. The research was funded by Philips Healthcare.
The University of Twente in the Netherlands, focused on research into early breast cancer detection, is developing a device called the photoacoustic mammoscope that uses sound waves in the breast to identify malignant tumors. The technology platform could lead to radiation-free breast cancer detection. Specificity with the device was relatively high compared with the conventional method, but it will take at least another 5 years for the device to be available for clinical use.
Zetiq, based in Tel Aviv, has developed the proprietary CellDetect® staining technology platform for the detection of cancer cells. It easily distinguishes between normal and neoplastic cells based on staining color and morphology, while preserving the morphological features of the cells. The technology platform enables color discrimination by showing green color staining in normal cells and red color staining in cancerous cells.
Johns Hopkins Cancer Center has developed cMethDNA, a quantitative, multiplexed, methylation-specific PCR (polymerase chain reaction) assay for a panel of 10 genes. This assay consists of the known breast cancer hypermethylated markers, which scientists identified on their previous study of DNA methylation patterns in breast tissue. This biomarker is expected to detect cell-free, tumor-specific DNA in peripheral blood of patients with metastatic breast cancer.
The Ohio State University College of Pharmacy is developing a blood-based biomarker test for lung cancer. The research involves blood passing over a tiny chip that resembles a microscope slide. Particles in the blood associated with lung cancer stick to the chip. Doctors can then check for signs of lung cancer under a microscope. If commercialized, the biomarker test can complement CT scans for lung cancer in high-risk patients.
Cancer Moonshot is an initiative started by the government to reduce or eliminate cancer. The Moonshot initiative’s goal is to create a national ecosystem for sharing and analyzing cancer data, so that researchers, clinicians, and patients will be able to contribute data, which will be an incentive to invest in artificial intelligence (AI) data analysis. The Cancer Moonshot will facilitate collaborations with researchers, doctors, philanthropies, patients and patient advocates, and biotechnology and pharmaceutical companies to accelerate the research efforts and break down barriers to progress by enhancing data access. The other objectives of this program are to accelerate the development of guidelines for routine monitoring and the management of patient-reported symptoms; to reduce cancer risk and cancer health disparities through approaches in development and testing; and to predict the response to standard treatments through retrospective analysis of patient specimens with AI algorithms. This initiative will speed up the development, evaluation and optimization of safe cancer vaccines, targeting unique cancers, opening opportunities for pharmaceutical and diagnostic companies that can leverage National Institutes of Health (NIH) investments to develop minimally invasive and non-invasive screening assays.
A non-invasive, blood sample-based liquid biopsy to detect cancer is an evolving technology as an alternative to surgical biopsies because tissue specimens limit the full market potential for cancer diagnostics. Videssa Breast by Provista is the first blood test of its kind to detect breast cancer by analyzing multiple types of tumor protein biomarkers. This liquid biopsy technique has made it possible for physicians to easily monitor and adjust patient therapy. Companies are collaborating on the development of cancer biomarkers and assays for therapy selection, management and monitoring for companion diagnostics utilizing liquid biopsy. Guardant Health entered into separate agreements with AstraZeneca, Merck, and Pfizer Inc. to develop a 500-plus-gene liquid biopsy panel to allow for low-risk, real-time monitoring of tumor response and the evolution of tumor resistance.
Future Technology Roadmap
Cutting-edge imaging technologies are being developed to aid in the early detection of cancer and the delivery of treatment. The use of biomarkers in research and diagnostics is expected to enable more precise, predictive and preventive clinical care. Promising technologies in the oncology diagnostics space are highlighted below.
Cell adhesion molecules, known as integrins, play a major role in cancerous cell angiogenesis and metastasis. Integrins can be recognized by the suitable cancer sequence and adhere to the target molecules. This process is known as angiogenesis. Scientists are focusing on the development of scintigraphy imaging of angiogenesis, which has the potential to detect cancer—especially breast cancer.
Research has indicated that hypoxia of cancer patients is best determined through noninvasive imaging and with the use of validated hypoxia markers, such as [18F]MISO and PET. This method provides a validated and reliable index of tissue hypoxia for individualized cancer treatment. Research papers have indicated that hypoxia imaging is more effective in predicting the survival of patients suffering from head and neck cancer.
As cells proliferate and the nucleus is divided between the resulting cells, iron content also is divided and the signal from each cell decreases. Apoptosis imaging to monitor cancer therapy can be crucial because during apoptosis the cells are weak and can be destroyed. MRI detection of apoptotic cells, in vitro and in vivo, has been demonstrated but the concept must be further explored.
Endocrine Tumor Imaging
Radiopharmaceuticals that are used to image neuroendocrine tumors are either similar in molecular structure to the hormones that the tumors synthesize or are incorporated into various metabolic and cellular processes of the tumor cells. By imaging the endocrinal hormone levels of the cells, one can effectively determine the extent and stage of cancer.
Imaging techniques have significantly improved, and as technologies are further refined, imaging modalities will become even more accurate and reliable.
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