Ultrasound breakthrough can pinpoint cancer with precision

Heriot Watt University | September 2019 | Ultrasound breakthrough can pinpoint cancer with precision

Experts at Heriot Watt University have found a new technique which uses super-resolution ultrasound methods that improves resolution of ultrasound images by 5-10 times compared to standard current ultrasound images.

Their innovation allows whole organs to be scanned in super-resolution for the first time which, it is anticipated, will lead to earlier cancer diagnoses and allow medical staff to more effectively target treatments to any malignant tissue. Potentially, it could eventually replace the need for biopsy altogether.

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The team behind this innovation  the aim is to start human trials using the new technique in three months’ time at the Western General Hospital in Edinburgh. Patients with prostate issues will be the first to benefit from the enhanced imaging.

Professor Alan McNeill, Consultant Urological Surgeon at the Western General Hospital in Edinburgh said: “Prostate cancer is an increasing problem for our society. Whilst we have a number of methods for detecting it, these don’t always provide us with the important information that we need regarding who has cancer that needs to be treated and who doesn’t.

“A method that maps the blood flow of the tumour accurately could well provide new information about the disease state that allows us to better identify those men who need urgent treatment and those who don’t. It is exciting that we will be the first hospital in the world that will assess this method with patients.” (Source: Heriot Watt University)

Read the full, unabridged press release from Heriot Watt University

Abstract

Objectives The aim of this study was to provide an ultrasound-based super-resolution methodology that can be implemented using clinical 2-dimensional ultrasound equipment and standard contrast-enhanced ultrasound modes. In addition, the aim is to achieve this for true-to-life patient imaging conditions, including realistic examination times of a few minutes and adequate image penetration depths that can be used to scan entire organs without sacrificing current super-resolution ultrasound imaging performance.

Methods Standard contrast-enhanced ultrasound was used along with bolus or infusion injections of SonoVue (Bracco, Geneva, Switzerland) microbubble (MB) suspensions. An image analysis methodology, translated from light microscopy algorithms, was developed for use with ultrasound contrast imaging video data. New features that are tailored for ultrasound contrast image data were developed for MB detection and segmentation, so that the algorithm can deal with single and overlapping MBs. The method was tested initially on synthetic data, then with a simple microvessel phantom, and then with in vivo ultrasound contrast video loops from sheep ovaries. Tracks detailing the vascular structure and corresponding velocity map of the sheep ovary were reconstructed. Images acquired from light microscopy, optical projection tomography, and optical coherence tomography were compared with the vasculature network that was revealed in the ultrasound contrast data. The final method was applied to clinical prostate data as a proof of principle.

Results Features of the ovary identified in optical modalities mentioned previously were also identified in the ultrasound super-resolution density maps. Follicular areas, follicle wall, vessel diameter, and tissue dimensions were very similar. An approximately 8.5-fold resolution gain was demonstrated in vessel width, as vessels of width down to 60 μm were detected and verified (λ = 514 μm). Best agreement was found between ultrasound measurements and optical coherence tomography with 10% difference in the measured vessel widths, whereas ex vivo microscopy measurements were significantly lower by 43% on average. The results were mostly achieved using video loops of under 2-minute duration that included respiratory motion. A feasibility study on a human prostate showed good agreement between density and velocity ultrasound maps with the histological evaluation of the location of a tumor.

Conclusions The feasibility of a 2-dimensional contrast-enhanced ultrasound-based super-resolution method was demonstrated using in vitro, synthetic and in vivo animal data. The method reduces the examination times to a few minutes using state-of-the-art ultrasound equipment and can provide super-resolution maps for an entire prostate with similar resolution to that achieved in other studies.

The original research is available in full from Investigative Radiology

In the news:

BBC News Ultrasound breakthrough ‘can spot cancer earlier’

New blood test for prostate cancer is highly-accurate and avoids invasive biopsies

Queen Mary University | September 2019 | New blood test for prostate cancer is highly-accurate and avoids invasive biopsies

A blood test developed by experts at Queen Mary University marks a ‘paradigm shift’ in the way prostate cancer is diagnosed. 

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The new prostate cancer test detects early cancer cells, or circulating tumor cells (CTCs), that have left the original tumour and entered the bloodstream prior to spreading around the body. By measuring intact living cancer cells in the patient’s blood, rather than the PSA protein which may be present in the blood for reasons other than cancer, it potentially provides a more accurate test for prostate cancer.

The study tested the use of the CTC test in 98 pre-biopsy patients and 155 newly diagnosed prostate cancer patients enrolled at St Bartholomew’s Hospital in London.

The research team found that the presence of CTCs in pre-biopsy blood samples were indicative of the presence of aggressive prostate cancer, and efficiently and non-invasively predicted the later outcome of biopsy results.

When the CTC tests were used in combination with the current PSA test, it was able to predict the presence of aggressive prostate cancer in subsequent biopsies with over 90 per cent accuracy, better than any previously reported biomarkers.

Additionally, the number and type of CTCs present in the blood was also indicative of the aggressiveness of the cancer. Focusing on more aggressive prostate cancer may reduce over-treatment and unnecessary biopsies for benign and non-aggressive conditions.

(Source Queen Mary University) 

Full reference: Xu, L. | 2019|Non-invasive Detection of Clinically Significant Prostate Cancer Using Circulating Tumor Cells | Journal of Urology | https://doi.org/10.1097/JU.0000000000000475

Purpose:

PSA testing results in unnecessary biopsy and over-diagnosis with consequent over-treatment. Tissue biopsy is an invasive procedure, associated with significant morbidity. More accurate non- or minimum-invasive diagnostic approaches should be developed to avoid unnecessary prostate biopsy and over-diagnosis. We investigated the potential of using circulating tumor cell analysis in cancer diagnosis, particularly in predicting clinically significant prostate cancer in pre-biopsy patients.

Material and Methods:

We enrolled 155 treatment naïve prostate cancer patients and 98 pre-biopsy patients for circulating tumor cell numeration. RNA was extracted from circulating tumor cells from 184 patients for gene expression analysis. Kruskal-Wallis, Spearman’s rank, multivariate logistic regression and random forest were applied to assess the association of circulating tumor cells with aggressive prostate cancer.

Results:

In localized prostate cancer patients, 54% were scored as circulating tumor cell positive, which was associated with higher Gleason score ( p=0.0003), risk group ( p<0.0001) and clinically significant prostate cancer. In pre-biopsy group, positive circulating tumor cell score in combination with PSA predicted clinically significant prostate cancer with AUC=0.869. A 12-gene panel prognostic for clinically significant prostate cancer was also identified. Combining PSA level, circulating tumor cell-score and the 12-gene panel, AUC for clinically significant prostate cancer prediction was 0.927 and in cases with multi-parametric MRI data, adding these to multi-parametric MRI significantly increased the prediction accuracy.

Conclusions:

Circulating tumor cell analysis has the potential to significantly improve patient stratification by PSA and/or multi-parametric MRI for biopsy and treatment.

The Library can provide the full article to Rotherham NHS Staff, request here

 

See also:

Science Daily New blood test for prostate cancer is highly-accurate and avoids invasive biopsies

GPs diagnosing cancers earlier

New study concludes that GPs appear to be diagnosing cancers earlier, helping to reduce the numbers of cancer patients receiving their diagnosis in accident and emergency (A&E) departments, thereby improving their chance of survival British Journal of General Practice | via OnMedica

In this large study, the researchers studied Routes to Diagnosis data on 554,621 patients with cancer in England who presented as emergencies between 2006 to 2015. They found there was a decline in the annual rate of emergency presentations, with emergency referrals from GPs falling by about a half.

The authors suggested this was likely to reflect increasing use by GPs of the two week wait referral pathways, as well as reductions in emergency presentations following a GP referral, likely indicating a trend towards earlier diagnosis in general practice.

Full story at OnMedica

Full article: Herbert A, Abel GA, Winters S, et al. | Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015 | British Journal of General Practice 2019

Rapid Diagnostic Centres Vision and 2019/20 Implementation Specification

NHS England | July 2019 | Rapid Diagnostic Centres Vision and 2019/20 Implementation Specification

NHS England have released Rapid Diagnostic Centres Vision and 2019/20 Implementation Specification the purpose of this document is to outline the draft vision and approach for how Rapid Diagnostic Centres (RDCs)  will develop and support the transformation of cancer diagnosis services over time and provide an implementation specification for Cancer Alliances to begin setting up RDCs in 2019/20.

Rapid Diagnostic Centres Vision and 2019/20 Implementation Specification

 

New life-saving treatment and diagnosis technology

Diseases could be detected even before people experience symptoms, thanks to a pioneering new health-data programme as part of the government’s modern Industrial Strategy

Businesses and charities are expected to jointly invest up to £160 million, alongside a £79 million government investment, as part of the Accelerating Detection of Disease programme. The project will support research, early diagnosis, prevention and treatment for diseases including cancer, dementia and heart disease.

The pioneering initiative will recruit up to 5 million healthy people. Volunteered data from the individuals will help UK scientists and researchers invent new ways to detect and prevent the development of diseases.

Full story: UK to innovate new life-saving treatment and diagnosis technology | Department of Health & Social Care

Early cancer detection and survival to be prioritised by NHS

Monitoring one-year survival will be central to measuring progress in transforming cancer care, the Health and Social Care Secretary has announced.

Screening programmes will be overhauled and diagnosis made faster and more accurate with new state-of-the-art technology as part of a blueprint for rapidly improving cancer detection and survival the Health and Social Care Secretary Matt Hancock has announced.

Speaking in the House of Commons, the Health and Social Care Secretary set out how the NHS will deliver on its commitments to improve early detection of cancer.

In January, the NHS Long Term Plan set the ambition for three-quarters of all cancers to be detected at an early stage and 55,000 more people surviving cancer for 5 years each year by 2028. The Implementation Framework, agreed by the NHS, provides a blueprint for how this will be achieved at a local level. The one-year metric will be used to measure progress.

Steps in the framework include:

  • a radical overhaul of screening programmes
  • new state-of-the-art technology to make diagnosis faster and more accurate
  • more investment in research and innovation
  • the roll-out of new Rapid Diagnostic Centres across the country, building on the success of a pilot scheme with Cancer Resarch UK
  • NHS England extending lung health checks, targeting areas with the lowest survival rates
  • Health Education England increasing the cancer workforce, which will lead to 400 clinical endoscopists and 300 reporting radiographers by 2021

The document sets out the framework through which each of the 300 commitments in the Long Term Plan will be delivered – including the 20 headline commitments – as well as how government will monitor and support systems at a local level.

Full detail at Department of Health and Social Care

Annual NHS cancer checks top two million for the first time

For the first time last year, the NHS in England carried out more than two million checks on people who feared they might have cancer.

In 2018, patients underwent a record 2.2 million cancer checks following urgent referral by their GP, almost 6,000 a day or more than four every minute. That was an increase of almost a quarter of a million on the 1.9 million people who were seen in 2017.

Record numbers of people also received treatment for cancer, with 308,058 receiving a first treatment in 2018, almost 13,000 more than in 2017 and the first time the number has topped 300,000.

Cancer survival is at an all time high with new figures showing 10,000 more patients surviving for at least 12 months after diagnosis than five years earlier. However, the NHS Long Term Plan aims to increasing the proportion of cancers caught early from half to three quarters, an improvement that will save up to 55,000 more lives each year.

Full story at NHS England