The value proposition of integrative diagnostics for (early) detection of cancer. On behalf of the EFLM interdisciplinary Task and Finish Group "CNAPS/CTC for early detection of cancer"

Tumor specific protein 70 targeted tumor cell isolation technology can improve the accuracy of cytopathological examination

OBJECTIVES

Although existing cytopathological examination is considered essential for the diagnosis of malignant serous effusions, its accuracy is pretty low. Tumor specific protein 70 (SP70), which is highly expressed on human tumor cell membrane, was identified in our previous study. This study aimed to explore whether SP70 targeted tumor cell isolation technology with immunomagnetic beads can improve the accuracy of cytopathological examination.

METHODS

Cytopathological analysis with SP70 targeted tumor cell isolation technology was used in this study. In total, 255 cases were enrolled. Serous effusions were analyzed by both existing cytopathological examination and the new cytopathological analysis concurrently.

RESULTS

The sensitivities of existing cytopathological examination and the new cytopathological analysis were 51.26 % and 85.43 %, respectively, while the specificities were 100 % for both. This new cytopathological analysis demonstrated a higher interobserver agreement with malignant diagnosis than the existing cytopathological examination (kappa coefficient: 0.720 vs. 0.316, p<0.001). In addition, it achieved superior diagnostic efficacy for malignancy differentiation compared to existing cytopathological examination (AUC: 0.927 vs. 0.756, p<0.001). The follow-up results showed that 74 malignant cases with final clinical diagnosis were positive only with the new cytopathological analysis. Among these cases, there were 58 negative and 16 atypical by the existing cytopathological examination. In these malignant cases, 74.3 % (55/74) had been confirmed to have serosa metastasis based on radiographic evidence, and 73.7 % (28/38) harbored tumor hotspot mutations.

CONCLUSIONS

As illustrated in this work, cytopathological analysis with SP70 targeted tumor cell isolation technology can improve the accuracy of existing cytopathological examination prominently.

Promoting value-based laboratory medicine: Moving towards an innovative model of clinical laboratory

The shift to value-based healthcare, emphasizing quality and clinical outcomes rather than volumes and volume-based payment models presents challenges and opportunities for clinical laboratories. In order to promote value-based laboratory medicine (VBLM), it is imperative to transition from a subjective interpretation of laboratory information by clinicians and/or users to an objective interpretation based on sound and measurable variables. This transition is of the utmost importance to provide evidence of the role of laboratory information and of the fundamental role of laboratory professionals. Therefore, laboratory professionals must promote the adoption of personalized reference intervals (pRIs), personalized decision limits (pDLs) and personalized reference change values (pRCVs), and the remodeling of laboratory information into valuable clinical insights should be achieved through the utilization of longitudinal data. Another essential issue is the role of laboratory medicine in promoting the shift from the prevailing emphasis on "sick care" to that of "well care", as laboratory data play a crucial role in monitoring the health status of both healthy individuals and patients. Finally, clinical laboratories need to move out of the silo and implement integrated practice units rather than focused factories focused on efficiency metrics such as volume, economies of scale and cost per test.

Defining the value proposition in diagnostic technology: challenges and opportunities for its understanding and development - a review with a multiperspective reflective analysis

Background

The Value Proposition (VP) in diagnostic technology serves as a "positioning statement" outlining the unique benefits, costs, and differentiation an innovation under development offers to healthcare organizations and its ability to effectively deliver these advantages in comparison to current interventions in the market. Despite its significance however, VP lacks a universally accepted definition, which is compounded by the diversity of technologies, their applications, and the varying needs of stakeholders. This paper aims to address this gap by offering a detailed conceptual analysis, revised definition of VP, and actionable recommendations for advancing VP development.

Methodology

We conducted a targeted narrative review, focusing on literature explicitly defining VPs in diagnostic technologies. Using Ovid's Medline and Embase databases, we identified 19 relevant papers, of which only 5 provided explicit VP definitions. Our analysis incorporated principles of team science, encompassing reflective and thematic analyses of (1) interdisciplinary co-author discussions enabling us to weave together diverse insights into a cohesive exploration of the topic, and (2) MTech's publicly available set of anonymised responses from NHS Associates, to capture the perspectives of the decision-makers and further enhance depth and breadth of our discourse.

Results and discussion

Our findings highlight the multifaceted nature of VP and its primary hurdles: inadequate identification of unmet needs and insufficient recognition of key stakeholders. We synthesized the evolution of VP definitions and explored the importance of unmet needs in their development, guided by frameworks, such as the Health Technology Navigation Pathway Tool, to ensure VPs meet both the pragmatic and aspirational goals of the healthcare. Thematic insights revealed opportunities for addressing these barriers through implementation science and collaborative strategies. This multi-perspective approach provided a conceptual examination of VP, enabling integration of varied viewpoints and insights.

Conclusion

By employing team science principles and reflective analysis, we introduced a revised definition of VP and a set of actionable recommendations to guide VP development in diagnostics. These findings highlight the importance of addressing stakeholder diversity, unmet needs, and the intricacies of blending interdisciplinary perspectives to advance the field.

Multiparametric MRI for characterization of the tumour microenvironment

Our understanding of tumour biology has evolved over the past decades and cancer is now viewed as a complex ecosystem with interactions between various cellular and non-cellular components within the tumour microenvironment (TME) at multiple scales. However, morphological imaging remains the mainstay of tumour staging and assessment of response to therapy, and the characterization of the TME with non-invasive imaging has not yet entered routine clinical practice. By combining multiple MRI sequences, each providing different but complementary information about the TME, multiparametric MRI (mpMRI) enables non-invasive assessment of molecular and cellular features within the TME, including their spatial and temporal heterogeneity. With an increasing number of advanced MRI techniques bridging the gap between preclinical and clinical applications, mpMRI could ultimately guide the selection of treatment approaches, precisely tailored to each individual patient, tumour and therapeutic modality. In this Review, we describe the evolving role of mpMRI in the non-invasive characterization of the TME, outline its applications for cancer detection, staging and assessment of response to therapy, and discuss considerations and challenges for its use in future medical applications, including personalized integrated diagnostics.

Imaging-based characterization of tumoral heterogeneity for personalized cancer treatment

With personalized tumor therapy, understanding and addressing the heterogeneity of malignant tumors is becoming increasingly important. Heterogeneity can be found within one lesion (intralesional) and between several tumor lesions emerging from one primary tumor (interlesional). The heterogeneous tumor cells may show a different response to treatment due to their biology, which in turn influences the outcome of the affected patients and the choice of therapeutic agents. Therefore, both intra- and interlesional heterogeneity should be addressed at the diagnostic stage. While genetic and biological heterogeneity are important parameters in molecular tumor characterization and in histopathology, they are not yet addressed routinely in medical imaging. This article summarizes the recently established markers for tumor heterogeneity in imaging as well as heterogeneous/mixed response to therapy. Furthermore, a look at emerging markers is given. The ultimate goal of this overview is to provide comprehensive understanding of tumor heterogeneity and its implications for radiology and for communication with interdisciplinary teams in oncology. KEY POINTS::   · Tumor heterogeneity can be described within one lesion (intralesional) or between several lesions (interlesional).. · The heterogeneous biology of tumor cells can lead to a mixed therapeutic response and should be addressed in diagnostics and the therapeutic regime.. · Quantitative image diagnostics can be enhanced using AI, improved histopathological methods, and liquid profiling in the future..

Integrated diagnostics

BACKGROUND

Integrated diagnostics is increasingly gaining scientific traction as it promises to address several challenges currently facing diagnostic medicine. These challenges range from the need for improved diagnostic accuracy to optimized timing of diagnostic procedures, to the variety of diagnostic markers and thus the complexity of their interpretation, and finally to economic pressure.

METHODICAL INNOVATIONS

While many of these challenges may be difficult to solve with a monomodal approach, the integration of laboratory markers and imaging procedures promises to allow both disciplines to achieve their actual clinical potential. Combining complementary diagnostic approaches can help to improve the interpretation of measurements, provide a better cost-effectiveness particularly when cutting-edge techniques are used for specific indications, and facilitate optimized timing and rational choice of appropriate diagnostic approaches for disease surveillance. Furthermore, close interdisciplinary assessment of diagnostic results will increase diagnostic accuracy and will enable selection of specific patient cohorts at increased risk for certain diseases who are suitable for further testing.

CONCLUSION

The potential of an integrated diagnostic approach represents a strategic goal for diagnostic disciplines as it achieves better visibility and greater clinical impact. In addition to close collaboration among relevant diagnostic experts, an appropriate structure for integrated data evaluation needs to be established to provide actionable health guidance so that integrated diagnostics can be implemented in standard care.