Laboratory/diagnostics
The lab field is exploding with promise … and promises. Which of these technologies will stand the test of time?
In the September issue of Repertoire, lab expert Jim Poggi wrote about exciting developments in tumor markers, including new, more specific molecular markers for a wide variety of cancers. The range of diagnostic benefits of newer markers is expanding quickly, as are the number of new tumor markers being brought to market, he said.
What about some of the other lab-related developments in the news today? They sound cool, but will they fly? We asked Poggi to give us his take.
Technology What is it? Market status Poggi says…
| Next-generation sequencing | The ability to look at millions of DNA changes in a single test to help determine the cause of disease | On the market | Dramatically changing what we know about causes of cancer and how it progresses. A big deal. |
| Liquid biopsy/blood markers | Blood tests for detection of colon cancer, lung cancer, etc. | On the market | This is where the future of colorectal cancer screening is going. Applicable to other cancers also. |
| HPV tests for cervical cancer | Researchers are investigating substituting Pap smear with HPV test, which is less invasive, with longer-lasting results | Under study | More objective and consistent than human-read slides. But, do we really know that cervical CA is always related to HPV? At this point, I believe both techniques still have value. |
| Nanopore sensors | Microchip can analyze one molecule at a time | Research phase | My first impression is that there are better ways to achieve this outcome. I would prefer to use LC/MS (Liquid chromatography–mass spectrometry), since it uses two different technologies to get a highly specific answer. The nanopore technology uses only one technology – pore size. |
| Risk prediction models | Use of algorithm/artificial intelligence to identify patients at highest risk of a certain diseases (e.g., lung cancer), to improve screening guidelines | Research phase | Hello, 1984! Risk prediction uses clinical data to correlate personal and environmental factors to development, progression and treatment of disease. I believe it is every bit as important as next generation sequencing to future prevention and treatment programs, and maybe your insurance premiums. |
| Routine DNA sequencing | Effort by some health systems to conduct DNA sequencing of entire patient population | Underway (Geisinger, for one) | What’s in YOUR genome? Privacy issues and percent yield of actionable data remain questions. BUT data indicates this technique can identify individuals with predisposition to certain cancers and heart disease. Privacy versus progress… |
| Voice-based technology | Machine intelligence helps detect changes in a user’s voice, which could signal a variety of health conditions | Research phase (Sonde Health) | Your mom always had this. But, outside of detecting anxiety, untruthfulness and relating vocal timber to pain, I don’t see enough specificity to care about. Get a CBC and a CMP instead. |
| Blood test for concussion | Proteins in the blood are measured to help predict which patients may have intracranial lesions visible by CT scan | FDA clearance granted February 2018 (Banyan Biomarkers Inc.) | Already proving to be useful. I believe it is useful ALONG WITH careful follow-up post-cranial injury/impact. Routine follow-up to staff meetings? |
| Wearable and point-of-care microscopes | Devices use on-chip illumination and sensing to non-invasively aid in diagnosis and monitoring health conditions | Research phase | If issues can be diagnosed on the fly with wearables, the infrastructure to send the results to the clinician, make appointments for further work, etc., is already in place. I believe there is a future. |
| Retinal examination | Uses correlation between retinal vessels and the risk of cardiovascular episodes to predict major CV events | Research phase (Google) | Retinal changes are already used to evaluate progression of diabetes. The specificity needs to be demonstrated for me to buy in. |
| Cell markers | Indicate a DNA mutation that changes protein synthesis, either promoting a disease process or inhibiting typical treatments from working | Research phase | Cell markers are the outcomes of changes in protein synthesis. They are the future of lab tests for cancer and other diseases. Think of them as metabolic end products. We already test for many metabolic end products, including bilirubin and creatinine. |
| Wearable glasses to measure blood pressure | Uses a combination of three optical sensors and a three-axis accelerometer | Research phase (Microsoft) | Worried well(thy), this dud’s for you! Unless you already know you have seriously uncontrolled hypertension (51 percent of diagnosed U.S. hypertensives are uncontrolled), save your dough. Exercise, eat right, stop smoking, have an annual physical and look forward to better drugs in the future. |
| Jim Poggi’s wild card!! | DNA/protein switch regulation | Research phase | “Genes on, genes off!” As we learn which switches control which genes to create which proteins, we can control metabolism and alter the incidence of diseases. This could change everything. |