Diagnostics of the future: tools more and more reliable and accurate

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Diagnostics of the future: tools more and more reliable and accurate

When the doctor assures us that everything is fine or that he announces a problem, we prefer that he be sure of his diagnosis. In order not to be wrong or to miss something, he can count on new tools, always more reliable and more precise.

Artificial intelligence takes the time backwards

The diagnostic aid that is most talked about is based on artificial intelligence (AI). Computer algorithms should indeed give a serious helping hand to radiologists. Fewer and fewer, they have to analyze more and more images to detect a cancer or a heart problem. Among the few solutions already used in hospitals, the Arterys software makes it possible to calculate the volume and strength of the heart faster, for example, to assess the degree of heart failure. A recent study published in Radiology also confirms that AI increases the diagnostic performance of mammograms for the detection of breast cancer, including at a very early stage. "The idea is not to have a computer that answers in the radiologist's place, but to save time (for patients) and, in some cases, to detect problems sooner", says Professor Loïc Boussel, head of the medical imaging department of the Civil Hospitals of Lyon.

Saliva reveals its secrets

It does not just trap criminals via their DNA! Thanks to new sequencing tools, we now know that this fluid contains more than 4,000 different proteins, or as many biomarkers. Rich in information, therefore. "But we still do not know how to distinguish" normal "saliva from pathological saliva. To do this, thousands of samples must be collected in order to compare them and to draw concrete applications from them »Dr. Christophe Hirtz, a biochemist at the University of Montpellier, who is currently working with his colleagues on a salivary data bank. Saliva also contains "waste" cells, which contain DNA. We can thus find the traces of certain cancers, in particular ENT cancers. A Chinese team has shown that mutations in the EGFR gene involved in some lung cancers can be isolated in saliva. In recent years, we have also been talking about a salivary test to detect Alzheimer's disease: "Today, the diagnosis is made by analyzing the cerebrospinal fluid. But there are biomarkers of the disease in saliva, including beta-amyloid. It remains to be seen if their dosage truly reflects what is happening in the brain "explains Professor Hirtz. That would be good news, because the oral sample has a big advantage on the puncture: it is fast and painless and nobody has the phobia of the cotton swab in the mouth!

The tip of our finger falls right

Despite its potential, saliva has competition because blood tests are also becoming less invasive. No need to take several blood tubes: for many dosages, a single drop at the tip of your finger is now enough. The principle is already used for HIV testing with self-tests, which can be done discreetly at home. Montpellier-based start-up Spot-To-Lab is producing tests for hepatitis B or C that require only a drop of blood on a blotting paper. "In Switzerland or Belgium, this type of test allows to relocate certain assays from laboratories to the doctor's office (for example, albumin to detect liver or kidney failure), in order to save time and have an almost immediate response "says Professor Hirtz. Even more promising: the Alsatian start-up Firalis has developed a test for Alzheimer's disease based on the identification of two biomarkers. In the course of validation in a European clinical study conducted on 800 patients, the ADDIA test, if proven, could be commercialized as early as 2022 and perhaps make it possible to dispense with lumbar punctures and brain imaging, very expensive, to make the diagnosis as soon as possible! The company is also developing blood tests to anticipate the risk of heart failure after an infarction or response to rheumatoid arthritis treatments.

The blood test extends his domain

The classic blood test will not disappear, especially since it could be a valuable ally in the fight against cancer. The team of Professor Patrizia Paterlini-Bréchot, oncologist and researcher in cell biology, caused a mini-revolution: it is now possible to detect in the blood cancer that is not yet visible on imaging. "Our ISET test identifies tumor cells circulating in the blood (they are larger than most other cells that walk around), sometimes several years before metastases of invasive cancer appear."says the researcher. In the future, we could therefore act much earlier, for example by strengthening the immune system of patients (via food, sports, meditation ...). Repetable, inexpensive and painless, these "liquid biopsies" would also provide better monitoring of the evolution of cancer. The ISET test is currently available as part of a pilot laboratory. But for it to be reimbursed, and therefore accessible on a large scale, the team will have to offer a specific test for each cancer, which will take time ...

Scanners rise in rank

Last progress to better track diseases: spectral imaging, already available on some scanners in France. It incorporates color into the images, for example to visualize the fixation of injected iodine on a tumor: this increases the detection sensitivity of cancers or heart problems. With it, one can also better assess the perfusion abnormalities related to stroke and treat a patient up to twenty-four hours after the accident (against six until recently). "In the next three to ten years, we will add to these scanners the photonic count, which increases their resolution and allows to see things three times smaller, up to 1 / 9th of a millimeter (against 1 / 6th). This will make it possible to better observe the calcifications in the arteries, and thus to be able to predict the risk of a cardiovascular event in a patient and to personalize his treatment. All while reducing the radiation that we receive when we pass the exam "adds Loïc Boussel of the Medical Imaging Department of Lyon's Civil Hospices, where a prototype is under development.

Read also :

⋙ Cancer diagnosis: artificial intelligence stronger than doctors

⋙ Soon a blood test to detect Alzheimer's disease?

⋙ Medical imaging: revolution in sight!

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