A Diagnostics & Imaging Week

The popularity of minimally invasive surgery is seen as boosting the growth prospects in Europe for enabling technologies such as robot-assisted surgery (RAS) and image-guided surgery (IGS), according to a report by global consulting firm Frost & Sullivan (F&S; London).

Noting that IGS and RAS support increased accuracy levels and improved surgical outcomes, Frost & Sullivan research analyst Kavitha Ravikumar said that "Assertive marketing and publicity campaigns, the prestige perceived in utilizing the latest technology for surgery, together with anticipated cost-efficiencies and streamlining of procedures, are set to provide a further boost to market expansion."

Use of 3-D navigation, with images capable of being altered to provide greater detail, allows for higher accuracy levels on the part of surgeons. Other improved outcomes include shorter operation times, minimal invasion into the body and quicker recovery time.

Ravikumar said superior surgical outcomes, the ability to go deeper and with more precision, overall technology advancements and an ongoing increase in applications are expected to be key in promoting demand for image-guided surgery.

Such smaller, less invasive and more precise surgeries are likely to benefit patients unable to withstand major surgeries, she said. "At the same time, robotic assistants are likely to aid in the performance of steadier surgical techniques, decrease surgery times, guide more precise procedures and permit staff to carry out more dynamic tasks."

Currently, IGS is being deployed in neurological, orthopedic, ENT surgeries, dental applications such as oral implantology and other emerging applications including maxillo-facial surgery. Robotic applications are presently designed for use in surgical procedures such as general, cardiac, orthopaedic and brain.

Improved precision levels in surgery are expected to be central to the popularity of RAS, Ravikumar said. "The ability to build on a surgeon's skill even while reducing stress levels is likely to be key to its increasing uptake." She cited such other advantages as freeing up medical personnel for more productive jobs and compensating for staff shortages by performing peripheral tasks.

Potential expansion into tele-surgery and simulated learning and extending the reach to other procedures such as endoscopies are also likely to support adoption rates, F&S said.

The report noted that at present, image guidance is more popular than robotic assistants, as the surgeon controls and performs the operation while using navigation to minimize errors and increase precision. Accordingly, the European IGS market was estimated at $93.6 million in 2004, with a compound annual growth rate of 13.9% projected over 2004-2008. The orthopedic segment in image-guided surgery is currently the fastest-growing and most promising.

The $18 million European robotic-assisted surgery market is forecast to grow at a more sedate rate of 3.6% from 2004 to 2008.

One of the key deterrents to market growth, Ravikumar said, is likely to be the capital equipment costs. Hospitals are looking for free upgrades as they become available and open platforms that enable them to integrate products from different companies into the system.

"Further technological improvements, greater integration along with more open and flexible platforms are likely to broaden the number of application areas, thereby spurring market growth," she said. "Manufacturers need to concentrate on surgical procedures where the product provides maximum benefit as well as clearly demonstrate how these products provide value for money in terms of investment versus outcome."

Possible new breast cancer biomarkers

Scientists from a joint research study conducted by Applied Biosystems Group (Foster City, California), and the Norwegian Radium Hospital (Oslo, Norway) reported the discovery of a new set of potential prognostic biomarkers for early stage breast cancer during the Human Genome Organization's (HUGO) 10th annual Human Genome Meeting in Kyoto, Japan.

Using Applied Biosystems' Expression Array System and Human Genome Survey Microarray, researchers identified a set of 54 genes they say have the greatest prognostic value for breast cancer and discovered, they added, that tumor aggressiveness may be determined at early stage in different subtypes of breast cancer.

Their findings suggest that these subtypes of breast cancer represent biologically distinct diseases and substantiate the value of gene expression-based subtypes in the prognosis and diagnosis of breast cancer at an early stage.

"Breast cancer is a complex disease and its biology remains a challenge to understand," said Anne-Lise B rresen-Dale, PhD, head of the department of genetics at Norwegian Radium Hospital. "While traditional prognosis factors, such as metastasis, lymph nodes and tumor size, provide limited information about the underlying biology of the disease, the Expression Array System has allowed us to further and systematically characterize the two breast cancer subtypes at the molecular level as well as to identify novel biomarkers."

Researchers identified 1,210 marker genes from samples of early stage breast tumors and characterized them into two previously defined subtypes of breast tumors, Luminal A, signifying an optimistic prognosis, and Basal, signifying a worse prognosis. Of the 1,210 genes, 54 were identified that best discriminate between the two breast cancer subtypes and were validated using TaqMan Gene Expression assays from Roche Molecular Systems (Pleasanton, California) as potential prognostic biomarkers.

Further analysis of the 1,210 genes using the Panther Protein Classification System for functional classification and pathway analysis revealed different molecular mechanisms predicting tumor aggressiveness that may be pre-programmed at early stage breast cancer, the researchers said in their Kyoto presentation.

Norwegian Radium Hospital's Department of Genetics focuses on the molecular biology of breast and ovarian cancer, with emphasis on identification of genotypes and gene expression profiles contributing to elevated cancer risk, radiation sensitivity, tumor aggressiveness, and therapy resistance.

Catherine Burzik, president of Applied Biosystems, an Applera Corp. (Norwalk, Connecticut) company, said the results from the study "provide further evidence that gene expression-based biomarkers may be useful in both the diagnosis and prognosis of early stage breast cancer, as well as in the identification of drug targets for more targeted breast cancer therapeutics."

Results of the study were presented in both an oral and poster presentation at the HUGO meeting.

Newborn screening lab application

The QuadraMed International (Sydney, Australia) division of QuadraMed (Reston, Virginia) reported completing implementation of a newborn screening lab information application for use with the company's Affinity Laboratory system at Great Ormond Street Hospital (GOSH; London).

The company said the new software features "highly specialized functionality" enabling the hospital's Newborn Screening Service to ensure the early detection and subsequent treatment of a number of newborn metabolic diseases to prevent potentially severe mental and/or physical disabilities.

QuadraMed said it developed, installed, configured and fully implemented the first stage of the product in just 10 weeks, with stage two enhancements to be provided over the next few months.

Newborn screening encompasses critical procedures conducted by selected centers in the UK. QuadraMed said the staff at Great Ormond Street Hospital faced the sunset of its existing screening lab software and the increasing complexity of screening. Based on its existing relationship with QuadraMed and the Affinity Laboratory system, the hospital selected the company to meet its need for rapid deployment of advanced screening software.

Affinity Laboratory is a laboratory information system focused on providing "consistent, accurate and timely data on a cost-effective basis," according to QuadraMed.

Dean Souleles, the company's chief technology officer, said, "our international division responded by working to help GOSH to assure [that] its clinicians will have the data they need when they need it to provide effective treatment."

Great Ormond Street Hospital offers the widest range of pediatric specialties in the UK, and treats children worldwide as a tertiary referral center. It said it traces its history to 1852, when it became the first children's facility in the English-speaking world.

QuadraMed International's UK offices are in Winchester, Hampshire.