SINGAPORE — Instead of having to put up with weeks of uncertainty, people who suspect that they have cancer will soon be able to confirm if they have a malignant tumour, as well as ascertain the stage of their cancer in as little as two hours.

Patients will also only need to provide doctors with a small amount of tissue sample equivalent to the size of a drop of blood – or 50 micro-litres – extracted by a fine needle.

The breakthrough from researchers at the National University of Singapore (NUS) also means that patients will no longer have to undergo multiple biopsies. 

Currently, the most popular fine needle aspiration (FNA) biopsy option has up to a 35 per cent chance of being inconclusive, which means one in three patients will have to return to the hospital for another jab.

But the new test has been more than 94 per cent accurate in not only detecting and classifying cancer cells but also determining how aggressive the cancer is among 69 breast cancer patients who participated in the study’s first phase of clinical trials here.

The researchers added that the test is estimated to cost S$50.  

Traditional tumor tissue biopsies can cost hundreds of dollars. Despite the price tag, these findings are inadequate for a definitive diagnosis on cancer staging and most cancer patients have to be operated upon before doctors can get the information they need to guide subsequent treatment decisions.

The study, led by Assistant Professor Shao Huilin from the NUS Institute for Health Innovation and Technology (NUS iHealthtech), made it on the cover of a prestigious scientific journal, Nature Biomedical Engineering, this month.

HOW IT WORKS

The key is in tapping on “DNA barcodes” that are programmed to measure billions of protein markers — the amount as well as the distribution of these protein markers in a cell.

While DNA, or deoxyribonucleic acid, has the capacity to measure that many markers, it was not used as it is susceptible to biological degradation and was thought as “unstable” for this kind of analysis noted Dr Shao.

However, Prof Shao and her team of nine researchers spent two years figuring out how to use the DNA, which exists in nature as long ribbons, by "folding" it into a compact nanostructure that resembles a pyramid so that it becomes stable enough as a “3D barcode”.

Each 3D barcode was then given a “localisation label” to encode protein marker location and distribution within the cell, said Mr Noah Sundah, a doctoral student from NUS iHealthtech as well as the NUS Department of Biomedical Engineering who is the first author of the study.

The team further implemented the technology on a chip, which is about half the size of a credit card. 

To use the chip, medical personnel can input the tissue sample on one end, and the barcoded sample can be extracted from the other end of the chip in one hour.

To read the barcodes, the engineered DNA can be “unfolded” by applying heat. The pool of linear DNA released can then be analysed using established technologies, such as the polymerase chain reaction method that can duplicate each DNA into thousands to millions of copies. The entire process takes two hours.

CAN IT BE USED FOR ALL CANCERS?

Theoretically yes, according to Prof Shao. She said it has the potential to be the “one-stop shop” for all cancer testing.

“By using different DNA barcodes, we can use the same chip for detecting different cancer types. This technology is able to measure the amount of protein markers, as well as the distribution of the markers in a cell,” Prof Shao said. "This massive amount of information can accurately diagnose and reveal disease aggressiveness."

This technology could particularly benefit patients with cancers located at the more internal organs — such as the lungs, liver, pancreas or brain — who would most likely opt for the least invasive form of biopsy to reduce potential complications.

WHEN THE TECHNOLOGY WILL HIT THE MARKET

In the next phase of trials, the study will be expanded to involve some 800 patients, across the most common types of cancers diagnosed here: Breast, colorectal and lung.

If all goes well, the technology is expected to reach the market in the next five years.

In the meantime, a provisional patent has been filed for the technology. Prof Shao and her team are in discussions with industry partners to further develop and commercialise it.

Cancer affects 20 per cent of males and 17 per cent of females worldwide, according to 2018 statistics from the World Health Organisation. Thirteen per cent of males and nine per cent of females die from it.

The Singapore Cancer Registry’s report in 2015 states that Singapore sees 34 new cases and 14 deaths daily.