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‘Sponge on a string’ test to transform oesophageal cancer diagnosis

last modified Aug 04, 2020 01:43 PM

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Comparison of the Cytosponge-TFF3 procedure with the endoscopy procedure
The trial results for the Cytosponge test, developed over many years by Rebecca Fitzgerald’s group at the MRC CU in collaboration with numerous collaborators, published in The Lancet today, mark a ‘game changer’ moment in the journey of the early detection device and test towards patient care.

   

The results published today, involved 13657 participants and show that the Cytosponge TFF3 test can identify ten times more people with Barrett’s oesophagus –a precursor condition to oesophageal cancer- than the usual GP route (140 cases of BE were detected with the Cytosponge. 13 cases were diagnosed in usual care). The test, which can be carried out by a nurse in the GP surgery, is also better at picking up abnormal cells and potentially early stage cancer (five cases of early cancer (stage 1 and 2) detected, versus only one case of early cancer detected in the usual care group).

The test, a quick, simple and well tolerated method, can be performed in a GP surgery and helps inform doctors who needs an endoscopy, sparing many people from having potentially unnecessary endoscopies. Alongside better detection, the test means cancer patients can benefit from kinder treatment options if their cancer is caught at a much earlier stage.

Because COVID-19 has reduced the number of endoscopies that can be carried out by the NHS, Addenbrooke’s Hospital in Cambridge has already fast-tracked the Cytosponge into use in order to help identify priority cases with suspected cancer who need further tests urgently.

The test is currently undergoing an economic evaluation and it is hoped that it will be rolled out within GP practices within three to five years. It’s expected that the Cytosponge will be offered by GPs to patients on medication for acid reflux symptoms. Rebecca has recently received funding from the government’s industrial strategy challenge fund towards this process and further innovations such as developing AI algorithms to assist pathologists to make rapid diagnoses from the Cytosponge cell samples is also underway.

To put the impact of this paper in context - around 9,200 people are diagnosed with oesophageal cancer in the UK each year and almost 7,900 sadly die. Early diagnosis is crucial to patients’ survival and a shift in stage can have a large impact on outcomes. 85% of people diagnosed with the earliest stage of oesophageal cancer in England survive their cancer for 1 year or more. This figure drops to 21% if the cancer is diagnosed at the most advanced stage.

Liz Chipchase, a retired scientist from Cambridge, was one of the people who took part in the Cytosponge clinical trial. Liz felt in good health but abnormalities were discovered and she was referred for further tests. Not only did Liz have Barrett’s oesophagus, she also had cancer.

She says: “If I hadn’t been invited and gone on the trial, I would’ve had no idea that I needed treatment for an early stage cancer. And I’m also aware that the survival rate for oesophageal cancer isn’t good, so the fact I am clear of cancer is wonderful. I feel so lucky thinking about the chain of events that led to the cancer being caught when it was. To me, this trial saved my life.”

 

The study entitled A pragmatic randomised, controlled trial of an offer of Cytosponge-TFF3 test compared with usual care to identify Barrett’s oesophagus in primary care was published in The Lancet on 31 July, 2020