unique biomarkers hiding in plain sight

Exposing circulating atypical cells in blood

X-ZELL single-cell diagnostics is a cytopathological tool to identify circulating atypical cells in a small blood sample and digitise them for AI-assisted analysis.


Cancer is known for causing distinctive morphological changes to cell shape and nucleus. These abnormal – or atypical – cells start shedding into the host blood when the tumour is just 1-2mm in size.¹

Cytological staining can expose some of these altered cells in tissue samples and cell smears. The most prominent example of a cytological stain is the Papanicolaou (Pap) test, which examines smears from the cervix to identify abnormalities that may expedite cancer diagnoses.²


Broad-based introduction of the Pap smear as a frontline screening tool has reduced cervical cancer mortality by up to 92 per cent since the 1960s – but the test’s population impact is still limited.

With cervical cancer accounting for just three per cent of cancer cases in 2020, some 97 per cent of patients do not have access to a genuine frontline screening test.

The reason why Pap-style screening has not been applied to more cancer types is that tumour-associated atypical cells are exceedingly rare – making them almost impossible to detect in most in most specimen.

To find them outside of cervical smears, cytologists typically require a tissue sample, which can only be obtained through an invasive biopsy.

Atypical cell examples (prostate and lung cancer)


By shifting from invasive smears and tissue extraction to non-invasive blood testing, X-ZELL is taking the Pap-test principle to the next level.

X-ZELL’s single-cell diagnostics platform can isolate individual atypical cells from 10mL of blood and digitise the sample for cytopathological evaluation.

X-ZELL’s deep-leaning artificial intelligence then scans the sample and flags suspicious cells live on screen to support the evaluation process as a quality control tool and reduce human error.

The system targets atypical cells from both tumour tissue and blood vessels, making it exceptionally effective for finding early-stage cancers that require clinical action.

To date, X-ZELL has analysed more than 2,000 samples and published 11 scientific papers and conference posters showing that single-cell diagnostics from blood has the potential to significantly improve diagnostic decision-making.

¹Infections, allergic reactions and autoimmune diseases also cause morphologies changes in cells. These changes are unique to the disease.

²Abnormal findings are typically followed up by more sensitive diagnostic procedures and, if warranted, interventions to prevent progression to cervical cancer.

Note: Cytopathology is only one of several tools to confirm the presence of cancer and should be supported by physical examination and medical imaging, such as ultrasound, CT scan or MRI scan. Unless specifically indicated, all X-ZELL products are designated as general laboratory equipment.

X-ZELL Publications

Bhakdi et al. Immunocytomorphological landscape of tCAC in the blood of lung cancer patients (abstract, ECC 2021) Advances in Clinical and Experimental Medicine 2021

Narula et al. Slide-based immunocytometry for diagnostics of acute leukemia (abstract, Blood 2021) Blood 2021 Abstract Book 2021

Bhakdi et al. Improved analysis of tumour-associated circulating rare cells (abstract, ECP 2021) Virchows Archiv 2021

Chiangjong et. al. Cell-main spectra profile screening technique in simulation of CTC using MALDI-TOF Cancers 2021

Bhakdi et al. Cytomorphologic and immunophenotypic characterization of tCAC in prostate adenocarcinoma (abstract, ECP 2020) Virchows Archiv 2020

Bhakdi et al. Accuracy of tCEC as a screening biomarker for clinically significant prostate cancer Cancers 2019

Bhakdi & Thaicharoen Easy employment and crosstalk-free detection of seven fluorophores in a widefield fluorescence microscope Methods & Protocols 2018

Bhakdi Tumour-derived circulating endothelial cells predict clinically significant prostate carcinoma (abstract, APCC 2018) BJU International 2018

Waseem et al. Buffer-optimized high-gradient magnetic separation for isolation of plasmodium-infected RBC Journal of Magnetics 2016

Waseem et al. Antibody-conjugated paramagnetic nanobeads: Kinetics of bead-cell binding International Journal of Molecular Sciences 2014

Bhakdi et al. Optimized high-gradient magnetic separation for isolation of plasmodium-infected RBC Malaria Journal 2010



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