Circulating tumor cells and microemboli can differentiate malignant and benign pulmonary lesions

Abstract

The presence of circulating tumor cells (CTC) or microemboli (CTM) in the peripheral blood can theoretically anticipate malignancy of solid lesions in a variety of organs. We aimed to preliminarily assess this capability in patients with pulmonary lesions of suspected malignant nature.We used a cell-size filtration method (ScreenCell) and cytomorphometric criteria to detect CTC/CTM in a 3 mL sample of peripheral blood that was taken just before diagnostic percutaneous CT-guided fine needle aspiration (FNA) or core biopsy of the suspicious lung lesion.At least one CTC/CTM was found in 47 of 67 (70%) patients with final diagnoses of lung malignancy and in none of 8 patients with benign pulmonary nodules. In particular they were detected in 38 (69%) of 55 primary lung cancers and in 9 (75%) of 12 lung metastases from extra-pulmonary cancers. Sensitivity of CTC/CTM presence for malignancy was 70.1% (95%CI: 56.9-83.1%), specificity 100%, positive predictive value 100% and negative predictive value 28.6% (95%CI: 11.9-45.3%). Remarkably, the presence of CTC/CTM anticipated the diagnosis of primary lung cancer in 3 of 5 patients with non-diagnostic or inconclusive results of FNA or core biopsy, whereas CTC/CTM were not observed in 1 patient with sarcoidosis and 1 with amarthocondroma.These results suggest that presently, due to the low sensitivity, the search of CTC/CTM cannot replace CT guided percutaneous FNA or core biopsy in the diagnostic work-up of patients with suspicious malignant lung lesions. However, the high specificity may as yet indicate a role in cases with non-diagnostic or inconclusive FNA or core biopsy results that warrants to be further investigated.

Clinical significance of circulating tumor cells and tumor markers in the diagnosis of lung cancer

“…It is very difficult to determine whether a pure ground glass nodule is benign or malignant based upon CT examination alone. The detection of CTCs cannot replace CT imaging or core biopsy for diagnostic patients with suspicious malignant lung lesions . However, detection of CTCs has the potential to provide more information about pulmonary nodules and is of value in helping clinicians to decide on the appropriate treatment in pulmonary nodules.…”

Liquid biopsy of cancer: a multimodal diagnostic tool in clinical oncology

“…CTCs were found in 47 out of 67 patients with primary lung cancer, and in 9 out of 12 patients with secondary lung cancer, with a sensitivity of 70%, a specificity of 100% and a positive predictive value of 100%. 72 …”

“…CTCs were found in 47 out of 67 patients with primary lung cancer, and in 9 out of 12 patients with secondary lung cancer, with a sensitivity of 70%, a specificity of 100% and a positive predictive value of 100%. 72 Once detected, CTCs are available for the analysis of their genomic and proteomic profiles, providing information on the presence of druggable molecular targets (Figure 4). A number of technical bias issues have been resolved, since NGS technologies have increased the sensitivity of mutational state detection and molecular information is now obtainable even from single cells.…”

Detection of circulating tumor cells in patients with laryngeal cancer using ScreenCell: Comparative pre- and post-operative analysis and association with prognosis

“…The development of semiautomatic technologies, such as the CellSearch system, has allowed evaluation of the prognostic role of CTC status in patients with other types of cancer, such as lung and breast cancer, with promising results (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49). A recent study from Chudasama et al (38) evaluated the efficacy of the ScreenCell filtration system, to capture, isolate and propagate CTCs from patients with primary lung cancer.…”