Malignancy Prediction Capacity and Possible Prediction Model of Circulating Tumor Cells for Suspicious Pulmonary Lesions

Abstract

More and more undetermined lung lesions are being identified in routine lung cancer screening. The aim of this study was to try to establish a malignancy prediction model according to the tumor presentations. From January 2017 to December 2018, 50 consecutive patients who were identified with suspicious lung lesions were enrolled into this study. Medical records were reviewed and tumor macroscopic and microscopic presentations were collected for analysis. Circulating tumor cells (CTC) were found to differ between benign and malignant lesions (p = 0.03) and also constituted the highest area under the receiver operation curve other than tumor presentations (p = 0.001). Since tumor size showed the highest sensitivity and CTC revealed the best specificity, a malignancy prediction model was proposed. Akaike information criterion (A.I.C.) of the combined malignancy prediction model was 26.73, which was lower than for tumor size or CTCs alone. Logistic regression revealed that the combined malignancy prediction model showed marginal statistical trends (p = 0.0518). In addition, the 95% confidence interval of combined malignancy prediction model showed less wide range than tumor size ≥ 0.7 cm alone. The calculated probability of malignancy in patients with tumor size ≥ 0.7 cm and CTC > 3 was 97.9%. By contrast, the probability of malignancy in patients whose tumor size was < 0.7 cm, and CTC ≤ 3 was 22.5%. A combined malignancy prediction model involving tumor size followed by the CTC count may provide additional information to assist decision making. For patients who present with tumor size ≥ 0.7 cm and CTC counts > 3, aggressive management should be considered, since the calculated probability of malignancy was 97.9%.

Circulating tumor cells help differentiate benign ovarian lesions from cancer before surgery: A literature review and proof of concept study using flow cytometry with fluorescence imaging

“…18259; Stemcell Technologies Inc.) according to the manufacturer's instructions. The methods used for CTC enrichment and counting have been previously described ( 27 , 33 , 34 ). CTCs were not collected from patients experiencing disease progression or death from cancer, as these were the predefined endpoints of the study for predicting survival events.…”

Association of early changes of circulating cancer stem-like cells with survival among patients with metastatic breast cancer

“…We employed positive detection and negative selection strategies to identify CTCs; these approaches had been validated in our previous studies. 17,[20][21][22][23] Specifically, a negative selection protocol with a CD45 depletion kit was employed to deplete leukocytes after standard red blood cell lysis; subsequently, flow cytometry was employed to quantitatively identify and count CTCs (EpCA M + Hoechst + CD45 − ) and cCSCs (CD133 + EpCAM + Hoechst + CD45 − ). The CTC tests were carried out using 4 mL samples of peripheral blood after discarding of the original 4 mL of blood to avoid epithelial contamination.…”

Circulating p16-Positive and p16-Negative Tumor Cells Serve as Independent Prognostic Indicators of Survival in Patients with Head and Neck Squamous Cell Carcinomas

“…The detection rates of p16-positive (>0 cells/mL blood) and p16-negative (≥3 cells/mL blood) CTCs were 51.2% (n = 21/41) and 70.7%, respectively. The cutoff values of CTCs (3 cells/mL) were the same as those used in previous studies [30,31]. a Patients with non-oropharyngeal cancer included 10 hypopharyngeal cancers, and 3 cancers of unknown primary site.…”