Freidin Maxim B, Tay Andee, Freydina Dasha V, Chudasama Dimple, Nicholson Andrew G, Rice Alexandra, Anikin Vladimir, Lim Eric
Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Lung Cancer. 2014 Aug;85(2):182-5. doi: 10.1016/j.lungcan.2014.05.017. Epub 2014 May 29.
Circulating tumour cells (CTCs) are reported to be predictive for prognosis and response to treatment in advanced lung cancer. However, the clinical utility of the CTCs detection remains unknown for early stage lung cancer as the number of CTCs is reported as low, providing challenges in identification. We have evaluated diagnostic performance of filtration-based technology using cytomorphologic criteria in patients undergoing surgery for lung cancer.
We processed blood from 76 patients undergoing surgery for known or suspected lung cancer using ScreenCell(®) Cyto filter devices. Captured cells were stained using haematoxylin and eosin and independently assessed by two pathologists for the presence of atypical cells suspicious for cancer. Diagnostic performance was evaluated against pathologist reported diagnoses of cancer from surgically obtained specimens.
Cancer was diagnosed in 57 patients (77.0%), including 32 with primary lung cancer (56.1%). The proportion of patients with early stage primary lung cancer in which CTCs were identified was 18 and 21 (56.3% and 65.6%, respectively) as reported by two pathologists. The agreement between the pathologists was 77.0% corresponding to a kappa-statistic of 53.7% indicating moderate agreement. No significant differences were found for the percentage of CTCs for primary and metastatic cancer as well as for cancer stages. On sensitivity weighted analysis, a sensitivity and specificity were 71.9% (95% CI 60.5-83.0) and 52.9% (95% CI 31.1-77.0), respectively. On specificity weighted analysis, a sensitivity and specificity were 50.9% (95% CI 39.3-64.4) and 82.4% (60.4-96.2), respectively.
The performance of the tested filter-based antibody-independent technology to capture CTCs using standard cytomorphologic criteria provides the potential of a diagnostic blood test for lung cancer.
据报道，循环肿瘤细胞（CTC）可预测晚期肺癌的预后及对治疗的反应。然而，由于早期肺癌患者的CTC数量较少，识别存在挑战，其检测的临床实用性仍不明确。我们使用细胞形态学标准评估了基于过滤技术在肺癌手术患者中的诊断性能。
我们使用ScreenCell(®) Cyto过滤装置处理了76例已知或疑似肺癌手术患者的血液。捕获的细胞用苏木精和伊红染色，并由两名病理学家独立评估是否存在可疑癌细胞的非典型细胞。根据病理学家报告的手术标本癌症诊断结果评估诊断性能。
57例患者（77.0%）被诊断为癌症，其中32例为原发性肺癌（56.1%）。两名病理学家报告的早期原发性肺癌患者中检测到CTC的比例分别为18例和21例（分别为56.3%和65.6%）。病理学家之间的一致性为77.0%，kappa统计量为53.7%，表明一致性中等。原发性癌和转移性癌以及癌症分期的CTC百分比未发现显著差异。在敏感性加权分析中，敏感性和特异性分别为71.9%（95%CI 60.5 - 83.0）和52.9%（95%CI 31.1 - 77.0）。在特异性加权分析中，敏感性和特异性分别为50.9%（95%CI 39.3 - 64.4）和82.4%（60.4 - 96.2）。
所测试的基于过滤的非抗体技术使用标准细胞形态学标准捕获CTC的性能为肺癌诊断性血液检测提供了潜力。
