HCA Healthcare UK, London, United Kingdom.
Department of Oncology, Broomsfield Hospital, Chelmsford, United Kingdom.
Cancer Cytopathol. 2021 Mar;129(3):226-238. doi: 10.1002/cncy.22366. Epub 2020 Sep 30.
Histopathologic examination (HPE) of tumor tissue obtained by invasive biopsy is the standard for cancer diagnosis but is resource-intensive and has been associated with procedural risks. The authors demonstrate that immunocytochemistry (ICC) profiling of circulating ensembles of tumor-associated cells (C-ETACs) can noninvasively provide diagnostic guidance in solid organ cancers.
The clinical performance of this approach was tested on blood samples from 30,060 individuals, including 9416 individuals with known cancer; 6725 symptomatic individuals with suspected cancer; and 13,919 asymptomatic individuals with no prior diagnosis of cancer. C-ETACs were harvested from peripheral blood and profiled by ICC for organ-specific and subtype-specific markers relevant to the cancer type. ICC profiles were compared with HPE diagnoses to determine concordance.
The presence of malignancy was confirmed by the detection of C-ETACs in 91.8% of the 9416 individuals with previously known cancer. Of the 6725 symptomatic individuals, 6025 were diagnosed with cancer, and 700 were diagnosed with benign conditions; C-ETACs were detected in 92.6% of samples from the 6025 individuals with cancer. In a subset of 3509 samples, ICC profiling of C-ETACs for organ-specific and subtype-specific markers was concordant with HPE findings in 93.1% of cases. C-ETACs were undetectable in 95% of samples from the 700 symptomatic individuals who had benign conditions and in 96.3% of samples from the 13,919 asymptomatic individuals.
C-ETACs were ubiquitous (>90%) in various cancers and provided diagnostically relevant information in the majority (>90%) of cases. This is the first comprehensive report on the feasibility of ICC profiling of C-ETACs to provide pan-cancer diagnostic guidance with accuracy comparable to that of HPE.
通过侵袭性活检获得的肿瘤组织的组织病理学检查（HPE）是癌症诊断的标准，但这种方法资源密集且与程序相关风险相关。作者证明，循环肿瘤相关细胞（C-ETAC）的免疫细胞化学（ICC）分析可以非侵入性地为实体瘤癌症提供诊断指导。
该方法的临床性能在 30060 个人的血液样本中进行了测试，包括 9416 名已知患有癌症的个体；6725 名有疑似癌症症状的个体；以及 13919 名没有先前癌症诊断的无症状个体。C-ETAC 从外周血中收获，并通过 ICC 对与癌症类型相关的器官特异性和亚型特异性标志物进行分析。将 ICC 图谱与 HPE 诊断进行比较以确定一致性。
在 9416 名先前已知患有癌症的个体中，通过检测 C-ETACs 确认了恶性肿瘤的存在，占 91.8%。在 6725 名有症状的个体中，6025 人被诊断患有癌症，700 人被诊断患有良性疾病；在 6025 名患有癌症的个体中，92.6%的样本中检测到 C-ETACs。在 3509 个样本的一个亚集中，C-ETACs 的 ICC 分析对器官特异性和亚型特异性标志物的分析与 HPE 结果在 93.1%的病例中一致。在 700 名患有良性疾病的有症状个体的 95%的样本中和 13919 名无症状个体的 96.3%的样本中未检测到 C-ETACs。
C-ETACs 在各种癌症中普遍存在（>90%），并在大多数（>90%）病例中提供了具有诊断意义的信息。这是第一篇关于 ICC 分析 C-ETACs 以提供与 HPE 相当的准确性的泛癌诊断指导的全面报告。
