Brennan Paul M, Butler Holly J, Christie Loren, Hegarty Mark G, Jenkinson Michael D, Keerie Catriona, Norrie John, O'Brien Rachel, Palmer David S, Smith Benjamin R, Baker Matthew J
Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH4 2XU, UK.
ClinSpec Diagnostics Limited, Royal College Building, Glasgow G1 1XW, UK.
Brain Commun. 2021 Mar 30;3(2):fcab056. doi: 10.1093/braincomms/fcab056. eCollection 2021.
Early diagnosis of brain tumours is challenging and a major unmet need. Patients with brain tumours most often present with non-specific symptoms more commonly associated with less serious diagnoses, making it difficult to determine which patients to prioritize for brain imaging. Delays in diagnosis affect timely access to treatment, with potential impacts on quality of life and survival. A test to help identify which patients with non-specific symptoms are most likely to have a brain tumour at an earlier stage would dramatically impact on patients by prioritizing demand on diagnostic imaging facilities. This clinical feasibility study of brain tumour early diagnosis was aimed at determining the accuracy of our novel spectroscopic liquid biopsy test for the triage of patients with non-specific symptoms that might be indicative of a brain tumour, for brain imaging. Patients with a suspected brain tumour based on assessment of their symptoms in primary care can be referred for open access CT scanning. Blood samples were prospectively obtained from 385 of such patients, or patients with a new brain tumour diagnosis. Samples were analysed using our spectroscopic liquid biopsy test to predict presence of disease, blinded to the brain imaging findings. The results were compared to the patient's index brain imaging delivered as per standard care. Our test predicted the presence of glioblastoma, the most common and aggressive brain tumour, with 91% sensitivity, and all brain tumours with 81% sensitivity, and 80% specificity. Negative predictive value was 95% and positive predictive value 45%. The reported levels of diagnostic accuracy presented here have the potential to improve current symptom-based referral guidelines, and streamline assessment and diagnosis of symptomatic patients with a suspected brain tumour.
脑肿瘤的早期诊断具有挑战性,是一个尚未得到满足的主要需求。脑肿瘤患者最常出现的是非特异性症状,这些症状更常见于诊断不太严重的情况,这使得很难确定哪些患者应优先进行脑部成像检查。诊断延迟会影响及时获得治疗,对生活质量和生存率产生潜在影响。一种有助于识别哪些有非特异性症状的患者最有可能在早期患有脑肿瘤的检测方法,将通过优先安排诊断成像设备的需求,对患者产生重大影响。这项脑肿瘤早期诊断的临床可行性研究旨在确定我们新型光谱液体活检检测对可能提示脑肿瘤的非特异性症状患者进行分流以进行脑部成像的准确性。根据初级保健中对症状的评估怀疑患有脑肿瘤的患者可被转诊进行开放式CT扫描。前瞻性地从385名此类患者或新诊断为脑肿瘤的患者中采集血样。使用我们的光谱液体活检检测对样本进行分析以预测疾病的存在,对脑部成像结果不知情。将结果与按照标准护理提供的患者索引脑部成像进行比较。我们的检测对最常见且侵袭性最强的脑肿瘤胶质母细胞瘤的存在预测敏感性为91%,对所有脑肿瘤的敏感性为81%,特异性为80%。阴性预测值为95%,阳性预测值为45%。此处报告的诊断准确性水平有可能改进当前基于症状的转诊指南,并简化对疑似脑肿瘤的有症状患者的评估和诊断。