J Cancer 2017; 8(12):2223-2230. doi:10.7150/jca.18418

Research Paper

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

Mario Mascalchi1, Cristina Maddau2, Lapo Sali1, Elena Bertelli1, Francesca Salvianti3, Stefania Zuccherelli1, Marzia Matucci2, Alessandra Borgheresi1, Claudio Raspanti4, Monica Lanzetta1, Massimo Falchini1, Ernesto Mazza4, Alessandra Vella5, Michaela Luconi6, Pamela Pinzani3, Mario Pazzagli3✉

1. Diagnostic and Interventional Radiology Units, “Mario Serio” Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy;
2. Oncological Prevention Laboratory, Institute for Cancer Research and Prevention (ISPO), Florence, Italy;
3. Clinical Biochemistry Unit, “Mario Serio” Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy;
4. Interventional Radiology Unit, Careggi Hospital, Florence, Italy;
5. Nuclear Medicine Unit, Le Scotte University Hospital, Siena, Italy;
6. Endocrinology Unit, “Mario Serio” Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy.

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.

Keywords: circulating tumor cells, lung nodule, lung cancer, lung metastases, CT-guided fine needle aspiration.

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How to cite this article:
Mascalchi M, Maddau C, Sali L, Bertelli E, Salvianti F, Zuccherelli S, Matucci M, Borgheresi A, Raspanti C, Lanzetta M, Falchini M, Mazza E, Vella A, Luconi M, Pinzani P, Pazzagli M. Circulating tumor cells and microemboli can differentiate malignant and benign pulmonary lesions. J Cancer 2017; 8(12):2223-2230. doi:10.7150/jca.18418. Available from http://www.jcancer.org/v08p2223.htm