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Abstract Objective The aim of this research is to investigate the feasibility of folate receptor‐positive circulating tumor cells (FR+CTCs) as a biomarker for the diagnosis of malignant pulmonary nodules and the correlation between clinicopathological factors and FR+CTC levels. Methods Patients initially diagnosed with one or more pulmonary nodules from a computed tomography scan were prospectively included. Three milliliters of peripheral blood was collected from each participant for FR+CTC analysis prior to surgery. Clinical and pathological parameters and FR+CTC levels were compared between patients with lung cancer and benign diseases. Results Six hundred fifty‐three patients had lung cancer and the other 124 had benign lung diseases based on pathological examinations of the resected specimens. The median FR+CTC value of the lung cancer group was 12.0 (95% CI 9.6–16.2) FU/3 mL and that of the benign group was 7.2 (95% CI 5.78–11.2) FU/3 mL. The difference was statistically significant (P

Objective: The aim of this research is to investigate the feasibility of folate receptor‐positive circulating tumor cells (FR+CTCs) as a biomarker for the diagnosis of malignant pulmonary nodules and the correlation between clinicopathological factors and FR+CTC levels. Methods: Patients initially diagnosed with one or more pulmonary nodules from a computed tomography scan were prospectively included. Three milliliters of peripheral blood was collected from each participant for FR+CTC analysis prior to surgery. Clinical and pathological parameters and FR+CTC levels were compared between patients with lung cancer and benign diseases. Results: Six hundred fifty‐three patients had lung cancer and the other 124 had benign lung diseases based on pathological examinations of the resected specimens. The median FR+CTC value of the lung cancer group was 12.0 (95% CI 9.6–16.2) FU/3 mL and that of the benign group was 7.2 (95% CI 5.78–11.2) FU/3 mL. The difference was statistically significant (P < 0.0001). In a receiver operating characteristic analysis to distinguish the two groups, the area under curve of FR+CTC was 0.7457 (95% CI 0.6893–0.8021; P < 0.0001) using a cutoff of 8.65 FU/3 mL. The sensitivity was 86.37%, and the specificity was 74.19%. Combined with conventional serum tumor biomarkers, the area under curve was 0.922 (0.499–0.963). The sensitivity was 92.20%, and the specificity was 83.05%. FR+CTC levels were related to tumor staging (P4 < 0.001), the degree of tumor invasion both in single (P = 0.011) and multiple lesions (P = 0.022), pathological subtypes (P = 0.013), and maximum tumor diameter (P = 0.014). Conclusions: FR+CTC is an effective and reliable biomarker for the diagnosis of lung cancer. Further, FR+CTC level is correlated with tumor staging, degree of invasion, pathological subtypes, and tumor size. [ABSTRACT FROM AUTHOR]

Noninvasive assessments of the risk of lymph node metastasis (LNM) in patients with lung adenocarcinoma (LAD) are of great value for selecting individualized treatment options. However, the diagnostic accuracies of different preoperative LN evaluation methods in routine clinical practice are not satisfactory. Here, an assessment to detect folate receptor (FR)‐positive circulating tumor cells (CTCs) based on ligand‐targeted enzyme‐linked polymerization is established. FR‐positive CTCs have the potential to improve the specificity and sensitivity of diagnosing LNM in lung cancer patients. The addition of CTC level improved the diagnostic efficiency of the initial prediction model that comprises other clinical parameters. A nomogram for predicting preoperative LNM is established, which showed good prediction and calibration capacities and achieved an average area under the curve of 0.786. Good correlations are observed between the CTC level and nodal classifications, such as the number of positive LNs and the ratio of the number of positive LNs to removed LNs (LN ratio or LNR). The ligand‐targeted enzyme‐linked polymerization‐assisted assessment of CTCs enables noninvasive detection and has a useful predictive value for the preoperative diagnosis of LNM in patients with LAD. [ABSTRACT FROM AUTHOR]