| Background:The incidence and mortality of lung cancer rank first among all cancers in China,seriously endangering people’s health.The 5-year survival rate of lung cancer is related to the clinical stage,and the later the stage,the lower the survival rate.Studies have shown that the use of LDCT to screen people at high risk of lung cancer can make early lung cancer detected in time,which in turn reduces the case fatality rate of lung cancer patients by about 20%.However,while improving the survival rate of lung cancer patients,a large number of pulmonary nodules contain been detected.The following question is how to effectively distinguish the benign and malignant pulmonary nodules.Imaging techniques and tumor markers are not sensitive enough to distinguish benign and malignant pulmonary nodules,while histopathologic biopsy has some disadvantages such as high trauma and difficult sampling,while liquid biopsy has been widely concerned in the benign and malignant differentiation of pulmonary nodules due to its non-invasive,effective and reproducible advantages.Anderson Cancer Center found that the 3p22.13,3q29,10q22.3,cep10 mutation occurred very early in NSCLC,so they named the cells containing this chromosomal locus mutation as circulating genetically abnormal cells(CACs).The purpose of this study is to detect the number of peripheral blood CACs in patients with pulmonary nodules and explore their value in differentiating benign and malignant pulmonary nodules.Methods:A total of 69 patients with isolated pulmonary nodules with lung lesions of 30 mm detected by chest CT in Huaihe Hospital of Henan University from October 2020 to October 2021 were selected as subjects 10 m L peripheral blood was extracted from the enrolled patients before surgery or needle biopsy,and the number of CACs in the peripheral blood samples was detected by FISH method and statistically analyzed.And after biopsy or surgical histological pathology outcomes,drawing ROC curve to analyze CACs differential sensitivity and specificity of pulmonary nodules benign and malignancy,and to determine the cut-off value,the analysis of CACs combined with tumor marker detection is more optimal for distinguishing the benign and malignant nature of pulmonary nodules.At the same time,the patient’s general clinical data is collected,including age,sex,smoking history,chronic lung disease history,tumor family history,nodule location,nodule diameter,nodule type,tumor marker,and pathological type.The correlation between general clinical features and CACs expression was analyzed by t test,χ2 test,Fisher accurate test.Results:1.The expression level of circulating genetically abnormal cells(CACs)was expressed in the median of 1.5 in the benign pulmonary nodule group and 4 in the non-benign pulmonary nodule group,indicating a significant difference between the two groups(P<0.001).2.The ROC curve of circulating genetically abnormal cells(CACs)for differentiating benign and malignant pulmonary nodules was obtained.AUC value was 0.8140,and the cut-off value was 3,sensitivity and specificity were 78.40% and 83.30%,respectively.3.The ROC curve of circulating genetically abnormal cells(CACs)was plotted to distinguish benign and malignant pulmonary nodules with different diameters.The results showed that when the diameter was 10 mm,the AUC value was 0.6900,and the sensitivity and specificity were 76.20% and71.40%,respectively.When the diameter is 10-30 mm,the AUC value is 0.8910,and the sensitivity and specificity are 80.00% and 90.90%,respectively.Both groups had good diagnostic values,the larger the nodule diameter was,the higher the diagnostic accuracy was.The results showed that when the diameter was 10 mm,the AUC value was 0.6900,and the sensitivity and specificity were 76.20% and 71.40%,respectively.When the diameter is 10-30 mm,the AUC value is 0.8910,and the sensitivity and specificity are 80.00% and 90.90%,respectively.Both groups have good diagnostic value,the larger the nodule diameter,the higher the diagnostic accuracy.4.The ROC curve of circulating genetically abnormal cells(CACs)was used to differentiate benign and malignant pulmonary nodules.The results showed that the AUC value was 0.8000 for solid nodules,sensitivity and specificity were 81.25% and 80.00%,respectively.The AUC value was 0.8364,and the sensitivity and specificity were 81.80% and 80.00%,respectively.AUC value was 0.7970,sensitivity and specificity were 75.00% and 87.50%,respectively.All three groups have good diagnostic value.5.The ROC curve was drawn for the combined detection of circulating genetically abnormal cells(CACs)and tumor markers to distinguish benign and malignant pulmonary nodules.The AUC value was 0.8040,the sensitivity was 74.50%,and the specificity was 83.30%.Compared with the ROC curve of CACs alone,the ROC curve was not better.6.There was no correlation between the expression level of circulating genetically abnormal cells(CACs)and the patient’s age and gender,history of smoking,history of chronic lung disease,family history of tumor,nodule location,nodule diameter,nodule type(P>0.05),and was associated with benign and malignant pulmonary nodules(P<0.001).Conclusions:1.Circulating genetically abnormal cells(CACs)≥3 can be used as independent predictors of malignant lung nodules,and CACs may be a novel marker to distinguish the benign and malignant nature of pulmonary nodules with different clinical features.2.Detection of circulating genetically abnormal cells(CACs)combined with tumor markers cannot improve the diagnostic efficacy of CACs in distinguishing benign and malignant pulmonary nodules. |
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