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Abstract：
BACKGROUND: Circulating tumor cell (CTC) detection is one form of liquid biopsy. It is a novel technique that is beginning to be applied in the field of thyroid cancer. The present study was designed to evaluate the diagnostic value of CTCs in patients with thyroid cancer.
METHODS: A total of 1478 patients were retrospectively analyzed and divided into malignant group (n = 747) and benign group (n = 731). Peripheral blood was collected, and CTCs were enriched and quantified before surgery. The baseline data of the two groups were matched by Propensity Score Matching (PSM). Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficiency of different indicators for thyroid cancer. The malignant group before PSM was further divided into subgroups according to the BRAF V600E mutation and lymphatic metastasis (N stage), and the number of CTCs in different subgroups was compared.
RESULTS: After 1:1 PSM, baseline characteristics of the malignant group and benign group were matched and assigned 315 cases in each group. The number of CTCs and the TPOAb values were comparable in the two groups (p > 0.05). The TgAb values [1.890 (1.110 - 16.010) vs 1.645 (1.030 - 7.073) IU/mL, p = 0.049] were significantly higher in the malignant group than in the benign group. After PSM, ROC analyses showed that the areas under the curve (AUCs) of CTC, TgAb and ultrasound were 0.537 (sensitivity 65.6%, specificity 45.8%), 0.546 (sensitivity 40.0%, specificity 70.8%) and 0.705 (sensitivity 77.1%, specificity 63.2%), respectively. The AUCs of the combined detection of \'CTC + ultrasound\' (combine 1) and the combined detection of \'CTC + TgAb + ultrasound\' (combine 2) were 0.718 (sensitivity 79.3%, specificity 61.7%) and 0.724 (sensitivity 78.0%, specificity 63.3%), respectively. The AUC of ultrasound was significantly higher than CTC (p < 0.001). There was no statistically significant difference in AUC between combination 1 and ultrasound, and between combination 2 and ultrasound (p > 0.05). The number of CTCs between the N0 and N1 subgroups, and between the BRAF mutant and BRAF wild subgroups was comparable (p > 0.05).
CONCLUSIONS: As an emerging and noninvasive testing tool, the efficacy of CTCs in diagnosing thyroid cancer is limited.
METHODS: A total of 1478 patients were retrospectively analyzed and divided into malignant group (n = 747) and benign group (n = 731). Peripheral blood was collected, and CTCs were enriched and quantified before surgery. The baseline data of the two groups were matched by Propensity Score Matching (PSM). Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficiency of different indicators for thyroid cancer. The malignant group before PSM was further divided into subgroups according to the BRAF V600E mutation and lymphatic metastasis (N stage), and the number of CTCs in different subgroups was compared.
RESULTS: After 1:1 PSM, baseline characteristics of the malignant group and benign group were matched and assigned 315 cases in each group. The number of CTCs and the TPOAb values were comparable in the two groups (p > 0.05). The TgAb values [1.890 (1.110 - 16.010) vs 1.645 (1.030 - 7.073) IU/mL, p = 0.049] were significantly higher in the malignant group than in the benign group. After PSM, ROC analyses showed that the areas under the curve (AUCs) of CTC, TgAb and ultrasound were 0.537 (sensitivity 65.6%, specificity 45.8%), 0.546 (sensitivity 40.0%, specificity 70.8%) and 0.705 (sensitivity 77.1%, specificity 63.2%), respectively. The AUCs of the combined detection of \'CTC + ultrasound\' (combine 1) and the combined detection of \'CTC + TgAb + ultrasound\' (combine 2) were 0.718 (sensitivity 79.3%, specificity 61.7%) and 0.724 (sensitivity 78.0%, specificity 63.3%), respectively. The AUC of ultrasound was significantly higher than CTC (p < 0.001). There was no statistically significant difference in AUC between combination 1 and ultrasound, and between combination 2 and ultrasound (p > 0.05). The number of CTCs between the N0 and N1 subgroups, and between the BRAF mutant and BRAF wild subgroups was comparable (p > 0.05).
CONCLUSIONS: As an emerging and noninvasive testing tool, the efficacy of CTCs in diagnosing thyroid cancer is limited.
摘要：
背景：循环肿瘤细胞（CTC）检测是液体活检的一种形式。这是一项新技术，已开始应用于甲状腺癌领域。本研究旨在评估CTC在甲状腺癌患者中的诊断价值。
方法：对1478例患者进行回顾性分析，分为恶性组（n=747）和良性组（n=731）。收集外周血,术前富集和定量CTC。采用倾向评分匹配(PSM)对两组患者的基线数据进行匹配。采用受试者工作特征(ROC)曲线评价不同指标对甲状腺癌的诊断效能。根据BRAFV600E突变和淋巴结转移（N分期）将PSM前的恶性组进一步分为亚组，比较不同亚组的CTC数量。
结果：1:1PSM后，将恶性组和良性组的基线特征进行匹配,并分配给每组315例病例.两组的CTC数量和TPOAb值具有可比性(p>0.05)。TgAb值[1.890（1.110-16.010）vs1.645（1.030-7.073）IU/mL，p=0.049]在恶性组中显著高于良性组。PSM之后,ROC分析表明，CTC的曲线下面积（AUC），TgAb和超声分别为0.537(灵敏度65.6%,特异性45.8%)，0.546(灵敏度40.0%,特异性70.8%)和0.705(灵敏度77.1%，特异性63.2%)，分别。联合检测CTC+超声（联合1）和联合检测CTC+TgAb+超声（联合2）的AUC为0.718（灵敏度79.3％，特异性61.7%)和0.724(灵敏度78.0%，特异性63.3%)，分别。超声的AUC明显高于CTC（p<0.001）。组合1与超声之间的AUC差异无统计学意义，在组合2和超声之间（p>0.05）。N0和N1亚组之间的CTC数量，BRAF突变体与BRAF野生型亚组之间具有可比性(p>0.05)。
结论：作为一种新兴的非侵入性测试工具，CTC诊断甲状腺癌的疗效有限.
方法：对1478例患者进行回顾性分析，分为恶性组（n=747）和良性组（n=731）。收集外周血,术前富集和定量CTC。采用倾向评分匹配(PSM)对两组患者的基线数据进行匹配。采用受试者工作特征(ROC)曲线评价不同指标对甲状腺癌的诊断效能。根据BRAFV600E突变和淋巴结转移（N分期）将PSM前的恶性组进一步分为亚组，比较不同亚组的CTC数量。
结果：1:1PSM后，将恶性组和良性组的基线特征进行匹配,并分配给每组315例病例.两组的CTC数量和TPOAb值具有可比性(p>0.05)。TgAb值[1.890（1.110-16.010）vs1.645（1.030-7.073）IU/mL，p=0.049]在恶性组中显著高于良性组。PSM之后,ROC分析表明，CTC的曲线下面积（AUC），TgAb和超声分别为0.537(灵敏度65.6%,特异性45.8%)，0.546(灵敏度40.0%,特异性70.8%)和0.705(灵敏度77.1%，特异性63.2%)，分别。联合检测CTC+超声（联合1）和联合检测CTC+TgAb+超声（联合2）的AUC为0.718（灵敏度79.3％，特异性61.7%)和0.724(灵敏度78.0%，特异性63.3%)，分别。超声的AUC明显高于CTC（p<0.001）。组合1与超声之间的AUC差异无统计学意义，在组合2和超声之间（p>0.05）。N0和N1亚组之间的CTC数量，BRAF突变体与BRAF野生型亚组之间具有可比性(p>0.05)。
结论：作为一种新兴的非侵入性测试工具，CTC诊断甲状腺癌的疗效有限.
