液体活检能排查早期肺癌
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By LabMedica International staff writers Posted on 19 Apr 2018 |
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两名肺结节患者的计算机断层扫描成像(CT)。左边的箭头指向良性（非癌）结节，而右边的箭头显示一小块肺癌（图片蒙谷地医院肺癌中心惠赐）。
肺结节的诊断是个难题，据估计美国的年发病数是160万例。大多数患者的肺结节属良性；然而，创伤性的活检费用昂贵，可能致病或致死，才能确定哪些结节是癌。
研究发现，每年检测到的肺结节中，90%以上直径二厘米以下（约3/4英寸）的结节是良性的，现行的检测方法包括正电子发射断层扫描成像(PET)、支气管镜检、针刺活检和手术。一项新研究已证实一种液体活检的准确性，它有助于排查早期肺癌。
一大群医学家与美国南卡罗莱纳州查尔斯顿市南卡罗莱纳医科大学的医学家合作，在美国和加拿大的33个地点开展了一项前瞻性多中心观察实验，包括685名患者，他们的肺结节大小在8-30毫米之间。多反应监测质谱技术测量血浆中两种蛋白质的相对丰度，一是半乳糖凝集素-3结合蛋白(LG3BP)，二是清道夫受体富半胱氨酸1型(C163A)。将结果与一个临床风险预测模型联用，鉴定可能的良性结节。计算灵敏度、特异性和阴性预测值。
研究所用的液体活检是美国华盛顿州西雅图市Integrated Diagnostic公司的二代诊断检验产品——Xpresys Lung 2 ('XL2')。其中178名患者肺癌的患病率是16%。集成分类器区分良性与恶性结节的灵敏度为97%，特异性为44%，阴性预测值(NPV)为98%。分类器的性能优于正电子发射断层扫描成像(PET)、确证过的肺结节风险模型和医师估计的癌症概率。如果直接用集成分类器的结果治疗，则针对良性结节的穿刺手术将减少40%，而3%的恶性结节将被误诊。
Integrated Diagnostics公司总裁Albert Luderer博士说：“医生往往能检测到患者得癌症的风险高，但很难确定一个良性的小肺结节。传统手段查出的低风险患者常被归为‘观察等待’类型，以备以后再次检查。XL2检验也许能帮助中低癌症风险的患者避免不必要的创伤性手术。”该研究的论文发表于2018年3月1日的《胸腔》(Chest)杂志。
南卡罗莱纳医科大学>>> www.musc.edu
Integrated Diagnostic >>> www.indidx.com
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