Background: Previous study has reported that circulating tumor cells (CTCs) could be served as a diagnostic biomarker in breast cancer (BC) screening. However, the differential efficacy of routine examination including ultrasound (US), mammogram (MG), magnetic resonance imaging (MR), and breast-specific gamma imaging (BSGI) and CTCs is unknown. This study aimed to compare CTCs with common used BC screening imaging modalities and to evaluate whether their combination would enhance the diagnostic potency in non-metastatic BC patients.
Methods: 102 treatment-naive non-metastatic BC patients, 177 patients with breast benign diseases (BBD) and 64 healthy females, who had CTC detection and at least one of the following medical imaging examinations, US, MG or MR between December 2017 and November 2018, were enrolled in this study.Correlations of CTC enumeration with patients’ clinicopathological characteristics and medical imaging examinations were evaluated.
Results: CTC detection rates (average CTC counts) in stage I-III BC patients were 92.9% (2.1), 87.2% (2.4) and 100% (4.2), respectively. CTCs counts were positively associated with cancer stage (p = 0.0084) and tumor size (p = 0.0301). CTC counts were more correlated with US than MR or MG. CTC counts were not associated with molecular subtypes of BC nor breast-specific gamma imaging (BSGI) results, indicating that CTC enumeration cannot be used to predict molecular signatures of BC. CTCs and medical imaging examinations would have the best diagnostic performance for BC when CTC cut-off was set to 2 and imaging Breast Imaging-Reporting and Data System (BI-RADS) was set to 4b. Combination of CTC with US, MG or MR increased the sensitivity for BC diagnosis, especially for MG. Sensitivity of MG increased from 0.694 to 0.917, even more than in conjugation with US (0.901).
Conclusion: CTCs counts can be used as a diagnostic aid in BC screening and early diagnosis. CTCs counts were more relevant to US than MR or MG. Conjugation of CTCs counts would improve the diagnostic potency of medical imaging examinations for diagnosing BC, especially for MG in Chinese women.