Despite imaging-guided percutaneous needle biopsy has been considered as a relatively safe procedure for peripheral lesions diagnosis, it is not free of complications ( 8, 9). Tissue biopsies are essential for LC diagnosis. However, the rate of false positives, overdiagnosis and unnecessary invasive procedures still remain major concerns ( 7).
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Recently, the same trial with a median follow-up of 12 years confirmed consistent benefits in terms of LC-related deaths reduction ( 6). The National Lung Screening Trial (NLST) showed a reduction of 20% in LC specific mortality rate with chest low dose computed tomography (LDCT) screening among high risk individuals, when compared with chest X-ray ( 5). Thoracic imaging is the traditional method used for early detection of LC, that occur either as an incidental finding or integrated in a screening program. Liquid Biopsy in Early Diagnosis: What is the Rationale? In this sense, and given the above highlighted aspects, this review provides an overview on the utility of liquid biopsy components as early diagnostic biomarkers. Indeed, the molecular assessment of tumor-derived components from peripheral blood is of high clinical value, besides to represent promising clinical biomarkers ( 4). Liquid biopsy is a non-invasive, easy and accessible tool for tumor cells or tumor-derived products detection in body fluids, with the potential of overcome the limitations of the strategies currently used for LC early detection.
Thus, to achieve the LC curative treatment, improving overall survival and to diminish the healthcare costs and adverse events related to systemic therapies, the development of novel diagnostic methods that improve the early diagnosis accuracy are of huge importance. The prognosis is closely related to the stage at diagnosis, with most cases being diagnosed at locally advanced and advanced stages, when curative treatment is no longer possible ( 2, 3). Lung cancer (LC) is the most common type of cancer and the leading cause of cancer-related mortality worldwide ( 1). The combination of different biomarkers, as well as their combination with other diagnostic tools show great promise, although further research is still required to define and validate the role of liquid biopsies in clinical practice.
While several biomarkers have shown exciting results, diagnostic performance and clinical applicability is still limited. In this article, we review the available data on the use of circulating biomarkers for the early detection of lung cancer, focusing on the circulating tumor cells, circulating cell-free DNA, circulating micro-RNAs, tumor-derived exosomes, and tumor-educated platelets, providing an overview of future potential applicability in the clinical practice. Several liquid biopsy-derived biomarkers have been identified and are currently under ongoing investigation. Liquid biopsy is an emerging technology with a potential role in the screening and early detection of lung cancer.
2Faculty of Medicine, University of Porto, Porto, Portugal.1Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal.Oliveira 7,9, José Luís Costa 2,4,10 and Venceslau Hespanhol 1,2,10 Cláudia Freitas 1,2*, Catarina Sousa 1, Francisco Machado 1, Mariana Serino 1, Vanessa Santos 1, Natália Cruz-Martins 2,3,4, Armando Teixeira 5,6, António Cunha 7,8, Tania Pereira 7, Hélder P.