Preoperative evaluation of solitary pulmonary nodules and adenocarcinoma invasiveness using ultra-high-resolution computed tomography and multidimensional liquid biopsy: a prospective exploratory study.
Combined CT and liquid biopsy model best distinguished malignant from benign lung nodules, AUC 0.946
Preoperative evaluation of solitary pulmonary nodules and adenocarcinoma invasiveness using ultra-high-resolution computed tomography and multidimensional liquid biopsy: a prospective exploratory study.
Accurate preoperative characterization of solitary pulmonary nodules (solitary pulmonary nodules), particularly differentiation of benign from malignant lesions and assessment of adenocarcinoma invasiveness, remains challenging based on morphological features alone.
We investigated whether integrating 1024-matrix ultra-high-resolution computed tomography (ultra-high-resolution computed tomography) with two liquid-biopsy signals, urinary cellular energy metabolism (cellular energy metabolism) and a seven tumor-associated autoantibody (7-TAAb) panel, could improve diagnostic performance in surgically treated patients with solitary pulmonary nodules.
In this single-center prospective study, consecutive adults with solitary pulmonary nodules (≤3 cm) scheduled for video-assisted thoracoscopic surgery between January 2022 and December 2024 were enrolled (n = 183).
the combined model best separated cancerous from benign nodules
Among 183 patients, 164 (89.6%) had malignant nodules.
Ultra-high-resolution computed tomography achieved the best single-modality discrimination (AUC, 0.831; sensitivity, 87.2%; specificity, 78.9%), outperforming cellular energy metabolism (AUC, 0.605) and 7-TAAbs (AUC, 0.558).
Under the parallel-rule strategy, multimodal testing increased sensitivity but markedly reduced specificity (sensitivity 98.8%, specificity 9.5%).
At the Youden-index threshold of 0.816, this model yielded sensitivity of 92.7%, specificity of 84.2%, PPV of 98.1%, NPV of 57.1%, and accuracy of 91.8%.
In surgically selected patients with solitary pulmonary nodules, 1024-matrix ultra-high-resolution computed tomography provided the strongest single-modality diagnostic information, while urinary cellular energy metabolism and 7-TAAbs offered complementary biological signals associated with invasive adenocarcinoma pathology.
Probability-based integration provided a more balanced diagnostic framework than a simple parallel-rule strategy.