Background/Objectives: Appropriate biomarkers are necessary for early diagnosis and multidisciplinary treatment of pancreatic ductal adenocarcinoma (PDAC). In recent years, the clinical utility of circulating tumor cells (CTC) as biomarkers for various can-cers has been reported; however, their detection rate in PDAC remains low, and clinical evidence is not yet established. CTC detection methods with high reliability and per-formance are essential for clarifying the importance of CTC in patients with PDAC. Methods: A total of 5 mL peripheral blood samples were collected from 38 patients newly diagnosed with PDAC and 17 healthy controls. Negatively enriched cells were immunofluorescently stained with EpCAM-phycoerythrin and cell surface vi-mentin-fluorescein isothiocyanate (CSV). Images were automatically captured using an all-in-one fluorescence microscope. Cellular regions were detected from these images, and the average luminance of the cellular regions was calculated. A total of 9086 and 1071 cell images were obtained from patients with PDAC and healthy controls, respec-tively. Results: In the EpCAM assay, a threshold that included 95% of healthy individuals was optimal for distinguishing patients with PDAC from healthy controls, with a sensi-tivity, specificity, and area under the curve of 0.74, 0.76, and 0.84, respectively. At this threshold, the CTC-positivity rate in patients with PDAC was 76.3%. Conversely, the CSV assay failed to demonstrate a valid threshold to distinguish patients with PDAC from healthy controls. No significant differences were found between CTC and clini-copathological features among patients with PDAC. Conclusions: The method using high-resolution image scanning has the potential to identify CTC with greater objectiv-ity by quantifying cell luminance values.
背景/目的：胰腺导管腺癌（PDAC）的早期诊断和多学科治疗需要合适的生物标志物。近年来，循环肿瘤细胞（CTC）作为多种癌症生物标志物的临床应用已有报道，但其在PDAC中的检出率仍然较低，临床证据尚未确立。建立高可靠性和高性能的CTC检测方法对于阐明CTC在PDAC患者中的重要性至关重要。方法：从38例新诊断的PDAC患者和17例健康对照者中采集5 mL外周血样本。采用EpCAM-藻红蛋白和细胞表面波形蛋白-异硫氰酸荧光素（CSV）对阴性富集细胞进行免疫荧光染色。使用一体化荧光显微镜自动捕获图像，从这些图像中检测细胞区域，并计算细胞区域的平均亮度。分别从PDAC患者和健康对照者中获得9086张和1071张细胞图像。结果：在EpCAM检测中，包含95%健康个体的阈值能最佳地区分PDAC患者与健康对照者，其敏感性、特异性和曲线下面积分别为0.74、0.76和0.84。在此阈值下，PDAC患者的CTC阳性率为76.3%。相反，CSV检测未能证明可有效区分PDAC患者与健康对照者的阈值。PDAC患者中CTC与临床病理特征之间未发现显著差异。结论：采用高分辨率图像扫描的方法通过量化细胞亮度值，有望更客观地识别CTC。
Novel CTC Detection Method in Patients with Pancreatic Cancer Using High-Resolution Image Scanning
肿瘤(癌症)患者之家