Les cellules tumorales circulantes en oncologie thoracique : enjeux, pièges et limites

The concept of circulating tumour cells (CTCs) probable exists since more one century. However, despite an increased number of publications related to this subject (notably in lung cancer patients), the detection and the characterization of CTCs are not routinely used in the French hospitals. However, the challenge of CTCs detection is pivotal in lung cancer patients for diagnosis and prognosis optimisation, but also for allowing better drug response prediction and in future development of screening tests in high risk populations. Different parameters can explain the current break for CTCs concept development in daily routine, 1) many different methods exist leading difficulties for multicenter validation of the results, 2) these methods have a variable sensitivity and specificity, 3) the cost recovery of these methods is not consistent with the current French health care system, and, 4) other circulating biomarkers (such as the circulating free tumoural DNA and the circulating microRNA) are becoming competitive in thoracic oncology. Beyond the issues, this review describes the main pitfalls and limits which are likely to restrict today the development of this approach in thoracic oncology.