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Table 2 Merits and Demerits of CTC-based methods, clinical methods and other biomarkers

From: Detection and clinical significance of circulating tumor cells in colorectal cancer

Methods Merits Demerits
CTCs Immunoaffinity-based Capture cells of specific phenotypes with relatively high specificity, high purity;
Overcome the heterogeneity of physical characteristic
Lack of broad-spectrum specific biomarkers;
Affect cell viability, downstream phenotype identification and molecular analysis;
High cost, low throughput
Biophysical Properties-based Good cell integrity and viability;
Not restricted by cell surface markers;
Low cost, high throughput
Low specificity and purity;
Significant difference in cell size lead to the omission of small CTTs
Commonality Low-risk, Low-invasive method for continuous sample acquisition;
Real-time (earlydiagnosis, predict metastasis or recurrence, monitor treatment response);
Live cells, morphological and molecular characterization (precision medicine);
In vitro culture, drug resistance and drug sensitivity cell experiments
Targeted cells are scarce;
Technical limitations (sensitivity and specificity);
Lack of uniform standards (cut-off value, detection time, etc.)
Lack of large-scale prospective trials
Clinical Methods Medical imaging Mature, standardized;
Non-invasive, dynamically monitor the morphological changes of lesions;
Insufficient sensitivity;
Not in-time;
The nature of some lesions is not clear
Pathological Mature, standardized;
High accuracy;
Immunohistochemical staining, genetic testing, in vitro cell culture, etc.
Invasive injury (local reaction, infection, dissemination and metastasis, etc.);
Some patients cannot undergo tissue biopsy (location, size, general condition, etc.);
Heterogeneity (time and space)
Tumor biomarkers Easy access to samples;
Dynamic monitoring of tumor changes and treatment response
High false positive and false negative rate;
Poor specificity
Other biomarkers ctDNA Relatively mature technologies (compared with CTCs);
Short half-life time;
More sensitive to tumor status;
Comprehensive molecular information of tumor
DNA fragments from necrotic or apoptotic cells, cannot represent living tumor cells;
Only provide genetic information;
Low gene mutation abundance, poor sensitivity
Extracellular Vesicles Large quantity, easy to enrich (compared with CTCs);
Extracellular vesicles can prevent internal nucleic acid substances from being degraded, high stability
Immature technologies (isolation, purification, enrichment of internal specific markers, etc.)
microRNA Closely related to cell metabolism under physiological and pathological conditions Immature technologies, few related research