{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:00:12Z","timestamp":1785387612449,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"14","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100018925","name":"Health Commission of Henan Province","doi-asserted-by":"publisher","award":["LHGJ20240142"],"award-info":[{"award-number":["LHGJ20240142"]}],"id":[{"id":"10.13039\/100018925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In pathology\u2010enriched referred hospital cohorts, stable radiologic\u2010pathologic linkage is often unavailable, so patient\u2010level malignant pathology may be a more reliable endpoint than lesion\u2010specific malignancy. We aimed to develop and internally validate a blood\u2010based model for patient\u2010level malignant\u2010versus\u2010benign pathology discrimination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 283 consecutive eligible source records from 22 February 2023 to 12 May 2025. After excluding unclassifiable pathology, lesions &gt;\u200930\u2009mm when verifiable, and obvious extrapulmonary primary tumors, we defined a strict primary cohort. A prespecified complete\u2010case logistic regression model including FR\u2009+\u2009CTC, peripheral CD8 count, age, and sex was developed and internally validated with bootstrap resampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The strict primary cohort included 234 patients (166 malignant, 68 benign). In the main model (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009232), FR\u2009+\u2009CTC was associated with higher odds of malignant pathology (OR 1.31 per 1\u2009FU\/3\u2009mL, 95% CI: 1.14\u20131.50;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas peripheral CD8 count was inversely associated (OR 0.50 per 100\u2009cells\/\u03bcL, 95% CI: 0.41\u20130.61;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Apparent and optimism\u2010corrected AUCs were 0.877 and 0.867, respectively. Adding an adjudicated patient\u2010level CT vascular sign yielded limited incremental value.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective single\u2010center, pathology\u2010enriched cohort, FR\u2009+\u2009CTC and peripheral CD8 provided useful internally validated discrimination for patient\u2010level malignant pathology. The model requires external validation and setting\u2010appropriate recalibration before broader clinical use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1759-7714.70358","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T12:48:21Z","timestamp":1784897301000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Internal Validation of a Patient\u2010Level Diagnostic Model Integrating Folate Receptor\u2010Positive Circulating Tumor Cells and Peripheral\n                    <scp>CD8<\/scp>\n                    Count for Malignant\u2010Versus\u2010Benign Pathology Discrimination in a Pathology\u2010Enriched Pulmonary Nodule Cohort"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8525-819X","authenticated-orcid":false,"given":"Chunyan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine Henan Provincial Chest Hospital, Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoke","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Tuberculosis Henan Provincial Chest Hospital, Zhengzhou University  Zhengzhou Henan China"},{"name":"Tuberculosis Clinical Research Center of Henan Province  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjian","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine Henan Provincial Chest Hospital, Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqian","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Medical Records Henan Provincial Chest Hospital, Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Henan Provincial Chest Hospital, Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojie","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Pathology Henan Provincial Chest Hospital, Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weidong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Henan Provincial Chest Hospital, Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3352-9408","authenticated-orcid":false,"given":"Fang","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine Henan Provincial Chest Hospital, Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.24287"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1997.00440290031002"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06\u20101261"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214726"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.4.2490"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12\u20102351"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201803\u2010173CME"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20220963"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41568\u2010022\u201000536\u20104"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000606"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2019.02.028"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40364\u2010024\u201000713\u20107"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7594"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18\u20101376"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895\u20104356(01)00341\u20109"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m441"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.21221"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2015.03.018"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.07.2168"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591\u2010024\u201003211\u20103"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589\u20107500(23)00125\u20105"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2007.084731"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00408\u2010024\u201000706\u20101"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2024.106788"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.7150\/jca.16856"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/crj.13601"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgm.3529"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1150539"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.21037\/tcr\u20102024\u20102493"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/03000605231199763"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12094\u2010024\u201003556\u20108"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20102600(20)30081\u20103"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tranon.2024.101968"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467\u2010025\u201065930\u20106"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.12.005"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916\u2010019\u20101466\u20107"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1844"}],"container-title":["Thoracic Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1759-7714.70358","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1759-7714.70358","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1759-7714.70358","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:36:19Z","timestamp":1785386179000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1759-7714.70358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":37,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/1759-7714.70358"],"URL":"https:\/\/doi.org\/10.1111\/1759-7714.70358","archive":["Portico"],"relation":{},"ISSN":["1759-7706","1759-7714"],"issn-type":[{"value":"1759-7706","type":"print"},{"value":"1759-7714","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-04-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70358"}}