Heterogeneity Landscape of Circulating Tumor Cells in Clinical Utility

Circulating tumor cells (CTCs) are seeds for metastasis and are key elements of liquid biopsies. Despite their small numbers, CTCs exhibit significant heterogeneity in terms of quantity, surface markers, and physical characteristics. This diversity poses challenges for the accurate detection and analysis of CTCs, which are essential for precise diagnosis and clinical decision-making. Additionally, spatiotemporal changes in physiological systems and the presence of circulating tumor endothelial cells (CTECs) contribute to fluctuations in the numbers and properties of both individual and clustered CTCs, affecting molecular changes and metastatic potential. It is imperative to carefully consider these variations during blood sampling, CTC detection, result analysis, and treatment planning to ensure successful clinical outcomes. The review has explored various aspects of CTC heterogeneity, emphasizing additional factors that may impact the reliability of CTC analyses and their clinical relevance for patient care. Furthermore, insights are offered to enhance the understanding of CTC heterogeneity in the context of precision diagnosis and clinical management.