EXPRESS: Fourier Transform Infrared Microspectroscopy as a Liquid Biopsy Tool to Detect Single Circulating Tumour Cells in the Blood of a Lung Cancer Patient.

Liquid biopsy is revolutionizing cancer management, with circulating tumor cells (CTCs), offering a transformative approach to screening, diagnosis, and treatment monitoring. However, existing CTC isolation methods relying on antigen expression or physical properties lack robustness, are operator-dependent, and suffer from automation challenges, leading to inconsistent and time-intensive analyses. A universal, unbiased methodology for CTC detection across tumor types is critically needed. Here, we present the first proof-of-concept study demonstrating the use of Fourier transform infrared (FT-IR) microspectroscopy to study cytospun blood samples coupled with a random forest (RF) classifier, for the detection of a single CTC in the blood of a lung cancer patient as confirmed via immunohistochemistry. Notably, our method utilizes glass coverslips as substrates, routinely employed in pathology departments, enabling seamless integration with histopathological analyses (e.g., staining, immunohistochemistry). Using FT-IR spectral data from in vitro growing lung cancer cells as a training model, we achieved precise CTC identification based on biochemical composition, specifically within the Fingerprint region (1800 cm^-1 to 1350 cm^-1). This study introduces FT-IR microspectroscopy as a novel, label-free approach for CTCs detection in liquid biopsies, with the potential to redefine cancer diagnostics. By enhancing precision and accessibility in CTC identification, the clinical implementation of this methodology may represent a significant advancement in personalized oncology, offering a clinically viable tool for real-time cancer monitoring and improved patient stratification.