Breast Cancer Cells in the Blood: A Pilot Study

Abstract

The goal of this pilot study was to determine in patients with operable breast cancer the incidence of breast cancer cells present in the blood, the clearance rate after surgical resection of the primary tumor, and the incidence of patients with persistent cancer cells in the blood after the primary tumor was removed. Twenty-one patients with operable breast cancer had 15 ml venous blood obtained twice prior to surgery and after surgery at 2, 4, 8, 12, 24, and 48 hours and also on days 7 and 14. Immunomagnetic selection of malignant cells was performed on each sample. Cells were then fixed on slides and immunocytochemistry performed on the collected cells. Cells that had a rosette of magnetic beads, cytoplasmic staining for keratin, and malignant morphology were counted as breast cancer cells. Eighteen of 19 of patients had cancer cells detected in at least one of the two blood samples preceding surgical removal of the primary tumor. The incidence of cancer cells in the blood of patients rapidly declined during the 48 hours postsurgery. The incidence of cancer cells in the blood remained stable in approximately 30% of patients to 14 days. The majority of breast cancer patients in this pilot study (even with small tumors and negative nodes) had detectable cancer cells in the blood prior to resection of the primary tumor. These findings justify further investigation. Successful application of this methodology may serve as a powerful indicator of which patients need systemic adjuvant therapy, the effectiveness of systemic adjuvant therapy, tumor recurrence, and early detection of breast cancer.

Detection of human mammaglobin mRNA in serial peripheral blood samples from patients with non-metastatic breast cancer is not predictive of disease recurrence

“…These cells are present not only in patients with metastatic disease, but also in those whose tumours are apparently localised [30]. This is also observed in breast cancer, where malignant cells seem to spread into the bloodstream in early stages of tumour development [31,32]. Many patients subsequently relapse at distant sites despite adequate local treatment, presumably as a result of undetected spread of the tumour cells before the removal of the primary tumour [30].…”

Dormancy in breast cancer

“…13,14 Nonetheless, approximately one-third of patients fail to clear tumor cells from the blood following removal of primary tumor. 15,16 Only a small fraction of CTC may be viable and able to enter secondary sites by mechanical entrapment or active migration through the endothelial cell layer. [17][18][19][20] Factors supporting extravasation are highly heterogeneous, including platelets; leucocytes; macrophages and factors secreted by them; selectins and their ligands expressed on endothelial cells and tumor cells, respectively; integrins; and fibrin deposition.…”

Evaluation of a Panel of Tumor Markers for Molecular Detection of Circulating Cancer Cells in Women with Suspected Breast Cancer

“…Application of these methods may allow for the early detection of cancer when the tumor burden is small and the disease is potentially more curable (5). It has been reported that anti -breast cancer epithelium monoclonal antibodies detected circulating cells in 95% of breast cancer patients before surgery and in 32% of the patients after surgery (8,9). These promising results support the design of feasibility studies that will utilize sensitive molecular techniques to detect circulating breast cancer cells.…”