Clinical significance of molecular detection of carcinoma cells

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PURPOSE : This study evaluated the clinical significance and predictive values for patients' prognosis of micrometastasis in the lymph nodes and samples of patients' with gastrointestinal or breast carcinomas.RESULTS : (A) BLOOD ; 1) Predictive values : Detection rate and sensitivity of cancer cells in peritumoral draining vein were increased using MACS(magnetic cell sorting system) for colon cancer patients. Of 7 cases with K-ras mutation in the draining vein, 2 cases (29%) developed recurrent disease after curative operation at 8 or 15 months, respectively. On the other hands, of 17 cases without K-ras mutation, only one case (6%) developed recurrence. 2) Application for clinical use : CEAmRNA was detected in peripheral bloods of 10 cases with recurrent or advanced disease before chemotherapy, CEAmRNA was disappeared in 3 cases (30%) during the therapy, this was useful for monitoring the chemotherapy. The patients who underwent operation could store their CEAmRNA negative blood for a … More transfusion, ensuring no contamination of cancer cells.(B) LYMPH NODES : 1) Predictive value : Of twenty-eight patients with histologically negative but CEAmRNA positive lymph nodes (28/64=44%), 3 cases (1 gastric, 1 colon, 1 esophageal cancer) developed recurrent disease. 2) Application for clinical use : Detection rate and sensitivity of cancer cells in lymph nodes were increased by RT-PCR. The patients without micrometastasis in the sentinel lymph node might save axillary nodes dissection of early breast cancer patients. We have established prompt RT-PCR technique which can be preformed within 60 minutes for practical molecular diagnosis during operation.CONCLUSION : It has been shown that RT-PCR is a powerful tool to detect very small number of cancer cells in the blood or the lymph nodes. The time-shortened RT-PCR technique is potentially very useful to determine the patients at high-risk for metastasis or patients indicative for less invasive surgery. It would be possible to choose various strategies for each case based on presence of mirometastasis. Less