在计划接受新辅助治疗的乳腺癌患者队列中，检测乳腺压迫前后的循环肿瘤细胞和循环肿瘤 DNA。
Detection of circulating tumor cells and circulating tumor DNA before and after mammographic breast compression in a cohort of breast cancer patients scheduled for neoadjuvant treatment.
机构信息
Department of Translational Medicine, Medical Radiation Physics, Lund University, Malmö, Sweden.
Department of Laboratory Medicine, Division of Translational Cancer Research, Lund University, Lund, Sweden.
出版信息
Breast Cancer Res Treat. 2019 Sep;177(2):447-455. doi: 10.1007/s10549-019-05326-5. Epub 2019 Jun 24.
PURPOSE
It is not known if mammographic breast compression of a primary tumor causes shedding of tumor cells into the circulatory system. Little is known about how the detection of circulating biomarkers such as circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA) is affected by breast compression intervention.
METHODS
CTCs and ctDNA were analyzed in blood samples collected before and after breast compression in 31 patients with primary breast cancer scheduled for neoadjuvant therapy. All patients had a central venous access to allow administration of intravenous neoadjuvant chemotherapy, which enabled blood collection from superior vena cava, draining the breasts, in addition to sampling from a peripheral vein.
RESULTS
CTC and ctDNA positivity was seen in 26% and 65% of the patients, respectively. There was a significant increase of ctDNA after breast compression in central blood (p = 0.01), not observed in peripheral testing. No increase related with breast compression was observed for CTC. ctDNA positivity was associated with older age (p = 0.05), and ctDNA increase after breast compression was associated with high Ki67 proliferating tumors (p = 0.04). CTCs were more abundant in central compared to peripheral blood samples (p = 0.04).
CONCLUSIONS
There was no significant release of CTCs after mammographic breast compression but more CTCs were present in central compared to peripheral blood. No significant difference between central and peripheral levels of ctDNA was observed. The small average increase in ctDNA after breast compression is unlikely to be clinically relevant. The results give support for mammography as a safe procedure from the point of view of CTC and ctDNA shedding to the blood circulation. The results may have implications for the standardization of sampling procedures for circulating tumor markers.
目的
目前尚不清楚乳腺肿瘤压迫是否会导致肿瘤细胞脱落到循环系统中。对于循环生物标志物（如循环肿瘤细胞[CTC]或循环肿瘤 DNA[ctDNA]）的检测如何受到乳腺压迫干预的影响，人们知之甚少。
方法
在 31 名计划接受新辅助治疗的原发性乳腺癌患者的血液样本中，分析了乳腺压迫前后采集的 CTC 和 ctDNA。所有患者均有中央静脉通路，允许静脉内给予新辅助化疗，除了从外周静脉取样外，还可以从引流乳房的上腔静脉采集血液。
结果
分别有 26%和 65%的患者出现 CTC 和 ctDNA 阳性。在中央血中，ctDNA 在乳腺压迫后显著增加（p=0.01），在外周检测中未观察到。CTC 与乳腺压迫无关的增加。ctDNA 阳性与年龄较大（p=0.05）相关，并且乳腺压迫后 ctDNA 增加与 Ki67 增殖肿瘤高（p=0.04）相关。ctDNA 在中央血中比外周血样本中更丰富（p=0.04）。
结论
乳腺压迫后没有明显的 CTC 释放，但中央血中的 CTC 比外周血中的更丰富。未观察到中央和外周 ctDNA 水平之间有显著差异。乳腺压迫后 ctDNA 的平均小幅度增加不太可能具有临床相关性。这些结果支持从 CTC 和 ctDNA 脱落到血液循环的角度来看，乳腺摄影是一种安全的程序。这些结果可能对循环肿瘤标志物采样程序的标准化具有重要意义。
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