Case Report: Detection and quantification of tumor cells in peripheral blood and ascitic fluid from a metastatic esophageal cancer patient using the CellSearch (®) technology.

Qian Tu,Claire Bastien,Camille Lemarie-Delaunay,Marcelo De Carvalho Bittencourt,Huili Cai,Gilbert C Faure,Marie C Bene

doi:10.12688/f1000research.3-12.v1

Abstract

Analysis of ascitic fluid should help to identify and characterize malignant cells in gastrointestinal cancer. However, despite a high specificity, the sensitivity of traditional ascitic fluid cytology remains insufficient, at around 60%. Since 2004 the CellSearch (®) technology has shown its advantages in the detection of circulating tumor cells (CTCs) in peripheral blood, which can perform an accurate diagnosis and molecular analysis at the same time. To our knowledge, no previous study has explored the potential utility of this technology for the detection and quantification of tumor cells in ascitic fluid samples. Herein we report a case of metastatic esophageal adenocarcinoma in a 70-year-old man presenting with dysphagia and a large amount of fluid in the peritoneal cavity. Analysis of a peripheral blood sample and ascites sample with the CellSearch (®) technology both revealed the presence of putative tumor cells that were positive for epithelial cell adhesion molecule (EpCAM) and cytokeratin (CK) expression. This study confirmed the hematogenous dissemination of esophageal cancer by the detection of circulating tumor cells in the peripheral blood, and is the first to demonstrate that tumor cells can be identified in ascitic fluid by using CellSearch (®) technology.

Highlights

Esophageal cancer is the eighth most common carcinoma and the sixth leading cause of cancer-related death worldwide, with approximately 482,000 new cases and 400,000 associated deaths per year[1]
The detection of circulating tumor cells (CTCs) had an increasingly important role in the domain of oncological research. These cells have long been considered as a reflection of tumor aggressiveness, while hematogenous spreading of CTCs from a primary tumor could be an important step in the metastasis cascade, leading to the formation of overt metastases[6]
The presence of tumor cells in the peripheral blood and ascitic fluid was evaluated by the CellSearch® technology (Veridex LLC, Raritan, NJ), which detects CTCs based on ferrofluids coated with epithelial cell-specific epithelial cell adhesion molecule (EpCAM) antibodies and a mixture of phycoerythrin-conjugated antibodies to CK 8, 18, and 19

Summary

Introduction

Esophageal cancer is the eighth most common carcinoma and the sixth leading cause of cancer-related death worldwide, with approximately 482,000 new cases and 400,000 associated deaths per year[1]. Keywords Circulating tumor cell; Metastatic esophageal cancer; Ascitic fluid; CellSearch technology The presence of tumor cells in the peripheral blood and ascitic fluid was evaluated by the CellSearch® technology (Veridex LLC, Raritan, NJ), which detects CTCs based on ferrofluids coated with epithelial cell-specific EpCAM antibodies and a mixture of phycoerythrin-conjugated antibodies to CK 8, 18, and 19.

Results

Conclusion