Diagnostic and prognostic value of circulating tumor cells in female breast cancer patients

Abstract

AimThe aim of the current study is to detect CTCs in the blood of breast cancer females by the expression of Mammoglobin and Mucin-1 to evaluate their potential as diagnostic and prognostic markers of breast cancer and predictors of metastasis. Subjects and methodsThe study involved 50 patients and thirty controls. Fifty patients recently diagnosed with breast cancer were proved by fine needle aspiration cytology or core biopsy, all the patients were operated upon by modified radical mastectomy under general anesthesia after complete preoperative evaluation. From each subject a blood sample was drawn before surgery, 2weeks after surgery and after 6 cycles of chemotherapy. Mononuclear cells were separated from 7.5ml blood using a phicoll gradient. From these cells mRNA was extracted, and RT-PCR was carried out to detect Mammoglobin and Mucin-1 gene expression from CTCs. Also CA 15.3 was measured in all the samples. ResultsCTCs were detected in more than 80% of primary breast cancer patients at presentation, that percent decreased after surgery and after adjuvant chemotherapy. CTCs detection after surgery and after chemotherapy was significantly correlated with tumor size, grad, vascular invasion and metastasis. CTCs posed an almost two-fold risk of metastasis and significantly lower DFS time in positive than in negative patients. Detection of CTCs in peripheral blood after chemotherapy successfully predicted subsequent metastasis. ConclusionThe hematogenous spread of tumor cells in patients with breast cancer may be an early phenomenon occurring before/apart from regional lymph nodes involvement. CTCs detection by RT-PCR could add to the initial evaluation of primary breast cancer patients. Also, adjuvant chemotherapy might eliminate or decrease occult tumor cells. But CTCs evaluation after adjuvant chemotherapy could predict metastasis and the presence of CTCs after chemotherapy reflect a higher potential for subsequent metastasis.