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Portal veinous blood test may improve diagnosis, treatment of pancreatic cancers
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Sampling portal venous blood via endoscopic ultrasound was found to be safe and feasible for counting circulating tumor cells in patients with pancreaticobiliary cancers, which may prove to be a valuable tool in diagnosing and guiding treatment for these cancers, according to recent study data.
“We demonstrated that this method is potentially quite valuable as well as noninvasive, feasible and safe,” Irving Waxman, MD, professor of medicine and surgery and director of the Center for Endoscopic Research and Therapeutics at the University of Chicago, said in a press release. “This is a novel and far more sensitive way to acquire, enumerate, and characterize [circulating tumor cells] from pancreatobiliary and other gastrointestinal cancers in this setting.”
Waxman and colleagues performed a single-center cohort study of 18 patients (mean age, 66.1 years; 78% men; 78% white) with suspected pancreaticobiliary cancers who were referred for endoscopic ultrasound (EUS) with cross-sectional imaging. Portal veinous blood samples were collected during EUS and peripheral blood samples were obtained before EUS, both of which were processed and analyzed for circulating tumor cells identically.
Circulating tumor cells were detected in all of the patients’ portal vein samples, but in only 22.2% of patients’ peripheral blood samples. Patients with confirmed pancreaticobiliary cancers had a mean of 118.4 ± 36.8 circulating tumor cells per 7.5 mL portal vein blood vs. 0.8 ± 0.4 per 7.5 mL peripheral blood (P < .01). Among nine patients with nonmetastatic, resectable or borderline-resectable pancreaticobiliary cancers, mean circulating tumor cells per 7.5 mL portal vein blood was 83.2. Further analysis in one patient showed that portal vein circulating tumor cells carried the same mutations as circulating tumor cells from a metastatic lymph node, and also expressed comparable P16, SMAD4 and P53 proteins levels.
“In the setting of localized cancer where these findings are most applicable, the additional information of portal vein [circulating tumor cell] number and their molecular characterization may help predict who will benefit from aggressive therapy before surgery, who is most at risk for a recurrence after the operation, and even who will not benefit from surgery at all,” Daniel Catenacci, MD, assistant professor of medicine at the University of Chicago, said in the press release.
“Ultimately, we envision that this new test could help plan treatment, based on a much more accurate record of the number and characteristics of circulating tumor cells,” Christopher Chapman, MD, member of the Center for Endoscopic Research and Therapeutics at the University of Chicago, said in the press release. “That should allow us to make better, more informed judgements about prognosis, and avoid interventions, such as surgery, that might not help.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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