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Sawabata et al. Circulating tumor cells after lung-cancer biopsy

Pulmonary wedge resection is also a crucial diagnostic fixed tumor cells. [16] ScreenCell Cyto is designed
®
technique for pulmonary nodules that may indicate lung for cytological studies and the filter allows a fast and
cancer. This procedure also may potentially dislodge regular filtration, preserving the CTC morphology and
tumor cells from the surgical margin to the body, even microcluster structures. Blood samples were diluted
when a specimen of pulmonary wedge resection with the (LC/CC) ScreenCell (ScreenCell, Westford,
®
contents histologically malignant negative surgical MA) dilution buffers for fixed cells. At the end of
®
margin. [6,7] Malignant-positive results in the surgical filtration, the ScreenCell Cyto filter was released onto
margin have been reported to be an indicator of poor a standard microscopy glass slide; a 7 mm circular
prognosis in a retrospective study. Furthermore, it coverslip was then laid down on the filter with the
[8]
has been reported that malignant surgical margins appropriate mounting medium.
of pulmonary wedge resection for lung cancer was
a negative prognostic predictor in a subset analysis Peripheral blood (3 mL) was collected into an EDTA
included in a multicenter prospective study of limited tube pre- and post-FFB. Tumor cells in two blood
pulmonary resection for compromised lung cancer samples from each patient were simultaneously
patients. [9] extracted using the method. These extracted cells
were stained using a hematoxylin and eosin method
TBB is also an important method in diagnosing and observed with a conventional microscope. Tumor
lung cancer. However, there have been reports cells were classified using three categories: no tumor
demonstrating a prognostic disadvantage for biopsy cells detected (N), single cell or less than four cells (S),
using FFB. [10,11] An observational study revealed that and clustered cells (C).
patients who were diagnosed with lung cancer using
a trans-pleural technique had a statistically (P = 0.04) RESULTS
better 5-year survival rate than patients diagnosed
[10]
using TBB. This phenomenon was also reported in FFB-TBB was carried out under localized anesthesia
a study using propensity score matched analysis. using radiography to confirm that a sampling device
[11]
These results may mean that an intervention in a reaches hits at a lesion. Samples for cytology and
cancer lesion using TBB may dislodge cancer cells pathology were collected from a lesion. Cytological
from the lesion to the circulating blood. diagnosis of malignancy was achieved in only four
cases, while all lesions revealed a pathological
There are also studies revealing that manipulation diagnosis, which is the result of manipulation that FFB-
during lung cancer surgery has the potential to dislodge TBB made while contacting a cancer lesion. There
cancer cells into the circulating blood, which is reported was no complication during and after FFB-TBB and all
to be aprognostic indicator of poor outcomes. [12-15] patients were discharged without event.
Above all, detecting cluster circulating tumor cell
(CTC) is speculated the best a strong predictor of early Patient/tumor characteristics and status of CTC in each
recurrence. FBB also manipulates the area of lung patient are shown in Table 1. There were five males
[13]
cancer during biopsy; thus, CTCs might be dislodged and one female with a median age of 63 years, (range
from the lesion to the circulating blood as the same 59-78 years). According to CT findings, all lesions were
manner as surgical manipulation. For that reason we solid and tumor size on CT findings was a median
assessed the status of CTC before and after FFB 2.5 cm (range 2.1-3.5 cm). Tumor invasiveness status
biopsy to diagnose lung cancer. in pathological diagnosis was “invasive” in all cases.
Clinical stage was clinical -- stage IA in four cases,
METHODS stage IB in one case and stage IIIA in one case.
Singular or cluster CTCs were detectable as shown
This investigation was approved by the institutional in Figure 1. The CTC counts at pre- and post-FFB
review board of the Hoshigaoka Medical Center and all procedures are shown in Table 1. In one case CTC
patients provided their informed consent to participate was detectable before FFB. This case was stage IIIA
in this study. with mediastinal lymphadenopathy. In an analysis of
all cell categories, no tumor cell was detected at pre-
Among 6 patients with non-small cell lung cancer FFB; at post-FFB a tumor cell was detected in three
(NSCLC) who underwent FFB to diagnose a lesion cases (50.0%). No tumor cell was detected at pre-FFB,
pathologically, CTCs were extracted from a peripheral while CTCs were detected at post-FFB in two cases
vein at pre-FFB and at post-FFB using a size selection (33.3%) and CTCs were detected at pre-FFB, while
method [ScreenCell Cyto (ScreenCell, Westford, numerous CTCs were detected at post-FFB in one
®
MA)]: using a micro-pore film that extracts formalin- case (17.7%). In analysis of singular cells, no tumor
Journal of Cancer Metastasis and Treatment ¦ Volume 3 ¦ January 23, 2017 17