DETECTION OF INTRAOPERATIVE TUMOR-CELL DISSEMINATION IN PATIENTS WITHBREAST-CANCER BY USE OF REVERSE TRANSCRIPTION AND POLYMERASE CHAIN-REACTION

Background. Animal studies have shown that malignant cells are shed in to the blood stream during surgical resection of a primary tumor and t hat this may enhance the development of metastases. The evidence for h umor cell dissemination during surgical manipulation of human cancer i s unclear. We have applied the technique of reverse transcription and polymerase chain reaction to defect circulating tumor cells in periphe ral venous blood of patients with breast cancer perioperatively. Metho ds. To target breast-specific gene transcription complementary DNA tea s prepared by reverse transcription of blood messenger RNA with oligon ucleotide primers unique to CK18 and DF3 antigens. Preliminary assessm ent of specificity showed that the DF3 antigen was more suitable than CK18 for the purpose of this study. Assessment of sensitivity showed t hat as few as 10 tumor cells per 5 mi blood could be identified by thi s method. Peripheral blood samples were obtained by venepuncture from patients before, during, and 24 hours after breast surgery (nine malig nant and three benign). Results. In the group of patients with maligna nt disease, tumor cells were detected in one patient before operation and four patients during operation. No tumor cells were detected in th e postoperative samples nor in any of the samples of patients with ben ign disease. Conclusions. These findings suggest that tumor manipulati on during operation encourages tumor cell dissemination.