Micrometastases in bone marrow of patients with suspected pancreatic and ampullary cancer

Aims: This prospective study aimed to evaluate the detection of micrometast ases in bone marrow of patients with: suspected pancreatic and ampullary ca ncer and to determine their predictive value on overall survival. Methods: Between December 1997 and December 1998, 35 patients (19 male, 42- 77 years) with suspected pancreatic and ampullary cancer underwent diagnost ic laparoscopy as a final staging procedure before exploration. Bone marrow was aspirated from the iliac crest at the beginning of laparoscopy. Mononu clear cells were isolated and stained using the specific monoclonal antibod y CAM 5.2. Results: Cytokeratin-positive cells were detected in 12/35 (34%) of all pat ients. In the 31 patients with a final diagnosis of carcinoma, a positive s taining was found in 10/31 (32%) of the bone marrow aspirates. After a medi an follow-up of 17 months (2-24), 15/31 (48%) patients had died: 7/10 (70%) with and 8/21 (38%) without micrometastases (*P<0.04). All four patients w ho turned out to have chronic pancreatitis were alive without malignancy. I n two of these four patients, distinct cytokeratin-positive cells were seen . Conclusions: Micrometastases in bone marrow of patients with the final diag nosis pancreatic or ampullary carcinoma seem to predict a significantly sho rter survival. However, clinical use of cytokeratin markers cannot be recom mended at present, because false-positive staining was found. (C) 2001 Harc ourt Publishers Ltd.