Lung cancer biopsy dislodges tumor cells into circulating blood

Abstract

Aim: A “seed” of lung cancer metastasis is circulating tumor cells (CTCs), which may be dislodged from a tumor during biopsy. This possibility was assessed among patients who underwent lung tumor biopsy using flexible fiber-topic bronchoscopy (FFB).

Methods: The study involved six patients with non-small cell lung cancer who underwent FFB biopsy to diagnose a lesion pathologically (5 males and 1 female, median age 63 years, 6 adenocarcinomas, of 4 clinical-stage IA, 1 stage IB, and 1 stage IIIA), CTCs were extracted from the peripheral vein blood at pre-FFB and at post-FFB using a size selection method.

Results: No tumor cell was detected at pre- and post-FFB was in three cases (50%); no tumor cells were detected pre-FFB while CTCs were detected at post-FFB in two cases (33.3%); and CTCs were detected at pre-FFB with numerous CTCs detected at post-FFB in one case (17.7%). In addition, similar tendencies were observed in each analysis of single-cell and clustered-cell categories.

Conclusion: These results suggest that a FFB biopsy of lung cancer may potentially dislodge CTCs from a tumor into the circulating peripheral blood.

Keywords

Lung cancer / biopsy / circulating tumor cells

References

[1] Sawabata N,Maeda H,Yamaguchi T,Itho M.Diagnosis of solitary pulmonary nodule: optimal strategy based on nodal size..Interact Cardiovasc Thorac Surg2006;5:105-8

[2] Sawabata N,Maeda H.Fine-needle aspiration cytologic technique for lung cancer has a high potential of malignant cell spread through the tract..Chest2000;118:936-9

[3] Inoue M,Tomiyama N,Sawabata N,Shintani Y,Okumura M.Risk of pleural recurrence after computed tomographic-guided percutaneous needle biopsy in stage I lung cancer patients..Ann Thorac Surg2011;91:1066-71

[4] Kashiwabara K,Fujii S.Preoperative percutaneous transthoracic needle biopsy increased the risk of pleural recurrence in pathological stage I lung cancer patients with sub-pleural pure solid nodules..Cancer Invest2016;34:373-7

[5] Robertson EG.Tumour seeding following percutaneous needle biopsy: the real story!.Clinical radiol2011;66:1007-14

[6] Sawabata N,Ohota H,Hirano H,Matsuda H.Cytologically malignant margins of wedge resected stage I non-small cell lung cancer..Ann Thorac Surg2002;74:1953-7

[7] Sawabata N,Umezu H,Seki N,Honma K.Cytologically malignant margin without continuous pulmonary tumor lesion: cases of wedge resection, segmentectomy and lobectomy..Interact Cardiovasc Thorac Surg2008;7:1044-8

[8] Sawabata N,Matsumura A,Okumura M.Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer..Surg Today2012;42:238-44

[9] Takahashi N,Kawamura M,Horio H,Nakayama M,Chida M.Multicenter prospective study of sublobar resection for c-stage I non-small cell lung cancer patients unable to undergo lobectomy (KLSG-0801): complete republication..Gen Thorac Cardiovasc Surg2016;64:470-5

[10] Sawabata N,Ohta M.Operable non-small cell lung cancer diagnosed by transpleural techniques: do they affect relapse and prognosis?.Chest2001;120:1595-8

[11] Nakajima J,Takamoto S.Does preoperative transbronchial biopsy worsen the postsurgical prognosis of lung cancer? A propensity score-adjusted analysis..Chest2005;128:3512-8

[12] Sawabata N,Utsumi T,Shiono H,Nishida T.Circulating tumor cells in peripheral blood caused by surgical manipulation of non-small-cell lung cancer: pilot study using an immunocytology method..Gen Thorac Cardiovasc Surg2007;55:189-92

[13] Sawabata N,Hyakutake T,Fujiwara A.Perioperative circulating tumor cells in surgical patients with non-small cell lung cancer: does surgical manipulation dislodge cancer cells thus allowing them to pass into the peripheral blood?.Surg Today2016;46:1402-9

[14] Hashimoto M,Yoneda K,Matsumoto S,Kondo N,Tsujimura T,Nakano T.Significant increase in circulating tumour cells in pulmonary venous blood during surgical manipulation in patients with primary lung cancer..Interact Cardiovasc Thorac Surg2014;18:775-83

[15] Yao X,Adalsteinsson VA,Fitton T,William RT,Love JC.Tumor cells are dislodged into the pulmonary vein during lobectomy..J Thorac Cardiovasc Surg2014;148:3224-31 PMCID:PMC4356533

[16] Desitter I,Benali-Furet N,Jänne PA,Yanagita M,Berkowitz JA,Cayre YE.A new device for rapid isolation by size and characterization of rare circulating tumor cells..Anticancer Res2011;31:427-41

[17] Hansen E,Knuechel R,Hofstaedter F.Tumor cells in blood shed from the surgical field..Arch Surg1995;130:387-93

[18] Yamashita J,Kurusu Y,Hayashi N.Preoperative evidence of circulating tumor cells by means of reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen messenger RNA is an independent predictor of survival in non-small cell lung cancer: a prospective study..J Thorac Cardiovasc Surg2002;124:299-305

[19] Brown DC,Birnie GD.Detection of intraoperative tumor cell dissemination in patients with breast cancer by use of reverse transcription and polymerase chain reaction..Surgery1995;117:95-101

[20] Allard WJ,Miller MC,Connelly MC,Tibbe AG,Terstappen LW.Tumor cells circulate in the peripheral blood of all major carcinomas but not in healthy subjects or patients with nonmalignant diseases..Clin Cancer Res2004;10:6897-904

[21] Crosbie PA,Krysiak P,Morris K,Booton R,Dive C.Circulating tumor cells detected in the tumor-draining pulmonary vein are associated with disease recurrence after surgical resection of NSCLC..J Thorac Oncol2016;11:1793-7 PMCID:PMC5063509

[22] Funaki S,Nakagiri T,Inoue M,Minami M.Novel approach for detection of isolated tumor cells in pulmonary vein using negative selection method: morphological classification and clinical implications..Eur J Cardiothorac Surg2011;40:322-7

[23] Funaki S,Abulaiti A,Inoue M,Minami M.Significance of tumour vessel invasion in determining the morphology of isolated tumour cells in the pulmonary vein in non-small-cell lung cancer..Eur J Cardiothorac Surg2013;43:1126-30

[24] Okumura Y,Yoneda K,Takuwa T,Hasegawa S.Circulating tumor cell in pulmonary venous blood of primary lung cancer patients..Ann Thorac Surg2009;87:1669-75

[25] Ma YC,Yu FL.Recent advances and prospects in the isolation by size of epithelial tumor cells (ISET) methodology..Technol Cancer Res Treat2013;12:295-309

[26] Aceto N,Miyamoto DT,Wittner BS,Yu M,Engstrom A,Brannigan BW,Stott SL,Ramaswamy S,Lin CP,Haber DA.Circulating tumor cell clusters are oligoclonal precursors of breast cancer metastasis..Cell2014;158:1110-22 PMCID:PMC4149753

[27] Altorki NK,Narula N,Nasar A,Lee PC,Stiles BM.Anatomical segmentectomy and wedge resections are associated with comparable outcomes for patients with small cT1N0 non-small cell lung cancer..J Thorac Oncol2016;11:1984-92

[28] Sawabata N,Shintani Y.Lung excision of non-small-cell lung cancer leaves cancer cells in residual lobe: cytological detection using pulmonary vein blood..Interact Cardiovasc Thorac Surg2016;22:131-5