The Diagnosis of Malignant Pancreatic Tumours by Circulating Tumour Cell Detection

ABSTRACT Introduction The fine needle aspiration by endoscopic ultrasound guide (EUS FNA) is a diagnostic examination of choice in solid tumour of the pancreas. This invasive technique has a sensitivity of about 70%. The search for circulating tumour cells (CTC) is a non invasive procedure, which could represent an alternative or complement to EUS FNA diagnostic. The objective of this prospective pilot study was to evaluate the diagnostic value of research CTC versus EUS FNA for the diagnosis of a solid tumour of the pancreas (STP). Patients and methods From 01/01 to 30/09/2011, all patients undergoing an EUS FNA for a STP were included. EUS FNA was performed with a 22 gauge needle and analyzed by two experienced pathologists. For detection of CTC, 10 ml of blood collected in the periphery before FNA was filtered by technology ScreencellCyto â, stained with Giemsa and analyzed by a cytologist. Peripheral cells were considered tumour if they had the following morphology: kernel> 7 m, anisocytosis, membrane irregularities, presence of a large nucleolus. Results Twenty six patients with TSP were included (14 men and 12 women), mean age was 64.2 years. The tumor was potentially resectable in 11 cases, 8 cases had a locoregional recurrence and 7 a metastatic extension. In total, 23/26 cases were analyzed due to technical failure of the CTC research (insufficient material) and two technical failures of EUS FNA. 20 patients had cancer objectified (including 15 adenocarcinomas or 57%) by EUS FNA pancreatic histological analysis of the specimen and/or clinical course. In this population of 26 patients the sensitivity of the search CTC was 60%, specificity 100%, positive predictive value 100% and negative predictive value of 27%. On the results of FNA sensitivity for the diagnosis of cancer was 75%, specificity 100%, PPV of 100% and NPV of 37.5%. In patients whose FNA was contributory to the sensitivity of CTC research was 83%, specificity 54%, PPV of 66% and NPV of 75%. Conclusion The detection of CTC for the diagnosis of adenocarcinoma in case of tumours of the pancreas is a technique feasible, non-invasive, with a satisfactory diagnostic yield. The results of this pilot study, the continued progress in the analysis of CTC and a confirmation of this results in a higher independent population could allow us to propose this procedure in a first diagnostic step. Disclosure All authors have declared no conflicts of interest.