Micrometastases in bone marrow of patients with suspected pancreatic and ampullary cancer.
OBJECTIVE
This prospective study aimed to evaluate the detection of micrometastases in bone marrow of patients with suspected pancreatic and ampullary cancer 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 diagnostic laparoscopy as a final staging procedure before exploration. Bone marrow was aspirated from the iliac crest at the beginning of laparoscopy. Mononuclear cells were isolated and stained using the specific monoclonal antibody CAM 5.2.


RESULTS
Cytokeratin-positive cells were detected in 12/35 (34%) of all patients. In the 31 patients with a final diagnosis of carcinoma, a positive staining was found in 10/31 (32%) of the bone marrow aspirates. After a median 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 who turned out to have chronic pancreatitis were alive without malignancy. In two of these four patients, distinct cytokeratin-positive cells were seen.


CONCLUSIONS
Micrometastases in bone marrow of patients with the final diagnosis pancreatic or ampullary carcinoma seem to predict a significantly shorter survival. However, clinical use of cytokeratin markers cannot be recommended at present, because false-positive staining was found.
van Heek
N T
NT
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Tascilar
M
M
van Beekveld
J L
JL
Drillenburg
P
P
Offerhaus
G J
GJ
Gouma
D J
DJ
D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D015415:Biomarkers; D014408:Biomarkers, Tumor / Q000032:analysis*; D001854:Bone Marrow Cells / Q000473:pathology; D019046:Bone Marrow Neoplasms / Q000175:diagnosis / Q000556:secondary*; D003138:Common Bile Duct Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D001239:Inhalation; D007633:Keratins / Q000032:analysis*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011446:Prospective Studies; D016019:Survival Analysis
D015415:Biomarkers; D014408:Biomarkers, Tumor; C400901:CAM 5.2 antigen; D007633:Keratins