title: Analysis of mutations in DNA isolated from plasma and stool of colorectal cancer patients.
abstract: OBJECTIVE
  Somatic mutations provide uniquely specific markers for the early detection of neoplasia that can be detected in DNA purified from plasma or stool of patients with colorectal cancer. The primary purpose of the present investigation was to determine the parameters that were critical for detecting mutations using a quantitative assay. A secondary purpose was to compare the results of plasma and stool DNA testing using the same technology.
  
  
  METHODS
  We examined DNA purified from the stool of 25 patients with colorectal cancers before surgery. In 16 of these cases, plasma samples also were available. Mutations in stool or plasma were assessed with an improved version of the BEAMing technology.
  
  
  RESULTS
  Of the 25 stool DNA samples analyzed, 23 (92%) contained mutations that were present in the corresponding tumors from the same patients. In contrast, only 8 of the 16 (50%) plasma DNA samples analyzed had detectable levels of mutated DNA. We found that the DNA fragments containing mutations in both stool and plasma DNA typically were smaller than 150 bases in size. The sensitivity of the new method was superior to a widely used technique for detecting mutations, using single base extension and sequencing, when assessed on the same samples (92% vs 60%; P = .008, exact McNemar test).
  
  
  CONCLUSIONS
  When assessed with sufficiently sensitive methods, mutant DNA fragments are detectable in the stool of more than 90% of colorectal cancer patients. DNA purified from stool provides a better template for mutation testing than plasma.
authors.affiliation: The Ludwig Center for Cancer Genetics and Therapeutics, Howard Hughes Medical Institute and Sidney Kimmel Cancer Center, Baltimore, Maryland, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Diehl
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schmidt
authors.forename: Kristine H
authors.initials: KH
authors.lastname: Durkee
authors.forename: Kent J
authors.initials: KJ
authors.lastname: Moore
authors.forename: Steve N
authors.initials: SN
authors.lastname: Goodman
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Shuber
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Kinzler
authors.forename: Bert
authors.initials: B
authors.lastname: Vogelstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000235:genetics*; D004252:DNA Mutational Analysis / Q000379:methods*; D004273:DNA, Neoplasm / Q000032:analysis* / Q000097:blood; D004655:Emulsions; D005243:Feces / Q000737:chemistry*; D005260:Female; D005434:Flow Cytometry; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D004273:DNA, Neoplasm; D004655:Emulsions