title: ERalpha-status of disseminated tumour cells in bone marrow of primary breast cancer patients.
abstract: BACKGROUND
  Isolated disseminated tumour cells (DTC) are regarded as surrogate markers for minimal residual disease in breast cancer. Characterisation of these cells could help understand the known limitations of adjuvant therapy. Of particular interest is their oestrogen-receptor (ER) status because endocrine adjuvant therapy remains a cornerstone of breast cancer treatment.
  
  
  METHODS
  Bone marrow (BM) aspirates from 254 patients with primary breast cancer were included in this study. A double immunofluorescence staining procedure was established for the identification of cytokeratin (CK) positive/Eralpha-positive cells. ERalpha status of the primary tumour was assessed immunohistochemically using the same antibody against ERalpha.
  
  
  RESULTS
  In 107 of 254 (42%) breast cancer patients, CK-positive cells could be detected in the BM. More than one DTC in the BM was observed in 38 of the 107 patients. The number of detected cells ranged between 1 and 55 cells per 2 x 10(6) mononuclear cells. DTCs demonstrated ERalpha positivity in 12% of the patients. The ERalpha expression was heterogeneous in 10 of the 38 (26%) patients with more than one DTC. The concordance rate of ERalpha status between primary tumour and DTC was 28%. Only 12 of 88 patients with ERalpha-positive tumours also had ERalpha-positive DTCs.
  
  
  CONCLUSIONS
  Primary tumours and DTCs displayed a concordant ERalpha status in only 28% of cases. Most of the DTCs were ERalpha negative despite the presence of an ERalpha-positive primary tumour. These findings further underline the distinct nature of DTCs and may explain the failure rates seen in conventional endocrine adjuvant therapy.
authors.affiliation: Department of Obstetrics and Gynecology, University of Tuebingen, Germany. tanja.fehm@t-online.de
authors.forename: Tanja
authors.initials: T
authors.lastname: Fehm
authors.forename: Natalia
authors.initials: N
authors.lastname: Krawczyk
authors.forename: Erich-Franz
authors.initials: EF
authors.lastname: Solomayer
authors.forename: Graziella
authors.initials: G
authors.lastname: Becker-Pergola
authors.forename: Silke
authors.initials: S
authors.lastname: Dürr-Störzer
authors.forename: Hans
authors.initials: H
authors.lastname: Neubauer
authors.forename: Harald
authors.initials: H
authors.lastname: Seeger
authors.forename: Annette
authors.initials: A
authors.lastname: Staebler
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
authors.forename: Sven
authors.initials: S
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology*; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy / Q000473:pathology*; D002277:Carcinoma / Q000737:chemistry / Q000188:drug therapy / Q000556:secondary*; D045744:Cell Line, Tumor / Q000737:chemistry; D017024:Chemotherapy, Adjuvant; D004847:Epithelial Cells / Q000737:chemistry*; D047628:Estrogen Receptor alpha / Q000032:analysis*; D004967:Estrogens; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007633:Keratins / Q000032:analysis; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis*; D018365:Neoplasm, Residual; D009376:Neoplasms, Hormone-Dependent / Q000737:chemistry / Q000188:drug therapy / Q000473:pathology*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047628:Estrogen Receptor alpha; D004967:Estrogens; D009363:Neoplasm Proteins; D007633:Keratins
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