title: Circulating tumor cells found in patients with localized and advanced pancreatic cancer.
abstract: OBJECTIVE
  Isolation of circulating tumor cells (CTCs) holds the promise of diagnosing and molecular profiling cancers from a blood sample. Here, we test a simple new low-cost filtration device for CTC isolation in patients with pancreatic ductal adenocarcinoma (PDAC).
  
  
  METHODS
  Peripheral blood samples drawn from healthy donors and PDAC patients were filtered using ScreenCell devices, designed to capture CTCs for cytologic and molecular analysis. Giemsa-stained specimens were evaluated by a pancreatic cytopathologist blinded to the histological diagnosis. Circulating tumor cell DNA was subjected to KRAS mutational analysis.
  
  
  RESULTS
  Spiking experiments demonstrated a CTC capture efficiency as low as 2 cells/mL of blood. Circulating tumor cells were identified by either malignant cytology or presence of KRAS mutation in 73% of 11 patients (P = 0.001). Circulating tumor cells were identified in 3 of 4 patients with early (≤American Joint Committee on Cancer stage IIB) and in 5 of 7 patients with advanced (≥ American Joint Committee on Cancer stage III) PDAC. No CTCs were detected in blood from 9 health donors.
  
  
  CONCLUSIONS
  Circulating tumor cells can be found in most patients with PDAC of any stage, whether localized, locally advanced, or metastatic. The ability to capture, cytologically identify, and genetically analyze CTCs suggests a possible tool for the diagnosis and characterization of genetic alterations of PDAC.
authors.affiliation: From the *Department of Surgery and †Andrew L. Warshaw Institute for Pancreatic Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA; ‡Department of Surgery, University Hospital Freiburg, Freiburg, Germany; §Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and ║Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Birte
authors.initials: B
authors.lastname: Kulemann
authors.forename: Martha B
authors.initials: MB
authors.lastname: Pitman
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Liss
authors.forename: Nakul
authors.initials: N
authors.lastname: Valsangkar
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-Del Castillo
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: Jens
authors.initials: J
authors.lastname: Hoeppner
authors.forename: Mari
authors.initials: M
authors.lastname: Mino-Kenudson
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Thayer
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000235:genetics; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000235:genetics / Q000473:pathology*; D016022:Case-Control Studies; D002469:Cell Separation; D005260:Female; D005374:Filtration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D010190:Pancreatic Neoplasms / Q000097:blood / Q000235:genetics / Q000473:pathology*; D011446:Prospective Studies; D016283:Proto-Oncogene Proteins p21(ras) / Q000235:genetics; D016037:Single-Blind Method
chemical_list: D014408:Biomarkers, Tumor; C117307:KRAS protein, human; D016283:Proto-Oncogene Proteins p21(ras)