title: Ultra-deep sequencing detects ovarian cancer cells in peritoneal fluid and reveals somatic TP53 mutations in noncancerous tissues.
abstract: Current sequencing methods are error-prone, which precludes the identification of low frequency mutations for early cancer detection. Duplex sequencing is a sequencing technology that decreases errors by scoring mutations present only in both strands of DNA. Our aim was to determine whether duplex sequencing could detect extremely rare cancer cells present in peritoneal fluid from women with high-grade serous ovarian carcinomas (HGSOCs). These aggressive cancers are typically diagnosed at a late stage and are characterized by TP53 mutations and peritoneal dissemination. We used duplex sequencing to analyze TP53 mutations in 17 peritoneal fluid samples from women with HGSOC and 20 from women without cancer. The tumor TP53 mutation was detected in 94% (16/17) of peritoneal fluid samples from women with HGSOC (frequency as low as 1 mutant per 24,736 normal genomes). Additionally, we detected extremely low frequency TP53 mutations (median mutant fraction 1/13,139) in peritoneal fluid from nearly all patients with and without cancer (35/37). These mutations were mostly deleterious, clustered in hotspots, increased with age, and were more abundant in women with cancer than in controls. The total burden of TP53 mutations in peritoneal fluid distinguished cancers from controls with 82% sensitivity (14/17) and 90% specificity (18/20). Age-associated, low frequency TP53 mutations were also found in 100% of peripheral blood samples from 15 women with and without ovarian cancer (none with hematologic disorder). Our results demonstrate the ability of duplex sequencing to detect rare cancer cells and provide evidence of widespread, low frequency, age-associated somatic TP53 mutation in noncancerous tissue.
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA 98195;
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Krimmel
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA 98195; Divisions of Hematology and Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98195;
authors.forename: Michael W
authors.initials: MW
authors.lastname: Schmitt
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195;
authors.forename: Maria I
authors.initials: MI
authors.lastname: Harrell
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195;
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Agnew
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA 98195;
authors.forename: Scott R
authors.initials: SR
authors.lastname: Kennedy
authors.affiliation: Department of Statistics, University of Washington, Seattle, WA 98195.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Emond
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA 98195;
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Loeb
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195;
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Swisher
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA 98195; rrisques@uw.edu.
authors.forename: Rosa Ana
authors.identifier: 0000-0002-0291-1858
authors.initials: RA
authors.lastname: Risques
mesh_terms: D000328:Adult; D000368:Aged; D001202:Ascitic Fluid; D005260:Female; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D016159:Tumor Suppressor Protein p53 / Q000235:genetics* / Q000378:metabolism
chemical_list: C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53
keywords: TP53 mutations; clonal hematopoiesis; ovarian cancer; premalignant mutations; ultra-deep sequencing