Tumor cells are dislodged into the pulmonary vein during lobectomy
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Love_Tumor cells.pdf
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Author(s)
Yao, Xiaosai
Williamson, Christina
D'Agostino, Richard S.
Fitton, Torin
Smaroff, Gregory G.
Wittrup, Karl Dane
Williams, Robert T.
Love, John C
Adalsteinsson, Viktor A.
Date Issued
July 2014
Journal
The Journal of Thoracic and Cardiovascular Surgery
Publisher
Elsevier
Citation
Yao, Xiaosai, Christina Williamson, Viktor A. Adalsteinsson, Richard S. D’Agostino, Torin Fitton, Gregory G. Smaroff, Robert T. William, K. Dane Wittrup, and J. Christopher Love. “Tumor Cells Are Dislodged into the Pulmonary Vein During Lobectomy.” The Journal of Thoracic and Cardiovascular Surgery 148, no. 6 (December 2014): 3224–3231.e5.
Version
Author's final manuscript
Abstract
Objective
Intraoperative tumor shedding may facilitate tumor dissemination. In earlier studies, shed tumor cells were defined primarily by cytomorphological examination, and normal epithelial cells could not always be distinguished from tumor cells. We sought to accurately identify tumor cells using single-cell sequencing and determine whether these cells were mobilized into the circulation during pulmonary lobectomy.
Methods
Forty-two blood samples collected from the tumor-draining pulmonary vein at the end of lobectomy procedures were analyzed. Arrays of nanowells were used to enumerate and retrieve single EpCAM[superscript +] cells. Targeted sequencing of 10 to 15 cells and nested polymerase chain reaction of single cells detected somatic mutations in shed epithelial cells consistent with patient-matched tumor but not normal tissue.
Results
The mean number of EpCAM[superscript +] cells in video-assisted thoracoscopy (VATS) lobectomy (no wedge) specimens (n = 16) was 165 (median, 115; range, 0-509) but sampling cells from 3 patients indicated that only 0% to 38% of the EpCAM[superscript +] cells were tumor cells. The mean number of EpCAM[superscript +] cells in VATS lobectomy (wedge) specimens (n = 12) was 1128 (median, 197; range, 47-9406) and all of the EpCAM[superscript +] cells were normal epithelial cells in 2 patients sampled. The mean number of EpCAM[superscript +] cells in thoracotomy specimens (n = 14) was 238 (median, 22; range, 9-2920) and 0% to 50% of total EpCAM[superscript +] cells were tumor cells based on 4 patients sampled.
Conclusions
Surgery mobilizes tumor cells into the pulmonary vein, along with many normal epithelial cells. EpCAM alone cannot differentiate between normal and tumor cells. On the other hand, single-cell genetic approaches with patient-matched normal and tumor tissues can accurately quantify the number of shed tumor cells.
MIT Department
Massachusetts Institute of Technology. Department of Biological Engineering
Massachusetts Institute of Technology. Department of Chemical Engineering
Koch Institute for Integrative Cancer Research at MIT
Terms of Use
Creative Commons Attribution-NonCommercial-NoDerivs License
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DOI of Published Version
https://doi.org/10.1016/j.jtcvs.2014.06.074
