Significance Of Detection Of Circulating Tumor Cells In Patients With Breast Cancer After Operation

Breast cancer is one of the world(including developed countries and developing countries)is one of the serious harm to the health of malignant tumor in women.Its incidence showed a gradual upward trend,and the growing trend of younger,the recurrence and metastasis is the main cause of death in patients with breast cancer[1]at present,breast cancer treatment is mainly to surgical and with chemotherapy(neoadjuvant chemotherapy),radiation therapy,targeted therapy and endocrine therapy for AIDS treatment.However,these methods are only in the determination of breast cancer after the means of disease,in the prevention of recurrence,metastasis and advanced breast cancer treatment,still can not achieve the desired results.In recent years,gradually realize that breast cancer is a systemic disease,which can occur early spread of tumors,about 15%--30%of breast cancer patients with negative axillary lymph nodes even after surgery may still develop distant metastases,suggesting that recurrence and metastasis have existed in the blood of tumor cells is important evidence,but is not routine clinical diagnostic methods to detect.Tumor cells that circulating tumor cells in peripheral blood in the blood(Circulating tumor,cells,CTCs)is a kind of,from the primary tumor or metastatic lesions from through a variety of mechanisms,and then through the EMT migration into the blood and a heterogeneous tumor cells can be detected in peripheral blood,it can promote the transfer of and the recurrence of disease of breast cancer,prostate cancer,colon cancer and other malignant tumors,even death caused by the disease progression.Circulating tumor cells in peripheral blood(circulatingtumorcells,CTCs)is one of the manifestations of malignant disease spread,detection of these tumor cells helps people to further understanding of the characteristics and metastasis of breast cancer prognosis,to better guide the treatment and monitoring the therapeutic effect.At present,a large number of research results show that in the development of breast cancer disease occurs in the early stage of distant spread,in recent years the application of flow cytometry,reverse transcription PCR technology to improve the detection of circulating tumor cells in peripheral blood of sensitivity and specificity,but the detection rate is still limited,some clearly existed in positive rate in patients with CTCs metastases is low.One of the reasons is probably not yet understood CTCs release rules(the release may be intermittent),and the CTCs often clumped distribution,single point detection time may have a certain bias(the actual expression may be higher),continuous sampling or increase the sample size will improve the detection rate and positive rate.In addition,the detection method itself also has some limitations,there may be false negative results.The expression level of CTCs in breast cancer patients was different in the primary pathological type,preoperative and postoperative chemotherapy.Objective To examine the expression of CTCs in the blood of patients with breast malignant lesions and benign breast lesions,and to analyze the expression of breast cancer before and after chemotherapy Relationship between chemotherapy efficacy and clinicopathological characteristics of breast cancer.Then we discuss the relationship between the expression and the occurrence,development and prognosis of breast cancer,and provide guidance for clinical diagnosis and treatment of breast cancer.Methods The expression of estrogen receptor(ER)and progesterone receptor(PR),human epidermal growth factor(HER-2)and Ki 67 were detected by immunohistochemistry in breast cancer specimens.To detect the expression of CTCs were counted using Cellsearch detection system,and then analyzes the relationship between the expression level of CTCs in breast cancer and clinical indicators,including age,tumor size and clinical staging,lymph node metastasis,histological grade,estrogen receptor(Estrogenreceptor,ER),progesterone receptor(Progestrogen,receptor,PR)and HER-2 expression state and molecular classification of breast cancer and the clinical therapeutic effect of chemical drugs.The relationship between the expression of CTCs count and the efficacy of chemotherapy and prognosis in patients with breast cancer was studied.All data were collected and analyzed using EXCEL2003 and SPSS 19.0.Results The definition of CTCs positive for each 7.5ml blood CTCs number of 5 or more.1.Expression of CTCs in patients with benign breast tumor and breast cancerThe results of Cellsearch detection system showed that in 25 cases of breast cancer patients with peripheral venous blood,CTCs positive in 20 cases,negative in 5 cases,the detection rate was 80%.In 10 cases of benign breast tumor patients with peripheral venous blood,CTCs positive in 1 cases,negative in 9 cases,the detection rate was 10%.2.Expression of CTCs in patients with breast cancer and its relationship with age25 cases of breast cancer patients,in premenopausal patients with,including CTCs positive in 10 cases,accounting for 100%:in postmenopausal patients with,CTCs positive in 10 cases,accounting for 66.7%.,CTCs negative in 5 cases,accounting for33.3%3.The relationship between the expression of CTCs and the expression of HER-2 in breast cancer patients25 cases of breast cancer were determined by immunohistochemical staining and FISH examination,6 cases were HER-2 positive,CTCs positive in 4 cases,accounting for 67%,negative in 2 cases,accounting for 33%of HER2 negative in 16 cases,14 cases were CTCs positive,accounting for 87.5%,2 cases of CTCs negative expression,accounting for 12.5%:HER-2 is unknown in 2 cases,1 cases were CTCs positive,accounting for 50%,1 CTCs negative patients,accounting for 50%.4.The relationship between the expression of CTCs and the expression of estrogen receptor ER in patients with breast cancerDetermined by immunohistochemical staining in 25 cases of breast cancer patients,17 cases were ER positive,CTCs positive in 13 cases,accounting for 76.5%,4 CTCs negative patients,accounting for 23.5%:ER negative in 8 cases,7 cases were CTCs positive,accounting for 87.5%,1 CTCs negative patients,accounting for 12.5%.5.The relationship between the expression of CTCs and the expression of progesterone receptor PR in patients with breast cancer25 cases of breast cancer patients were determined by immunohistochemical staining,PR positive in 21 cases,CTCs positive in 16 cases,accounting for,CTCs negative in 5 cases,accounting for 23.8%:PR negative in all cases,CTCs positive in 4 cases,accounting for 100%.6.The relationship between the expression of CTCs and pathological types in patients with breast cancerIn 25 cases of breast cancer patients with breast cancer pathological specimens by pathology results confirmed 22 cases of infiltrating ductal carcinoma,17 cases were CTCs positive,accounting for 77.3%,CTCs negative 5 cases,accounted for 22.7%,1 cases of invasive lobular carcinoma,1 cases were CTCs positive,accounting for 100%.(other types of invasive apocrine carcinoma and infiltrating ductal carcinoma with invasive lobular carcinoma)in 2 cases,2 cases were CTCs positive,accounting for 100%.7.Relationship between CTCs expression and tumor size in patients with breast cancerIn 25 cases of breast cancer patients with breast cancer pathological specimens by pathology measurements to determine the maximum diameter of<2cm,10 cases,8 cases were CTCs positive,accounting for 80%,CTCs negative 2 cases,accounting for 20%of maximum diameter between 2-5cm in 15 cases,12 cases were CTCs positive,accounting for 80%,3 cases of negative CTCs,accounting for 20%.8.The relationship between the expression of CTCs and the number of axillary lymph node metastasis in patients with breast cancerIn 25 cases of breast cancer patients with breast cancer pathological specimens by pathology results confirmed without axillary lymph node metastasis in 15 cases,12 cases were CTCs positive,accounting for 80%,CTCs negative 3 cases,accounted for 20%,6 cases of axillary lymph node metastasis between 1-3 and CTCs was positive in 6 cases,accounting for 100%;axillary lymph node metastasis was 4 in 4 cases,2 cases were CTCs positive,accounting for 50%,2 CTCs negative patients,accounting for 50%.9.The relationship between CTCs expression and TNM staging in patients with breast cancerIn 25 cases of breast cancer patients,TNM in stage I 9 cases,CTCs was positive in 7 cases,accounting for 77.8%,CTCs negative 2 cases,accounted for 22.2%in TNM stage ? 13 cases,CTCs was positive in 12 cases,accounting for 92.3%,CTCs negative 1 cases,accounting for 7.7%,in TNM III during the period of the 3 cases,1 cases were CTCs positive,accounting for 33.3%,2 CTCs negative patients,accounting for 66.7%.10.The relationship between the expression of CTCs and histological grade in breast cancer patientsIn 25 cases of breast cancer patients,II grade in 7 cases,5 cases were CTCs positive,accounting for 71.4%,CTCs negative 2 cases,accounting for 28.6%in III grade 15 cases,CTCs was positive in 12 cases,accounting for 80%,CTCs negative 3 cases,accounting for 20%,1 cases in grade,1 cases were CTCs positive,accounting for 100%.11.In 25 cases of breast cancer patients before and after surgery for the detection of CTCs before operation in 11 cases(44%)were detected in CTCs(5/7.5ml blood),5 days after surgery in 4 cases(16%)were detected by CTCs(5/7.5ml blood).12.25 cases of breast cancer patients after chemotherapy,chemotherapy,CTCs(+)in the 11 cases,the state from positive to negative in the case of,accounting for CTCs(+)of 73%.CTCs(-)14 cases of(CTCs)from negative to positive,accounting for CTCs(-)of 50%.The first phase of the experiment showed that the expression level of CTCs in peripheral blood of patients with breast cancer was significantly different from that of benign tumor patients(P<0.01).The expression level of CTCs in peripheral blood of breast cancer patients was significantly different from that of breast cancer patients(surgery or not)(P<0.05).The expression level of serum CTCs in patients with breast cancer was not correlated with age,tumor size,axillary lymph node metastasis,ER,PR,HER2,histological grade and TNM stage(P>0.05).Conclusion1 the level of serum CTCs in patients with breast cancer was higher than that in benign tumor patients with CTCs.These results suggest that the presence of CTCs may be associated with the occurrence and progression of breast cancer.2.In breast cancer patients,serum CTCs levels and age,tumor size,number of axillary lymph node metastasis,the expression of ER receptor and PR receptor expression,HER-2 expression,TNM stage,histological grade and clinical features of breast cancer without obvious correlation was not statistically significant.3.CTCs may play an important role in the occurrence and development of breast cancer.The detection method of CTCs is simple,effective and minimally invasive.It may be a new diagnostic method for breast cancer,and may be an important index for evaluating the clinical features of breast cancer.4 the positive rate of CTCs was significantly decreased after operation,and the changes of CTCs before and after operation were related to the effect of surgery,which indicated that surgery is a good way to treat breast cancer and reduce the risk of breast cancer.5 the positive rate of CTCs after chemotherapy was significantly reduced,and the changes of CTCs before and after chemotherapy were related to the efficacy of chemotherapy,suggesting that the changes of CTCs before and after chemotherapy can predict the efficacy of chemotherapy.