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Biliary sampling technique improves detection
Newsdesk
Better detection of colon-cancer micrometastases The presence of micrometastases in stage II colon cancer might have prognostic value (Ann Surg 2007; 246: 568–77). “Detection of micrometastases could aid the selection of patients for adjuvant systemic chemotherapy”, says lead author Anton Bilchik (John Wayne Cancer Center, Santa Monica, CA, USA). A quarter of patients with stage II colon cancer have recurrence after complete resection, suggesting the presence of undetected nodal metastases. In this trial, sentinelnode material from 152 patients with resectable colorectal cancer, which was shown to be negative for micrometastases by haematoxylin and eosin staining, was reassessed using immunohistochemistry and quanitative real-time PCR (qRT-PCR). Of 92 node-negative patients, 25 had micrometastases detectable by IHC and qRT-PCR and four were positive
by qRT-PCR only. At a mean follow-up of 25 months, patients with a positive sentinel node shown by any method had a recurrence. No recurrences occurred in patients negative for micrometastases by all three methods. “The latter are likely to be cured by surgery alone”, says Bilchik. Patients with detectable micrometastases could be considered for adjuvant chemotherapy. This approach is currently not the standard treatment for stage II colon cancer but, controversially, some oncologists do offer it. “We found that medical oncologists were twice as likely to treat stage II patients with chemotherapy if they had evidence of immunohistochemically positive micrometastases”, reports Bilchik. “This study adds to the growing body of evidence that micrometastatic disease detected by qRT-PCR in colorectal cancer is of prognostic significance”, comments Fergal Fleming
(Saint Vincent’s University Hospital, Dublin, Ireland). Fleming believes that the finding of a relationship between the detection of micrometastases and subsequent recurrence in patients with colon cancer is interesting, but notes the relatively short follow-up time. “Also, the authors do not analyse whether these findings are simply related to the presence of known adverse prognostic factors, such as lymphovascular invasion and tumour grade”, says Fleming. Aimery de Gramont (Hôpital SaintAntoine, Paris, France) comments that validation of any new useful biomarker in patients with stage II disease will need a careful multivariate analysis, taking into account all recognised prognostic factors. “At the moment, these data do not appear strong enough to recommend this procedure in all stage II patients”, he says.
Kathryn Senior
Biliary sampling technique improves detection
CNRI/Science Photo Library
Biliary sampling by use of a grasping basket during endoscopic retrograde cholangiography (ERC) detects more cancers than sampling with a cytology brush, (Am J Gastroenterol, published online September 27, 2007; DOI:10.1111/j.1572-0241.2007. 01543.x).
Malignant biliary strictures can be caused by pancreatic cancer
966
In a randomised-controlled trial, the sensitivities of the two methods of sampling during ERC for the detection of cancer were compared, and the effect of presampling stricture dilation on sensitivity of cancer detection was assessed. 56 patients were randomly assigned to first sampling with use of either the grasping basket or brush, which was followed by a second sampling procedure by use of the alternate device during the same ERC. 50 patients were diagnosed to have malignant stricture. Sensitivity for cancer detection in the first sample was higher in the basket group (20 of 25) compared with the brush group (12 of 25; odds ratio 4·33 [95% CI 1·24–15·21]; p=0·018). Two (4%) patients who had malignant strictures had negative basket samples but positive brush samples, and 15 (30%) patients with negative brush samples were noted to be positive for cancer
by basket sampling. The basket method more frequently yielded positive samples from malignant strictures when presampling balloon dilation was used. Lead author Jean-Marc Dumonceau (Geneva University Hospital, Geneva, Switzerland) comments, “our study showed significant (p=0·002) difference between pairs of samples from identical patients, and the sensitivity of basketing was clearly out of the range of poor sensitivities reported with brushing”. Gregory Gores (Mayo Clinic, Rochester, MN, USA) says, “I think this is an interesting study, but advanced cytological techniques with fluorescence-in-situ hybridisation (FISH) still result in the best sensitivity. However, FISH could be easily coupled to this endoscopic technique”.
Sharan Prakash Sharma
http://oncology.thelancet.com Vol 8 November 2007
Better detection of colon-cancer micrometastases The presence of micrometastases in stage II colon cancer might have prognostic value (Ann Surg 2007; 246: 568–77). “Detection of micrometastases could aid the selection of patients for adjuvant systemic chemotherapy”, says lead author Anton Bilchik (John Wayne Cancer Center, Santa Monica, CA, USA). A quarter of patients with stage II colon cancer have recurrence after complete resection, suggesting the presence of undetected nodal metastases. In this trial, sentinelnode material from 152 patients with resectable colorectal cancer, which was shown to be negative for micrometastases by haematoxylin and eosin staining, was reassessed using immunohistochemistry and quanitative real-time PCR (qRT-PCR). Of 92 node-negative patients, 25 had micrometastases detectable by IHC and qRT-PCR and four were positive
by qRT-PCR only. At a mean follow-up of 25 months, patients with a positive sentinel node shown by any method had a recurrence. No recurrences occurred in patients negative for micrometastases by all three methods. “The latter are likely to be cured by surgery alone”, says Bilchik. Patients with detectable micrometastases could be considered for adjuvant chemotherapy. This approach is currently not the standard treatment for stage II colon cancer but, controversially, some oncologists do offer it. “We found that medical oncologists were twice as likely to treat stage II patients with chemotherapy if they had evidence of immunohistochemically positive micrometastases”, reports Bilchik. “This study adds to the growing body of evidence that micrometastatic disease detected by qRT-PCR in colorectal cancer is of prognostic significance”, comments Fergal Fleming
(Saint Vincent’s University Hospital, Dublin, Ireland). Fleming believes that the finding of a relationship between the detection of micrometastases and subsequent recurrence in patients with colon cancer is interesting, but notes the relatively short follow-up time. “Also, the authors do not analyse whether these findings are simply related to the presence of known adverse prognostic factors, such as lymphovascular invasion and tumour grade”, says Fleming. Aimery de Gramont (Hôpital SaintAntoine, Paris, France) comments that validation of any new useful biomarker in patients with stage II disease will need a careful multivariate analysis, taking into account all recognised prognostic factors. “At the moment, these data do not appear strong enough to recommend this procedure in all stage II patients”, he says.
Kathryn Senior
Biliary sampling technique improves detection
CNRI/Science Photo Library
Biliary sampling by use of a grasping basket during endoscopic retrograde cholangiography (ERC) detects more cancers than sampling with a cytology brush, (Am J Gastroenterol, published online September 27, 2007; DOI:10.1111/j.1572-0241.2007. 01543.x).
Malignant biliary strictures can be caused by pancreatic cancer
966
In a randomised-controlled trial, the sensitivities of the two methods of sampling during ERC for the detection of cancer were compared, and the effect of presampling stricture dilation on sensitivity of cancer detection was assessed. 56 patients were randomly assigned to first sampling with use of either the grasping basket or brush, which was followed by a second sampling procedure by use of the alternate device during the same ERC. 50 patients were diagnosed to have malignant stricture. Sensitivity for cancer detection in the first sample was higher in the basket group (20 of 25) compared with the brush group (12 of 25; odds ratio 4·33 [95% CI 1·24–15·21]; p=0·018). Two (4%) patients who had malignant strictures had negative basket samples but positive brush samples, and 15 (30%) patients with negative brush samples were noted to be positive for cancer
by basket sampling. The basket method more frequently yielded positive samples from malignant strictures when presampling balloon dilation was used. Lead author Jean-Marc Dumonceau (Geneva University Hospital, Geneva, Switzerland) comments, “our study showed significant (p=0·002) difference between pairs of samples from identical patients, and the sensitivity of basketing was clearly out of the range of poor sensitivities reported with brushing”. Gregory Gores (Mayo Clinic, Rochester, MN, USA) says, “I think this is an interesting study, but advanced cytological techniques with fluorescence-in-situ hybridisation (FISH) still result in the best sensitivity. However, FISH could be easily coupled to this endoscopic technique”.
Sharan Prakash Sharma
http://oncology.thelancet.com Vol 8 November 2007