Detection of cancer cells in the axillary drainage using RT-PCR after operations for breast cancer

Hidden messages in fluids: A review of clinical and fundamental perspectives on post-lymph node dissection drains

In recent years, there has been a growing interest in liquid biopsy due to its non-invasive diagnostic value. Postoperative drainage fluid (PDF) is the fluid exudate from the wound site following lymph node dissection. PDF is regarded as a medical waste with no specific clinical significance. Nevertheless, the liquid biopsy of PDF may enable the reuse of this fluid. PDF contains a variety of body fluids, including blood and lymph. PDF contains a variety of biological components, including cytokines, extracellular vesicles (EVs), proteins, nucleic acids, cells and bacteria. These components are indicative of the postoperative inflammatory response, the immune response and the therapeutic response. In this review, we examine the current state of research in the field of liquid biopsy in PDF, elucidating how the analysis of its components can assess the prognosis of patients after lymph node dissection, monitor real-time changes in patient status, and identify new biomarkers and potential therapeutic targets.

Biomarkers in wound drainage fluids of head and neck squamous cell carcinoma patients receiving neck dissection: A pilot study

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Molecular prognostication lags behind for head and neck squamous cell carcinoma.

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Analysis of wound drainage fluids after neck dissection has prognostic potential.

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Expression of CXCL-12 may predict minimal residual disease after radical surgery.

Aim

In a pilot prospective study, we aimed to test the feasibility and report on the preliminary results on the expression of molecular biomarkers in wound drainage fluids (WDFs) of operated head and neck squamous cell carcinoma (HNSCC) patients.

Material and methods

Nineteen patients undergoing primary tumor resection with en-block neck dissection were enrolled. In postoperative days 1–3, the expression of several biomarkers in WDFs was measured using enzyme-linked immunosorbent assay (ELISA) kits and correlated with clinical and histopathologic features.

Results

The expression of stromal cell-derived factor 1 (CXCL-12) was significantly increased in WDFs in presence of lymph node metastases, extranodal extension (ENE), and in case of close resection margins. In addition, Osteopontin expression was significantly increased in presence of ENE, whereas transforming growth factor beta (TGF-β) detection was significantly reduced. At multivariate analysis, CXCL-2 levels in both day 1 and 3 post-surgery were the only factor which retained significance in the prediction of close surgical margins (p = 0.028 and 0.025 for day 1 and day 3, respectively). Both CXCL-2 and Ostepontin assays were significantly correlated with ENE (p = 0.018 and 0.035 for day 1; 0.052 and 0.025 for day 3, respectively) whereas TGF- β expression was significant at day 1 only (p = 0.038)

Conclusions

Our pilot study showed that WDFs could qualify as a potential source of relevant postoperative information. Further studies are needed to confirm the prognostic impact of CXCL-12, Osteopontin and TGF-β expressed in WDFs on the personalized management of HNSCC.

Seroma Cytology in Breast Cancer: An Underappreciated Issue

BACKGROUND

The presence of malignant cells in postoperative seroma has been ignored in current breast cancer treatment. We aimed to assess the presence of malignant seroma cytology and to evaluate its relationship with the known prognostic factors for breast cancer.

PATIENTS AND METHODS

The solution from irrigation of the operation field and postoperative drainage fluid from 68 patients were prospectively collected and examined for malignant cytology. The results were evaluated according to the tumor characteristics and patient demographics.

RESULTS

Malignant cytology was found in none of the intraoperative samples but was found in the postoperative samples from 4 patients. Of these 4 patients, 3 were free of axillary metastasis. None of the common risk factors for breast cancer was associated with the finding of malignant cytology.

CONCLUSION

Malignant cells can be seen in the drainage fluids from breast cancer patients independent of any contamination occurring during surgery, even in those without axillary metastasis.

Multiparametric monitoring of tumor response to chemotherapy by noninvasive imaging

With the emerging concept of individualized cancer therapy, it becomes crucial to develop methods for the noninvasive assessment of treatment outcome. With this in mind, we designed a novel approach for the comprehensive evaluation of response to chemotherapy with the established agent doxorubicin in a preclinical breast cancer model. This approach delivers information not only about change in tumor size but also about target antigen expression. Our strategy relies on a tumor-specific contrast agent (MN-EPPT) targeting the underglycosylated MUC-1 (uMUC-1) tumor antigen, found on more than 90% of breast cancers and predictive of chemotherapeutic response. MN-EPPT consists of superparamagnetic iron oxide nanoparticles (MN) for magnetic resonance imaging, modified with Cy5.5 dye (for near-IR fluorescence optical imaging), and conjugated to peptides (EPPT), specifically recognizing uMUC-1. In vivo, treatment of mice bearing orthotopic human breast carcinomas with doxorubicin led to a reduction in tumor mass and resulted in down-regulation of uMUC-1. The tumor-specific accumulation of MN-EPPT allowed the assessment of change in tumor volume by noninvasive imaging. Furthermore, in mice injected with MN-EPPT, tumor delta-T2 was significantly reduced after treatment with doxorubicin, indicating a lower accumulation of MN-EPPT and reflecting the reduced expression of uMUC-1. With these studies, we have shown the utility of magnetic resonance imaging for the multiparametric characterization of breast tumor response to chemotherapy. This approach has the potential of significantly advancing our ability to better direct the development of molecularly targeted individualized therapy protocols because it permits the monitoring of therapy on a molecular scale.