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众所周知，乳腺钼靶检查时需要对乳房进行挤压。不过，目前尚不清楚如果乳腺钼靶检查时原发肿瘤受到挤压，会不会引起肿瘤细胞脱落进入血液循环。此外，乳房挤压对循环肿瘤细胞或循环肿瘤DNA等血液循环生物标志检测的影响知之甚少。 2019年6月24日，施普林格·自然《乳腺癌研究与治疗》在线发表瑞典隆德大学的研究报告，检测了早期乳腺癌拟行新辅助治疗患者乳腺钼靶检查时乳房挤压前后的循环肿瘤细胞和循环肿瘤DNA。 该研究对瑞典隆德大学医院31例原发性乳腺癌拟行新辅助治疗患者乳腺钼靶检查时乳房挤压前后的血液标本循环肿瘤细胞和循环肿瘤DNA进行分析。除了从外周静脉采血之外，全部患者都有中心静脉通路，可以进行静脉注射新辅助化疗，还可以从上腔静脉采血或引流。 结果发现，26%和65%的患者循环肿瘤细胞和循环肿瘤DNA位阳性。乳房挤压后，循环肿瘤细胞未见显著增加，循环肿瘤DNA显著增加仅见于中心静脉血液（P=0.01）而未见于外周静脉血液。 乳房挤压后循环肿瘤DNA阳性显著相关因素：
中心静脉与外周静脉的血液标本相比，循环肿瘤细胞显著较多（P=0.04）。 因此，该研究结果表明，乳腺钼靶检查时乳房挤压后，循环肿瘤细胞并未显著释放，但是中心静脉与外周静脉的血液标本相比，循环肿瘤细胞较多、循环肿瘤DNA水平相似。乳房挤压后循环肿瘤DNA平均小幅增加不太可能具有临床意义。从循环肿瘤细胞和循环肿瘤DNA脱落进入血液循环的角度来看，上述结果支持将乳腺钼靶作为早期乳腺癌患者的安全检查项目之一，可能对循环肿瘤标志采样程序标准化有意义。 Breast Cancer Res Treat. 2019 Jun 24. Detection of circulating tumor cells and circulating tumor DNA before and after mammographic breast compression in a cohort of breast cancer patients scheduled for neoadjuvant treatment. Daniel Fornvik, Kristina E. Aaltonen, Yilun Chen, Anthony M. George, Christian Brueffer, Robert Rigo, Niklas Loman, Lao H. Saal, Lisa Rydén. Lund University, Malmo, Sweden; Lund University, Lund, Sweden; Skane University Hospital, Lund, Sweden; Skane University Hospital, Malmo, Sweden. PURPOSE: It is not known if mammographic breast compression of a primary tumor causes shedding of tumor cells into the circulatory system. Little is known about how the detection of circulating biomarkers such as circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA) is affected by breast compression intervention. METHODS: CTCs and ctDNA were analyzed in blood samples collected before and after breast compression in 31 patients with primary breast cancer scheduled for neoadjuvant therapy. All patients had a central venous access to allow administration of intravenous neoadjuvant chemotherapy, which enabled blood collection from superior vena cava, draining the breasts, in addition to sampling from a peripheral vein. RESULTS: CTC and ctDNA positivity was seen in 26% and 65% of the patients, respectively. There was a significant increase of ctDNA after breast compression in central blood (p=0.01), not observed in peripheral testing. No increase related with breast compression was observed for CTC. ctDNA positivity was associated with older age (p=0.05), and ctDNA increase after breast compression was associated with high Ki67 proliferating tumors (p=0.04). CTCs were more abundant in central compared to peripheral blood samples (p=0.04). CONCLUSIONS: There was no significant release of CTCs after mammographic breast compression but more CTCs were present in central compared to peripheral blood. No significant difference between central and peripheral levels of ctDNA was observed. The small average increase in ctDNA after breast compression is unlikely to be clinically relevant. The results give support for mammography as a safe procedure from the point of view of CTC and ctDNA shedding to the blood circulation. The results may have implications for the standardization of sampling procedures for circulating tumor markers. KEYWORDS: Circulating tumor cells Circulating tumor DNA Breast compression Breast cancer Mammography Neoadjuvant DOI: 10.1007/s10549-019-05326-5
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