Cytology and cell-block immunohistochemistry of circulating tumour cells

The study set out to assess the feasibility of using Parsortix^TM circulating tumour cell (CTC) extraction and CytoFoam Disc cell-block immunohistochemistry to diagnose metastatic carcinoma from blood samples in a National Health Service district general hospital.

Blood samples were taken from 50 patients with metastatic carcinoma and 50 healthy volunteers and processed, using a previously published method, to extract CTCs and collect them in a cell-block for routine formalin-fixed paraffin sectioning and immunohistochemistry. The extracted cells were compared with the patients' routine diagnostic samples.

The samples from the 50 carcinoma patients showed cytokeratin-positive cells in 19 cases. In eight of these, the cytokeratin-positive cells had a similar immunoprofile to the carcinoma in the conventional biopsy or cytology specimen. Some carcinoma patients also had circulating cytokeratin-positive cells that were probably benign epithelial cells and circulating megakaryocytes. Both of these types of cells were also found in healthy volunteers. Processing and initial examination could be completed in 2 days. The full processing cost was approximately £316 per case.

CTCs could be extracted from the blood of some patients with metastatic carcinoma and formed into a formalin-fixed cell-block for routine paraffin processing and immunohistochemistry. The specificity of this approach is constrained by the observation that some patients with metastatic carcinoma had circulating cytokeratin-positive cells that were probably benign, and these were also found in healthy volunteers. Circulating megakaryocytes were present in carcinoma patients and healthy volunteers.