It is the most reliable and widely accepted tool facilitating the simultaneous identification of thousands of genetic elements even a single gene. Evaluation of CTCs should incorporate histological, immunehistochemical, and molecular characterization to enable clinicians to obtain the comprehensive diagnostic, prognostic and therapeutic information necessary to provide appropriate personalized care to cancer patients.Ĭirculating tumor cell (CTC) Circulating Tumor cell Cancer Isolation Detection Metastasis Prognosis.ĬTC: Circulating tumor cell RT-PCR: Reverse transcriptase-polymerase chain reaction EMT: Epithelial-mesenchymal transition MET: Mesenchymal-epithelial transition TRAIL: Tumor necrosis factor-related apoptosis-inducing ligand CEA: Carcinoembryonic antigen CUP: Cancer of unknown primary CAP: College of American Pathologists AMP: Association for Molecular Pathology ASCO: American Society of Clinical Oncology.ĭeoxyribonucleic acid (DNA) microarrays are collections of DNA probes arranged on a base pair and the latest commercialized molecular diagnostic technologies that offer high throughput results, more sensitive and require less time. Additionally, cytological specimens have been shown to be useful for ancillary testing in patients when surgical resection specimens or biopsies are not available. Using morphological evaluation, CTCs in body fluids could be used for primary diagnosis in the setting of cancer of unknown primary (CUP) or in initial or early diagnostic scenarios. However, these have limitations, of which most of them do not have the ability to perform morphological evaluation.
Current methodologies are based on quantifying CTCs and include technologies based on physical, immunological, and molecular techniques. Although the current clinical utility has been focused on the prognostic significance, other clinical applications are being explored, such as determining if a patient is a candidate for treatment, determining the efficacy of treatment, evaluation for resistance to therapy, prediction of metastatic site, or as an early predictor of metastases. Circulating tumor cells (CTCs) are the precursors to metastases and increased numbers of CTCs in the peripheral circulation have been shown to correlate with decreased progression-free and overall survival.