Blood-based biopsies-clinical utility beyond circulating tumor cells.

Circulating tumor cells (CTCs), epithelial-mesenchymal transition (EMT) cells, as well as a number of circulating cancer stromal cells (CStCs) are known to shed into the blood of cancer patients. Individually, and together, these cells provide biological and clinical information about the cancers. Filtration is a method used to isolate all of these cells, while eliminating red and white blood cells from whole peripheral blood. We have previously shown that accurate identification of these cell types is paramount to proper clinical assessment by describing the overlapping phenotypes of CTCs to one such CStC, the cancer-associated macrophage-like cell (CAML). We report that CAMLs possess a number of parallel applications to CTCs but have a broader range of clinical utility, including cancer screening, companion diagnostics, diagnosis, prognosis, monitoring of treatment response, and detection of recurrence. © 2018 The Authors. Cytometry Part A published by Wiley Periodicals, Inc. on behalf of ISAC.

Filtration and Analysis of Circulating Cancer Associated Cells from the Blood of Cancer Patients.

Filtration is one of the most efficient methods to remove red and white blood cells from whole blood, while retaining larger cells on the surface of the filter. Precision pore microfilters, such as the CellSieve™ microfilters, are ideally suited for this purpose, as they are strong, with uniform pore size and distribution, and have low fluorescent background required for microscopic image analysis. We present a system to implement the filtration of whole blood in combination with CellSieve™ microfilters that is simple and straightforward to use. Being that the blood of cancer patients often contains both tumor cells and stromal cells associated with cancer that are larger than normal blood cells, microfiltration shows great promise in better understanding these cell types. Accurate identification and characterization of cancer associated cells has led to increased specificity as it relates to CTCs and epithelial-mesenchymal transition cells (EMTs) and enabled the identification of previously unknown cell types, such as cancer associated macrophage-like cells (CAMLs). Using a system that isolates both CTCs and circulating stromal cells, clinicians can better diagnose cancer patients to determine therapy, monitor treatment, and watch for recurrence.