Tumor cells from shed ovarian neoplasms can be collected through lavage of the uterine cavity, according to the results of a proof-of-concept study.
This process led to the detection of ovarian cancer, endometrial cancer and clinically occult ovarian cancer, suggesting its potential efficacy as an early diagnostic tool, according to researchers.
High-grade type 2 ovarian cancer and endometrial cancer often are diagnosed at an advanced stage, which corresponds with poor survival. However, increasing evidence suggests that Müllerian duct cancers may exfoliate cells.
Paul Speiser, MD, professor at Medical College of Vienna, and colleagues developed an approach for lavage of the uterine cavity to detect cancer cells that have been shed.
Speiser and colleagues performed lavage of the uterine cavity to obtain samples from 65 patients with ovarian cancer (n = 30), endometrial cancer (n = 5), other malignancies (n = 3) or benign lesions of the gynecologic organs (n = 27).
Researchers used next-generation sequencing to examine these samples — along with corresponding tumor tissue — for the presence of somatic mutations. They also used singleplex analysis in a subset study.
Use of lavage successfully extracted sufficient amounts of DNA from all patients. Using next-generation sequencing, the researchers identified mutations in 60% (n = 18) of samples of patients with ovarian cancer. Those mutations primarily were in TP53.
The use of singleplex analysis of mutations previously determined in corresponding tumor tissue produced further mutation identification in six patients.
When taken together, mutation identification occurred in 80% (n = 24) of patients with ovarian cancer, including one patient with occult ovarian cancer.
All patients with endometrial cancer harbored mutations. Eight patients with benign lesions tested positive for mutations, 75% (n = 6) of which were KRAS mutations.
“Possible improvements for future follow-up studies comprise performing the lavage at specific time points during the menstrual cycle,” Speiser and colleagues wrote. “Additional information will be obtained from comparing liquid Pap smears with lavage samples from the same patients. Both are expected to be exquisitely specific for neoplasia, given the nature of the biomarker assessed. …
“In summary, this proof-of-concept study demonstrates the potentially high diagnostic power of the lavage approach for ovarian cancer and endometrial cancer detection, especially for early detection in high-risk populations,” the researchers added. “This is currently being investigated in a large study.” – by Cameron Kelsall
Disclosure: Speiser reports travel expenses from Roche, as well as a private patent related to the content of this study. Please see the full study for a list of all other researchers’ relevant financial disclosures.