Compared with a previous CTC detection strategy based on the phenotypic characteristics of the CTCs,45, 46 the method we used in this study was based on karyotyping of the CTCs, which facilitated straightforward identification of nonhematopoietic heteroploid CTCs, regardless of CTC phenotypic changes, such as downregulated or absent expression of EpCAM or other tumor cell surface markers.47, 48, 49 Although the detection rate in our present study was not as high as the phenotypic methods reported previously, we believe that our methods achieved a higher accuracy rate. Here, EPCAM is linked to neoplasm.