Grading follicular lymphoma on fine needle aspiration specimens. Comparison with proliferative index by DNA image analysis and Ki-67 labeling index

OBJECTIVE

To determine whether follicular lymphoma (FL) can be graded on fine needle aspiration (FNA) biopsies by determining the percentage of centroblasts in the neoplastic follicles on the smears.

STUDY DESIGN

Eighty-nine cases of histologically confirmed cases of FL, including 31 grade 1, 46 grade 2 and 12 grade 3, were evaluated. Proliferative index (PI) by DNA image analysis (DIA) and Ki-67 labeling index (LI) were obtained on all cases. A minimum of 200 cells were counted per case (range, 200-800 cells) at 40x magnification, and the number of large cells (centroblasts) was expressed as a percentage of the total number of cells counted within the follicles.

RESULTS

The percentage of centroblasts in the follicular aggregates was 9.7 +/- 2.9% in grade 1 FLs, 24.7 +/- 5.6% in grade 2 and 48.4 +/- 7.5% in grade 3. These differences were significant (P < .05). DNA image analysis of PI and Ki-67 LI differed significantly between grade 1 FLs and grade 2 and 3 FLs (P < .05), but there were no significant differences between grade 2 and 3 FLs.

CONCLUSION

Determining the percentage of centroblasts in the follicular aggregates on FNA specimens is a good method of grading FLs. Using the percentage of centroblasts per follicular structure, FL grades 1, 2 and 3 were adequately distinguished. PI by DIA and Ki-67 LI clearly distinguished FL grade 1 from FL grades 2 and 3; however, it did not clearly distinguish between grades 2 and 3.

Detection of DNA methylation. Potential applications to diagnostic cytopathology

Inactivation of tumor suppressor genes is often the result of genetic mutations or deletions. However, another mechanism for silencing genes involves DNA methylation. In this setting, a methyl group is added to cytosine residues within the gene promoter region; that prevents transcription. Tumors usually contain multiple genes that have been silenced by methylation, unlike normal tissues, in which gene methylation events are less common. The list of genes methylated in a given tumor is often referred to as a gene methylation profile. Gene methylation profiles may be almost unique for each type of tumor. Methylation-specific polymerase chain reaction is a sensitive technique that can detect gene methylation in cytologic samples. Application of this technique to cytologic cancer screening tests may increase their sensitivity. Also, the introduction of novel chemotherapeutic drugs that target DNA methylation may utilize gene methylation assays on fine needle aspiration biopsies of tumors.

[Sharper diagnostic tool the future promise of laser-assisted microdissection]

The paper describes the use of laser-assisted microdissection to retrieve microscopically defined cell populations including single cells from tissue sections for subsequent analysis of genomic DNA and mRNA. A general background is given on the techniques available and requirements for PCR based on minute templates. Different pre-PCR approaches are briefly described and possibilities and limitations of using archival material compared to fresh frozen tissue are discussed. In the article we give one example on how we have used the PALM laser microscopy system in combination with a nested, multiplex PCR system to analyze single normal keratinocytes as well as tumor cells from a case of basal cell cancer. We found that p53 mutations are common in normal, chronically sun-exposed skin. Widespread yet common mutations in the p53 gene that were unrelated to immunoreactivity for the p53 antibody were found in tumor cells. In addition there were rare mutations in occasional tumor cells that apparently did not result in selective growth advantage. Perspectives for the future are presented and the potential of laser assisted microdissection is highlighted within the fields of cancer research, developmental studies as well as studies of inflammatory and degenerative diseases. The combination of a method that allows careful selection of defined cells with powerful micro array based techniques, provides a setting with potential to uncover pathogenic mechanisms for large variety of human diseases.

[Increasing importance of cytological diagnostics in the Netherlands]

Cytological diagnosis has important practical clinical value, as shown by the observation that 54% of all diagnostic activities in pathology laboratories consist of cytological investigations. New impulses are, however, required to ensure ongoing developments. For example, from a scientific point of view, there appears to be little evidence-based information. A shift from case reports to systematic evaluation and from descriptive to prescriptive research is needed. The discipline of cytological diagnostics requires greater academic interest, and better guidance and structuring.

Tissue engineering of urinary organs

Tissue engineering can serve as an alternative treatment for a malfunctioning or lost organ. Isolated and expanded cells adhere to a temporary scaffold, proliferate, and secrete their own extracellular matrices (ECM) replacing the biodegrading scaffold. The genitourinary system, composed of the kidney, ureter, bladder, urethra, and genital organs, is exposed to a variety of possible injury sites from the time of fetal development. All the urinary organs are mainly composed of smooth muscle and uroepithelial cells and which may be approached by tissue engineering techniques. A large number of materials, including naturally-derived and synthetic polymers have been utilized to fabricate prostheses for the genitourinary system. Usually, whenever there is a lack of native urologic tissue, reconstruction is considered with native non-urologic tissue, such as, gastrointestinal segments, or skin or mucosa from multiple body sites. Engineering tissues using selective cell transplantation may provide a means to create functional new genitourinary tissues. This review concerns urinary tissues reconstructed with bladder uroepithelial cells and smooth muscle cells (SMCs) implanted on biodegradable polymer matrices.

[Cervical screening--its essence and quality-control methodology in cytology laboratories]

The essence and importance of the quality control in the activity of the cytological laboratories, fulfilling the 1st step of the cervical screening are discussed. The methodology is presented, as well as the possibilities of the different kinds of internal and external control and the place of the introduced in the practice of the developed countries automated analyzing systems are under consideration.

Atomic force microscopy in histology and cytology

This review briefly introduces the principles of the atomic force microscope (AFM) and shows our own results of AFM application to biological samples. The AFM, invented in 1986, is an instrument that traces the surface topography of the sample with a sharp probe while monitoring the interaction forces working between the probe and sample surface. Thus, the AFM provides three-dimensional surface images of the sample with high resolution. The advantage of the AFM for biologists is that AFM can visualize non-conductive materials in a non-vacuous (i.e., air or liquid) environment. AFM images of the plasmid DNA are comparable to those by transmission electron microscopy using a rotary shadowing technique, and have the advantage of examining directly the molecule without staining nor coating. The surface structure of human metaphase chromosomes and mouse collagen fibrils demonstrated in air by the non-contact mode AFM is comparable to that obtained by scanning electron microscopy. Quantitative information on the heights of structures is further obtainable from the AFM images. Embedment-free thin tissue-sections are useful for observing intracellular structures by AFM. The present review also shows AFM images of living cultured cells which have been collected in a contact mode in liquid. This technique afforded us three-dimensional observation of the cellular movement with high resolution. Although there are some innate limitations for AFM imaging, the AFM has great potential for providing valuable new information in histology and cytology.

Image cytometry: current applications and future trends

Image cytometry has numerous clinical and research applications and is particularly useful in anatomic pathology for the study of malignant lesions. Modern image systems encompass morphometry, densitometry, neural networks, and expert systems. Rapid advances in technology and the development of user-friendly systems have provided pathologists with an alternative to flow cytometry, particularly useful in the evaluation of small or hypocellular specimens. The most common current application of image cytometry is for DNA analysis, followed by quantitation of immunohistochemical staining. Newer uses under active investigation include development of expert systems that may act as diagnostic consultants in the future. Beyond DNA analysis, image cytometry holds great promise for improved tumor classification, for screening and surveillance in high-risk populations, and as a tool to improve diagnostic ability. This article discusses types of image analysis systems, specimen preparation, data acquisition, current applications in specific organ sites, and possible future applications.

Flow cytometric applications in cytopathology

Flow cytometric (FCM) methodology represents a powerful analytical tool for screening and detecting abnormal and malignant cells, for subclassifying malignancies beyond conventional morphologic type and grade and for transcending light microscopic features by providing more biologically meaningful information. This paper reviews the historical background leading to the development of the FCM methodology and instrumentation that is presently being used for cytopathologic (and histopathologic) diagnosis, tumor subclassification and identification of aggressive cancers. Emphasis is placed on human carcinomas, with reference to hematologic malignancies when appropriate. Examples of FCM DNA content and cytokinetic techniques are described for the various cytologic sampling methods. The advantages, limitations and future prospects for the application of flow cytometric techniques in cytopathology are discussed.

Flow cytometry in cytopathology. Overview and perspectives

The future applications of flow cytometry (FCM) are briefly discussed. Whereas the early goals of its clinical applications were cancer diagnosis and classification, it has now become apparent that FCM can more successfully provide information on a variety of cell constituents of crucial importance in the evaluation of tumor prognosis and treatment sensitivity. It is suggested that (1) the data being provided by FCM will probably lead to a more clinically relevant classification of tumors, based more on the biochemical/molecular markers of individual cells and an assessment of tumor heterogeneity and less on classical cell morphology and tumor progression, and (2) FCM seems likely to become established as a routine methodology in cytopathology.

Aspiration cytology in Sweden: The Karolinska Group

The method of aspiration biopsy cytology began to receive international attention after publications, innovations, and courses originating at the Karalinska Hospital in Sweden. Sixteen Franzen, Josef Zajieek, Pier Esposti, and Torsten Lowhagen were prime movers of this clinical and scientific development. The history of their arrival at the Karolinska and their seminal contributions is reviewed.

Stereological methods in cell biology: where are we--where are we going?

The current state of the art in morphometric cell biology is reviewed by looking at the developmental state of stereological methods, and at the approaches used to arrive at quantitative structure-function correlation. Stereological methods have reached a fairly advanced level of sophistication since mathematical stereology has been developed as a branch of geometric probability theory. The application of these methods in cell biology lags behind, both quantitatively and qualitatively. Among the strategies used in exploiting stereological methods in cell biology the physiological approach (where a change is induced experimentally and its effect on the cells is followed by biochemical and morphometric methods) ranks highest and is still valid. More analytical approaches, such as combining stereology and biochemistry in cell fraction studies, are fraught with difficulties. In considering future developments of stereological methods, the emphasis will have to be 1) on developing procedures for eliminating biases such as section thickness or resolution effects, and 2) on increasing the efficiency of the methods by better sampling rules and improved instrumentation. The future trends in morphometric cell biology might best be served by exploiting the potentials of histochemistry and stereology by combining them with a view to 1) establishing procedures for cell-specific sampling and 2) developing methods towards "molecular morphometry" on the basis of immunocytochemical labeling.