1
|
Covalently deposited dyes: a new chromogen paradigm that facilitates analysis of multiple biomarkers in situ. J Transl Med 2017; 97:104-113. [PMID: 27869794 DOI: 10.1038/labinvest.2016.115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/06/2016] [Accepted: 10/03/2016] [Indexed: 01/10/2023] Open
Abstract
Multiplexed analysis of multiple biomarkers in a tissue sample requires use of reporter dyes with specific spectral properties that enable discrimination of signals. Conventional chromogens with broad absorbance spectra, widely used in immunohistochemistry (IHC), offer limited utility for multiplexed detection. Many dyes with narrow absorbance spectra, eg rhodamines, fluoresceins, and cyanines, potentially useful for multiplexed detection are well-characterized; however, generation of a chromogenic reagent useful for IHC analysis has not been demonstrated. Studies reported herein demonstrate utility of tyramine-chemistry for synthesis of a wide variety of new chromogenic dye conjugates useful for multiplexed in situ analysis using conventional light microscopes. The dyes, useful individually or in blends to generate new colors, provide signal sensitivity and dynamic range similar to conventional DAB chromogen, while enabling analysis of co-localized biomarkers. It is anticipated that this new paradigm will enable generation of a wide variety of new chromogens, useful for both research and clinical biomarker analysis that will benefit clinicians and patients.
Collapse
|
2
|
Atasoy S, Erturan SS, Yılmaz N, Kuru D, Çırakoğlu A, Yılmaz Ş, Deviren A. Analysis of Chromosome 3, 7 and 8 Centromeric Regions in Bronchial Lavage Specimens by FISH. Turk Thorac J 2016; 17:141-147. [PMID: 29404144 DOI: 10.5152/turkthoracj.2016.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/15/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Multiple genetic changes are observed in malignant tumors but are rare or absent in benign conditions. Aneuploidy is the most common feature of solid tumors including lung cancer and diagnosis of malignant tumors is possible through detection of aneuploidy. The aim of this study was to investigate chromosomal abnormalities in cells from non-small cell lung cancer patients obtained bronchoscopically and to evaluate the suitability of fluorescence in situ hybridization (FISH). MATERIAL AND METHODS Bronchial lavage samples of 17 non-small cell lung cancer (NSCLC) patients were evaluated with four-color FISH using deoxyribonucleic acid (DNA) probes specific for the centromere regions of chromosomes 3, 7 and 8. tested specimens were first hybridized with probes, then visualized under fluorescence microscobe and captured with device's camera. RESULTS High number of aneuploidic cells were detected in all the samples. Increased or decreased abnormal copies or chromosomes 3, 7 and 8 were obserced in all the 17 patients. Aneuploidy of chromosome 3 (21.35%) was higher than those of chromosome 7 (9.06%) and chromosome 8 (15.47%). Moreover, our results were significant for monosomy and trisomy of chromosome 3, trisomy of chromosome 7, nullisomy, monosomy and trisomy of, chromosome 8 (p< 0.05). CONCLUSION It has been observed that FISH is a useful technique for detection of aneuploidy in bronchial lavage samples obtained by bronchoscopy. Interphase cells were evaluated without cell culturing with this method and high number of tumor cells were enumerated rapidly. Our study has demonstrated that, FISH technique may be used successfully in detection of chromosome number abnormalities in NSCLC patients and may facilitate evaluation of genetic abnormalities.
Collapse
Affiliation(s)
- Sezen Atasoy
- Department of Medical Biology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Salih Serdar Erturan
- Department of Chest Diseases, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Nail Yılmaz
- Department of Chest Diseases, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Dilhan Kuru
- Department of Medical Biology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ayşe Çırakoğlu
- Department of Medical Biology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Şükriye Yılmaz
- Department of Medical Biology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ayhan Deviren
- Department of Medical Biology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| |
Collapse
|
3
|
Zhai J. Multitarget fluorescence in situ hybridization assay for the detection of lung cancer in bronchial cytology specimens. Diagn Cytopathol 2015. [DOI: 10.1002/dc.23310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jing Zhai
- Department of Pathology; Cedars-Sinai Medical Center; Los Angeles California
| |
Collapse
|
4
|
Reynolds JP, Voss JS, Brankley SM, Caudill JM, Henry MR, Clayton AC, Halling KC, Nassar A. Diagnostic accuracy of bronchial brush cytology and the added value of immunohistochemistry and fluorescence in situ hybridization of pulmonary neuroendocrine tumors. Cytojournal 2015; 11:32. [PMID: 25558272 PMCID: PMC4278144 DOI: 10.4103/1742-6413.146120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/09/2014] [Indexed: 11/24/2022] Open
Abstract
Background: Bronchial brush (BB) cytology carries low sensitivity for detecting neuroendocrine carcinomas (NECs), including typical carcinoid (TC) tumors of the lung. We aimed to investigate the detection of neuroendocrine tumors including TC through BB routine cytology cell block (CB), immunohistochemistry (IHC), and fluorescence in situ hybridization (FISH). Materials and Methods: A SNOMED search showed 187 lung biopsy or resection specimens from 2008 through 2011 containing neuroendocrine or carcinoid in the diagnosis. Residual BB specimens retained in PreservCyt were used to prepare a ThinPrep slide for FISH analysis. CBs were stained with H and E and IHC for chromogranin and synaptophysin. Results: Of the 187 cases, 16 had residual BB material available within 1 year of diagnosis and were used in CB preparation for IHC and FISH slides. Cytologic evaluation determined 1 case positive for malignancy (small cell lung carcinoma [SCLC]), 1 suspicious for adenocarcinoma, and 14 negative for malignancy. On the basis of histologic diagnosis, FISH was performed. SCLC showed polysomy (86% abnormal cells); 2 TC tumors showed a gain of 7p12 (15% abnormal cells) and a gain of 5q15 (72% abnormal cells), respectively. Two cases had CBs with positive immunoreactivity for chromogranin and synaptophysin. The sensitivity for detection of NEC was 18.8%, 15.4%, and 25% for cytologic evaluation, CB, and FISH, respectively. Conclusion: Neuroendocrine tumors, including TC are difficult to detect with BB cytologic evaluation, most likely because tumor cells lack in the specimen. Assessment of further studies is needed to explore the role of cytology and ancillary methods for detection of these tumors.
Collapse
Affiliation(s)
- Jordan P Reynolds
- Address: Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jesse S Voss
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Shannon M Brankley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Jill M Caudill
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Michael R Henry
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Amy C Clayton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Kevin C Halling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Aziza Nassar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, United States
| |
Collapse
|
5
|
Development of a multivariate model to predict the likelihood of carcinoma in patients with indeterminate peripheral lung nodules after a nondiagnostic bronchoscopic evaluation. Hum Pathol 2014; 45:41-7. [DOI: 10.1016/j.humpath.2013.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/26/2013] [Accepted: 07/31/2013] [Indexed: 11/23/2022]
|
6
|
|
7
|
Nana-Sinkam SP, Powell CA. Molecular biology of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e30S-e39S. [PMID: 23649444 PMCID: PMC3961820 DOI: 10.1378/chest.12-2346] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/30/2012] [Indexed: 12/14/2022] Open
Abstract
Based on recent bench and clinical research, the treatment of lung cancer has been refined, with treatments allocated according to histology and specific molecular features. For example, targeting mutations such as epidermal growth factor receptor (EGFR) with tyrosine kinase inhibitors has been particularly successful as a treatment modality, demonstrating response rates in selected patients with adenocarcinoma tumors harboring EGFR mutations that are significantly higher than those for conventional chemotherapy. However, the development of new targeted therapies is, in part, highly dependent on an improved understanding of the molecular underpinnings of tumor initiation and progression, knowledge of the role of molecular aberrations in disease progression, and the development of highly reproducible platforms for high-throughput biomarker discovery and testing. In this article, we review clinically relevant research directed toward understanding the biology of lung cancer. The clinical purposes of this research are (1) to identify susceptibility variants and field molecular alterations that will promote the early detection of tumors and (2) to identify tumor molecular alterations that serve as therapeutic targets, prognostic biomarkers, or predictors of tumor response. We focus on research developments in the understanding of lung cancer somatic DNA mutations, chromosomal aberrations, epigenetics, and the tumor microenvironment, and how they can advance diagnostics and therapeutics.
Collapse
Affiliation(s)
- Serge Patrick Nana-Sinkam
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Medical Oncology, Ohio State University, Columbus, OH
| | - Charles A Powell
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine, New York, NY.
| |
Collapse
|
8
|
Voss JS, Kipp BR, Halling KC. Detection of lung cancer in bronchial brushing specimens by FISH. Expert Rev Mol Diagn 2013; 12:679-81. [PMID: 23153235 DOI: 10.1586/erm.12.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Bronchial brushing cytology specimens collected during flexible bronchoscopy are an important part of the diagnostic workup of patients with indeterminate pulmonary nodules. Unfortunately, false-negative diagnoses are not uncommon when sampling peripheral nodules, especially small nodules <2 cm in diameter. A number of studies have evaluated different FISH probe sets to increase the detection rate of lung cancer on bronchial brushings and washings. Most studies have shown that FISH with routine cytology increases the sensitivity of lung cancer detection over routine cytology alone, while maintaining high specificity. In this article, the authors review a recently published three-probe FISH assay for the detection of lung cancer in bronchial brushing specimens.
Collapse
Affiliation(s)
- Jesse S Voss
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | |
Collapse
|
9
|
Quintans JSS, Antoniolli AR, Onofre FMB, Onofre ASC. Detection of lung cancer using multiple genetic markers--a systematic review. Diagn Cytopathol 2013; 41:834-42. [PMID: 23513001 DOI: 10.1002/dc.22978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/01/2013] [Indexed: 11/08/2022]
Abstract
Lung cancer is the leading cause of cancer deaths worldwide, and has one of the lowest survival rates of any solid tumor. In recent years, several attempts have been conducted to improve an early or accelerated diagnosis due to better overall prognosis after therapy. The aim of this study was evaluating the use of genetic markers for diagnosis of lung cancer. This study was conducted in accordance to Transparent Reporting of Systematic Reviews and Meta-Analyses. Three Internet sources were used to search: MEDLINE-PubMed, EMBASE, and LILACS. The databases were searched for studies conducted in the period up to and including May 10, 2011. The following inclusion criteria were applied: lung cancer studies, and the use of genetic markers for diagnosis. Studies using animal models, review articles, meta-analyses, abstracts, conference proceedings, editorials/letters, case reports, incorrect study population, inadequate data, and cytology was not obtained, were excluded. A total of 1,901 abstracts/citations were identified for preliminary review. From 24 final selected studies, 17 referred to chromosomal markers diagnosis, eight to genes as marker, and one to both subjects. Fluorescence in situ hybridization (FISH) was applied in all studies. Despite the limitations of this study, application of genetic markers to lung cancer diagnosis seems to have prognosis value irrespective of detection methodology used. FISH was the main technique applied to diagnose genetics alterations and revealed a high specificity, although some authors reported low sensitivity.
Collapse
|
10
|
Aisner DL, Sams SB. The role of cytology specimens in molecular testing of solid tumors: Techniques, limitations, and opportunities. Diagn Cytopathol 2012; 40:511-24. [DOI: 10.1002/dc.22820] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
11
|
Liu YZ, Wang Z, Fang LL, Li L, Cao J, Xu X, Han YL, Cai Y, Wang LX, Wang MR. A potential probe set of fluorescence in situ hybridization for detection of lung cancer in bronchial brushing specimens. J Cancer Res Clin Oncol 2012; 138:1541-9. [DOI: 10.1007/s00432-012-1232-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 04/10/2012] [Indexed: 12/13/2022]
|
12
|
Abstract
Conventional cytogenetics in conjunction with Fluorescence in Situ Hybridization (FISH) continues to remain an important and integral component in the diagnosis and management of solid tumors. The ability to effectively detect the vast majority of clinically relevant chromosomal aberrations with a rapid-to-acceptable turnaround time makes them the most cost-effective screening/detection tool currently available in modern pathology. In this review, we describe a representative set of solid tumors in which chromosomal analysis and/or FISH plays a significant role in the routine clinical management of solid tumors.
Collapse
|
13
|
Collins GR, Thomas J, Joshi N, Zhang S. The diagnostic value of cell block as an adjunct to liquid-based cytology of bronchial washing specimens in the diagnosis and subclassification of pulmonary neoplasms. Cancer Cytopathol 2011; 120:134-41. [DOI: 10.1002/cncy.20181] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/06/2011] [Accepted: 06/15/2011] [Indexed: 11/07/2022]
|
14
|
Schramm M, Wrobel C, Born I, Kazimirek M, Pomjanski N, William M, Kappes R, Gerharz CD, Biesterfeld S, Böcking A. Equivocal cytology in lung cancer diagnosis: improvement of diagnostic accuracy using adjuvant multicolor FISH, DNA-image cytometry, and quantitative promoter hypermethylation analysis. Cancer Cytopathol 2011; 119:177-92. [PMID: 21413159 DOI: 10.1002/cncy.20142] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 01/24/2011] [Accepted: 01/25/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sometimes, cytological lung cancer diagnosis is challenging because equivocal diagnoses are common. To enhance diagnostic accuracy, fluorescent in situ hybridization (FISH), DNA-image cytometry, and quantitative promoter hypermethylation analysis have been proposed as adjuncts. METHODS Bronchial washings and/or brushings or transbronchial fine-needle aspiration biopsies were prospectively collected from patients who were clinically suspected of having lung carcinoma. After routine cytological diagnosis, 70 consecutive specimens, each cytologically diagnosed as negative, equivocal, or positive for cancer cells, were investigated with adjuvant methods. Suspicious areas on the smears were restained with the LAVysion multicolor FISH probe set (Abbott Molecular, Des Plaines, Illinois) or according to the Feulgen Staining Method for DNA-image cytometry analysis. DNA was extracted from residual liquid material, and frequencies of aberrant methylation of APC, p16(INK4A) , and RASSF1A gene promoters were determined with quantitative methylation-specific polymerase chain reaction (QMSP) after bisulfite conversion. Clinical and histological follow-up according to a reference standard, defined in advance, were available for 198 of 210 patients. RESULTS In the whole cohort, cytology, FISH, DNA-image cytometry, and QMSP achieved sensitivities of 83.7%, 78%, 79%, and 49.6%, respectively (specificities of 69.8%, 98.2%, 98.2%, and 98.4%, respectively). Subsequent to cytologically equivocal diagnoses, FISH, DNA-image cytometry, and QMSP definitely identified malignancy in 79%, 83%, and 49%, respectively. With QMSP, 4 of 22 cancer patients with cytologically negative diagnoses were correctly identified. CONCLUSIONS Thus, adjuvant FISH or DNA-image cytometry in cytologically equivocal diagnoses improves diagnostic accuracy at comparable rates. Adjuvant QMSP in cytologically negative cases with persistent suspicion of lung cancer would enhance sensitivity.
Collapse
Affiliation(s)
- Martin Schramm
- Institute of Cytopathology, Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Complement Factor H Is Elevated in Bronchoalveolar Lavage Fluid and Sputum from Patients with Lung Cancer. Cancer Epidemiol Biomarkers Prev 2010; 19:2665-72. [DOI: 10.1158/1055-9965.epi-10-0467] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
16
|
Bettio D, Venci A, Cariboni U, Di Rocco M, Infante M. Fluorescent in situ hybridization (FISH) in the differential diagnosis of ground-glass opacities in the lung. Lung Cancer 2010; 71:319-22. [PMID: 20674071 DOI: 10.1016/j.lungcan.2010.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 06/16/2010] [Accepted: 06/18/2010] [Indexed: 11/25/2022]
Abstract
Computed tomographic (CT) screening for lung cancer has increased the detection rate of nodules manifesting as ground-glass opacities (GGOs). The natural history of this new entity it is not well known nor is the factors that influence the growth, progression and malignant potential. This genetic study was performed in order to identify molecular markers with possible diagnostic and prognostic significance to differentiate lesions with malignant or benign profiles. Ten pure GGO fresh samples and 5 specimens of normal lung tissue were cytogenetically investigated using a direct method and short-term cultures, and molecular analysis was performed using the 4-target FISH LAVysion kit for the detection of non-small cell lung cancer (NSCLC). Interestingly, all the karyotypes turned out to be normal both with the direct method and cultured cells, while in 3 out of 10 GGOs FISH analysis was abnormal for all the targets and in 2 cases only c-MYC amplification was observed. Karyotypes and FISH performed on the normal tissue samples gave normal results. Two of three FISH positive patients died, one had a relapse of the disease and at the last follow-up showed lung and bone metastases. Despite the small sample due to the rarity of pure GGOs, these preliminary results indicate that interphase FISH analyses are more informative than metaphase studies and might contribute clinically relevant information about the nature of these lesions.
Collapse
Affiliation(s)
- Daniela Bettio
- Cytogenetic Laboratory, Operative Unit of Clinical Investigations, IRCCS Humanitas Clinical Institute, Milan 20089, Italy.
| | | | | | | | | |
Collapse
|
17
|
Abstract
IMPORTANCE OF THE FIELD Despite many efforts to improve early detection, lung cancer remains the leading cause of cancer deaths. Stage is the main determinant of prognosis and the basis for deciding treatment options. Screening tests for lung cancer have not been successful so far. AREAS COVERED IN THE REVIEW The article reviews the available literature related to biomarkers in use at present and those that could be used for early diagnosis, staging, prognosis, response to therapy and prediction of recurrence. The single biomarkers are analysed, divided according to the technological methods used and the locations of sampling. WHAT THE READER WILL GAIN The reader will gain knowledge on biomarkers in use and those now under study. The reader will also gain insights into the difficulties pertaining to the development of biomarkers, results reproducibility and clinical application. TAKE HOME MESSAGE Although some markers seem to be promising, at present there is no consensus on the proven value of their clinical use in lung cancer. The future lies probably in a panel of biomarkers instead of individual assays, or in predictive models derived from the integration of clinical variables and gene expression profiles.
Collapse
Affiliation(s)
- Massimiliano Paci
- Division of Thoracic Surgery, Azienda Santa Maria Nuova di Reggio Emilia, Viale Risorgimento 80, 42100 Reggio Emilia, Italy +39 0522 296929 ; +39 0522 296191 ;
| | | | | |
Collapse
|
18
|
Voss JS, Kipp BR, Halling KC, Henry MR, Jett JR, Clayton AC, Rickman OB. Fluorescencein SituHybridization Testing Algorithm Improves Lung Cancer Detection in Bronchial Brushing Specimens. Am J Respir Crit Care Med 2010; 181:478-85. [DOI: 10.1164/rccm.200907-1121oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
19
|
Fluorescence in situ hybridization (FISH) as an ancillary diagnostic tool in the diagnosis of melanoma. Am J Surg Pathol 2009; 33:1146-56. [PMID: 19561450 DOI: 10.1097/pas.0b013e3181a1ef36] [Citation(s) in RCA: 307] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the clinical and pathologic diagnosis of some melanomas is clear-cut, there are many histopathologic simulators of melanoma that pose problems. Over-diagnosis of melanoma can lead to inappropriate therapy and psychologic burdens, whereas under-diagnosis can lead to inadequate treatment of a deadly cancer. We used existing data on DNA copy number alterations in melanoma to assemble panels of fluorescence in situ hybridization (FISH) probes suitable for the analysis of paraffin-embedded tissue. Using FISH data from a training set of 301 tumors, we established a discriminatory algorithm and validated it on an independent set of 169 unequivocal nevi and melanomas as well as 27 cases with ambiguous pathology, for which we had long-term follow-up data. An algorithm-using signal counts from a combination of 4 probes targeting chromosome 6p25, 6 centromere, 6q23, and 11q13 provided the highest diagnostic discrimination. This algorithm correctly classified melanoma with 86.7% sensitivity and 95.4% specificity in the validation cohort. The test also correctly identified as melanoma all 6 of 6 cases with ambiguous pathology that later metastasized. There was a significant difference in the metastasis free survival between test-positive and negative cases with ambiguous pathology (P=0.003). Sufficient chromosomal alterations are present in melanoma that a limited panel of FISH probes can distinguish most melanomas from most nevi, providing useful diagnostic information in cases that cannot be classified reliably by current methods. As a diagnostic aid to traditional histologic evaluation, this assay can have significant clinical impact and improve classification of melanocytic neoplasms with conflicting morphologic criteria.
Collapse
|
20
|
Massion PP, Zou Y, Uner H, Kiatsimkul P, Wolf HJ, Baron AE, Byers T, Jonsson S, Lam S, Hirsch FR, Miller YE, Franklin WA, Varella-Garcia M. Recurrent genomic gains in preinvasive lesions as a biomarker of risk for lung cancer. PLoS One 2009; 4:e5611. [PMID: 19547694 PMCID: PMC2699220 DOI: 10.1371/journal.pone.0005611] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Accepted: 04/17/2009] [Indexed: 12/12/2022] Open
Abstract
Lung carcinoma development is accompanied by field changes that may have diagnostic significance. We have previously shown the importance of chromosomal aneusomy in lung cancer progression. Here, we tested whether genomic gains in six specific loci, TP63 on 3q28, EGFR on 7p12, MYC on 8q24, 5p15.2, and centromeric regions for chromosomes 3 (CEP3) and 6 (CEP6), may provide further value in the prediction of lung cancer. Bronchial biopsy specimens were obtained by LIFE bronchoscopy from 70 subjects (27 with prevalent lung cancers and 43 individuals without lung cancer). Twenty six biopsies were read as moderate dysplasia, 21 as severe dysplasia and 23 as carcinoma in situ (CIS). Four-micron paraffin sections were submitted to a 4-target FISH assay (LAVysion, Abbott Molecular) and reprobed for TP63 and CEP 3 sequences. Spot counts were obtained in 30-50 nuclei per specimen for each probe. Increased gene copy number in 4 of the 6 probes was associated with increased risk of being diagnosed with lung cancer both in unadjusted analyses (odds ratio = 11, p<0.05) and adjusted for histology grade (odds ratio = 17, p<0.05). The most informative 4 probes were TP63, MYC, CEP3 and CEP6. The combination of these 4 probes offered a sensitivity of 82% for lung cancer and a specificity of 58%. These results indicate that specific cytogenetic alterations present in preinvasive lung lesions are closely associated with the diagnosis of lung cancer and may therefore have value in assessing lung cancer risk.
Collapse
Affiliation(s)
- Pierre P Massion
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt Ingram Cancer Center, Veterans Administration Medical Center, Nashville, TN, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Gill RK, Vazquez MF, Kramer A, Hames M, Zhang L, Heselmeyer-Haddad K, Ried T, Shilo K, Henschke C, Yankelevitz D, Jen J. The use of genetic markers to identify lung cancer in fine needle aspiration samples. Clin Cancer Res 2009; 14:7481-7. [PMID: 19010865 DOI: 10.1158/1078-0432.ccr-07-5242] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We seek to establish a genetic test to identify lung cancer using cells obtained through computed tomography-guided fine needle aspiration (FNA). EXPERIMENTAL DESIGN We selected regions of frequent copy number gains in chromosomes 1q32, 3q26, 5p15, and 8q24 in non-small cell lung cancer and tested their ability to determine the neoplastic state of cells obtained by FNA using fluorescent in situ hybridization. Two sets of samples were included. The pilot set included six paraffin-embedded, noncancerous lung tissues and 33 formalin-fixed FNA specimens. These 39 samples were used to establish the optimal fixation and single scoring criteria for the samples. The test set included 40 FNA samples. The results of the genetic test were compared with the cytology, pathology, and clinical follow-up for each case to assess the sensitivity and specificity of the genetic test. RESULTS Nontumor lung tissues had < or= 4 signals per nucleus for all tested markers, whereas tumor samples had > or = 5 signals per nucleus in five or more cells for at least one marker. Among the 40 testing cases, 36 of 40 (90%) FNA samples were analyzable. Genetic analysis identified 15 cases as tumor and 21 cases as nontumor. Clinical and pathologic diagnoses confirmed the genetic test in 15 of 16 lung cancer cases regardless of tumor subtype, stage, or size and in 20 of 20 cases diagnosed as benign lung diseases. CONCLUSIONS A set of only four genetic markers can distinguish the neoplastic state of lung lesion using small samples obtained through computed tomography-guided FNA.
Collapse
Affiliation(s)
- Rajbir K Gill
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Choi CM, Seo KW, Jang SJ, Oh YM, Shim TS, Kim WS, Lee DS, Lee SD. Chromosomal instability is a risk factor for poor prognosis of adenocarcinoma of the lung: Fluorescence in situ hybridization analysis of paraffin-embedded tissue from Korean patients. Lung Cancer 2008; 64:66-70. [PMID: 18814932 DOI: 10.1016/j.lungcan.2008.07.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 07/24/2008] [Accepted: 07/27/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND In this study, we sought to evaluate the prognostic importance of chromosomal instability (CIN) in adenocarcinoma (AC) of the lung. The relationship between CIN detected by fluorescence in situ hybridization (FISH) and survival in AC patients was examined. METHODS Sixty-three surgical specimens of lung AC were analyzed. To identify tumors with CIN, p16 and multi-target DNA FISH assays for c-myc, chromosome 6, EGFR, and chromosome 5 (LAVysion, Vysis) were performed on nuclei extracted from paraffin-embedded tumor tissues. Survival rates were compared in terms of sex, age, histology, T factor, N factor, CIN, and smoking status. A sample was classified as CIN-positive if at least three of the five chromosomes were positive. RESULTS Out of the 63 specimens, 32 (39.7%) were CIN-positive. The 5-year overall disease-free survival rate was 58.7% as a whole, 46.9% for CIN-positive patients and 71.0% for the CIN-negative patients [hazard ratio (HR), 2.34; 95% confidence interval (CI), 1.04-5.26; p = 0.04]. The 5-year overall survival rate was 81.0%, 68.7% for CIN-positive patients and 93.5% for the CIN-negative patients (HR, 5.64; 95% CI, 1.23-25.70; p = 0.026). In multivariate analysis after adjusting for pathologic nodal staging, tumor staging, sex, age, and smoking history, compared with the CIN-negative patients, the CIN-positive status remained significantly associated with decreased overall survival (HR, 8.48; 95% CI, 1.66-43.42; p = 0.010). CONCLUSIONS CIN can be effectively detected in primary AC of lung using FISH analysis. CIN is associated with poor prognosis for AC, and may thus be utilized as an independent prognostic factor for the disease.
Collapse
Affiliation(s)
- Chang-Min Choi
- Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Nordberg ML. Molecular pathology--translating research into clinical practice: an expanding frontier in surgical oncology. Surg Oncol Clin N Am 2008; 17:303-21, viii. [PMID: 18375354 DOI: 10.1016/j.soc.2008.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Molecular assays have now become essential to the pathologist and clinician alike in diagnosing and managing disease. This article highlights the techniques and molecular targets no longer ancillary to basic research. Ripe for discussion are the likely future impact of genetics on clinical care, the potential models for service provision, and the broader ethical, legal, and social issues related to the use of genetic information for nonmedical purposes. Molecular methods are forecasted to increase in assisting in the diagnosis of human diseases. The author's mission is to embrace this discipline and use these technologies in clinical practice.
Collapse
Affiliation(s)
- Mary Lowery Nordberg
- Department of Pathology, LSUHSC/Feist-Weiller Cancer Center, Room C2-26, 1501 Kings Highway, Shreveport, LA 71130-3932, USA.
| |
Collapse
|
24
|
The impact of genetic markers on the diagnosis of lung cancer: a current perspective. J Thorac Oncol 2008; 2:1044-51. [PMID: 17975498 DOI: 10.1097/jto.0b013e318158eed4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lung cancer is the leading worldwide source of cancer-related death. It is acknowledged that prognosis and treatment outcomes in lung cancer might be improved by increasing the effectiveness of early-stage diagnosis. Several recently published studies have produced intriguing results regarding the detection of biomarkers in tumor samples, but also in easily accessible specimens such as sputum, plasma, and exhaled breath condensate. This review presents advances in genetic diagnostics of lung cancer, with particular reference to the clinical usefulness of individual biomarkers, specimens, and methods. The adequacy of their sensitivity and specificity for cancer screening and early detection is discussed in detail.
Collapse
|
25
|
Halling KC, Kipp BR. Fluorescence in situ hybridization in diagnostic cytology. Hum Pathol 2007; 38:1137-44. [PMID: 17640552 DOI: 10.1016/j.humpath.2007.04.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 04/25/2007] [Indexed: 12/17/2022]
Abstract
Fluorescence in situ hybridization (FISH) is a technique that uses fluorescently labeled DNA probes to detect chromosomal alterations in cells. FISH can detect various types of cytogenetic alterations including aneusomy (ie, abnormalities of chromosome copy number), duplication, amplification, deletion, and translocation. Because tumor cells generally contain chromosomal alterations, FISH is able to detect cells that have chromosomal abnormalities consistent with neoplasia in exfoliative and aspiration cytology specimens. This review will discuss the utility of FISH for the detection of bladder, lung, pancreatobiliary, and esophageal carcinoma in cytologic specimens.
Collapse
Affiliation(s)
- Kevin C Halling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
| | | |
Collapse
|
26
|
Wei EX, Anga AA, Martin SS, Jackson JG, Nordberg ML, Herrera GA, Turbat-Herrera EA. EGFR expression as an ancillary tool for diagnosing lung cancer in cytology specimens. Mod Pathol 2007; 20:905-13. [PMID: 17643093 DOI: 10.1038/modpathol.3800939] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Lung cancer evolves in a multistep process, and its early detection portends a better prognosis. Bronchial washings/brushings and fine-needle aspirations are often used as early screening and cytological diagnosis of lung cancer. In some cases, it is difficult to differentiate morphologically malignant from reactive cells. Epidermal growth factor receptor (EGFR) is a transmembrane receptor overexpressed in high percentage lung cancers, and contributes to tumor growth. Assessing EGFR expression levels by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) may provide critical information of tumor marker abnormalities, assist in the cytological diagnosis, and stratify patients for EGFR inhibitor therapy. Fifty patients with bronchial washings/brushings or fine-needle aspiration specimens, and corresponding histologically confirmed lung biopsies, were studied for EGFR expression with FISH and IHC. Copy numbers of the EGFR gene locus were analyzed with those of chromosome 7 by FISH. EGFR and FISH results were compared to our FISH data with combined EGFR, c-myc, 5p15.2, and chromosome 6 probes in selected cases. Cell blocks, if available, and tissue biopsy sections were used for EGFR IHC. The intensity of IHC was scored, and quantified. Only balanced aneuploidy of EGFR was identified by FISH. Gene amplification was not detected. The chromosomal abnormalities of EGFR were often accompanied by other chromosomal aneuploidies demonstrated in c-myc (8q24), 5p15.2 or 6p, indicating a general genomic instability. About half of the specimens with confirmed malignancy showed EGFR balanced aneuploidy by FISH, and gene copy number was not coupled with protein expression in many cases. The benign or reactive cytology specimens confirmed by biopsies had high specificity by FISH (96%) and IHC (88%). FISH and IHC analysis of EGFR, possibly along with other tumor markers, may be a useful ancillary tool to classify difficult cytology cases and inform clinicians arranging targeted chemotherapy.
Collapse
MESH Headings
- Aneuploidy
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biopsy, Fine-Needle
- Bronchoalveolar Lavage Fluid/chemistry
- Bronchoalveolar Lavage Fluid/cytology
- Carcinoma, Non-Small-Cell Lung/chemistry
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Small Cell/chemistry
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/genetics
- Carcinoma, Small Cell/pathology
- Chromosomes, Human, Pair 5
- Chromosomes, Human, Pair 6
- Chromosomes, Human, Pair 7
- ErbB Receptors/analysis
- ErbB Receptors/genetics
- Gene Expression Regulation, Neoplastic
- Genes, myc
- Genomic Instability
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lung Neoplasms/chemistry
- Lung Neoplasms/diagnosis
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Predictive Value of Tests
- Prognosis
- Reproducibility of Results
Collapse
Affiliation(s)
- Eric X Wei
- Department of Hematopathology, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.
| | | | | | | | | | | | | |
Collapse
|
27
|
Glatz K, Savic S, Glatz D, Francz G, Barascud A, Grilli B, Herzog M, Dalquen P, Feichter G, Spieler P, Tamm M, Bubendorf L. An online quiz uncovers limitations of morphology in equivocal lung cytology. Cancer 2006; 108:480-7. [PMID: 17091509 DOI: 10.1002/cncr.22286] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Equivocal atypia in respiratory cytology can be a diagnostic challenge. In such cases fluorescence in situ hybridization (FISH) may be used for the analysis of chromosomal aberrations and often allows a reliable distinction of benign and malignant cells. METHODS An online picture gallery of 30 respiratory cytologic preparations comprising 23 specimens with equivocal cytology as well as 5 positive and 2 negative controls was prepared (www.unibas.ch/patho/lungenzyto/loesung). The final diagnoses were confirmed by clinical follow-up or biopsy or both. Each of the illustrated cell groups was analyzed by multitarget FISH after PAP image capturing and automatic relocalization. RESULTS The online questionnaire was completed by 137 cytomorphologists from all continents. The control cases were assessed accurately to a significantly higher percentage than the equivocal cases. In equivocal cases participants more often made false-positive than false-negative diagnoses. In 2 patients with benign conditions (tuberculosis and pulmonary capillaritis) the rate of false-positive answers was remarkably high (31.4% and 62.8% respectively). The result of the 20 best-performing participants for the 5 cases with the highest percentage of inaccurate answers was not better than if they had chosen their answer by chance. CONCLUSIONS These data illustrate that single cells or cell clusters of a subgroup of equivocal lung cytology are a diagnostic challenge even for highly experienced morphologists. Internet-based tests are able to reveal limitations of cytomorphology.
Collapse
Affiliation(s)
- Katharina Glatz
- Department for Pathology, Institute for Pathology, University Hospital, Basel, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Kettunen E, Salmenkivi K, Vuopala K, Toljamo T, Kuosma E, Norppa H, Knuutila S, Kaleva S, Huuskonen MS, Anttila S. Copy number gains on 5p15, 6p11-q11, 7p12, and 8q24 are rare in sputum cells of individuals at high risk of lung cancer. Lung Cancer 2006; 54:169-76. [PMID: 16935392 DOI: 10.1016/j.lungcan.2006.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 07/02/2006] [Accepted: 07/15/2006] [Indexed: 11/21/2022]
Abstract
UNLABELLED Lung cancer specimens display recurrent copy number aberrations in distinguished chromosomal regions as compared with normal lung cells. Such alterations have been utilized in design of fluorescence in situ hybridization (FISH) probe sets in attempts to improve the cytological diagnosis of lung cancer. One of such probe sets, LAVysion, detects copy number changes in the centromeric region of chromosome 6 (CEP6), and regions 5p15, 8q24, and 7p12, often gained in lung cancer. METHODS We evaluated the feasibility of the LAVysion multi-color probe set in detection of individuals at high risk of lung cancer by applying the FISH probe set on smears prepared of induced sputa obtained from 20 lung cancer patients, 43 asbestos-exposed workers, 21 heavy tobacco smokers, and 15 healthy never-smokers. The hybridized sputum smears were examined using fluorescence microscopy and the number of signals in epithelial cells was examined throughout the hybridized area. Additionally, we review here the previous studies using LAVysion probe set. RESULTS The FISH probe set was slightly more sensitive than cytology alone in detecting lung cancer. No significant differences in copy number gain were found between high-risk individuals and healthy never-smokers. The proportions of individuals with copy number gains in sputa among the lung cancer patients, asbestos-exposed workers, tobacco smokers, and never-smokers were 50, 20, 12, and 27%, respectively, when three or more cells with a copy number gain detected by at least two different probes was used as the cut-off point. In comparison, the sensitivity of cytology in detecting lung cancer was 44%. In the lung cancer patients the number of abnormal cells by FISH correlated well with the cytologic atypia class (Spearman rank correlation coefficient 0.77, p<0.01). Using multivariant variance analysis, gains in CEP6, 5p15, 8q24 and 7p12 were not associated with smoking or asbestos exposure. CONCLUSIONS FISH did not significantly exceed the sensitivity of sputum cytology in finding lung cancers. Significant differences were not found between sputa of asbestos-exposed individuals, heavy-smokers and never-smokers. More sensitive methods are needed for the follow-up of populations at high risk of contracting lung cancer.
Collapse
Affiliation(s)
- Eeva Kettunen
- Finnish Institute of Occupational Health, Centre of Expertise for Health and Work Ability, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Halling KC, Rickman OB, Kipp BR, Harwood AR, Doerr CH, Jett JR. A Comparison of Cytology and Fluorescence in Situ Hybridization for the Detection of Lung Cancer in Bronchoscopic Specimens. Chest 2006; 130:694-701. [PMID: 16963665 DOI: 10.1378/chest.130.3.694] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES To determine the relative sensitivity and specificity of cytology and fluorescence in situ hybridization (FISH) for the detection of lung cancer in bronchoscopically obtained specimens. DESIGN Cytology and FISH were performed on brushing and washing specimens obtained from patients undergoing bronchoscopy for suspected lung cancer. FISH utilized the LAVysion probe set (Abbott Molecular; Des Plaines, IL), which contains locus-specific probes to 5p15, 7p12 (EGFR), 8q24 (C-MYC), and a centromeric probe to chromosome 6. SETTING Single-center, academic, tertiary medical center. PARTICIPANTS One hundred thirty-seven patients referred for bronchoscopy for suspicion of lung cancer. INTERVENTIONS Cytology and FISH were performed on bronchoscopic brushings and washings. MEASUREMENTS AND RESULTS One hundred thirty-seven patients undergoing bronchoscopy had pathology, FISH, and cytology results. FISH and cytology were performed on 123 washing and 78 brushing specimens. Sensitivities of FISH and cytology were 71% and 51% (p = 0.007), respectively, for brushing specimens, and 49% and 44% (p = 0.541) for washing specimens. When FISH and cytology results were combined, sensitivities were 75% and 61%, respectively, for brushing and washing specimens, which was significantly better (p < 0.001) than cytology alone. Specificities of FISH and cytology for patients with negative findings at the time of initial bronchoscopy were 83% and 100% (p = 0.125), respectively, for brushing specimens, and 95% and 100% (p = 0.500) for washing specimens. CONCLUSIONS These findings show that FISH is significantly more sensitive than conventional cytology for detecting lung cancer in bronchial brushing specimens; when combined with cytology, FISH can improve the diagnostic sensitivity of detecting malignancy in bronchial brushing and washing specimens.
Collapse
Affiliation(s)
- Kevin C Halling
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Savic S, Glatz K, Schoenegg R, Spieler P, Feichter G, Tamm M, Bubendorf L. Multitarget Fluorescence In Situ Hybridization Elucidates Equivocal Lung Cytology. Chest 2006; 129:1629-35. [PMID: 16778285 DOI: 10.1378/chest.129.6.1629] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The category of equivocal respiratory cytology is a common diagnostic dilemma to both cytopathologists and clinicians. Chromosomal alterations are a hallmark of cancer but are rare or absent in benign conditions. The goal of this study was to test the ability of multitarget fluorescence in situ hybridization (FISH) for dissecting equivocal respiratory cytology into reactive and malignant categories. A consecutive series of 54 Papanicolaou-stained cytologic specimens of the lung was analyzed. The Papanicolaou-stained atypical cell groups were photographed, and the exact locations on the specimens were saved using automated stage and relocation software. The specimens were hybridized with a multitarget FISH probe that contains a mixture of fluorescent probes to the centromeric region of chromosome 6 and to the 5p15, 8q24 (site of the MYC gene) and 7p12 (site of the EGFR gene) loci. The hybridized atypical cells were selectively scored after relocation. A final diagnosis was available in 45 patients, revealing lung carcinoma in 55.5% (n = 25), no evidence of malignancy in 37.8% (n = 17), and pulmonary metastasis of another primary carcinoma in 6.7% (n = 3). FISH results were negative in all 17 patients with benign pulmonary disease and positive in 20 of the 25 patients (80%) with lung carcinoma (p < 0.0001). The sensitivity, specificity, and positive and negative predictive values for detection of malignancy were 79%, 100%, 100%, and 74%, respectively. These data suggest that multitarget FISH in conjunction with automated relocation is a powerful approach for the elucidation of equivocal lung cytology.
Collapse
Affiliation(s)
- Spasenija Savic
- Institute for Pathology, University Hospital Schönbeinstrasse 40, 4003 Basel, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
31
|
Schmiemann V, Böcking A, Kazimirek M, Onofre ASC, Gabbert HE, Kappes R, Gerharz CD, Grote HJ. Methylation assay for the diagnosis of lung cancer on bronchial aspirates: a cohort study. Clin Cancer Res 2006; 11:7728-34. [PMID: 16278393 DOI: 10.1158/1078-0432.ccr-05-0999] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Recent studies have detected aberrant promoter methylation of adenomatous polyposis coli promoter 1 A (APC), cyclin-dependent kinase inhibitor-2A (p16(INK4a)), retinoic acid receptor beta2, and RAS association domain family protein 1 (RASSF1A) in bronchial aspirates and suggested their use as biomarkers for lung cancer diagnostics. The purpose of this study was to validate these candidate marker genes in a retrospective cohort study. EXPERIMENTAL DESIGN Bronchial aspirates collected from a cohort comprising 247 patients with suspected lung cancer were investigated retrospectively regarding aberrant promoter methylation using a quantitative methylation-specific real-time PCR (QMSP). RESULTS Eighty-nine patients were diagnosed with primary lung cancer, 102 had benign lung disease, and 56 showed miscellaneous other conditions. A panel consisting of APC, p16(INK4a), and RASSF1A emerged as useful combination. This panel detected aberrant methylation in bronchial aspirates of 22 of 35 (63%) and 21 of 44 (44%) centrally and peripherally located primary lung cancers, respectively. Bronchial aspirates also showed aberrant methylation in 5 of 7 (71%) patients with a recurrent lung cancer and in 8 of 30 (27%) cases without tumor recurrence. In contrast, only 1 of 102 patients with benign lung disease displayed a (false) positive test result. Rarely, aberrant methylation was found in patients with other malignancies (3 of 16). The QMSP assay correctly confirmed lung cancer in 8 of 12 (67%) cases with an ambiguous cytology. Moreover, it disclosed 9 of 26 (35%) of peripheral tumors lacking simultaneous cytologic or histologic diagnosis of malignancy. CONCLUSIONS Our findings suggest that the QMSP assay could be applied as a reflex test in cases of suspected lung cancer that defy a definite diagnosis by conventional methods. Thus, the assay could be a useful diagnostic adjunct especially regarding peripheral tumors.
Collapse
Affiliation(s)
- Viola Schmiemann
- Institut fuer Cytopathologie, Heinrich-Heine-Universitaet, Duesseldorf, Germany
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Nakamura H, Aute I, Kawasaki N, Taguchi M, Ohira T, Kato H. Quantitative detection of lung cancer cells by fluorescence in situ hybridization: comparison with conventional cytology. Chest 2005; 128:906-11. [PMID: 16100185 DOI: 10.1378/chest.128.2.906] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVE The aim of this study was to clarify whether fluorescence in situ hybridization (FISH) can diagnose lung cancer in various clinical specimens in comparison with conventional cytology. DESIGN Prospective study. SETTING University hospital in a metropolitan area. PATIENTS Fifty consecutive patients with abnormal chest radiography or CT scan findings were enrolled. The patients included 32 men and 18 women, with an average age of 64 years. The final definitive diagnosis was made by histologic examination, as follows: 38 primary lung cancers (24 adenocarcinomas, 8 squamous cell carcinomas, 2 large cell carcinomas, and 4 small cell carcinomas); 1 metastatic renal cell carcinoma; and 11 benign lesions. METHODS Four types of clinical specimens were analyzed. Cells obtained by transbronchial brushing and transbronchial fine-needle aspiration using a fiberoptic bronchoscope under fluoroscopy, CT scan-guided percutaneous needle biopsy, and bronchial washings. On every examination, duplicate slides were made for analyses of conventional cytology and FISH. RESULTS Classifications according to conventional cytology were as follows: class I, 4 patients; class II, 15 patients; class IIIa, 3 patients; class IIIb, 5 patients; and class V, 23 patients. A classification higher than class IIIb was considered to be positive for cancer. For cytology, we found no false-positive cases and 11 false-negative cases. The specificity was 100%, and the sensitivity was 71.8%. By FISH, 34 cases showed aberrant copy numbers in either chromosome 3 or 17. We found no false-positive cases and five false-negative cases. The specificity was 100%, and the sensitivity was 87.1%. CONCLUSION The ability of FISH to detect aneusomic lung cancer cells is superior to conventional cytology for the diagnosis of lung cancer.
Collapse
Affiliation(s)
- Haruhiko Nakamura
- Department of Chest Surgery, Atami Hospital, International University of Health and Welfare, 13-1 Higashikaigan-cho, Atami-city, Shizuoka, Japan 413-0012.
| | | | | | | | | | | |
Collapse
|
33
|
Mimbacas AB, Cardoso JH. A recurrent chromosome 4 marker in primary squamous cell lung cancer. ACTA ACUST UNITED AC 2005; 28:331-3. [PMID: 15542256 DOI: 10.1016/j.cdp.2004.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Accepted: 06/17/2004] [Indexed: 10/26/2022]
Abstract
A sample of eight primary lung tumors histologically identified as squamous cell type carcinomas (SQC) were cytogenetically analyzed after a short-term (7 days) culture. Several numerical and structural abnormalities were observed. As G-banding analysis is unable to fully characterize complex marker chromosomes, we applied the fluorescence chromosome painting technique to identify one as a marker derived from a chromosome 4 that has not been described until now. We found it in half of the analyzed cases.
Collapse
Affiliation(s)
- Adriana Beatriz Mimbacas
- Departamento de Citogenética, Instituto de Investigaciones Biológicas Clemente Estable, Avenida Italia 3318, C.P. 11300 Montevideo, Uruguay.
| | | |
Collapse
|
34
|
Barkan GA, Caraway NP, Jiang F, Zaidi TM, Fernandez R, Vaporcyin A, Morice R, Zhou X, Bekele BN, Katz RL. Comparison of molecular abnormalities in bronchial brushings and tumor touch preparations. Cancer 2005; 105:35-43. [PMID: 15605362 DOI: 10.1002/cncr.20800] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preneoplastic lung lesions and early-stage lung carcinomas are associated with molecular abnormalities. The authors performed a pilot study to evaluate the use of DNA fluorescence in situ hybridization (FISH) probes to ascertain whether these biomarkers can predict nonsmall cell lung carcinoma (NSCLC). METHODS Fourteen bronchial brushings ipsilateral to the tumor (BB/Ts), tumor touch imprints, and touch imprints of the bronchus adjacent to the tumor obtained from 15 patients with early-stage NSCLC were analyzed. The LAVysion multicolor probe set consisting of probes to 5p15, 6, 7p12, and 8q2 and the in-house probes 3p22.1 and 10q22 was used. Using the LAVysion multicolor probe set, 25 epithelial cells were counted and considered positive if > 5 cells were abnormal. Using 3p22.1 and 10q22, > or = 100 nuclei per slide were scored. The results were tabulated as the percentage of cells with deletions compared with the centromeric probes 3 and 10. Greater than 2% of the deletions were positive for 3p22.1 and 10q22. Bronchial washings from patients without lung tumors were used as controls. RESULTS The BB/Ts were negative for malignant cells by cytologic evaluation and the LAVysion probe set; however, the combined in-house probes for 3p22.1 and 10q22 tested on BB/Ts predicted cancer in 100% of cancer patients. FISH positivity in the lung cancers was 100% for 3p22.1 deletions, 79% for 10q22 deletions, and 57% for LAVysion probes. When compared with the bronchial epithelium, tumor cells showed a 3.7-fold excess of 3p22.1 deletions, a 2-fold excess of 10q22 deletions, and a 12.6-fold excess of abnormal cells. CONCLUSIONS The current study indicated that detection of molecular abnormalities in bronchial epithelial cells via FISH was very useful in identifying patients at high risk for developing lung carcinoma. The molecular abnormalities identified in the BB/Ts were detected at elevated levels in the tumor specimens.
Collapse
Affiliation(s)
- Güliz A Barkan
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Identification of biomarkers is one of the most promising approaches for the detection of early malignant or even premalignant lesions with the chance of diagnosing early stages of non-small cell lung cancer that could be treated curatively. Alterations of chromosomes (3p, 5q, 9p), genes (Rb, C-myc, C-mos, hTERT), proteins (p16, p53, K-ras, hnRNP A2/B1, MCM2, EGFR, erbB-2, erbB-3, erbB-4) and others can be found in lung cancer. Some of these occur at early stages of the disease and few could serve as potential screening markers. The actual literature is reviewed and the relevance of the different biomarkers for early lung cancer detection is discussed.
Collapse
Affiliation(s)
- W Hilbe
- Department of General Internal Medicine, Oncology, University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria.
| | | | | | | |
Collapse
|
36
|
Fahmy M, Skacel M, Gramlich TL, Brainard JA, Rice TW, Goldblum JR, Connor JT, Casey G, Legator MS, Tubbs RR, Falk GW. Chromosomal gains and genomic loss of p53 and p16 genes in Barrett's esophagus detected by fluorescence in situ hybridization of cytology specimens. Mod Pathol 2004; 17:588-96. [PMID: 15017433 DOI: 10.1038/modpathol.3800088] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endoscopic brush cytology is a promising surveillance technique for Barrett's esophagus. Ancillary markers are sought to increase the sensitivity of cytology and allow identification of patients at increased risk for disease progression. To determine if there are specific genetic changes in Barrett's esophagus with associated high-grade dysplasia/intramucosal adenocarcinoma compared to those without dysplasia, we performed fluorescence in situ hybridization (FISH) on cytologic specimens using probes to chromosomes and genomic regions previously described as altered in this disease. We studied archival brush cytology slides from 40 Barrett's esophagus patients: 21 with biopsy-proven high-grade dysplasia/carcinoma and 19 with no dysplasia and a minimum 5 years of negative follow-up. Centromeric enumeration probes (CEP) for chromosomes 6, 7, 11, and 12, and locus-specific probes (LSI) for 9p21 (p16 gene), and 17p13.1 (p53 gene) loci along with their corresponding CEP (9 and 17, respectively) were used in this study. A positive FISH result was defined as the presence of cells with >2 CEP signals or with a loss of the LSI signals relative to their corresponding CEP. p53 locus loss and/or aneusomy of chromosomes 6, 7, 11, and 12 abnormalities could be detected by FISH in routinely processed endoscopic brush cytology specimens from 95% of biopsy-positive cases with a specificity of 100%. Interestingly, all five cases with cytologic changes classified as indefinite for dysplasia from patients with a positive biopsy showed changes by FISH. Loss of the p16 locus was seen commonly in patients both with and without dysplasia/carcinoma. Selected biomarkers from this study merit further investigation to determine their potential to detect genetic changes in patients with Barrett's esophagus prior to the development of high-grade dysplasia.
Collapse
MESH Headings
- Barrett Esophagus/genetics
- Barrett Esophagus/pathology
- Biopsy
- Chromosome Aberrations
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 6/genetics
- Chromosomes, Human, Pair 7/genetics
- Chromosomes, Human, Pair 9/genetics
- Cyclin-Dependent Kinase Inhibitor p16/genetics
- Cytodiagnosis/methods
- Esophagus/metabolism
- Esophagus/pathology
- Humans
- In Situ Hybridization, Fluorescence/methods
- Nucleic Acid Probes/genetics
- Sensitivity and Specificity
- Tumor Suppressor Protein p53/genetics
Collapse
Affiliation(s)
- Mona Fahmy
- Department of Anatomic and Clinical Pathology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Romeo MS, Sokolova IA, Morrison LE, Zeng C, Barón AE, Hirsch FR, Miller YE, Franklin WA, Varella-Garcia M. Chromosomal abnormalities in non-small cell lung carcinomas and in bronchial epithelia of high-risk smokers detected by multi-target interphase fluorescence in situ hybridization. J Mol Diagn 2003; 5:103-12. [PMID: 12707375 PMCID: PMC1907319 DOI: 10.1016/s1525-1578(10)60459-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Human lung carcinogenesis is accompanied by complex chromosomal changes that may be detected in interphase cells by fluorescence in situ hybridization (FISH) assay using recently developed multitarget DNA probes. Touch preparations of 20 non-small cell lung carcinomas, sputum specimens from 3 patients with lung cancer and from 11 ex-smokers without lung cancer, and cultured benign bronchial epithelium of 42 high-risk smokers, 9 of whom had concurrent invasive carcinoma, were tested using a four-color FISH probe (LAVysion) targeting centromere 6, 5p15.2, 7p12 (EGFR), and 8q24 (MYC). Significantly high frequencies of abnormal cells were found in each of the 20 NSCLC (100%) and in the 3 sputum specimens from lung cancer patients. None of the cytologically normal sputa contained FISH abnormalities. Cultured bronchial epithelial cells from 11 of 42 patients (26%) were abnormal for at least one probe. Abnormal FISH patterns had no association with gender, presence of tumor or histology. Multicolor FISH can readily detect chromosomal abnormalities in imprints and sputa from lung carcinomas. Chromosomal aneusomy is also frequent in bronchial epithelial cells from long-term smokers. The prognostic significance of the multicolor LAVysion FISH probe set should be validated in a controlled clinical trial.
Collapse
Affiliation(s)
- Maura Santos Romeo
- Department of Medicine, School of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Liu Z, Klominek J. Regulation of matrix metalloprotease activity in malignant mesothelioma cell lines by growth factors. Thorax 2003; 58:198-203. [PMID: 12612292 PMCID: PMC1746590 DOI: 10.1136/thorax.58.3.198] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The extracellular matrix metalloproteases (MMPs) produced by tumour and stromal cells are believed to play a key role in tumour cell invasion and metastasis. Malignant mesothelioma is a highly aggressive tumour. Previous studies have shown that malignant mesothelioma cells express MMP-1, -2, -3, -7 and -9. However, the regulation of MMP expression in malignant mesothelioma cells has not been thoroughly investigated. METHODS The effects of a number of growth factors on the secretion of MMP-2, -3 and -9 in malignant mesothelioma cells were studied by substrate zymography. The expression of relevant growth factor receptors in malignant mesothelioma cells was also examined using RT-PCR. RESULTS The exposure of malignant mesothelioma cells to different growth factors including epidermal growth factor (EGF), transforming growth factor-alpha, amphiregulin, heparin binding EGF, beta-cellulin (BTC), stem cell factor, insulin-like growth factors I and II, acidic and basic fibroblast growth factors, and hepatocyte growth factor increased secretion of MMP-9 and/or MMP-3. EGF receptor ligands BTC and EGF had the most potent effect on MMP-9 and MMP-3 production, respectively. Production of MMP-2 was not affected by any growth factors used in this study. We have also demonstrated mRNA expression of different growth factor receptors in malignant mesothelioma cells, and found that the tyrosine kinase inhibitor genistein inhibited the increased production of MMPs resulting from stimulation with different growth factors. CONCLUSION This study shows, for the first time, the broad extent of regulation of MMPs by various growth factors in malignant mesothelioma cells.
Collapse
Affiliation(s)
- Z Liu
- Division of Clinical Immunology and Division of Respiratory Medicine and Allergology, Karolinska Institute at Huddinge University Hospital, S-141 86 Stockholm, Sweden
| | | |
Collapse
|