1
|
Markopoulos G, Lampri E, Tragani I, Kourkoumelis N, Vartholomatos G, Seretis K. Intraoperative Flow Cytometry for the Rapid Diagnosis and Validation of Surgical Clearance of Non-Melanoma Skin Cancer: A Prospective Clinical Feasibility Study. Cancers (Basel) 2024; 16:682. [PMID: 38398076 PMCID: PMC10887295 DOI: 10.3390/cancers16040682] [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: 01/04/2024] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Non-melanoma skin cancer (NMSC) is the most prevalent cancer in humans, with a high global incidence. We present a prospective clinical feasibility study on the use of intraoperative flow cytometry (iFC) for the instant diagnosis of NMSC and its complete surgical clearance. Flow cytometry, a laser-based technique, quantifies cell features, which has applications in cancer research. This study aim is to explore the potential applicability of iFC in detecting and characterizing NMSC and its surgical margins. In total, 30 patients who underwent diagnosis for NMSC were recruited. The method demonstrated high sensitivity (95.2%) and specificity (87.1%), with an accuracy of 91.1%, as confirmed with a receiver operating characteristic curve analysis. The results also indicated that most tumors were diploid, with two cases being hypoploid. The average G0/G1 fractions for normal and tumor tissue samples were 96.03 ± 0.30% and 88.03 ± 1.29%, respectively, with the tumor index escalating from 3.89 ± 0.30% to 11.95 ± 1.29% in cancerous cells. These findings underscore iFC's capability for precise intraoperative NMSC characterization and margin evaluation, promising enhanced complete tumor excision rates. Given the technique's successful application in various other malignancies, its implementation in NMSC diagnosis and treatment holds significant promise and warrants further research in clinical trials.
Collapse
Affiliation(s)
- Georgios Markopoulos
- Haematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45110 Ioannina, Greece; (G.M.); (G.V.)
| | - Evangeli Lampri
- Department of Pathology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (E.L.); (I.T.)
| | - Ioulia Tragani
- Department of Pathology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (E.L.); (I.T.)
| | - Nikolaos Kourkoumelis
- Department of Medical Physics, Medical School, University of Ioannina, 45110 Ioannina, Greece;
| | - Georgios Vartholomatos
- Haematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45110 Ioannina, Greece; (G.M.); (G.V.)
| | - Konstantinos Seretis
- Department of Plastic Surgery, Medical School, University of Ioannina, 45110 Ioannina, Greece
| |
Collapse
|
2
|
Liaropoulos I, Liaropoulos A, Liaropoulos K. Critical Assessment of Cancer Characterization and Margin Evaluation Techniques in Brain Malignancies: From Fast Biopsy to Intraoperative Flow Cytometry. Cancers (Basel) 2023; 15:4843. [PMID: 37835537 PMCID: PMC10571534 DOI: 10.3390/cancers15194843] [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: 09/08/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
Brain malignancies, given their intricate nature and location, present significant challenges in both diagnosis and treatment. This review critically assesses a range of diagnostic and surgical techniques that have emerged as transformative tools in brain malignancy management. Fast biopsy techniques, prioritizing rapid and minimally invasive tissue sampling, have revolutionized initial diagnostic stages. Intraoperative flow cytometry (iFC) offers real-time cellular analysis during surgeries, ensuring optimal tumor resection. The advent of intraoperative MRI (iMRI) has seamlessly integrated imaging into surgical procedures, providing dynamic feedback and preserving critical brain structures. Additionally, 5-aminolevulinic acid (5-ALA) has enhanced surgical precision by inducing fluorescence in tumor cells, aiding in their complete resection. Several other techniques have been developed in recent years, including intraoperative mass spectrometry methodologies. While each technique boasts unique strengths, they also present potential limitations. As technology and research continue to evolve, these methods are set to undergo further refinement. Collaborative global efforts will be pivotal in driving these advancements, promising a future of improved patient outcomes in brain malignancy management.
Collapse
|
3
|
Vartholomatos G, Markopoulos GS, Vartholomatos E, Goussia AC, Dova L, Dimitriadis S, Mantziou S, Zoi V, Nasios A, Sioka C, Kyritsis AP, Voulgaris S, Alexiou GA. Assessment of Gliomas' Grade of Malignancy and Extent of Resection Using Intraoperative Flow Cytometry. Cancers (Basel) 2023; 15:2509. [PMID: 37173975 PMCID: PMC10177593 DOI: 10.3390/cancers15092509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Intraoperative Flow Cytometry (iFC) is a novel technique for the assessment of the grade of malignancy and the diagnosis of tumor type and resection margins during solid tumor surgery. Herein, we set out to analyze the role of iFC in the grading of gliomas and the evaluation of resection margins. MATERIAL AND METHODS iFC uses a fast cell cycle analysis protocol (Ioannina Protocol) that permits the analysis of tissue samples within 5-6 min. Cell cycle analysis evaluated the G0/G1 phase, S-phase, mitosis, and tumor index (S + mitosis phase fraction) and ploidy status. In the current study, we evaluated tumor samples and samples from the peripheral borders from patients with gliomas who underwent surgery over an 8-year period. RESULTS Eighty-one patients were included in the study. There were sixty-eight glioblastoma cases, five anaplastic astrocytomas, two anaplastic oligodendrogliomas, one pilocytic astrocytoma, three oligodendrogliomas and two diffuse astrocytomas. High-grade gliomas had a significantly higher tumor index than low grade gliomas (median value 22 vs. 7.5, respectively, p = 0.002). Using ROC curve analysis, a cut-off value of 17% in the tumor index could differentiate low- from high-grade gliomas with a 61.4% sensitivity and 100% specificity. All low-grade gliomas were diploid. From the high-grade gliomas, 22 tumors were aneuploid. In glioblastomas, aneuploid tumors had a significantly higher tumor index (p = 0.0018). Twenty-three samples from glioma margins were evaluated. iFC verified the presence of malignant tissue in every case, using histology as the gold standard. CONCLUSION iFC constitutes a promising intraoperative technique for glioma grading and resection margin assessment. Comparative studies with additional intraoperative adjuncts are necessary.
Collapse
Affiliation(s)
- George Vartholomatos
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
| | - Georgios S. Markopoulos
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
| | - Eyrysthenis Vartholomatos
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
| | - Anna C. Goussia
- Department of Pathology, Ioannina University Hospital, 45500 Ioannina, Greece;
- Department of Pathology, German Oncology Center, 4108 Limassol, Cyprus
| | - Lefkothea Dova
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
| | - Savvas Dimitriadis
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
| | - Stefania Mantziou
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
| | - Vaso Zoi
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
| | - Anastasios Nasios
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Chrissa Sioka
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
- Department of Nuclear Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Athanasios P. Kyritsis
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
| | - Spyridon Voulgaris
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - George A. Alexiou
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece; (G.V.); (G.S.M.); (E.V.); (L.D.); (S.D.); (S.M.); (V.Z.); (A.N.); (C.S.); (A.P.K.); (S.V.)
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| |
Collapse
|
4
|
Markopoulos GS, Vartholomatos G, Alexiou GΑ, Tatsis V, Bali C, Mitsis M. Resection margin status evaluation in gastric cancer surgery by intraoperative flow cytometry. J Surg Oncol 2023; 127:896-897. [PMID: 36598180 DOI: 10.1002/jso.27187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Georgios S Markopoulos
- Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.,Hematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, Ioannina, Greece
| | - George Vartholomatos
- Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.,Hematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, Ioannina, Greece
| | - George Α Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Vasileios Tatsis
- Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Christina Bali
- Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.,Biobank Cancer Center, University of Ioannina, Ioannina, Greece
| |
Collapse
|
5
|
Next-generation margin evaluation techniques in breast conserving surgery: A memorandum on intraoperative flow cytometry. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:675-676. [PMID: 35477846 DOI: 10.1016/j.ejso.2022.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022]
|
6
|
Alexiou GA, Markopoulos GS, Vartholomatos E, Goussia AC, Dova L, Dimitriadis S, Mantziou S, Zoi V, Nasios A, Sioka C, Kyritsis AP, Voulgaris S, Vartholomatos G. Intraoperative Flow Cytometry for the Evaluation of Meningioma Grade. Curr Oncol 2023; 30:832-838. [PMID: 36661712 PMCID: PMC9858265 DOI: 10.3390/curroncol30010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Meningiomas are the most frequent central nervous system tumors in adults. The majority of these tumors are benign. Nevertheless, the intraoperative identification of meningioma grade is important for modifying surgical strategy in order to reduce postoperative complications. Here, we set out to investigate the role of intraoperative flow cytometry for the differentiation of low-grade (grade 1) from high-grade (grade 2-3) meningiomas. The study included 59 patients. Intraoperative flow cytometry analysis was performed using the 'Ioannina Protocol' which evaluates the G0/G1 phase, S-phase, mitosis and tumor index (S + mitosis phase fraction) of a tumor sample. The results are available within 5 min of sample receipt. There were 41 grade 1, 15 grade 2 and 3 grade 3 meningiomas. High-grade meningiomas had significantly higher S-phase fraction, mitosis fraction and tumor index compared to low-grade meningiomas. High-grade meningiomas had significantly lower G0/G1 phase fraction compared to low-grade meningiomas. Thirty-eight tumors were diploids and twenty-one were aneuploids. No significant difference was found between ploidy status and meningioma grade. ROC analysis indicated 11.4% of tumor index as the optimal cutoff value thresholding the discrimination between low- and high-grade meningiomas with 90.2% sensitivity and 72.2% specificity. In conclusion, intraoperative flow cytometry permits the detection of high-grade meningiomas within 5 min. Thus, surgeons may modify tumor removal strategy.
Collapse
Affiliation(s)
- George A. Alexiou
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Georgios S. Markopoulos
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory—Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45500 Ioannina, Greece
| | | | - Anna C. Goussia
- Department of Pathology, University Hospital of Ioannina, 45500 Ioannina, Greece
- Department of Pathology, German Oncology Center, 4108 Limassol, Cyprus
| | - Lefkothea Dova
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory—Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Savvas Dimitriadis
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
| | - Stefania Mantziou
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory—Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Vasiliki Zoi
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
| | - Anastasios Nasios
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Chrissa Sioka
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Nuclear Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Athanasios P. Kyritsis
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
| | - Spyridon Voulgaris
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - George Vartholomatos
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory—Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45500 Ioannina, Greece
| |
Collapse
|
7
|
Accurate Characterization of Bladder Cancer Cells with Intraoperative Flow Cytometry. Cancers (Basel) 2022; 14:cancers14215440. [PMID: 36358858 PMCID: PMC9656620 DOI: 10.3390/cancers14215440] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Simple Summary Bladder cancer is a malignancy that predominantly affects male patients. Surgical treatment is the first option for clinical management and cancer cell characterization is critical for tumor margin detection and complete tumor removal. We developed a specialized intraoperative flow cytometry (iFC) methodology for bladder cancer cell detection. Our study, including 52 individuals, reveals that iFC is highly specific, sensitive and accurate in detecting cancer cells, based on the quantification of cell proliferation and the presence of tumor aneuploidy. The results of this study advocate further research on the utility of iFC as a next-generation malignancy evaluation technique during transurethral resections. Abstract Bladder cancer represents a major health issue. Transurethral resection is the first line treatment and an accurate assessment of tumor margins might warrant complete tumor removal. Genomic instability and proliferative potential are common hallmarks of cancer cells. We have previously demonstrated the utility of intraoperative flow cytometry (iFC), a next-generation margin evaluation methodology for assessment of DNA content, in the detection of several types of malignancy. In the current study we investigated the possible value of iFC in the characterization of bladder cancer during surgery. Samples from a population of 52 people with urothelial cancer were included in the study. The total time for iFC evaluation is 3–5 min per sample and included a two-step analysis, including DNA-index and Tumor-index calculation. First, DNA-index calculation revealed 24 hyperploid and one hypoploid tumor. Second, cell cycle analysis and Tumor-index calculation revealed that tumor samples are distinguished from normal cells based on their significantly higher proliferative potential. The standard for iFC evaluation was pathology assessment and revealed that our protocol exhibits an accuracy of 98% in defining the presence of cancer cells in a given sample. Our results support the further assessment of iFC value towards its use as a novel malignancy evaluation tool in transurethral resections.
Collapse
|
8
|
D’Amato Figueiredo MV, Alexiou GA, Vartholomatos G, Rehder R. Advances in Intraoperative Flow Cytometry. Int J Mol Sci 2022; 23:ijms232113430. [PMID: 36362215 PMCID: PMC9655491 DOI: 10.3390/ijms232113430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Flow cytometry is the gold-standard laser-based technique to measure and analyze fluorescence levels of immunostaining and DNA content in individual cells. It provides a valuable tool to assess cells in the G0/G1, S, and G2/M phases, and those with polyploidy, which holds prognostic significance. Frozen section analysis is the standard intraoperative assessment for tumor margin evaluation and tumor resection. Here, we present flow cytometry as a promising technique for intraoperative tumor analysis in different pathologies, including brain tumors, leptomeningeal dissemination, breast cancer, head and neck cancer, pancreatic tumor, and hepatic cancer. Flow cytometry is a valuable tool that can provide substantial information on tumor analysis and, consequently, maximize cancer treatment and expedite patients’ survival.
Collapse
Affiliation(s)
- Marcos V. D’Amato Figueiredo
- Department of Neurosurgery, Hospital Estadual Mario Covas, Santo Andre 09190-615, Brazil
- Department of Neurosurgery, Hospital do Coracao, Sao Paulo 04004-030, Brazil
| | - George A. Alexiou
- Department of Neurosurgery, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
- Neurosurgical Institute, University of Ioannina, 45500 Ioannina, Greece
- Correspondence: ; Tel.: +30-6948-525134
| | - George Vartholomatos
- Neurosurgical Institute, University of Ioannina, 45500 Ioannina, Greece
- Hematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Roberta Rehder
- Department of Neurosurgery, Hospital do Coracao, Sao Paulo 04004-030, Brazil
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Hospital Santa Marcelina, Sao Paulo 08270-070, Brazil
| |
Collapse
|
9
|
Anastasiadi Z, Mantziou S, Akrivis C, Paschopoulos M, Balasi E, Lianos GD, Alexiou GA, Mitsis M, Vartholomatos G, Markopoulos GS. Intraoperative Flow Cytometry for the Characterization of Gynecological Malignancies. BIOLOGY 2022; 11:biology11091339. [PMID: 36138818 PMCID: PMC9495699 DOI: 10.3390/biology11091339] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 12/23/2022]
Abstract
Simple Summary Aneuploidy and high proliferative potential are distinct features of neoplastic cells. Based on the established role of intraoperative flow cytometry in various types of cancer, the aim of the present study was to investigate its role in cancer cell identification during surgery for gynecological malignancies. The analysis time was 5–6 min per sample. A large percentage of tumors were characterized as aneuploid, while all tumor samples had a significantly high proliferation. Flow cytometry was performed in accordance with pathological evaluation, and the method had high sensitivity and specificity. Our results verify the value of intraoperative flow cytometry in gynecological malignancies, and warrant further investigation in multicenter studies. Abstract Cell-cycle analysis has shown the presence of aneuploidy to be associated with poor prognosis. We developed an innovative rapid cell-cycle analysis protocol (the Ioannina protocol) that permitted the intraoperative identification of neoplastic cells in a plethora of malignancies. Herein, we aimed to investigate the potential role of cell-cycle analysis in the intraoperative characterization of gynecological malignancies. Women who underwent surgery for gynecological malignancies in our institution over a three-year period were included in this study. Permanent section pathology evaluation was used as the gold standard for malignancy evaluation. Total accordance was observed between flow cytometry and pathology evaluation. In total, 21 aneuploid cancers were detected following DNA index calculation. Of these, 20 were hyperploid and 1 was hypoploid. In addition, tumor samples were characterized by a significantly lower percentage of cells in G0/G1, as well as an induced tumor index. The response time for flow cytometry to obtain results was 5–6 min per sample. It seems that flow cytometry analyses for intraoperative tumor evaluation can be safely expanded to gynecological malignancies. This is a novel practical approach that has been proven valuable in several tumor types to date, and also seems to be reliable for gynecological malignancies. Intraoperative flow cytometry is expected to be crucial in decisions of lymph node dissection in endometrial cancers, due to its rapid response regarding the tumor invasion of part or all of the myometrial thickness. In this way, the surgeon can quickly modify the plane of dissection. Our results warrant the further investigation of applying iFC in larger, multicenter studies.
Collapse
Affiliation(s)
- Zoi Anastasiadi
- Department of Obstetrics and Gynecology, ‘G. Chatzikosta’ General Hospital, 45001 Ioannina, Greece
| | - Stefania Mantziou
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Christos Akrivis
- Department of Obstetrics and Gynecology, ‘G. Chatzikosta’ General Hospital, 45001 Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Eufemia Balasi
- Pathology Department, ‘G. Chatzikosta’ General Hospital, 45001 Ioannina, Greece
| | - Georgios D. Lianos
- Department of Surgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - George A. Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
- Neurosurgical Institute, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - George Vartholomatos
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, 45500 Ioannina, Greece
- Neurosurgical Institute, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Correspondence: (G.V.); (G.S.M.)
| | - Georgios S. Markopoulos
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, 45500 Ioannina, Greece
- Neurosurgical Institute, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Correspondence: (G.V.); (G.S.M.)
| |
Collapse
|
10
|
Markopoulos GS, Goussia A, Bali CD, Messinis T, Alexiou GΑ, Vartholomatos G. Resection Margins Assessment by Intraoperative Flow Cytometry in Pancreatic Cancer. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11645-7. [PMID: 35303176 DOI: 10.1245/s10434-022-11645-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Georgios S Markopoulos
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
- Faculty of Medicine, Neurosurgical Institute, University of Ioannina, Ioannina, Greece
| | - Anna Goussia
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Christina D Bali
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Thomas Messinis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - George Α Alexiou
- Faculty of Medicine, Neurosurgical Institute, University of Ioannina, Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - George Vartholomatos
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece.
- Faculty of Medicine, Neurosurgical Institute, University of Ioannina, Ioannina, Greece.
| |
Collapse
|
11
|
Markopoulos GS, Harissis H, Andreou M, Alexiou GΑ, Vartholomatos G. Intraoperative flow cytometry for invasive breast cancer conserving surgery: A new alternative or adjunct to cavity shaving technique? Surg Oncol 2022; 42:101712. [DOI: 10.1016/j.suronc.2022.101712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
|
12
|
Vartholomatos G, Harissis H, Markopoulos GS, Alexiou GA. The Role of Intraoperative Flow Cytometry in Breast-Conserving Surgery. Ann Surg Oncol 2021; 28:785-786. [PMID: 34523004 DOI: 10.1245/s10434-021-10794-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022]
Affiliation(s)
- George Vartholomatos
- University Hospital of Ioannina, Ioannina, Greece.,University of Ioannina School of Medicine, Ioannina, Greece
| | - Haralambos Harissis
- University of Ioannina School of Medicine, Ioannina, Greece.,Breast Unit, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios S Markopoulos
- University Hospital of Ioannina, Ioannina, Greece.,University of Ioannina School of Medicine, Ioannina, Greece
| | - George A Alexiou
- University of Ioannina School of Medicine, Ioannina, Greece. .,Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece.
| |
Collapse
|
13
|
Bitonto V, Ruggiero MR, Pittaro A, Castellano I, Bussone R, Broche LM, Lurie DJ, Aime S, Baroni S, Geninatti Crich S. Low-Field NMR Relaxometry for Intraoperative Tumour Margin Assessment in Breast-Conserving Surgery. Cancers (Basel) 2021; 13:cancers13164141. [PMID: 34439294 PMCID: PMC8392401 DOI: 10.3390/cancers13164141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Breast cancer is the most diagnosed cancer for women, and clear surgical margins in breast-conserving surgery (BCS) are essential for preventing recurrence. In this study, the potential of fast field-cycling 1H-NMR relaxometry as a new tool for intraoperative margin assessment was evaluated. The technique allows the determination of the tissue proton relaxation rates as a function of the applied magnetic field on small tissue samples excised from surgical specimens, at the margins of tumour resection, prior to histopathological analysis. It was found that a good accuracy in margin assessment, i.e., a sensitivity of 92% and a specificity of 85%, can be achieved. The discriminating ability shown by the relaxometric assay relies mainly on the difference of fat/water content between healthy and tumour cells. The information obtained has the potential to support the surgeon in real-time margin assessment during BCS. Abstract As conserving surgery is routinely applied for the treatment of early-stage breast cancer, the need for new technology to improve intraoperative margin assessment has become increasingly important. In this study, the potential of fast field-cycling 1H-NMR relaxometry as a new diagnostic tool was evaluated. The technique allows the determination of the tissue proton relaxation rates (R1), as a function of the applied magnetic field, which are affected by the changes in the composition of the mammary gland tissue occurring during the development of neoplasia. The study involved 104 small tissue samples obtained from surgical specimens destined for histopathology. It was found that a good accuracy in margin assessment, i.e., a sensitivity of 92% and a specificity of 85%, can be achieved by using two quantifiers, namely (i) the slope of the line joining the R1 values measured at 0.02 and 1 MHz and (ii) the sum of the R1 values measured at 0.39 and 1 MHz. The method is fast, and it does not rely on the expertise of a pathologist or cytologist. The obtained results suggest that a simplified, low-cost, automated instrument might compete well with the currently available tools in margin assessment.
Collapse
Affiliation(s)
- Valeria Bitonto
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
| | - Maria Rosaria Ruggiero
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
| | - Alessandra Pittaro
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.P.); (I.C.)
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.P.); (I.C.)
| | | | - Lionel M. Broche
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (L.M.B.); (D.J.L.)
| | - David J. Lurie
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (L.M.B.); (D.J.L.)
| | - Silvio Aime
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
- IRCCS SDN, Via E. Gianturco 113, 80143 Napoli, Italy
| | - Simona Baroni
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
- Correspondence:
| | - Simonetta Geninatti Crich
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
| |
Collapse
|