1
|
Omran SA, Ghani BA. Effect of fenugreek oil on healing of experimentally induced buccal mucosal ulcer by immunohistochemical evaluation of Ki-67 expression. Cell Biochem Biophys 2024:10.1007/s12013-024-01347-0. [PMID: 38869686 DOI: 10.1007/s12013-024-01347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 06/14/2024]
Abstract
Wound healing involves multiple populations of cells, the extracellular matrix, and soluble mediators' actions like growth factors and cytokines. Wound care was the target of many research, utilizing new therapy techniques and the progression of acute and chronic wound treatments with techniques involving plants to improve healing and decrease the side effects of drugs. When fenugreek is applied to an ulcer, its anti-inflammatory components are released, reducing unnecessary inflammation and accelerating the healing process. Healing is controlled by growth factors that naturally activate and boost the proliferation of cells, such as Ki-67, which is associated with the growth fraction and represents the cell's ability to proliferate. The current study aims to assess the expression of Ki-67 in rat mucosal ulcers treated with fenugreek leave oil. Twenty-four male Wistar albino rats of 350-450 gm weight were used. The rats were grouped as follows; normal group (normal tissue without ulcer induction), control group (tissue with surgical ulcer induction on the right side), and study group (ulcer treated with fenugreek leave oil on the left side), and had been sacrificed at 3- and 7-day healing durations. Thereafter, the tissue specimens were used for immunohistochemical analysis of Ki-67. The obtained outcomes showed that expression of Ki-67 increased in groups where ulcers were induced, with significant differences between control and study groups on the 3rd day. It was concluded that the application of fenugreek oil had an accelerating effect on the healing process of mucosal ulcers, as indicated by the elevated expression level of Ki-67.
Collapse
Affiliation(s)
- Sarah A Omran
- Department of Oral Diagnostic Sciences, College of Dentistry, University of Baghdad, Baghdad, Iraq.
| | - Ban A Ghani
- Department of Oral Diagnostic Sciences, College of Dentistry, University of Baghdad, Baghdad, Iraq
| |
Collapse
|
2
|
Mustakim KR, Eo MY, Seo MH, Yang HC, Kim MK, Myoung H, Kim SM. Ultrastructural and immunohistochemical evaluation of hyperplastic soft tissues surrounding dental implants in fibular jaws. Sci Rep 2024; 14:10717. [PMID: 38730018 PMCID: PMC11087521 DOI: 10.1038/s41598-024-60474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
In reconstructive surgery, complications post-fibula free flap (FFF) reconstruction, notably peri-implant hyperplasia, are significant yet understudied. This study analyzed peri-implant hyperplastic tissue surrounding FFF, alongside peri-implantitis and foreign body granulation (FBG) tissues from patients treated at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Using light microscopy, pseudoepitheliomatous hyperplasia, anucleate and pyknotic prickle cells, and excessive collagen deposition were observed in FFF hyperplastic tissue. Ultrastructural analyses revealed abnormal structures, including hemidesmosome dilation, bacterial invasion, and endoplasmic reticulum (ER) swelling. In immunohistochemical analysis, unfolded protein-response markers ATF6, PERK, XBP1, inflammatory marker NFκB, necroptosis marker MLKL, apoptosis marker GADD153, autophagy marker LC3, epithelial-mesenchymal transition, and angiogenesis markers were expressed variably in hyperplastic tissue surrounding FFF implants, peri-implantitis, and FBG tissues. NFκB expression was higher in peri-implantitis and FBG tissues compared to hyperplastic tissue surrounding FFF implants. PERK expression exceeded XBP1 significantly in FFF hyperplastic tissue, while expression levels of PERK, XBP1, and ATF6 were not significantly different in peri-implantitis and FBG tissues. These findings provide valuable insights into the interconnected roles of ER stress, necroptosis, apoptosis, and angiogenesis in the pathogenesis of oral pathologies, offering a foundation for innovative strategies in dental implant rehabilitation management and prevention.
Collapse
Affiliation(s)
- Kezia Rachellea Mustakim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Mi Hyun Seo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyeong-Cheol Yang
- Department of Dental Biomaterials Science, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Keun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Oral and Maxillofacial Microvascular Reconstruction LAB, Brong Ahafo Regional Hospital, P.O.Box 27, Sunyani, Ghana.
| |
Collapse
|
3
|
Liu L, Zhao M, Lang X, Jia S, Kang X, Liu Y, Liu J. Modified Lichong decoction intervenes in colorectal cancer by modulating the intestinal flora and the Wnt/β-catenin signaling pathway. J Cancer Res Clin Oncol 2024; 150:234. [PMID: 38710918 PMCID: PMC11074041 DOI: 10.1007/s00432-024-05763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The pathogenesis and treatment of colorectal cancer (CRC) continue to be areas of ongoing research, especially the benefits of traditional Chinese medicine (TCM) in slowing the progression of CRC. This study was conducted to investigate the effectiveness and mechanism of action of modified Lichong decoction (MLCD) in inhibiting CRC progression. METHODS We established CRC animal models using azoxymethane/dextran sodium sulfate (AOM/DSS) and administered high, medium, or low doses of MLCD or mesalazine (MS) for 9 weeks to observe MLCD alleviation of CRC. The optimal MLCD dose group was then subjected to metagenomic and RNA sequencing (RNA-seq) to explore the differentially abundant flora and genes in the control, model and MLCD groups. Finally, the mechanism of action was verified using WB, qRT‒PCR, immunohistochemistry and TUNEL staining. RESULTS MLCD inhibited the progression of CRC, and the optimal effect was observed at high doses. MLCD regulated the structure and function of the intestinal flora by decreasing the abundance of harmful bacteria and increasing that of beneficial bacteria. The differentially expressed genes were mainly associated with the Wnt/β-catenin pathway and the cell cycle. Molecular biology analysis indicated that MLCD suppressed the Wnt/β-catenin pathway and the epithelial-mesenchymal transition (EMT), inhibited abnormal cell proliferation and promoted intestinal epithelial cell apoptosis. CONCLUSION MLCD mitigated the abnormal growth of intestinal epithelial cells and promoted apoptosis, thereby inhibiting the progression of CRC. This inhibition was accomplished by modifying the intestinal microbiota and disrupting the Wnt/β-catenin pathway and the EMT. Therefore, MLCD could serve as a potential component of TCM prescriptions for CRC treatment.
Collapse
Affiliation(s)
- Longhui Liu
- Graduate School of Hebei University of Chinese Medicine, Shijiazhuang, 050091, Hebei, China
| | - Mengmeng Zhao
- Graduate School of Hebei University of Chinese Medicine, Shijiazhuang, 050091, Hebei, China
| | - Xiaomeng Lang
- Department of Spleen and Stomach Diseases, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050013, Hebei, China
| | - Sujie Jia
- Graduate School of Hebei University of Chinese Medicine, Shijiazhuang, 050091, Hebei, China
| | - Xin Kang
- Department of Spleen and Stomach Diseases, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050013, Hebei, China
| | - Yue Liu
- Graduate School of Hebei University of Chinese Medicine, Shijiazhuang, 050091, Hebei, China
| | - Jianping Liu
- Department of Spleen and Stomach Diseases, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050013, Hebei, China.
| |
Collapse
|
4
|
Chandy M, Hill T, Jimenez-Tellez N, Wu JC, Sarles SE, Hensel E, Wang Q, Rahman I, Conklin DJ. Addressing Cardiovascular Toxicity Risk of Electronic Nicotine Delivery Systems in the Twenty-First Century: "What Are the Tools Needed for the Job?" and "Do We Have Them?". Cardiovasc Toxicol 2024; 24:435-471. [PMID: 38555547 DOI: 10.1007/s12012-024-09850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
Cigarette smoking is positively and robustly associated with cardiovascular disease (CVD), including hypertension, atherosclerosis, cardiac arrhythmias, stroke, thromboembolism, myocardial infarctions, and heart failure. However, after more than a decade of ENDS presence in the U.S. marketplace, uncertainty persists regarding the long-term health consequences of ENDS use for CVD. New approach methods (NAMs) in the field of toxicology are being developed to enhance rapid prediction of human health hazards. Recent technical advances can now consider impact of biological factors such as sex and race/ethnicity, permitting application of NAMs findings to health equity and environmental justice issues. This has been the case for hazard assessments of drugs and environmental chemicals in areas such as cardiovascular, respiratory, and developmental toxicity. Despite these advances, a shortage of widely accepted methodologies to predict the impact of ENDS use on human health slows the application of regulatory oversight and the protection of public health. Minimizing the time between the emergence of risk (e.g., ENDS use) and the administration of well-founded regulatory policy requires thoughtful consideration of the currently available sources of data, their applicability to the prediction of health outcomes, and whether these available data streams are enough to support an actionable decision. This challenge forms the basis of this white paper on how best to reveal potential toxicities of ENDS use in the human cardiovascular system-a primary target of conventional tobacco smoking. We identify current approaches used to evaluate the impacts of tobacco on cardiovascular health, in particular emerging techniques that replace, reduce, and refine slower and more costly animal models with NAMs platforms that can be applied to tobacco regulatory science. The limitations of these emerging platforms are addressed, and systems biology approaches to close the knowledge gap between traditional models and NAMs are proposed. It is hoped that these suggestions and their adoption within the greater scientific community will result in fresh data streams that will support and enhance the scientific evaluation and subsequent decision-making of tobacco regulatory agencies worldwide.
Collapse
Affiliation(s)
- Mark Chandy
- Robarts Research Institute, Western University, London, N6A 5K8, Canada
| | - Thomas Hill
- Division of Nonclinical Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Nerea Jimenez-Tellez
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - S Emma Sarles
- Biomedical and Chemical Engineering PhD Program, Rochester Institute of Technology, Rochester, NY, 14623, USA
| | - Edward Hensel
- Department of Mechanical Engineering, Rochester Institute of Technology, Rochester, NY, 14623, USA
| | - Qixin Wang
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Daniel J Conklin
- Division of Environmental Medicine, Department of Medicine, Center for Cardiometabolic Science, Christina Lee Brown Envirome Institute, University of Louisville, 580 S. Preston St., Delia Baxter, Rm. 404E, Louisville, KY, 40202, USA.
| |
Collapse
|
5
|
Katayama A, Aoki Y, Watanabe Y, Horiguchi J, Rakha EA, Oyama T. Current status and prospects of artificial intelligence in breast cancer pathology: convolutional neural networks to prospective Vision Transformers. Int J Clin Oncol 2024:10.1007/s10147-024-02513-3. [PMID: 38619651 DOI: 10.1007/s10147-024-02513-3] [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: 01/16/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024]
Abstract
Breast cancer is the most prevalent cancer among women, and its diagnosis requires the accurate identification and classification of histological features for effective patient management. Artificial intelligence, particularly through deep learning, represents the next frontier in cancer diagnosis and management. Notably, the use of convolutional neural networks and emerging Vision Transformers (ViT) has been reported to automate pathologists' tasks, including tumor detection and classification, in addition to improving the efficiency of pathology services. Deep learning applications have also been extended to the prediction of protein expression, molecular subtype, mutation status, therapeutic efficacy, and outcome prediction directly from hematoxylin and eosin-stained slides, bypassing the need for immunohistochemistry or genetic testing. This review explores the current status and prospects of deep learning in breast cancer diagnosis with a focus on whole-slide image analysis. Artificial intelligence applications are increasingly applied to many tasks in breast pathology ranging from disease diagnosis to outcome prediction, thus serving as valuable tools for assisting pathologists and supporting breast cancer management.
Collapse
Affiliation(s)
- Ayaka Katayama
- Diagnostic Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan.
| | - Yuki Aoki
- Center for Mathematics and Data Science, Gunma University, Maebashi, Japan
| | - Yukako Watanabe
- Clinical Training Center, Gunma University Hospital, Maebashi, Japan
| | - Jun Horiguchi
- Department of Breast Surgery, International University of Health and Welfare, Narita, Japan
| | - Emad A Rakha
- Department of Histopathology School of Medicine, University of Nottingham, University Park, Nottingham, UK
- Department of Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Tetsunari Oyama
- Diagnostic Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
| |
Collapse
|
6
|
Đokić S, Gazić B, Grčar Kuzmanov B, Blazina J, Miceska S, Čugura T, Grašič Kuhar C, Jeruc J. Clinical and Analytical Validation of Two Methods for Ki-67 Scoring in Formalin Fixed and Paraffin Embedded Tissue Sections of Early Breast Cancer. Cancers (Basel) 2024; 16:1405. [PMID: 38611083 PMCID: PMC11011015 DOI: 10.3390/cancers16071405] [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: 03/05/2024] [Revised: 03/29/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
Proliferation determined by Ki-67 immunohistochemistry has been proposed as a useful prognostic and predictive marker in breast cancer. However, the clinical validity of Ki-67 is questionable. In this study, Ki-67 was retrospectively evaluated by three pathologists using two methods: a visual assessment of the entire slide and a quantitative assessment of the tumour margin in 411 early-stage breast cancer patients with a median follow-up of 26.8 years. We found excellent agreement between the three pathologists for both methods. The risk of recurrence for Ki-67 was time-dependent, as the high proliferation group (Ki-67 ≥ 30%) had a higher risk of recurrence initially, but after 4.5 years the risk was higher in the low proliferation group. In estrogen receptor (ER)-positive patients, the intermediate Ki-67 group initially followed the high Ki-67 group, but eventually followed the low Ki-67 group. ER-positive pN0-1 patients with intermediate Ki-67 treated with endocrine therapy alone had a similar outcome to patients treated with chemotherapy. A cut-off value of 20% appeared to be most appropriate for distinguishing between the high and low Ki-67 groups. To summarize, a simple visual whole slide Ki-67 assessment turned out to be a reliable method for clinical decision-making in early breast cancer patients. We confirmed Ki-67 as an important prognostic and predictive biomarker.
Collapse
Affiliation(s)
- Snežana Đokić
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Barbara Gazić
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
| | - Biljana Grčar Kuzmanov
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
| | - Jerca Blazina
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
| | - Simona Miceska
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Cytopathology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Tanja Čugura
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Cvetka Grašič Kuhar
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Jera Jeruc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| |
Collapse
|
7
|
Park S, Lee Y, Lee J, Min YW, Kim HK, Choi JY, Jung HA, Choi YS, Choi YL, Shim YM, Sun JM. Neoadjuvant Nivolumab Therapy for Esophageal Squamous Cell Carcinoma: A Single-Arm, Phase II Study. Cancer Res Treat 2024; 56:567-579. [PMID: 37846467 PMCID: PMC11016664 DOI: 10.4143/crt.2023.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023] Open
Abstract
PURPOSE Programmed death-1/programmed death-ligand 1 (PD-L1) inhibitors have shown efficacy in metastatic esophageal squamous cell carcinoma (ESCC) therapy. However, data is still limited regarding neoadjuvant immunotherapy for operable ESCC. MATERIALS AND METHODS Patients with clinical stage T2 or T3 and N0 ESCC received three cycles of nivolumab therapy every two weeks before surgical resection. The primary endpoint is major pathologic responses (MPR) rate (≤ 10% of residual viable tumor [RVT]). RESULTS Total 20 patients completed the planned nivolumab therapy. Among them, 17 patients underwent surgery as protocol, showing MPR in two patients (MPR rate, 11.8%), including one pathologic complete response, on conventional pathologic response evaluation. Pathologic response was re-evaluated using the immune-related pathologic response criteria based on immune-related RVT (irRVT). Three patients were classified as immunologic major pathologic response (iMPR; ≤ 10% irRVT, iMPR rate: 17.6%), five as pathologic partial response (> 10% and < 90% irRVT), and nine as pathologic nonresponse (≥ 90% irRVT). The combined positive score (CPS) for PD-L1 in the baseline samples was predictable for iMPR, with the probability as 37.5% in CPS ≥ 10 (3/8) and 0% in CPS < 10 (0/9). CONCLUSION Although the efficacy of neoadjuvant nivolumab therapy was modest in unselected ESCC patients, further researches on neoadjuvant immunotherapy are necessary in patients with PD-L1 expressed ESCC.
Collapse
Affiliation(s)
- Sehhoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yurimi Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Brogård MB, Nielsen PS, Christensen KB, Georgsen JB, Wandler A, Lade-Keller J, Steiniche T. Immunohistochemical double nuclear staining for cell-specific automated quantification of the proliferation index - A promising diagnostic aid for melanocytic lesions. Pathol Res Pract 2024; 255:155177. [PMID: 38330618 DOI: 10.1016/j.prp.2024.155177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
AIMS Pathologists often use immunohistochemical staining of the proliferation marker Ki67 in their diagnostic assessment of melanocytic lesions. However, the interpretation of Ki67 can be challenging. We propose a new workflow to improve the diagnostic utility of the Ki67-index. In this workflow, Ki67 is combined with the melanocytic tumour-cell marker SOX10 in a Ki67/SOX10 double nuclear stain. The Ki67-index is then quantified automatically using digital image analysis (DIA). The aim of this study was to optimise and test three different multiplexing methods for Ki67/SOX10 double nuclear staining. METHODS Multiplex immunofluorescence (mIF), multiplex immunohistochemistry (mIHC), and multiplexed immunohistochemical consecutive staining on single slide (MICSSS) were optimised for Ki67/SOX10 double nuclear staining. DIA applications were designed for automated quantification of the Ki67-index. The methods were tested on a pilot case-control cohort of benign and malignant melanocytic lesions (n = 23). RESULTS Using the Ki67/SOX10 double nuclear stain, malignant melanocytic lesions could be completely distinguished from benign lesions by the Ki67-index. The Ki67-index cut-offs were 1.8% (mIF) and 1.5% (mIHC and MICSSS). The AUC of the automatically quantified Ki67-index based on double nuclear staining was 1.0 (95% CI: 1.0;1.0), whereas the AUC of conventional Ki67 single-stains was 0.87 (95% CI: 0.71;1.00). CONCLUSIONS The novel Ki67/SOX10 double nuclear stain highly improved the diagnostic precision of Ki67 interpretation. Both mIHC and mIF were useful methods for Ki67/SOX10 double nuclear staining, whereas the MICSSS method had challenges in the current setting. The Ki67/SOX10 double nuclear stain shows potential as a valuable diagnostic aid for melanocytic lesions.
Collapse
Affiliation(s)
- Mette Bak Brogård
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Patricia Switten Nielsen
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kristina Bang Christensen
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark
| | - Jeanette Bæhr Georgsen
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Anne Wandler
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark
| | - Johanne Lade-Keller
- Department of Pathology, Aalborg University Hospital, Ladegårdsgade 3, 9000 Aalborg, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| |
Collapse
|
9
|
Zappe K, Pühringer K, Pflug S, Berger D, Weis S, Spiegl-Kreinecker S, Cichna-Markl M. Association of MGMT Promoter and Enhancer Methylation with Genetic Variants, Clinical Parameters, and Demographic Characteristics in Glioblastoma. Cancers (Basel) 2023; 15:5777. [PMID: 38136323 PMCID: PMC10742072 DOI: 10.3390/cancers15245777] [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: 11/03/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The response of glioblastoma (GBM) patients to the alkylating agent temozolomide (TMZ) vitally depends on the expression level of the repair protein O6-methylguanine-DNA methyltransferase (MGMT). Since MGMT is strongly regulated by promoter methylation, the methylation status of the MGMT promoter has emerged as a prognostic and predictive biomarker for GBM patients. By determining the methylation levels of the four enhancers located within or close to the MGMT gene, we recently found that enhancer methylation contributes to MGMT regulation. In this study, we investigated if methylation of the four enhancers is associated with SNP rs16906252, TERT promoter mutations C228T and C250T, TERT SNP rs2853669, proliferation index Ki-67, overall survival (OS), age, and sex of the patients. In general, associations with genetic variants, clinical parameters, and demographic characteristics were caused by a complex interplay of multiple CpGs in the MGMT promoter and of multiple CpGs in enhancer regions. The observed associations for intragenic enhancer 4, located in intron 2 of MGMT, differed from associations observed for the three intergenic enhancers. Some findings were restricted to subgroups of samples with either methylated or unmethylated MGMT promoters, underpinning the relevance of the MGMT promoter status in GBMs.
Collapse
Affiliation(s)
- Katja Zappe
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (K.Z.); (K.P.); (S.P.); (D.B.)
| | - Katharina Pühringer
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (K.Z.); (K.P.); (S.P.); (D.B.)
| | - Simon Pflug
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (K.Z.); (K.P.); (S.P.); (D.B.)
| | - Daniel Berger
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (K.Z.); (K.P.); (S.P.); (D.B.)
| | - Serge Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Kepler University Hospital GmbH, Johannes Kepler University, 4040 Linz, Austria;
| | - Sabine Spiegl-Kreinecker
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University, 4040 Linz, Austria;
| | - Margit Cichna-Markl
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (K.Z.); (K.P.); (S.P.); (D.B.)
| |
Collapse
|
10
|
Chidananda Murthy G. Ki-67 Index and Its Correlation with Clinical and Pathological Variables in Breast Cancer. Indian J Surg Oncol 2023; 14:943-948. [PMID: 38187860 PMCID: PMC10766571 DOI: 10.1007/s13193-023-01833-6] [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: 12/25/2022] [Accepted: 10/03/2023] [Indexed: 01/09/2024] Open
Abstract
The role of the Ki-67 index as a prognostic marker in breast cancer is controversial. This study was undertaken to assess the association of Ki-67 index with other clinicopathological factors in breast cancer. The prospectively conducted study included 127 female patients with clinical tumor stage 1-3 and nodal stage 0 or 1 treated between March 2015 and March 2017. Ki-67 index was correlated with age, tumor size, lymph node status, histological grade, ER, PR, HER2, and molecular subtypes using Chi-square or Fisher's exact test. Mean age of the patients was 53.28 years (range, 25-86 years). Mean Ki-67 index was 33.59 (range, 2.5-95). Ki-67 index showed a positive correlation with pathological stage (p=0.025), grade (p=0.0001), and molecular subtype (p=0.0001) of the tumor. It was inversely associated with ER (p=0.0001) and PR status (p=0.0001). Its association with pathological nodal status (p=0.06) and size (p=0.08) of the tumor was not statistically significant. There was no correlation with age (p=0.892) and HER2 status (p=0.287). Association of the Ki-67 index with common prognostic factors such as grade, stage, ER, PR, and molecular subtype suggests its role as a prognostic factor in breast cancer.
Collapse
Affiliation(s)
- Giridhar Chidananda Murthy
- Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Nallurahalli, Whitefield, Bangalore, 560066 India
| |
Collapse
|
11
|
Behrman DB, Lubin DJ, Magliocca K, Shi Q, Viswanathan K. Exploration of Digital Image Analysis for Ki67 Quantification in the Grading of Medullary Thyroid Carcinoma: A Pilot Study with 85 Cases. Head Neck Pathol 2023; 17:638-646. [PMID: 37294412 PMCID: PMC10514252 DOI: 10.1007/s12105-023-01564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although uncommon, medullary thyroid carcinoma (MTC) accounts for a significant proportion of thyroid cancer deaths. Recent studies have validated the two-tier International Medullary Thyroid Carcinoma Grading System (IMTCGS) to predict clinical outcomes. A 5% Ki67 proliferative index (Ki67PI) cut-off separates low-grade from high-grade MTC. In this study, we compared digital image analysis (DIA) to manual counting (MC) for determining the Ki67PI in a MTC cohort, and explored the challenges encountered. METHODS Available slides from 85 MTCs were reviewed by two pathologists. The Ki67PI was documented by immunohistochemistry for each case, scanned with the Aperio® slide scanner at 40× magnification, and quantified using the QuPath® DIA platform. The same hotspots were screenshot, printed in color, and blindly counted. For each case, over 500 MTC cells were counted. Each MTC was graded using IMTCGS criteria. RESULTS In our MTC cohort (n = 85), 84.7 and 15.3% were low- and high-grade with the IMTCGS. In the entire cohort, QuPath® DIA performed well (R2 = 0.9891) but appeared to undercall compared to MC. QuPath® performed better in high-grade cases (R2 = 0.99) compared to low-grade cases (R2 = 0.7071). Overall, Ki67PI determined with either MC or DIA did not affect IMTCGS grade. Encountered DIA challenges include optimizing cell detection, overlapping nuclei, and tissue artifacts. Encountered MC challenges include background staining, morphologic overlap with normal elements, and counting time. CONCLUSION Our study highlights the utility of DIA in quantifying Ki67PI for MTC and can serve as an adjunct for grading in conjunction with the other criteria of mitotic activity and necrosis.
Collapse
Affiliation(s)
| | - Daniel J. Lubin
- Department of Pathology, Emory University Hospital Midtown, Atlanta, GA USA
- Winship Cancer Center, Decatur, GA USA
| | - Kelly Magliocca
- Department of Pathology, Emory University Hospital Midtown, Atlanta, GA USA
- Winship Cancer Center, Decatur, GA USA
| | - Qiuying Shi
- Department of Pathology, Emory University Hospital Midtown, Atlanta, GA USA
- Winship Cancer Center, Decatur, GA USA
| | - Kartik Viswanathan
- Department of Pathology, Emory University Hospital Midtown, Atlanta, GA USA
- Winship Cancer Center, Decatur, GA USA
- Division of Head and Neck Pathology and Cytopathology, Department of Pathology and Laboratory Medicine, Emory University Hospital Midtown, 550 Peachtree St, Atlanta, GA 30309 USA
| |
Collapse
|
12
|
Nielsen S, Bzorek M, Vyberg M, Røge R. Lessons Learned, Challenges Taken, and Actions Made for "Precision" Immunohistochemistry. Analysis and Perspectives From the NordiQC Proficiency Testing Program. Appl Immunohistochem Mol Morphol 2023; 31:452-458. [PMID: 36194495 PMCID: PMC10396077 DOI: 10.1097/pai.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022]
Abstract
Immunohistochemistry (IHC) has for decades been an integrated method within pathology applied to gain diagnostic, prognostic, and predictive information. However, the multimodality of the analytical phase of IHC is a challenge to ensure the reproducibility of IHC, which has been documented by external quality assessment (EQA) programs for many biomarkers. More than 600 laboratories participate in the Nordic immunohistochemical Quality Control EQA program for IHC. In the period, 2017-2021, 65 different biomarkers were assessed and a total of 31,967 results were evaluated. An overall pass rate of 79% was obtained being an improvement compared with 71% for the period, 2003-2015. The pass rates for established predictive biomarkers (estrogen receptor, progesterone receptor, and HER2) for breast carcinoma were most successful showing mean pass rates of 89% to 92%. Diagnostic IHC biomarkers as PAX8, SOX10, and different cytokeratins showed a wide spectrum of pass rates ranging from 37% to 95%, mean level of 75%, and attributed to central parameters as access to sensitive and specific antibodies but also related to purpose of the IHC test and validation performed accordingly to this. Seven new diagnostic biomarkers were introduced, and all showed inferior pass rates compared with the average level for diagnostic biomarkers emphasizing the challenge to optimize, validate, and implement new IHC biomarkers. Nordic immunohistochemical Quality Control operates by "Fit-For-Purpose" EQA principles and for programmed death-ligand 1, 2 segments are offered aligned to the "3-dimensional" approach-bridging diagnostic tests, drugs to be offered, and diseases addressed. Mean pass rates of 65% and 79% was obtained in the 2 segments for programmed death-ligand 1.
Collapse
Affiliation(s)
- Søren Nielsen
- NordiQC, Department of Pathology, Aalborg University Hospital, Aalborg
| | - Michael Bzorek
- Department of Surgical Pathology, Zealand University Hospital, Roskilde
| | - Mogens Vyberg
- Center for RNA Medicine, Aalborg University, Copenhagen, Denmark
| | - Rasmus Røge
- NordiQC, Department of Pathology, Aalborg University Hospital, Aalborg
| |
Collapse
|
13
|
Moutafi M, Koliou GA, Papaxoinis G, Economopoulou P, Kotsantis I, Gkotzamanidou M, Anastasiou M, Pectasides D, Kyrodimos E, Delides A, Giotakis E, Papadimitriou NG, Panayiotides IG, Perisanidis C, Fernandez AI, Xirou V, Poulios C, Gagari E, Yaghoobi V, Gavrielatou N, Shafi S, Aung TN, Kougioumtzopoulou A, Kouloulias V, Palialexis K, Gkolfinopoulos S, Strati A, Lianidou E, Fountzilas G, Rimm DL, Foukas PG, Psyrri A. Phase II Window Study of Olaparib Alone or with Cisplatin or Durvalumab in Operable Head and Neck Cancer. CANCER RESEARCH COMMUNICATIONS 2023; 3:1514-1523. [PMID: 37575280 PMCID: PMC10414130 DOI: 10.1158/2767-9764.crc-23-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023]
Abstract
Purpose We conducted a phase II randomized noncomparative window of opportunity (WOO) trial to evaluate the inhibition of cellular proliferation and the modulation of immune microenvironment after treatment with olaparib alone or in combination with cisplatin or durvalumab in patients with operable head and neck squamous cell carcinoma (HNSCC). Experimental Design Forty-one patients with HNSCC were randomized to cisplatin plus olaparib (arm A), olaparib alone (arm B), no treatment (arm C) or durvalumab plus olaparib (arm D). The primary endpoint was to evaluate the percentage of patients in each arm that achieved a reduction of at least 25% in Ki67. Secondary endpoints included objective response rate (ORR), safety, and pathologic complete response (pCR) rate. Paired baseline and resection tumor biopsies and blood samples were evaluated for prespecified biomarkers. Results A decrease in Ki67 of at least 25% was observed in 44.8% of treated patients, as measured by quantitative immunofluorescence. The ORR among treated patients was 12.1%. pCR was observed in 2 patients. Two serious adverse events occurred in 2 patients.Programmed death ligand 1 (PD-L1) levels [combined positive score (CPS)] were significantly higher after treatment in arms A and D. Expression of CD163 and colony-stimulating factor 1 receptor (CSF1R) genes, markers of M2 macrophages, increased significantly posttreatment whereas the expression of CD80, a marker of M1 macrophages, decreased. Conclusion Preoperative olaparib with cisplatin or alone or with durvalumab was safe in the preoperative setting and led to decrease in Ki67 of at least 25% in 44.8% of treated patients. Olaparib-based treatment modulates the tumor microenvironment leading to upregulation of PD-L1 and induction of protumor features of macrophages. Significance HNSCC is characterized by defective DNA repair pathways and immunosuppressive tumor microenvironment. PARP inhibitors, which promote DNA damage and "reset" the inflammatory tumor microenvironment, can establish an effective antitumor response. This phase II WOO trial in HNSCC demonstrated the immunomodulatory effects of PARP inhibitor-induced DNA damage. In this chemo-naïve population, PARP inhibitor-based treatment, reduced tumor cell proliferation and modulated tumor microenvironment. After olaparib upregulation of PD-L1 and macrophages, suggests that combinatorial treatment might be beneficial. Synopsis Our WOO study demonstrates that preoperative olaparib results in a reduction in Ki67, upregulation of PD-L1 CPS, and induction of protumor features of macrophages in HNSCC.
Collapse
Affiliation(s)
- Myrto Moutafi
- Second Department of Internal Medicine, Medical Oncology Section, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | | | - George Papaxoinis
- Second Department of Internal Medicine, Agios Savvas Cancer Hospital, Athens, Greece
| | - Panagiota Economopoulou
- Second Department of Internal Medicine, Medical Oncology Section, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ioannis Kotsantis
- Second Department of Internal Medicine, Medical Oncology Section, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Maria Gkotzamanidou
- Second Department of Internal Medicine, Medical Oncology Section, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Maria Anastasiou
- Second Department of Internal Medicine, Medical Oncology Section, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios Pectasides
- Second Department of Internal Medicine, Medical Oncology Section, Hippokration General Hospital, Athens, Greece
| | - Efthymios Kyrodimos
- Department of Otolaryngology-Head and Neck Surgery, Hippokration General Hospital, University of Athens, Athens, Greece
| | - Alexander Delides
- Second Otolaryngology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Evangelos Giotakis
- Department of Otolaryngology-Head and Neck Surgery, Hippokration General Hospital, University of Athens, Athens, Greece
| | - Nikolaos G. Papadimitriou
- Second Otolaryngology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ioannis G. Panayiotides
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Christos Perisanidis
- Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Aileen I. Fernandez
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Vasiliki Xirou
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Christos Poulios
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Eleni Gagari
- Oral Medicine Clinics, A. Syggros Hospital of Dermatologic and Venereal Diseases, Department of Dermatology, School of Medicine, University of Athens, Athens, Greece
| | - Vesal Yaghoobi
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Niki Gavrielatou
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Saba Shafi
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Thazin Nwe Aung
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Andromachi Kougioumtzopoulou
- Second Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Vassilis Kouloulias
- Second Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Palialexis
- Second Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | - Areti Strati
- Analysis of Circulating Tumor Cells Lab, Lab of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Evi Lianidou
- Analysis of Circulating Tumor Cells Lab, Lab of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Greece
| | - George Fountzilas
- German Oncology Center, Limassol, Cyprus
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - David L. Rimm
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Periklis G. Foukas
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Amanda Psyrri
- Second Department of Internal Medicine, Medical Oncology Section, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| |
Collapse
|
14
|
Gown AM. The Biomarker Ki-67: Promise, Potential, and Problems in Breast Cancer. Appl Immunohistochem Mol Morphol 2023; 31:478-484. [PMID: 36730064 DOI: 10.1097/pai.0000000000001087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 02/03/2023]
Abstract
Ki-67 is a nuclear protein serendipitously discovered by monoclonal antibody selection in the early 1980s. While it has been applied for decades in the context of breast cancer as a putative prognostic and, more recently, predictive, biomarker, even after all this time there is incomplete agreement as to the validity of the immunohistochemical assays employed for Ki-67 assessment, given possible effects of the disparate methodologies employed and possible confounding preanalytical, analytical, and interpretive variables. In this brief review, the history of Ki-67 and the problems, particularly with the analytical and interpretive variables, are highlighted through a selective review of the published literature. The contributions of the International Ki-67 Breast Cancer Working Group are highlighted, and in particular, the recommendations made by this group are reviewed. The potential of Ki-67 as a biomarker for breast cancer has not yet been fully realized, but an understanding of the power as well as the limitations of the methods of Ki-67 assessment are important if this biomarker can realize its potential.
Collapse
Affiliation(s)
- Allen M Gown
- Department of Pathology, University of British Columbia, Vancouver, BC
| |
Collapse
|
15
|
Li W, Lu N, Chen C, Lu X. Identifying the optimal cutoff point of Ki-67 in breast cancer: a single-center experience. J Int Med Res 2023; 51:3000605231195468. [PMID: 37652458 PMCID: PMC10478558 DOI: 10.1177/03000605231195468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE Ki-67 is associated with breast cancer subtypes, but the optimal cutoff point of Ki-67 has not been established in our center. We evaluated the cutoff point of Ki-67 in breast cancer and analyzed the associations among Ki-67, clinicopathological features, and prognosis. METHODS The clinicopathological data and prognostic information of patients with breast cancer treated in our center were retrospectively collected, and the optimal cutoff point of Ki-67 was determined by univariate and multivariate survival risk analyses. The cutoff point was used to group the patients, and the differences in the clinicopathological features and prognosis were analyzed between the two groups. RESULTS In total, 609 patients with estrogen receptor-positive and human epidermal growth factor receptor 2-negative primary breast cancer were enrolled. The mean Ki-67 value was 22.3% ± 15.4%, the median was 20%, and a cutoff point of 30% was an independent factor influencing recurrence-free survival. When 30% was used as the cutoff point, patients with a Ki-67 value of ≤30% had a better prognosis and lower tumor malignancy. CONCLUSION The optimal cutoff point of Ki-67 in breast cancer in our center is 30%.
Collapse
Affiliation(s)
- Wang Li
- School of Graduate, Bengbu Medical College, Bengbu, China
- Department of Breast Surgery, Affiliated Hospital of Jiaxing University (the First Hospital of Jiaxing), Jiaxing, China
| | - Ning Lu
- Department of Pathology, Affiliated Hospital of Jiaxing University (the First Hospital of Jiaxing), Jiaxing, China
| | - Caiping Chen
- Department of Breast Surgery, Affiliated Hospital of Jiaxing University (the First Hospital of Jiaxing), Jiaxing, China
| | - Xiang Lu
- School of Graduate, Bengbu Medical College, Bengbu, China
| |
Collapse
|
16
|
Tini P, Yavoroska M, Mazzei MA, Miracco C, Pirtoli L, Tomaciello M, Marampon F, Minniti G. Low expression of Ki-67/MIB-1 labeling index in IDH wild type glioblastoma predicts prolonged survival independently by MGMT methylation status. J Neurooncol 2023:10.1007/s11060-023-04342-2. [PMID: 37227648 PMCID: PMC10322955 DOI: 10.1007/s11060-023-04342-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE The Ki-67/MIB-1 labeling index (LI) is clinically used to differentiate between high and low-grade gliomas, while its prognostic value remains questionable. Glioblastoma (GBM) expressing wild-type isocitrate dehydrogenase IDHwt, a relatively common malignant brain tumor in adults, is characterized by a dismal prognosis. Herein, we have retrospectively investigated the prognostic role of Ki-67/MIB-1-LI in a large group of IDHwt GBM. METHODS One hundred nineteen IDHwt GBM patients treated with surgery followed by Stupp's protocol in our Institution between January 2016 and December 2021 were selected. A cut-off value for Ki-67/MIB-1-LI was used with minimal p-value based approach. RESULTS A multivariate analysis showed that Ki-67/MIB-1-LI expression < 15% significantly correlated with a longer overall survival (OS), independently from the age of the patients, Karnofsky performance status scale, extent of surgery and O6-methylguanine (O6-MeG)-DNA methyltransferase promoter methylation status. CONCLUSIONS Among other studies focused on Ki-67/MIB-1-LI, this is the first observational study showing a positive correlation between OS of IDHwt GBM patients and Ki-67/MIB-1-LI that we propose as a new predictive marker in this subtype of GBM.
Collapse
Affiliation(s)
- Paolo Tini
- Unit of Radiotherapy, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - Mariya Yavoroska
- Unit of Radiotherapy, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Clelia Miracco
- Unit of Pathological Anatomy, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luigi Pirtoli
- Center for Biotechnology, College of Science and Technology, Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, USA
| | - Miriam Tomaciello
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University, Rome, Italy
| | - Francesco Marampon
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University, Rome, Italy
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| |
Collapse
|
17
|
Yang Y, Cheng C, He B, Du X, Liu J, Xia H, Wang P, Wu M, Wu H, Liu Q. Cigarette smoking, by accelerating the cell cycle, promotes the progression of non-small cell lung cancer through an HIF-1α-METTL3-m 6A/CDK2AP2 axis. JOURNAL OF HAZARDOUS MATERIALS 2023; 455:131556. [PMID: 37156046 DOI: 10.1016/j.jhazmat.2023.131556] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/09/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
Cigarette smoking killed about 8 million people every year and promoted non-small cell lung cancer (NSCLC). We investigated the molecular mechanism of smoking-promoted NSCLC progression. Relative to non-smokers, NSCLC patients who were smokers had a higher tumor malignancy. For NSCLC cells, cigarette smoke extract (CSE) increased levels of HIF-1α, METTL3, Cyclin E1, and CDK2 and promoted the G1/S transition, which promoted cell proliferation. Down-regulation HIF-1α or METTL3 reversed these effects. meRIP-seq and RNA-seq revealed the m6A modification in Cyclin Dependent Kinase 2 Associated Protein 2 (CDK2AP2) mRNA as the key downstream target. Further, for NSCLC cells exposed to CSE, HIF-1α activated METTL3 transcription. Xenografts in nude mice demonstrated that HIF-1α via METTL3 participated in tumor growth. In NSCLC tissues of smokers, protein levels of HIF-1α and METTL3 were higher, and levels of CDK2AP2 were lower. In conclusion, HIF-1α via METTL3 regulation of the m6A modification of CDK2AP2 mRNA drives smoking-induced progression of NSCLC through promoting cell proliferation. This is a previously unknown molecular mechanism for smoking-induced NSCLC progression. The results have potential value for treatment of NSCLC, especially for patients who smoke.
Collapse
Affiliation(s)
- Yi Yang
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Center for Global Health, The Key Laboratory of Modern Toxicology, Ministry of Education, School of Public Health, Suzhou Institute of Public Health, Gusu School, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Cheng Cheng
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Center for Global Health, The Key Laboratory of Modern Toxicology, Ministry of Education, School of Public Health, Suzhou Institute of Public Health, Gusu School, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Bin He
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Xuan Du
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Jinyuan Liu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Haibo Xia
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Center for Global Health, The Key Laboratory of Modern Toxicology, Ministry of Education, School of Public Health, Suzhou Institute of Public Health, Gusu School, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Peiwen Wang
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Center for Global Health, The Key Laboratory of Modern Toxicology, Ministry of Education, School of Public Health, Suzhou Institute of Public Health, Gusu School, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Meng Wu
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Center for Global Health, The Key Laboratory of Modern Toxicology, Ministry of Education, School of Public Health, Suzhou Institute of Public Health, Gusu School, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Hao Wu
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China.
| | - Qizhan Liu
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Center for Global Health, The Key Laboratory of Modern Toxicology, Ministry of Education, School of Public Health, Suzhou Institute of Public Health, Gusu School, Nanjing Medical University, Nanjing 211166, Jiangsu, China.
| |
Collapse
|
18
|
Faragalla H, Plotkin A, Barnes P, Lu FI, Kos Z, Mulligan AM, Bane A, Nofech Mozes S. Ki67 in Breast Cancer Assay: An Ad Hoc Testing Recommendation from the Canadian Association of Pathologists Task Force. Curr Oncol 2023; 30:3079-3090. [PMID: 36975446 PMCID: PMC10047249 DOI: 10.3390/curroncol30030233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Ki67, a marker of cellular proliferation, is commonly assessed in surgical pathology laboratories. In breast cancer, Ki67 is an established prognostic factor with higher levels associated with worse long-term survival. However, Ki67 IHC is considered of limited clinical use in breast cancer management largely due to issues related to standardization and reproducibility of scoring across laboratories. Recently, both the American Food and Drug Administration (FDA) and Health Canada have approved the use of abemaciclib (CDK4/6 inhibitor) for patients with HR+/HER2: high-risk early breast cancers in the adjuvant setting. Health Canada and the FDA have included a Ki67 proliferation index of ≥20% in the drug monograph. The approval was based on the results from monarchE, a phase III clinical trial in early-stage chemotherapy-naïve, HR+, HER2 negative patients at high risk of early recurrence. The study has shown significant improvement in invasive disease-free survival (IDFS) with abemaciclib when combined with adjuvant endocrine therapy at two years. Therefore, there is an urgent need by the breast pathology and medical oncology community in Canada to establish national guideline recommendations for Ki67 testing as a predictive marker in the context of abemaciclib therapy consideration. The following recommendations are based on previous IKWG publications, available guidance from the monarchE trial and expert opinions. The current recommendations are by no means final or comprehensive, and their goal is to focus on its role in the selection of patients for abemaciclib therapy. The aim of this document is to guide Canadian pathologists on how to test and report Ki67 in invasive breast cancer. Testing should be performed upon a medical oncologist’s request only. Testing must be performed on treatment-naïve tumor tissue. Testing on the core biopsy is preferred; however, a well-fixed resection specimen is an acceptable alternative. Adhering to ASCO/CAP fixation guidelines for breast biomarkers is advised. Readout training is strongly recommended. Visual counting methods, other than eyeballing, should be used, with global rather than hot spot assessment preferred. Counting 100 cells in at least four areas of the tumor is recommended. The Ki67 scoring app developed to assist pathologists with scoring Ki67 proposed by the IKWG, available for free download, may be used. Automated image analysis is very promising, and laboratories with such technology are encouraged to use it as an adjunct to visual counting. A score of <5 or >30 is more robust. The task force recommends that the results are best expressed as a continuous variable. The appropriate antibody clone and staining protocols to be used may take time to address. For the time being, the task force recommends having tonsils/+pancreas on-slide control and enrollment in at least one national/international EQA program. Analytical validation remains a pending goal. Until the data become available, using local ki67 protocols is acceptable. The task force recommends participation in upcoming calibration and technical validation initiatives.
Collapse
Affiliation(s)
- Hala Faragalla
- Department of Laboratory Medicine, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Correspondence:
| | - Anna Plotkin
- Department of Laboratory Medicine and Molecular Diagnostics Sunnybrook Health Sciences Center, Toronto, ON M4N 3M5, Canada
| | - Penny Barnes
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, NS B3H 2E2, Canada
| | - Fang-I Lu
- Department of Laboratory Medicine and Molecular Diagnostics Sunnybrook Health Sciences Center, Toronto, ON M4N 3M5, Canada
| | - Zuzana Kos
- Department of Pathology, BC Cancer, Vancouver, BC V5Z 4E6, Canada
| | - Anna Marie Mulligan
- Department of Laboratory Medicine, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Anita Bane
- Department of Laboratory Medicine, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Sharon Nofech Mozes
- Department of Laboratory Medicine and Molecular Diagnostics Sunnybrook Health Sciences Center, Toronto, ON M4N 3M5, Canada
| |
Collapse
|
19
|
Xu P, Wu D, Liu X. A proposed grading scheme for predicting recurrence in medullary thyroid cancer based on the Ki67 index and metastatic lymph node ratio. Endocrine 2023:10.1007/s12020-023-03328-4. [PMID: 36823341 DOI: 10.1007/s12020-023-03328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE The Ki67 index and lymph node ratio (LNR) have been proposed as components of alternative pathological classification schemes, but the most appropriate classification for patients with medullary thyroid cancer (MTC) remains unknown. The aim of the present study was to examine the usefulness of a new grading system combining the Ki67 index and LNR as a predictor of prognostic and disease-free survival (DFS) in MTC. METHODS We conducted a retrospective study of patients with MTC who were registered at Sun Yat-sen University Cancer Center, Guangzhou, P. R. China from June 2003 to October 2021. The DFS rates were assessed using risk-adjusted Cox proportional hazard regression modeling to explore the relationship among pathological features, nutritional status and DFS. The Ki67 index (cutoff value: 5% and 10%) and LNR (cutoff value: 0.2 and 0.3) were combined to create a new grading system. RESULTS In total, 101 matched patients were assessed. The integrated grading system showed better separation of Kaplan Meier (KM) curves for DFS. As the grading stage progressed, there was a significant stepwise decrease in DFS, which was better than Ki67, LNR and N staging alone. According to the grading system, the high-risk group had a worse prognosis. CONCLUSION The proposed grading scheme demonstrated a better prognostic performance in MTC patients than the Ki67, LNR and N staging alone. However, larger scale studies are needed to further verify our findings.
Collapse
Affiliation(s)
- Pengfei Xu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
| | - Di Wu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
| | - Xuekui Liu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China.
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China.
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China.
| |
Collapse
|
20
|
Cieslak C, Mitteldorf C, Krömer-Olbrisch T, Kempf W, Stadler R. QuPath Analysis for CD30+ Cutaneous T-Cell Lymphoma. Am J Dermatopathol 2023; 45:93-98. [PMID: 36669072 DOI: 10.1097/dad.0000000000002330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/10/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Mycosis fungoides is the most common subtype of cutaneous T-cell lymphoma, in which the expression of cluster of differentiation 30 (CD30)+ subtype can now be treated with the CD30 antibody conjugate brentuximab vedotin. Diagnostic methods are based on immunohistochemical (IHC) staining followed by manual assessment by pathologists, which is always a subjective calculation. QuPath, an open-source software for digital pathology image analysis, satisfies the requirements of objective approaches. METHODS Ten samples from mycosis fungoides patients with CD30 expression at different stages were stained for CD3 and CD30 by IHC staining, scanned, and quantitative analysis was performed using QuPath (version 2.1). Each slide was independently assessed by 3 board-certified dermatopathologists. RESULTS Individual estimates for CD30+/CD3+ cells varied among the individual histopathologists (mean coefficient of variation, 0.46; range, 0-0.78). QuPath analysis showed excellent separation between the positively stained cells for CD3 and CD30 IHC and other cells and tissue structures, although the results correlated strongly with the respective mean estimates of the 3 histopathologists (Pearson-R 0.93). CONCLUSIONS The results show a high interobserver variability evaluation of IHC markers, although quantitative image analysis offer a significant advantage for comparison. This is not only relevant for clinical routine but also especially critical in therapeutic studies addressing targeted molecules.
Collapse
Affiliation(s)
- Cassandra Cieslak
- University Clinic for Dermatology, Johannes Wesling Medical Centre, Minden, Germany
- University Hospital of Ruhr-University, Bochum, Germany
| | - Christina Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany; and
| | - Tanja Krömer-Olbrisch
- University Clinic for Dermatology, Johannes Wesling Medical Centre, Minden, Germany
- University Hospital of Ruhr-University, Bochum, Germany
| | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Rudolf Stadler
- University Clinic for Dermatology, Johannes Wesling Medical Centre, Minden, Germany
- University Hospital of Ruhr-University, Bochum, Germany
| |
Collapse
|
21
|
Moreno JCA, Bahmad HF, Aljamal AA, Delgado R, Salami A, Guillot C, Castellano-Sánchez AA, Medina AM, Sriganeshan V. Prognostic Significance of p53 and p63 in Diffuse Large B-Cell Lymphoma: A Single-Institution Experience. Curr Oncol 2023; 30:1314-1331. [PMID: 36826063 PMCID: PMC9955855 DOI: 10.3390/curroncol30020102] [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: 12/21/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma in adults. We evaluated the immunohistochemical (IHC) expression of p63 and p53 in DLBCL and their significance on overall survival (OS) and progression-free survival (PFS). We conducted a retrospective cohort study of 177 patients with DLBCL who presented to Mount Sinai Medical Center of Florida (Miami Beach, Florida) between 2010 and 2020. IHC staining for p63 and p53 protein expression was performed. A significant correlation was found between p63 positivity and p53 expression, p53/p63 co-positivity, Ki-67 proliferation index, MYC expression, and MYC/BCL2 double expression. Regardless of the germinal center B-cell like (GCB) subgrouping, there was a trend among p53+ patients to have MYC/BCL2 double expression, positive MYC expression, and lower OS and PFS. A tendency of poor OS was seen in p53+ patients in the non-GCB, GCB, and double expressors subgroups and poor PFS in p53+ patients regardless of the subgrouping. In conclusion, our results suggest that p63 and p53 may represent potential additional prognostic biomarkers in DLBCL and may be included in the initial diagnostic work up of patients with DLBCL.
Collapse
Affiliation(s)
- Juan Carlos Alvarez Moreno
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Hisham F Bahmad
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Abed Alhalim Aljamal
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Ruben Delgado
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Ali Salami
- Department of Mathematics, Faculty of Sciences, Lebanese University, Nabatieh 1700, Lebanon
| | - Carolina Guillot
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Amilcar A Castellano-Sánchez
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Ana Maria Medina
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Vathany Sriganeshan
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| |
Collapse
|
22
|
Bahmad HF, Lopez O, Moreno JCA, Lopez K, Malik F, Salami A, Nieder AM, Omarzai Y, Poppiti RJ. Clinicopathological analysis of recurrence and progression of low-grade papillary urothelial carcinoma of the urinary bladder: Predicting the outcome. Ann Diagn Pathol 2022; 61:152030. [DOI: 10.1016/j.anndiagpath.2022.152030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 11/26/2022]
|
23
|
Acs B, Leung SCY, Kidwell KM, Arun I, Augulis R, Badve SS, Bai Y, Bane AL, Bartlett JMS, Bayani J, Bigras G, Blank A, Buikema H, Chang MC, Dietz RL, Dodson A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hartman J, Kos Z, Lænkholm AV, Laurinavicius A, Levenson RM, Mahboubi-Ardakani R, Mastropasqua MG, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Quintayo MA, Rau TT, Reinhard S, Robertson S, Salgado R, Sugie T, van der Vegt B, Viale G, Zabaglo LA, Hayes DF, Dowsett M, Nielsen TO, Rimm DL. Systematically higher Ki67 scores on core biopsy samples compared to corresponding resection specimen in breast cancer: a multi-operator and multi-institutional study. Mod Pathol 2022; 35:1362-1369. [PMID: 35729220 PMCID: PMC9514990 DOI: 10.1038/s41379-022-01104-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 02/06/2023]
Abstract
Ki67 has potential clinical importance in breast cancer but has yet to see broad acceptance due to inter-laboratory variability. Here we tested an open source and calibrated automated digital image analysis (DIA) platform to: (i) investigate the comparability of Ki67 measurement across corresponding core biopsy and resection specimen cases, and (ii) assess section to section differences in Ki67 scoring. Two sets of 60 previously stained slides containing 30 core-cut biopsy and 30 corresponding resection specimens from 30 estrogen receptor-positive breast cancer patients were sent to 17 participating labs for automated assessment of average Ki67 expression. The blocks were centrally cut and immunohistochemically (IHC) stained for Ki67 (MIB-1 antibody). The QuPath platform was used to evaluate tumoral Ki67 expression. Calibration of the DIA method was performed as in published studies. A guideline for building an automated Ki67 scoring algorithm was sent to participating labs. Very high correlation and no systematic error (p = 0.08) was found between consecutive Ki67 IHC sections. Ki67 scores were higher for core biopsy slides compared to paired whole sections from resections (p ≤ 0.001; median difference: 5.31%). The systematic discrepancy between core biopsy and corresponding whole sections was likely due to pre-analytical factors (tissue handling, fixation). Therefore, Ki67 IHC should be tested on core biopsy samples to best reflect the biological status of the tumor.
Collapse
Affiliation(s)
- Balazs Acs
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Indu Arun
- Tata Medical Center, Kolkata, West Bengal, India
| | - Renaldas Augulis
- Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Sunil S Badve
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yalai Bai
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Anita L Bane
- Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - John M S Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Jane Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Gilbert Bigras
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Annika Blank
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Henk Buikema
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin C Chang
- Department of Pathology & Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Robin L Dietz
- Department of Pathology, Olive View-UCLA Medical Center, Los Angeles, CA, USA
| | - Andrew Dodson
- UK NEQAS for Immunocytochemistry and In-Situ Hybridisation, London, United Kingdom
| | - Susan Fineberg
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cornelia M Focke
- Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany
| | - Dongxia Gao
- University of British Columbia, Vancouver, BC, Canada
| | | | - Carolina Gutierrez
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Arvydas Laurinavicius
- Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Richard M Levenson
- Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Rustin Mahboubi-Ardakani
- Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Sharon Nofech-Mozes
- University of Toronto Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Frédérique M Penault-Llorca
- Imagerie Moléculaire et Stratégies Théranostiques, UMR1240, Université Clermont Auvergne, INSERM, Clermont-Ferrand, France
- Service de Pathologie, Centre Jean PERRIN, Clermont-Ferrand, France
| | - Tammy Piper
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | | | - Tilman T Rau
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Heinrich Heine University and University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Stefan Reinhard
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Stephanie Robertson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA, Antwerp, Belgium
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | | | - Bert van der Vegt
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giuseppe Viale
- European Institute of Oncology, Milan, Italy
- European Institute of Oncology IRCCS, and University of Milan, Milan, Italy
| | - Lila A Zabaglo
- The Institute of Cancer Research, London, United Kingdom
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Mitch Dowsett
- The Institute of Cancer Research, London, United Kingdom
| | | | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
| | | |
Collapse
|
24
|
Wang G, Kumar A, Ding W, Korangath P, Bera T, Wei J, Pai P, Gabrielson K, Pastan I, Sukumar S. Intraductal administration of transferrin receptor-targeted immunotoxin clears ductal carcinoma in situ in mouse models of breast cancer-a preclinical study. Proc Natl Acad Sci U S A 2022; 119:e2200200119. [PMID: 35675429 PMCID: PMC9214490 DOI: 10.1073/pnas.2200200119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/29/2022] [Indexed: 12/14/2022] Open
Abstract
The human transferrin receptor (TFR) is overexpressed in most breast cancers, including preneoplastic ductal carcinoma in situ (DCIS). HB21(Fv)-PE40 is a single-chain immunotoxin (IT) engineered by fusing the variable region of a monoclonal antibody (HB21) against a TFR with a 40 kDa fragment of Pseudomonas exotoxin (PE). In humans, the administration of other TFR-targeted immunotoxins intrathecally led to inflammation and vascular leakage. We proposed that for treatment of DCIS, intraductal (i.duc) injection of HB21(Fv)-PE40 could avoid systemic toxicity while retaining its potent antitumor effects on visible and occult tumors in the entire ductal tree. Pharmacokinetic studies in mice showed that, in contrast to intravenous injection, IT was undetectable by enzyme-linked immunosorbent assay in blood following i.duc injection of up to 3.0 μg HB21(Fv)-PE40. We demonstrated the antitumor efficacy of HB21(Fv)-PE40 in two mammary-in-duct (MIND) models, MCF7 and SUM225, grown in NOD/SCID/gamma mice. Tumors were undetectable by In Vivo Imaging System (IVIS) imaging in intraductally treated mice within 1 wk of initiation of the regimen (IT once weekly/3 wk, 1.5 μg/teat). MCF7 tumor-bearing mice remained tumor free for up to 60 d of observation with i.duc IT, whereas the HB21 antibody alone or intraperitoneal IT treatment had minimal/no antitumor effects. These and similar findings in the SUM225 MIND model were substantiated by analysis of mammary gland whole mounts, histology, and immunohistochemistry for the proteins Ki67, CD31, CD71 (TFR), and Ku80. This study provides a strong preclinical foundation for conducting feasibility and safety trials in patients with stage 0 breast cancer.
Collapse
Affiliation(s)
- Guannan Wang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007
| | - Alok Kumar
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Wanjun Ding
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Preethi Korangath
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Tapan Bera
- Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Junxia Wei
- Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Priya Pai
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Kathleen Gabrielson
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Ira Pastan
- Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Saraswati Sukumar
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| |
Collapse
|
25
|
Lee MKI, Rabindranath M, Faust K, Yao J, Gershon A, Alsafwani N, Diamandis P. Compound computer vision workflow for efficient and automated immunohistochemical analysis of whole slide images. J Clin Pathol 2022:jclinpath-2021-208020. [PMID: 35169066 DOI: 10.1136/jclinpath-2021-208020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/10/2022] [Indexed: 11/04/2022]
Abstract
AIMS Immunohistochemistry (IHC) assessment of tissue is a central component of the modern pathology workflow, but quantification is challenged by subjective estimates by pathologists or manual steps in semi-automated digital tools. This study integrates various computer vision tools to develop a fully automated workflow for quantifying Ki-67, a standard IHC test used to assess cell proliferation on digital whole slide images (WSIs). METHODS We create an automated nuclear segmentation strategy by deploying a Mask R-CNN classifier to recognise and count 3,3'-diaminobenzidine positive and negative nuclei. To further improve automation, we replaced manual selection of regions of interest (ROIs) by aligning Ki-67 WSIs with corresponding H&E-stained sections, using scale-invariant feature transform (SIFT) and a conventional histomorphological convolutional neural networks to define tumour-rich areas for quantification. RESULTS The Mask R-CNN was tested on 147 images generated from 34 brain tumour Ki-67 WSIs and showed a high concordance with aggregate pathologists' estimates ([Formula: see text] assessors; [Formula: see text] r=0.9750). Concordance of each assessor's Ki-67 estimates was higher when compared with the Mask R-CNN than between individual assessors (ravg=0.9322 vs 0.8703; p=0.0213). Coupling the Mask R-CNN with SIFT-CNN workflow demonstrated ROIs can be automatically chosen and partially sampled to improve automation and dramatically decrease computational time (average: 88.55-19.28 min; p<0.0001). CONCLUSIONS We show how innovations in computer vision can be serially compounded to automate and improve implementation in clinical workflows. Generalisation of this approach to other ancillary studies has significant implications for computational pathology.
Collapse
Affiliation(s)
- Michael Kyung Ik Lee
- Laboratory Medicine & Pathobiology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Madhumitha Rabindranath
- Laboratory Medicine & Pathobiology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Kevin Faust
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Jennie Yao
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ariel Gershon
- Pathology, University Health Network, Toronto, Ontario, Canada
| | - Noor Alsafwani
- Pathology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Phedias Diamandis
- Laboratory Medicine & Pathobiology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada .,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Pathology, University Health Network, Toronto, Ontario, Canada.,Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Faust K, Lee MK, Dent A, Fiala C, Portante A, Rabindranath M, Alsafwani N, Gao A, Djuric U, Diamandis P. Integrating morphologic and molecular histopathological features through whole slide image registration and deep learning. Neurooncol Adv 2022; 4:vdac001. [PMID: 35156037 PMCID: PMC8826810 DOI: 10.1093/noajnl/vdac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Modern molecular pathology workflows in neuro-oncology heavily rely on the integration of morphologic and immunohistochemical patterns for analysis, classification, and prognostication. However, despite the recent emergence of digital pathology platforms and artificial intelligence-driven computational image analysis tools, automating the integration of histomorphologic information found across these multiple studies is challenged by large files sizes of whole slide images (WSIs) and shifts/rotations in tissue sections introduced during slide preparation.
Methods
To address this, we develop a workflow that couples different computer vision tools including scale-invariant feature transform (SIFT) and deep learning to efficiently align and integrate histopathological information found across multiple independent studies. We highlight the utility and automation potential of this workflow in the molecular subclassification and discovery of previously unappreciated spatial patterns in diffuse gliomas.
Results
First, we show how a SIFT-driven computer vision workflow was effective at automated WSI alignment in a cohort of 107 randomly selected surgical neuropathology cases (97/107 (91%) showing appropriate matches, AUC = 0.96). This alignment allows our AI-driven diagnostic workflow to not only differentiate different brain tumor types, but also integrate and carry out molecular subclassification of diffuse gliomas using relevant immunohistochemical biomarkers (IDH1-R132H, ATRX). To highlight the discovery potential of this workflow, we also examined spatial distributions of tumors showing heterogenous expression of the proliferation marker MIB1 and Olig2. This analysis helped uncovered an interesting and unappreciated association of Olig2 positive and proliferative areas in some gliomas (r = 0.62).
Conclusion
This efficient neuropathologist-inspired workflow provides a generalizable approach to help automate a variety of advanced immunohistochemically compatible diagnostic and discovery exercises in surgical neuropathology and neuro-oncology.
Collapse
Affiliation(s)
- Kevin Faust
- Department of Computer Science, University of Toronto, 40 St. George Street, Toronto, ON M5S 2E4, Canada
- Laboratory Medicine Program, Department of Pathology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Michael K Lee
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Anglin Dent
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Clare Fiala
- Laboratory Medicine Program, Department of Pathology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Alessia Portante
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Madhu Rabindranath
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Noor Alsafwani
- Laboratory Medicine Program, Department of Pathology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box.2208, Dammam, 31441, Saudi Arabia
| | - Andrew Gao
- Laboratory Medicine Program, Department of Pathology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ugljesa Djuric
- Princess Margaret Cancer Centre, 101 College Street, Toronto, ON M5G 1L7, Canada
| | - Phedias Diamandis
- Laboratory Medicine Program, Department of Pathology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Princess Margaret Cancer Centre, 101 College Street, Toronto, ON M5G 1L7, Canada
- Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, ON M5G 1L7, Canada
| |
Collapse
|
27
|
Ki-67 as a Prognostic Biomarker in Invasive Breast Cancer. Cancers (Basel) 2021; 13:cancers13174455. [PMID: 34503265 PMCID: PMC8430879 DOI: 10.3390/cancers13174455] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary In breast cancer development, the expression of Ki-67 is strongly associated with cancer proliferation and is a known indicator of prognosis and outcome. Ki-67 expression levels are also useful to inform treatment decision making in some cases. As a result, routine measurement of Ki-67 is now widely performed during pathological tumour evaluation. However, the Ki-67 appraisal is not without its limitations and shortcomings—the aim of this study was to provide an overview of Ki-67 use in the clinical setting, the current challenges associated with its measurement, and the novel strategies that will hopefully enhance Ki-67 proliferation indices for prospective breast cancer patients. Abstract The advent of molecular medicine has transformed breast cancer management. Breast cancer is now recognised as a heterogenous disease with varied morphology, molecular features, tumour behaviour, and response to therapeutic strategies. These parameters are underpinned by a combination of genomic and immunohistochemical tumour factors, with estrogen receptor (ER) status, progesterone receptor (PgR) status, human epidermal growth factor receptor-2 (HER2) status, Ki-67 proliferation indices, and multigene panels all playing a contributive role in the substratification, prognostication and personalization of treatment modalities for each case. The expression of Ki-67 is strongly linked to tumour cell proliferation and growth and is routinely evaluated as a proliferation marker. This review will discuss the clinical utility, current pitfalls, and promising strategies to augment Ki-67 proliferation indices in future breast oncology.
Collapse
|
28
|
Challenging, Accurate and Feasible: CAF-1 as a Tumour Proliferation Marker of Diagnostic and Prognostic Value. Cancers (Basel) 2021; 13:cancers13112575. [PMID: 34073937 PMCID: PMC8197349 DOI: 10.3390/cancers13112575] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/14/2023] Open
Abstract
Simple Summary There is an emerging need for new weapons in the battle against cancer; therefore, the discovery of new biomarkers with diagnostic, prognostic, and therapeutic value is a priority of current cancer research. An important task is to identify how quickly a tumour proliferates. A tumour’s proliferation rate is critical for grading and clinical decision-making; hence, there is an imperative need for accurate proliferation markers. Here, we review evidence demonstrating that chromatin assembly factor 1 (CAF-1) is a proliferation marker of clinical value. CAF-1 is selectively expressed in proliferating cells and its expression can be evaluated by immunohistochemistry in cytology smears and biopsies. CAF-1 expression is increased in almost all cancers and correlates strongly with the expression of Ki-67, the current routine proliferation marker. Overexpression of CAF-1 is associated with poor clinical outcome (advanced cancer stage, recurrence, metastasis, and decreased survival). CAF-1 is a robust, reproducible, and feasible proliferation marker of prognostic importance and may represent an attractive alternative or complementary to Ki-67 for cancer stratification and clinical guidance. Abstract The discovery of novel biomarkers of diagnostic, prognostic, and therapeutic value is a major challenge of current cancer research. The assessment of tumour cell proliferative capacity is pivotal for grading and clinical decision-making, highlighting the importance of proliferation markers as diagnostic and prognostic tools. Currently, the immunohistochemical analysis of Ki-67 expression levels is routinely used in clinical settings to assess tumour proliferation. Inasmuch as the function of Ki-67 is not fully understood and its evaluation lacks standardization, there is interest in chromatin regulator proteins as alternative proliferation markers of clinical value. Here, we review recent evidence demonstrating that chromatin assembly factor 1 (CAF-1), a histone chaperone selectively expressed in cycling cells, is a proliferation marker of clinical value. CAF-1 expression, when evaluated by immunocytochemistry in breast cancer cytology smears and immunohistochemistry in cancer biopsies from several tissues, strongly correlates with the expression of Ki-67 and other proliferation markers. Notably, CAF-1 expression is upregulated in almost all cancers, and CAF-1 overexpression is significantly associated, in most cancer types, with high histological tumour grade, advanced stage, recurrence, metastasis, and decreased patient survival. These findings suggest that CAF-1 is a robust, reproducible, and feasible proliferation marker of prognostic importance. CAF-1 may represent an attractive alternative or complementary to Ki-67 for cancer stratification and clinical guidance.
Collapse
|