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Hunter-Smith AE, Rayter Z. One-step nucleic acid amplification: the possible value in assessing sentinel lymph node metastasis during mastectomy. BREAST CANCER (DOVE MEDICAL PRESS) 2018; 10:13-21. [PMID: 29416374 PMCID: PMC5790072 DOI: 10.2147/bctt.s113737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Breast cancer is the most common cancer in women, worldwide, and 1,400 deaths per day are attributed to it. The success of national screening programs has seen breast cancers being diagnosed at an earlier stage. With conservative surgery to the breast demonstrating equivalent long-term outcomes, the last 10 years have seen a growing interest in the safety of less invasive management for the axilla in breast cancer patients. One-step nucleic acid amplification (OSNA) is a validated, reliable, and efficient tool in identifying micro- and macro-metastases intraoperatively. It is the most widely used intraoperative analysis tool within the United Kingdom, and is employed by over 320 units across Europe and Asia. Recent evidence from the AMAROS, IBCSG 23-01, and ACOSOG Z0011 trials has changed surgical practice in managing the axilla of patients with breast cancer. We propose a clinical algorithm demonstrating the role of OSNA as an intraoperative analysis tool in today's management of breast cancer as well as prospects for the future use of OSNA.
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Affiliation(s)
- Alison E Hunter-Smith
- Breast Surgery Unit, Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Zenon Rayter
- Breast Surgery Unit, Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK
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2
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Detection of micrometastases by flow cytometry in sentinel lymph nodes from patients with renal tumours. Br J Cancer 2016; 115:957-966. [PMID: 27599044 PMCID: PMC5061909 DOI: 10.1038/bjc.2016.279] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Stage is an important prognostic factor in renal tumours and dissemination to regional lymph nodes is associated with poor outcomes. Lymph nodes are routinely assessed by immunohistochemistry and microscopic evaluation, a time-consuming process where micrometastases might go undiagnosed. We evaluate an alternative method for detecting metastatic cells in sentinel nodes (SNs) by flow cytometry. METHODS A total of 15 nodes from 5 patients diagnosed with renal tumours were analysed by flow cytometry. Staining for the intracellular marker cytokeratin 18 (CK18) with the surface markers carbonic anhydrase IX (CA9) and Cadherin 6 were used in flow cytometry analysis. Peripheral blood mononuclear cells (PBMCs) with the addition of known concentrations of cancer cell lines were analysed to investigate the sensitivity of micrometastasis detection. RESULTS Stability of the assay was marked by low intra-assay variability (coefficient of variance ⩽16%) and low inter-assay variability (R2=0.9996-1). Eight nodes in four patients were positive for metastasis; six of them were considered being micrometastatic. These metastases were undetected by routine pathology and the patients were restaged from pN0 to pN1. CONCLUSIONS Flow cytometry is able to detect micrometastases in lymph nodes of renal tumour patients that were undetected under H&E examination.
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HER2 drives Mucin-like 1 to control proliferation in breast cancer cells. Oncogene 2016; 35:4225-34. [PMID: 26725324 PMCID: PMC4996539 DOI: 10.1038/onc.2015.487] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/22/2015] [Accepted: 11/14/2015] [Indexed: 01/09/2023]
Abstract
Mucin-like 1 (MUCL1) was first identified as a breast-specific gene over a decade
ago. Based on its highly restricted mRNA expression in breast tissue and
continued expression during breast tumorigenesis and progression, MUCL1 is an
attractive tumor-associated antigen and a potential therapeutic target. However,
very little is known about the cellular location, biological functions and
regulation of the MUCL1 protein, which will have a major impact on its
druggability. Here we describe our efforts to fully characterize the cellular
localization of MUCL1, investigate its regulation by key breast cancer oncogenes
such as human epidermal growth factor receptor 2 (HER2) and discover its
functional roles in breast cancer. Although some mucins are membrane bound, our
data indicate that MUCL1 is secreted by some breast cancer cells, whereas others
only express high levels of intracellular MUCL1. MUCL1 expression is highest in
HER2-amplified breast tumors and inhibiting HER2 activity in tumor cells
resulted in a decreased MUCL1 expression. In-depth investigation demonstrated
that phosphoinositide3-kinase/Akt pathway, but not Ras/MEK pathway,
controls MUCL1 expression downstream of HER2. Phenotypic assays revealed a
strong dependence of HER2-positive cells on MUCL1 for cell proliferation. We
further identified the mechanism by which MUCL1 regulates cell growth. Knockdown
of MUCL1 induced a G1/S phase arrest concomitant with decreased cyclin D and
increased p21 and p27 levels. Finally, we investigated the impact of MUCL1 loss
on kinase signaling pathways in breast cancer cells through phospho-kinase array
profiling. MUCL1 silencing abrogated phospho-focal adhesion kinase (FAK), Jun
NH2-terminal kinase (JNK) and c-Jun signals, but not
extracellular signal-regulated kinase or Akt pathway activities, thereby
pointing to FAK/JNK pathway as the downstream effector of MUCL1 signaling.
We are the first to identify an important role for MUCL1 in the proliferation of
breast cancer cells, probably mediated via the FAK/JNK signaling pathway.
Taken together, these data suggest a potential utility for therapeutic targeting
of this protein in breast cancer.
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4
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Busch M, Dünker N. Trefoil factor family peptides – friends or foes? Biomol Concepts 2015; 6:343-59. [DOI: 10.1515/bmc-2015-0020] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/20/2015] [Indexed: 12/13/2022] Open
Abstract
AbstractTrefoil factor family (TFF) peptides are a group of molecules bearing a characteristic three-loop trefoil domain. They are mainly secreted in mucous epithelia together with mucins but are also synthesized in the nervous system. For many years, TFF peptides were only known for their wound healing and protective function, e.g. in epithelial protection and restitution. However, experimental evidence has emerged supporting a pivotal role of TFF peptides in oncogenic transformation, tumorigenesis and metastasis. Deregulated expression of TFF peptides at the gene and protein level is obviously implicated in numerous cancers, and opposing functions as oncogenes and tumor suppressors have been described. With regard to the regulation of TFF expression, epigenetic mechanisms as well as the involvement of various miRNAs are new, promising aspects in the field of cancer research. This review will summarize current knowledge about the expression and regulation of TFF peptides and the involvement of TFF peptides in tumor biology and cancerogenesis.
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Affiliation(s)
- Maike Busch
- 1Medical Faculty, Institute for Anatomy II, Department of Neuroanatomy, University of Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany
| | - Nicole Dünker
- 1Medical Faculty, Institute for Anatomy II, Department of Neuroanatomy, University of Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany
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5
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Lau WH, Pandey V, Kong X, Wang XN, Wu Z, Zhu T, Lobie PE. Trefoil Factor-3 (TFF3) Stimulates De Novo Angiogenesis in Mammary Carcinoma both Directly and Indirectly via IL-8/CXCR2. PLoS One 2015; 10:e0141947. [PMID: 26559818 PMCID: PMC4641663 DOI: 10.1371/journal.pone.0141947] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/13/2015] [Indexed: 12/19/2022] Open
Abstract
Mammary carcinoma cells produce pro-angiogenic factors to stimulate angiogenesis and tumor growth. Trefoil factor-3 (TFF3) is an oncogene secreted from mammary carcinoma cells and associated with poor prognosis. Herein, we demonstrate that TFF3 produced in mammary carcinoma cells functions as a promoter of tumor angiogenesis. Forced expression of TFF3 in mammary carcinoma cells promoted proliferation, survival, invasion and in vitro tubule formation of human umbilical vein endothelial cells (HUVEC). MCF7-TFF3 cells with forced expression of TFF3 generated tumors with enhanced microvessel density as compared to tumors formed by vector control cells. Depletion of TFF3 in mammary carcinoma cells by siRNA concordantly decreased the angiogenic behavior of HUVEC. Forced expression of TFF3 in mammary carcinoma cells stimulated IL-8 transcription and subsequently enhanced IL-8 expression in both mammary carcinoma cells and HUVEC. Depletion of IL-8 in mammary carcinoma cells with forced expression of TFF3, or antibody inhibition of IL-8, partially abrogated mammary carcinoma cell TFF3-stimulated HUVEC angiogenic behavior in vitro, as did inhibition of the IL-8 receptor, CXCR2. Depletion of STAT3 by siRNA in MCF-7 cells with forced expression of TFF3 partially diminished the angiogenic capability of TFF3 on stimulation of cellular processes of HUVEC. Exogenous recombinant hTFF3 also directly promoted the angiogenic behavior of HUVEC. Hence, TFF3 is a potent angiogenic factor and functions as a promoter of de novo angiogenesis in mammary carcinoma, which may co-coordinate with the growth promoting and metastatic actions of TFF3 in mammary carcinoma to enhance tumor progression.
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MESH Headings
- Animals
- Apoptosis/genetics
- Blotting, Western
- Breast Neoplasms/blood supply
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Cell Line, Tumor
- Cell Movement/genetics
- Cell Proliferation/genetics
- Cells, Cultured
- Coculture Techniques
- Female
- Human Umbilical Vein Endothelial Cells/metabolism
- Humans
- Interleukin-8/genetics
- Interleukin-8/metabolism
- MCF-7 Cells
- Mice, Inbred BALB C
- Mice, Nude
- Microscopy, Fluorescence
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/metabolism
- Peptides/genetics
- Peptides/metabolism
- RNA Interference
- Receptors, Interleukin-8B/genetics
- Receptors, Interleukin-8B/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- STAT3 Transcription Factor/genetics
- STAT3 Transcription Factor/metabolism
- Transplantation, Heterologous
- Trefoil Factor-3
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Affiliation(s)
- Wai-Hoe Lau
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Vijay Pandey
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Xiangjun Kong
- Hefei National Laboratory for Physical Sciences at Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Xiao-Nan Wang
- Department of Pathology, Anhui Medical University, Hefei, Anhui, PR China
- Laboratory of Pathogenic Microbiology and Immunology, Anhui Medical University, Hefei, Anhui 230032, PR China
| | - ZhengSheng Wu
- Department of Pathology, Anhui Medical University, Hefei, Anhui, PR China
| | - Tao Zhu
- Hefei National Laboratory for Physical Sciences at Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, Anhui, PR China
- * E-mail: (PEL); (TZ)
| | - Peter E Lobie
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- National University Cancer Institute of Singapore, National Health System, National University of Singapore, Singapore, Singapore
- * E-mail: (PEL); (TZ)
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6
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Milioli HH, Vimieiro R, Riveros C, Tishchenko I, Berretta R, Moscato P. The Discovery of Novel Biomarkers Improves Breast Cancer Intrinsic Subtype Prediction and Reconciles the Labels in the METABRIC Data Set. PLoS One 2015; 10:e0129711. [PMID: 26132585 PMCID: PMC4488510 DOI: 10.1371/journal.pone.0129711] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/12/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The prediction of breast cancer intrinsic subtypes has been introduced as a valuable strategy to determine patient diagnosis and prognosis, and therapy response. The PAM50 method, based on the expression levels of 50 genes, uses a single sample predictor model to assign subtype labels to samples. Intrinsic errors reported within this assay demonstrate the challenge of identifying and understanding the breast cancer groups. In this study, we aim to: a) identify novel biomarkers for subtype individuation by exploring the competence of a newly proposed method named CM1 score, and b) apply an ensemble learning, as opposed to the use of a single classifier, for sample subtype assignment. The overarching objective is to improve class prediction. METHODS AND FINDINGS The microarray transcriptome data sets used in this study are: the METABRIC breast cancer data recorded for over 2000 patients, and the public integrated source from ROCK database with 1570 samples. We first computed the CM1 score to identify the probes with highly discriminative patterns of expression across samples of each intrinsic subtype. We further assessed the ability of 42 selected probes on assigning correct subtype labels using 24 different classifiers from the Weka software suite. For comparison, the same method was applied on the list of 50 genes from the PAM50 method. CONCLUSIONS The CM1 score portrayed 30 novel biomarkers for predicting breast cancer subtypes, with the confirmation of the role of 12 well-established genes. Intrinsic subtypes assigned using the CM1 list and the ensemble of classifiers are more consistent and homogeneous than the original PAM50 labels. The new subtypes show accurate distributions of current clinical markers ER, PR and HER2, and survival curves in the METABRIC and ROCK data sets. Remarkably, the paradoxical attribution of the original labels reinforces the limitations of employing a single sample classifiers to predict breast cancer intrinsic subtypes.
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Affiliation(s)
- Heloisa Helena Milioli
- Priority Research Centre for Bioinformatics, Biomarker Discovery and Information-Based Medicine, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Environmental and Life Science, The University of Newcastle, Callaghan, NSW, Australia
| | - Renato Vimieiro
- Priority Research Centre for Bioinformatics, Biomarker Discovery and Information-Based Medicine, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Centro de Informática, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Carlos Riveros
- Priority Research Centre for Bioinformatics, Biomarker Discovery and Information-Based Medicine, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Electrical Engineering and Computer Science, The University of Newcastle, Callaghan, NSW, Australia
| | - Inna Tishchenko
- Priority Research Centre for Bioinformatics, Biomarker Discovery and Information-Based Medicine, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Electrical Engineering and Computer Science, The University of Newcastle, Callaghan, NSW, Australia
| | - Regina Berretta
- Priority Research Centre for Bioinformatics, Biomarker Discovery and Information-Based Medicine, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Electrical Engineering and Computer Science, The University of Newcastle, Callaghan, NSW, Australia
| | - Pablo Moscato
- Priority Research Centre for Bioinformatics, Biomarker Discovery and Information-Based Medicine, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Electrical Engineering and Computer Science, The University of Newcastle, Callaghan, NSW, Australia
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7
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Jara-Lazaro AR, Hussain IHM, Thike AA, Wong CY, Ho GH, Yong WS, Ong KW, Madhukumar P, Tan BKT, Oey CL, Hwang JSG, Tan PH. Assessment of suitability of the one step nucleic acid amplification (OSNA) assay as an intraoperative procedure for detection of metastasis in sentinel lymph nodes of breast cancer. J Clin Pathol 2014; 67:1032-7. [PMID: 25217710 DOI: 10.1136/jclinpath-2014-202361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM We aimed to assess the one step nucleic acid amplification (OSNA) assay as an intraoperative method in comparison with frozen sections (FS) for detection of metastasis in sentinel lymph nodes (SLNs) of breast cancer. METHOD 100 SLNs from patients with breast carcinoma were enrolled within a 3-month period. Alternate 2 mm node slices were subjected to routine FS, and later to permanent histology, and the rest for automated molecular detection of CK19 mRNA using OSNA. FS and OSNA findings were compared with permanent histology results. Difference in turnaround time was also noted. RESULTS With permanent histology as gold standard, OSNA was discrepant in 8 of 98 (3 false negative, 5 false positive) included SLNs whereas FS had 2 false negative cases. FS had higher sensitivity (89%, p=<0.001), specificity (100%, p=0.001) and concordance rate (98%) than OSNA (83%, 94% and 92%, respectively). FS showed almost perfect agreement (κ=0.929) whereas OSNA showed substantial agreement (κ=0.740) when compared with permanent histology. OSNA turnaround time was twice longer (mean of 47.7 min) than FS. CONCLUSIONS Automation of SLN assessment using OSNA is a potentially useful intraoperative diagnostic tool with acceptable accuracy. Discordant findings in this study may be due to sampling allocation. Since OSNA is more time-consuming, its practical advantage over routine FS requires further study in view of current technical workflow considerations.
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Affiliation(s)
| | | | - Aye Aye Thike
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Chow Yin Wong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Gay Hui Ho
- Department of Surgical Oncology, National Cancer Center, Singapore, Singapore
| | - Wei Sean Yong
- Department of Surgical Oncology, National Cancer Center, Singapore, Singapore
| | - Kong Wee Ong
- Department of Surgical Oncology, National Cancer Center, Singapore, Singapore
| | - Preetha Madhukumar
- Department of Surgical Oncology, National Cancer Center, Singapore, Singapore
| | - Benita Kiat Tee Tan
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Chung Lie Oey
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
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8
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An improved axillary staging system using the OSNA assay does not modify the therapeutic management of breast cancer patients. Sci Rep 2014; 4:5743. [PMID: 25034150 PMCID: PMC4102897 DOI: 10.1038/srep05743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/30/2014] [Indexed: 12/17/2022] Open
Abstract
The one-step nucleic acid amplification (OSNA) assay is a molecular procedure that can identify deposits of breast cancer (BC) cells in the sentinel lymph node (SLN). We examined the consistency of the OSNA assay with a classic hematoxylin-eosin (H&E)-based immunohistochemistry (IHC) study and evaluated how OSNA-based axillary staging might impact the therapeutic management of BC patients. SLN biopsy results were considered to be positive in 60 patients (40%) in the OSNA group (N = 148) and in 43 (28%) patients in the IHC cohort (N = 153, p = 0.023). There was no difference in the macrometastasis (22% for OSNA, 15% for H&E, p = 0.139) or micrometastasis (19% for OSNA, 13% for H&E, p = 0.166) rates, but we found statistically significant differences in the number of isolated tumor cells (1% for OSNA, 11% for H&E, p < 0.001). There were no differences in the administration rate of adjuvant systemic therapy between the OSNA (66% in the SLN(+) patients) and the H&E (74% in the SLN(+) patients) groups (p = 0.159). The OSNA assay allows for the detection of SLN metastases more precisely than conventional pathologic methods but does not alter the therapeutic management of SLN(+) BC patients.
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9
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Du TY, Luo HM, Qin HC, Wang F, Wang Q, Xiang Y, Zhang Y. Circulating serum trefoil factor 3 (TFF3) is dramatically increased in chronic kidney disease. PLoS One 2013; 8:e80271. [PMID: 24282531 PMCID: PMC3840008 DOI: 10.1371/journal.pone.0080271] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/11/2013] [Indexed: 01/10/2023] Open
Abstract
Objectives Trefoil factor 3 (TFF3) is a small peptide that plays an important role in mucosal protection, cell proliferation, and cell migration. The aberrant expression of TFF3 is correlated with gastrointestinal inflammation, solid tumors, and other clinical diseases. The objective of this study was to identify the distribution characteristics of serum TFF3 in common clinical diseases. Materials and Methods A large prospective randomized study of 1,072 Chinese patients was performed using an enzyme-linked immunosorbent assay (ELISA) to examine the serum TFF3 concentrations in patients with different diseases. A matched case-control study was conducted on patients with chronic kidney disease (CKD) stages 1–5. Immunohistochemistry (IHC) was performed using renal tissues to determine the relationship between the severity of CKD and the serum and urine concentrations of TFF3 peptides. Results The mean serum concentrations of TFF3 in patients with CKD, metastatic and secondary carcinoma (MC) and acute gastroenteritis (AG) (200.9 ng/ml, 95.7 ng/ml and 71.7 ng/ml, respectively) were significantly higher than those in patients with other common clinical diseases. A positive correlation tendency was observed between the serum TFF3 concentrations and the severity of CKD. The mean serum TFF3 values for CKD stages 1–5 were 23.6 ng/ml, 29.9 ng/ml, 54.9 ng/ml, 85.0 ng/ml and 176.6 ng/ml, respectively. The same trend was observed in the urine TFF3 concentrations and the CKD stages. The creatinine(Cr)-corrected concentrations of TFF3 in urine were 367.1 ng/mg·Cr, 910.6 ng/mg·Cr, 1,149.0 ng/mg·Cr, 1,610.0 ng/mg·Cr and 3,475.0 ng/mg·Cr for CKD stages 1–5, respectively. IHC revealed that TFF3 expression was concentrated in tubular epithelial cells. Conclusions The influence of kidney injuries must be fully considered when performing clinical TFF3 research. Further studies on TFF3 in CKD will contribute to our understanding of its pathological roles and mechanisms in other diseases.
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Affiliation(s)
- Ting-yi Du
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming, Yunnan Province, China
- University of the Chinese Academy of Sciences, Beijing, China
- Department of Clinical Laboratory Medicine, the First People’s Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Hui-ming Luo
- Department of Nephrology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Hai-chun Qin
- Department of Gastroenterology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Fang Wang
- Department of Clinical Laboratory Medicine, the First People’s Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Qing Wang
- Department of Gynecology, The First People’s Hospital of Yunnan Province,Kunming, Yunnan Province, China
| | - Yang Xiang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming, Yunnan Province, China
| | - Yun Zhang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, The Chinese Academy of Sciences, Kunming, Yunnan Province, China
- * E-mail:
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10
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Yue L, Xiang J, Shen Z, Wang Z, Yao Y, Zhou Q, Ding A, Qiu W. Inhibition of ErbB-2 induces TFF3 downregulation in breast cancer cell lines. APMIS 2013; 122:628-35. [PMID: 24164280 DOI: 10.1111/apm.12203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 09/06/2013] [Indexed: 12/15/2022]
Abstract
ErbB-2 gene plays an important role in carcinoma formation whose overexpression was observed in many types of tumors, including breast cancer. Dysregulation of Trefoil factor 3 (TFF3), which is thought to function in the development and progression of breast cancer, was found to be upregulated in ErbB2-overexpressing breast cancers and cells. However, a putative interaction between ErbB-2 and TFF3 in breast cancer remains unknown. To determine whether TFF3 has an important role in breast tumor, its levels were measured by immunohistochemistry in 130 cases of breast infiltrating duct carcinoma and 30 cases of normal breast tissue with a specific monoclonal antibody raised against human TFF3. Patients who were positive for ErbB-2 also had high expression levels of TFF3 (p < 0.05). Also, after infecting the SK-BR-3 cells with lentivirus-mediated ErbB2-specific shRNA (Lenti-ShERBB2), we detected the expressions of ErbB-2 and TFF3 by real-time polymerase chain reaction and Western blotting, respectively. Compared with the control groups, ErbB-2 mRNA expression was decreased in the Lenti-ShERBB2 infection group, and Western blotting indicated a concordant ErbB-2 protein reduction. On the other hand, TFF3 expression at both mRNA and protein levels was significantly downregulated by ErbB-2 silencing in SK-BR-3. These findings are a proof of the foundation for a certain relationships of ErbB-2 and TFF3, which may serve as novel therapeutic markers of ErbB2-overexpressing breast cancers in the future.
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Affiliation(s)
- Lu Yue
- Department of Oncology, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
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11
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Iinuma H, Tamura J, Omoto D, Kamo N, Ohnaka S, Mitoma Y, Miyazawa Y, Okinaga K, Imamura T, Fukushima R, Watanabe T, Ikeda T. Accurate and rapid novel genetic diagnosis for detection of sentinel lymph node metastasis in breast cancer patients. Br J Cancer 2012; 107:724-31. [PMID: 22782345 PMCID: PMC3419953 DOI: 10.1038/bjc.2012.300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The transcription-reverse transcription concerted reaction (TRC) test is a novel molecular-based procedure, which can assess nodal metastasis accurately and quickly. We examined the usefulness of the TRC test with a double marker, cytokeratin 19 (CK19) and carcinoembryonic antigen (CEA) mRNA, to detect sentinel lymph nodes (SLN) metastasis in breast cancer patients. Methods: A total of 264 SLNs from 131 breast cancer patients were assigned to a training set (109 SLNs from 50 patients) and validation set (155 SLNs from 81 patients). Cytokeratin 19 and CEA mRNA were detected by TRC tests, and the sensitivity and specificity of the SLN metastasis between the TRC and histology cohorts were compared. Results: Mean copy numbers of CK19 and CEA by TRC tests were increased according to the metastatic size. In the training set, TRC test showed 100% sensitivity, specificity and concordance rates against the permanent histopathology test. In the validation set, sensitivity was 97.1%, specificity was 99.2% and the concordance rate was 99.4%. Conclusion: Our results showed that the detection of CK19 and CEA mRNA using the TRC test is, an accurate and rapid method for detection of SLN metastasis and can be applied as an intraoperative molecular diagnosis in breast cancer patients.
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Affiliation(s)
- H Iinuma
- Department of Surgery, Teikyo University School of Medicine, Tokyo 173-0003, Japan.
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12
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Cserni G. How Much is Enough? Pathologic Evaluation of Sentinel Lymph Nodes. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0073-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Le Frère-Belda MA, Bats AS, Gillaizeau F, Poulet B, Clough KB, Nos C, Peoc'h M, Seffert P, Bouteille C, Leroux A, Guillemin F, Blanc-Fournier C, Crouet H, Arnould L, Cuisenier J, Penault-Llorca F, Gimbergues P, Jacquemier J, Houvenaeghel G, Chatellier G, Lécuru F. Diagnostic performance of one-step nucleic acid amplification for intraoperative sentinel node metastasis detection in breast cancer patients. Int J Cancer 2011; 130:2377-86. [PMID: 21780107 DOI: 10.1002/ijc.26291] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 05/19/2011] [Accepted: 06/07/2011] [Indexed: 11/10/2022]
Abstract
The purpose of this prospective multicenter study was to assess one-step nucleic acid amplification (OSNA) for intraoperative sentinel lymph node (SLN) metastasis detection in breast cancer patients, using final histology as the reference standard. OSNA results were also compared to intraoperative histology SLN evaluation and to standard clinicopathological risk markers. For this study, fresh SLNs were cut in four blocks, and alternate blocks were used for OSNA and histology. CK19 mRNA copy number was categorized as strongly positive, positive or negative. Positive histology was defined as presence of macrometastasis or micrometastasis. When discrepancies occurred, the entire SLNs were subjected to histological studies and the node lysates to additional molecular studies. Five hundred three SLN samples from 233 patients were studied. Mean time to evaluate two SLNs was 40 min. Sensitivity per patient was 91.4% (95% CI, 76.9-98.2%), specificity 93.3% (95% CI, 88.6-96.6%), positive likelihood ratio 13.7 and negative likelihood ratio 0.1. Sensitivity was 63.6% for frozen sections and 47.1% for touch imprint cytology. Both methods were 100% specific. Positive histology and positive OSNA were significantly associated with highest clinical stage, N1 status and vascular invasion; and OSNA results correlated with HER2/neu status and benefited patients with negative histology. These findings show that OSNA assay can allow detection of SLN metastasis in breast cancer patients intraoperatively with a good sensitivity, thus minimizing the need for second surgeries for axillary lymph node detection.
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Molecular detection of breast cancer metastasis in sentinel lymph nodes by reverse transcriptase polymerase chain reaction (RT-PCR): identifying, evaluating and establishing multi-marker panels. Breast Cancer Res Treat 2011; 130:833-44. [DOI: 10.1007/s10549-011-1710-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
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15
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Molloy TJ, Bosma AJ, Baumbusch LO, Synnestvedt M, Borgen E, Russnes HG, Schlichting E, van't Veer LJ, Naume B. The prognostic significance of tumour cell detection in the peripheral blood versus the bone marrow in 733 early-stage breast cancer patients. Breast Cancer Res 2011; 13:R61. [PMID: 21672237 PMCID: PMC3218950 DOI: 10.1186/bcr2898] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/04/2011] [Accepted: 06/14/2011] [Indexed: 11/25/2022] Open
Abstract
Introduction The detection of circulating tumour cells (CTCs) in the peripheral blood and disseminated tumour cells (DTCs) in the bone marrow are promising prognostic tools for risk stratification in early breast cancer. There is, however, a need for further validation of these techniques in larger patient cohorts with adequate follow-up periods. Methods We assayed CTCs and DTCs at primary surgery in 733 stage I or II breast cancer patients with a median follow-up time of 7.6 years. CTCs were detected in samples of peripheral blood mononuclear cells previously stored in liquid-nitrogen using a previously-developed multi-marker quantitative PCR (QPCR)-based assay. DTCs were detected in bone marrow samples by immunocytochemical analysis using anti-cytokeratin antibodies. Results CTCs were detected in 7.9% of patients, while DTCs were found in 11.7%. Both CTC and DTC positivity predicted poor metastasis-free survival (MFS) and breast cancer-specific survival (BCSS); MFS hazard ratio (HR) = 2.4 (P < 0.001)/1.9 (P = 0.006), and BCSS HR = 2.5 (P < 0.001)/2.3 (P = 0.01), for CTC/DTC status, respectively). Multivariate analyses demonstrated that CTC status was an independent prognostic variable for both MFS and BCSS. CTC status also identified a subset of patients with significantly poorer outcome among low-risk node negative patients that did not receive adjuvant systemic therapy (MFS HR 2.3 (P = 0.039), BCSS HR 2.9 (P = 0.017)). Using both tests provided increased prognostic information and indicated different relevance within biologically dissimilar breast cancer subtypes. Conclusions These results support the use of CTC analysis in early breast cancer to generate clinically useful prognostic information.
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Affiliation(s)
- Timothy J Molloy
- Division of Experimental Therapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Molloy TJ, Devriese LA, Helgason HH, Bosma AJ, Hauptmann M, Voest EE, Schellens JHM, van't Veer LJ. A multimarker QPCR-based platform for the detection of circulating tumour cells in patients with early-stage breast cancer. Br J Cancer 2011; 104:1913-9. [PMID: 21587256 PMCID: PMC3111197 DOI: 10.1038/bjc.2011.164] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The detection of circulating tumour cells (CTCs) has been linked with poor prognosis in advanced breast cancer. Relatively few studies have been undertaken to study the clinical relevance of CTCs in early-stage breast cancer. METHODS In a prospective study, we evaluated CTCs in the peripheral blood of 82 early-stage breast cancer patients. Control groups consisted of 16 advanced breast cancer patients and 45 healthy volunteers. The CTC detection was performed using ErbB2/EpCAM immunomagnetic tumour cell enrichment followed by multimarker quantitative PCR (QPCR). The CTC status and common clinicopathological factors were correlated to relapse-free, breast cancer-related and overall survival. RESULTS Circulating tumour cells were detected in 16 of 82 (20%) patients with early-stage breast cancer and in 13 out of 16 (81%) with advanced breast cancer. The specificity was 100%. The median follow-up time was 51 months (range: 17-60). The CTC positivity in early-stage breast cancer patients resulted in significantly poorer relapse-free survival (log rank test: P=0.003) and was an independent predictor of relapse-free survival (multivariate hazard ratio=5.13, P=0.006, 95% CI: 1.62-16.31). CONCLUSION The detection of CTCs in peripheral blood of early-stage breast cancer patients provided prognostic information for relapse-free survival.
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Affiliation(s)
- T J Molloy
- Division of Experimental Therapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Trefoil factor 3 is oncogenic and mediates anti-estrogen resistance in human mammary carcinoma. Neoplasia 2011; 12:1041-53. [PMID: 21170268 DOI: 10.1593/neo.10916] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/12/2010] [Accepted: 08/24/2010] [Indexed: 01/05/2023] Open
Abstract
We report herein that trefoil factor 3 (TFF3) is oncogenic and mediates anti-estrogen resistance in human mammary carcinoma. Forced expression of TFF3 in mammary carcinoma cells increased cell proliferation and survival, enhanced anchorage-independent growth, and promoted migration and invasion. Moreover, forced expression of TFF3 increased tumor size in xenograft models. Conversely, depletion of endogenous TFF3 with small interfering RNA (siRNA) decreased the oncogenicity and invasiveness of mammary carcinoma cells. Neutralization of secreted TFF3 by antibody promoted apoptosis, decreased cell growth in vitro, and arrested mammary carcinoma xenograft growth. TFF3 expression was significantly correlated to decreased survival of estrogen receptor (ER)-positive breast cancer patients treated with tamoxifen. Forced expression of TFF3 in mammary carcinoma cells increased ER transcriptional activity, promoted estrogen-independent growth, and produced resistance to tamoxifen and fulvestrant in vitro and to tamoxifen in xenograft models. siRNA-mediated depletion or antibody inhibition of TFF3 significantly enhanced the efficacy of antiestrogens. Increased TFF3 expression was observed in tamoxifen-resistant (TAMR) cells and antibody inhibition of TFF3 in TAMR cells improved tamoxifen sensitivity. Functional antagonism of TFF3 therefore warrants consideration as a novel therapeutic strategy for mammary carcinoma.
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Houpeau JL, Baranzelli MC, Giard S, Chauvet MP, Robin YM, Farre I, Andre C, Vilain MO, Bonneterre J. [Intraoperative molecular assessment of sentinel nodes in the breast cancer using the Gene Search BLN Assay technique: our experience about 126 patients]. ACTA ACUST UNITED AC 2011; 40:297-304. [PMID: 21353398 DOI: 10.1016/j.jgyn.2011.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 01/13/2011] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Intraoperative molecular assay Gene Search BLN Assay (BLN) detects sentinel lymph node (SLN) metastasis in breast cancer. Our objective was to compare BLN to the definitive conventional histologic methods and to experiment the management of BLN in routine. MATERIAL AND METHODS Each SLN was cut into alternate slabs. Half slabs were analysed with the intraoperative BLN molecular method, and the other slabs with the definitive histologic method. RESULTS Two hundred and thirty four SLN have been analysed (124 patients). Thirty-five SLN had metastasis for 29 patients (23.4%). BLN correctly identified 28 patients. Two cases of discordance between BLN and standard method were found, probably explained by a sample bias. The sensibility of BLN is 96.4%, the sensitivity is 99%, the predictive positive value is 96.4%, the predictive negative value is 99% and the concordance is 98.4%. The surgery time increases and there is a need to adapt the theatre organization accordingly. CONCLUSION The Gene Search BLN Assay gives a great interest for the patient, the surgeon and the pathologist because it increases the quality of the intraoperative analysis by comparison with the intraoperative conventional histology.
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Affiliation(s)
- J-L Houpeau
- Département de sénologie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59020 Lille cedex, France.
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Snook KL, Layer GT, Jackson PA, de Vries CS, Shousha S, Sinnett HD, Nigar E, Singhal H, Chia Y, Cunnick G, Kissin MW. Multicentre evaluation of intraoperative molecular analysis of sentinel lymph nodes in breast carcinoma. Br J Surg 2010; 98:527-35. [DOI: 10.1002/bjs.7347] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2010] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Ideally, intraoperative sentinel lymph node (SLN) analysis in breast cancer should be automated, have high concordance with extensive histopathology, and be applicable in any hospital setting. A prospective multicentre evaluation of the one-step nucleic acid amplification (OSNA) automated molecular diagnostic system of SLN analysis was undertaken.
Methods
Intraoperative examination of SLNs from 204 patients with breast cancer was performed by OSNA at four sites in the UK. Half of each SLN was assessed by OSNA (for cytokeratin 19 mRNA) and the remaining half was paraffin embedded for intensive histological examination at ten levels. Discordant cases were reanalysed by further molecular biological techniques and by additional histological examination of all remaining nodal material to ascertain whether the discordance was due to an uneven distribution of metastases, known as tissue allocation bias (TAB).
Results
After exclusion of samples affected by TAB, the overall concordance rate for OSNA versus histopathology was 96·0 per cent, with a sensitivity of 91·7 per cent and a specificity of 96·9 per cent. The median time to process a single SLN was 32 (range 22–97) min, and that for two nodes 42 (30–73) min.
Conclusion
OSNA enables accurate automated intraoperative diagnosis and can be used successfully in different UK hospitals. When the SLN is shown to be positive, the patient can undergo immediate axillary clearance under the same anaesthetic rather than having a delayed second procedure.
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Affiliation(s)
| | - K L Snook
- Breast Unit, Royal Surrey County Hospital, Guildford, UK
- Postgraduate Medical School, University of Surrey, Guildford, UK
| | - G T Layer
- Breast Unit, Royal Surrey County Hospital, Guildford, UK
- Postgraduate Medical School, University of Surrey, Guildford, UK
| | - P A Jackson
- Histopathology Department, Royal Surrey County Hospital, Guildford, UK
| | - C S de Vries
- Postgraduate Medical School, University of Surrey, Guildford, UK
| | - S Shousha
- Histopathology Department, Charing Cross Hospital, London, UK
| | - H D Sinnett
- Breast Unit, Charing Cross Hospital, London, UK
| | - E Nigar
- Pathology Department, Northwick Park Hospital, Harrow, UK
| | - H Singhal
- Breast Unit, Northwick Park Hospital, Harrow, UK
| | - Y Chia
- Pathology Department, Wycombe Hospital, High Wycombe, UK
| | - G Cunnick
- Breast Unit, Wycombe Hospital, High Wycombe, UK
| | - M W Kissin
- Breast Unit, Royal Surrey County Hospital, Guildford, UK
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Du TY, Qin HC, Liu J, Zhang Y. Trefoil factor: implications for clinical laboratory diagnostics. Shijie Huaren Xiaohua Zazhi 2010; 18:2794-2799. [DOI: 10.11569/wcjd.v18.i26.2794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Trefoil factors (TFF), expressed physiologically in the secretory cells of gastrointestinal mucosa and other mucosal tissues, compose a unique peptide family with important biologic functions. Aberrant expression and/or continued secretion of TFF might exist concurrently with the processes of digestive system inflammation, tumor or other related pathological changes. Previous pathological studies have shown that the abnormal expression of TFF is associated with the prognosis of digestive system diseases. The results obtained from gene expression profiling, tumor secretomics and bioinformatic analysis have positively confirmed that clinical detection of TFF peptides or mRNAs has an excellent diagnostic performance to detect digestive system diseases, especially for the monitoring of recurrence or metastasis of tumors and for the estimation of therapeutic efficacy and prognosis. Therefore, TFF is a potential biomarker for diagnosis, treatment and prognosis of digestive system diseases.
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Layfield DM, Agrawal A, Roche H, Cutress RI. Intraoperative assessment of sentinel lymph nodes in breast cancer. Br J Surg 2010; 98:4-17. [DOI: 10.1002/bjs.7229] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2010] [Indexed: 01/10/2023]
Abstract
Abstract
Background
Sentinel lymph node biopsy (SLNB) reduces the morbidity of axillary clearance and is the standard of care for patients with clinically node-negative breast cancer. The ability to analyse the sentinel node during surgery enables a decision to be made whether to proceed to full axillary clearance during primary surgery, thus avoiding a second procedure in node-positive patients.
Methods
Current evidence for intraoperative sentinel node analysis following SLNB in breast cancer was reviewed and evaluated, based on articles obtained from a MEDLINE search using the terms ‘sentinel node’, ‘intra-operative’ and ‘breast cancer’.
Results and conclusion
Current methods for evaluating the sentinel node during surgery include cytological and histological techniques. Newer quantitative molecular assays have been the subject of much recent clinical research. Pathological techniques of intraoperative SLNB analysis such as touch imprint cytology and frozen section have a high specificity, but a lower and more variably reported sensitivity. Molecular techniques are potentially able to sample a greater proportion of the sentinel node, and could have higher sensitivity.
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Affiliation(s)
- D M Layfield
- Southampton Breast Surgical Unit, Southampton University Hospitals Trust, Southampton, UK
| | - A Agrawal
- Portsmouth Breast Surgical Unit, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - H Roche
- Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
| | - R I Cutress
- Southampton Breast Surgical Unit, Southampton University Hospitals Trust, Southampton, UK
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Abstract
The role of immune surveillance in controlling the spread of breast cancer to the regional nodes is poorly understood. In theory regional nodal irradiation (RNI) might compromise this host function. However the clinical evidence suggests that the risk of regional recurrence is lower in patients with early breast cancer whose axilla has been irradiated compared to no axillary treatment. The role of RNI after breast conserving surgery has not been well studied. A policy of level III clearance and only irradiating the axilla for residual disease and a selective policy of axillary irradiation in node positive patients after sentinel node biopsy or lower axillary node sample is recommended. Irradiation of the medial supraclavicular fossa after axillary dissection is suggested where there are four or more nodes involved on axillary dissection. There is little data to inform selection of patients for RNI after neoadjuvant systemic therapy. The role of postmastectomy radiotherapy (PMRT) was largely established on the basis of comprehensive RNI. It is unclear whether irradiating less than the chest wall and peripheral lymphatics confers the same level of benefit. The role of PMRT in women with 1-3 involved nodes remains controversial and investigational. Biological factors such as oestrogen and progesterone receptor status and HER-2 protein expression may play a role in determining benefits from PMRT. The role of internal mammary nodal irradiation is unclear. The individualisation of RNI based on molecular and genetic factors should be a priority for research. The benefits of RNI need to be carefully balanced against the risks of cardiotoxicity, pneumonitis, lymphoedema, brachial plexopathy and secondary malignancy.
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Affiliation(s)
- Ian H Kunkler
- Edinburgh Cancer Centre, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, Scotland, UK.
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Breast cancer circulating tumor cells. Oncol Rev 2009. [DOI: 10.1007/s12156-009-0023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nakamura R, Sakakibara M, Nagashima T, Sangai T, Arai M, Fujimori T, Takano S, Shida T, Nakatani Y, Miyazaki M. Accumulation of regulatory T cells in sentinel lymph nodes is a prognostic predictor in patients with node-negative breast cancer. Eur J Cancer 2009; 45:2123-31. [DOI: 10.1016/j.ejca.2009.03.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 03/21/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
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Cserni G, Decker T. [Sentinel node biopsy in breast cancer: pathological analysis and interpretation]. DER PATHOLOGE 2009; 30:156-62. [PMID: 19224216 DOI: 10.1007/s00292-008-1099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This overview examines how the introduction of sentinel lymph node biopsy (SLNB) has changed the pathological staging of breast cancer. The more intensive analysis of the sentinel lymph nodes (gross slicing, step sections, immunohistological or molecular analysis) has lead to stage shifting in breast cancer. Regarding the rate of up-staging by positive results of SLNB, there are significant differences between institutes, some method-related, some related to the interpretation of results. Methodological differences should be reduced by means of reliable guidelines with the goal of systematically identifying metastases of a particular size (a macrometastasis over 2 mm being the minimum criterion). The next review of the TNM classification should result in a reduction in interobserver variability as a result of better definitions of staging categories for isolated tumor cells and micrometastases. In addition, a staging category is expected for metastases which have been identified by calibrated quantitative molecular tests only and which are larger than isolated tumors. Even in settings where nodal staging by SLNB is based on molecular tests at least a proportion of the lymph node should be investigated histologically.
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Affiliation(s)
- G Cserni
- Bács-Kiskun County Teaching Hospital, Kecskemét, Ungarn.
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27
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Schem C, Maass N, Bauerschlag DO, Carstensen MH, Löning T, Roder C, Batic O, Jonat W, Tiemann K. One-step nucleic acid amplification—a molecular method for the detection of lymph node metastases in breast cancer patients; results of the German study group. Virchows Arch 2008; 454:203-10. [DOI: 10.1007/s00428-008-0703-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 10/02/2008] [Accepted: 11/11/2008] [Indexed: 10/21/2022]
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28
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Marín-Aguilera M, Mengual L, Burset M, Oliver A, Ars E, Ribal MJ, Colomer D, Mellado B, Villavicencio H, Algaba F, Alcaraz A. Molecular Lymph Node Staging in Bladder Urothelial Carcinoma: Impact on Survival. Eur Urol 2008; 54:1363-72. [DOI: 10.1016/j.eururo.2008.04.059] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 04/23/2008] [Indexed: 01/27/2023]
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29
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GISTEREK I, FRYDECKA I, ŚWIĄTONIOWSKI G, FIDLER S, KORNAFEL J. Tumour-infiltrating CD4 and CD8 T lymphocytes in breast cancer. Rep Pract Oncol Radiother 2008. [DOI: 10.1016/s1507-1367(10)60011-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Management of the axilla after the finding of a positive sentinel lymph node: a proposal for an evidence-based risk-adapted algorithm. Am J Clin Oncol 2008; 31:293-9. [PMID: 18525310 DOI: 10.1097/coc.0b013e318161dc1b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Axillary lymph node dissection after the finding of a positive sentinel lymph node is a common clinical practice. A review is performed for the efficacy and morbidity of axillary lymph node dissection, the rationale for nonsurgical management of the axilla, and the efficacy, technical limitations, and toxicity of axillary radiation therapy; a management algorithm is then proposed based upon currently available prediction tools.
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Abstract
Isolated tumor cells and micrometastases represent low-volume or minimal disease in the regional lymph nodes of breast cancer patients as compared to macrometastases. Sentinel lymph node biopsy is a functional selection and removal of the most likely site of regional metastasis, and gives pathologists the opportunity to concentrate detection techniques on a limited number of lymph nodes. Consequently, more lesions belonging in the two mentioned staging categories are discovered in sentinel lymph nodes. Despite some publications contradicting stochastic models of breast cancer, micrometastases seem to reflect a prognosis intermediate between the node-negative and macrometastatic nodal status, and they also reflect a risk of non-sentinel node involvement slightly higher than that associated with a node-negative status. Data are more contradictory as concerns isolated tumor cells. This minireview summarizes the definitions, their inconsistencies, pathological protocols aiming at the detection of minimal nodal disease, the prognostic impact and non-sentinel node involvement related risk of such nodal lesions, and their therapeutic consequences.
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Visser M, Jiwa M, Horstman A, Brink AATP, Pol RP, van Diest P, Snijders PJF, Meijer CJLM. Intra-operative rapid diagnostic method based on CK19 mRNA expression for the detection of lymph node metastases in breast cancer. Int J Cancer 2008; 122:2562-7. [PMID: 18324628 PMCID: PMC2658031 DOI: 10.1002/ijc.23451] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Staging by sentinel node (SN) biopsy is the standard procedure for clinically node-negative breast cancer patients. Intra-operative analysis of the SN allows immediate axillary lymph node (ALN) dissection in SN positive patients, but a quick, reliable and reproducible method is lacking. We tested the suitability of a quantitative cytokeratin 19 (CK19) mRNA one step nucleic acid amplification (OSNA#) technique (OSNA-CK19) for intra-operative SN analysis. OSNA-CK19 involves a short manual sample preparation step and subsequent fully automated amplification of CK19 mRNA based on reverse transcription loop-mediated isothermal amplification, with results available within 30–40 min. OSNA-CK19 was compared to histological staining (Hematoxylin&Eosin and CAM5.2 and CK19 immunostaining) of 346 frozen ALNs from 32 breast cancer patients, using half of the lymph node for each method. 267 samples were negative and 61 positive by both methods. Three samples were histology positive and OSNA-CK19 negative. Fifteen samples were histology negative and OSNA-CK19 positive, 11 of which had copy numbers close to the cut-off level of OSNA-CK19. Seven of these 15 samples were RT-PCR positive for epithelial markers and/or showed CK19 protein expression by Western blot suggesting the presence of tumor deposits in the lymph node part investigated by OSNA-CK19. Concordance with histology was 94.8%, and 96.8% after exclusion of the latter 7 discordant cases. Sensitivity was 95.3% and specificity was 94.7% before and 97.1% after discordant case investigation. Our results indicate that OSNA-CK19 can potentially be useful in an intra-operative clinical setting to detect SN tumor involvement in breast cancer patients.
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Affiliation(s)
- Mike Visser
- Department of Pathology, VU Medical Center Amsterdam, The Netherlands
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Skliris GP, Hubé F, Gheorghiu I, Mutawe MM, Penner C, Watson PH, Murphy LC, Leygue E, Myal Y. Expression of small breast epithelial mucin (SBEM) protein in tissue microarrays (TMAs) of primary invasive breast cancers. Histopathology 2008; 52:355-69. [PMID: 18269587 PMCID: PMC2253716 DOI: 10.1111/j.1365-2559.2007.02955.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Small breast epithelial mucin (SBEM) is a recently described gene product that shows promise as a new breast biomarker. The aim was to investigate for the first time SBEM protein expression in a large cohort (n = 300) of invasive breast cancers, its relationship to established clinical variables and its association with clinical outcome. METHODS AND RESULTS Immunohistochemical analysis was performed on tissue microarrays consisting of 149 oestrogen receptor (ER) alpha- and 151 ERalpha+ breast cancers. Overall, 18% of tumours were SBEM+ (n = 53/300). However, SBEM protein was more frequently observed in ER- (22%) than in ER+ cancers (13%; P = 0.049). A significant association with psoriasin/S100A7 expression (P < or = 0.0001) was observed in the entire cohort. SBEM was also positively associated with HER-2 (P = 0.046) in ER- cancers, and increased levels of SBEM were strongly associated with higher tumour grade (P = 0.0015). Furthermore, SBEM expression showed a trend towards an association with reduced overall survival and relapse-free survival in the ER+ cohort (P = 0.063 and P = 0.072, respectively). CONCLUSIONS Our results suggest that SBEM may identify a unique subset of breast cancers with poor prognosis and may have future implications for therapeutic management of this disease.
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Affiliation(s)
- G P Skliris
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
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Perry JK, Kannan N, Grandison PM, Mitchell MD, Lobie PE. Are trefoil factors oncogenic? Trends Endocrinol Metab 2008; 19:74-81. [PMID: 18054496 DOI: 10.1016/j.tem.2007.10.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 10/19/2007] [Accepted: 10/22/2007] [Indexed: 12/24/2022]
Abstract
Trefoil factors (TFFs), in particular TFF1, are classical estrogen-regulated genes and have served as markers of estrogen gene regulation by various environmental estrogens. TFFs are also regulated by several other factors including growth hormone (hGH), insulin-like growth factor-1 (IGF-1), epidermal growth factor (EGF) and various oncogenic stimuli. TFFs are secreted proteins present in serum and possess the potential to act as growth factors promoting cell survival, anchorage-independent growth and motility. Recent compelling evidence has emerged from experimental and clinical studies to indicate a pivotal role of TFFs in oncogenic transformation, growth and metastatic extension of common human solid tumours. This review will summarize the current evidence for the involvement of TFFs in human cancer.
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Affiliation(s)
- Jo K Perry
- Liggins Institute, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Comparative evaluation of an extensive histopathologic examination and a real-time reverse-transcription-polymerase chain reaction assay for mammaglobin and cytokeratin 19 on axillary sentinel lymph nodes of breast carcinoma patients. Ann Surg 2008; 247:136-42. [PMID: 18156933 DOI: 10.1097/sla.0b013e318157d22b] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the accuracy of a commercially available real-time reverse-transcription-polymerase chain reaction assay for mammaglobin and cytokeratin 19 mRNAs [GeneSearch Breast Lymph Node (BLN) Assay, Veridex LLC, Warren, NJ] in the detection of axillary sentinel lymph nodes (SLNs) metastases in patients with breast carcinoma. SUMMARY BACKGROUND DATA Because of the lack of standardized and widely accepted protocols for a truly accurate histopathologic examination of SLN, the relative merits of alternative assays based on the identification of tumor specific mRNA markers deserve further assessment. METHODS : A prospective series of 293 consecutive SLNs from 293 patients was evaluated. The BLN assay results were compared with those of an extensive histopathologic examination of the entire SLNs performed on serial frozen sections cut at 40 to 50 microm intervals. RESULTS The BLN assay correctly identified 51 of 52 macrometastatic and 5 of 20 micrometastatic SLNs, with a sensitivity of 98.1% to detect metastases larger than 2 mm, 94.7% for metastases larger than 1 mm, and 77.8% for metastases larger than 0.2 mm. The overall concordance with histopathology was 90.8%, with specificity of 95.0%, positive predictive value of 83.6%, and negative predictive value of 92.9%. When the results were evaluated according to the occurrence of additional metastases to non-SLN in patients with histologically positive SLNs, the assay was positive in 33 (91.7%) of the 36 patients with additional metastases and in 22 (66.6%) of the 33 patients without further echelon involvement. CONCLUSIONS The sensitivity of the reverse-transcription -polymerase chain reaction assay is comparable to that of the histopathologic examination of the entire SLN by serial sectioning at 1.5 to 2 mm.
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Rutgers EJT. Sentinel node biopsy: interpretation and management of patients with immunohistochemistry-positive sentinel nodes and those with micrometastases. J Clin Oncol 2008; 26:698-702. [PMID: 18258976 DOI: 10.1200/jco.2007.14.4667] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The sentinel node procedure is an adequate tool to identify lymph node metastasis in breast cancer. Sentinel nodes are generally examined with greater attention mainly to exclude, as reliably as possible, lymph node metastasis. To achieve this, many protocols are used, resulting in different rates of micrometastasis or isolated tumor cells encountered. Since the prognostic significance of isolated tumor cells or micrometastasis in the sentinel nodes, and the risk of further axillary lymph node involvement in patients with isolated tumor cells, is uncertain and at most limited, these findings may pose difficulties for clinicians in clinical decision making. Protocols that identify lymph node metastasis, from which the clinical relevance is known, are warranted. Unnecessary lymph node dissections should be avoided.
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Affiliation(s)
- Emiel J T Rutgers
- Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
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Lefferts JA, Bartels CL, Tsongalis GJ. Molecular oncology: current trends in diagnostics. Future Oncol 2008; 4:61-70. [DOI: 10.2217/14796694.4.1.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Applications of molecular diagnostics to oncology have been slow to make their way to the clinical laboratory. While numerous genes and mutation spectra have been found to be involved in tumorigenesis, it is only recently that these findings begin to become useful in a clinical setting. Building on the technical knowledge obtained from molecular infectious disease testing, new instruments and assays have been developed to answer similar questions regarding qualitative, quantitative and genotyping issues. In this manuscript we describe two current examples of clinical molecular diagnostic applications, the assessment of BCR–ABL in chronic myelogenous leukemia patients and the detection of tumor cells in the sentinel lymph nodes of breast cancer patients, to demonstrate the role of molecular techniques in a routine clinical setting.
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Affiliation(s)
- Joel A Lefferts
- Dartmouth Medical School, Department of Pathology, Dartmouth–Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Claudine L Bartels
- Dartmouth Medical School, Department of Pathology, Dartmouth–Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Gregory J Tsongalis
- Dartmouth Medical School, Department of Pathology, Dartmouth–Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
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Molloy TJ, Bosma AJ, van't Veer LJ. Towards an optimized platform for the detection, enrichment, and semi-quantitation circulating tumor cells. Breast Cancer Res Treat 2008; 112:297-307. [PMID: 18213476 DOI: 10.1007/s10549-007-9872-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 12/14/2007] [Indexed: 11/25/2022]
Abstract
Metastasis describes the process of migration of a frequently clinically occult circulating tumor cell (CTC) from the primary lesion to a new location and the subsequent formation of an overt growth. We and others have shown that the detection and quantitation of these cells has significant prognostic value, however there still remains no consensus as to the optimal methods to achieve this. The work described herein therefore considered various techniques, from storage and sample processing to data acquisition and analysis, to find an optimal combination of methods for an effective and practical platform for the detection of CTCs in peripheral blood. A dual-antigen epithelial cell enrichment procedure followed by a multi-marker QPCR analysis demonstrated the highest sensitivity and specificity, with the ability to detect as few as 10 tumor cells from a background of 10(6) peripheral blood mononuclear cells. Using these techniques in conjunction with a quadratic linear discriminant analysis (QDA) resulted in a platform able to generate this data and then combine it a single score for each patient, in which positivity reflected tumor cell presence, and negativity represented tumor cell absence. This assay was able to correctly determine tumor cell presence or absence in 100% of healthy controls and 84% of metastatic patients in a validation cohort of 39 individuals. This platform represents a highly sensitive and specific assay which could augment current routine assays for CTCs in the clinic.
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Affiliation(s)
- T J Molloy
- Division of Experimental Therapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Afrimzon E, Deutsch A, Shafran Y, Zurgil N, Sandbank J, Pappo I, Deutsch M. Intracellular esterase activity in living cells may distinguish between metastatic and tumor-free lymph nodes. Clin Exp Metastasis 2008; 25:213-24. [DOI: 10.1007/s10585-007-9135-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 11/29/2007] [Indexed: 11/28/2022]
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Soares CT, Frederigue-Junior U, Luca LAD. Anatomopathological analysis of sentinel and nonsentinel lymph nodes in breast cancer: hematoxylin-eosin versus immunohistochemistry. Int J Surg Pathol 2007; 15:358-68. [PMID: 17913942 DOI: 10.1177/1066896907302124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors compare the detection of metastases in sentinel lymph nodes (SLNs) and nonsentinel lymph nodes (NSLNs) using hematoxylin-eosin (HE) staining versus immunohistochemistry (IHC). Thirty-six patients with breast carcinoma undergo exeresis of the primary tumor and of 50 SLNs and 491 NSLNs. Sentinel lymph nodes are sectioned into transverse slices of 2- to 3-mm thickness, and a cytologic smear and a frozen section were obtained from each slice. The slices are completely cut into serial sections at 100-microm intervals. Two consecutive 4-microm-thick sections are then obtained from each level and were prepared for HE staining and IHC. Nonsentinel lymph nodes are evaluated similarly to SLNs. The authors obtain 4076 SLN sections and 32 012 NSLN sections, for a total of 36 088 sections. A comparison of HE staining versus IHC based on the total number of sections shows a sensitivity of 93.8%, a negative predictive value of 98.9%, and an accuracy of 99.1%. The values obtained by HE staining are similar to those obtained by IHC.
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Affiliation(s)
- Cleverson Teixeira Soares
- Laboratório de Anatomia Patológica do Instituto Lauro de Souza Lima, Rodovia Comandante João Ribeiro de Barros Km. 225/226, 17034-971 Bauru, São Paulo, Brazil.
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Tsujimoto M, Nakabayashi K, Yoshidome K, Kaneko T, Iwase T, Akiyama F, Kato Y, Tsuda H, Ueda S, Sato K, Tamaki Y, Noguchi S, Kataoka TR, Nakajima H, Komoike Y, Inaji H, Tsugawa K, Suzuki K, Nakamura S, Daitoh M, Otomo Y, Matsuura N. One-step nucleic acid amplification for intraoperative detection of lymph node metastasis in breast cancer patients. Clin Cancer Res 2007; 13:4807-16. [PMID: 17699859 DOI: 10.1158/1078-0432.ccr-06-2512] [Citation(s) in RCA: 319] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Detection of sentinel lymph node (SLN) metastasis in breast cancer patients has conventionally been determined by intraoperative histopathologic examination of frozen sections followed by definitive postoperative examination of permanent sections. The purpose of this study is to develop a more efficient method for intraoperative detection of lymph node metastasis. EXPERIMENTAL DESIGN Cutoff values to distinguish macrometastasis, micrometastasis, and nonmetastasis were determined by measuring cytokeratin 19 (CK19) mRNA in histopathologically positive and negative lymph nodes using one-step nucleic acid amplification (OSNA). In an intraoperative clinical study involving six facilities, 325 lymph nodes (101 patients), including 81 SLNs, were divided into four blocks. Alternate blocks were used for the OSNA assay with CK19 mRNA, and the remaining blocks were used for H&E and CK19 immunohistochemistry-based three-level histopathologic examination. The results from the two methods were then compared. RESULTS We established CK19 mRNA cutoff values of 2.5 x 10(2) and 5 x 10(3) copies/muL. In the clinical study, an overall concordance rate between the OSNA assay and the three-level histopathology was 98.2%. Similar results were obtained with 81 SLNs. The OSNA assay discriminated macrometastasis from micrometastasis. No false positive was observed in the OSNA assay of 144 histopathologically negative lymph nodes from pN0 patients, indicating an extremely low false positive for the OSNA assay. CONCLUSION The OSNA assay of half of a lymph node provided results similar to those of three-level histopathology. Clinical results indicate that the OSNA assay provides a useful intraoperative detection method of lymph node metastasis in breast cancer patients.
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Cserni G. What is a positive sentinel lymph node in a breast cancer patient? A practical approach. Breast 2007; 16:152-60. [PMID: 17081752 DOI: 10.1016/j.breast.2006.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 07/29/2006] [Accepted: 07/31/2006] [Indexed: 10/24/2022] Open
Abstract
Sentinel lymph node (SN) biopsy has become increasingly used for the staging of breast carcinoma, resulting in the upstaging of this disease, and this has led to concerns with regard to what should be considered a positive SN. Factors influencing the positive staging of an SN include metastasis size, the method used for metastasis detection, the definition of metastasis and the individual pathologist. Until evidence to the contrary emerges, an SN should be considered positive if metastases (nodal involvement >0.2mm in the largest dimension) are detected in it by histology. A target size should be identified, and SNs, as the most likely sites of nodal metastases, should be searched systematically to find (nearly) all of the targeted metastases. The European guidelines for SN assessment have set two such target sizes: as a minimum, all metastases >2mm should be identified, and optimally all micrometastases should also be sought.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyiri ut 38, H-6000 Kecskemét, Hungary.
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Abstract
The sentinel lymph nodes are the most likely site of nodal metastasis. Their focused analysis results in upstaging cancers, although the extra yield from a more intensive work-up is generally dominated by micrometastases and isolated tumor cells. Nodal staging is generally done to reflect systemic spread of solid tumors and guide treatment accordingly. However, in general, the two processes of haematogenous and lymphogenic spread are not causally interrelated, and the extrapolation from low-volume nodal involvement to systemic involvement and therapeutic consequences of this extrapolation are still under investigation.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyiri ut 38, H-6000 Kecskemét, Hungary.
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Karp CM, Shukla MN, Buckley DJ, Buckley AR. HRPAP20: a novel calmodulin-binding protein that increases breast cancer cell invasion. Oncogene 2006; 26:1780-8. [PMID: 17001319 DOI: 10.1038/sj.onc.1209980] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We previously reported the identification of HRPAP20 (hormone-regulated proliferation-associated protein 20), a novel hormone-regulated, proliferation-associated protein. In tumor cell lines, constitutive HRPAP20 expression enhanced proliferation and suppressed apoptosis, characteristics frequently associated with malignant progression. Here, we report that highly invasive breast cancer cell lines and human breast tumor specimens express elevated HRPAP20, which in transfection experiments in MCF-7 and MDA-MB-231 cells, increased invasion. Results from mechanistic studies revealed that HRPAP20 bound to calmodulin (CaM) via a conserved CaM-binding motif. Transfection of MCF-7 breast cancer cells with HRPAP20 harboring a mutated CaM-binding motif (HRPAP20K73A) inhibited its interaction with CaM and failed to increase invasion. Other experiments revealed that transfection with HRPAP20, but not HRPAP20K73A, increased secretion of matrix metalloproteinase-9 (MMP-9). Moreover, knockdown of HRPAP20 with small interfering RNA in MCF-7/HRPAP20 transfectants and wild-type MDA-MB-231 cells reduced invasion and inhibited secretion of MMP-9. Together these observations suggest that HRPAP20 may be an important regulator of breast tumor cell invasion by a CaM-mediated mechanism that leads to increased MMP-9 secretion. We conclude that dysregulation of HRPAP20 expression in tumor cells may contribute to the observed phenotypic changes associated with breast cancer progression.
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Affiliation(s)
- C M Karp
- College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
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Mazumder A, Wang Y, Godsey JH. Molecular and cellular approaches to patient management in oncology. Per Med 2006; 3:299-310. [PMID: 29788655 DOI: 10.2217/17410541.3.3.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Many of the techniques that are employed today by pathologists and oncologists to generate a diagnosis, prognosis or prediction of response have not changed over several decades. However, new molecular and cellular technologies will enable more precise and objective decision-making. This review will detail some of the more recent developments in these areas from Veridex, LLC, academic laboratories and other commercial entities. The discussion of molecular technologies will focus on breast sentinel lymph node biopsy, prostate biopsy, carcinoma of unknown primary, prediction of recurrence in lymph node negative colon and breast cancers and pharmacogenomics. The discussion of cellular technologies will focus on the use of circulating cells to serve in both prognostic and predictive capacities and on the use of molecular methods to interrogate the DNA and RNA isolated from these circulating cells.
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Affiliation(s)
- Abhijit Mazumder
- Veridex LLC, a Johnson and Johnson company, 33 Technology Drive, Warren, NJ 07059, USA.
| | - Yixin Wang
- Veridex LLC, a Johnson and Johnson company, 33 Technology Drive, Warren, NJ 07059, USA.
| | - James H Godsey
- Veridex LLC, a Johnson and Johnson company, 33 Technology Drive, Warren, NJ 07059, USA.
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Dell'Orto P, Biasi MO, Del Curto B, Zurrida S, Galimberti V, Viale G. Assessing the status of axillary sentinel lymph nodes of breast carcinoma patients by a real-time quantitative RT-PCR assay for mammaglobin 1 mRNA. Breast Cancer Res Treat 2006; 98:185-90. [PMID: 16538532 DOI: 10.1007/s10549-005-9148-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 12/13/2005] [Indexed: 10/24/2022]
Abstract
The aim of the study was to assess the accuracy of a real-time quantitative RT-PCR (qRT-PCR) assay for mammaglobin 1 mRNA in the detection of metastatic breast cancer in axillary sentinel lymph nodes (SLN), comparing the results with those of qualitative RT-PCR assays and of an extensive histopathological examination. A retrospective series of 81 SLN from 72 patients and a validation series of 61 SLN from 61 patients were evaluated. In the retrospective series, the qRT-PCR assay was positive for 23 (28.4%) of the 81 SLN. The overall concordance with histopathology was 93.8%, with a sensitivity of 90.9%, a specificity of 94.9%, a positive predictive value (PPV) of 87% and a negative predictive value (NPV) of 96.6%. In the same series, qualitative RT-PCR showed an overall concordance with histopathology of 86.4%, a sensitivity of 72.7%, a specificity of 91.5%, a PPV of 76.2% and a NPV of 90%. In the validation series, including 23 patients with pure in situ carcinoma, the real-time qRT-PCR assay showed an overall concordance with the histopathologic findings of 93.4%, with a sensitivity of 75.0%, a specificity of 94.7%, a PPV of 50.0% and a NPV of 98.2%. We conclude that real-time qRT-PCR assays for mammaglobin 1 are more sensitive and specific that qualitative RT-PCR assays for the detection of metastatic breast carcinoma in axillary SLN, but it should not be regarded as a possible substitute for an extensive histopathological scrutiny of the SLN in the clinical practice.
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Affiliation(s)
- Patrizia Dell'Orto
- Department of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
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Sandvik AK, Alsberg BK, Nørsett KG, Yadetie F, Waldum HL, Laegreid A. Gene expression analysis and clinical diagnosis. Clin Chim Acta 2006; 363:157-64. [PMID: 16168978 DOI: 10.1016/j.cccn.2005.05.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Revised: 04/28/2005] [Accepted: 05/16/2005] [Indexed: 01/23/2023]
Abstract
BACKGROUND A new basis for diagnostic tests is being provided by the vast amount of data on gene expression that are now becoming available through large-scale measurement of mRNA abundance. The insights gained from these resources are most likely going to provide both a better basic understanding of disease mechanisms, and to identify molecular markers for more precise diagnoses and for prediction of prognosis and treatment response. METHODS Some quantitative RT-PCR assays are utilized today for diagnosis of both malignant and non-malignant disease, but the use of gene expression measurements in clinical medicine can be expected to increase dramatically. CONCLUSIONS There are important technical issues that must be adequately solved in order to obtain robust assays, such as standardized protocols with appropriate quality controls that ensure reliable data for the specific samples being analysed and good inter-laboratory reproducibility.
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Affiliation(s)
- A K Sandvik
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim.
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Viale G, Mastropasqua MG, Maiorano E, Mazzarol G. Pathologic examination of the axillary sentinel lymph nodes in patients with early-stage breast carcinoma: current and resolving controversies on the basis of the European Institute of Oncology experience. Virchows Arch 2005; 448:241-7. [PMID: 16362823 DOI: 10.1007/s00428-005-0103-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 10/17/2005] [Indexed: 10/25/2022]
Abstract
Several controversial aspects of sentinel lymph node biopsy (SLNB) for patients with early-stage, node-negative breast carcinoma have been dealt with and resolved in the past decade since its introduction. Unfortunately, however, there is still no consensus on how best to examine sentinel lymph nodes (SLN) histologically. As a consequence, the protocols for SLN examination are remarkably variable in different institutions, leading to a very poor reproducibility of the data stemming from investigations on series of patients whose SLNs have been evaluated according to diverse protocols. Patient outcomes, however, can be optimised only by standardization of the whole procedure of SLNB, with particular reference to the histopathologic scrutiny. Lack of a standardized histopathologic protocol likely derives also from the uncertainties about the clinical implications of minimal lymph node involvement (isolated tumour cells and micrometastases) with regard both to the risk of additional metastases to non-sentinel lymph nodes of the same basin and to the prognostic value for patients' survival. This review aims at highlighting some of the controversial issues of the histopathologic examination of the SLNs, including the number of sections and cutting intervals, the use of immunohistochemistry and the role of molecular biology assays.
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Affiliation(s)
- Giuseppe Viale
- Department of Pathology and Laboratory Medicine, European Institute of Oncology, Via Ripamonti, 435, Milan, Italy.
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Weeraratna AT. Discovering causes and cures for cancer from gene expression analysis. Ageing Res Rev 2005; 4:548-63. [PMID: 16243590 DOI: 10.1016/j.arr.2005.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 06/17/2005] [Indexed: 01/10/2023]
Abstract
Tumorigenesis is governed by a series of complex genetic and epigenetic changes. Both mechanisms can result in either the silencing or aberrant expression of messages in a cell. Gene expression profiling techniques such as the serial analysis of gene expression (SAGE) or microarray analysis can provide global overviews of these changes, as well identify key genes and pathways involved in this process. This review outlines the current roles of these techniques in cancer research, and how they may contribute to finding not only mechanisms of this disease, but potential targets for therapy.
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Affiliation(s)
- Ashani T Weeraratna
- Laboratory of Immunology, National Institutes of Health, National Institute on Aging, Gerontology Research Center, 5600 Nathan Shock Drive, Box 21, Baltimore, MD 21224, USA.
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Kohrt HE, Nouri N, Nowels K, Johnson D, Holmes S, Lee PP. Profile of immune cells in axillary lymph nodes predicts disease-free survival in breast cancer. PLoS Med 2005; 2:e284. [PMID: 16124834 PMCID: PMC1198041 DOI: 10.1371/journal.pmed.0020284] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Accepted: 07/14/2005] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While lymph node metastasis is among the strongest predictors of disease-free and overall survival for patients with breast cancer, the immunological nature of tumor-draining lymph nodes is often ignored, and may provide additional prognostic information on clinical outcome. METHODS AND FINDINGS We performed immunohistochemical analysis of 47 sentinel and 104 axillary (nonsentinel) nodes from 77 breast cancer patients with 5 y of follow-up to determine if alterations in CD4, CD8, and CD1a cell populations predict nodal metastasis or disease-free survival. Sentinel and axillary node CD4 and CD8 T cells were decreased in breast cancer patients compared to control nodes. CD1a dendritic cells were also diminished in sentinel and tumor-involved axillary nodes, but increased in tumor-free axillary nodes. Axillary node, but not sentinel node, CD4 T cell and dendritic cell populations were highly correlated with disease-free survival, independent of axillary metastasis. Immune profiling of ALN from a test set of 48 patients, applying CD4 T cell and CD1a dendritic cell population thresholds of CD4 > or = 7.0% and CD1a > or = 0.6%, determined from analysis of a learning set of 29 patients, provided significant risk stratification into favorable and unfavorable prognostic groups superior to clinicopathologic characteristics including tumor size, extent or size of nodal metastasis (CD4, p < 0.001 and CD1a, p < 0.001). Moreover, axillary node CD4 T cell and CD1a dendritic cell populations allowed more significant stratification of disease-free survival of patients with T1 (primary tumor size 2 cm or less) and T2 (5 cm or larger) tumors than all other patient characteristics. Finally, sentinel node immune profiles correlated primarily with the presence of infiltrating tumor cells, while axillary node immune profiles appeared largely independent of nodal metastases, raising the possibility that, within axillary lymph nodes, immune profile changes and nodal metastases represent independent processes. CONCLUSION These findings demonstrate that the immune profile of tumor-draining lymph nodes is of novel biologic and clinical importance for patients with early stage breast cancer.
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Affiliation(s)
- Holbrook E Kohrt
- 1Department of Medicine, Division of Hematology, Stanford University, Stanford, California, United States of America
| | - Navid Nouri
- 1Department of Medicine, Division of Hematology, Stanford University, Stanford, California, United States of America
| | - Kent Nowels
- 2Department of Pathology, Stanford University, Stanford, California, United States of America
| | - Denise Johnson
- 3Department of Surgery, Division of Surgical Oncology, Stanford University, Stanford, California, United States of America
| | - Susan Holmes
- 4Department of Statistics, Stanford University, Stanford, California, United States of America
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