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Cytomorphological Characterization of Individual Metastatic Tumor Cells from Gastrointestinal Cancer Patient Lymph Nodes with Imaging Flow Cytometry. GASTROINTESTINAL DISORDERS 2019. [DOI: 10.3390/gidisord1040030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The presence or absence of tumor cells within patient lymph nodes is an important prognostic indicator in a number of cancer types and an essential element of the staging process. However, patients with the same pathological stage will not necessarily have the same outcome. Therefore, additional factors may aid in identifying patients at a greater risk of developing metastasis. In this proof of principle study, initially, spiked tumor cells in rat lymph nodes were used to mimic a node with a small cancer deposit. Next, human lymph nodes were obtained from cancer patients for morphological characterization. Nodes were dissociated with a manual tissue homogenizer and stained with fluorescent antibodies against CD45 and Pan-Cytokeratin and then imaging flow cytometry (AMNIS ImageStreamX Mark II) was performed. We show here that imaging flow cytometry can be used for the detection and characterization of small numbers of cancer cells in lymph nodes and we also demonstrate the phenotypical and morphological characterization of cancer cells in gastrointestinal cancer patient lymph nodes. When used in addition to conventional histological techniques, this high throughput detection of tumor cells in lymph nodes may offer additional information assisting in the staging process with therapeutic and prognostic applications.
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Dihge L, Grabau DA, Rasmussen RW, Bendahl PO, Rydén L. The accuracy of preoperative axillary nodal staging in primary breast cancer by ultrasound is modified by nodal metastatic load and tumor biology. Acta Oncol 2016; 55:976-82. [PMID: 27050668 PMCID: PMC4950423 DOI: 10.3109/0284186x.2016.1146826] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The outcome of axillary ultrasound (AUS) with fine-needle aspiration biopsy (FNAB) in the diagnostic work-up of primary breast cancer has an impact on therapy decisions. We hypothesize that the accuracy of AUS is modified by nodal metastatic burden and clinico-pathological characteristics. Material and methods The performance of AUS and AUS-guided FNAB for predicting nodal metastases was assessed in a prospective breast cancer cohort subjected for surgery during 2009–2012. Predictors of accuracy were included in multivariate analysis. Results AUS had a sensitivity of 23% and a specificity of 95%, while AUS-guided FNAB obtained 73% and 100%, respectively. AUS-FNAB exclusively detected macro-metastases (median four metastases) and identified patients with more extensive nodal metastatic burden in comparison with sentinel node biopsy. The accuracy of AUS was affected by metastatic size (OR 1.11), obesity (OR 2.46), histological grade (OR 4.43), and HER2-status (OR 3.66); metastatic size and histological grade were significant in the multivariate analysis. Conclusions The clinical utility of AUS in low-risk breast cancer deserves further evaluation as the accuracy decreased with a low nodal metastatic burden. The diagnostic performance is modified by tumor and clinical characteristics. Patients with nodal disease detected by AUS-FNAB represent a group for whom neoadjuvant therapy should be considered.
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Affiliation(s)
- Looket Dihge
- Institution of Clinical Sciences Lund, Department of Surgery, Lund University, Skåne University Hospital, Lund, Sweden
- Hallands Sjukhus Halmstad, Halmstad, Sweden
| | - Dorthe A. Grabau
- Institution of Clinical Sciences Lund, Department of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Clinical Pathology, Laboratory Medicine Skåne, Lund, Sweden
| | | | - Pär-Ola Bendahl
- Institution of Clinical Sciences Lund, Department of Oncology and Pathology, Lund University, Lund, Sweden
| | - Lisa Rydén
- Institution of Clinical Sciences Lund, Department of Surgery, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Surgery and Urology, Skåne University Hospital, Malmö, Sweden
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Khoo JJ, Ng CS, Sabaratnam S, Arulanantham S. Sentinel Node Biopsy Examination for Breast Cancer in a Routine Laboratory Practice: Results of a Pilot Study. Asian Pac J Cancer Prev 2016; 17:1149-55. [DOI: 10.7314/apjcp.2016.17.3.1149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kjölhede H, Bratt O, Gudjonsson S, Sundqvist P, Liedberg F. Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer. Scand J Urol 2014; 49:97-102. [DOI: 10.3109/21681805.2014.968867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Winter M, Gibson R, Ruszkiewicz A, Thompson SK, Thierry B. Beyond conventional pathology: Towards preoperative and intraoperative lymph node staging. Int J Cancer 2014; 136:743-51. [DOI: 10.1002/ijc.28742] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/23/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Marnie Winter
- Ian Wark Research Institute; University of South Australia; Adelaide SA Australia
| | - Rachel Gibson
- Discipline of Anatomy and Pathology School of Medical Sciences; University of Adelaide; Adelaide SA Australia
| | | | - Sarah K. Thompson
- Department of Surgery Royal Adelaide Hospital and School of Health Sciences; University of South Australia; Adelaide SA Australia
| | - Benjamin Thierry
- Ian Wark Research Institute; University of South Australia; Adelaide SA Australia
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Dauplat MM, Barranger E, Classe JM, Toledano A, Houvenaeghel G. L’exploration et le traitement de la région axillaire des tumeurs infiltrantes du sein (RPC 2013). ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2340-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ainsworth RK, Kollias J, Blanc AL, Silva PD. The clinical impact of the American College of Surgeons Oncology Group Z-0011 trial – Results from the BreastSurgANZ National Breast Cancer Audit. Breast 2013; 22:733-5. [DOI: 10.1016/j.breast.2012.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022] Open
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8
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Kirwan CC, Debnath D, Howe MC, Johnson RK, Bundred NJ. Letter to the editor regarding manuscript entitled: completion axillary dissection can safely be omitted in screen detected breast cancer patients with micrometastases. A decade's experience from a single institution. Grabau D, Dihge L, Ferno M, Ingvar C, Ryden L. Eur J Surg Oncol. 2013 Jun;39(6):601-7. Eur J Surg Oncol 2013; 39:1294-5. [PMID: 24007836 DOI: 10.1016/j.ejso.2013.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/09/2013] [Indexed: 11/15/2022] Open
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9
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Kim B, Verghese ET, Horgan K. Causes of false-negative sentinel node biopsy in patients with breast cancer (Br J Surg 2013; 100: 775-783). Br J Surg 2013; 100:1398-9. [PMID: 23939859 DOI: 10.1002/bjs.9250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Grabau D, Dihge L, Fernö M, Ingvar C, Rydén L. Completion axillary dissection can safely be omitted in screen detected breast cancer patients with micrometastases. A decade's experience from a single institution. Eur J Surg Oncol 2013; 39:601-7. [DOI: 10.1016/j.ejso.2013.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/21/2013] [Accepted: 03/13/2013] [Indexed: 12/25/2022] Open
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11
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Dauplat MM, Mishellany F, Radosevic-Robin N, Tréchot I, Tixier L, Penault-Llorca F. Analyse peropératoire et définitive du ganglion sentinelle (GS), classification de l’atteinte ganglionnaire. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Uehiro N, Horii R, Iwase T, Tanabe M, Sakai T, Morizono H, Kimura K, Iijima K, Miyagi Y, Nishimura S, Makita M, Ito Y, Akiyama F. Validation study of the UICC TNM classification of malignant tumors, seventh edition, in breast cancer. Breast Cancer 2013; 21:748-53. [DOI: 10.1007/s12282-013-0453-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 02/01/2013] [Indexed: 10/27/2022]
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Andersson Y, Frisell J, Sylvan M, de Boniface J, Bergkvist L. Causes of false-negative sentinel node biopsy in patients with breast cancer. Br J Surg 2013; 100:775-83. [DOI: 10.1002/bjs.9085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2013] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection as the routine staging procedure in clinically node-negative breast cancer. False-negative SLN biopsy results in misclassification and may cause undertreatment of the disease. The aim of this study was to investigate whether serial sectioning of SLNs reveals metastases more frequently in patients with false-negative SLNs than in patients with true-negative SLNs.
Methods
This was a case–control study. Tissue blocks from patients with false-negative SLNs, defined as tumour-positive lymph nodes excised at completion axillary dissection or a subsequent axillary tumour recurrence, were reassessed by serial sectioning and immunohistochemical staining. For each false-negative node, two true-negative SLN biopsies were analysed. Tumour and node characteristics in patients with false-negative SLNs were compared with those in patients with a positive SLN by univariable and multivariable regression analysis.
Results
Undiagnosed SLN metastases were discovered in nine (18 per cent) of 50 patients in the false-negative group and in 12 (11.2 per cent) of 107 patients in the true-negative group (P = 0.245). The metastases were represented by isolated tumour cells in 14 of these 21 patients. The risk of a false-negative SLN was higher in patients with hormone receptor-negative (odds ratio (OR) 2.50, 95 per cent confidence interval 1.17 to 5.33) or multifocal tumours (OR 3.39, 1.71 to 6.71), or if only one SLN was identified (OR 3.57, 1.98 to 6.45).
Conclusion
SLN serial sectioning contributes to a higher rate of detection of SLN metastasis. The rate of upstaging of the tumour is similar in false- and true-negative groups of patients.
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Affiliation(s)
- Y Andersson
- Department of Surgery, Central Hospital, Västerås, Sweden
| | - J Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Endocrine and Breast Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Sylvan
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - J de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Endocrine and Breast Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - L Bergkvist
- Department of Surgery, Central Hospital, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden
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Saegusa-Beecroft E, Machi J, Mamou J, Hata M, Coron A, Yanagihara ET, Yamaguchi T, Oelze ML, Laugier P, Feleppa EJ. Three-dimensional quantitative ultrasound for detecting lymph node metastases. J Surg Res 2013; 183:258-69. [PMID: 23333189 DOI: 10.1016/j.jss.2012.12.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 11/12/2012] [Accepted: 12/07/2012] [Indexed: 01/27/2023]
Abstract
PURPOSE Detection of metastases in lymph nodes (LNs) is critical for cancer management. Conventional histological methods may miss metastatic foci. To date, no practical means of evaluating the entire LN volume exists. The aim of this study was to develop fast, reliable, operator-independent, high-frequency, quantitative ultrasound (QUS) methods for evaluating LNs over their entire volume to effectively detect LN metastases. METHODS We scanned freshly excised LNs at 26 MHz and digitally acquired echo-signal data over the entire three-dimensional (3D) volume. A total of 146 LNs of colorectal, 26 LNs of gastric, and 118 LNs of breast cancer patients were enrolled. We step-sectioned LNs at 50-μm intervals and later compared them with 13 QUS estimates associated with tissue microstructure. Linear-discriminant analysis classified LNs as metastatic or nonmetastatic, and we computed areas (Az) under receiver-operator characteristic curves to assess classification performance. The QUS estimates and cancer probability values derived from discriminant analysis were depicted in 3D images for comparison with 3D histology. RESULTS Of 146 LNs of colorectal cancer patients, 23 were metastatic; Az = 0.952 ± 0.021 (95% confidence interval [CI]: 0.911-0.993); sensitivity = 91.3% (specificity = 87.0%); and sensitivity = 100% (specificity = 67.5%). Of 26 LNs of gastric cancer patients, five were metastatic; Az = 0.962 ± 0.039 (95% CI: 0.807-1.000); sensitivity = 100% (specificity = 95.3%). A total of 17 of 118 LNs of breast cancer patients were metastatic; Az = 0.833 ± 0.047 (95% CI: 0.741-0.926); sensitivity = 88.2% (specificity = 62.5%); sensitivity = 100% (specificity = 50.5%). 3D cancer probability images showed good correlation with 3D histology. CONCLUSIONS These results suggest that operator- and system-independent QUS methods allow reliable entire-volume LN evaluation for detecting metastases. 3D cancer probability images can help pathologists identify metastatic foci that could be missed using conventional methods.
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Affiliation(s)
- Emi Saegusa-Beecroft
- Department of Surgery, University of Hawaii and Kuakini Medical Center, Honolulu, Hawaii 96817, USA.
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Vera-Román JM. [Advances on breast cancer: a perspective]. Med Clin (Barc) 2012; 139:293-4. [PMID: 22672964 DOI: 10.1016/j.medcli.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 03/22/2012] [Accepted: 04/12/2012] [Indexed: 11/29/2022]
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