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Bali C, Georvasili VK, Mitsis M, Vartholomatos G, Markopoulos GS. A response to 'A commentary on "Detection of cancer cells and tumor margins during colorectal cancer surgery by intraoperative flow cytometry"'. Int J Surg 2023; 109:3740-3741. [PMID: 37737905 PMCID: PMC10651240 DOI: 10.1097/js9.0000000000000667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Christina Bali
- Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences
| | - Vaia K. Georvasili
- Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences
- Biobank Cancer Center, University of Ioannina
| | - George Vartholomatos
- Hematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios S. Markopoulos
- Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences
- Hematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, Ioannina, Greece
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Petrilli LL, Fuoco C, Palma A, Pasquini L, Pericoli G, Grabovska Y, Mackay A, Rossi S, Carcaboso AM, Carai A, Mastronuzzi A, Jones C, Cesareni G, Locatelli F, Vinci M. Inter and intra-tumor heterogeneity of paediatric type diffuse high-grade gliomas revealed by single-cell mass cytometry. Front Oncol 2022; 12:1016343. [PMID: 36568177 PMCID: PMC9773089 DOI: 10.3389/fonc.2022.1016343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open
Abstract
Paediatric-type diffuse high-grade gliomas (PDHGG) are aggressive tumors affecting children and young adults, with no effective treatment. These highly heterogeneous malignancies arise in different sites of the Central Nervous System (CNS), carrying distinctive molecular alterations and clinical outcomes (inter-tumor heterogeneity). Moreover, deep cellular and molecular profiling studies highlighted the coexistence of genetically and phenotypically different subpopulations within the same tumor mass (intra-tumor heterogeneity). Despite the recent advances made in the field, the marked heterogeneity of PDHGGs still impedes the development of effective targeted therapies and the identification of suitable biomarkers. In order to fill the existing gap, we used mass cytometry to dissect PDHGG inter- and intra-heterogeneity. This is one of the most advanced technologies of the "-omics" era that, using antibodies conjugated to heavy metals, allows the simultaneous measurement of more than 40 markers at single-cell level. To this end, we analyzed eight PDHGG patient-derived cell lines from different locational and molecular subgroups. By using a panel of 15 antibodies, directly conjugated to metals or specifically customized to detect important histone variants, significant differences were highlighted in the expression of the considered antigens. The single-cell multiparametric approach realized has deepened our understanding of PDHGG, confirming a high degree of intra- and inter-tumoral heterogeneity and identifying some antigens that could represent useful biomarkers for the specific PDHGG locational or molecular subgroups.
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Affiliation(s)
- Lucia Lisa Petrilli
- Department of Onco-hematology, Gene and Cell Therapy, Bambino Gesù Children’s Hospital– IRCCS, Rome, Italy
| | - Claudia Fuoco
- Department of Biology, University of Rome “Tor Vergata”, Rome, Italy
| | - Alessandro Palma
- Department of Onco-hematology, Gene and Cell Therapy, Bambino Gesù Children’s Hospital– IRCCS, Rome, Italy
| | - Luca Pasquini
- Core Facilities, Istituto Superiore di Sanità, Rome, Italy
| | - Giulia Pericoli
- Department of Onco-hematology, Gene and Cell Therapy, Bambino Gesù Children’s Hospital– IRCCS, Rome, Italy
| | - Yura Grabovska
- Division of Molecular Pathology, Institute of Cancer Research, Sutton, United Kingdom
| | - Alan Mackay
- Division of Molecular Pathology, Institute of Cancer Research, Sutton, United Kingdom
| | - Sabrina Rossi
- Department of Laboratories-Pathology Unit, Bambino Gesù Children’s Hospital-IRCCS, Rome, Italy
| | - Angel M. Carcaboso
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Andrea Carai
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital -IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Neuro-oncology Unit, Department of Onco-haematology, Gene and Cell Therapy, Bambino Gesù Children’s Hospital-IRCCS, Rome, Italy
| | - Chris Jones
- Division of Molecular Pathology, Institute of Cancer Research, Sutton, United Kingdom
| | - Gianni Cesareni
- Department of Biology, University of Rome “Tor Vergata”, Rome, Italy
| | - Franco Locatelli
- Department of Onco-hematology, Gene and Cell Therapy, Bambino Gesù Children’s Hospital– IRCCS, Rome, Italy
| | - Maria Vinci
- Department of Onco-hematology, Gene and Cell Therapy, Bambino Gesù Children’s Hospital– IRCCS, Rome, Italy
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Georvasili VK, Markopoulos GS, Batistatou A, Mitsis M, Messinis T, Lianos GD, Alexiou G, Vartholomatos G, Bali CD. Detection of cancer cells and tumor margins during colorectal cancer surgery by intraoperative flow cytometry. Int J Surg 2022; 104:106717. [PMID: 35724804 DOI: 10.1016/j.ijsu.2022.106717] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/22/2022] [Accepted: 06/06/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Flow Cytometry is an analytical technique for the precise quantification of cellular phenotype. Intraoperative Flow Cytometry (iFC) utilizes flow cytometry for DNA content/ploidy and cell cycle distribution analysis during surgery for cancer cell characterization and evaluation of tumor margins. Various types of cancers, including intracranial, head and neck, breast and liver malignancies have been evaluated with iFC. In the current study we present an intraoperative Flow Cytometry protocol for colorectal cancer cell detection and potential resection margin evaluation. MATERIALS AND METHODS This study includes 106 colorectal cancer patients in which samples from cancer and normal colon epithelium were prospectively collected intraoperatively and comparatively assessed with iFC. Patients' demographics, tumor data and cytometry parameters were assessed. RESULTS We have demonstrated that a cut-off value of 10.5% for tumor-index (fraction of cells in S and G2/M cell cycle phases) predicts with ∼91% accuracy (82.2% sensitivity and 99.9% specificity) the presence of cancer cells. Evaluation of tumor margins by iFC in the subpopulation of rectal cancer patients with or without neoadjuvant therapy, revealed an accuracy of 79% and 88%, respectively. CONCLUSION Our data support that regarding colorectal cancer, iFC is a useful adjunct method for tumor cell identification and probably margin evaluation, which could be utilized in rectal cancer treatment in the era of organ sparing procedures.
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Affiliation(s)
- Vaia K Georvasili
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Anna Batistatou
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Michael Mitsis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Thomas Messinis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - George Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Christina D Bali
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece.
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Markopoulos GS, Glantzounis GK, Goussia AC, Lianos GD, Karampa A, Alexiou GA, Vartholomatos G. Touch Imprint Intraoperative Flow Cytometry as a Complementary Tool for Detailed Assessment of Resection Margins and Tumor Biology in Liver Surgery for Primary and Metastatic Liver Neoplasms. Methods Protoc 2021; 4:mps4030066. [PMID: 34564312 PMCID: PMC8482241 DOI: 10.3390/mps4030066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/14/2022] Open
Abstract
Liver resection is the main treatment for primary and metastatic liver tumors in order to achieve long-term survival with good quality of life. The ultimate goal of surgical oncology is to achieve complete tumor removal with adequate clear surgical margins. Flow cytometry is a powerful analytical technique with applications such as phenotypic analysis and quantification of DNA content. Intraoperative flow cytometry (iFC) is the application of flow cytometry for DNA content/ploidy and cell cycle distribution analysis during surgery for tumor cell analysis and margin evaluation. It has been used for cell analysis of intracranial tumors and recently of head and neck carcinomas and breast carcinomas, as well as for tumor margin evaluation. Herein, we present a novel touch imprint iFC protocol for the detailed assessment of tumor margins during excision of malignant hepatic lesions. The protocol aims to offer information on surgical margins after removal of malignant liver tumors based on DNA content of cancer cells and to corroborate the results of iFC with that of histopathological analysis. Based on the established role of iFC in other types of malignancies, our specialized protocol has the potential, through characterization of cells in liver transection surface post hepatectomy, to offer significant information on the type of resection and tumor biology. This information can be used to effectively guide intra- and postoperative patient management.
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Affiliation(s)
- Georgios S. Markopoulos
- Neurosurgical Institute, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (G.S.M.); (G.A.A.)
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, 45110 Ioannina, Greece
| | - Georgios K. Glantzounis
- Department of Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (G.K.G.); (G.D.L.); (A.K.)
| | - Anna C. Goussia
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Georgios D. Lianos
- Department of Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (G.K.G.); (G.D.L.); (A.K.)
| | - Anastasia Karampa
- Department of Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (G.K.G.); (G.D.L.); (A.K.)
| | - George A. Alexiou
- Neurosurgical Institute, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (G.S.M.); (G.A.A.)
- Department of Neurosurgery, University of Ioannina, 45110 Ioannina, Greece
| | - George Vartholomatos
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, 45110 Ioannina, Greece
- Correspondence:
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Vartholomatos E, Vartholomatos G, Alexiou GA, Markopoulos GS. The Past, Present and Future of Flow Cytometry in Central Nervous System Malignancies. Methods Protoc 2021; 4:mps4010011. [PMID: 33530325 PMCID: PMC7839046 DOI: 10.3390/mps4010011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
Central nervous system malignancies (CNSMs) are categorized among the most aggressive and deadly types of cancer. The low median survival in patients with CNSMs is partly explained by the objective difficulties of brain surgeries as well as by the acquired chemoresistance of CNSM cells. Flow Cytometry is an analytical technique with the ability to quantify cell phenotype and to categorize cell populations on the basis of their characteristics. In the current review, we summarize the Flow Cytometry methodologies that have been used to study different phenotypic aspects of CNSMs. These include DNA content analysis for the determination of malignancy status and phenotypic characterization, as well as the methodologies used during the development of novel therapeutic agents. We conclude with the historical and current utility of Flow Cytometry in the field, and we propose how we can exploit current and possible future methodologies in the battle against this dreadful type of malignancy.
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Affiliation(s)
- Evrysthenis Vartholomatos
- Faculty of Medicine, Neurosurgical Institute, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (E.V.); (G.A.A.)
| | - George Vartholomatos
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, 45110 Ioannina, Greece;
| | - George A. Alexiou
- Faculty of Medicine, Neurosurgical Institute, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (E.V.); (G.A.A.)
- Department of Neurosurgery, University of Ioannina, 45110 Ioannina, Greece
| | - Georgios S. Markopoulos
- Faculty of Medicine, Neurosurgical Institute, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (E.V.); (G.A.A.)
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, 45110 Ioannina, Greece;
- Correspondence:
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Alexiou GA, Vartholomatos G, Kobayashi T, Voulgaris S, Kyritsis AP. The emerging role of intraoperative flow cytometry in intracranial tumor surgery. Clin Neurol Neurosurg 2020; 192:105742. [PMID: 32087499 DOI: 10.1016/j.clineuro.2020.105742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 12/29/2022]
Abstract
Intraoperative flow cytometry has been recently emerged as a novel and promising tool for intracranial tumor surgery. Herewith, we discuss the role of intraoperative flow cytometry for the identification of gliomas boundaries, which may permit maximal resection and better prognosis. We also discuss its role in assessing tumor's grade of malignancy, both in adults and children and the prognostic information that may provide. Finally, intraoperative immunophenotypic analysis opens new horizons for flow cytometry. By evaluating tumor's specific cluster differentiation markers a diagnosis, within minutes, of certain tumor type can be achieved and additional information for therapeutic guidance can be provided.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Greece; Neurosurgical Research Institute, University of Ioannina, Greece.
| | - George Vartholomatos
- Neurosurgical Research Institute, University of Ioannina, Greece; Department of Hematology-Unit of Molecular Biology, University Hospital of Ioannina, Greece
| | - Tatsuya Kobayashi
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan; Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Greece; Neurosurgical Research Institute, University of Ioannina, Greece
| | - Athanasios P Kyritsis
- Neurosurgical Research Institute, University of Ioannina, Greece; Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
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Andreou M, Vartholomatos E, Harissis H, Markopoulos GS, Alexiou GA. Past, Present and Future of Flow Cytometry in Breast Cancer - A Systematic Review. EJIFCC 2019; 30:423-437. [PMID: 31814815 PMCID: PMC6893890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast cancer is the most common malignancy in women worldwide. In this systematic review 28 studies were taken into account, in order to evaluate the role of DNA content and cell cycle phases, measured by flow cytometry in breast cancer. Presence of aneuploidy and S-phase fraction have been extensively studied as a prognostication tool. With the current dawn of the age of intraoperative flow cytometry the present systematic review provide an insight of the current role of flow cytometry in breast cancer and future horizons.
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Affiliation(s)
- Maria Andreou
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, Greece
| | | | | | - Georgios S. Markopoulos
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, Greece
- Laboratory of Biology, Department of Medicine, Faculty of Medicine, School of Health Sciences, Ioannina, Greece
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