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Noltes ME, Kruijff S, Appelman APA, Jansen L, Zandee WT, Links TP, van Hemel BM, Schouw HM, Dierckx RAJO, Francken AB, Kelder W, van der Hoorn A, Brouwers AH. Head-to-head comparison of [ 11C]methionine PET, [ 11C]choline PET, and 4-dimensional CT as second-line scans for detection of parathyroid adenomas in primary hyperparathyroidism. Eur J Nucl Med Mol Imaging 2024; 51:1050-1059. [PMID: 37975887 PMCID: PMC10881780 DOI: 10.1007/s00259-023-06488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Accurate preoperative localization is imperative to guide surgery in primary hyperparathyroidism (pHPT). It remains unclear which second-line imaging technique is most effective after negative first-line imaging. In this study, we compare the diagnostic effectiveness of [11C]methionine PET/CT, [11C]choline PET/CT, and four dimensional (4D)-CT head-to-head in patients with pHPT, to explore which of these imaging techniques to use as a second-line scan. METHODS We conducted a powered, prospective, blinded cohort study in patients with biochemically proven pHPT and prior negative or discordant first-line imaging consisting of ultrasonography and 99mTc-sestamibi. All patients underwent [11C]methionine PET/CT, [11C]choline PET/CT, and 4D-CT. At first, all scans were interpreted by a nuclear medicine physician, and a radiologist who were blinded from patient data and all imaging results. Next, a non-blinded scan reading was performed. The scan results were correlated with surgical and histopathological findings. Serum calcium values at least 6 months after surgery were used as gold standard for curation of HPT. RESULTS A total of 32 patients were included in the study. With blinded evaluation, [11C]choline PET/CT was positive in 28 patients (88%), [11C]methionine PET/CT in 23 (72%), and 4D-CT in 15 patients (47%), respectively. In total, 30 patients have undergone surgery and 32 parathyroid lesions were histologically confirmed as parathyroid adenomas. Based on the blinded evaluation, lesion-based sensitivity of [11C]choline PET/CT, [11C]methionine PET/CT, and 4D-CT was respectively 85%, 67%, and 39%. The sensitivity of [11C]choline PET/CT differed significantly from that of [11C]methionine PET/CT and 4D-CT (p = 0.031 and p < 0.0005, respectively). CONCLUSION In the setting of pHPT with negative first-line imaging, [11C]choline PET/CT is superior to [11C]methionine PET/CT and 4D-CT in localizing parathyroid adenomas, allowing correct localization in 85% of adenomas. Further studies are needed to determine cost-benefit and efficacy of these scans, including the timing of these scans as first- or second-line imaging techniques.
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Affiliation(s)
- Milou E Noltes
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Auke P A Appelman
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Liesbeth Jansen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wouter T Zandee
- Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thera P Links
- Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hugo M Schouw
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | | | - Wendy Kelder
- Department of Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Metman MJH, Jonker PKC, Sondorp LHJ, van Hemel BM, Sywak MS, Gill AJ, Jansen L, van Diest PJ, van Ginhoven TM, Löwik CWGM, Nguyen AH, Robinson DJ, van Dam GM, Links TP, Coppes RP, Fehrmann RSN, Kruijff S. MET-receptor targeted fluorescent imaging and spectroscopy to detect multifocal papillary thyroid cancer. Eur J Nucl Med Mol Imaging 2023:10.1007/s00259-023-06525-5. [PMID: 38017325 DOI: 10.1007/s00259-023-06525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Multifocal disease in PTC is associated with an increased recurrence rate. Multifocal disease (MD) is underdiagnosed with the current gold standard of pre-operative ultrasound staging. Here, we evaluate the use of EMI-137 targeted molecular fluorescence-guided imaging (MFGI) and spectroscopy as a tool for the intra-operative detection of uni- and multifocal papillary thyroid cancer (PTC) aiming to improve disease staging and treatment selection. METHODS A phase-1 study (NCT03470259) with EMI-137 was conducted to evaluate the possibility of detecting PTC using MFGI and quantitative fiber-optic spectroscopy. RESULTS Fourteen patients underwent hemi- or total thyroidectomy (TTX) after administration of 0.09 mg/kg (n = 1), 0.13 mg/kg (n = 8), or 0.18 mg/kg (n = 5) EMI-137. Both MFGI and spectroscopy could differentiate PTC from healthy thyroid tissue after administration of EMI-137, which binds selectively to MET in PTC. 0.13 mg/kg was the lowest dosage EMI-137 that allowed for differentiation between PTC and healthy thyroid tissue. The smallest PTC focus detected by MFGI was 1.4 mm. MFGI restaged 80% of patients from unifocal to multifocal PTC compared to ultrasound. CONCLUSION EMI-137-guided MFGI and spectroscopy can be used to detect multifocal PTC. This may improve disease staging and treatment selection between hemi- and total thyroidectomy by better differentiation between unifocal and multifocal disease. TRIAL REGISTRATION NCT03470259.
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Affiliation(s)
- Madelon J H Metman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Pascal K C Jonker
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
- Department of Endocrine Surgery and Surgical Oncology, Royal North Shore Hospital, St Leonards, Australia
| | - Luc H J Sondorp
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
- Department of Biomedical Sciences of Cell & Systems - Section Molecular Cell Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mark S Sywak
- Department of Endocrine Surgery and Surgical Oncology, Royal North Shore Hospital, St Leonards, Australia
| | - Anthony J Gill
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Cancer Diagnosis and Pathology Group Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Australia
| | - Liesbeth Jansen
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, USA
| | | | - Clemens W G M Löwik
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Anh H Nguyen
- Department of Pathology, Erasmus MC, Rotterdam, the Netherlands
| | - Dominic J Robinson
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Gooitzen M van Dam
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- AxelaRx/TRACER B.V, Groningen, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rob P Coppes
- Department of Biomedical Sciences of Cell & Systems - Section Molecular Cell Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rudolf S N Fehrmann
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Lončar I, van Velsen EFS, Massolt ET, van Kemenade FJ, van Engen-van Grunsven ACH, van Hemel BM, van Nederveen FH, Netea-Maier R, Links TP, Peeters RP, van Ginhoven TM. European experience with the Afirma Gene Expression Classifier for indeterminate thyroid nodules: A clinical utility study in the Netherlands. Head Neck 2023; 45:2227-2236. [PMID: 37490544 DOI: 10.1002/hed.27472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/30/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The Gene Expression Classifier (GEC) and Genomic Sequencing Classifier (GSC) were developed to improve risk stratification of indeterminate nodules. Our aim was to assess the clinical utility in a European population with restrictive diagnostic workup. METHODS Clinical utility of the GEC was assessed in a prospective multicenter cohort of 68 indeterminate nodules. Diagnostic surgical rates for Bethesda III and IV nodules were compared to a historical cohort of 171 indeterminate nodules. Samples were post hoc tested with the GSC. RESULTS The GEC classified 26% as benign. Surgical rates between the prospective and historical cohort did not differ (72.1% vs. 76.6%). The GSC classified 59% as benign, but misclassified six malignant lesions as benign. CONCLUSION Implementation of GEC in management of indeterminate nodules in a European country with restrictive diagnostic workup is currently not supported, especially in oncocytic nodules. Prospective studies with the GSC in European countries are needed to determine the clinical utility.
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Affiliation(s)
- Ivona Lončar
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Evert F S van Velsen
- Department of Internal Medicine, Erasmus MC Academic Center for Thyroid Diseases, Rotterdam, the Netherlands
| | - Elske T Massolt
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | | | - Bettien M van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Romana Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus MC Academic Center for Thyroid Diseases, Rotterdam, the Netherlands
| | - Tessa M van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Noltes ME, Bader M, Metman MJH, Vonk J, Steinkamp PJ, Kukačka J, Westerlaan HE, Dierckx RAJO, van Hemel BM, Brouwers AH, van Dam GM, Jüstel D, Ntziachristos V, Kruijff S. Towards in vivo characterization of thyroid nodules suspicious for malignancy using multispectral optoacoustic tomography. Eur J Nucl Med Mol Imaging 2023; 50:2736-2750. [PMID: 37039901 PMCID: PMC10317911 DOI: 10.1007/s00259-023-06189-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/05/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Patient-tailored management of thyroid nodules requires improved risk of malignancy stratification by accurate preoperative nodule assessment, aiming to personalize decisions concerning diagnostics and treatment. Here, we perform an exploratory pilot study to identify possible patterns on multispectral optoacoustic tomography (MSOT) for thyroid malignancy stratification. For the first time, we directly correlate MSOT images with histopathology data on a detailed level. METHODS We use recently enhanced data processing and image reconstruction methods for MSOT to provide next-level image quality by means of improved spatial resolution and spectral contrast. We examine optoacoustic features in thyroid nodules associated with vascular patterns and correlate these directly with reference histopathology. RESULTS Our methods show the ability to resolve blood vessels with diameters of 250 μm at depths of up to 2 cm. The vessel diameters derived on MSOT showed an excellent correlation (R2-score of 0.9426) with the vessel diameters on histopathology. Subsequently, we identify features of malignancy observable in MSOT, such as intranodular microvascularity and extrathyroidal extension verified by histopathology. Despite these promising features in selected patients, we could not determine statistically relevant differences between benign and malignant thyroid nodules based on mean oxygen saturation in thyroid nodules. Thus, we illustrate general imaging artifacts of the whole field of optoacoustic imaging that reduce image fidelity and distort spectral contrast, which impedes quantification of chromophore presence based on mean concentrations. CONCLUSION We recommend examining optoacoustic features in addition to chromophore quantification to rank malignancy risk. We present optoacoustic images of thyroid nodules with the highest spatial resolution and spectral contrast to date, directly correlated to histopathology, pushing the clinical translation of MSOT.
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Affiliation(s)
- Milou E Noltes
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Maximilian Bader
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Madelon J H Metman
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jasper Vonk
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter J Steinkamp
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan Kukačka
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Henriette E Westerlaan
- Department of Radiology, University Medical Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gooitzen M van Dam
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- AxelaRx/TRACER Europe BV, Groningen, the Netherlands
| | - Dominik Jüstel
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Munich Institute of Robotics and Machine Intelligence (MIRMI), Technical University of Munich, Munich, Germany
| | - Schelto Kruijff
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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van Schaik JE, Muller Kobold AC, van der Laan BFAM, van der Vegt B, van Hemel BM, Plaat BEC. SCC Antigen Concentrations in Fine-Needle Aspiration Samples to Detect Cervical Lymph Node Metastases: A Prospective Analysis. Otolaryngol Head Neck Surg 2023; 168:407-412. [PMID: 35639471 DOI: 10.1177/01945998221102870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the diagnostic value of measuring squamous cell carcinoma antigen (SCC-Ag) and cancer antigen 15-3 (CA15-3) concentrations in fine-needle aspiration (FNA) samples for the detection of squamous cell carcinoma (SCC) metastases in cervical lymph nodes. STUDY DESIGN A prospective study with patients consecutively included between November 2018 and May 2021. SETTING A tertiary head and neck oncologic center. METHODS Out of 138 patients, SCC-Ag concentrations were analyzed in 168 FNA cervical lymph node samples and CA15-3 in 152 samples. Results were compared with FNA cytology (FNAC) or definitive histology to establish sensitivity and specificity rates. RESULTS For the detection of cervical SCC lymph node metastases, SCC-Ag measurement had an 89.4% sensitivity and 79.3% specificity at a cutoff concentration of 0.1 µg/L. Measurement of CA15-3 concentration in addition to SCC-Ag concentration did not lead to improved accuracy for the detection of SCC. In histology-confirmed cases, FNAC had an 80.0% sensitivity and 100% specificity, as opposed to 93.3% and 57.1%, respectively, for SCC-Ag. CONCLUSION Measurement of SCC-Ag concentration for detection of SCC lymph node metastases has a sensitivity at least comparable to FNAC and could be used as a relatively cheap screening tool in samples with nondiagnostic or indeterminate FNAC results or when multiple lymph nodes are sampled. However, SCC-Ag in FNA samples has a lower specificity than FNAC assessed by pathologists experienced in head and neck oncology. Addition of CA15-3 measurement did not lead to improved accuracy.
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Affiliation(s)
- Jeroen E van Schaik
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anna C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Lubbers JM, Koopman B, de Klerk‐Sluis JM, van Rooij N, Plat A, Pijper H, Koopman T, van Hemel BM, Hollema H, Wisman B, Nijman HW, de Bruyn M. Association of homozygous variants of STING1 with outcome in human cervical cancer. Cancer Sci 2021; 112:61-71. [PMID: 33040406 PMCID: PMC7780010 DOI: 10.1111/cas.14680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 01/04/2023] Open
Abstract
DNA-sensing receptor Cyclic GMP-AMP Synthase (cGAS) and its downstream signaling effector STimulator of INterferon Genes (STING) have gained significant interest in the field of tumor immunology, as a dysfunctional cGAS-STING pathway is associated with poor prognosis and worse response to immunotherapy. However, studies so far have not taken into account the polymorphic nature of the STING-encoding STING1 gene. We hypothesized that the presence of allelic variance in STING1 would cause variation between individuals as to their susceptibility to cancer development, cancer progression, and potential response to (immuno)therapy. To start to address this, we defined the genetic landscapes of STING1 in cervical scrapings and investigated their corresponding clinical characteristics across a unique cohort of cervical cancer patients and compared them with independent control cohorts. Although we did not observe an enrichment of particular STING1 allelic variants in cervical cancer patients, we did find that the occurrence of homozygous variants HAQ/HAQ and R232H/R232H of STING1 were associated with both younger age of diagnosis and higher recurrence rate. These findings were accompanied by worse survival, despite comparable mRNA and protein levels of STING and numbers of infiltrated CD8+ T cells. Our findings suggest that patients with HAQ/HAQ and R232H/R232H genotypes may have a dysfunctional cGAS-STING pathway that fails to promote efficient anticancer immunity. Interestingly, the occurrence of these genotypes coincided with homozygous presence of the V48V variant, which was found to be individually associated with worse outcome. Therefore, we propose V48V to be further evaluated as a novel prognostic marker for cervical cancer.
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Affiliation(s)
- Joyce M. Lubbers
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Bart Koopman
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Jessica M. de Klerk‐Sluis
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Nienke van Rooij
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Annechien Plat
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Harry Pijper
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Timco Koopman
- Department of PathologyPathologie FrieslandLeeuwardenThe Netherlands
| | - Bettien M. van Hemel
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Harry Hollema
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Bea Wisman
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Hans W. Nijman
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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Woolderink JM, De Bock GH, van Hemel BM, Geuken E, Hollema H, Werner N, Mourits MJ. Feasibility of endometrial sampling by vaginal tampons in women with Lynch syndrome. BMC Womens Health 2020; 20:54. [PMID: 32183830 PMCID: PMC7079431 DOI: 10.1186/s12905-020-00920-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/06/2020] [Indexed: 01/13/2023]
Abstract
Background Endometrial sampling for the surveillance of women with Lynch syndrome is an invasive and painful procedure. The aim of this study was to evaluate the feasibility of a less invasive procedure of collecting vital cells by vaginal tampons. Methods This was a prospective feasibility study of women scheduled to undergo annual gynecological surveillance, including endometrial sampling. We included consecutive asymptomatic women with Lynch syndrome or first-degree relatives and asked them to insert a vaginal tampon 2–4 h before attending their outpatient appointment. Feasibility was evaluated by the following metrics: patient acceptance, pain intensity of each procedure (assessed by visual analog scale; range 0–10), and the presence of vital cells obtained by tampon-based or endometrial sampling methods. Two pathologists independently evaluated all samples. Results In total, 25 of 32 approached women completed the tampon-based procedure, with 23 of these subsequently undergoing invasive endometrial sampling. The median visual analog scale scores for tampon use and invasive endometrial sampling were 0 (range, 0–10) and 5.5 (range, 1–10) (p < 0.001). None of the tampon samples analyzed by cytology showed endometrial cells, but they did contain vital squamous cells and granulocytes. By contrast, 18 (78%) of the invasive endometrial samples contained enough endometrial tissue for analysis. No endometrial abnormalities were found by endometrial sampling. Conclusions Tampon-based endometrial surveillance was a well-accepted and non-painful procedure, and although tampons contained vital cells, they did not provide endometrial cells. However, this study was limited to asymptomatic women with Lynch syndrome (no endometrial pathology), indicating that research is needed to evaluate whether the tampon method has any utility for endometrial surveillance in women with Lynch syndrome.
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Affiliation(s)
- Jorien M Woolderink
- Department of Gynecology, Martini Hospital, Groningen, the Netherlands. .,Department of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700, RB, Groningen, the Netherlands.
| | - Geertruida H De Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Erwin Geuken
- Department of Pathology, Martini Hospital, Groningen, the Netherlands
| | - Harry Hollema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Naomi Werner
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marian J Mourits
- Department of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700, RB, Groningen, the Netherlands
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Aitken CA, van Agt HME, Siebers AG, van Kemenade FJ, Niesters HGM, Melchers WJG, Vedder JEM, Schuurman R, van den Brule AJC, van der Linden HC, Hinrichs JWJ, Molijn A, Hoogduin KJ, van Hemel BM, de Kok IMCM. Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study. BMC Med 2019; 17:228. [PMID: 31829241 PMCID: PMC6907114 DOI: 10.1186/s12916-019-1460-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In January 2017, the Dutch cervical cancer screening programme transitioned from cytomorphological to primary high-risk HPV (hrHPV) DNA screening, including the introduction of self-sampling, for women aged between 30 and 60 years. The Netherlands was the first country to switch to hrHPV screening at the national level. We investigated the health impact of this transition by comparing performance indicators from the new hrHPV-based programme with the previous cytology-based programme. METHODS We obtained data from the Dutch nationwide network and registry of histo- and cytopathology (PALGA) for 454,573 women eligible for screening in 2017 who participated in the hrHPV-based programme between 1 January 2017 and 30 June 2018 (maximum follow-up of almost 21 months) and for 483,146 women eligible for screening in 2015 who participated in the cytology-based programme between 1 January 2015 and 31 March 2016 (maximum follow-up of 40 months). We compared indicators of participation (participation rate), referral (screen positivity; referral rate) and detection (cervical intraepithelial neoplasia (CIN) detection; number of referrals per detected CIN lesion). RESULTS Participation in the hrHPV-based programme was significantly lower than that in the cytology-based programme (61% vs 64%). Screen positivity and direct referral rates were significantly higher in the hrHPV-based programme (positivity rate: 5% vs 9%; referral rate: 1% vs 3%). CIN2+ detection increased from 11 to 14 per 1000 women screened. Overall, approximately 2.2 times more clinical irrelevant findings (i.e. ≤CIN1) were found in the hrHPV-based programme, compared with approximately 1·3 times more clinically relevant findings (i.e. CIN2+); this difference was mostly due to a national policy change recommending colposcopy, rather than observation, of hrHPV-positive, ASC-US/LSIL results in the hrHPV-based programme. CONCLUSIONS This is the first time that comprehensive results of nationwide implementation of hrHPV-based screening have been reported using high-quality data with a long follow-up. We have shown that both benefits and potential harms are higher in one screening round of a well-implemented hrHPV-based screening programme than in an established cytology-based programme. Lower participation in the new hrHPV programme may be due to factors such as invitation policy changes and the phased roll-out of the new programme. Our findings add further to evidence from trials and modelling studies on the effectiveness of hrHPV-based screening.
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Affiliation(s)
- Clare A Aitken
- Department of Public Health, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 CN, Rotterdam, the Netherlands.
| | - Heleen M E van Agt
- Department of Public Health, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 CN, Rotterdam, the Netherlands
| | - Albert G Siebers
- PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, De Bouw 123, 3991 SZ, Houten, the Netherlands.,Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 CN, Rotterdam, the Netherlands
| | - Hubert G M Niesters
- Division of Clinical Virology, Department of Medical Microbiology, The University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Judith E M Vedder
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Rob Schuurman
- Facilitaire Samenwerking Bevolkingsonderzoeken, Godebaldkwartier 435, 3511 DT, Utrecht, the Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Adriaan J C van den Brule
- Jeroen Bosch Hospital, Pathologie-DNA, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, the Netherlands
| | - Hans C van der Linden
- Jeroen Bosch Hospital, Pathologie-DNA, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, the Netherlands
| | - John W J Hinrichs
- Symbiant Pathology Expert Centre Hoorn (Westfriesgasthuis), Maelsonstraat 3, 1624 NP, Hoorn, the Netherlands.,Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Anco Molijn
- NMDL-LCPL, Visseringlaan 25, 2288 ER, Rijswijk, the Netherlands
| | | | - Bettien M van Hemel
- Department of Pathology and Medical Biology, the University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 CN, Rotterdam, the Netherlands
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9
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van Schaik JE, Muller Kobold AC, van der Laan BFAM, van der Vegt B, van Hemel BM, Plaat BEC. Squamous cell carcinoma antigen concentration in fine needle aspiration samples: A new method to detect cervical lymph node metastases of head and neck squamous cell carcinoma. Head Neck 2019; 41:2561-2565. [PMID: 30828886 PMCID: PMC6766850 DOI: 10.1002/hed.25733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/22/2019] [Accepted: 02/19/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the additional diagnostic value of squamous cell carcinoma antigen (SCC-Ag) in cervical lymph node fine needle aspiration (FNA) samples for the detection of regional metastases of head and neck squamous cell carcinoma (HNSCC). METHODS In 149 FNA samples of 114 patients, SCC-Ag concentration was retrospectively analyzed and associated with diagnosis to establish a cutoff concentration in relation to sensitivity and specificity of HNSCC detection. RESULTS SCC-Ag was elevated in lymph nodes from patients with HNSCC compared to lymph nodes from other patients (P < 0.01). With 0.3 μg/L as the cutoff concentration, SCC-Ag has 96% sensitivity for detecting HNSCC. CONCLUSIONS SCC-Ag in FNA is a reliable test for detecting HNSCC in cervical lymph nodes.
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Affiliation(s)
- Jeroen E van Schaik
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bettien M van Hemel
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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10
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de Vries LH, Lodewijk L, Willems SM, Dreijerink KMA, de Keizer B, van Diest PJ, Schepers A, Bonenkamp HJ, van Engen-van Grunsven IACH, Kruijff S, van Hemel BM, Links TP, Nieveen van Dijkum EJM, van Eeden S, Valk GD, Borel Rinkes IHM, Vriens MR. SSTR2A expression in medullary thyroid carcinoma is correlated with longer survival. Endocrine 2018; 62:639-647. [PMID: 30128959 PMCID: PMC6244936 DOI: 10.1007/s12020-018-1706-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Medullary thyroid carcinoma (MTC) derives from the parafollicular C-cells of the thyroid gland. Somatostatin receptors (SSTRs) are expressed in various neuroendocrine tumours including MTC. The aim of this study was to evaluate SSTR2A as a prognostic factor for MTC, to study distribution of SSTR2A expression within tumours and to compare expression of SSTR2A between primary tumours and corresponding lymph node metastases. METHODS Patients who underwent surgery between 1988 and 2014 for MTC from five tertiary referral centres in The Netherlands were included. In total, primary tumours of 114 patients and lymph node metastases of 34 patients were analysed for expression of SSTR2A using a tissue microarray, and correlated with clinicopathological variables and survival. RESULTS The mean age of patients was 45.5 years (SD 16.2), 55 patients were male (49.5%). Primary tumours of 58 patients (50.9%) showed SSTR2A expression. In multivariate Cox-regression analysis, SSTR2A positivity correlated independently with better overall survival (OS) (HR 0.3; 95% CI 0.1-1.0). In stage IV MTC patients, 10-year survival rates for SSTR2A-negative and positive patients were 43% and 96%, respectively. In 53.9% of patients with lymph node metastases, expression in primary tumour and lymph node metastases differed. CONCLUSION SSTR2A expression is correlated with longer OS in MTC, especially for stage IV patients, suggesting that SSTR2A expression might be a useful prognostic factor in MTC. The SSTR2A status of the primary MTC does not predict expression in lymph node metastases.
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Affiliation(s)
- Lisa H de Vries
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Lutske Lodewijk
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Koen M A Dreijerink
- Department of Endocrine Oncology, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Han J Bonenkamp
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein 8, 6525GA, Nijmegen, The Netherlands
| | | | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University Medical Centre Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands
| | - Thera P Links
- Department of Internal Medicine, University Medical Centre Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Susanne van Eeden
- Department of Pathology, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
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11
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Lodewijk L, Willems SM, Dreijerink KMA, de Keizer B, van Diest PJ, Schepers A, Morreau H, Bonenkamp HJ, Van Engen-van Grunsven IACH, Kruijff S, van Hemel BM, Links TP, Nieveen van Dijkum E, van Eeden S, Valk GD, Borel Rinkes IHM, Vriens MR. The theranostic target prostate-specific membrane antigen is expressed in medullary thyroid cancer. Hum Pathol 2018; 81:245-254. [PMID: 30055186 DOI: 10.1016/j.humpath.2018.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/30/2018] [Accepted: 06/30/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Lutske Lodewijk
- University Medical Center Utrecht, Department of Surgery, 3584CX Utrecht, The Netherlands
| | - Stefan M Willems
- University Medical Center Utrecht, Department of Pathology, 3584CX Utrecht, The Netherlands
| | - Koen M A Dreijerink
- University Medical Center Utrecht, Department of Endocrine Oncology, 3584CX Utrecht, The Netherlands
| | - Bart de Keizer
- University Medical Center Utrecht, Department of Radiology, 3584CX Utrecht, The Netherlands
| | - Paul J van Diest
- University Medical Center Utrecht, Department of Pathology, 3584CX Utrecht, The Netherlands
| | - Abbey Schepers
- Leiden University Medical Center, Department of Surgery, 2333ZA Leiden, The Netherlands
| | - Hans Morreau
- Leiden University Medical Center, Department of Pathology, 2333ZA Leiden, The Netherlands
| | - Han J Bonenkamp
- Radboud University Medical Center, Department of Surgery, Nijmegen 6525GA, The Netherlands
| | | | - Schelto Kruijff
- University Medical Center Groningen, Department of Surgery, 9700RB, Groningen, The Netherlands
| | - Bettien M van Hemel
- University Medical Center Groningen, Department of Pathology, 9700RB, Groningen, The Netherlands
| | - Thera P Links
- University Medical Center Groningen, Department of Internal Medicine, 9700RB, Groningen, The Netherlands
| | - Els Nieveen van Dijkum
- Academic Medical Center Amsterdam, Department of Surgery, 1105AZ, Amsterdam, The Netherlands
| | - Susanne van Eeden
- Academic Medical Center Amsterdam, Department of Pathology, 1105AZ, Amsterdam, The Netherlands
| | - Gerlof D Valk
- University Medical Center Utrecht, Department of Endocrine Oncology, 3584CX Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- University Medical Center Utrecht, Department of Surgery, 3584CX Utrecht, The Netherlands
| | - Menno R Vriens
- University Medical Center Utrecht, Department of Surgery, 3584CX Utrecht, The Netherlands.
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12
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Klein Hesselink EN, Zafon C, Villalmanzo N, Iglesias C, van Hemel BM, Klein Hesselink MS, Montero-Conde C, Buj R, Mauricio D, Peinado MA, Puig-Domingo M, Riesco-Eizaguirre G, Reverter JL, Robledo M, Links TP, Jordà M. Increased Global DNA Hypomethylation in Distant Metastatic and Dedifferentiated Thyroid Cancer. J Clin Endocrinol Metab 2018; 103:397-406. [PMID: 29165662 DOI: 10.1210/jc.2017-01613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/15/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Global DNA hypomethylation is a major event for the development and progression of cancer, although the significance in thyroid cancer remains unclear. Therefore, we aimed to investigate its role in thyroid cancer progression and its potential as a prognostic marker. METHODS Global hypomethylation of Alu repeats was used as a surrogate marker for DNA global hypomethylation, and was assessed using the Quantification of Unmethylated Alu technique. Mutations in BRAF and RAS were determined by Sanger sequencing. RESULTS Ninety primary thyroid tumors were included [28 low-risk differentiated thyroid cancer (DTC), 13 pediatric DTC, 33 distant metastatic DTC, 7 poorly differentiated thyroid cancer (PDTC), and 9 anaplastic thyroid cancer (ATC)], as well as 24 distant metastases and 20 normal thyroid tissues. An increasing hypomethylation was found for distant metastatic DTC [median, 4.0; interquartile range (IQR), 3.1 to 6.2] and PDTC/ATC (median, 9.3; IQR, 7.0 to 12.1) as compared with normal thyroid tissue (median, 2.75; IQR, 2.30 to 3.15), whereas low-risk and pediatric DTC were not affected by hypomethylation. Alu hypomethylation was similar between distant metastases and matched primary tumors. Within distant metastatic DTC, Alu hypomethylation was increased in BRAF vs RAS mutated tumors. Kaplan-Meier and Cox regression analyses showed that thyroid cancer-related and all-cause mortality were associated with tumor hypomethylation, but this association was lost after adjustment for thyroid cancer risk category. CONCLUSION Distant metastatic DTC, PDTC, and ATC were increasingly affected by global Alu hypomethylation, suggesting that this epigenetic entity may be involved in thyroid cancer progression and dedifferentiation.
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Affiliation(s)
- Esther N Klein Hesselink
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carles Zafon
- Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Endocrinology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center in Diabetes and Associated Metabolic Diseases, CIBERDEM, Institute of Health Carlos III, Madrid, Spain
- Consortium for the Study of Thyroid Cancer, CECaT, Barcelona, Spain
| | - Núria Villalmanzo
- Program for Predictive and Personalized Medicine of Cancer, Germans Trias i Pujol Research Institute, Badalona, Barcelona, Spain
| | - Carmela Iglesias
- Consortium for the Study of Thyroid Cancer, CECaT, Barcelona, Spain
- Department of Pathology, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Bettien M van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mariëlle S Klein Hesselink
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cristina Montero-Conde
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Center, Madrid, Spain
| | - Raquel Buj
- Consortium for the Study of Thyroid Cancer, CECaT, Barcelona, Spain
- Program for Predictive and Personalized Medicine of Cancer, Germans Trias i Pujol Research Institute, Badalona, Barcelona, Spain
| | - Dídac Mauricio
- Biomedical Research Networking Center in Diabetes and Associated Metabolic Diseases, CIBERDEM, Institute of Health Carlos III, Madrid, Spain
- Consortium for the Study of Thyroid Cancer, CECaT, Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute and University Hospital, Badalona, Spain
| | - Miguel A Peinado
- Consortium for the Study of Thyroid Cancer, CECaT, Barcelona, Spain
- Program for Predictive and Personalized Medicine of Cancer, Germans Trias i Pujol Research Institute, Badalona, Barcelona, Spain
| | - Manel Puig-Domingo
- Biomedical Research Networking Center in Diabetes and Associated Metabolic Diseases, CIBERDEM, Institute of Health Carlos III, Madrid, Spain
- Consortium for the Study of Thyroid Cancer, CECaT, Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute and University Hospital, Badalona, Spain
- Biomedical Research Networking Center in Rare Diseases, CIBERER, Institute of Health Carlos III, Madrid, Spain
| | - Garcilaso Riesco-Eizaguirre
- Department of Endocrinology and Nutrition, Hospital Universitario de Móstoles, Madrid, Spain
- Biomedical Research Networking Center in Oncology, CIBERONC, Institute of Health Carlos III, Madrid, Spain
| | - Jordi L Reverter
- Consortium for the Study of Thyroid Cancer, CECaT, Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute and University Hospital, Badalona, Spain
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Center, Madrid, Spain
- Biomedical Research Networking Center in Rare Diseases, CIBERER, Institute of Health Carlos III, Madrid, Spain
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mireia Jordà
- Consortium for the Study of Thyroid Cancer, CECaT, Barcelona, Spain
- Program for Predictive and Personalized Medicine of Cancer, Germans Trias i Pujol Research Institute, Badalona, Barcelona, Spain
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13
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Tjon Pian Gi REA, San Giorgi MRM, Slagter-Menkema L, van Hemel BM, van der Laan BFAM, van den Heuvel ER, Dikkers FG, Schuuring EMD. Clinical course of recurrent respiratory papillomatosis: comparison between aggressiveness of human papillomavirus-6 and human papillomavirus-11. Head Neck 2014; 37:1625-32. [PMID: 24955561 DOI: 10.1002/hed.23808] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/24/2014] [Accepted: 06/18/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Recurrent respiratory papillomatosis (RRP) is mainly associated with human papillomavirus (HPV)6 or HPV11. The purpose of this study was to compare clinical outcome, aggressiveness, and treatment response between HPV6- and HPV11-associated RRP. METHODS A retrospective cohort of 55 patients with RRP (1974-2012) was used. Surgical interventions (n = 814) were analyzed, and complications scored. HPV6/11-specific polymerase chain reaction (PCR) was performed on RRP biopsies. RESULTS Seventy-six percent of patients (42 of 55) were infected with HPV6 and 24% (13 of 55) with HPV11. The HPV11 group had anatomically more widespread disease. The expected number of surgical interventions was higher in the younger age (<22.4 years) HPV11 group, and the older age (<22.4 years) HPV6 group. Regardless of HPV type, earlier age of onset of RRP resulted in a higher number of surgical interventions. CONCLUSION Anatomically, HPV11-associated RRP behaves more aggressively. Younger patients with HPV11 and older patients with HPV6 experience a worse clinical course of RRP.
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Affiliation(s)
- Robin E A Tjon Pian Gi
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, The Netherlands
| | - Michel R M San Giorgi
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, The Netherlands
| | - Lorian Slagter-Menkema
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, The Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, The Netherlands
| | - Edwin R van den Heuvel
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, The Netherlands
| | - Ed M D Schuuring
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, The Netherlands
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14
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Boers A, Slagter-Menkema L, van Hemel BM, Belinson JL, Ruitenbeek T, Buikema HJ, Klip H, Ghyssaert H, van der Zee AGJ, de Bock GH, Wisman GBA, Schuuring E. Comparing the Cervista HPV HR test and Hybrid Capture 2 assay in a Dutch screening population: improved specificity of the Cervista HPV HR test by changing the cut-off. PLoS One 2014; 9:e101930. [PMID: 25051098 PMCID: PMC4106783 DOI: 10.1371/journal.pone.0101930] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 06/13/2014] [Indexed: 11/24/2022] Open
Abstract
The diagnostic performance of the widely-used Cervista HPV HR test was compared to the Hybrid Capture 2 (HC2) test in a Dutch population-based cervical cancer screening program. In 900 scrapings of women with normal cytomorphology, specificity was 90% (95%CI: 87.84–91.87) for the Cervista HPV HR test and 96% (95%CI: 94.76–97.37) for the HC2 test with 93% agreement between both tests (κ = 0.5, p<0.001). The sensitivity for CIN2+ using 65 scrapings of women with histological-confirmed CIN2+ was 91% (95%CI: 80.97–96.51) for the Cervista HPV HR test and 92% (95%CI: 82.94–97.43) for the HC2 test with 95% agreement between both tests (κ = 0.7, p<0.001). Fifty-seven of 60 HC2 negative/Cervista positive cases tested HPV-negative with PCR-based HPV assays; of these cases 56% were defined as Cervista triple-positive with FOZ values in all 3 mixes higher than the second cut-off of 1.93 (as set by manufacturer). By setting this cut-off at 5.0, specificity improved significantly without affecting sensitivity. External validation of this new cut-off at 5.0 in triple-positive scrapings of women selected from the SHENCCASTII database revealed that 22/24 histological normal cases now tested HPV-negative in the Cervista HPV HR test, while CIN2+ lesions remained HPV-positive. The intra-laboratory reproducibility of the Cervista HPV HR test (n = 510) showed a concordance of 92% and 93% for cut-off 1.93 and 5.0 (κ = 0.83 and κ = 0.84, p<0.001) and inter-laboratory agreement of the Cervista HPV HR test was 90% and 93% for cut-off 1.93 and 5.0 (κ = 0.80 and κ = 0.85, p<0.001). In conclusion, the specificity of the Cervista HPV HR test could be improved significantly by increasing the second cut-off from 1.93 to 5.0, without affecting the sensitivity of the test in a population-based screening setting.
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Affiliation(s)
- Aniek Boers
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Lorian Slagter-Menkema
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bettien M. van Hemel
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jerome L. Belinson
- Preventive Oncology International, Inc, Cleveland Heights and Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Teus Ruitenbeek
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Henk J. Buikema
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Harry Klip
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hilde Ghyssaert
- Department of Pathology, AZ St Jan Brugge-Oostende, Brugge, Belgium
| | - Ate G. J. van der Zee
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - G. Bea A. Wisman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ed Schuuring
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- * E-mail:
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15
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van der Laan TP, Bij HP, van Hemel BM, Plaat BEC, Wedman J, van der Laan BFAM, Halmos GB. The importance of multimodality therapy in the treatment of sinonasal neuroendocrine carcinoma. Eur Arch Otorhinolaryngol 2013; 270:2565-8. [DOI: 10.1007/s00405-013-2554-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/03/2013] [Indexed: 11/25/2022]
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van Hemel BM, Haarsma JG, Ruitenbeek T, Groen HJ, Suurmeijer AJH. Application of the ThinPrep imaging system in urine cytology: a prospective study. Cancer Cytopathol 2013; 121:410-4. [PMID: 23907818 DOI: 10.1002/cncy.21301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/22/2013] [Accepted: 02/07/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND In this prospective study, for the first time, the authors compared the accuracy of reading urine specimens using the ThinPrep Imager System (TIS) with the accuracy of conventional screening for the detection of abnormal urine cells. METHODS ThinPrep slides were made from 1455 urine specimens and were read with conventional screening and with TIS. Findings were categorized as "unsatisfactory or failure to read the slide," "benign," or "abnormal." The Cohen κ coefficient was calculated to determine inter-rater agreement between both methods. Urine samples that were followed by biopsies were used to compare the sensitivity, specificity, positive predictive value, and negative predictive value of both methods. From 22 urine specimens, the screening times were measured and compared. RESULTS There was substantial agreement between both methods (κ score, 0.77). Of 175 urine specimens that were followed by bladder biopsies, for conventional screening, the sensitivity was 51.3%, specificity was 68.4%, the positive predictive value was 77.2%, and the negative predictive value was 40.2%; for TIS screening, the respective values were 54.6%, 68.4%, 78.3%, and 41.9%. The average time was 5.2 minutes for conventional screening and 3.9 minutes for TIS. CONCLUSIONS With a κ score of 0.77, the current study demonstrated a good correlation between reading urine specimens with conventional screening and with TIS. Using TIS resulted in slightly increased sensitivity, positive predictive value, and negative predictive value compared with conventional screening and had the same specificity. These results indicate that reading urine specimens using TIS is equally reliable as conventional cytology.
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Affiliation(s)
- Bettien M van Hemel
- Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands.
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van Hemel BM, Suurmeijer AJH. Effective application of the methanol-based PreservCyt(™) fixative and the Cellient(™) automated cell block processor to diagnostic cytopathology, immunocytochemistry, and molecular biology. Diagn Cytopathol 2013; 41:734-41. [PMID: 23444168 DOI: 10.1002/dc.22963] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 09/30/2012] [Accepted: 01/01/2013] [Indexed: 11/12/2022]
Abstract
We studied the feasibility of immunocytochemistry (ICC), in situ hybridization (ISH), and polymerase chain reaction (PCR) after Cellient(™) automated cell block processing, and tested whether methanol-based PreservCyt(™) fixation could replace formalin fixation, in an attempt to eliminate toxic formaldehyde vapors. Immunostaining with 30 different antibodies was performed on cell blocks from 73 FNA specimens and 42 body cavity fluid specimens prepared by Cellient(™) automated processing that uses the methanol-based fixative (PreservCyt(™) ). For each antibody we evaluated ICC in at least three different cell block specimens and compared it with immunohistochemistry (IHC) in formalin-fixed, paraffin-embedded (FFPE) histological sections from the corresponding tumors. The quality of DNA and RNA in Cellient(™) blocks was analyzed by ISH, applying a SYT gene break-apart assay and EBER probes, respectively. Moreover, DNA quality was analyzed by PCR by using primer sets for DNA products of 100, 200, 300, 400, 500, and 600 base pairs, and evaluated by gel electrophoresis. When compared with IHC results in corresponding FFPE tumor tissue from the same patient, 24 out of 30 antibodies showed concordant ICC results. With FISH, distinctive hybridization signals were observed for SYT DNA sequences and EB virus RNA sequences. With PCR, DNA products, up to 600 base pairs in size, were readily observed after gel electrophoresis. The antibodies that showed concordant immunostaining in Cellient(™) blocks could be applied to diagnostic algorithms that proved to be helpful in the discrimination of major tumor types (carcinoma, lymphoma, melanoma, and germ cell tumors), discrimination of carcinoma subtypes, and determination of primary tumor site in cases of metastatic carcinoma. In a separate study, we found that the application of ICC to this cell block technique provided additional diagnostic and clinically important information in 24% of 100 consecutive cases. The high quality of DNA and RNA in Cellient(™) cell blocks allowed sensitive and specific molecular biologic analysis, in particular FISH and PCR.
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Affiliation(s)
- Bettien M van Hemel
- Department of Pathology and Medical Biology, Cytology Laboratory, University Medical Center Groningen, University of Groningen, The Netherlands
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Tjon Pian Gi REA, Halmos GB, van Hemel BM, van den Heuvel ER, van der Laan BFAM, Plaat BEC, Dikkers FG. Narrow band imaging is a new technique in visualization of recurrent respiratory papillomatosis. Laryngoscope 2012; 122:1826-30. [DOI: 10.1002/lary.23344] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/08/2012] [Accepted: 03/14/2012] [Indexed: 11/08/2022]
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van Hemel BM, Lamprou AA, Weersma R, Plukker JTM, Suurmeijer AJH, van Dullemen HM. Procedure-related, false-positive cytology results during EUS-guided FNA in patients with esophageal cancer. Gastrointest Endosc 2010; 71:1130-3. [PMID: 20598243 DOI: 10.1016/j.gie.2010.01.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 01/22/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND EUS is a standard staging procedure in esophageal cancer. For adequate staging, FNA of suspicious lymph nodes is recommended. Based on optimal staging, sophisticated treatment can be applied more properly. The working channel of the endoscope can potentially be contaminated by cancer cells derived from the luminal surface of esophageal cancer during EUS-guided FNA, which may result in false-positive cytology results of EUS-guided FNA of celiac lymph nodes. OBJECTIVE To determine whether passing an endoscope through intraluminal esophageal cancer can lead to contamination of the working channel with tumor cells. DESIGN An ex vivo assessment of contamination of endoscope working channels. SETTING University hospital. PATIENTS This study involved 13 patients with esophageal cancer. INTERVENTION Working channels of endoscopes that had been used in patients with intraluminal esophageal cancer were studied immediately after EUS. A routine ex vivo FNA was performed through the endoscope on 8 patients. The same procedure was performed through the endoscope on 5 other patients after the working channel had been cleaned by extensive flushing. MAIN OUTCOME MEASUREMENTS Semiquantitative scoring of cytology smears. RESULTS Six of 8 specimens contained carcinoma cells. No contamination by carcinoma cells or normal cells was observed when the working channel was flushed with tap water prior to the sham FNA procedure. LIMITATIONS This was an ex vivo study of a limited group of patients. CONCLUSION The working channel of the endoscope can be contaminated during the EUS-guided FNA procedure. Cancer cell contamination can be avoided by flushing the endoscope.
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Affiliation(s)
- Bettien M van Hemel
- Departments of Pathology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Oonk MH, van Hemel BM, Hollema H, de Hullu JA, Ansink AC, Vergote I, Verheijen RH, Maggioni A, Gaarenstroom KN, Baldwin PJ, van Dorst EB, van der Velden J, Hermans RH, van der Putten HW, Drouin P, Runnebaum IB, Sluiter WJ, van der Zee AG. Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol 2010; 11:646-52. [PMID: 20537946 DOI: 10.1016/s1470-2045(10)70104-2] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Currently, all patients with vulvar cancer with a positive sentinel node undergo inguinofemoral lymphadenectomy, irrespective of the size of sentinel-node metastases. Our study aimed to assess the association between size of sentinel-node metastasis and risk of metastases in non-sentinel nodes, and risk of disease-specific survival in early stage vulvar cancer. METHODS In the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V), sentinel-node detection was done in patients with T1-T2 (<4 cm) squamous-cell vulvar cancer, followed by inguinofemoral lymphadenectomy if metastatic disease was identified in the sentinel node, either by routine examination or pathological ultrastaging. For the present study, sentinel nodes were independently reviewed by two pathologists. FINDINGS Metastatic disease was identified in one or more sentinel nodes in 135 (33%) of 403 patients, and 115 (85%) of these patients had inguinofemoral lymphadenectomy. The risk of non-sentinel-node metastases was higher when the sentinel node was found to be positive with routine pathology than with ultrastaging (23 of 85 groins vs three of 56 groins, p=0.001). For this study, 723 sentinel nodes in 260 patients (2.8 sentinel nodes per patient) were reviewed. The proportion of patients with non-sentinel-node metastases increased with size of sentinel-node metastasis: one of 24 patients with individual tumour cells had a non-sentinel-node metastasis; two of 19 with metastases 2 mm or smaller; two of 15 with metastases larger than 2 mm to 5 mm; and ten of 21 with metastases larger than 5 mm. Disease-specific survival for patients with sentinel-node metastases larger than 2 mm was lower than for those with sentinel-node metastases 2 mm or smaller (69.5%vs 94.4%, p=0.001). INTERPRETATION Our data show that the risk of non-sentinel-node metastases increases with size of sentinel-node metastasis. No size cutoff seems to exist below which chances of non-sentinel-node metastases are close to zero. Therefore, all patients with sentinel-node metastases should have additional groin treatment. The prognosis for patients with sentinel-node metastasis larger than 2 mm is poor, and novel treatment regimens should be explored for these patients.
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Affiliation(s)
- Maaike H Oonk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Yang N, Eijsink JJH, Lendvai A, Volders HH, Klip H, Buikema HJ, van Hemel BM, Schuuring E, van der Zee AGJ, Wisman GBA. Methylation markers for CCNA1 and C13ORF18 are strongly associated with high-grade cervical intraepithelial neoplasia and cervical cancer in cervical scrapings. Cancer Epidemiol Biomarkers Prev 2009; 18:3000-7. [PMID: 19843677 DOI: 10.1158/1055-9965.epi-09-0405] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Recently, we reported 13 possible cervical cancer-specific methylated biomarkers identified by pharmacologic unmasking microarray in combination with large-genome computational screening. The aim of the present study was to perform an in-depth analysis of the methylation patterns of these 13 candidate genes in cervical neoplasia and to determine their diagnostic relevance. EXPERIMENTAL DESIGN AND RESULTS Five of the 13 gene promoters (C13ORF18, CCNA1, TFPI2, C1ORF166, and NPTX1) were found to be more frequently methylated in frozen cervical cancer compared with normal cervix specimens. Quantitative methylation analysis for these five markers revealed that both CCNA1 and C13ORF18 were methylated in 68 of 97 cervical scrapings from cervical cancer patients and in only 5 and 3 scrapings, respectively, from 103 healthy controls (P < 0.0005). In cervical scrapings from patients referred with an abnormal Pap smear, CCNA1 and C13ORF18 were methylated in 2 of 43 and 0 of 43 CIN 0 (no cervical intraepithelial neoplasia) and in 1 of 41 and 0 of 41 CIN I, respectively. Furthermore, 8 of 43 CIN II, 22 of 43 CIN III, and 3 of 3 microinvasive cancer patients were positive for both markers. Although sensitivity for CIN II or higher (for both markers 37%) was low, specificity (96% and 100%, respectively) and positive predictive value (92% and 100%, respectively) were high. CONCLUSION Methylation of CCNA1 and C13ORF18 in cervical scrapings is strongly associated with CIN II or higher-grade lesions. Therefore, these markers might be used for direct referral to gynecologists for patients with a methylation-positive scraping.
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Affiliation(s)
- Nan Yang
- Department of Gynecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
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Remijn JA, IJsseldijk MJW, van Hemel BM, Galanakis DK, Hogan KA, Lounes KC, Lord ST, Sixma JJ, de Groot PG. Reduced platelet adhesion in flowing blood to fibrinogen by alterations in segment gamma316-322, part of the fibrin-specific region. Br J Haematol 2002; 117:650-7. [PMID: 12028038 DOI: 10.1046/j.1365-2141.2002.03467.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The interaction of platelets with fibrinogen is a key event in the maintenance of a haemostatic response. It has been shown that the 12-carboxy-terminal residues of the gamma-chain of fibrinogen mediate platelet adhesion to immobilized fibrinogen. These studies, however, did not exclude the possibility that other domains of fibrinogen are involved in interactions with platelets. To obtain more insight into the involvement of other domains of fibrinogen in platelet adhesion, we studied platelet adhesion in flowing blood to patient dysfibrinogen Vlissingen/Frankfurt IV (V/FIV), to several variant recombinant fibrinogens with abnormalities in the gamma-chain segments gamma318-320 and gamma408-411. Perfusion studies at physiological shear rates showed that platelet adhesion was absent to gammaDelta408-411, slightly reduced to the heterozygous patient dysfibrinogen V/FIV and strongly reduced to the homozygous recombinant fibrinogens: gammaDelta319-320, gamma318Asp-->Ala and gamma320Asp-->Ala. Furthermore, antibodies raised against the sequences gamma308-322 and gamma316-333 inhibited platelet adhesion under shear conditions. These experiments indicated that the overlapping segment gamma316-322 contains amino acids that could be involved in platelet adhesion to immobilized fibrinogen under flow conditions. In soluble fibrinogen, this sequence is buried inside the fibrinogen molecule and becomes exposed after polymerization. In addition, we have shown that this fibrin-specific sequence also becomes exposed when fibrinogen is immobilized on a surface.
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Affiliation(s)
- Jasper A Remijn
- Thrombosis and Haemostasis Laboratory, Department of Haematology, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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