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Schreier S, Triampo W. The Blood Circulating Rare Cell Population. What is it and What is it Good For? Cells 2020; 9:cells9040790. [PMID: 32218149 PMCID: PMC7226460 DOI: 10.3390/cells9040790] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 02/06/2023] Open
Abstract
Blood contains a diverse cell population of low concentration hematopoietic as well as non-hematopoietic cells. The majority of such rare cells may be bone marrow-derived progenitor and stem cells. This paucity of circulating rare cells, in particular in the peripheral circulation, has led many to believe that bone marrow as well as other organ-related cell egress into the circulation is a response to pathological conditions. Little is known about this, though an increasing body of literature can be found suggesting commonness of certain rare cell types in the peripheral blood under physiological conditions. Thus, the isolation and detection of circulating rare cells appears to be merely a technological problem. Knowledge about rare cell types that may circulate the blood stream will help to advance the field of cell-based liquid biopsy by supporting inter-platform comparability, making use of biological correct cutoffs and “mining” new biomarkers and combinations thereof in clinical diagnosis and therapy. Therefore, this review intends to lay ground for a comprehensive analysis of the peripheral blood rare cell population given the necessity to target a broader range of cell types for improved biomarker performance in cell-based liquid biopsy.
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Affiliation(s)
- Stefan Schreier
- School of Bioinnovation and Bio-based Product Intelligence, Faculty of Science, Mahidol University, Rama VI Rd, Bangkok 10400, Thailand;
- Thailand Center of Excellence in Physics, Ministry of Higher Education, Science, Research and Innovation, 328 Si Ayutthaya Road, Bangkok 10400, Thailand
| | - Wannapong Triampo
- Thailand Center of Excellence in Physics, Ministry of Higher Education, Science, Research and Innovation, 328 Si Ayutthaya Road, Bangkok 10400, Thailand
- Department of Physics, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
- Correspondence:
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Cytomorphological Characterization of Individual Metastatic Tumor Cells from Gastrointestinal Cancer Patient Lymph Nodes with Imaging Flow Cytometry. GASTROINTESTINAL DISORDERS 2019. [DOI: 10.3390/gidisord1040030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The presence or absence of tumor cells within patient lymph nodes is an important prognostic indicator in a number of cancer types and an essential element of the staging process. However, patients with the same pathological stage will not necessarily have the same outcome. Therefore, additional factors may aid in identifying patients at a greater risk of developing metastasis. In this proof of principle study, initially, spiked tumor cells in rat lymph nodes were used to mimic a node with a small cancer deposit. Next, human lymph nodes were obtained from cancer patients for morphological characterization. Nodes were dissociated with a manual tissue homogenizer and stained with fluorescent antibodies against CD45 and Pan-Cytokeratin and then imaging flow cytometry (AMNIS ImageStreamX Mark II) was performed. We show here that imaging flow cytometry can be used for the detection and characterization of small numbers of cancer cells in lymph nodes and we also demonstrate the phenotypical and morphological characterization of cancer cells in gastrointestinal cancer patient lymph nodes. When used in addition to conventional histological techniques, this high throughput detection of tumor cells in lymph nodes may offer additional information assisting in the staging process with therapeutic and prognostic applications.
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Miller RT. Avoiding pitfalls in diagnostic immunohistochemistry–important technical aspects that every pathologist should know. Semin Diagn Pathol 2019; 36:312-335. [DOI: 10.1053/j.semdp.2019.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Strien L, Leidenius M, Heikkilä P. False-positive and false-negative sentinel node findings in 473 breast cancers. Hum Pathol 2012; 43:1940-7. [PMID: 22575258 DOI: 10.1016/j.humpath.2012.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/23/2012] [Accepted: 01/25/2012] [Indexed: 11/25/2022]
Abstract
We reviewed lymph node samples from 473 consecutive breast cancer cases with either negative sentinel nodes or isolated tumor cells to evaluate the rate of false-positive sentinel node findings. Nuclear morphometry was applied to compare nuclear atypia between the primary tumor and metastases classified as isolated tumor cells by size. In addition, the role of the diagnostic preoperative biopsy method, either core needle biopsy or fine needle aspiration cytology, on the prevalence of isolated tumor cells was investigated. In addition, we studied the expression of metastasis-associated protein 1 in the primary tumor and corresponding metastases in 95 cases, including 52 isolated tumor cell cases, to distinguish a true metastasis from a benign epithelial displacement. Our review revealed 4 false positives and 7 false negatives from 473 sentinel node cases. In addition, 5 true-positive cases were upstaged from isolated tumor cells to micrometastases. No association was found between the preoperative biopsy method and the sentinel node status (P=.859). There was no difference in nuclear atypia, when the cells in isolated tumor cells and primary tumor were compared. Therefore, small metastases do not represent benign epithelial displacement. Isolated tumor cell findings did not correlate with preoperative biopsy methods. The metastasis-associated protein 1 staining score sum was lower in the metastases than in the primary tumor in 72% of cases, including all sizes of metastases. These data suggest that metastasis-associated protein 1 staining is not ideal for investigating the possible malignant nature of smaller metastases because of the relatively low concordance between the primary tumor and metastases, even macrometastases.
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Affiliation(s)
- Leena Strien
- Department of Pathology, Helsinki University Central Hospital, and University of Helsinki, Haartman Institute, Helsinki, Finland.
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Prognostic impact of isolated tumor cells in breast cancer axillary nodes: single tumor cell(s) versus tumor cell cluster(s) and microanatomic location. Breast Cancer Res Treat 2011; 131:645-51. [PMID: 21927853 DOI: 10.1007/s10549-011-1771-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/03/2011] [Indexed: 10/17/2022]
Abstract
In breast cancer, it has been shown that pN0(i+) and pN1mi have a comparable negative impact on disease-free survival, compared with pN0. However, pN0(i+) is considered to be a heterogeneous group. We determined the effect of metastatic size and microanatomic location within the pN0(i+) group on breast cancer recurrence. We included all Dutch breast cancer patients diagnosed in 1998-2005 with favorable primary tumor characteristics and a final nodal status of pN0(i+). For this analysis, only patients without adjuvant systemic therapy were eligible (n = 513). Presence of single tumor cells versus cell clusters, metastatic size and microanatomic location were recorded. Primary endpoint was disease-free survival. Analyses were adjusted for age at diagnosis, tumor size, tumor grade, axillary treatment and hormone receptor status. The 5-year disease-free survival of patients with single tumor cell(s) (n = 93) was 78.6% and with tumor cell cluster(s) (n = 404) 77.1%. The hazard ratio for disease events was 1.05 (95% CI 0.63-1.76) for cell cluster(s) compared with single cell(s). In a Cox regression model, doubling of metastatic tumor size corresponded to a hazard ratio of 1.21 (95% CI 1.02-1.43). The adjusted hazard ratio was 0.90 (95% CI 0.54-1.50) for parenchymal (n = 112) versus sinusoidal location (n = 395). Single tumor cells bear similar prognostic information as small tumor cell clusters, even though results do suggest that within the pN0(i+) group, increasing size of nodal involvement is associated with reduced survival. Microanatomic location does not seem to have prognostic relevance.
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van Deurzen CH, de Bruin PC, Koelemij R, Hillegersberg R, van Diest PJ. Isolated tumor cells in breast cancer sentinel lymph nodes: displacement or metastases? An immunohistochemical study. Hum Pathol 2009; 40:778-82. [DOI: 10.1016/j.humpath.2008.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 10/26/2008] [Accepted: 10/29/2008] [Indexed: 11/26/2022]
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Wiese D, Saha S, Yestrepsky B, Korant A, Sirop S. A Prospective Study of False-Positive Diagnosis of Micrometastatic Cells in the Sentinel Lymph Nodes in Colorectal Cancer. Ann Surg Oncol 2009; 16:2166-9. [PMID: 19412630 DOI: 10.1245/s10434-009-0497-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 04/11/2009] [Accepted: 04/12/2009] [Indexed: 11/18/2022]
Affiliation(s)
- D Wiese
- Department of Pathology, Michigan State University, McLaren Regional Medical Center, Flint, MI, USA.
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Li J, Rudas M, Kemmner W, Warnick P, Fischer J, Gnant M, Schlag PM, Bembenek A. The location of small tumor deposits in the SLN predicts Non-SLN macrometastases in breast cancer patients. Eur J Surg Oncol 2008; 34:857-862. [PMID: 17764886 DOI: 10.1016/j.ejso.2007.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 07/16/2007] [Indexed: 11/29/2022] Open
Abstract
AIMS The extent to which the location of micrometastases (MIC) or isolated tumor cells (ITC) in sentinel lymph nodes (SLNs) is correlated with the risk of downstream metastases is still unknown. This study examined this issue and compared the impact of MIC/ITC location with other established risk factors. METHODS Paraffin slides of SLNs with MIC/ITC-involvement obtained from 68 breast cancer patients were evaluated for MIC/ITC location, lesion size, and various SLN morphologic features. These parameters, together with demographic data and primary tumor characteristics, were analyzed using univariate and multivariate analysis to determine their association with the presence of downstream macrometastases in Non-SLN. RESULTS Eighteen of 68 patients with MIC (n=37) or ITC (n=31) had Non-SLN metastases. After multivariate analysis, the location of MIC/ITC in the SLN (parenchyma vs. sinus/vessel) had the strongest association with the presence of Non-SLN macrometastases (p<0.0001), followed by the pT-category (p=0.008). Sixteen of 18 patients with parenchymal involvement but only 2 of 31 without parenchymal involvement had Non-SLN macrometastases. The metric size of the primary tumor and the estrogen receptor status were significantly associated only on univariate analysis (p=0.041, 0.034), whereas the correlation to the size classification for tumor cell deposits (MIC vs. ITC) was not significant (p=0.077). CONCLUSIONS The results indicate that lesion location is an important predictor of Non-SLN-macrometastases. This finding may simplify the decision for axillary treatment in patients with small tumor deposits in the SLN.
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Affiliation(s)
- J Li
- Department of Surgery and Surgical Oncology, Robert-Roessle Cancer Center at the Max-Delbrueck-Center of Molecular Medicine, Charité University Medicine Berlin, Campus Buch, in "Helios Klinikum Berlin", Lindenberger Weg 80, D13125 Berlin, Germany
| | - M Rudas
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - W Kemmner
- Department of Surgery and Surgical Oncology, Robert-Roessle Cancer Center at the Max-Delbrueck-Center of Molecular Medicine, Charité University Medicine Berlin, Campus Buch, in "Helios Klinikum Berlin", Lindenberger Weg 80, D13125 Berlin, Germany
| | - P Warnick
- Department of Surgery and Surgical Oncology, Robert-Roessle Cancer Center at the Max-Delbrueck-Center of Molecular Medicine, Charité University Medicine Berlin, Campus Buch, in "Helios Klinikum Berlin", Lindenberger Weg 80, D13125 Berlin, Germany
| | - J Fischer
- Department of Electronic Data Processing & Statistics, Robert-Roessle Cancer Center at the Max-Delbrueck-Center of Molecular Medicine, Charité University Medicine Berlin, Campus Buch, in "Helios Klinikum Berlin", Lindenberger Weg 80, D13125 Berlin, Germany
| | - M Gnant
- Department of Surgical-Experimental Oncology in the Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - P M Schlag
- Department of Surgery and Surgical Oncology, Robert-Roessle Cancer Center at the Max-Delbrueck-Center of Molecular Medicine, Charité University Medicine Berlin, Campus Buch, in "Helios Klinikum Berlin", Lindenberger Weg 80, D13125 Berlin, Germany
| | - A Bembenek
- Department of Surgery and Surgical Oncology, Robert-Roessle Cancer Center at the Max-Delbrueck-Center of Molecular Medicine, Charité University Medicine Berlin, Campus Buch, in "Helios Klinikum Berlin", Lindenberger Weg 80, D13125 Berlin, Germany.
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Klevesath MB, Bobrow LG, Pinder SE, Purushotham AD. The value of immunohistochemistry in sentinel lymph node histopathology in breast cancer. Br J Cancer 2005; 92:2201-5. [PMID: 15942633 PMCID: PMC2361824 DOI: 10.1038/sj.bjc.6602641] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The optimal protocol for the histopathological examination of sentinel lymph nodes (SLNs) in breast cancer has not been determined. The value of more detailed examination using immunohistochemistry (IHC) is controversial. A total of 476 SLNs from 216 patients were reviewed. Sentinel lymph nodes were sectioned at three levels at 100 μm intervals and stained with haematoxylin and eosin (H&E). If the H&E sections showed no evidence of metastasis, then the three serial sections were stained with a murine monoclonal anti-cytokeratin antibody (CAM 5.2). Metastatic deposits were classified as macrometastasis (>2.0 mm), micrometastasis (0.2–2.0 mm) or isolated tumour cells (ITC, <0.2 mm). Of the 216 patients, 56 (26%) had metastasis as identified by H&E. Immunohistochemistry detected metastatic deposits in a further nine patients (4%), of whom four (2%) had micrometastasis and five (2%) had ITC only. Those cases with micrometastases were all, on review, visible on the H&E sections. Immunohistochemistry detects only a small proportion of metastasis in SLNs. All metastatic deposits identified by IHC were either micrometastasis or ITC. Until the prognostic significance of these deposits has been determined, IHC may be of limited value in the histopathological examination of SLNs.
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Affiliation(s)
- M B Klevesath
- Cambridge Breast Unit, Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK
| | - L G Bobrow
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK
| | - S E Pinder
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK
- Department of Histopathology, Box 235, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK. E-mail:
| | - A D Purushotham
- Cambridge Breast Unit, Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK
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