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Jie W, Bai J, Yan J, Chi Y, Li BB. Multi-Site Tumour Sampling Improves the Detection of Intra-Tumour Heterogeneity in Oral and Oropharyngeal Squamous Cell Carcinoma. Front Med (Lausanne) 2021; 8:670305. [PMID: 34041255 PMCID: PMC8141800 DOI: 10.3389/fmed.2021.670305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC) are very common in head and neck malignancy. Intratumour heterogeneity (ITH) may hamper their responses to treatment. Hence, novel tumour sampling methods that reflect ITH are required. In this study, we investigated the clinical significance of multi-site tumour sampling (MSTS) to detect ITH in OSCC and OPSCC. Methods: One hundred eighty-two paired specimens were sampled by routine sampling (RS) or MSTS, respectively. Histologically, tumour grade, peri-tumoural vascular and lymphatic growth, perineural permeation, tumour necrosis, and muscle invasion were assessed. Immunohistochemically, the positive and average detection rates of P53(mutant), ki67 and CyclinD1 were detected. The exon 9 and exon 20 mutations of PIK3CA gene and the methylation status of the CDKN2A promoter were analysed. Results: Microscopically, the detection rate of perineural permeation, the detection density of peri-tumoural vascular and lymphatic growth, necrosis and muscle invasion in MSTS were significantly more frequent than those in RP (P < 0.05, P < 0.05, P < 0.01, P < 0.01). MSTS resulted in a higher detection rate of P53 (mutant), ki67, and CyclinD1 expression than did RS, but the difference was not significant. MSTS's detection rates in PIK3CA gene mutation and gene methylation sequencing in CDKN2A gene promoter region were both higher than RP (P < 0.05, P < 0.01). To be emphasised, the hotspot mutation H1047Rwas detected in one MSTS specimen (case 24M5) but in no RS specimens. Conclusions: This study verified that MSTS's advantage in the reflection of morphological and molecular characteristics of OSCC and OPSCC. MSTS was more representative than RP. Therefore, MSTS can compensate the RP limitations in ITH detection especially in large tumours.
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Affiliation(s)
- Weiping Jie
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Unit of Precision Pathologic Diagnosis in Tumours of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaying Bai
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Unit of Precision Pathologic Diagnosis in Tumours of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Yan
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Unit of Precision Pathologic Diagnosis in Tumours of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanting Chi
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Unit of Precision Pathologic Diagnosis in Tumours of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin-Bin Li
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Unit of Precision Pathologic Diagnosis in Tumours of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing, China
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Xu M, Wang Z, Yu XC, Lin JH, Hu YC. Guideline for Limb-Salvage Treatment of Osteosarcoma. Orthop Surg 2020; 12:1021-1029. [PMID: 32633103 PMCID: PMC7454155 DOI: 10.1111/os.12702] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022] Open
Abstract
Osteosarcoma is the most common primary malignant bone tumor, occurring mainly in children and adolescents, and the limbs are the main affected sites. At present, limb‐salvage treatment is considered as an effective basic standard treatment for osteosarcoma of the limb. China has a vast territory, but the development of technology is not balanced,which requires sufficient theoretical coverage, strong technical guidance and the application of limb‐salvage treatment guidelines to the treatment of osteosarcoma. Therefore, to standardize and promote the development of limb‐salvage surgery technology and improve the success rate of limb‐salvage treatment, this guide systematically introduces limb‐salvage techniques for the treatment of patients with limb osteosarcoma through definition of limb‐salvage treatment, surgical methods, efficacy evaluation, postoperative treatment and prevention of complications, rehabilitation guidance, and follow‐up advice.
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Affiliation(s)
- Ming Xu
- Department of Orthopedics, The 960th Hospital of PLA, Jinan, China
| | - Zhen Wang
- Department of Orthopedics, Xi-jing Hospital, Air Force Military Medical University, Xi'an, China
| | - Xiu-Chun Yu
- Department of Orthopedics, The 960th Hospital of PLA, Jinan, China
| | - Jian-Hua Lin
- Department of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin hospital, Tianjin, China
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The Impact of Tumor Eco-Evolution in Renal Cell Carcinoma Sampling. Cancers (Basel) 2018; 10:cancers10120485. [PMID: 30518081 PMCID: PMC6316833 DOI: 10.3390/cancers10120485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 12/31/2022] Open
Abstract
Malignant tumors behave dynamically as cell communities governed by ecological principles. Massive sequencing tools are unveiling the true dimension of the heterogeneity of these communities along their evolution in most human neoplasms, clear cell renal cell carcinomas (CCRCC) included. Although initially thought to be purely stochastic processes, very recent genomic analyses have shown that temporal tumor evolution in CCRCC may follow some deterministic pathways that give rise to different clones and sub-clones randomly spatially distributed across the tumor. This fact makes each case unique, unrepeatable and unpredictable. Precise and complete molecular information is crucial for patients with cancer since it may help in establishing a personalized therapy. Intratumor heterogeneity (ITH) detection relies on the correctness of tumor sampling and this is part of the pathologist’s daily work. International protocols for tumor sampling are insufficient today. They were conceived decades ago, when ITH was not an issue, and have remained unchanged until now. Noteworthy, an alternative and more efficient sampling method for detecting ITH has been developed recently. This new method, called multisite tumor sampling (MSTS), is specifically addressed to large tumors that are impossible to be totally sampled, and represent an opportunity to improve ITH detection without extra costs.
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Guarch R, Lawrie CH, Larrinaga G, Angulo JC, Pulido R, López JI. High levels of intratumor heterogeneity characterize the expression of epithelial-mesenchymal transition markers in high-grade clear cell renal cell carcinoma. Ann Diagn Pathol 2018; 34:27-30. [PMID: 29661723 DOI: 10.1016/j.anndiagpath.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 12/18/2022]
Abstract
Immunohistochemistry is a basic routine in establishing the diagnosis of many tumors. However, immunomarkers are often irregularly distributed across different regions of the same tumor, alternating positive and negative areas without any apparent cause. Full identification of this type of intratumor heterogeneity is crucial for patients since the expression of many markers is linked to the prognosis and/or treatment of some tumors. We have quantified this variability testing 406 tumor samples from eight clear cell renal cell carcinomas using four epithelial-mesenchymal transition markers (vimentin, ZEB-1, β-catenin, and E-cadherin) and two different sampling protocols. Routine sampling included an amount of 59 samples (average, 7.3 samples/case) and multisite tumor sampling did a total of 347 samples (average, 43.3 samples/case). High variability of immunostaining was detected with E-cadherin and ZEB-1 in all high-grade cases. Irregular patterns of expression were detected in all tumors including all histologically homogeneous low-grade tumors. Multisite tumor sampling protocol detected a significant decreased number of E-cadherin, β-catenin and ZEB-1 positive samples in high-grade tumors. We conclude that high levels of intratumor heterogeneity characterize the immunohistochemical expression of epithelial-mesenchymal transition markers in high-grade clear cell renal cell carcinomas. Multisite tumor sampling protocol outperforms routine sampling in detecting immunohistochemical intratumor heterogeneity.
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Affiliation(s)
- Rosa Guarch
- Department of Pathology, Complejo Hospitalario B de Navarra, Pamplona, Navarra, Spain
| | - Charles H Lawrie
- Onco-hematology Unit, Biodonostia Research Institute, Donostia-San Sebastián, Spain; Department of Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain; Nuffield Department of Clinical Laboratory Sciences, University of Oxford, UK; IKERBASQUE, The Basque Foundation for Science, Bilbao, Spain
| | - Gorka Larrinaga
- Department of Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain; Department of Nursing I, University of the Basque Country (UPV/EHU), Leioa, Spain; Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, Spain
| | - Javier C Angulo
- Department of Urology, Getafe University Hospital, Getafe, Madrid, Spain; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain
| | - Rafael Pulido
- IKERBASQUE, The Basque Foundation for Science, Bilbao, Spain; Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, Spain; Department of Cellular Biology and Histology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - José I López
- Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, Spain; Department of Pathology, Cruces University Hospital, University of the Basque Country (UPV/EHU), Barakaldo, Spain.
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Multisite tumor sampling enhances the detection of intratumor heterogeneity at all different temporal stages of tumor evolution. Virchows Arch 2017; 472:187-194. [DOI: 10.1007/s00428-017-2223-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/01/2017] [Accepted: 08/20/2017] [Indexed: 12/11/2022]
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Multisite tumor sampling: a new tumor selection method to enhance intratumor heterogeneity detection. Hum Pathol 2017; 64:1-6. [DOI: 10.1016/j.humpath.2017.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/14/2017] [Accepted: 02/09/2017] [Indexed: 01/20/2023]
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Cortés JM, de Petris G, López JI. Detection of Intratumor Heterogeneity in Modern Pathology: A Multisite Tumor Sampling Perspective. Front Med (Lausanne) 2017; 4:25. [PMID: 28321395 PMCID: PMC5337957 DOI: 10.3389/fmed.2017.00025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/20/2017] [Indexed: 12/30/2022] Open
Abstract
Current sampling protocols of neoplasms along the digestive tract and in the urinary bladder have to be updated, as they do not respond to the necessities of modern personalized medicine. We show here that an adapted version of multisite tumor sampling (MSTS) is a sustainable model to overcome current deficiencies in digestive and bladder tumors when they are large enough so as to make unaffordable a total sampling. The new method is based on the divide-and-conquer algorithm and includes a slight modification of the MSTS, which proved to be useful very recently in clear cell renal cell carcinoma. This in silico analysis confirms the usefulness of MSTS for detecting intratumor heterogeneity (ITH) in tumors arising in hollow viscera. However, MSTS does not seem to improve routine traditional sampling in detecting tumor budding, extramural venous invasion, and perineural invasion. We conclude that (1) MSTS is the best method for tumor sampling to detect ITH balancing high performance and sustainable cost, (2) MSTS must be adapted to tumor shape and tumor location for an optimal performance.
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Affiliation(s)
- Jesús M Cortés
- Quantitative Biomedicine Unit, Biocruces Research Institute, Barakaldo, Spain; Ikerbasque: The Basque Foundation for Science, Bilbao, Spain; Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Giovanni de Petris
- Department of Pathology and Laboratory Medicine, Penrose St Francis Hospital , Colorado Springs, CO , USA
| | - José I López
- Department of Pathology, Cruces University Hospital, Barakaldo, Spain; Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, Spain; University of the Basque Country (UPV/EHU), Leioa, Spain
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Guarch R, Cortés JM, Lawrie CH, López JI. Multi-site tumor sampling (MSTS) improves the performance of histological detection of intratumor heterogeneity in clear cell renal cell carcinoma (CCRCC). F1000Res 2016; 5:2020. [PMID: 27635226 PMCID: PMC5007747 DOI: 10.12688/f1000research.9419.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2016] [Indexed: 12/23/2022] Open
Abstract
Current standard-of-care tumor sampling protocols for CCRCC (and other cancers) are not efficient at detecting intratumoural heterogeneity (ITH). We have demonstrated in silico that an alternative protocol, multi-site tumor sampling (MSTS) based upon the divide and conquer (DAC) algorithm, can significantly increase the efficiency of ITH detection without extra costs. Now we test this protocol on routine hematoxylin-eosin (HE) sections in a series of 38 CCRCC cases. MSTS was found to outperform traditional sampling when detecting either high grade (p=0.0136) or granular/eosinophilic cells (p=0.0114). We therefore propose that MSTS should be used in routine clinical practice.
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Affiliation(s)
- Rosa Guarch
- Department of Pathology, Complejo Hospitalario B de Navarra, Pamplona, Navarra, 31008, Spain
| | - Jesús M Cortés
- Quantitative Biomedicine Unit, Biocruces Research Institute, Barakaldo, 48903, Spain; Ikerbasque: The Basque Foundation for Science, Bilbao, 48013, Spain; Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Leioa, 48940, Spain
| | - Charles H Lawrie
- Ikerbasque: The Basque Foundation for Science, Bilbao, 48013, Spain; Molecular Oncology Group, Biodonostia Research Institute, San Sebastian, 20014, Spain; Department of Physiology, University of the Basque Country (UPV/EHU), Leioa, 48940, Spain; Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - José I López
- Department of Pathology, Cruces University Hospital, University of the Basque Country (UPV/EHU), Barakaldo, 48903, Spain; Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, 48903, Spain
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Guarch R, Cortés JM, Lawrie CH, López JI. Multi-site tumor sampling (MSTS) improves the performance of histological detection of intratumor heterogeneity in clear cell renal cell carcinoma (CCRCC). F1000Res 2016. [PMID: 27635226 DOI: 10.12688/f1000research.9419.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Current standard-of-care tumor sampling protocols for CCRCC (and other cancers) are not efficient at detecting intratumoural heterogeneity (ITH). We have demonstrated in silico that an alternative protocol, multi-site tumor sampling (MSTS) based upon the divide and conquer (DAC) algorithm, can significantly increase the efficiency of ITH detection without extra costs. Now we test this protocol on routine hematoxylin-eosin (HE) sections in a series of 38 CCRCC cases. MSTS was found to outperform traditional sampling when detecting either high grade (p=0.0136) or granular/eosinophilic cells (p=0.0114). We therefore propose that MSTS should be used in routine clinical practice.
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Affiliation(s)
- Rosa Guarch
- Department of Pathology, Complejo Hospitalario B de Navarra, Pamplona, Navarra, 31008, Spain
| | - Jesús M Cortés
- Quantitative Biomedicine Unit, Biocruces Research Institute, Barakaldo, 48903, Spain; Ikerbasque: The Basque Foundation for Science, Bilbao, 48013, Spain; Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Leioa, 48940, Spain
| | - Charles H Lawrie
- Ikerbasque: The Basque Foundation for Science, Bilbao, 48013, Spain; Molecular Oncology Group, Biodonostia Research Institute, San Sebastian, 20014, Spain; Department of Physiology, University of the Basque Country (UPV/EHU), Leioa, 48940, Spain; Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - José I López
- Department of Pathology, Cruces University Hospital, University of the Basque Country (UPV/EHU), Barakaldo, 48903, Spain; Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, 48903, Spain
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