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Bekkhus T, Avenel C, Hanna S, Boger MF, Klemm A, Bacovia DV, Wärnberg F, Wählby C, Ulvmar MH. Automated detection of vascular remodeling in tumor-draining lymph nodes by the deep learning tool HEV-finder. J Pathol 2022; 258:4-11. [PMID: 35696253 PMCID: PMC9543492 DOI: 10.1002/path.5981] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/22/2022] [Accepted: 06/09/2022] [Indexed: 12/02/2022]
Abstract
Vascular remodeling is common in human cancer and has potential as future biomarkers for prediction of disease progression and tumor immunity status. It can also affect metastatic sites, including the tumor‐draining lymph nodes (TDLNs). Dilation of the high endothelial venules (HEVs) within TDLNs has been observed in several types of cancer. We recently demonstrated that it is a premetastatic effect that can be linked to tumor invasiveness in breast cancer. Manual visual assessment of changes in vascular morphology is a tedious and difficult task, limiting high‐throughput analysis. Here we present a fully automated approach for detection and classification of HEV dilation. By using 12,524 manually classified HEVs, we trained a deep‐learning model and created a graphical user interface for visualization of the results. The tool, named the HEV‐finder, selectively analyses HEV dilation in specific regions of the lymph nodes. We evaluated the HEV‐finder's ability to detect and classify HEV dilation in different types of breast cancer compared to manual annotations. Our results constitute a successful example of large‐scale, fully automated, and user‐independent, image‐based quantitative assessment of vascular remodeling in human pathology and lay the ground for future exploration of HEV dilation in TDLNs as a biomarker. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Tove Bekkhus
- The Beijer Laboratory, Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Christophe Avenel
- Department of Information Technology, Uppsala University, Uppsala, Sweden.,BioImage Informatics Facility, SciLifeLab, Uppsala, Sweden
| | - Sabella Hanna
- The Beijer Laboratory, Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Mathias Franzén Boger
- The Beijer Laboratory, Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Anna Klemm
- Department of Information Technology, Uppsala University, Uppsala, Sweden.,BioImage Informatics Facility, SciLifeLab, Uppsala, Sweden
| | - Daniel Vasiliu Bacovia
- The Beijer Laboratory, Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Fredrik Wärnberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Carolina Wählby
- Department of Information Technology, Uppsala University, Uppsala, Sweden.,BioImage Informatics Facility, SciLifeLab, Uppsala, Sweden
| | - Maria H Ulvmar
- The Beijer Laboratory, Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
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Jazrawi A, Pantiora E, Abdsaleh S, Bacovia DV, Eriksson S, Leonhardt H, Wärnberg F, Karakatsanis A. Magnetic-Guided Axillary UltraSound (MagUS) Sentinel Lymph Node Biopsy and Mapping in Patients with Early Breast Cancer. A Phase 2, Single-Arm Prospective Clinical Trial. Cancers (Basel) 2021; 13:cancers13174285. [PMID: 34503095 PMCID: PMC8428333 DOI: 10.3390/cancers13174285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 01/23/2023] Open
Abstract
Lymph Node Dissection (SLND) is standard of care for diagnosing sentinel lymph node (SLN) status in patients with early breast cancer. Study aim was to determine whether the combination of Superparamagnetic iron oxide nanoparticles (SPIO) MRI-lymphography (MRI-LG) and a Magnetic-guided Axillary UltraSound (MagUS) with biopsy can allow for minimally invasive, axillary evaluation to de-escalate surgery. Patients were injected with 2 mL of SPIO and underwent MRI-LG for SN mapping. Thereafter MagUS and core needle biopsy (CNB) were performed. Patients planned for neoadjuvant treatment, the SLN was clipped and SLND was performed after neoadjuvant with the addition of isotope. During surgery, SLNs were controlled for signs of previous biopsy or clip. The primary endpoint was MagUS SLN detection rate, defined as successful SLN detection of at least one SLN of those retrieved in SLND. In 79 patients, 48 underwent upfront surgery, 12 received neoadjuvant and 19 had recurrent cancer. MagUS traced the SLN in all upfront and neoadjuvant cases, detecting all patients with macrometastases (n = 10). MagUS missed only one micrometastasis, outperforming baseline axillary ultrasound AUS (AUC: 0.950 vs. 0.508, p < 0.001) and showing no discordance to SLND (p = 1.000). MagUS provides the niche for minimally invasive axillary mapping that can reduce diagnostic surgery.
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Affiliation(s)
- Allan Jazrawi
- Centre for Clinical Research, County Västmanland, Uppsala University, 72189 Västerås, Sweden; (A.J.); (S.E.)
- Department of Surgery, Västmanlands County Hospital, 72189 Västerås, Sweden
| | - Eirini Pantiora
- Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden; (E.P.); (S.A.); (F.W.)
- Department of Surgery, Section for Endocrine and Breast Surgery, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Shahin Abdsaleh
- Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden; (E.P.); (S.A.); (F.W.)
- Aleris Mammography Unit, 75320 Uppsala, Sweden
| | - Daniel Vasiliu Bacovia
- Department Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden;
| | - Staffan Eriksson
- Centre for Clinical Research, County Västmanland, Uppsala University, 72189 Västerås, Sweden; (A.J.); (S.E.)
- Department of Surgery, Västmanlands County Hospital, 72189 Västerås, Sweden
| | - Henrik Leonhardt
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41343 Gothenburg, Sweden;
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden; (E.P.); (S.A.); (F.W.)
- Department of Surgery, Section for Endocrine and Breast Surgery, Uppsala University Hospital, 75185 Uppsala, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Andreas Karakatsanis
- Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden; (E.P.); (S.A.); (F.W.)
- Department of Surgery, Section for Endocrine and Breast Surgery, Uppsala University Hospital, 75185 Uppsala, Sweden
- Correspondence:
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Bekkhus T, Martikainen T, Olofsson A, Franzén Boger M, Vasiliu Bacovia D, Wärnberg F, Ulvmar MH. Remodeling of the Lymph Node High Endothelial Venules Reflects Tumor Invasiveness in Breast Cancer and is Associated with Dysregulation of Perivascular Stromal Cells. Cancers (Basel) 2021; 13:cancers13020211. [PMID: 33430113 PMCID: PMC7827313 DOI: 10.3390/cancers13020211] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/16/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 01/02/2023] Open
Abstract
The tumor-draining lymph nodes (TDLNs) are primary sites for induction of tumor immunity. They are also common sites of metastasis, suggesting that tumor-induced mechanisms can subvert anti-tumor immune responses and promote metastatic seeding. The high endothelial venules (HEVs) together with CCL21-expressing fibroblastic reticular cells (FRCs) are essential for lymphocyte recruitment into the LNs. We established multicolor antibody panels for evaluation of HEVs and FRCs in TDLNs from breast cancer (BC) patients. Our data show that patients with invasive BC display extensive structural and molecular remodeling of the HEVs, including vessel dilation, thinning of the endothelium and discontinuous expression of the HEV-marker PNAd. Remodeling of the HEVs was associated with dysregulation of CCL21 in perivascular FRCs and with accumulation of CCL21-saturated lymphocytes, which we link to loss of CCL21-binding heparan sulfate in FRCs. These changes were rare or absent in LNs from patients with non-invasive BC and cancer-free organ donors and were observed independent of nodal metastasis. Thus, pre-metastatic dysregulation of core stromal and vascular functions within TDLNs reflect the primary tumor invasiveness in BC. This adds to the understanding of cancer-induced perturbation of the immune response and opens for prospects of vascular and stromal changes in TDLNs as potential biomarkers.
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Affiliation(s)
- Tove Bekkhus
- The Beijer Laboratory, Department Immunology, Genetics and Pathology, Rudbeck Laboratory, Dag Hammarskjölds väg 20, Uppsala University, 75185 Uppsala, Sweden; (T.B.); (T.M.); (A.O.); (M.F.B.); (D.V.B.)
| | - Teemu Martikainen
- The Beijer Laboratory, Department Immunology, Genetics and Pathology, Rudbeck Laboratory, Dag Hammarskjölds väg 20, Uppsala University, 75185 Uppsala, Sweden; (T.B.); (T.M.); (A.O.); (M.F.B.); (D.V.B.)
| | - Anna Olofsson
- The Beijer Laboratory, Department Immunology, Genetics and Pathology, Rudbeck Laboratory, Dag Hammarskjölds väg 20, Uppsala University, 75185 Uppsala, Sweden; (T.B.); (T.M.); (A.O.); (M.F.B.); (D.V.B.)
| | - Mathias Franzén Boger
- The Beijer Laboratory, Department Immunology, Genetics and Pathology, Rudbeck Laboratory, Dag Hammarskjölds väg 20, Uppsala University, 75185 Uppsala, Sweden; (T.B.); (T.M.); (A.O.); (M.F.B.); (D.V.B.)
| | - Daniel Vasiliu Bacovia
- The Beijer Laboratory, Department Immunology, Genetics and Pathology, Rudbeck Laboratory, Dag Hammarskjölds väg 20, Uppsala University, 75185 Uppsala, Sweden; (T.B.); (T.M.); (A.O.); (M.F.B.); (D.V.B.)
| | - Fredrik Wärnberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, 41345 Gothenburg, Sweden;
| | - Maria H. Ulvmar
- The Beijer Laboratory, Department Immunology, Genetics and Pathology, Rudbeck Laboratory, Dag Hammarskjölds väg 20, Uppsala University, 75185 Uppsala, Sweden; (T.B.); (T.M.); (A.O.); (M.F.B.); (D.V.B.)
- Correspondence: ; Tel.: +46-737834297
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