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Budner O, Cwalinski T, Skokowski J, Marano L, Resca L, Cwalina N, Kalinowski L, Hoveling R, Roviello F, Polom K. Methylene Blue Near-Infrared Fluorescence Imaging in Breast Cancer Sentinel Node Biopsy. Cancers (Basel) 2022; 14:cancers14071817. [PMID: 35406588 PMCID: PMC8997777 DOI: 10.3390/cancers14071817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 01/25/2023] Open
Abstract
Simple Summary Currently the gold standard for sentinel node biopsy in breast cancer patients is radioactive nanocolloid and a blue dye. In the age of fluorescence guided surgery new fluorophores are used and methylene blue presents some fluorescent properties. This study is the first in a clinical series presenting the possible use of methylene blue as a fluorescent dye for the identification of sentinel nodes in breast cancer sentinel node biopsy. We presented a feasibility of this new method and also in additional experiments because of the quenching effect limitation, found possible dilution of methylene blue presenting improved fluorescence. Abstract Introduction: Fluorescence-based navigation for breast cancer sentinel node biopsy is a novel method that uses indocyanine green as a fluorophore. However, methylene blue (MB) also has some fluorescent properties. This study is the first in a clinical series presenting the possible use of MB as a fluorescent dye for the identification of sentinel nodes in breast sentinel node biopsy. Material and methods: Forty-nine patients with breast cancer who underwent sentinel node biopsy procedures were enrolled in the study. All patients underwent standard simultaneous injection of nanocolloid and MB. We visualized and assessed the sentinel nodes and the lymphatic channels transcutaneously, with and without fluorescence, and calculated the signal-to-background ratio (SBR). We also analyzed the corresponding fluorescence intensity of various dilutions of MB. Results: In twenty-three patients (46.9%), the location of the sentinel node, or the end of the lymphatic path, was visible transcutaneously. The median SBR for transcutaneous sentinel node location was 1.69 (range 1.66–4.35). Lymphatic channels were visible under fluorescence in 14 patients (28.6%) prior to visualization by the naked eye, with an average SBR of 2.01 (range 1.14–5.6). The sentinel node was visible under fluorescence in 25 patients (51%). The median SBR for sentinel node visualization with MB fluorescence was 2.54 (range 1.34–6.86). Sentinel nodes were visualized faster under fluorescence during sentinel node preparation. Factors associated with the rate of visualization included diabetes (p = 0.001), neoadjuvant chemotherapy (p = 0.003), and multifocality (p = 0.004). The best fluorescence was obtained using 40 μM (0.0128 mg/mL) MB, but we also observed a clinically relevant dilution range between 20 μM (0.0064 mg/mL) and 100 μM (0.032 mg/mL). Conclusions: For the first time, we propose the clinical usage of MB as a fluorophore for fluorescence-guided sentinel node biopsy in breast cancer patients. The quenching effect of the dye may be the reason for its poor detection rate. Our analysis of different concentrations of MB suggests a need for a detailed clinical analysis to highlight the practical usefulness of the dye.
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Affiliation(s)
- Oliver Budner
- Frauenheilkunde und Geburtshilfe, HELIOS Kliniken Schwerin, Wissmarsche Street 393-397, 19-055 Schwerin, Germany;
| | - Tomasz Cwalinski
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdansk, Marii Sklodowskiej-Curie Street 3a, 80-217 Gdansk, Poland; (T.C.); (J.S.)
| | - Jarosław Skokowski
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdansk, Marii Sklodowskiej-Curie Street 3a, 80-217 Gdansk, Poland; (T.C.); (J.S.)
- Department of Medical Laboratory Diagnostics–Biobank Fahrenheit BBMRI.pl, Medical University of Gdansk, Debinki Street 7, 80-211 Gdańsk, Poland;
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.pl), 80-210 Gdańsk, Poland
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci 16, 53-100 Siena, Italy; (L.M.); (L.R.); (F.R.)
| | - Luca Resca
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci 16, 53-100 Siena, Italy; (L.M.); (L.R.); (F.R.)
| | - Natalia Cwalina
- Department of Pediatrics Ascension, St. John Children’s Hospital, Detroit, MI 48236, USA;
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics–Biobank Fahrenheit BBMRI.pl, Medical University of Gdansk, Debinki Street 7, 80-211 Gdańsk, Poland;
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.pl), 80-210 Gdańsk, Poland
- BioTechMed/Department of Mechanics of Materials and Structures, Gdansk University of Technology, Gabriela Narutowicza Street 11/12, 80-233 Gdansk, Poland
| | - Richelle Hoveling
- Quest Medical Imagining, Industrieweg 41, 1775 PW Middenmeer, The Netherlands;
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci 16, 53-100 Siena, Italy; (L.M.); (L.R.); (F.R.)
| | - Karol Polom
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdansk, Marii Sklodowskiej-Curie Street 3a, 80-217 Gdansk, Poland; (T.C.); (J.S.)
- Correspondence: ; Tel.: +48-58-349-31-90
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Abstract
Preeclampsia is a devastating pregnancy-associated disorder affecting 5% to 8% of pregnant women worldwide. It emerges as an autoimmune-driven disease, and, among others, the autoantibodies against angiotensin type 1 receptor II have been proposed to account for preeclampsia symptoms. Despite much attention focused on describing autoantibodies associated with preeclampsia, there is no clue concerning the cell population producing them. CD19
+
CD5
+
B-1a B cells constitute the main source of natural and polyreactive antibodies, which can be directed against own structures. Here, we aimed to identify the B-cell subpopulation responsible for autoantibody production during preeclampsia and to study their regulation, as well as their possible use as markers for the disease. The frequency of CD19
+
CD5
+
cells in peripheral blood of preeclamptic patients is dramatically increased compared with normal pregnant women as analyzed by flow cytometry. This seems to be driven by the high human chorionic gonadotropin levels present in the serum and placenta supernatant of preeclamptic patients versus normal pregnant women. Not only ≈95% of CD19
+
CD5
+
cells express the human chorionic gonadotropin receptor, but these cells also expand on human chorionic gonadotropin stimulation in a lymphocyte culture. Most importantly, isolated CD19
+
CD5
+
cells produce autoantibodies against angiotensin type 1 receptor II, and CD19
+
CD5
+
cells were further detected in the placenta of preeclamptic but not of normal pregnancies where barely B cells are present. Our results identify a B-cell population able to produce pregnancy-pathological autoantibodies as possible markers for preeclampsia, which opens vast diagnostic and therapeutic applications.
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Affiliation(s)
- Federico Jensen
- From the Experimental Obstetrics and Gynecology (F.J., T.E.-M., A.C.Z.), Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Experimental and Clinical Research Center (G.W., F.H., R.D.), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; University Women's Clinic (O.B., S.-D.C.), Otto-von-Guericke University, Magdeburg, Germany; HELIOS Klinikum Berlin-Buch (R.D.), Berlin, Germany
| | - Gerd Wallukat
- From the Experimental Obstetrics and Gynecology (F.J., T.E.-M., A.C.Z.), Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Experimental and Clinical Research Center (G.W., F.H., R.D.), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; University Women's Clinic (O.B., S.-D.C.), Otto-von-Guericke University, Magdeburg, Germany; HELIOS Klinikum Berlin-Buch (R.D.), Berlin, Germany
| | - Florian Herse
- From the Experimental Obstetrics and Gynecology (F.J., T.E.-M., A.C.Z.), Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Experimental and Clinical Research Center (G.W., F.H., R.D.), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; University Women's Clinic (O.B., S.-D.C.), Otto-von-Guericke University, Magdeburg, Germany; HELIOS Klinikum Berlin-Buch (R.D.), Berlin, Germany
| | - Oliver Budner
- From the Experimental Obstetrics and Gynecology (F.J., T.E.-M., A.C.Z.), Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Experimental and Clinical Research Center (G.W., F.H., R.D.), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; University Women's Clinic (O.B., S.-D.C.), Otto-von-Guericke University, Magdeburg, Germany; HELIOS Klinikum Berlin-Buch (R.D.), Berlin, Germany
| | - Tarek El-Mousleh
- From the Experimental Obstetrics and Gynecology (F.J., T.E.-M., A.C.Z.), Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Experimental and Clinical Research Center (G.W., F.H., R.D.), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; University Women's Clinic (O.B., S.-D.C.), Otto-von-Guericke University, Magdeburg, Germany; HELIOS Klinikum Berlin-Buch (R.D.), Berlin, Germany
| | - Serban-Dan Costa
- From the Experimental Obstetrics and Gynecology (F.J., T.E.-M., A.C.Z.), Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Experimental and Clinical Research Center (G.W., F.H., R.D.), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; University Women's Clinic (O.B., S.-D.C.), Otto-von-Guericke University, Magdeburg, Germany; HELIOS Klinikum Berlin-Buch (R.D.), Berlin, Germany
| | - Ralf Dechend
- From the Experimental Obstetrics and Gynecology (F.J., T.E.-M., A.C.Z.), Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Experimental and Clinical Research Center (G.W., F.H., R.D.), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; University Women's Clinic (O.B., S.-D.C.), Otto-von-Guericke University, Magdeburg, Germany; HELIOS Klinikum Berlin-Buch (R.D.), Berlin, Germany
| | - Ana Claudia Zenclussen
- From the Experimental Obstetrics and Gynecology (F.J., T.E.-M., A.C.Z.), Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Experimental and Clinical Research Center (G.W., F.H., R.D.), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; University Women's Clinic (O.B., S.-D.C.), Otto-von-Guericke University, Magdeburg, Germany; HELIOS Klinikum Berlin-Buch (R.D.), Berlin, Germany
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