Intraoperative flow cytometry for head and neck lesions. Assessment of malignancy and tumour-free resection margins

Vartholomatos, George; Basiari, Lentiona; Exarchakos, Georgios; Kastanioudakis, Ioannis; Komnos, Ioannis; Michali, Maria; Μαρκόπουλος, Γεώργιος; Batistatou, Anna; Papoudou‐Bai, Alexandra; Alexiou, George Α.

doi:10.1016/j.oraloncology.2019.06.025

Cited by 26 publications

(19 citation statements)

References 15 publications

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“…This method offers numerous advantages, and can be successfully used for tumor diagnosis, as clonal expansion of cancer cells can be monitored as subpopulations with distinct genetic characteristics. It contributes towards precise intraoperative identification of tumor margins, offering the potential of complete removal, and is currently applied in brain [ 21 , 22 ], head-and-neck [ 23 , 24 ], breast [ 25 , 26 , 27 ], liver [ 28 ], pancreatic [ 29 ], and colorectal neoplasms [ 30 ]. To the best of our knowledge, the present study is the first application of iFC in the detection and characterization of cancer cells in gynecological malignancies.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative flow cytometry (iFC) is a breakthrough technique enabling the cytometric analysis of DNA content/ploidy and cell-cycle distribution of cells acquired during surgical resection of tumors to characterize cancer cells and to evaluate the limits of resection, bridging the aforementioned gap between evaluation and surgery. This procedure has been applied by our team during central nervous tumor surgeries, and its significance has since been confirmed in several additional cancer types, including head-and-neck malignancies, breast cancer, hepatocellular cancer, pancreatic cancer, and colorectal cancer [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Intraoperative flow cytometry offers good diagnostic potential with high sensitivity and specificity, while a prognostic role is also suggested.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Flow Cytometry for the Characterization of Gynecological Malignancies

Anastasiadi

Mantziou

Akrivis

et al. 2022

Biology

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Cell-cycle analysis has shown the presence of aneuploidy to be associated with poor prognosis. We developed an innovative rapid cell-cycle analysis protocol (the Ioannina protocol) that permitted the intraoperative identification of neoplastic cells in a plethora of malignancies. Herein, we aimed to investigate the potential role of cell-cycle analysis in the intraoperative characterization of gynecological malignancies. Women who underwent surgery for gynecological malignancies in our institution over a three-year period were included in this study. Permanent section pathology evaluation was used as the gold standard for malignancy evaluation. Total accordance was observed between flow cytometry and pathology evaluation. In total, 21 aneuploid cancers were detected following DNA index calculation. Of these, 20 were hyperploid and 1 was hypoploid. In addition, tumor samples were characterized by a significantly lower percentage of cells in G0/G1, as well as an induced tumor index. The response time for flow cytometry to obtain results was 5–6 min per sample. It seems that flow cytometry analyses for intraoperative tumor evaluation can be safely expanded to gynecological malignancies. This is a novel practical approach that has been proven valuable in several tumor types to date, and also seems to be reliable for gynecological malignancies. Intraoperative flow cytometry is expected to be crucial in decisions of lymph node dissection in endometrial cancers, due to its rapid response regarding the tumor invasion of part or all of the myometrial thickness. In this way, the surgeon can quickly modify the plane of dissection. Our results warrant the further investigation of applying iFC in larger, multicenter studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative Flow Cytometry for the Characterization of Gynecological Malignancies

Anastasiadi

Mantziou

Akrivis

et al. 2022

Biology

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“…Our research team is working on the way to establish iFC as a universal next generation margin evaluation tool [ 28 ]. Till now, iFC has been successfully implemented in surgical procedures regarding malignancies of brain, head-and-neck, breast, gynecological, hepatobilliary and colorectum, with a high accuracy that in most cases is beyond 90% [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. The current study extends the utility of iFC in bladder cancer analysis during transurethral resections and reveals that it exhibits a high accuracy (>98%) towards bladder cancer cell characterization.…”

Section: Discussionmentioning

confidence: 99%

“…Our team has utilized intraoperative flow cytometry, originally for brain malignancies [ 20 , 21 , 22 , 23 ]. Based on the high diagnostic potential of iFC, the methodology has further been standardized and applied in several types of malignancy, including head and neck [ 24 , 25 ], breast [ 26 , 27 , 28 ], liver [ 29 ], pancreatic [ 30 ] colorectal [ 31 ], as well as gynecological neoplasms [ 32 ]. Since iFC facilitates near real time detection of aneuploidy and calculation of S- plus G2/M-phase fraction in surgical samples, it offers an accurate measurement of cancer hallmarks in 3–5 min.…”

Section: Introductionmentioning

confidence: 99%

Accurate Characterization of Bladder Cancer Cells with Intraoperative Flow Cytometry

Paliouras

Μαρκόπουλος

Tsampalas

et al. 2022

Cancers

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Bladder cancer represents a major health issue. Transurethral resection is the first line treatment and an accurate assessment of tumor margins might warrant complete tumor removal. Genomic instability and proliferative potential are common hallmarks of cancer cells. We have previously demonstrated the utility of intraoperative flow cytometry (iFC), a next-generation margin evaluation methodology for assessment of DNA content, in the detection of several types of malignancy. In the current study we investigated the possible value of iFC in the characterization of bladder cancer during surgery. Samples from a population of 52 people with urothelial cancer were included in the study. The total time for iFC evaluation is 3–5 min per sample and included a two-step analysis, including DNA-index and Tumor-index calculation. First, DNA-index calculation revealed 24 hyperploid and one hypoploid tumor. Second, cell cycle analysis and Tumor-index calculation revealed that tumor samples are distinguished from normal cells based on their significantly higher proliferative potential. The standard for iFC evaluation was pathology assessment and revealed that our protocol exhibits an accuracy of 98% in defining the presence of cancer cells in a given sample. Our results support the further assessment of iFC value towards its use as a novel malignancy evaluation tool in transurethral resections.

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“…As regards prognosis, recent data suggest that calculation of malignancy index based on iFC may also act as a novel prognostic factor following radiotherapy and chemotherapy with temozolomide [ 13 ]. The utility of iFC is currently being expanded beyond CNSTs into the analysis of tumor margins in several additional cancer types [ 14 ], with candidates such as head-and-neck malignancies [ 15 , 16 ] and breast cancer [ 17 ]. The rationale of the current study is the presentation of a novel modified protocol that uses a touch imprint on a nylon membrane of the hepatic transaction area, in order to obtain cells for flow cytometric analysis.…”

Section: Introductionmentioning

confidence: 99%

Touch Imprint Intraoperative Flow Cytometry as a Complementary Tool for Detailed Assessment of Resection Margins and Tumor Biology in Liver Surgery for Primary and Metastatic Liver Neoplasms

Μαρκόπουλος

Glantzounis

Goussia

et al. 2021

MPs

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Liver resection is the main treatment for primary and metastatic liver tumors in order to achieve long-term survival with good quality of life. The ultimate goal of surgical oncology is to achieve complete tumor removal with adequate clear surgical margins. Flow cytometry is a powerful analytical technique with applications such as phenotypic analysis and quantification of DNA content. Intraoperative flow cytometry (iFC) is the application of flow cytometry for DNA content/ploidy and cell cycle distribution analysis during surgery for tumor cell analysis and margin evaluation. It has been used for cell analysis of intracranial tumors and recently of head and neck carcinomas and breast carcinomas, as well as for tumor margin evaluation. Herein, we present a novel touch imprint iFC protocol for the detailed assessment of tumor margins during excision of malignant hepatic lesions. The protocol aims to offer information on surgical margins after removal of malignant liver tumors based on DNA content of cancer cells and to corroborate the results of iFC with that of histopathological analysis. Based on the established role of iFC in other types of malignancies, our specialized protocol has the potential, through characterization of cells in liver transection surface post hepatectomy, to offer significant information on the type of resection and tumor biology. This information can be used to effectively guide intra- and postoperative patient management.

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Intraoperative flow cytometry for head and neck lesions. Assessment of malignancy and tumour-free resection margins

Cited by 26 publications

References 15 publications

Intraoperative Flow Cytometry for the Characterization of Gynecological Malignancies

Intraoperative Flow Cytometry for the Characterization of Gynecological Malignancies

Accurate Characterization of Bladder Cancer Cells with Intraoperative Flow Cytometry

Touch Imprint Intraoperative Flow Cytometry as a Complementary Tool for Detailed Assessment of Resection Margins and Tumor Biology in Liver Surgery for Primary and Metastatic Liver Neoplasms

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