Intraoperative Flow Cytometry for the Characterization of Gynecological Malignancies

Abstract

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.

Intraoperative Flow Cytometry for the Evaluation of Meningioma Grade

“…IFC has recently been introduced as a useful tool for solid tumor evaluation [6,[8][9][10][11][12][13]. Cell cycle analysis was one of the first applications of flow cytometry, and when a flow cytometer is available, cell cycle analysis can be performed at virtually no cost.…”

“…A real-time intraoperative device based on flow cytometry has also been proposed [19]. IFC has also been proven to be useful during surgery for other solid tumors such as liver cancer, pancreatic cancer, head and neck malignancies, breast cancer surgery, colorectal, gynecological and urological cancers [8][9][10][11][12][13]20].…”

Accurate Characterization of Bladder Cancer Cells with Intraoperative Flow Cytometry

“…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.…”

“…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.…”

Advances in Intraoperative Flow Cytometry

“…In a recent study, 21 aneuploid cancers were detected following the DNA index calculation. Tumor samples were characterized by a significantly lower percentage of cells in G0/G1, as well as by an increased tumor index [ 77 ].…”