B. Michael Ghadimi

Gert Auer

Kerstin Heselmeyer‐Haddad

Thomas Ried

English

PubMed

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3Mini reviewInterphase cytogenetics: At the interface ofgenetics and morphologyB. Michael Ghadimi a,∗,Kerstin Heselmeyer-Haddad a, Gert Auer b andThomas Ried aa Genetics Department, National Cancer Institute,National Institutes of Health, Bethesda, MD, USAb Division of Cellular and Molecular Analysis,Department of Oncology and Pathology, KarolinskaInstitute and Hospital, Stockholm, SwedenCancer is a genetic disease caused by chromoso-mal aberrations and gene mutations, which propel nor-mal cells into uncontrolled growth, invasiveness andmetastases formation. Because chromosomal and ge-netic alterations impact tumour aggressiveness, ther-apy response, and prognosis their detection in clinicalsamples (e.g., fine needle aspirates and bioptic mate-rial) plays an increasingly critical role in individualizeddisease management. In situ hybridization with geneticmarkers to tumour specimen, a concept coined “Inter-phase Cytogenetics” [3] allows one to visualize chro-mosomal alterations in intact cell nuclei. Both numer-ical and structural chromosomal aberrations can be vi-sualized using suitable probes or probe cocktails. Thegrowing knowledge on tumour specific genetic andchromosomal aberrations can therefore be translated todiagnostic pathology. The identification and validationof such biomarkers will be greatly accelerated by high-throughput analysis tools such as cDNA-arrays for theanalysis of differentially expressed messages [5] andtissues arrays [14] for the simultaneous screening ofthe expression pattern of hundreds of different tumours(see Fig. 1).The detection of chromosome and gene alterationsin interphase nuclei of cytological specimens and tis-*Corresponding author: B. Michael Ghadimi, National Cancer In-stitute/NIH, Bldg. 49, Rm. 4C24, 49 Convent Drive, Bethesda, MD20892, USA. Tel.: (301) 402 2008; Fax: (301) 402 1204; E-mail:ghadimim@mail.nih.gov.sue sections is the only technique available for the si-multaneous visualization of genetic changes and cellmorphology on a single cell level. This can be extendedto the simultaneous assessment of immunophenotypeand genotype [2,13,22]. The maintenance of morpho-logical information is arguably beneficial, because thewealth of genetic and non-genetic changes that con-tribute to a particular phenotype is not lost. Interphasecytogenetics can be performed on freshly frozen orfixed and archived tissues and is therefore applicableto the prospective, and particularly the retrospectivestudy of tumour tissues. The development of multiplecolor fluorescent as well as colorimetric detection sys-tems affords the possibility of enumerating multiplegenetic and chromosomal target regions in a single ex-periment [19–21].The relevance of the “loss of inhibiting chromo-somes” or the “gain of promoting chromosomes”was established almost a century ago by von Hanse-mann [10] and Boveri [1]. Refinement of techniques incytogenetics and molecular cytogenetics has resultedin a resurrection of the prophetic hypothesis of thesetwo contemporaries and large scale analysis of solidtumours through the use of comparative genomic hy-bridization (CGH) have revealed a surprisingly recur-rent and tumour specific pattern of genomic imbal-ances in cancer cells (reviewed in [6,12,18]). CGH ex-periments require only genomic DNA extracted fromformalin fixed tissue blocks and histologically charac-terized tissue sections and therefore allow the correla-tion between the cytogenetic profile and tumour phe-notype and tumour stages. The application of CGH es-tablished a non-random sequence of chromosomal ab-normalities during carcinogenesis [11,16,17]. In cervi-cal cancer, for example, the gain of an additional copyof chromosome 3q occurs at the transition of prein-vasive dysplastic lesions to invasive carcinomas andprecedes the acquisition of a more complex pattern ofDNA gains and losses at more advanced tumour stages.Analytical Cellular Pathology 19 (1999) 3–6ISSN 0921-8912 / $8.00 Ó 1999, IOS Press. All rights reserved4 B.M. Ghadimi et al. / Interphase cytogeneticsFig. 1. Flow chart: from gene discovery to clinical application.Such a chromosomal marker has the potential to be-come useful as a predictor for the progressive poten-tial of premalignant lesions. Unlike cervical carcino-genesis, a higher number of recurring chromosomalchanges can be detected in tumours of, e.g., the breast,colon, ovary, and pancreas. CGH studies, however, in-dicate that the utilization of up to 4 different DNAprobes specific for recurrently involved chromosomearms will be sufficient to detect almost all tumours.The tumour type dependent distribution of chromoso-mal imbalances might also assist in the differential di-agnosis in cases where the site of origin cannot be un-ambiguously established. For example, an interphaseprobe set for the detection of cervical cancer will in-clude tags for the chromosomes and chromosome arms1q, 3q, 5p and 20 whereas its counterpart for breastcancer will contain probes for 1q, 4q, 6q and 8q.The translational application of these results to thehisto- and cytomorphology based diagnosis of can-cer holds great promise for more than an incremen-tal increase in diagnostics accuracy. The considerablepotential of interphase cytogenetics can be deducedfrom the need for an early detection of malignant dis-ease when a curative treatment is sought. Phenotypicchanges in pre-invasive or early invasive disease areoften less clear than those in advanced disease. DNAbased assays, such as PCR, for the detection of cancerspecific gene mutations are more ambiguous in earlylesions since the contamination with normal cells com-plicates data interpretation.Two examples that provide diagnostic dilemmas fordifferent reasons are breast and pancreatic carcinomas.Successful mammography screening programs in par-ticular in Northern European countries result in an ear-lier detection of suspicious breast lesions and conse-quently in tumours that are smaller at the time of di-agnosis [9]. For the cytopathologist, however, smallertumours, more of which are naturally premalignantlesions are more difficult to definitively diagnose. Itis conceivable that the complementation of morphol-ogy with pertinent genetic and chromosomal markersmay fill a bothersome gap. Another tumour type whosemortality has certainly not been reduced by improvedscreening programs is pancreatic adenocarcinoma. Inpancreatic cancer, early diagnosis is the exception, notthe rule. The majority of patients die within one yearafter diagnosis. The application of an interphase cyto-genetics based diagnostic procedure to aspiration biop-sies and pancreatic juice acquired during endoscopicprocedure of high risk patients are therefore a worth-while endeavor [7,8].In general, two different kinds of probe sets are be-ing used for interphase cytogenetics. The most fre-quently used probes are directed against chromosome-specific centromeric repeat units. These centromere-specific probes are easy to use, have a superb signalto noise ratio, and their ability to enumerate chromo-some copy number changes have been amply demon-strated in a variety of tumours (for a review see [4]).Their most relevant limitation is that although copynumber changes involving entire chromosomes (in-cluding the centromere) can be visualized, chromo-some arm changes remain undetected. CGH analyses,however, have revealed abundant evidence that imbal-ances of chromosomal arms occur frequently in solidtumours. Hence, the usefulness of interphase cytoge-netics would be increased through the use of locus- andgene-specific probes targeting highly recurrent, tumourtype- and tumour stage-specific aberrations. A panel ofdifferently labeled gene-specific probes would not onlyhelp in the crucial decision whether a tumourous lesionis benign or malignant, but would also allow the inves-tigator to simultaneously assess the deletion and ampli-fication status of pertinent tumour suppressor genes oroncogenes, respectively. The importance of determin-ing such a genetic status for prognostication and choiceof therapeutic regimen cannot be overestimated andwill be part of a molecular profiling of cancer cells thatis likely to become a prerequisite for an individualizedB.M. Ghadimi et al. / Interphase cytogenetics 5therapy plan. An example is the prognostic and ther-apeutic relevance of the erbB2 status in patients withbreast cancer (for a review see [15]). Only patients witherbB2 gene amplification might benefit from an adju-vant or palliative treatment with Herceptin, a mono-clonal antibody directed against the erbB2 epitope.BAC or P1 clones are the preferred vector if sin-gle gene or locus specific probes are required becauseof their size (approximately 100 Kbp) and vector toinsert ratio. Compared to YAC clones, the frequencyof chimarism is low. The hybridization efficiency andsignal to noise ratio can be further optimized whensingle clones are extended to small contigs. A cen-tralized BAC clone repository that covers the entirehuman genome with a cytogenetically linked resolu-tion of about 1 Mbp is presently assembled. This Can-cer Chromosome Aberration Project (C-cap) is part ofthe Cancer Genome Anatomy Project funded throughthe National Cancer Institute, USA. The progress ofthis clone mapping project and additional pertinentinformation can be obtained from the C-cap website(http://www.ncbi.nlm.nih.gov/CCAP/). C-cap’s goal isto integrate the physical, genetic, and cytogenetic mapsof the human genome and secure ready access toBAC clones from any given chromosomal location andclones that are specific for major tumour suppressorgenes and oncogenes.The future of interphase cytogenetics looks promis-ing, however, its introduction into the clinical set-ting requires further improvements and validation. Theanalysis of hundred of cells is currently performed bymanually counting FISH signals in interphase nuclei.Signal acquisition, as well as quantitation, needs tobe automated to allow the timely screening of clini-cal samples prior to the introduction into clinics. Prob-lems of nuclei segmentation, nuclei overlaps and sig-nal thresholds also need to be addressed before reli-able scoring can be achieved. Automated spot countingrequires fully automated hardware as well as sophisti-cated software that will allow high-throughput screen-ing of hundreds of clinical samples. The constructionof DNA-probe kits, individualized for each given tu-mourtype, containing up to 4 BAC clones labeled withdifferent fluorochromes (multicolor) will enable thedetection and prognostication of malignancies. It isalso conceivable that different kits can be constructedfor diagnostics, prognostics or therapy-monitoring.The correlation of certain biomarkers with morpho-logical phenotype still warrants validation for certainprecursor lesions. In this respect, prospective studies,e.g., demonstrating a malignant potential of dysplasticlesions in the breast with concurrent gains of an ex-tra copy of chromosome 1q, are urgently needed. Theuse of interphase cytogenetics to samples like aspira-tion cytologies or cytospins can be applied to any givenclinical sample, including blood preparations. The iso-lation of circulating epithelial cells in the blood us-ing iron particles coated with antibodies specific forepithelial markers is an especially useful technologyto which interphase cytogenetics can be applied. First,the unambiguous identification of cells with or withoutgenetic alterations will significantly contribute to thespecificity of this approach. The goal is to develop andoptimize this non-invasive procedure for early diagno-sis of symptom-free patients belonging to either hered-itary or environmental risk groups. Second, the verifi-cation of circulating cells and, moreover the detectionof circulating cells with certain prognostic characteris-tics (e.g., erbB2), might have therapeutic consequencesfor individualized patient treatment. Third, this non-invasive “blood test” could accompany a patient’s adju-vant or palliative treatment and might allows cliniciansto monitor in a very sensitive manner responsivenessto therapy.In conclusion, interphase cytogenetics has the poten-tial to become a powerful tool for early and improvedcancer diagnosis and can contribute to molecular pro-filing by identifying the genetic makeup of cells.AcknowledgementsThe authors wish to thank Dr M.J. Difilippantoniofor critically reading the manuscript and many helpfuldiscussions. Dr B.M. Ghadimi received a postdoctoralfellowship from the Deutsche Krebshilfe.References[1] T. Boveri, Zur Frage der Entstehung maligner Tumoren, Fis-cher Verlag, Jena, 1914.[2] J. Bulten, P.J. Poddighe, J.C. Robben, J.H. Gemmink, P.C. deWilde and A.G. Hanselaar, Interphase cytogenetic analysis ofcervical intraepithelial neoplasia, Am. J. Pathol. 152(2) (1998),495–503.[3] T. Cremer, J. Landegent, A. Bruckner, H.P. Scholl,M. Schardin, H.D. Hager, P. Devilee, P. 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Interphase Cytogenetics: At the Interface of Genetics and Morphology

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