Name: the application of 1% methylene blue dye as a single technique in breast cancer sentinel node biopsy
Uploaded: 2019-06-01T12:30:00
Description: Watch this Scientific Journal Video about The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy at JoVE.com

The authors have nothing to disclose.

All procedures including human subjects have been approved by Dharmais Cancer Hospital Ethics Committee with certificate number of 040/KEPK/VII/2017. All patients signed the consent forms and expressed agreement to participate in this study.
NOTE: The inclusion criteria are patients with diagnosis of early breast cancer, with tumor stage T1-T2 without palpable and ultrasonography lymph nodes enlargement (cNo). The exclusion criteria are locally advanced breast cancer, received neo adjuvant che...

<ol>
	<li>Giuliano, A. E., Han, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Local+and+regional+control+in+breast+cancer:+role+of+sentinel+node+biopsy.">Local and regional control in breast cancer: role of sentinel node biopsy.</a> Advances in Surgery. 45 (1), 101-116 (2011).</li><li>D'Angelo-Donovan, D. D., Dickson-Witmer, D., Petrelli, N. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sentinel+lymph+node+biopsy+in+breast+cancer:+a+history+and+current+clinical+recommendations.">Sentinel lymph node biopsy in breast cancer: a history and current clinical recommendations.</a> Surgical Oncology. 21 (3), 196-200 (2012).</li><li>McLaughlin, S. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+lymphedema+in+women+with+breast+cancer+5+years+after+sentinel+lymph+node+biopsy+or+axillary+dissection:+objective+measurements.">Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements.</a> Journal of Clinical Oncology. 26 (32), 5213-5219 (2008).</li><li>Erickson, V. S., Pearson, M. L., Ganz, P. A., Adams, J., Kahn, K. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arm+edema+in+breast+cancer+patients.">Arm edema in breast cancer patients.</a> Journal of the National Cancer Institute. 93 (2), 96-111 (2001).</li><li>Veronesi, U., Stafyla, V., Luiniand, A., Veronesi, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breast+cancer:+from+&amp;#34;maximum+tolerable&amp;#34;+to+&amp;#34;minimum+effective&amp;#34;+treatment.">Breast cancer: from &amp;#34;maximum tolerable&amp;#34; to &amp;#34;minimum effective&amp;#34; treatment.</a> Frontiers of Oncology. 2, 1-5 (2012).</li><li>Kim, T., Giuliano, A. E., Lyman, G. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+mapping+and+sentinel+lymph+node+biopsy+in+early-stage+breast+carcinoma:+a+meta-analysis.">Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a meta-analysis.</a> Cancer. 106 (1), 4-16 (2006).</li><li>Wong, J. H., Cagle, L. A., Morton, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+drainage+of+skin+to+a+sentinel+lymph+node+in+a+feline+model.">Lymphatic drainage of skin to a sentinel lymph node in a feline model.</a> Annals of Surgery. 214 (5), 637 (1991).</li><li>Simmons, R. M., Smith, S. M. R., Osborne, M. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methylene+blue+dye+as+an+alternative+to+isosulfan+blue+dye+for+sentinel+lymph+node+localization.">Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization.</a> The Breast Journal. 7 (3), 181-183 (2001).</li><li>Nour, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+methylene+blue+dye+in+localization+of+sentinel+lymph+node+in+breast+cancer+patients.">Efficacy of methylene blue dye in localization of sentinel lymph node in breast cancer patients.</a> Breast Journal. 10 (5), 388-391 (2004).</li><li>Varghese, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methylene+blue+dye+versus+combined+dye-radioactive+tracer+technique+for+sentinel+lymph+node+localisation+in+early+breast+cancer.">Methylene blue dye versus combined dye-radioactive tracer technique for sentinel lymph node localisation in early breast cancer.</a> European Journal of Surgical Oncology. 33 (2), 147-152 (2007).</li><li>Bakhtiar, N., Jaleel, F., Moosa, F. A., Qureshi, N. A., Jawaid, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sentinel+lymph+node+identification+by+blue+dye+in+patients+with+breast+carcinoma.">Sentinel lymph node identification by blue dye in patients with breast carcinoma.</a> Pakistan Journal of Medical Sciences. 32 (2), 448 (2016).</li><li>Thevarajah, S., Huston, T. L., Simmons, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+of+the+adverse+reactions+associated+with+isosulfan+blue+versus+methylene+blue+dye+in+sentinel+lymph+node+biopsy+for+breast+cancer.">A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer.</a> American Journal of Surgical. 189 (2), 236-239 (2005).</li><li>Brahma, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+predictive+value+of+methylene+blue+dye+as+a+single+technique+in+breast+cancer+sentinel+node+biopsy:+a+study+from+Dharmais+Cancer+Hospital.">The predictive value of methylene blue dye as a single technique in breast cancer sentinel node biopsy: a study from Dharmais Cancer Hospital.</a> World journal of Surgical Oncology. 15 (1), 41 (2017).</li><li>Lyman, G. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sentinel+lymph+node+biopsy+for+patients+with+early-stage+breast+cancer:+American+society+of+clinical+oncology+clinical+practice+guideline+update.">Sentinel lymph node biopsy for patients with early-stage breast cancer: American society of clinical oncology clinical practice guideline update.</a> Journal of Clinical Oncology. 32 (13), 1365-1383 (2014).</li><li>Mamounas, E. P., Kuehn, T., Rutgers, E. J., von Minckwitz, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+approach+of+the+axilla+in+patients+with+early-stage+breast+cancer.">Current approach of the axilla in patients with early-stage breast cancer.</a> Lancet. , (2014).</li><li>Peek, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+blue+dye+still+required+during+sentinel+lymph+node+biopsy+for+breast+cancer?.">Is blue dye still required during sentinel lymph node biopsy for breast cancer?.</a> Ecancermedicalscience. , (2016).</li><li>Lyman, G. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=American+Society+of+Clinical+Oncology+Guideline+Recommendations+for+Sentinel+Lymph+Node+Biopsy+in+Early-Stage+Breast+Cancer.">American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer.</a> Journal of Clinical Oncology. 23 (30), 7703-7720 (2005).</li><li>Masannat, Y., Shenoy, H., Speirs, V., Hanby, A., Horgan, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Properties+and+characteristics+of+the+dyes+injected+to+assist+axillary+sentinel+node+localization+in+breast+surgery.">Properties and characteristics of the dyes injected to assist axillary sentinel node localization in breast surgery.</a> EJSO. 32 (4), 381-384 (2006).</li><li>Brahma, B., Haryono, S. J., Ramadhan, ., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methylene+blue+dye+as+a+single+agent+in+breast+cancer+sentinel+lymph+node+biopsy:+initial+study+of+cancer+centre+hospital.">Methylene blue dye as a single agent in breast cancer sentinel lymph node biopsy: initial study of cancer centre hospital.</a> 19th Asian Congress of Surgery &amp; SingHealth Surgical Congress. , (2013).</li><li>Borgstein, P. J., Meijer, S., Pijpers, R. J., van Diest, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+Lymphatic+Anatomy+for+Sentinel+Node+Biopsy+in+Breast+Cancer+Echoes+from+the+Past+and+the+Periareolar+Blue+Method.">Functional Lymphatic Anatomy for Sentinel Node Biopsy in Breast Cancer Echoes from the Past and the Periareolar Blue Method.</a> Annals of Surgery. 232 (1), 81 (2000).</li><li>Tuttle, T. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Subareolar+Injection+of+99mTc+Facilitates+Sentinel+Lymph+Node+Identification.">Subareolar Injection of 99mTc Facilitates Sentinel Lymph Node Identification.</a> Annals of Surgical Oncology. 9 (1), 77-81 (2002).</li><li>Suami, H., Pan, W. R., Taylor, G. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Historical+Review+of+Breast+Lymphatic+Studies.">Historical Review of Breast Lymphatic Studies.</a> Clinical Anatomy. 22 (5), 531-536 (2009).</li><li>Sadeghi, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Axillary+concordance+between+superficial+and+deep+sentinel+node+mapping+material+injections+in+breast+cancer+patients:+systematic+review+and+meta-analysis+of+the+literature.">Axillary concordance between superficial and deep sentinel node mapping material injections in breast cancer patients: systematic review and meta-analysis of the literature.</a> Breast Cancer Research and Treatment. 144 (2), 213-222 (2014).</li><li>Clough, K. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+anatomical+classification+of+the+axilla+with+implications+for+sentinel+node+biopsy.">New anatomical classification of the axilla with implications for sentinel node biopsy.</a> British Journal of Surgery. 97 (11), 1659-1665 (2010).</li><li>Ueda, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+of+sentinel+lymph+node+location+based+on+body+surface+landmarks+in+early+breast+cancer+patients.">Identification of sentinel lymph node location based on body surface landmarks in early breast cancer patients.</a> Breast Cancer. 16 (3), 219-222 (2009).</li><li>Kang, B., Jun, H., Lee, K., Lee, K., Kim, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+application+of+sentinel+lymph+node+biopsy+based+on+axillary+anatomy+in+breast+cancer:+A+single+institution+experience.">Clinical application of sentinel lymph node biopsy based on axillary anatomy in breast cancer: A single institution experience.</a> The Breast. 23 (6), 812-815 (2014).</li><li>Layfield, D. M., Agrawal, A., Roche, H., Cutress, R. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+assessment+of+sentinel+lymph+nodes+in+breast+cancer.">Intraoperative assessment of sentinel lymph nodes in breast cancer.</a> British Journal of Surgery. 98 (1), 4-17 (2011).</li><li>Weaver, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pathology+evaluation+of+sentinel+lymph+nodes+in+breast+cancer:+protocol+recommendations+and+rationale.">Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale.</a> Modern Pathology. 23 (S2), S26 (2010).</li><li>Bishop, J. A., Sun, J., Ajkay, N., Sanders, M. A. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Decline+in+Frozen+Section+Diagnosis+for+Axillary+Sentinel+Lymph+Nodes+as+a+Result+of+the+American+College+of+Surgeons+Oncology+Group+Z0011+Trial.">Decline in Frozen Section Diagnosis for Axillary Sentinel Lymph Nodes as a Result of the American College of Surgeons Oncology Group Z0011 Trial.</a> Archives of Pathology and Laboratory Medicine. 140 (8), 830-835 (2015).</li><li>Thevarajah, S., Huston, T. L., Simmons, R. 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In the modern era of breast cancer surgery, SNB has replaced ALND as the standard of care for axillary staging in early breast cancer and ALND should be abandoned if the SNs are free from metastasis14,15. The lymphatic mapping technique which is commonly used in developed countries is the application of radioisotope tracer and PBD as a combined or single technique16,17. The question on how to perform SNB ...

The status of axillary lymph nodes (ALNs) metastasis is the most important prognostic factor in breast cancer. Axillary lymph node dissection (ALND) was the conventional procedure to assess metastatic status of ALNs1,2. Unfortunately, ALND results in morbidities to the patients which decreases the quality of life, especially by increasing the risk of lymphedema after this procedure3,4. Nowadays, sentinel node biopsy (SNB) has replaced ALND for axillary staging because of its minimal morbidities among patients5. The most common method for performing SNB is using radioisotope tracer and PBD6. In some parts of the world, including in developing countries, these tracer agents could be difficult to procure and searching for an alternative tracer agent is critical to solve the problem.
Initially, MBD was used by Wong et al. as a tracer agent for mapping sentinel nodes (SNs)7. In their study using a feline model, intradermal injection of MBD showed poor lymphatic uptake and isosulfan blue was chosen as the preferred dye for sentinel node (SN) mapping7. Methylene blue dye has been used in breast cancer SNB since the first successful report by Simmons et al.8. Several studies have also reported MBD as the favorable dye for SNs identification, and that the false negative rates of MBD technique were comparable to radioisotope or PBD9,10,11. Fewer allergic reactions and lower price are the other reasons to consider its use in SN mapping12.
Recently, we studied the use of 1% MBD alone for SNB in clinically node negative breast cancer. In early stages, MBD has a favorable identification rate and negative predictive value13. We inject 2 mL of 1% MBD into the subareolar space or peritumoral area if there was an excisional biopsy scar at the upper outer quadrant or nipple areolar complex (NAC) of the breast. The blue nodes and non-blue nodes with lymphatic blue channels are categorized as SNs. The anatomical landmark in the axilla is used as a guidance to find SNs. Intraoperative examination is applied to assess the metastasis and the SNs are sent for histopathology analysis based on American Society of Clinical Oncology (ASCO) Guidelines14.
If the cases are selected carefully and the skills required for this technique are obtained by the surgeons as well as pathologists, many patients could be saved from the harmful effects of ALND while still having favorable survival.

<table border="0" cellpadding="0" cellspacing="0" style="width:1046px;" width="1046">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:348px;">Metiblo 50mg/5ml</td>
			<td style="width:174px;">Laboratories Sterop NV</td>
			<td style="width:353px;">BE475217</td>
			<td style="width:171px;">Methylene Blue Dye</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Disposable syringe with needle - 3mL (Luer Lock Tip)</td>
			<td>Terumo Europe NV</td>
			<td>dvr-3414</td>
			<td>Syringe for Injection</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">ForceTriad energy platform</td>
			<td>Medtronic</td>
			<td>ForceTriad</td>
			<td>Surgical cautery</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Shandon Cryomatrix embedding resin</td>
			<td>Thermo (scientific)</td>
			<td>6769006</td>
			<td rowspan="2">Frozen Section</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Cryotome FSE</td>
			<td>Thermo (scientific)</td>
			<td>77210153</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">HistoStar Embedding Workstation</td>
			<td>Thermo (scientific)</td>
			<td>A81000001</td>
			<td rowspan="3" style="width:171px;">Histopathological Examination</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Finesse Me+</td>
			<td>Thermo (scientific)</td>
			<td>A77510272</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Gemini AS</td>
			<td>Thermo (scientific)</td>
			<td>A81500002</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Benchmark GX</td>
			<td>Ventana Medical Systems</td>
			<td>750-850</td>
			<td rowspan="2">Immunohistochemistry</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Benchmark XT</td>
			<td>Ventana Medical Systems</td>
			<td>750-700</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Microscope</td>
			<td>Olympus</td>
			<td>Model BX53</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Ultrasound</td>
			<td>Phillips</td>
			<td>HD 7XE</td>
			<td></td>
		</tr>
	</tbody>
</table>

the application of 1% methylene blue dye as a single technique in breast cancer sentinel node biopsy

In this study, we injected 1% methylene blue dye (MBD) into the subareolar or peritumoral space of the breast. In the case of breast conserving surgery (BCS), a separate incision in the lower axilla hairline was made to find the sentinel nodes (SNs). In mastectomy, the SNs were identified through the same mastectomy incision. The SNs were described as blue nodes or nodes with lymphatic blue channels. An anatomical landmark in the axilla was used to facilitate SNs identification. The SNs metastases were evaluated by intraoperative frozen section analysis and histopathology examination as it is a gold standard. Here, we described the MBD as the lone technique in breast cancer sentinel node biopsy (SNB) which could be useful when radioisotope tracer or patent or isosulfan blue dye (PBD) cannot be provided.

Here, we describe the results from the presented technique. Two milliliters of 1% MBD were injected at the deep subareolar space as the standard technique of injection (Figure 1A). If the peritumoral injection is indicated, it should be performed under ultrasound guidance (Figure 1B). The blue nodes or lymphatic blue tracts were seen after entering the axillary space. Following the lymphatic blue tracts lead to finding the SNs (<...

Watch this Scientific Journal Video about The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy at JoVE.com

The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy

In Indonesia, sentinel node biopsy (SNB) is not routinely performed for breast cancer surgery because of the limitation to provide radioisotope tracer and isosulfan or patent blue dye (PBD). To overcome this obstacle, we applied 1% methylene blue dye (MBD) as a single agent to map the sentinel nodes (SNs).

In this study, we injected 1% methylene blue dye (MBD) into the subareolar or peritumoral space of the breast. In the case of breast conserving surgery ...

The application of one percent methylene blue dye as a single technique in breast cancer sentinel node biopsy. The overall goal of this procedure is to show the application of blue dye alone as a single technique for early breast cancer axillary node biopsy, using 1%methylene blue dye and to show how to isosulfan examination of sentinel nodes. Section one preparation of one percent methylene blue dye and the injection technique.Section two sentinel node biopsy technique in breast conserving surgery. Section three. sentinel node biopsy technique in mastectomy.Section four pathological examination of sentinel nodes. Section five intraoperative examination. Section six results.Section seven conclusion.

the-application-1-methylene-blue-dye-as-single-technique-breast

Research

JoVE Journal

Cancer Research

Utilizing Functional Genomics Screening to Identify Potentially Novel Drug Targets in Cancer Cell Spheroid Cultures

The identification of functional driver events in cancer is central to furthering our understanding of cancer biology and indispensable for the discovery of the next generation of novel drug targets. It is becoming apparent that more complex models of cancer are required to fully appreciate the contributing factors that drive tumorigenesis in vivo and increase the efficacy of novel therapies that make the transition from pre-clinical models to clinical trials.
Here we present a methodology for generating uniform and reproducible tumor spheroids that can be subjected to siRNA functional screening. These spheroids display many characteristics that are found in solid tumors that are not present in traditional two-dimension culture. We show that several commonly used breast cancer cell lines are amenable to this protocol. Furthermore, we provide proof-of-principle data utilizing the breast cancer cell line BT474, confirming their dependency on amplification of the epidermal growth factor receptor HER2 and mutation of phosphatidylinositol-4,5-biphosphate 3-kinase (PIK3CA) when grown as tumor spheroids. Finally, we are able to further investigate and confirm the spatial impact of these dependencies using immunohistochemistry.

Identifying novel drug targets that transition from pre-clinical testing to human trials is a scientific priority. To that end, here we describe a functional genomics approach for examining the impact of gene depletion on cancer cell line spheroids, which more appropriately model human cancers in vivo.

The identification of functional driver events in cancer is central to furthering our understanding of cancer biology and indispensable for the discovery ...

Ultrasonographic Evaluation of Breast Cancer-related Lymphedema

Lymphedema is one of the most common complications after breast cancer surgery. There are many diagnostic tools for lymphedema, but no standard method yet exists. Progressive Resistance Exercise (PRE) is expected to improve lymphedema without additional swelling. This study showed the therapeutic effects of PRE on lymphedema by using ultrasonography to measure the change in thickness of the muscle and subcutaneous tissue. The thickness of subcutaneous tissue decreased more in the PRE group than in the non-PRE group. Ultrasonography is widely used in many clinics because of its easy accessibility, safety, and inexpensiveness. Ultrasound is one of the best tools for diagnosing and determining treatment efficacy on breast cancer-related lymphedema (BCRL).

This study utilized ultrasonography for diagnosis and follow-up tests to confirm treatment efficacy of Progressive Resistance Exercise (PRE) in breast cancer-related lymphedema (BCRL). Ultrasonography can be applied effectively to ensure diagnosis and treatment of lymphedema.

Lymphedema is one of the most common complications after breast cancer surgery. There are many diagnostic tools for lymphedema, but no standard method yet ...

Studying Triple Negative Breast Cancer Using Orthotopic Breast Cancer Model

Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype with limited therapeutic options. When compared to patients with less aggressive breast tumors, the 5-year survival rate of TNBC patients is 77% due to their characteristic drug-resistant phenotype and metastatic burden. Toward this end, murine models have been established aimed at identifying novel therapeutic strategies limiting TNBC tumor growth and metastatic spread. This work describes a practical guide for the TNBC orthotopic model where MDA-MB-231 breast cancer cells suspended in a basement membrane matrix are implanted in the fourth mammary fat pad, which closely mimics the cancer cell behavior in humans. Measurement of tumors by caliper, lung metastasis assessment via in vivo and ex vivo imaging, and molecular detection are discussed. This model provides an excellent platform to study therapeutic efficacy and is especially suitable for the study of the interaction between the primary tumor and distal metastatic sites.

This work presets an advanced protocol to accurately assess tumor loading by detection of green fluorescent protein and bioluminescence signals as well as the integration of quantitative molecular detection technique.

Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype with limited therapeutic options. When compared to patients with less ...

Orthotopic Transplantation of Breast Tumors as Preclinical Models for Breast Cancer

Preclinical models that faithfully recapitulate tumor heterogeneity and therapeutic response are critical for translational breast cancer research. Immortalized cell lines are easy to grow and genetically modify to study molecular mechanisms, yet the selective pressure from cell culture often leads to genetic and epigenetic alterations over time. Patient-derived xenograft (PDX) models faithfully recapitulate the heterogeneity and drug response of human breast tumors. PDX models exhibit a relatively short latency after orthotopic transplantation that facilitates the investigation of breast tumor biology and drug response. The transplantable genetically engineered mouse models allow the study of breast tumor immunity. The current protocol describes the method to orthotopically transplant breast tumor fragments into the mammary fat pad followed by drug treatments. These preclinical models provide valuable approaches to investigate breast tumor biology, drug response, biomarker discovery and mechanisms of drug resistance.

Patient-derived xenograft (PDX) models and transplantable genetically engineered mouse models faithfully recapitulate human disease and are preferred models for basic and translational breast cancer research. Here, a method is described to orthotopically transplant breast tumor fragments into the mammary fat pad to study tumor biology and evaluate drug response.

Preclinical models that faithfully recapitulate tumor heterogeneity and therapeutic response are critical for translational breast cancer research. ...

Using Computer-based Image Analysis to Improve Quantification of Lung Metastasis in the 4T1 Breast Cancer Model

Breast cancer is a devastating malignancy, accounting for 40,000 female deaths and 30% of new female cancer diagnoses in the United States in 2019 alone. The leading cause of breast cancer related deaths is the metastatic burden. Therefore, preclinical models for breast cancer need to analyze metastatic burden to be clinically relevant. The 4T1 breast cancer model provides a spontaneously-metastasizing, quantifiable mouse model for stage IV human breast cancer. However, most 4T1 protocols quantify the metastatic burden by manually counting stained colonies on tissue culture plates. While this is sufficient for tissues with lower metastatic burden, human error in manual counting causes inconsistent and variable results when plates are confluent and difficult to count. This method offers a computer-based solution to human counting error. Here, we evaluate the protocol using the lung, a highly metastatic tissue in the 4T1 model. Images of methylene blue-stained plates are acquired and uploaded for analysis in Fiji-ImageJ. Fiji-ImageJ then determines the percentage of the selected area of the image that is blue, representing the percentage of the plate with metastatic burden. This computer-based approach offers more consistent and expeditious results than manual counting or histopathological evaluation for highly metastatic tissues. The consistency of Fiji-ImageJ results depends on the quality of the image. Slight variations in results between images can occur, thus it is recommended that multiple images are taken and results averaged. Despite its minimal limitations, this method is an improvement to quantifying metastatic burden in the lung by offering consistent and rapid results.

We describe a more consistent and expeditious method to quantify lung metastasis in the 4T1 breast cancer model by using Fiji-ImageJ.

Breast cancer is a devastating malignancy, accounting for 40,000 female deaths and 30% of new female cancer diagnoses in the United States in 2019 alone. ...

Modeling Breast Cancer in Human Breast Tissue using a Microphysiological System

Breast cancer (BC) remains a leading cause of death for women. Despite more than $700 million invested in BC research annually, 97% of candidate BC drugs fail clinical trials. Therefore, new models are needed to improve our understanding of the disease. The NIH Microphysiological Systems (MPS) program was developed to improve the clinical translation of basic science discoveries and promising new therapeutic strategies. Here we present a method for generating MPS for breast cancers (BC-MPS). This model adapts a previously described approach of culturing primary human white adipose tissue (WAT) by sandwiching WAT between adipose-derived stem cell sheets (ASC)s. Novel aspects of our BC-MPS include seeding BC cells into non-diseased human breast tissue (HBT) containing native extracellular matrix, mature adipocytes, resident fibroblasts, and immune cells; and sandwiching the BC-HBT admixture between HBT-derived ASC sheets. The resulting BC-MPS is stable in culture ex vivo for at least 14 days. This model system contains multiple elements of the microenvironment that influence BC including adipocytes, stromal cells, immune cells, and the extracellular matrix. Thus BC-MPS can be used to study the interactions between BC and its microenvironment. 
We demonstrate the advantages of our BC-MPS by studying two BC behaviors known to influence cancer progression and metastasis: 1) BC motility and 2) BC-HBT metabolic crosstalk. While BC motility has previously been demonstrated using intravital imaging, BC-MPS allows for high-resolution time-lapse imaging using fluorescence microscopy over several days. Furthermore, while metabolic crosstalk was previously demonstrated using BC cells and murine pre-adipocytes differentiated into immature adipocytes, our BC-MPS model is the first system to demonstrate this crosstalk between primary human mammary adipocytes and BC cells in vitro.

This protocol describes the construction of an in vitro microphysiological system for studying breast cancer using primary human breast tissue with off the shelf materials.

Breast cancer (BC) remains a leading cause of death for women. Despite more than $700 million invested in BC research annually, 97% of candidate BC drugs ...

Modeling Brain Metastasis Via Tail-Vein Injection of Inflammatory Breast Cancer Cells

Metastatic spread to the brain is a common and devastating manifestation of many types of cancer. In the United States alone, about 200,000 patients are diagnosed with brain metastases each year. Significant progress has been made in improving survival outcomes for patients with primary breast cancer and systemic malignancies; however, the dismal prognosis for patients with clinical brain metastases highlights the urgent need to develop novel therapeutic agents and strategies against this deadly disease. The lack of suitable experimental models has been one of the major hurdles impeding advancement of our understanding of brain metastasis biology and treatment. Herein, we describe a xenograft mouse model of brain metastasis generated via tail-vein injection of an endogenously HER2-amplified cell line derived from inflammatory breast cancer (IBC), a rare and aggressive form of breast cancer. Cells were labeled with firefly luciferase and green fluorescence protein to monitor brain metastasis, and quantified metastatic burden by bioluminescence imaging, fluorescent stereomicroscopy, and histologic evaluation. Mice robustly and consistently develop brain metastases, allowing investigation of key mediators in the metastatic process and the development of preclinical testing of new treatment strategies.

We describe a xenograft mouse model of breast cancer brain metastasis generated via tail-vein injection of an endogenously HER2-amplified inflammatory breast cancer cell line.

Metastatic spread to the brain is a common and devastating manifestation of many types of cancer. In the United States alone, about 200,000 patients are ...

Isolation of Primary Cancer-Associated Fibroblasts from a Syngeneic Murine Model of Breast Cancer for the Study of Targeted Nanoparticles

Cancer-associated fibroblasts (CAFs) are key actors in the context of the tumor microenvironment. Despite being reduced in number as compared to tumor cells, CAFs regulate tumor progression and provide protection from antitumor immunity. Emerging anticancer strategies aim to remodel the tumor microenvironment through the ablation of pro-tumorigenic CAFs or reprogramming of CAFs functions and their activation status. A promising approach is the development of nanosized delivery agents able to target CAFs, thus allowing the specific delivery of drugs and active molecules. In this context, a cellular model of CAFs may provide a useful tool for in vitro screening and preliminary investigation of such nanoformulations.
This study describes the isolation and culture of primary CAFs from the syngeneic 4T1 murine model of triple-negative breast cancer. Magnetic beads were used in a 2-step separation process to extract CAFs from dissociated tumors. Immunophenotyping control was performed using flow cytometry after each passage to verify the process yield. Isolated CAFs can be employed to study the targeting capability of different nanoformulations designed to tackle the tumor microenvironment. Fluorescently labeled H-ferritin nanocages were used as candidate nanoparticles to set up the method. Nanoparticles, either bare or conjugated with a targeting ligand, were analyzed for their binding to CAFs. The results suggest that ex vivo extraction of breast CAFs may be a useful system to test and validate nanoparticles for the specific targeting of tumorigenic CAFs.

This paper aims to provide a protocol for the isolation and culture of primary cancer-associated fibroblasts from a syngeneic murine model of triple-negative breast cancer and their application for the preclinical study of novel nanoparticles designed to target the tumor microenvironment.&#160;

Cancer-associated fibroblasts (CAFs) are key actors in the context of the tumor microenvironment. Despite being reduced in number as compared to tumor ...

Mammary Epithelial and Endothelial Cell Spheroids as a Potential Functional In vitro Model for Breast Cancer Research

Breast cancer is the leading cause of mortality in women. The growth of breast cancer cells and their subsequent metastasis is a key factor for its progression. Although the mechanisms involved in promoting breast cancer growth have been intensively studied using monocultures of breast cancer cells such as MCF-7 cells, the contribution of other cell types, such as vascular and lymphatic endothelial cells that are intimately involved in tumor growth, has not been investigated in depth. Cell-cell interaction plays a key role in tumor growth and progression. Neoangiogenesis, or the development of vessels, is essential for tumor growth, whereas the lymphatic system serves as a portal for cancer cell migration and subsequent metastasis. Recent studies provide evidence that vascular and lymphatic endothelial cells can significantly influence cancer cell growth. These observations imply a need for developing in vitro models that would more realistically reflect breast cancer growth processes in vivo. Moreover, restrictions in animal research require the development of ex vivo models to elucidate better the mechanisms involved.
This article describes the development of breast cancer spheroids composed of both breast cancer cells (estrogen receptor-positive MCF-7 cells) and vascular and/or lymphatic endothelial cells. The protocol describes a detailed step-by-step approach in creating dual-cell spheroids using two different approaches, hanging drop (gold standard and cheap) and 96-well U-bottom plates (expensive). In-depth instructions are provided for how to delicately pick up the formed spheroids to monitor growth by microscopic sizing and assessing viability using dead and live cell staining. Moreover, procedures to fix the spheroids for sectioning and staining with growth-specific antibodies to differentiate growth patterns in spheroids are delineated. Additionally, details for preparing spheroids with transfected cells and methods to extract RNA for molecular analysis are provided. In conclusion, this article provides in-depth instructions for preparing multi-cell spheroids for breast cancer research.

Mammary Epithelial and Endothelial Cell Spheroids as a Potential Functional In vitro Model for Breast Cancer Research

Crosstalk between mammary epithelial cells and endothelial cells importantly contributes to breast cancer progression, tumor growth, and metastasis. In this study, spheroids have been made from breast cancer cells together with vascular and/or lymphatic endothelial cells and demonstrate their applicability as an in vitro system for breast cancer research.

Breast cancer is the leading cause of mortality in women. The growth of breast cancer cells and their subsequent metastasis is a key factor for its ...

Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy

Sentinel lymph node (SLN) mapping and biopsy is a promising technique for visualizing and evaluating lymph node status in cancer. This approach has been recommended for low-risk endometrial cancer (EC) patients by authoritative international guidelines, but it has not been performed broadly in China and worldwide. This work aims to describe detailed SLN mapping and biopsy procedures to promote the clinical application. SLN mapping and postoperative pathologic ultrastaging were conducted in a patient with low-risk EC using indocyanine green (ICG) dye to track the SLNs under laparoscopy and resecting them completely for ultrastaging. In conclusion, this protocol describes details of ICG injection, and SLN mapping and biopsy in EC patients based on the experiences gained during clinical practice.

This protocol describes the identification and resection of sentinel lymph nodes to make the operation as easy and minimally invasive as possible.

Sentinel lymph node (SLN) mapping and biopsy is a promising technique for visualizing and evaluating lymph node status in cancer. This approach has been ...