title: Combined automatic immunological and molecular cytogenetic analysis allows exact identification and quantification of tumor cells in the bone marrow.
abstract: OBJECTIVE
  To improve the detection of disseminated tumor cells in bone marrow (BM) and peripheral blood samples of solid tumor patients, a novel computer-assisted scanning system for automatic search, image analysis, and repositioning of these cells was developed. This system allows precise identification and quantification of tumor cells by sequential immunological and molecular cytogenetic analysis. In this study, we attempt to demonstrate the practical use of this approach by analyzing BM samples from neuroblastoma patients.
  
  
  METHODS
  The disialo-ganglioside (GD2) molecule was used as the immunological target. The GD2 molecule was described as being specific for neuroblastoma cells, although false positive reactions had been suspected. To verify or disprove the neoplastic nature of the immunologically positive cells, sequential fluorescence in situ hybridization was performed on these cells to search for those genetic aberrations found in the corresponding primary tumors. A total of 115 samples from 40 newly diagnosed patients were evaluated for the presence of GD2(+) cells in the BM.
  
  
  RESULTS
  GD2 positivity was detected in 95.2% of stage 4 patients, in 100% of stage 4s patients, and in 38.5% of patients with localized/regional disease. In stage 4 and 4s BM samples, the GD2(+) cells were unequivocally identified as tumor cells based on the molecular cytogenetic aberrations found by fluorescence in situ hybridization. However, in BM samples from patients with localized/regional disease, all GD2(+) cells were concluded to represent false positivity due to the absence of genetic aberrations.
  
  
  CONCLUSIONS
  Automatic search and sequential molecular cytogenetic analysis of the immunologically positive cells provide precise information on both the number and cytogenetic profile of disseminated tumor cells.
authors.affiliation: Children's Cancer Research Institute, St. Anna Kinderspital, A-1090 Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Méhes
authors.forename: A
authors.initials: A
authors.lastname: Luegmayr
authors.forename: I M
authors.initials: IM
authors.lastname: Ambros
authors.forename: R
authors.initials: R
authors.lastname: Ladenstein
authors.forename: P F
authors.initials: PF
authors.lastname: Ambros
mesh_terms: D001854:Bone Marrow Cells / Q000737:chemistry / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D002869:Chromosome Aberrations; D020732:Cytogenetic Analysis; D005455:Fluorescent Antibody Technique; D005732:Gangliosides / Q000032:analysis*; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007223:Infant; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000097:blood / Q000235:genetics / Q000473:pathology*
chemical_list: D005732:Gangliosides; C025447:sialogangliosides