ONKOS Molecular Diagnostics, Ribeirão Preto, São Paulo, Brazil.
Department of Research and Development (R&D), Fleury Group, Sao Paulo, Brazil.
J Clin Pathol. 2018 Jul;71(7):584-593. doi: 10.1136/jclinpath-2017-204887. Epub 2017 Dec 16.
AIMS: Cancers of unknown primary sites account for 3%-5% of all malignant neoplasms. Current diagnostic workflows based on immunohistochemistry and imaging tests have low accuracy and are highly subjective. We aim to develop and validate a gene-expression classifier to identify potential primary sites for metastatic cancers more accurately. METHODS: We built the largest Reference Database (RefDB) reported to date, composed of microarray data from 4429 known tumour samples obtained from 100 different sources and divided into 25 cancer superclasses formed by 58 cancer subclass. Based on specific profiles generated by 95 genes, we developed a gene-expression classifier which was first trained and tested by a cross-validation. Then, we performed a double-blinded retrospective validation study using a real-time PCR-based assay on a set of 105 metastatic formalin-fixed, paraffin-embedded (FFPE) samples. A histopathological review performed by two independent pathologists served as a reference diagnosis. RESULTS: The gene-expression classifier correctly identified, by a cross-validation, 86.6% of the expected cancer superclasses of 4429 samples from the RefDB, with a specificity of 99.43%. Next, the performance of the algorithm for classifying the validation set of metastatic FFPE samples was 83.81%, with 99.04% specificity. The overall reproducibility of our gene-expression-classifier system was 97.22% of precision, with a coefficient of variation for inter-assays and intra-assays and intra-lots <4.1%. CONCLUSION: We developed a complete integrated workflow for the classification of metastatic tumour samples which may help on tumour primary site definition.
目的:不明原发灶肿瘤约占所有恶性肿瘤的 3%-5%。目前基于免疫组化和影像学检查的诊断流程准确性较低,且主观性较强。我们旨在开发和验证一种基因表达分类器,以更准确地识别转移性癌症的潜在原发灶。
方法:我们构建了迄今为止报道的最大参考数据库(RefDB),该数据库由来自 100 个不同来源的 4429 个已知肿瘤样本的微阵列数据组成,分为由 58 个癌症亚类组成的 25 个癌症超级类。基于由 95 个基因产生的特定谱,我们开发了一种基因表达分类器,该分类器首先通过交叉验证进行训练和测试。然后,我们使用基于实时 PCR 的检测方法对 105 例转移性福尔马林固定、石蜡包埋(FFPE)样本进行了双盲回顾性验证研究。由两名独立病理学家进行的组织病理学回顾作为参考诊断。
结果:基因表达分类器通过交叉验证正确识别了 RefDB 中 4429 个样本的预期癌症超级类的 86.6%,特异性为 99.43%。接下来,该算法对转移性 FFPE 样本验证集的分类性能为 83.81%,特异性为 99.04%。我们的基因表达分类器系统的整体重现性为 97.22%的精度,批间和批内变异系数<4.1%。
结论:我们开发了一种完整的集成工作流程,用于分类转移性肿瘤样本,这可能有助于确定肿瘤的原发灶。
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