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Technical Advance |


From the Finsen Laboratory,*
Rigshospitalet Copenhagen
University Hospital, Copenhagen; the Department of Molecular Cell
Biology,
University of Copenhagen, Copenhagen;
and the Stereological Research Laboratory,
University of Åarhus, Åarhus, Denmark
| Abstract |
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| Introduction |
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Volumes estimated by computer-assisted stereology can be determined with high precision and accuracy, provided that tissue sampling is performed appropriately.6,7 The purpose of this study was to develop a practical method for the stereological analysis of lung metastasis volume using computer-assisted stereology.7 The stereological method has been applied in a series of lungs with different metastasis burden, and the precision of the method has been evaluated.
| Materials and Methods |
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Female C57BL/6J mice (8-to 10-weeks old) from Gammel Bomholdtgaard, Ry, Denmark, were used. Parental Lewis lung carcinoma cells were obtained from Deutches Krebsforshung Institut, Heidelberg Germany. The computer-assisted stereology setup consisted of a Leica Dialux 22 microscope equipped with a charge-coupled device camera (JAI 2040; JAI Corporation, Yokohama, Japan) and a motorized X-Y stage directed by a multicontroller unit (Olympus, Albertslund, Denmark). The computer (PC 300 GL; IBM, Portsmouth, UK) had a 24-bit framegrabber board (SM II, Fast Multimedia AG, München, Germany) and Cast-grid software (Olympus) installed. Microscopic images were projected to a 17-inch monitor (FlexScan F56, Eizo Corporation, Matto, Japan).
Methods
Lewis Lung Transplantation and Metastasis Assay
Lewis lung carcinoma cells were propagated by retransplantation in C57BL/6 mice. Transplantation was done by dissecting 10- to 12-day-old tumors: fresh tumor pieces from five to eight mice were picked and the necrotic tissue removed. A tumor mince was prepared by cutting up the tumor pieces with razor blades, and suspending them in phosphate-buffered saline (PBS) and passing them through a 21-gauge syringe. Cells (106 cells in 100 µl) were injected subcutaneously into the upper flank of C57BL/6 mice. After 7 to 21 days, the mice were sacrificed and perfused with 10 ml of ice-cold PBS followed by perfusion fixation with 10 ml of ice-cold 4% paraformaldehyde in PBS (PFA) and the lungs were removed for further fixation. During growth, the primary tumor width and length were measured using a Vernier gauge and the volume was determined as 0.5 (width2 x length).
Fixation and Tissue Sampling for Stereology
To obtain optimal morphology, lungs were evacuated under vacuum
for 1 hour within 4 hours of removal. They were then left 2 days in 4%
PFA followed by 2 days in 20% sucrose at 4°C. Because tissue shrinks
considerably during paraffin embedding (eg, lungs shrink to
approximately half of the original volume), we chose the cryostat
processing approach in which overall tissue shrinkage is negligible.
The lungs (from a single mouse) were mounted at room temperature
in
2 ml of Tissue-Tek (OCT compound, code 4583; Sakura, Zoeterwoude,
The Netherlands) that was placed on a bent spatula with a
4-cm2
head. An additional 2 to 3 ml of Tissue-Tek
was added to cover the lungs, and just after this the spatula with
Tissue-Tek-embedded lungs was snap-frozen in isopentane/dry ice. After
30 to 60 seconds the spatula was withdrawn and the embedded lungs
were removed and stored at -20°C until further processing. To ensure
systematic uniform and random sampling,6
the fixed and
frozen lungs were cut transversally to the trachea, into 2.0-mm-thick
parallel slabs with a random position of the first cut in the first 2.0
mm of the lung resulting in a total of five to eight slabs per lung.
The slabs were placed with identical orientation in a metal capsule.
These steps were performed on a -20°C freezing desk. The Tissue-Tek
was allowed to melt and then the specimens were embedded in additional
ice-cold Tissue-Tek and frozen on dry ice. Cryostat sections (6 to 8
µm) were cut from the upper-cut surface of the slab at -16°C, air
dried on a 60°C heating plate, postfixed for 10 minutes in PFA, and
finally counterstained with hematoxylin and eosin. Generally, the
technically best-preserved section out of three adjacent sections
processed from each block was selected. In cases where we initially
found very small metastasis volumes (smaller than
0.1
mm3), 8 to 10 additional sections separated by
200 µm were analyzed. We estimate a single metastatic focus of
0.01 mm3
to be the smallest detectable in this
assay.
Stereology
The stereological measurements of the metastasis volumes were
performed using the Cavalieri principle.6,7
The estimated
volume V of the metastases
Vmet is:
![]() | (1) |
Point Counting
Point counting was done according to the recommendations described
in Gundersen and colleagues,7
and was performed using the
CAST-grid stereology software (Olympus). Briefly, the entire section,
processed from tissue blocks as described above, was delineated
(Meander sampling). The step length was fixed to 2000 x 1400 µm
enabling the evaluation of the total tissue area with a x4 objective
(a total of 125 times magnification on the computer monitor), ie, the
sum of all fields of vision from a section equals the whole section.
The Meander sampling gave rise to 70 to 130 fields to be evaluated on
the sample of sections. The fields were superposed with a test system
with regularly arranged points. Point counting was performed with areas
per point (a/p), ranging from 4000 to 46,000
µm2
depending on the metastasis burden,
providing a total number of hitting points
Pi
between 100 and 200. For small metastasis volumes (smaller than
1
mm3)
Pi ranged from 1 to
100. Because the slab thickness was 2000 µm, each time a point hits
metastatic tissue it represents 0.008 to 0.092
mm3
of metastasis.
Estimation of Variation and Error Coefficients on the Metastasis Volume
The coefficient of error (CE = SEM/mean) on the volume as
estimated by Equation 1
is the sum of the CE related to the small
number of slabs (sectional variation, CES) and
the CE related to the point counting itself (CEP)
and was calculated using the method described by Gundersen and
colleagues.6
![]() | (2) |
2000 µm
in diameter. There are, for example, 50 profiles per section and only a
count of
20 point hitting. In this situation
CEP is approximately that of a Poisson
distribution (independent counts):
![]() | (3) |
![]() | (4) |
P because of the low number, 6 to 7, of
systematically spaced sections is also governed by the
three-dimensional shape of the set of metastases: anywhere between 1000
to 10 to 100,000 isolated lumps of cells, very rarely of a diameter of
2 mm. Technically, the variance is mostly because of small-scale
effects: of the
50 metastases hit by a section, almost none are hit
by the next section 2 mm away. The CES is
computed as
![]() | (5) |
Pi2,
B =
(Pi·Pi+1),
C =
(Pi·Pi+2)
(see also Table 1
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The total variation of the metastasis volume in a group of mice is the
contribution from variation in stereological estimation
(CEstereology) and the contribution from the
biological variation between the individual mice in the experiment
(CVbiology):
![]() | (6) |
Inter- and Intra-Observer Variation
For interobserver variation, point counting was performed on eight
cases and was performed blinded by two observers, using the same grid
densities. For intra-observer variation point counting was performed
blinded with
1 month between counting sessions. Pearsons moment
correlations were calculated and the paired t-test was used
to test for systematic differences.
Counting of Surface Metastases and Comparison with the Lung Metastasis Volume
Twenty-one days after inoculation of Lewis lung carcinoma cells, mice were sacrificed, perfusion-fixed, and the lungs isolated. After additional fixation, the lungs were weighed and the number of metastases on the lung surface counted under an inverted stereomicroscope. The lungs were then processed for stereological analysis after embedding in Tissue-Tek as specified above. Pearsons product moment correlations and their 95% confidence intervals (CI) were calculated.
| Results |
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To obtain an optimal morphology without tissue shrinkage, lung
samples were perfusion-fixed, air-evacuated, left in 20% sucrose for 2
days, and processed for cryostat sectioning, as described in the
Materials and Methods section. The morphology of a Lewis lung
metastasis is shown in Figure 1, d and e
.
To obtain lung sections with an unbiased presentation of the total
lung, 2-mm parallel slabs were cut, with the first cut randomly
positioned, and placed with identical orientation in a single embedding
capsule for Tissue-Tek embedding. This approach ensures that the
distance between slabs remains 2 mm independently of sectioning.
Second, point counting can be performed on a small set of systematic
sections from each mouse. Three typical sections are shown in Figure 1
;
a, b, and c.
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The appearance of metastatic foci, as well as their total volume, must depend on time since transplantation of the primary tumor. We removed lungs at days 7, 10, 12, 14, 17, and 19 after transplantation. No metastases were detected in seven cases studied on day 7. Three out of eight cases had visible metastases on day 10, and two of six cases had metastases on day 12. On days 14, 17, and 19, all cases (seven on each day) had detectable metastases.
Metastasis Volume Estimations
Twenty-one days after inoculation of Lewis lung carcinoma cells
into a group of nine mice, the mean primary tumor volume
VPT was 2300 mm3
with a 63% coefficient of variation (CV) (Table 2)
. Lungs were removed and processed for
stereological estimation of the metastasis volume
(Vmet) as described in
Materials and Methods. The values varied between 0.01 and 14.5
mm3
(Table 2)
. The CV of the metastasis volumes
within this group was 90%. Although the two smallest metastasis
volumes were measured in the mice with the two smallest primary tumors,
there was no significant correlation between the
VPT and the
Vmet in this small material. This is
not surprising, because a large variation in the metastasis volumes in
the experimental animals is expected as a consequence of metastatic
cells arising with a low frequency in the primary tumor.
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CE Calculations
In another set of five mice, we estimated the CE on the metastasis
volume (Table 1
and Figure 1f
) using the approach described by
Gundersen and colleagues.6,8
The CE
(Vmet) =
CEstereology was calculated using Equation 2
. The
results from the five cases are shown in Table 3
. The average
CEstereology of the five cases was 14.5%, range
8 to 23%. The CEstereology is a combination of
the intersectional variation (CES) and the
variation related to the point counting itself
(CEP). CES was estimated
using Equation 5 and had a mean 12.4%, range 6 to 21%, and
CEP estimated by Equation 4
was 7.3%, range 5 to
10%. Therefore, the major contribution to
CEstereology is related to the intersectional
variation (CES), contributing with 63%, whereas
CEP will only add 37%, range 16 to 51%. To the
total CVbiology, Equation 6
the
CEstereology will add 2.5%, indicating that the
variation on the volume estimates will add essentially nothing to the
total biological variation within the group. For groups like these with
intra-animal variability CV
100%, one may well reduce the number of
sections to half (using 4-mm slabs) and the total number of points
counted to 50 to 100.
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To compare the metastasis volumes with the lung weight and the
number of surface metastases, we tested lungs from 14 mice. First, the
lung weight was measured, then the surface metastasis count was
obtained by thorough analysis under an inverted microscope. For
stereological analysis, the lungs were then embedded in Tissue-Tek and
processed according to the detailed description above. The results are
shown in Table 4
. Calculation of
Pearsons moment correlation indicated that there was no strong
correlation between the metastasis volume and the surface metastases
number (r = 0.38; 95% CI, -0.19, 0.76). As an
example, lung 14 had a high metastasis volume (32.4
mm3) because of many small metastases, of which
only two were detectable on the lung surface. Another illustration of
the discordance appears when lung 9 with a metastasis volume of 10.1
mm3
and only three large surface metastases is
compared with lung 12 that has a 1.5-fold higher metastasis volume
(15.3 mm3), but 13-fold as many surface
metastasis (38). In lung 1 we measured a small but distinct metastasis
volume (0.1 mm3), but were unable to detect any
surface metastases. Pearsons moment correlation also indicated that
there was no strong correlation between the metastasis volume and the
lung weight (r = 0.42; 95% CI, -0.14, 0.78),
probably because of a pronounced variation in the lung weight between
healthy individuals (lowest weight = 170 mg, highest weight =
260 mg; n = 8). For example, lungs 7 and 8 had similar
metastasis volumes (6.8 and 7.6 mm3), but were
very different in weights (325 and 205 mg, respectively). Also between
metastasis surface count number and the lung weight there was no strong
correlation (r = -0.24; 95% CI, -0.68, 0.33).
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| Discussion |
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CEstereology is a combination of the variation related to the sampling of slabs (intersection variation) and the variation related to the point counting. The intersection variation, CES, was 63%, and the variation related to the point counting, CEP, the remaining 37% of the total CEstereology. However, increasing the number of slabs and/or the grid density would only increase the precision of single mouse Vmet without affecting the total CV in the experimental group, and thus, would not improve the precision on the final estimate for the group of mice.
The volume estimates were highly reproducible by a given observer. The
same observer estimated the same sample with a mean CV of 8%. There
was a product-moment correlation >99% between two independent
observers, indicating a high degree of relative agreement. However, in
terms of absolute values a significant difference of metastasis volumes
was estimated by two independent observersone estimated
20%
larger volumes than the other. This difference may be explained alone
by the evaluation of points hitting the peripheral zone of metastatic
tissue, and indicates that in a given experiment, all volumetric
measurements should be performed by the same observer (as required by
best laboratory practice). Note that the interobserver variation
because of this phenomenon is maximal in a tissue that consists of very
large numbers of isolated, very small lumps of cells.
Our method is based on cryostat sections and was developed with the aim to avoid imprecisions because of tissue shrinkage during paraffin embedding. Tissue shrinkage seems to be an important factor in stereology,9,10 and has been reported to lead to misinterpretation of data.11 The degree of tissue shrinkage may depend on the rigidity of tissue, and this may again be dependent on the content of extracellular matrix components such as collagens. We are particularly interested in enzymes that actively degrade extracellular matrix proteins, and want to compare metastases in different mouse strains with various deficiencies in matrix-degrading enzymes. Thus, we found it prudent to develop a method that minimizes the influence of tissue shrinkage.
Few studies on a direct estimation of total metastasis volume have been reported. In a study by Barbera-Guillem and colleagues,4 liver metastasis volume fraction after intrasplenal injection of B16 melanoma cells or Lewis lung carcinoma cells were estimated by stereology. In studies by Kuruppu and colleagues,5,12 liver metastasis volume in a murine model was estimated by stereology using another approach. First, the total liver volume was estimated using the Cavalieri principle on a dissecting microscope. Then the metastasis fraction was determined on a conventional microscope as a percentage of the total number of points hitting metastatic versus normal tissue. This percentage count was used to calculate the metastasis volume. CE values on the metastasis volumes and the interobserver variability were not reported in any of these studies.
Identification of micrometastases in lungs is an attractive goal. The
smallest metastases that we observed reliably contained
10 cells in
a section. Smaller foci were not possible to identify with certainty,
at the very low primary magnification of x4.
We compared our volumetric method with surface metastasis count and the total lung weight in a group of 14 mice, No strong correlations between any of these three measures were however obtained. The lung weight was found to be a very imprecise measure of the metastasis burden, because the overall variation in the normal lung weight blurred small weight increments caused by the metastases. The surface metastasis count was found not to account for a variation in metastasis size and not to account for small metastases within the lungs. Accordingly, we detected small metastases with the volumetric assay, which were undetectable as foci on the lung surface. Taken together, we consider it a major advantage of the volumetric assay presented here that it is unbiased by the spatial distribution and the individual size of lung metastases, and conclude that the metastasis volume is the most precise of the three methods to measure the metastasis burden.
The total number of metastatic foci in a set of lungs would also be an interesting property to determine. Counting efficiency of metastases has been improved by the use of lacZ-transfected tumor cell lines, which can be visualized after incubation with ß-galactosidase substrate.13-16 Also, B16 melanoma, which is a pigmented cell line, represents a potential alternative for a precise quantification of the metastasis number.17 However, to the best of our knowledge, no unbiased method to determine metastasis number has been reported.
In conclusion, we have developed a method that measures the lung metastasis volume in mice with high precision. It can possibly be used for all metastatic tumor types. The method is unbiased and may significantly improve the detailed quantitative analysis of tumor cell dissemination.
| Acknowledgements |
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| Footnotes |
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Supported by the Danish Cancer Society and the Astrid Thaysen Fund.
Accepted for publication March 13, 2001.
| References |
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