Abstract
Current standard-of-care tumor sampling protocols for CCRCC (and other cancers) are not efficient at detecting intratumoural heterogeneity (ITH). We have demonstrated in silico that an alternative protocol, multi-site tumor sampling (MSTS) based upon the divide and conquer (DAC) algorithm, can significantly increase the efficiency of ITH detection without extra costs. Now we test this protocol on routine hematoxylin-eosin (HE) sections in a series of 38 CCRCC cases. MSTS was found to outperform traditional sampling when detecting either high grade (p=0.0136) or granular/eosinophilic cells (p=0.0114). We therefore propose that MSTS should be used in routine clinical practice.
Highlights
Clear cell renal cell carcinoma (CCRCC) is the most frequent form of renal cancer in Western Countries[1] and a paradigmatic example of intratumoural heterogeneity (ITH)[2,3,4,5]
We have recently demonstrated that a multi-site tumor sampling (MSTS) protocol following the divide-and-conquer (DAC) algorithm outperforms routine sampling protocols (RS) in detecting ITH when tested in silico[6]
Partial solutions are combined to solve the original problem. Since such a strategy does not necessarily increase the cost of procedures and can be performed without significant changes in the pathologist’s routine, we proposed its generalized implementation in pathology labs[6,7]
Summary
Clear cell renal cell carcinoma (CCRCC) is the most frequent form of renal cancer in Western Countries[1] and a paradigmatic example of intratumoural heterogeneity (ITH)[2,3,4,5]. We have recently demonstrated that a multi-site tumor sampling (MSTS) protocol following the divide-and-conquer (DAC) algorithm outperforms routine sampling protocols (RS) in detecting ITH when tested in silico[6]. Partial solutions are combined to solve the original problem Since such a strategy does not necessarily increase the cost of procedures and can be performed without significant changes in the pathologist’s routine, we proposed its generalized implementation in pathology labs[6,7]. This study extends this hypothesis to a real life scenario by comparing the MSTS protocol with RS when detecting classic morphological ITH in a series of 38 CCRCC
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