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First international consensus on the methodology of lymphangiogenesis quantification in solid human tumours

Identifieur interne : 003C74 ( Pmc/Checkpoint ); précédent : 003C73; suivant : 003C75

First international consensus on the methodology of lymphangiogenesis quantification in solid human tumours

Auteurs : I. Van Der Auwera [Belgique] ; Y. Cao [Suède] ; J C Tille [Suède] ; M S Pepper [Afrique du Sud] ; D G Jackson [Royaume-Uni] ; S B Fox [Australie] ; A L Harris [Royaume-Uni] ; L Y Dirix [Belgique] ; P B Vermeulen [Belgique]

Source :

RBID : PMC:2360768

Abstract

The lymphatic system is the primary pathway of metastasis for most human cancers. Recent research efforts in studying lymphangiogenesis have suggested the existence of a relationship between lymphatic vessel density and patient survival. However, current methodology of lymphangiogenesis quantification is still characterised by high intra- and interobserver variability. For the amount of lymphatic vessels in a tumour to be a clinically useful parameter, a reliable quantification technique needs to be developed. With this consensus report, we therefore would like to initiate discussion on the standardisation of the immunohistochemical method for lymphangiogenesis assessment.


Url:
DOI: 10.1038/sj.bjc.6603445
PubMed: 17117184
PubMed Central: 2360768


Affiliations:


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PMC:2360768

Le document en format XML

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<p>The lymphatic system is the primary pathway of metastasis for most human cancers. Recent research efforts in studying lymphangiogenesis have suggested the existence of a relationship between lymphatic vessel density and patient survival. However, current methodology of lymphangiogenesis quantification is still characterised by high intra- and interobserver variability. For the amount of lymphatic vessels in a tumour to be a clinically useful parameter, a reliable quantification technique needs to be developed. With this consensus report, we therefore would like to initiate discussion on the standardisation of the immunohistochemical method for lymphangiogenesis assessment.</p>
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<name>
<surname>Van der Auwera</surname>
<given-names>I</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
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<name>
<surname>Cao</surname>
<given-names>Y</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
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<name>
<surname>Tille</surname>
<given-names>J C</given-names>
</name>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pepper</surname>
<given-names>M S</given-names>
</name>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jackson</surname>
<given-names>D G</given-names>
</name>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Fox</surname>
<given-names>S B</given-names>
</name>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Harris</surname>
<given-names>A L</given-names>
</name>
<xref ref-type="aff" rid="aff7">7</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dirix</surname>
<given-names>L Y</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
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<name>
<surname>Vermeulen</surname>
<given-names>P B</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="corresp" rid="caf1">*</xref>
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<aff id="aff1">
<label>1</label>
<institution>Translational Cancer Research Group Antwerp, Laboratory of Pathology, University of Antwerp/University Hospital Antwerp, Edegem 2650, Belgium; Oncology Centre, General Hospital Sint-Augustinus</institution>
, Wilrijk 2610,
<country>Belgium</country>
</aff>
<aff id="aff2">
<label>2</label>
<institution>Laboratory of Angiogenesis Research, Microbiology and Tumor Biology Center, Karolinska Institutet</institution>
, Stockholm 171 77,
<country>Sweden</country>
</aff>
<aff id="aff3">
<label>3</label>
<institution>Department of Microbiology, Laboratory of Angiogenesis Research, Tumor and Cell Biology, Karolinska Institutet</institution>
, Stockholm 171 77,
<country>Sweden</country>
</aff>
<aff id="aff4">
<label>4</label>
<institution>NetCare Molecular Medicine Institute, Unitas Hospital and Department of Immunology, Faculty of Health Sciences, University of Pretoria</institution>
, Pretoria 0002,
<country>South Africa</country>
</aff>
<aff id="aff5">
<label>5</label>
<institution>Medical Research Council Human Immunology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital</institution>
, Oxford OX3 9DS,
<country>UK</country>
</aff>
<aff id="aff6">
<label>6</label>
<institution>Department of Pathology, Peter MacCallum Cancer Centre</institution>
, Victoria 8006,
<country>Australia</country>
</aff>
<aff id="aff7">
<label>7</label>
<institution>Cancer Research UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital</institution>
, Oxford OX3 9DS,
<country>UK</country>
</aff>
<author-notes>
<corresp id="caf1">
<label>*</label>
Author for correspondence:
<email xlink:href="mailto:peter.vermeulen@gvagroup.be">peter.vermeulen@gvagroup.be</email>
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</author-notes>
<pub-date pub-type="epub">
<day>12</day>
<month>12</month>
<year>2006</year>
</pub-date>
<pub-date pub-type="ppub">
<day>18</day>
<month>12</month>
<year>2006</year>
</pub-date>
<volume>95</volume>
<issue>12</issue>
<fpage>1611</fpage>
<lpage>1625</lpage>
<history>
<date date-type="received">
<day>24</day>
<month>05</month>
<year>2006</year>
</date>
<date date-type="rev-recd">
<day>18</day>
<month>09</month>
<year>2006</year>
</date>
<date date-type="accepted">
<day>26</day>
<month>09</month>
<year>2006</year>
</date>
</history>
<copyright-statement>Copyright 2006, Cancer Research UK</copyright-statement>
<copyright-year>2006</copyright-year>
<permissions>
<copyright-holder>Cancer Research UK</copyright-holder>
</permissions>
<abstract>
<p>The lymphatic system is the primary pathway of metastasis for most human cancers. Recent research efforts in studying lymphangiogenesis have suggested the existence of a relationship between lymphatic vessel density and patient survival. However, current methodology of lymphangiogenesis quantification is still characterised by high intra- and interobserver variability. For the amount of lymphatic vessels in a tumour to be a clinically useful parameter, a reliable quantification technique needs to be developed. With this consensus report, we therefore would like to initiate discussion on the standardisation of the immunohistochemical method for lymphangiogenesis assessment.</p>
</abstract>
<kwd-group>
<kwd>lymphangiogenesis</kwd>
<kwd>lymphatic vessel density (LVD)</kwd>
<kwd>lymphatic endothelial cell proliferation (LECP)</kwd>
<kwd>podoplanin</kwd>
<kwd>lymph node metastasis</kwd>
<kwd>vascular endothelial growth factor (VEGF)</kwd>
</kwd-group>
</article-meta>
</front>
<floats-wrap>
<fig id="fig1">
<label>Figure 1</label>
<caption>
<p>Lymphangiogenic growth factors and their receptors.</p>
</caption>
<graphic mime-subtype="jpeg" xlink:href="95-6603445f1"></graphic>
</fig>
<fig id="fig2">
<label>Figure 2</label>
<caption>
<p>Representation of lymphangiogenic markers on lymphatic endothelial cells.</p>
</caption>
<graphic mime-subtype="jpeg" xlink:href="95-6603445f2"></graphic>
</fig>
<table-wrap id="tbl1" position="float">
<label>Table 1</label>
<caption>
<p content-type="table-title">Molecular players of lymphangiogenesis</p>
</caption>
<table frame="hsides" rules="groups" border="1" width="85%">
<colgroup>
<col align="left"></col>
<col align="left"></col>
<col align="left"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left" valign="top" charoff="50">
<bold>Gene</bold>
</th>
<th align="left" valign="top" charoff="50">
<bold>Involvement in lymphangiogenesis</bold>
</th>
<th align="left" valign="top" charoff="50">
<bold>Reference</bold>
</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left" valign="top" charoff="50">
<italic>VEGF-C</italic>
</td>
<td align="left" valign="top" charoff="50">Essential for sprouting the first lymphatic vessel from Prox-1-positive endothelial cells of veins</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib61">Karkkainen
<italic>et al</italic>
(2004)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Overexpression in mouse tumour models promotes the growth of intratumourous lymphatic vessels and metastasis to regional lymph nodes</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib123">Skobe
<italic>et al</italic>
(2001)</xref>
,
<xref ref-type="other" rid="bib62">Karpanen
<italic>et al</italic>
(2001)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>VEGF-D</italic>
</td>
<td align="left" valign="top" charoff="50">Overexpression in mouse tumour models induces the formation of lymphatic vessels within the tumour and leads to spread of the tumour to lymph nodes</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib126">Stacker
<italic>et al</italic>
(2001)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>VEGFR-3</italic>
</td>
<td align="left" valign="top" charoff="50">Plays an important role in the development of the lymphatic vasculature</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib60">Karkkainen
<italic>et al</italic>
(2000)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Induces proliferation of cultured LECs</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib79">Mäkinen
<italic>et al</italic>
(2001)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Induces lymphangiogenesis in transgenic mice</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib144">Veikkola
<italic>et al</italic>
(2001)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>VEGF-A</italic>
</td>
<td align="left" valign="top" charoff="50">Overexpression in mouse tumour models induces the growth of peritumourous lymphatic vessels and leads to lymphatic metastasis</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib12">Bjorndahl
<italic>et al</italic>
(2005b)</xref>
,
<xref ref-type="other" rid="bib46">Hirakawa
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">VEGFR-2 is expressed in LECs</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib48">Hong
<italic>et al</italic>
(2004)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Can induce lymphangiogenesis indirectly by recruiting VEGFR-1 expressing inflammatory cells including monocytes/macrophages and neutrophils</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib26">Cursiefen
<italic>et al</italic>
(2004)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>FGF-2</italic>
</td>
<td align="left" valign="top" charoff="50">Stimulates proliferation, migration and tube formation of cultured LECs</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib21">Chang
<italic>et al</italic>
(2004)</xref>
,
<xref ref-type="other" rid="bib121">Shin
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Induces sprouting of lymphatic vessels in a mouse corneal model can induce lymphangiogenesis indirectly by recruiting inflammatory cells</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib21">Chang
<italic>et al</italic>
(2004)</xref>
,
<xref ref-type="other" rid="bib68">Kubo
<italic>et al</italic>
(2002)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>PDGF-BB</italic>
</td>
<td align="left" valign="top" charoff="50">Stimulates cell motility of cultured LECs</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib17">Cao
<italic>et al</italic>
(2004)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Isolated LECs express both PDGFR-alpha and beta</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Overexpression in a mouse tumour model stimulates the growth of intratumourous lymphatic vessels and lymphatic metastasis</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>Ang-2</italic>
</td>
<td align="left" valign="top" charoff="50">Ang-2-knockout mice show disorganised and hypoplastic dermal and intestinal lymphatic capillaries</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib36">Gale
<italic>et al</italic>
(2002)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>Ang-1</italic>
</td>
<td align="left" valign="top" charoff="50">Restores lymphatic defects of Ang-2-knock-out mice</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib36">Gale
<italic>et al</italic>
(2002)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Promotes LYVE-1-positive lymphatic vessel formation in murine cornea</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib88">Morisada
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>HGF</italic>
</td>
<td align="left" valign="top" charoff="50">Stimulates proliferation, migration and tube formation of cultured LECs</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib59">Kajiya
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Induces sprouting and growth of new LYVE-1 expressing lymphatic vessels in mice corneal and tumour models</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib16">Cao
<italic>et al</italic>
(2006)</xref>
,
<xref ref-type="other" rid="bib53">Jiang
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>IGF-1</italic>
</td>
<td align="left" valign="top" charoff="50">Stimulates proliferation and migration of cultured LECs</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib11">Bjorndahl
<italic>et al</italic>
(2005a)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">IGFR-1 is present in lymphatic endothelium</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Induces growth of new LYVE-1 expressing lymphatic vessels in murine cornea</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>IGF-2</italic>
</td>
<td align="left" valign="top" charoff="50">Stimulates proliferation and migration of cultured LECs</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib11">Bjorndahl
<italic>et al</italic>
(2005a)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">IGFR-1 and -2 are present in lymphatic endothelium</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Induces growth of new LYVE-1 expressing lymphatic vessels in murine cornea</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tbl2" position="float">
<label>Table 2</label>
<caption>
<p content-type="table-title">List of studies on the prognostic value of lymphangiogenesis in solid human tumours</p>
</caption>
<graphic xlink:href="95-6603445t1"></graphic>
</table-wrap>
<table-wrap id="tbl3" position="float">
<label>Table 3</label>
<caption>
<p content-type="table-title">Studies on circulating VEGF-C and VEGF-D levels in patients with cancer</p>
</caption>
<table frame="hsides" rules="groups" border="1" width="85%">
<colgroup>
<col align="left"></col>
<col align="left"></col>
<col align="left"></col>
<col align="left"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left" valign="top" charoff="50">
<bold>Tumour</bold>
</th>
<th align="left" valign="top" charoff="50">
<bold>Markers (source)</bold>
</th>
<th align="left" valign="top" charoff="50">
<bold>Comments</bold>
</th>
<th align="left" valign="top" charoff="50">
<bold>Reference</bold>
</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left" valign="top" charoff="50">
<italic>Colorectal ca.</italic>
</td>
<td align="left" valign="top" charoff="50">VEGF-C (plasma)</td>
<td align="left" valign="top" charoff="50">Increased in cancer patient compared to control</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib30">Duff
<italic>et al</italic>
(2003)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Significantly higher in advanced Dukes C and D (LN+) compared to Dukes A and B (LN−)</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">VEGF-C (plasma)</td>
<td align="left" valign="top" charoff="50">Decreased expression in cancer patient compare to control</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib31">Duff
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">VEGF-D (serum)</td>
<td align="left" valign="top" charoff="50">No difference between cancer and control</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib38">George
<italic>et al</italic>
(2001)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">VEGF-D (plasma)</td>
<td align="left" valign="top" charoff="50">No difference between cancer and control</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib31">Duff
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>Non-small cell lung ca.</italic>
</td>
<td align="left" valign="top" charoff="50">VEGF-C (serum)</td>
<td align="left" valign="top" charoff="50">Increased in carcinoma compared to benign lesions and control individuals</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib134">Tamura and Ohta (2003)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Correlation with pathologic stage, LN metastasis and lymphatic vessel invasion</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">VEGF-C (serum)</td>
<td align="left" valign="top" charoff="50">Correlation with pathologic stage, LN metastasis and lymphatic vessel invasion</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib132">Tamura
<italic>et al</italic>
(2004a</xref>
,
<xref ref-type="other" rid="bib132">2004b</xref>
)</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>Cervical ca.</italic>
</td>
<td align="left" valign="top" charoff="50">VEGF-C (serum)</td>
<td align="left" valign="top" charoff="50">Increased in squamous cervical cancer compared to controls</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib86">Mitsuhashi
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">Correlation with FIGO stage, tumour size and recurrence but not with LN metastasis</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">No increase in cervical adenocarcinoma compared to controls</td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">VEGF-C (serum)</td>
<td align="left" valign="top" charoff="50">Increased in cervical cancer compared to controls</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib83">Mathur
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>Prostate ca.</italic>
</td>
<td align="left" valign="top" charoff="50">VEGF-D (plasma)</td>
<td align="left" valign="top" charoff="50">Increased in early stage (LN neg) compare to late stage (LN or bone) metastasis</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib64">Kaushal
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>Angiosarcoma</italic>
</td>
<td align="left" valign="top" charoff="50">VEGF-D (serum)</td>
<td align="left" valign="top" charoff="50">Increased compared to controls</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib5">Amo
<italic>et al</italic>
(2004)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>Ovarian ca.</italic>
</td>
<td align="left" valign="top" charoff="50">VEGF-C (serum)</td>
<td align="left" valign="top" charoff="50">Not increased compared to controls</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib83">Mathur
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>Breast ca.</italic>
</td>
<td align="left" valign="top" charoff="50">VEGF-D (plasma)</td>
<td align="left" valign="top" charoff="50">Not increased compared to controls</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib47">Hoar
<italic>et al</italic>
(2004)</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">
<italic>Head and neck ca.</italic>
</td>
<td align="left" valign="top" charoff="50">VEGF-C (plasma)</td>
<td align="left" valign="top" charoff="50">Not increased compared to controls</td>
<td align="left" valign="top" charoff="50">
<xref ref-type="other" rid="bib129">Strauss
<italic>et al</italic>
(2005)</xref>
</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tbl4" position="float">
<label>Table 4</label>
<caption>
<p content-type="table-title">Proposed standard method for the assessment of lymphangiogenesis</p>
</caption>
<table frame="hsides" rules="groups" border="1" width="85%">
<colgroup>
<col align="left"></col>
<col align="left"></col>
<col align="left"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left" valign="top" charoff="50">
<bold>Methodological aspect</bold>
</th>
<th align="left" valign="top" charoff="50">
<bold>Proposed standard</bold>
</th>
<th align="left" valign="top" charoff="50">
<bold>Advantage</bold>
</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left" valign="top" charoff="50">1. Immunostaining</td>
<td align="left" valign="top" charoff="50">Double immunostain with the D2-40 monoclonal antibody and the anti-Ki-67 monoclonal antibody</td>
<td align="left" valign="top" charoff="50">Highly specific and sensitive marker of the lymphatic endothelium</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">2. Selection of the quantification fields</td>
<td align="left" valign="top" charoff="50">Manual vascular hot spot selection at low magnification (e.g. × 10) – in viable tumour tissue and adjacent (e.g. within diameter of one field at × 200 magnification) stromal tissue</td>
<td align="left" valign="top" charoff="50">All highly vascular areas can be detected</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">3. Quantification of lymphatic vessels</td>
<td align="left" valign="top" charoff="50">Chalkley point graticule method</td>
<td align="left" valign="top" charoff="50">Exclusion of the subjective step of identifying individual lymphatic vessels in an endothelial cell cluster</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">4. Quantification of LEC proliferation</td>
<td align="left" valign="top" charoff="50">Counting of the number of proliferating LECs
<italic>vs</italic>
nonproliferating LECs</td>
<td align="left" valign="top" charoff="50">Reflection of the ongoing lymphangiogenesis</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">5. Number of observers</td>
<td align="left" valign="top" charoff="50">Sequential assessment by two investigators</td>
<td align="left" valign="top" charoff="50">More practical in a clinical setting than co-observation</td>
</tr>
</tbody>
</table>
</table-wrap>
</floats-wrap>
</pmc>
<affiliations>
<list>
<country>
<li>Afrique du Sud</li>
<li>Australie</li>
<li>Belgique</li>
<li>Royaume-Uni</li>
<li>Suède</li>
</country>
</list>
<tree>
<country name="Belgique">
<noRegion>
<name sortKey="Van Der Auwera, I" sort="Van Der Auwera, I" uniqKey="Van Der Auwera I" first="I" last="Van Der Auwera">I. Van Der Auwera</name>
</noRegion>
<name sortKey="Dirix, L Y" sort="Dirix, L Y" uniqKey="Dirix L" first="L Y" last="Dirix">L Y Dirix</name>
<name sortKey="Vermeulen, P B" sort="Vermeulen, P B" uniqKey="Vermeulen P" first="P B" last="Vermeulen">P B Vermeulen</name>
</country>
<country name="Suède">
<noRegion>
<name sortKey="Cao, Y" sort="Cao, Y" uniqKey="Cao Y" first="Y" last="Cao">Y. Cao</name>
</noRegion>
<name sortKey="Tille, J C" sort="Tille, J C" uniqKey="Tille J" first="J C" last="Tille">J C Tille</name>
</country>
<country name="Afrique du Sud">
<noRegion>
<name sortKey="Pepper, M S" sort="Pepper, M S" uniqKey="Pepper M" first="M S" last="Pepper">M S Pepper</name>
</noRegion>
</country>
<country name="Royaume-Uni">
<noRegion>
<name sortKey="Jackson, D G" sort="Jackson, D G" uniqKey="Jackson D" first="D G" last="Jackson">D G Jackson</name>
</noRegion>
<name sortKey="Harris, A L" sort="Harris, A L" uniqKey="Harris A" first="A L" last="Harris">A L Harris</name>
</country>
<country name="Australie">
<noRegion>
<name sortKey="Fox, S B" sort="Fox, S B" uniqKey="Fox S" first="S B" last="Fox">S B Fox</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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