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Imaging	Mass	Spectrometry:	A	New	Technology
for	the	Analysis	of	Protein	Expression	in
Mammalian	Tissues
Article		in		Nature	Medicine		May	2001
DOI:	10.1038/86573		Source:	PubMed
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                                                                                                                    2001 Nature Publishing Group http://medicine.nature.com
                                                                                                                                                                       NEW TECHNOLOGY
                                                                     Imaging mass spectrometry: A new technology for the
                                                                      analysis of protein expression in mammalian tissues
                                                                                         MARKUS STOECKLI, PIERRE CHAURAND, DENNIS E. HALLAHAN & RICHARD M. CAPRIOLI
                                                                                   Mass Spectrometry Research Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
                                                                                               Correspondence should be addressed to R.M.C.; email: r.caprioli@vanderbilt.edu
 2001 Nature Publishing Group http://medicine.nature.com
                                                             The molecular specificity and sensitivity of mass spectrometry            Geneva, Switzerland). With a laser frequency of 20 Hz, the time
                                                             (MS) has been employed in a new technology for direct map-                cycle was about 2.5 seconds per data point, including acquisi-
                                                             ping and imaging of biomolecules present in tissue sections.              tion, data download to the computer, data processing and repo-
                                                             This technology has been developed using matrix-assisted laser            sitioning of the sample stage. A typical data array was
                                                             desorption/ionization MS (MALDI MS)1 and has been initially               1,00030,000 spots depending on the desired image resolution,
                                                             targeted for the analysis of peptides and proteins present on or          which contains the intensity of ions desorbed at each spot in a
                                                             near the surface of tissue sections2. Imaging MS brings a new             molecular weight range of 500 D to over 80 kD. For most tissue
                                                             tool to bear on the problem of unraveling and understanding               sections, we recorded over 200 protein and peptide peaks in the
                                                             the molecular complexities of cells. It joins techniques such as          mass spectrum from each spot ablated by the laser. We could
                                                             immunochemistry and fluorescence microscopy for the study of              produce an MS image or molecular weight-specific map of the
                                                             the spatial arrangement of molecules within biological tissues.           sample at any desired molecular weight value. It is commonly
                                                             Many previous experiments using MS to image samples have fo-              possible to generate individual maps to verify the presence, mol-
                                                             cused on the measurement of the distribution of elements and              ecular weight and location of proteins. In the fullest extent,
                                                             small molecules in biological specimens, including tissue slices          from a single raster of a piece of tissue, imaging MS could pro-
                                                             and individual cells35. An extensive review on imaging by MS             duce hundreds of image maps each at a discrete molecular
                                                             can be found in the article by Pacholski and Winograd6.                   weight value.
                                                             Technological aspects                                                     Application to mammalian tissue
                                                             For the molecular image analysis, tissue samples can be pre-              We used imaging MS to study normal tissue sections from
                                                             pared using several protocols: direct analysis of fresh frozen sec-       mouse brain and human brain tumor xenograph sections. These
                                                             tions79, individual cells or clusters of cells isolated by               samples contained well-defined regions, many of which had
                                                             laser-capture microdissection or contact blotting of a tissue on a        subsets of proteins and peptides in a unique distribution or
                                                             membrane target10. In a typical preparation procedure (Fig. 1),           array. The bilateral symmetry of the brain provides an internal
                                                             we mounted a frozen section of tissue on a stainless steel target         confirmation of the localized distribution of proteins and the
                                                             plate, coated it with a solution of matrix (for example, sinapinic        homogeneity of the prepared tissue sections. An optical image
                                                             acid), then dried and introduced into the vacuum inlet of the             of the normal mouse brain section fixed on a metal plate and
                                                             mass spectrometer (Voyager Elite DE, Applied Biosystems,                  coated with matrix is shown in Fig. 2a. We scanned the section
                                                             Framingham, Massachusetts). The instrument was controlled by              by acquiring 170  90 spots with a spot-to-spot center distance
                                                             MS imaging software written in our laboratory11. We created               of 100 m in each direction. We recorded ions occurring in 82
                                                             molecular images from a raster over the surface of the sample             different mass ranges and created images by integrating the
                                                             with consecutive laser spots (25 m in diameter). The laser po-          peak areas and plotting the relative values using a color scale.
                                                             sition was fixed and the sample plate was repositioned for con-           For specific molecular images, we acquired data in a window de-
                                                             secutive spots. Each spot produced a mass spectrum obtained               limited by two mass-to-charge (m/z) units on either side of the
                                                             from molecules present within the irradiated area. Typically,             molecular peak. Although many of the protein signals were
                                                             each mass spectrum was the average of 50 laser shots acquired             common to all areas of the brain, some were found to be highly
                                                             using a fast transient recorder PC board (DP211, Acqiris,                 specific for a given brain region. For example, the protein de-
                                                                                                                                       tected at m/z 8258  1 (Fig. 2b) was present in the regions of the
                                                                                                                                       cerebral cortex and the hippocampus; the protein at m/z 6716 
                                                                                                                                       1 (Fig. 2c) was localized in the regions of the substantia nigra
                                                                                                                                       and medial geniculate nucleus; and the peptide at m/z 2564  1
                                                                                                                                       was in the midbrain (Fig. 2d). These ions are [M+H]+ species, and
                                                                                                                                       the molecular weights of the compounds were obtained by sub-
                                                                                                                                       tracting the weight of a proton, nominally 1 m/z unit from the
                                                                                                                                       Fig. 1 Methodology developed for the spatial analysis of tissue by
                                                                                                                                       MALDI mass spectrometry. Frozen sections are mounted on a metal plate,
                                                                                                                                       coated with an UV-absorbing matrix and placed in the mass spectrome-
                                                                                                                                       ter. A pulsed UV laser desorbs and ionizes analytes from the tissue and
                                                                                                                                       their m/z values are determined using a time-of-flight analyzer. From a
                                                                                                                                       raster over the tissue and measurement of the peak intensities over thou-
                                                                                                                                       sands of spots, mass spectrometric images are generated at specific
                                                                                                                                       molecular weight values.
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                                                                                                                        2001 Nature Publishing Group http://medicine.nature.com
                                                            NEW TECHNOLOGY
                                                                                                                                                                   Fig. 2 Mass spectrometric images of a
                                                             a                                                         b                                           mouse brain section. a, Optical image
                                                                                                                                                                   of a frozen section mounted on a gold-
                                                                                                                                                                   coated plate. b, m/z 8,258 in the re-
                                                                                                                                                                   gions of the cerebral cortex and the
                                                                                                                                                                   hippocampus. c, m/z 6,716 in the re-
                                                                                                                                                                   gions of the substantia nigra and medial
                                                                                                                                                                   geniculate nucleus d, m/z 2,564 in the
                                                                                                                                                                   midbrain.
                                                             c                                                         d
 2001 Nature Publishing Group http://medicine.nature.com
                                                             measured m/z value. Identification of the proteins can be done          in Fig. 3a. The orientation in the figure is such that the actively
                                                             through extraction, HPLC fractionation, proteolysis, mass spec-         growing area of the tumor is at the top of the figure, and the
                                                             trometric sequencing of one or more of the fragments and pro-           point where the tumor was attached to the healthy tissue at the
                                                             tein database searching. This procedure is illustrated below for        bottom. The fine line (cross-hatched) pattern on the optical
                                                             proteins in tumor sections.                                             image was produced by laser ablation of the surface during the
                                                                                                                                     scan. Mass spectrometric images were produced from a raster
                                                             Molecular imaging of tumor sections                                     over an area of 8.5 mm  8 mm (image spots 100 m apart on
                                                             One our aims is the molecular analysis and imaging of peptides          center). During the scan, we recorded images of ions in 45 mass
                                                             and proteins in brain tumors, specifically in human glioblas-           ranges and the mass spectra were saved for further analysis.
                                                             toma. Such an analysis would be an important if not essential           Three mass spectrometric images of molecules present in dis-
                                                             part of strategies designed to locate specific proteins that are        tinct areas of the tumor are shown in Fig. 3bd. In this figure,
                                                             more highly expressed in tumors and those greatly diminished            color is used to represent different ions, with color saturation a
                                                             in expression, relative to normal tissue. Currently, brain tumors       function of the relative intensity (see color reference bar).
                                                             account for 2% of all cancer deaths, or about 11,000 deaths an-         Overall, we detected over 150 different proteins, with many
                                                             nually in the United States. Gliomas account for 50% of all pri-        being present in all parts of the tissue. Individual selected pro-
                                                             mary brain tumors, with glioblastomas compromising half of              teins were identified as described below. We took three different
                                                             those12.
                                                                Here, tumor-bearing tissues were generated                 a                                  b
                                                             by subcutaneous implantation of human
                                                             glioblastoma cells (D54) into the hind limb of
                                                             a nude mouse. After tumors grew to about 1
                                                             cm in diameter, we surgically removed them
                                                             from the mouse and immediately froze them
                                                             using liquid nitrogen. For image analysis, we
                                                             cut the tumor tissue using a microtome in 12-
                                                             m thick sections orthogonal to the point of
                                                             attachment to normal tissue. Frozen sections
                                                             were processed following the protocol de-
                                                             scribed above before image analysis by MS.
                                                                The optical image of a frozen human                        c                                  d
                                                             glioblastoma section taken immediately fol-
                                                             lowing mass spectrometric imaging is shown
                                                             Fig. 3 Selected protein images from a glioblastoma
                                                             section. a, Human glioblastoma slice mounted on a
                                                             metal plate, coated with matrix (the lines are from
                                                             ablation of matrix with the laser). bd, Mass spectro-
                                                             metric images of proteins showing high concentra-
                                                             tion in the proliferating area of the tumor (d) and
                                                             other proteins present specifically in the ischemic and
                                                             necrotic areas (b and c).
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                                                                                                                     2001 Nature Publishing Group http://medicine.nature.com
                                                                                                                                                                         NEW TECHNOLOGY
                                                                                                                                        Fig. 4 MALDI mass spectra taken at different locations within a glioblas-
                                                                                                                                        toma slice (Fig. 3). Over 150 different peaks could be detected, with some
                                                                                                                                        of them having a distinct spatial distribution in the tissue. Top, distal and
                                                                                                                                        most active area of tumor proliferation; middle, an ischemic area; bottom,
                                                                                                                                        a necrotic area of the tumor. The inset shows an expanded portion of the
                                                                                                                                        spectrum in the region of thymosin .4.
                                                                                                                                        ion spectrum (MS/MS analysis) using an electrospray quadru-
                                                                                                                                        pole TOF mass spectrometer (Q-Star, Applied Biosystems/SCIEX,
 2001 Nature Publishing Group http://medicine.nature.com
                                                                                                                                        Foster City, California) from one of the tryptic fragments. The
                                                                                                                                        MS/MS spectrum of the N-terminal tryptic peptide obtained
                                                                                                                                        from a similar digest of T.4 purified from a mouse with prostate
                                                                                                                                        cancer is shown in Fig. 6. Fragment ions were matched by iden-
                                                             mass spectra from different regions of the glioblastoma during             tifying portions of the y and b ion series17, covering the com-
                                                             the scan (Fig. 4). These spectra clearly show differences in pro-          plete sequence of the peptide. This spectrum confirmed the
                                                             tein expression in different parts of the tumor.                           presence of T.4 in mouse models of prostate cancer.
                                                                The proliferating area of the tumor was of particular interest          Furthermore, from the MS/MS spectrum, the presence of an
                                                             with many proteins being expressed at higher levels relative to            acetyl group at the N-terminal end of the T.4 peptide was con-
                                                             normal tissue. For example, the protein of molecular weight                firmed. The protein of molecular weight 11,639  2 (Fig. 3c) was
                                                             4,964 (Fig. 3d) is localized only in the outer area of the tumor.          similarly identified as S100 calcium-binding protein A4
                                                             Other proteins, such as that of molecular weight 41,662 (Fig.              (S100A4), and the protein of measured molecular weight 41,659
                                                             3b), were localized in the necrotic area. In addition, other pro-           4 to be cytoplasmic actin.
                                                             teins were localized in the ischemic area between the necrotic
                                                             center and proliferating periphery, as shown for the protein               Discussion
                                                             with a molecular weight of 11,639. To identify the mapped pro-             The identification of specific tumor markers, for example T.4,
                                                             teins, we made an extract of the appropriate portion of the                in the proliferating area of the tumors demonstrates the poten-
                                                             glioblastoma tissue, and then fractionated the proteins by                 tial of this technique to be used in intra-operative assessment of
                                                             HPLC. The UV chromatogram of such an extract is shown in                   the surgical margins of tumors. Currently, frozen sections and
                                                             Fig. 5. The on-line mass spectrometric analysis (Ion Trap,                 light microscopy are required for rapid decisions, but are, at
                                                             Finnigan Company, San Jose, California) performed using elec-              times, inaccurate18,19. There is presently a need to develop tech-
                                                             trospray ionization MS easily permitted localization of the frac-          nology to improve the accuracy of such decisions20,21. For exam-
                                                             tion containing the proteins of interest. For example, one of the          ple, cancer invasion into muscle indicates that more extensive
                                                             proteins of molecular weight 4,964 eluted at 28.35 min in the              surgery or adjuvant therapy is needed22,23 and intra-operative di-
                                                             chromatogram. We spotted a sample of this fraction onto a                  agnosis of central nerve system neoplasia is required for surgical
                                                             MALDI target plate and performed an on-target digestion by                 management2426. Clinical validation will determine the useful-
                                                             trypsin. We analyzed the digest by MALDI MS followed by a                  ness of imaging MS to demonstrate these pathologic criteria
                                                             database search in SwissProt using the software MoverZ                   accurately for more aggressive management of cancer.
                                                             (ProteoMetrics, New York, New York). Thymosin .4 (T.4) was                  Beyond the application of imaging MS to brain cancer research,
                                                             found to match the digest data precisely. The sequence analysis            we are currently using this technology to study prostate and colon
                                                             of the amino-terminal peptide confirmed the identification of              cancer development and progression. In both cases, numerous
                                                             the protein as T.4 in this human glioblastoma xenograft.                  tumor-specific markers have been identified and specifically local-
                                                             Increased expression of T.4 has been reported in a variety of             ized within the tumors. Protein profiling and imaging MS are also
                                                             different tumors13. The localization of T.4 in the proliferating          proving to be of prime importance in our current research aiming
                                                             area of the tumor correlates with previous findings of higher              at a better understanding of prostate development. Overall, imag-
                                                             levels of T.4 in embryonic/neoplastic tissue compared with                ing MS can be a valuable molecular tool in a wide variety of studies
                                                             normal/benign tissue14. One of the known activities of this im-            and applications involving animal tissues.
                                                             munoregulatory peptide is its ability to sequester cytoplasmic
                                                             monomeric actin15. Moreover, actin filaments have been shown
                                                             to change into clump formation in apoptosis induced by anti-
                                                             tumor drugs, a process thought to be the result of decreased T.4
                                                             concentrations16.
                                                                We also observed the increased expression of T.4 in other tu-
                                                             mors as well. For example, in some mouse models of prostate
                                                             cancer, high levels of this protein have been found using imag-
                                                             ing MS. To confirm the identification, we generated a fragment
                                                             Fig. 5 UV chromatogram of a LC separation on a glioblastoma
                                                             xenograft extract. The analyte of molecular weight 4,964 was detected by
                                                             online electrospray mass spectrometry (inset shows mass spectrum) at a
                                                             retention time of 28.3 min.
                                                            NATURE MEDICINE  VOLUME 7  NUMBER 4  APRIL 2001                                                                                                    495
                                                                                                                              2001 Nature Publishing Group http://medicine.nature.com
                                                            NEW TECHNOLOGY
                                                                                                                                                     Methods
                                                                                                                                                     Tissue preparation. 12-m sections were cut from a frozen
                                                                                                                                                     mouse brain on a Leica CM 3000 cryostat at 15 C and di-
                                                                                                                                                     rectly picked up onto a gold-coated stainless steel plate. The
                                                                                                                                                     sections were immediately transferred to a cold room (4 C),
                                                                                                                                                     where 10 l of matrix (sinapinic acid, 10 mg/ml in acetoni-
                                                                                                                                                     trile/0.05% trifluoroacetic acid 50:50) were deposited with a
                                                                                                                                                     pipette in a line adjacent to the tissue and mechanically
                                                                                                                                                     spread over the tissue using a small plastic spatula. After air-
 2001 Nature Publishing Group http://medicine.nature.com
                                                                                                                                                     drying for 45 min, the sections were dried for 2 h in a desic-
                                                                                                                                                     cator before mass spectrometric analysis. This application
                                                                                                                                                     technique results in formation of crystals of the organic ma-
                                                                                                                                                     trix on the surface of the tissue while minimizing the spread-
                                                                                                                                                     ing of sample molecules.
                                                                                                                                                     Glioblastoma extraction and protein fractionation by
                                                             Fig. 6 The mass spectrometric analysis by electrospray MS/MS of the N-
                                                             terminal tryptic fragment of T.4. The complete sequence of the frag-                   HPLC. A portion of the glioblastoma (82 mg) was immersed
                                                             ment was confirmed from the mass spectrometric data.                                    in 500 l extraction buffer (0.25 M sucrose, 0.01 M Tris-HCl
                                                                                                                                                     and inhibitor mix; (Roche Molecular Biochemicals,
                                                                                                                                                     Switzerland), homogenized using a Duall homogenizer and
                                                                                                                                                     centrifuged 3 times (10 min at 680g, 10 min at 10,000g and
                                                             Acknowledgments                                                                         1 h at 55,000g), each time transferring the soluble fraction
                                                             We thank S. Schroeter, E. Sierra-Rivera, B. DaGue and Darell Bigner                     to a new tube. The final fraction (50 l) was separated over a
                                                             for help with this study. This work was supported by NIH grants GM                      C4 microbore column (Vydac, Hesperia, California), samples
                                                             58008 (to R.M.C.), CA 58506 (to D.H.) and C.A. 70937 (to D.H.).                         were collected and the separation run was recorded with a
                                                                                                                                                     UV detector set at 214 nm. Solvent A was 0.1 trifluoro acetic
                                                             1. Karas, M., Bachmann, D., Bahr, U. & Hillenkamp, F. Matrix-assisted ultravio-
                                                                 let-laser desorption of nonvolatile compounds. Int. J. Mass Spectrom. Ion           acid and solvent B was 95% acetonitrile, 5% water and 0.1%
                                                                 Process. 78, 5368 (1987).                                                          trifluoro acetic acid. A flow rate of 200 l/min was used with
                                                             2. Caprioli, R.M., Farmer, T.B. & Gile, J. Molecular imaging of biological sam-         a gradient of 5 min at 5% B, then in 55 min to 60% B, then
                                                                 ples: Localization of peptides and proteins using MALDI-TOF MS. Anal. Chem.
                                                                 69, 47514760 (1997).                                                               in 10 min to 100% B, and finally 5 min at 100% B.
                                                             3. Valaskovic, G.A. & Morrison, G.H. Quantitative imaging ion microscopy  a
                                                                 short review. Scanning Microscopy 6, 305318 (1992).
                                                             4. Levisetti, R. et al. Imaging-SIMS (secondary-ion mass-spectroscopy) studies of
                                                                                                                                                     On-target digestion by trypsin. For this procedure, the
                                                                 advanced materials. Scanning Microsc. 7, 11611172 (1993).                          sample (2 l) was placed on the target and allowed to dry
                                                             5. Todd, P.J., McMahon, J.M., Short, R.T. & McCandlish, C.A. Organic SIMS of            before adding digest solution (2 l, 20 nM bovine trypsin,
                                                                 biological tissue. Anal. Chem. 69, 529A535A (1997).
                                                             6. Pacholski, M.L. & Winograd, N. Imaging with mass spectrometry. Chem. Rev.
                                                                                                                                                     sequencing-grade, (Roche Molecular Biochemicals), and 50
                                                                 99, 29773005 (1999).                                                               mM ammonium hydrogen carbonate). The plate was kept at
                                                             7. Li, K.W. et al. Direct peptide profiling by mass spectrometry of single identi-      37 C for 30 min while adding water to maintain the vol-
                                                                 fied neurons reveals complex neuropeptide-processing pattern. J. Biol. Chem.
                                                                 269, 3028830292 (1994).                                                            ume. After drying the sample, 2 l of a saturated -cyano-4-
                                                             8. Jimenez, C.R. et al. Direct mass spectrometric peptide profiling and sequenc-        hydroycinnamic acid (Sigma) solution in 50:50 acetonitrile
                                                                 ing of single neurons reveals differential peptide patterns in a small neuronal     and 0.1% trifluoro acetic acid (2 l) was added as a MALDI
                                                                 network. Biochemistry 37, 20702076 (1998).
                                                             9. Moroz, L.L., Gillette, R. & Sweedler, J.V. Single-cell analyses of nitrergic neu-    matrix.
                                                                 rons in simple nervous systems. J. Exp. Biol. 202, 333341 (1999).
                                                             10. Chaurand, P., Stoeckli, M. & Caprioli, R.M. Direct profiling of proteins in bio-
                                                                 logical tissue sections by MALDI mass spectrometry. Anal. Chem. 71,
                                                                 52635270 (1999).                                                                      lymph nodes. Ann. Surg. Oncol. 6, 699704 (1999).
                                                             11. Stoeckli, M., Farmer, T.B. & Caprioli, R.M. Automated mass spectrometry            20. Richter, T., Nahrig, J., Komminoth, P., Kowolik, J. & Werner, M. Protocol for
                                                                 imaging with a matrix-assisted laser desorption ionization time-of-flight in-          ultrarapid immunostaining of frozen sections. J. Clin. Pathol. 52, 461463
                                                                 strument. J. Am. Soc. Mass Spectrom. 10, 6771 (1999).                                 (1999).
                                                             12. Nelson, D.F., McDonald, J.V., Lapham, L.W., Quazi, R. & Rubin, P. Central          21. Wang, H.W., Willis, J., Canto, M.I.F., Sivak, M.V. & Izatt, J.A. Quantitative
                                                                 nervous system tumors. in Clinical Oncology: A Multidisciplinary Approach for          laser scanning confocal autofluorescence microscopy of normal, premalig-
                                                                 Physicians and Students (ed. Rubin, P.) 617644 (WB Saunders, Philadelphia,            nant, and malignant colonic tissues. IEEE Trans. Biomed. Eng. 46, 12461252
                                                                 1993).                                                                                 (1999).
                                                             13. Paciucoi, R. et al. Isolation of plasminogen activator, cathepsin H, and non-      22. Cheng, L., Neumann, R.M., Weaver, A.L., Spotts, B.E. & Bostwick, D.G.
                                                                 specific cross-reacting antigen from SK-PC-1 pancreas cancer cells using sub-          Predicting cancer progression in patients with stage T1 bladder carcinoma.
                                                                 tractive hybridization. FEBS Lett. 385, 7276 (1996).                                  J. Clin. Oncol. 17, 31823187 (1999).
                                                             14. Hall, A.K. Differential expression of thymosin genes in human tumors and in        23. Longacre, T.A. & Hendrickson, M.R. Diffusely infiltrative endometrial adeno-
                                                                 the developing human kidney. Int. J. Cancer 48, 672677 (1991).                        carcinoma  an adenoma malignum pattern of myoinvasion. Am. J. Surg.
                                                             15. Sun, H.Q., Kwiatowska, K., Yin, H.L. Actin monomer binding proteins. Curr.             Pathol. 23, 6978 (1999).
                                                                 Opin. Cell Biol. 7, 102110 (1995).                                                24. Shah, A.B., Muzumdar, G.A., Chitale, A.R. & Bhagwati, S.N. Squash prepara-
                                                             16. Iguchi, K. et al. Decreased thymosin .4 in apoptosis induced by a variety of          tion and frozen section in intra-operative diagnosis of central nervous system
                                                                 antitumor drugs. Biochem. Pharmacol. 57, 11051111 (1999).                             tumors. Acta Cytologica 42, 11491154 (1998).
                                                             17. Roepstorff, P. Proposal for a common nomenclature for sequence ions in             25. Silbergeld, D.L. & Chicoine, M.R. Isolation and characterization of human
                                                                 mass spectra of peptides. Biomed. Mass Spectrom. 11, 601 (1984).                       malignant glioma cells from histologically normal brain. J. Neurosurg. 86,
                                                             18. Turner, R.R., Hansen, N.M., Stern, S.L. & Giuliano, A.E. Intra-operative exam-         525531 (1997).
                                                                 ination of the sentinel lymph node for breast carcinoma staging. Am. J. Clin.      26. Firlik, K.S., Martinez, A.J. & Lunsford, L.D. Use of cytological preparations for
                                                                 Pathol. 112, 627634 (1999).                                                           the intra-operative diagnosis of stereotactically obtained brain biopsies: A 19-
                                                             19. Gibbs, J.F., Huang, P.P., Zhang, P.J., Kraybill, W.G. & Cheney, R. Accuracy of         year experience and survey of neuropathologists. J. Neurosurg. 91, 454458
                                                                 pathologic techniques for the diagnosis of metastatic melanoma in sentinel             (1999).
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