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Humaran Cozar D, Pérez-Anker J, Fernández Ruiz P, Castellà Fernández E, Pérez Roca L, Blay Aulina L, Pascual Miguel I, Puig Sardà S, Malvehy Guilera J, Julián Ibáñez JF. Ex-vivo fusion confocal microscopy for margin assessment in breast cancer surgery. Br J Surg 2024; 111:znad394. [PMID: 37992254 DOI: 10.1093/bjs/znad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/04/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Daniel Humaran Cozar
- General and Digestive Surgery Department, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
- Department of Surgery and Morphological Sciences of the Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Pedro Fernández Ruiz
- Pathology Department, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | | | - Laia Pérez Roca
- Pathology Department, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | - Lidia Blay Aulina
- General and Digestive Surgery Department, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | - Iciar Pascual Miguel
- General and Digestive Surgery Department, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | - Susana Puig Sardà
- Dermatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
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2
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Kinzler MN, Schulze F, Reitz A, Gretser S, Ziegler P, Shmorhun O, Friedrich-Rust M, Bojunga J, Zeuzem S, Schnitzbauer AA, Bechstein WO, Reis H, Barreiros AP, Wild PJ. Fluorescence confocal microscopy on liver specimens for full digitization of transplant pathology. Liver Transpl 2023; 29:940-951. [PMID: 37016761 DOI: 10.1097/lvt.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/01/2023] [Indexed: 04/06/2023]
Abstract
Fluorescence confocal microscopy (FCM) is a rapidly evolving tool that provides real-time virtual HE images of native tissue. Data about the potential of FCM as an alternative to frozen sections for the evaluation of donor liver specimens are lacking so far. The aim of the current study was to determine the value of FCM in liver specimens according to the criteria of the German Society for Organ Procurement. In this prospective study, conventional histology and FCM scans of 50 liver specimens (60% liver biopsies, 26% surgical specimens, and 14% donor samples) were evaluated according to the German Society for Organ Procurement. A comparison of FCM scans and conventional frozen sections revealed almost perfect levels of agreement for cholangitis (κ = 0.877), fibrosis (κ = 0.843), and malignancy (κ = 0.815). Substantial levels of agreement could be obtained for macrovesicular steatosis (κ = 0.775), inflammation (κ = 0.763), necrosis (κ = 0.643), and steatohepatitis (κ = 0.643). Levels of agreement were moderate for microvesicular steatosis (κ = 0.563). The strength of agreement between frozen sections and FCM was superior to the comparison of conventional HE and FCM imaging. We introduce FCM as a potential alternative to the frozen section that may represent a novel approach to liver transplant pathology where timely feedback is crucial and the deployment of human resources is becoming increasingly difficult.
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Affiliation(s)
- Maximilian N Kinzler
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Falko Schulze
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Alexandra Reitz
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Steffen Gretser
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Paul Ziegler
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Oleksandr Shmorhun
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Andreas A Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Wolf Otto Bechstein
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Henning Reis
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Ana Paula Barreiros
- German Organ Procurement Organization (DSO), 60594 Frankfurt am Main, Germany
| | - Peter J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
- Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
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3
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Villarreal JZ, Pérez-Anker J, Puig S, Xipell M, Espinosa G, Barnadas E, Larque AB, Malvehy J, Cervera R, Pereira A, Martinez-Pozo A, Quintana LF, García-Herrera A. Ex vivo confocal microscopy detects basic patterns of acute and chronic lesions using fresh kidney samples. Clin Kidney J 2023; 16:1005-1013. [PMID: 37260998 PMCID: PMC10229294 DOI: 10.1093/ckj/sfad019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Ex vivo confocal microscopy is a real-time technique that provides high-resolution images of fresh, non-fixed tissues, with an optical resolution comparable to conventional pathology. The objective of this study was to investigate the feasibility of using ex vivo confocal microscopy in fusion mode (FuCM) and the haematoxylin and eosin (H&E)-like digital staining that results for the analysis of basic patterns of lesion in nephropathology. METHODS Forty-eight renal samples were scanned in a fourth-generation ex vivo confocal microscopy device. Samples were subjected to confocal microscopy imaging and were then processed using conventional pathology techniques. Concordance between the techniques was evaluated by means of the percentage of agreement and the κ index. RESULTS Agreement between conventional microscopy and H&E-like digital staining was strong (κ = 0.88) in the evaluation of acute tubular damage and was substantial (κ = 0.79) in the evaluation of interstitial fibrosis, interstitial inflammation, arterial and arteriolar lesions. H&E-like digital staining also allows rapid identification of extracapillary proliferation (κ = 0.88), necrosis and segmental sclerosis (κ = .88) in the glomerular compartment, but the results reported here are limited because of the small number of cases with these glomerular findings. CONCLUSIONS FuCM proved to be as effective as conventional techniques in evaluating the presence of acute tubular necrosis and interstitial fibrosis changes, but in fresh tissue. The ease of acquisition of ex vivo confocal microscopy images suggests that FuCM may be useful for rapid evaluation of kidney biopsies and to restructure the clinical workflow in renal histopathology.
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Affiliation(s)
- Jesús Z Villarreal
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Fundación Hospital Clinic, Barcelona, Spain
| | - Javiera Pérez-Anker
- Fundación Hospital Clinic, Barcelona, Spain
- Department of Dermatology, Melanoma Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Susana Puig
- Department of Dermatology, Melanoma Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Marc Xipell
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Esther Barnadas
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - Ana B Larque
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - J Malvehy
- Department of Dermatology, Melanoma Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Arturo Pereira
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - Antonio Martinez-Pozo
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - Adriana García-Herrera
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
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4
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Stigliano S, Crescenzi A, Taffon C, Marocchi G, Di Matteo FM. Fluorescence confocal microscopy for rapid evaluation of EUS fine-needle biopsy in pancreatic solid lesions. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:113-114. [PMID: 36935810 PMCID: PMC10020000 DOI: 10.1016/j.vgie.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Video 1EUS fine-needle biopsy of a pancreatic solid lesion evaluated with fluorescence confocal microscopy.
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Affiliation(s)
- Serena Stigliano
- Operative Endoscopy Department, Campus Bio-Medico University Hospital, Rome, Italy
| | - Anna Crescenzi
- Pathology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Chiara Taffon
- Pathology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Gianmarco Marocchi
- Operative Endoscopy Department, Campus Bio-Medico University Hospital, Rome, Italy
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5
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Di Pompo G, Kusuzaki K, Ponzetti M, Leone VF, Baldini N, Avnet S. Radiodynamic Therapy with Acridine Orange Is an Effective Treatment for Bone Metastases. Biomedicines 2022; 10:biomedicines10081904. [PMID: 36009451 PMCID: PMC9405350 DOI: 10.3390/biomedicines10081904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
Current multimodal treatment of bone metastases is partially effective and often associated with side effects, and novel therapeutic options are needed. Acridine orange is a photosensitizing molecule that accumulates in acidic compartments. After photo- or radiodynamic activation (AO-PDT or AO-RDT), acridine orange can induce lysosomal-mediated cell death, and we explored AO-RDT as an acid-targeted anticancer therapy for bone metastases. We used osteotropic carcinoma cells and human osteoclasts to assess the extracellular acidification and invasiveness of cancer cells, acridine orange uptake and lysosomal pH/stability, and the AO-RDT cytotoxicity in vitro. We then used a xenograft model of bone metastasis to compare AO-RDT to another antiacid therapeutic strategy (omeprazole). Carcinoma cells showed extracellular acidification activity and tumor-derived acidosis enhanced cancer invasiveness. Furthermore, cancer cells accumulated acridine orange more than osteoclasts and were more sensitive to lysosomal death. In vivo, omeprazole did not reduce osteolysis, whereas AO-RDT promoted cancer cell necrosis and inhibited tumor-induced bone resorption, without affecting osteoclasts. In conclusion, AO-RDT was selectively toxic only for carcinoma cells and effective to impair both tumor expansion in bone and tumor-associated osteolysis. We therefore suggest the use of AO-RDT, in combination with the standard antiresorptive therapies, to reduce disease burden in bone metastasis.
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Affiliation(s)
- Gemma Di Pompo
- Biomedical Science and Technologies and Nanobiotechnology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Katsuyuki Kusuzaki
- Department of Musculoskeletal Oncology, Takai Hospital, Tenri 632-0372, Japan
| | - Marco Ponzetti
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | | | - Nicola Baldini
- Biomedical Science and Technologies and Nanobiotechnology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Sofia Avnet
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
- Correspondence:
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Zhang Y, Kang L, Lo CTK, Tsang VTC, Wong TTW. Rapid slide-free and non-destructive histological imaging using wide-field optical-sectioning microscopy. BIOMEDICAL OPTICS EXPRESS 2022; 13:2782-2796. [PMID: 35774335 PMCID: PMC9203115 DOI: 10.1364/boe.454501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 06/15/2023]
Abstract
Histopathology based on formalin-fixed and paraffin-embedded tissues has long been the gold standard for surgical margin assessment (SMA). However, routine pathological practice is lengthy and laborious, failing to guide surgeons intraoperatively. In this report, we propose a practical and low-cost histological imaging method with wide-field optical-sectioning microscopy (i.e., High-and-Low-frequency (HiLo) microscopy). HiLo can achieve rapid and non-destructive imaging of freshly-excised tissues at an extremely high acquisition speed of 5 cm2/min with a spatial resolution of 1.3 µm (lateral) and 5.8 µm (axial), showing great potential as an SMA tool that can provide immediate feedback to surgeons and pathologists for intraoperative decision-making. We demonstrate that HiLo enables rapid extraction of diagnostic features for different subtypes of human lung adenocarcinoma and hepatocellular carcinoma, producing surface images of rough specimens with large field-of-views and cellular features that are comparable to the clinical standard. Our results show promising clinical translations of HiLo microscopy to improve the current standard of care.
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7
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Bishop KW, Maitland KC, Rajadhyaksha M, Liu JTC. In vivo microscopy as an adjunctive tool to guide detection, diagnosis, and treatment. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-220032-PER. [PMID: 35478042 PMCID: PMC9043840 DOI: 10.1117/1.jbo.27.4.040601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 05/05/2023]
Abstract
SIGNIFICANCE There have been numerous academic and commercial efforts to develop high-resolution in vivo microscopes for a variety of clinical use cases, including early disease detection and surgical guidance. While many high-profile studies, commercialized products, and publications have resulted from these efforts, mainstream clinical adoption has been relatively slow other than for a few clinical applications (e.g., dermatology). AIM Here, our goals are threefold: (1) to introduce and motivate the need for in vivo microscopy (IVM) as an adjunctive tool for clinical detection, diagnosis, and treatment, (2) to discuss the key translational challenges facing the field, and (3) to propose best practices and recommendations to facilitate clinical adoption. APPROACH We will provide concrete examples from various clinical domains, such as dermatology, oral/gastrointestinal oncology, and neurosurgery, to reinforce our observations and recommendations. RESULTS While the incremental improvement and optimization of IVM technologies should and will continue to occur, future translational efforts would benefit from the following: (1) integrating clinical and industry partners upfront to define and maintain a compelling value proposition, (2) identifying multimodal/multiscale imaging workflows, which are necessary for success in most clinical scenarios, and (3) developing effective artificial intelligence tools for clinical decision support, tempered by a realization that complete adoption of such tools will be slow. CONCLUSIONS The convergence of imaging modalities, academic-industry-clinician partnerships, and new computational capabilities has the potential to catalyze rapid progress and adoption of IVM in the next few decades.
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Affiliation(s)
- Kevin W. Bishop
- University of Washington, Department of Bioengineering, Seattle, Washington, United States
- University of Washington, Department of Mechanical Engineering, Seattle, Washington, United States
| | - Kristen C. Maitland
- Texas A&M University, Department of Biomedical Engineering, College Station, Texas, United States
| | - Milind Rajadhyaksha
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York, United States
| | - Jonathan T. C. Liu
- University of Washington, Department of Bioengineering, Seattle, Washington, United States
- University of Washington, Department of Mechanical Engineering, Seattle, Washington, United States
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
- Address all correspondence to Jonathan T.C. Liu,
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8
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Villard A, Breuskin I, Casiraghi O, Asmandar S, Laplace-Builhe C, Abbaci M, Moya Plana A. Confocal laser endomicroscopy and confocal microscopy for head and neck cancer imaging: Recent updates and future perspectives. Oral Oncol 2022; 127:105826. [DOI: 10.1016/j.oraloncology.2022.105826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/18/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023]
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9
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Shavlokhova V, Flechtenmacher C, Sandhu S, Vollmer M, Vollmer A, Saravi B, Engel M, Ristow O, Hoffmann J, Freudlsperger C. Ex vivo fluorescent confocal microscopy images of oral mucosa: Tissue atlas and evaluation of the learning curve. JOURNAL OF BIOPHOTONICS 2022; 15:e202100225. [PMID: 34796650 DOI: 10.1002/jbio.202100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/13/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
Ex vivo fluorescence confocal microscopy (FCM) is a developing tool providing rapid digital imaging of fresh tissue utilizing high-resolution optical sectioning that highly corresponds with conventional hmatoxylin and eosin (H&E)-stained slides. A very little data on oral mucosa lesions exist currently. The present work aimed to create an image atlas of benign and malignant oral tissues and compare them to the corresponding histopathology. Furthermore, we aimed to evaluate the learning curve for confocal image interpretation. From 50 samples obtained from the oral mucosa, including oral squamous cell carcinoma (OSCC), dysplasia, and healthy oral tissue, ex vivo FCM images and corresponding H&E slides were created and collected into a tissue atlas. Additionally, two experts were asked to analyze the images to assess the learning curve. Ex vivo FCM images revealed high comparability with histopathological images. Tissues including OSCC, dysplasia, and normal oral mucosa were implemented in the image atlas to provide the diagnostic fundament for pathologists and surgeons; the learning curve was short. Future studies on this topic will be advantageous for the development of artificial intelligence-based diagnostic approaches. The current work provides a novel set of data that are structured as an atlas of common pathologies of the mucosa to enhance the existing knowledge and material on confocal images.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | | | - Sameena Sandhu
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
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Liao H, Sheridan T, Cosar E, Owens C, Zuo T, Wang X, Akalin A, Kandil D, Dresser K, Fogarty K, Bellve K, Baer C, Fischer A. Deconvolution Microscopy: A Platform for Rapid On-Site Evaluation (ROSE) of Fine Needle Aspiration (FNA) Specimens that Enables Recovery of the Sample. Cytopathology 2022; 33:312-320. [PMID: 35102620 PMCID: PMC9305921 DOI: 10.1111/cyt.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/03/2022] [Accepted: 01/22/2022] [Indexed: 12/01/2022]
Abstract
CONTEXT Rapid on-site evaluation (ROSE) optimizes the performance of cytology, but requires skilled handling, and smearing can make the material unavailable for some ancillary tests. There is a need to facilitate ROSE without sacrificing part of the sample. OBJECTIVE We evaluated the image quality of inexpensive deconvolution fluorescence microscopy for optically sectioning non-smeared FNA tissue fragments. DESIGN A portion of residual material from 14 FNA samples was stained for 3 minutes in Hoechst 33342 and SyproTM Red to label DNA and protein respectively, transferred to an imaging chamber, and imaged at 200X or 400X magnification at 1 micron intervals using a GE DeltaVision inverted fluorescence microscope. A deconvolution algorithm was applied to remove out of plane signal, and resulting images were inverted and pseudocolored to resemble an H&E section. Five cytopathologists blindly diagnosed 2 to 4 representative image stacks per case (total 70 evaluations), and later compared them to conventional epifluorescent images. RESULTS Accurate definitive diagnoses were rendered in 45 of 70 (64%) total evaluations; equivocal diagnoses (atypical or suspicious) were made in 21 of 70 (30%). There were two false positive and two false negative "definite" diagnoses in three cases (4/70; 6%). Cytopathologists preferred deconvolved images compared to raw images (p< 0.01). The imaged fragments were recovered and prepared into a ThinPrep or cell block without discernable alteration. CONCLUSIONS Deconvolution improves image quality of FNA fragments compared to epifluorescence, often allowing definitive diagnosis while enabling the ROSE material to be subsequently triaged.
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Affiliation(s)
| | | | - Ediz Cosar
- University of Massachusetts Medical School
| | | | - Tao Zuo
- University of Massachusetts Medical School
| | | | - Ali Akalin
- University of Massachusetts Medical School
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11
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Titze U, Sievert KD, Titze B, Schulz B, Schlieker H, Madarasz Z, Weise C, Hansen T. Ex Vivo Fluorescence Confocal Microscopy in Specimens of the Liver: A Proof-of-Concept Study. Cancers (Basel) 2022; 14:590. [PMID: 35158859 PMCID: PMC8833349 DOI: 10.3390/cancers14030590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Ex vivo Fluorescence Confocal Microscopy (FCM) is a technique providing high-resolution images of native tissues. The method is increasingly used in surgical settings in areas of dermatology and urology. Only a few publications exist about examinations of tumors and non-neoplastic lesions of the liver. We report on the application of FCM in biopsies, surgical specimens and autopsy material (33 patients, 39 specimens) of the liver and compare the results to conventional histology. Our preliminary examinations indicated a perfect suitability for tumor diagnosis (ĸ = 1.00) and moderate/good suitability for the assessment of inflammation (ĸ = 0.4-0.6) with regard to their severity and localization. Macro-vesicular steatosis was reliably detected, micro-vesicular steatosis tended to be underestimated. Cholestasis and eosinophilic granules in granulocytes were not represented in the scans. The tissue was preserved as native material and maintained its quality for downstream histological, immunohistological and molecular examinations. In summary, FCM is a material sparing method that provides rapid feedback to the clinician about the presence of tumor, the degree of inflammation and structural changes. This can lead to faster therapeutic decisions in the management of liver tumors, treatment of hepatitis or in liver transplant medicine.
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Affiliation(s)
- Ulf Titze
- Institute of Pathology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany; (B.T.); (B.S.); (T.H.)
| | - Karl-Dietrich Sievert
- Department of Urology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany;
| | - Barbara Titze
- Institute of Pathology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany; (B.T.); (B.S.); (T.H.)
| | - Birte Schulz
- Institute of Pathology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany; (B.T.); (B.S.); (T.H.)
| | - Heiko Schlieker
- Department of Gastroenterology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany;
| | - Zsolt Madarasz
- Department of General Surgery, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany;
| | - Christian Weise
- Department of Pediatrics, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany;
| | - Torsten Hansen
- Institute of Pathology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany; (B.T.); (B.S.); (T.H.)
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12
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Yoshitake T, Rosen S, Cahill LC, Lamothe S, Ward A, Fujimoto JG. Rapid histological imaging of bone without microtome sectioning using nonlinear microscopy. Bone 2022; 154:116254. [PMID: 34743041 PMCID: PMC9832301 DOI: 10.1016/j.bone.2021.116254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/06/2021] [Accepted: 11/02/2021] [Indexed: 02/07/2023]
Abstract
Tissue preparation for histologic evaluation of bone is particularly lengthy, limiting its use in intraoperative or intraprocedural histological evaluation. Nonlinear microscopy (NLM) is an optical sectioning microscopy method that can visualize pathology in freshly excised tissue without requiring physical microtome sectioning. This study describes a rapid protocol for NLM imaging of bone and associated cartilage. NLM imaging was performed on 71 specimens of normal bone as well as arthritic, malignant and inflammatory bone tissue from 40 patients who underwent joint replacement, amputation, bone marrow biopsy or autopsy. Specimens ranged in size from core needle biopsies to transections of entire femoral heads. Specimens were stained with acridine orange and sulforhodamine 101, nuclear and cytoplasmic/stromal fluorescent dyes, for 5 min, then rinsed for 30 s. NLM fluorescent images were displayed using colors analogous to hematoxylin and eosin (H&E) to facilitate interpretation. Pathologists examined NLM images of the specimens in real time by rapidly translating the specimen to areas of interest, similar to a standard transmission light microscope. By adjusting the NLM focus depth, images from a few-μm-thick layer could be obtained down to ~100 μm below the tissue surface, analogous to serial sectioning. Following real-time NLM imaging, the tissue was processed for conventional paraffin histology, and H&E slides were compared to recorded NLM images. Similarities and differences between NLM and paraffin H&E were assessed. NLM enabled visualization of normal bone architecture, including the lamellar matrix and osteocytes of trabecular bone, articular cartilage, as well as pathological bone features such osteoarthritis, osteomyelitis, and malignancy with an appearance resembling the paraffin H&E. Differences such as changes in cell border sharpness, cellular and nucleolar size, and color patterns were noted, suggesting that training is required for accurate evaluation of bone pathology with NLM. Irregular surface contours and debris generated by gross tissue preparation of bone can make some regions difficult to evaluate with NLM, but the ability to perform rapid three-dimensional translation and sub-surface imaging reduced these problems. NLM is a promising technique for rapid evaluation of bone pathology. Further studies assessing diagnostic performance are warranted.
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Affiliation(s)
- Tadayuki Yoshitake
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lucas C Cahill
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Simon Lamothe
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashley Ward
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA.
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13
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Shavlokhova V, Sandhu S, Flechtenmacher C, Koveshazi I, Neumeier F, Padrón-Laso V, Jonke Ž, Saravi B, Vollmer M, Vollmer A, Hoffmann J, Engel M, Ristow O, Freudlsperger C. Deep Learning on Oral Squamous Cell Carcinoma Ex Vivo Fluorescent Confocal Microscopy Data: A Feasibility Study. J Clin Med 2021; 10:5326. [PMID: 34830608 PMCID: PMC8618824 DOI: 10.3390/jcm10225326] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ex vivo fluorescent confocal microscopy (FCM) is a novel and effective method for a fast-automatized histological tissue examination. In contrast, conventional diagnostic methods are primarily based on the skills of the histopathologist. In this study, we investigated the potential of convolutional neural networks (CNNs) for automatized classification of oral squamous cell carcinoma via ex vivo FCM imaging for the first time. MATERIAL AND METHODS Tissue samples from 20 patients were collected, scanned with an ex vivo confocal microscope immediately after resection, and investigated histopathologically. A CNN architecture (MobileNet) was trained and tested for accuracy. RESULTS The model achieved a sensitivity of 0.47 and specificity of 0.96 in the automated classification of cancerous tissue in our study. CONCLUSION In this preliminary work, we trained a CNN model on a limited number of ex vivo FCM images and obtained promising results in the automated classification of cancerous tissue. Further studies using large sample sizes are warranted to introduce this technology into clinics.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Sameena Sandhu
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | | | | | | | | | - Žan Jonke
- Munich Innovation Labs GmbH, 80336 Munich, Germany; (V.P.-L.); (Ž.J.)
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany;
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
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14
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Ruini C, Schlingmann S, Jonke Ž, Avci P, Padrón-Laso V, Neumeier F, Koveshazi I, Ikeliani IU, Patzer K, Kunrad E, Kendziora B, Sattler E, French LE, Hartmann D. Machine Learning Based Prediction of Squamous Cell Carcinoma in Ex Vivo Confocal Laser Scanning Microscopy. Cancers (Basel) 2021; 13:cancers13215522. [PMID: 34771684 PMCID: PMC8583634 DOI: 10.3390/cancers13215522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 01/02/2023] Open
Abstract
Image classification with convolutional neural networks (CNN) offers an unprecedented opportunity to medical imaging. Regulatory agencies in the USA and Europe have already cleared numerous deep learning/machine learning based medical devices and algorithms. While the field of radiology is on the forefront of artificial intelligence (AI) revolution, conventional pathology, which commonly relies on examination of tissue samples on a glass slide, is falling behind in leveraging this technology. On the other hand, ex vivo confocal laser scanning microscopy (ex vivo CLSM), owing to its digital workflow features, has a high potential to benefit from integrating AI tools into the assessment and decision-making process. Aim of this work was to explore a preliminary application of CNN in digitally stained ex vivo CLSM images of cutaneous squamous cell carcinoma (cSCC) for automated detection of tumor tissue. Thirty-four freshly excised tissue samples were prospectively collected and examined immediately after resection. After the histologically confirmed ex vivo CLSM diagnosis, the tumor tissue was annotated for segmentation by experts, in order to train the MobileNet CNN. The model was then trained and evaluated using cross validation. The overall sensitivity and specificity of the deep neural network for detecting cSCC and tumor free areas on ex vivo CLSM slides compared to expert evaluation were 0.76 and 0.91, respectively. The area under the ROC curve was equal to 0.90 and the area under the precision-recall curve was 0.85. The results demonstrate a high potential of deep learning models to detect cSCC regions on digitally stained ex vivo CLSM slides and to distinguish them from tumor-free skin.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence:
| | - Sophia Schlingmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Žan Jonke
- Munich Innovation Labs GmbH, 80336 Munich, Germany; (Ž.J.); (V.P.-L.)
| | - Pinar Avci
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | | | - Florian Neumeier
- M3i Industry-in-Clinic-Platform GmbH, 80336 Munich, Germany; (F.N.); (I.K.); (I.U.I.)
| | - Istvan Koveshazi
- M3i Industry-in-Clinic-Platform GmbH, 80336 Munich, Germany; (F.N.); (I.K.); (I.U.I.)
| | - Ikenna U. Ikeliani
- M3i Industry-in-Clinic-Platform GmbH, 80336 Munich, Germany; (F.N.); (I.K.); (I.U.I.)
| | - Kathrin Patzer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Elena Kunrad
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Benjamin Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Elke Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Lars E. French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
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15
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Stigliano S, Crescenzi A, Taffon C, Covotta F, Hassan C, Antonelli G, Verri M, Biasutto D, Scarpa RM, Di Matteo FM. Role of fluorescence confocal microscopy for rapid evaluation of EUS fine-needle biopsy sampling in pancreatic solid lesions. Gastrointest Endosc 2021; 94:562-568.e1. [PMID: 33798539 DOI: 10.1016/j.gie.2021.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS EUS fine-needle biopsy (EUS-FNB) sampling is the standard procedure for diagnosis of pancreatic lesions. Fluorescence confocal microscopy (FCM) allows imaging of tissues in the fresh state, requiring minimal preparation without damage or loss of tissue. Until now, no data exist on FCM in the field of microhistologic specimens. We aimed to assess the diagnostic performance of FCM in predicting histologic adequacy of EUS-FNB samples in pancreatic solid lesions and to assess the agreement between FCM evaluation and final histology. METHODS In this single-center prospective study on consecutive patients with pancreatic lesions receiving EUS-FNB, the obtained samples have been evaluated at FCM and classified as "inadequate" or "adequate" (benign, suspicious, or malignant). The kappa test was used to quantify agreement. The diagnostic accuracy of FCM was assessed. A P < .05 was considered to be statistically significant. RESULTS From April 2020 to September 2020, 81 patients were enrolled. In all cases FCM showed the macro image of the sample and created a digital image. Of the samples, 92.6% was defined as adequate at the FCM evaluation and confirmed at histopathology. Histologic diagnoses were 8% benign, 17.3% atypical/suspicious, and 74.7% malignant with satisfactory agreement with the FCM evaluation (Cohen's κ coefficient, .95; 95% confidence interval [CI], .89-1.01; P = .001). The sensitivity of the FCM evaluation was 100% (95% CI, 95%-100%), specificity 66.7% (95% CI, 22.3%-95.7%), accuracy 97% (95% CI, 90.7%-99.7%), positive predictive value 97% (95% CI, 91.8%-99%), and negative predictive value 100%. CONCLUSIONS FCM represents a new technique successfully applicable to microhistologic specimens. It provides fast information about sample adequacy in small specimens with good agreement in the final histology.
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Affiliation(s)
- Serena Stigliano
- Operative Endoscopy Department, Campus Bio-Medico University Hospital, Rome, Italy
| | - Anna Crescenzi
- Pathology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Chiara Taffon
- Pathology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Francesco Covotta
- Operative Endoscopy Department, Campus Bio-Medico University Hospital, Rome, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | | | - Martina Verri
- Pathology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Dario Biasutto
- Operative Endoscopy Department, Campus Bio-Medico University Hospital, Rome, Italy
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16
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Guerrero JA, Pérez-Anker J, Fernández-Esparrach G, Archilla I, Diaz A, Lopez-Prades S, Rodrigo-Calvo M, Lahoz S, Camps J, Puig S, Malvehy J, Cuatrecasas M. Ex vivo Fusion Confocal Microscopy of Colorectal Polyps: A Fast Turnaround Time of Pathological Diagnosis. Pathobiology 2021; 88:392-399. [PMID: 34407541 DOI: 10.1159/000517190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/11/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Colorectal cancer screening programs have accomplished a mortality reduction from the disease but have created bottlenecks in endoscopy units and pathology departments. We aimed to explore the feasibility of ex vivo fusion confocal microscopy (FuCM) to improve the histopathology diagnostic efficiency and reduce laboratory workload. METHODS Consecutive fresh polyps removed at colonoscopy were scanned using ex vivo FuCM, then went through histopathologic workout and hematoxylin and eosin (H&E) diagnosis. Two pathologists blinded to H&E diagnosis made a diagnosis based on FuCM scanned images. RESULTS Thirty-six fresh polyps from 22 patients were diagnosed with FuCM and H&E. Diagnostic agreement between H&E and FuCM was 97.2% (kappa = 0.96) for pathologist #1 and 91.7% (kappa = 0.87) for pathologist #2. Diagnostic performance concordance between FuCM and H&E to discern adenomatous from nonadenomatous polyps was 100% (kappa = 1) for pathologist #1 and 97.2% (kappa = 0.94) for pathologist #2. Global interobserver agreement was 94.44% (kappa = 0.91) and kappa = 0.94 to distinguish adenomatous from nonadenomatous polyps. CONCLUSIONS Ex vivo FuCM shows an excellent correlation with standard H&E for the diagnosis of colorectal polyps. The clinical direct benefit for patients, pathologists, and endoscopists allows adapting personalized surveillance protocols after colonoscopy and a workload decrease in pathology departments.
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Affiliation(s)
- Jose Andres Guerrero
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain
| | | | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain
| | - Ivan Archilla
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alba Diaz
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sandra Lopez-Prades
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maite Rodrigo-Calvo
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Lahoz
- University of Barcelona, Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Gastrointestinal and Pancreatic Oncology Team, Hospital Clínic, Barcelona, Spain
| | - Jordi Camps
- University of Barcelona, Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Gastrointestinal and Pancreatic Oncology Team, Hospital Clínic, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Faculty of Medicine, University Autonomous of Barcelona, Bellaterra, Spain
| | - Susana Puig
- Dermatology Department, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Banc de Teixits-Biobanc Clinic-IDIBAPS, Barcelona, Spain
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17
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Ruini C, Vladimirova G, Kendziora B, Salzer S, Ergun E, Sattler E, French LE, Hartmann D. Ex-vivo fluorescence confocal microscopy with digital staining for characterizing basal cell carcinoma on frozen sections: A comparison with histology. JOURNAL OF BIOPHOTONICS 2021; 14:e202100094. [PMID: 33991061 DOI: 10.1002/jbio.202100094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
Ex-vivo fluorescence confocal microscopy (FCM) has been used on fresh tissue, but there is little experience on frozen sections. We evaluated the applicability of FCM on frozen sections of basal cell carcinomas (BCCs), stained with acridine orange and digitally colored to simulate hematoxylin and eosin (H&E) dyes. We compared our diagnostic accuracy in detecting and subtyping BCCs with FCM to our gold standard (H&E stained frozen sections used in 3D horizontal micrographic surgery). Fourty-six primary BCCs were analyzed for free margins as well as histological subtype with all FCM modes and conventional H&E staining. Adnexa, artifacts and diagnostic confidence were evaluated. Free margins were identified with a sensitivity and specificity of 92% and 91%. Concordance for tumor subtype was 88%. FCM may be used on both fresh tissue and frozen samples, although with reduced performance and different artifacts. The device is useful for the intraoperative diagnosis, subtyping and margin-mapping of BCCs.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Italy
| | | | - Benjamin Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - Suzanna Salzer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - Ecem Ergun
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - Elke Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
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18
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Mitrou A, Feng X, Khan A, Yaroslavsky AN. Feasibility of dual-contrast fluorescence imaging of pathological breast tissues. JOURNAL OF BIOPHOTONICS 2021; 14:e202100007. [PMID: 34010507 DOI: 10.1002/jbio.202100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/23/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
The combination of intravital dye, methylene blue (MB), with molecular cancer marker, pH low insertion peptide (pHLIP) conjugated with fluorescent Alexa532 (Alexa532-pHLIP), was evaluated for enhancing contrast of pathological breast tissue ex vivo. Fresh, thick breast specimens were stained sequentially with Alexa532-pHLIP and aqueous MB and imaged using dual-channel fluorescence microscopy. MB and Alexa532-pHLIP accumulated in the nuclei and cytoplasm of cancer cells, respectively. MB also stained nuclei of normal cells. Some Alexa532-pHLIP fluorescence emission was detected from connective tissue and benign cell membranes. Overall, Alexa532-pHLIP showed high affinity to cancer, while MB highlighted tissue morphology. The results indicate that MB and Alexa532-pHLIP provide complementary information and show promise for the detection of breast cancer.
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Affiliation(s)
- Androniki Mitrou
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Xin Feng
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Ashraf Khan
- Department of Pathology, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Anna N Yaroslavsky
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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19
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Rapid brain structure and tumour margin detection on whole frozen tissue sections by fast multiphotometric mid-infrared scanning. Sci Rep 2021; 11:11307. [PMID: 34050224 PMCID: PMC8163866 DOI: 10.1038/s41598-021-90777-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/17/2021] [Indexed: 01/31/2023] Open
Abstract
Frozen section analysis is a frequently used method for examination of tissue samples, especially for tumour detection. In the majority of cases, the aim is to identify characteristic tissue morphologies or tumour margins. Depending on the type of tissue, a high number of misdiagnoses are associated with this process. In this work, a fast spectroscopic measurement device and workflow was developed that significantly improves the speed of whole frozen tissue section analyses and provides sufficient information to visualize tissue structures and tumour margins, dependent on their lipid and protein molecular vibrations. That optical and non-destructive method is based on selected wavenumbers in the mid-infrared (MIR) range. We present a measuring system that substantially outperforms a commercially available Fourier Transform Infrared (FT-IR) Imaging system, since it enables acquisition of reduced spectral information at a scan field of 1 cm2 in 3 s, with a spatial resolution of 20 µm. This allows fast visualization of segmented structure areas with little computational effort. For the first time, this multiphotometric MIR system is applied to biomedical tissue sections. We are referencing our novel MIR scanner on cryopreserved murine sagittal and coronal brain sections, especially focusing on the hippocampus, and show its usability for rapid identification of primary hepatocellular carcinoma (HCC) in mouse liver.
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20
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Ortner VK, Sahu A, Cordova M, Kose K, Aleissa S, Alessi-Fox C, Haedersdal M, Rajadhyaksha M, Rossi AM. Exploring the utility of Deep Red Anthraquinone 5 for digital staining of ex vivo confocal micrographs of optically sectioned skin. JOURNAL OF BIOPHOTONICS 2021; 14:e202000207. [PMID: 33314673 PMCID: PMC8274380 DOI: 10.1002/jbio.202000207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 05/11/2023]
Abstract
We investigated the utility of the fluorescent dye Deep Red Anthraquinone 5 (DRAQ5) for digital staining of optically sectioned skin in comparison to acridine orange (AO). Eight fresh-frozen thawed Mohs discard tissue specimens were stained with AO and DRAQ5, and imaged using an ex vivo confocal microscope at three wavelengths (488 nm and 638 nm for fluorescence, 785 nm for reflectance). Images were overlaid (AO + Reflectance, DRAQ5 + Reflectance), digitally stained, and evaluated by three investigators for perceived image quality (PIQ) and histopathological feature identification. In addition to nuclear staining, AO seemed to stain dermal fibers in a subset of cases in digitally stained images, while DRAQ5 staining was more specific to nuclei. Blinded evaluation showed substantial agreement, favoring DRAQ5 for PIQ (82%, Cl 75%-90%, Gwet's AC 0.74) and for visualization of histopathological features in (81%, Cl 73%-89%, Gwet's AC 0.67), supporting its use in digital staining of multimodal confocal micrographs of skin.
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Affiliation(s)
- Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - Aditi Sahu
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kivanc Kose
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saud Aleissa
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony Mario Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Clinical Applications of In Vivo and Ex Vivo Confocal Microscopy. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11051979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Confocal laser scanning microscopy (CLSM) has been introduced in clinical settings as a tool enabling a quasi-histologic view of a given tissue, without performing a biopsy. It has been applied to many fields of medicine mainly to the skin and to the analysis of skin cancers for both in vivo and ex vivo CLSM. In vivo CLSM involves reflectance mode, which is based on refractive index of cell structures serving as endogenous chromophores, reaching a depth of exploration of 200 μm. It has been proven to increase the diagnostic accuracy of skin cancers, both melanoma and non-melanoma. While histopathologic examination is the gold standard for diagnosis, in vivo CLSM alone and in addition to dermoscopy, contributes to the reduction of the number of excised lesions to exclude a melanoma, and to improve margin recognition in lentigo maligna, enabling tissue sparing for excisions. Ex vivo CLSM can be performed in reflectance and fluorescent mode. Fluorescence confocal microscopy is applied for “real-time” pathological examination of freshly excised specimens for diagnostic purposes and for the evaluation of margin clearance after excision in Mohs surgery. Further prospective interventional studies using CLSM might contribute to increase the knowledge about its application, reproducing real-life settings.
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O'Shea A, Tam AL, Kilcoyne A, Flaherty KT, Lee SI. Image-guided biopsy in the age of personalised medicine: strategies for success and safety. Clin Radiol 2020; 76:154.e1-154.e9. [PMID: 32896425 DOI: 10.1016/j.crad.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/04/2020] [Indexed: 12/28/2022]
Abstract
Oncology has progressed into an era of personalised medicine, whereby the therapeutic regimen is tailored to the molecular profile of the patient's cancer. Determining personalised therapeutic options is achieved by using tumour genomics and proteomics to identify the specific molecular targets against which candidate drugs can interact. Several dozen targeted drugs, many for multiple cancer types are already widely in clinical use. Molecular profiling of tumours is contingent on high-quality biopsy specimens and the most common method of tissue sampling is image-guided biopsy. Thus, for radiologists performing these biopsies, the paradigm has now shifted away from obtaining specimens simply for histopathological diagnosis to acquiring larger amounts of viable tumour cells for DNA, RNA, or protein analysis. These developments have highlighted the central role now played by radiologists in the delivery of personalised cancer care. This review describes the principles of molecular profiling assays and biopsy techniques for optimising yield, and describes a scoring system to assist in patient selection for percutaneous biopsy.
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Affiliation(s)
- A O'Shea
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - A L Tam
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - A Kilcoyne
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - K T Flaherty
- Department of Medicine, Division of Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S I Lee
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
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23
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Villarreal JZ, Pérez-Anker J, Puig S, Pellacani G, Solé M, Malvehy J, Quintana LF, García-Herrera A. Ex vivo confocal microscopy performs real-time assessment of renal biopsy in non-neoplastic diseases. J Nephrol 2020; 34:689-697. [PMID: 32876939 DOI: 10.1007/s40620-020-00844-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ex vivo confocal microscopy is a technique for tissue examination, which generates images of fresh samples with an optical resolution comparable to those obtained by conventional pathology. The objective of this study was to evaluate the feasibility of using ex vivo confocal microscopy in fusion mode (reflectance and fluorescence) and the H&E-like digital staining that is obtained for the analysis of non-neoplastic kidney biopsies. METHODS Twenty-four renal samples acquired from autopsies were scanned in a 4th generation ex vivo confocal microscopy device. The imaging process was completed in an average of three minutes. RESULTS Confocal images correlated very well to the corresponding conventional histological sections, both in normal tissue and in chronic lesions (glomerulosclerosis, fibrosis and tubular atrophy). The ex vivo confocal microscopy protocol did not add artifacts to the sample for the ulterior study with light microscopy, nor to the histochemical or immunohistochemical studies. CONCLUSION The ease and speed of grayscale and fluorescence image acquisition, together with the quality of the H&E-like digitally stained images obtained with this approach, suggest that this technique shows promise for use in clinical nephrology and renal transplantation.
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Affiliation(s)
- Jesús Z Villarreal
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - J Pérez-Anker
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - S Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M Solé
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
| | - J Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. .,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain.
| | - A García-Herrera
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
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24
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Kantere D, Siarov J, De Lara S, Parhizkar S, Olofsson Bagge R, Wennberg Larkö A, Ericson MB. Label‐free laser scanning microscopy targeting sentinel lymph node diagnostics: A feasibility study ex vivo. TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.202000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Despoina Kantere
- Department of Dermatology and Venereology, Institute of Clinical Sciences University of Gothenburg Gothenburg Sweden
| | - Jan Siarov
- Department of Pathology University of Gothenburg Gothenburg Sweden
| | - Shahin De Lara
- Department of Pathology University of Gothenburg Gothenburg Sweden
| | - Samad Parhizkar
- Department of Pathology University of Gothenburg Gothenburg Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences University of Gothenburg Gothenburg Sweden
| | - Ann‐Marie Wennberg Larkö
- Department of Dermatology and Venereology, Institute of Clinical Sciences University of Gothenburg Gothenburg Sweden
| | - Marica B. Ericson
- Biomedical photonics group, Department of Chemistry and Molecular Biology University of Gothenburg Gothenburg Sweden
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25
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Malvehy J, Pérez-Anker J, Toll A, Pigem R, Garcia A, Alos LL, Puig S. Ex vivo confocal microscopy: revolution in fast pathology in dermatology. Br J Dermatol 2020; 183:1011-1025. [PMID: 32134506 DOI: 10.1111/bjd.19017] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
Abstract
Confocal microscopy with in vivo and ex vivo modalities has been used in the evaluation of skin cancer and other dermatological disorders. Recent developments in ex vivo confocal microscopy allow for faster pathology assessment with greater accuracy by the visualization of cellular and architectural details, similarly to standard pathology, in either paraffin-embedded or frozen samples. They include the possibility of multimodal confocal microscopy using different lasers and fusion images. New staining protocols including immunostaining, with no damage to conventional histopathology preparation, have been recently described in melanocytic tumours and inflammatory skin diseases. Digital staining with haematoxylin and eosin is also incorporated in the new devices. In this review the applications of ex vivo confocal microscopy will be presented with the description of the technique and the technology, clinical evidence in dermatology and other fields, and further applications.
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Affiliation(s)
- J Malvehy
- Dermatology Department, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - J Pérez-Anker
- Dermatology Department, University of Barcelona, Barcelona, Spain
| | - A Toll
- Dermatology Department, University of Barcelona, Barcelona, Spain
| | - R Pigem
- Dermatology Department, University of Barcelona, Barcelona, Spain
| | - A Garcia
- Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - L L Alos
- Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - S Puig
- Dermatology Department, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
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Ex Vivo Confocal Microscopy Using Fusion Mode and Digital Staining: Changing Paradigms in Histological Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Krishnamurthy S, Sabir S, Ban K, Wu Y, Sheth R, Tam A, Meric-Bernstam F, Shaw K, Mills G, Bassett R, Hamilton S, Hicks M, Gupta S. Comparison of Real-Time Fluorescence Confocal Digital Microscopy With Hematoxylin-Eosin-Stained Sections of Core-Needle Biopsy Specimens. JAMA Netw Open 2020; 3:e200476. [PMID: 32134465 PMCID: PMC7059022 DOI: 10.1001/jamanetworkopen.2020.0476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Strategies to procure high-quality core-needle biopsy (CNB) specimens are critical for making basic tissue diagnoses and for ancillary testing. OBJECTIVES To investigate acquisition of fluorescence confocal microscopy (FCM) images of interventional radiology (IR)-guided CNB in real time in the radiology suite and to compare the accuracy of FCM diagnoses with those of hematoxylin-eosin (H&E)-stained CNB sections. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic study, FCM imaging of IR-guided CNBs was performed in the radiology suite at a major cancer center for patients with an imaging abnormality from August 1, 2016, to April 30, 2019. The time taken to acquire FCM images and the quality of FCM images based on percentage of interpretable tissue with optimal resolution was recorded. The FCM images were read by 2 pathologists and categorized as nondiagnostic, benign/atypical, or suspicious/malignant; these diagnoses were compared with those made using H&E-stained tissue sections. Cases with discrepant diagnosis were reassessed by the pathologists together for a consensus diagnosis. Data were analyzed from June 3 to July 19, 2019. INTERVENTIONS Each IR-guided CNB was stained with 0.6mM acridine orange, subjected to FCM imaging, and then processed to generate H&E-stained sections. MAIN OUTCOMES AND MEASURES Mean time taken for acquisition of FCM images, quality of FCM images based on interpretable percentage of the image, and accuracy of diagnostic categorization based on FCM images compared with H&E-stained sections. RESULTS A total of 105 patients (57 male [54.3%]; mean [SD] age, 63 [13] years) underwent IR-guided CNBs in a mean (SD) of 7 (2) minutes each. The FCM images showed at least 20% of the tissue with optimal quality in 101 CNB specimens (96.2%). The FCM images were accurately interpreted by the 2 pathologists in 100 of 105 cases (95.2%) (2 false-positive and 3 false-negative) and 90 of 105 cases (85.7%) (6 false-positive and 9 false-negative). A reassessment of 14 discordant diagnoses resulted in consensus diagnoses that were accurate in 101 of 105 cases (96.2%) (1 false-positive and 3 false-negative). CONCLUSIONS AND RELEVANCE The ease of acquisition of FCM images of acceptable quality and the high accuracy of the diagnoses suggest that FCM may be useful for rapid evaluation of IR-guided CNBs. This approach warrants further investigation.
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Affiliation(s)
- Savitri Krishnamurthy
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Sharjeel Sabir
- Department of Radiology, Scripps Mercy Hospital, San Diego, California
| | - Kechen Ban
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Yun Wu
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Rahul Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Alda Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston
| | - Kenna Shaw
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston
| | - Gordon Mills
- Oregon Health and Science University Knight Cancer Institute, Portland
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Stanley Hamilton
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Marshall Hicks
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston
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28
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Kirby AJ, Lavrador JP, Bodi I, Vergani F, Bhangoo R, Ashkan K, Finnerty GT. Ex vivo ultrasonic samples of human brain tumors in the molecular era. Neurooncol Adv 2020; 2:vdaa014. [PMID: 32226940 PMCID: PMC7099933 DOI: 10.1093/noajnl/vdaa014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Gliomas are composed of multiple clones of tumor cells. This intratumor heterogeneity contributes to the ability of gliomas to resist treatment. It is vital that gliomas are fully characterized at a molecular level when a diagnosis is made to maximize treatment effectiveness. Methods We collected ultrasonic tissue fragments during glioma surgery. Large tissue fragments were separated in the operating theater and bathed continuously in oxygenated artificial cerebrospinal fluid to keep them alive. The ex vivo tissue fragments were transferred to a laboratory and incubated in 5-aminolevulinic acid (5-ALA). 5-ALA is metabolized to Protoporphyrin IX (PpIX), which accumulates in glioma cells and makes them fluorescent. The molecular and neuropathological features of the PpIX fluorescent ultrasonic tissue fragments were studied. Results We show that PpIX fluorescence can rapidly identify tissue fragments infiltrated by glioma in the laboratory. Ultrasonic tissue fragments from the tumor core provided molecular and neuropathological information about the glioma that was comparable to the surgical biopsy. We characterized the heterogeneity within individual gliomas by studying ultrasonic tissue fragments from different parts of the tumor. We found that gliomas exhibit a power relationship between cellular proliferation and tumor infiltration. Tissue fragments that deviate from this relationship may contain foci of more malignant glioma. The methylation status of the O 6-methylguanine DNA methyltransferase gene promoter varied within each glioma. Conclusions Ex vivo ultrasonic tissue fragments can be rapidly screened for glioma infiltration. They offer a viable platform to characterize heterogeneity within individual gliomas, thereby enhancing their diagnosis and treatment.
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Affiliation(s)
- Alastair J Kirby
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - José P Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Istvan Bodi
- Department of Basic and Clinical Neuroscience, King's College London, London, UK; Department of Clinical Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Department of Basic and Clinical Neuroscience, King's College London, London, UK; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Gerald T Finnerty
- Department of Basic and Clinical Neuroscience, King's College London, London, UK; Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
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29
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Pérez-Anker J, Malvehy J, Moreno-Ramírez D. Ex Vivo Confocal Microscopy Using Fusion Mode and Digital Staining: Changing Paradigms in Histological Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:236-242. [PMID: 31959303 DOI: 10.1016/j.ad.2019.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
The ex vivo confocal microscope is an imaging system designed to analyze freshly excised tissue using two diode lasers with different wavelengths. The technique can dramatically reduce margin analysis times and offers a sensitivity of 88% and a specificity of 89% relative to histopathology. A new technology has recently been developed that produces images more quickly and with a higher resolution than before. By means of a fusion mode that combines simultaneously scanned fluorescence and reflectance images, it produces digitally stained images that simulate the effect of hematoxylin-eosin staining. Application of this new technology has opened the door to real-time tissue diagnostics.
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Affiliation(s)
- J Pérez-Anker
- Departamento de Dermatología, Hospital Clínic de Barcelona, Barcelona, España.
| | - J Malvehy
- Departamento de Dermatología, Hospital Clínic de Barcelona, Barcelona, España; IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - D Moreno-Ramírez
- Departamento de Dermatología, Hospital Clínic de Barcelona, Barcelona, España; Departamento de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
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30
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Byvaltsev VA, Bardonova LA, Onaka NR, Polkin RA, Ochkal SV, Shepelev VV, Aliyev MA, Potapov AA. Acridine Orange: A Review of Novel Applications for Surgical Cancer Imaging and Therapy. Front Oncol 2019; 9:925. [PMID: 31612102 PMCID: PMC6769070 DOI: 10.3389/fonc.2019.00925] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction: Acridine orange (AO) was first extracted from coal tar in the late nineteenth century and was used as a fluorescent dye. In this paper, we review emergent research about novel applications of AO for fluorescence surgery and cancer therapy. Materials and methods: We performed a systematic search in the MEDLINE, PubMed, Cochrane library, Google Scholar, Embase, Web of Science, and Scopus database using combinations of the term "acridine orange" with the following: "surgical oncology," "neuropathology," "microsurgery," "intraoperative fluorescence," "confocal microscopy," "pathology," "endomicroscopy," "guidance," "fluorescence guidance," "oncology," "surgery," "neurooncology," and "photodynamic therapy." Peer-reviewed articles published in English were included in this review. We have also scanned references for relevant articles. Results: We have reviewed studies on the various application of AO in microscopy, endomicroscopy, intraoperative fluorescence guidance, photodynamic therapy, sonodynamic therapy, radiodynamic therapy. Conclusion: Although the number of studies on the clinical use of AO is limited, pilot studies have demonstrated the safety and feasibility of its application as an intraoperative fluorescent dye and as a novel photo- and radio-sensitizator. Further clinical studies are necessary to more definitively assess the clinical benefit AO-based fluorescence guidance, therapy for sarcomas, and to establish feasibility of this new approach for the treatment of other tumor types.
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Affiliation(s)
- Vadim A. Byvaltsev
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
- Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
| | - Liudmila A. Bardonova
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Naomi R. Onaka
- University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Roman A. Polkin
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Sergey V. Ochkal
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Valerij V. Shepelev
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Marat A. Aliyev
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Alexander A. Potapov
- Federal State Autonomous Institution “N. N. Burdenko National Scientific and Practical Center for Neurosurgery” of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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Krishnamurthy S, Brown JQ, Iftimia N, Levenson RM, Rajadhyaksha M. Ex Vivo Microscopy: A Promising Next-Generation Digital Microscopy Tool for Surgical Pathology Practice. Arch Pathol Lab Med 2019; 143:1058-1068. [PMID: 31295016 PMCID: PMC7365575 DOI: 10.5858/arpa.2019-0058-ra] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT.— The rapid evolution of optical imaging modalities in recent years has opened the opportunity for ex vivo tissue imaging, which has significant implications for surgical pathology practice. These modalities have promising potential to be used as next-generation digital microscopy tools for examination of fresh tissue, with or without labeling with contrast agents. OBJECTIVE.— To review the literature regarding various types of ex vivo optical imaging platforms that can generate digital images for tissue recognition with potential for utilization in anatomic pathology clinical practices. DATA SOURCES.— Literature relevant to ex vivo tissue imaging obtained from the PubMed database. CONCLUSIONS.— Ex vivo imaging of tissues can be performed by using various types of optical imaging techniques. These next-generation digital microscopy tools have a promising potential for utilization in surgical pathology practice.
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Affiliation(s)
- Savitri Krishnamurthy
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
| | - Jonathan Quincy Brown
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
| | - Nicusor Iftimia
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
| | - Richard M Levenson
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
| | - Milind Rajadhyaksha
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
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32
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Mathur SC, Fitzmaurice M, Reder NP, Krishnamurthy S, Kennedy M, Tearney GJ, Shevchuk-Chaban MM. Development of Functional Requirements for Ex Vivo Pathology Applications of In Vivo Microscopy Systems: A Proposal From the In Vivo Microscopy Committee of the College of American Pathologists. Arch Pathol Lab Med 2019; 143:1052-1057. [PMID: 30763117 DOI: 10.5858/arpa.2018-0482-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— In vivo microscopy (IVM) allows direct, real-time visualization of tissue histology in living patients without the need for tissue removal, processing, or staining. The IVM technologies in clinical use include confocal microscopy and optical coherence tomography. These technologies also show promise for use with pathology specimens (ex vivo microscopy [EVM]). However, few systems designed for EVM are commercially available, at least in part because of the lack of defined minimal functional requirements (FRs). OBJECTIVE.— To develop minimal FRs for likely high-volume pathology applications of EVM. DESIGN.— The IVM Committee of the College of American Pathologists identified potential EVM pathology applications based on the published literature. A subcommittee of IVM and EVM early adopters and experts then defined FRs for the most likely EVM applications. RESULTS.— Potential EVM applications include assessment of margins, adequacy of needle biopsies and aspirates for diagnosis, and transplant tissues; selection of tissue for molecular studies or biorepository; and guidance in block selection from gross specimens. The first 3 applications were selected for development of FRs. The FRs were identified based on existing laboratory practices and guidelines and input from experts in the field and included device footprint and portability, specimen preparation, imaging time, field of view or resolution, morphologic diagnostic capability, yield, accuracy, ease of use, safety, and cost. CONCLUSIONS.— Consensus was achieved on FRs that would accommodate the selected EVM applications. Publication and dissemination of those FRs will provide guidance to engineers, researchers, and vendors on how to optimally adapt IVM technologies for EVM for widespread adoption by pathologists.
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Affiliation(s)
- Sharad C Mathur
- From the Department of Pathology and Laboratory Medicine Service, VA Medical Center, Kansas City, Missouri (Dr Mathur); the Department of Pathology, University Hospitals of Cleveland, Cleveland, Ohio (Dr Fitzmaurice); the Department of Pathology, University of Washington, Seattle (Dr Reder); the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Clinical Informatics, College of American Pathologists, Northfield, Illinois (Ms Kennedy); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Tearney); and the Department of Pathology and Laboratory Medicine, Weil Cornell Medical College, New York, New York (Dr Shevchuk-Chaban)
| | - Maryann Fitzmaurice
- From the Department of Pathology and Laboratory Medicine Service, VA Medical Center, Kansas City, Missouri (Dr Mathur); the Department of Pathology, University Hospitals of Cleveland, Cleveland, Ohio (Dr Fitzmaurice); the Department of Pathology, University of Washington, Seattle (Dr Reder); the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Clinical Informatics, College of American Pathologists, Northfield, Illinois (Ms Kennedy); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Tearney); and the Department of Pathology and Laboratory Medicine, Weil Cornell Medical College, New York, New York (Dr Shevchuk-Chaban)
| | - Nicholas P Reder
- From the Department of Pathology and Laboratory Medicine Service, VA Medical Center, Kansas City, Missouri (Dr Mathur); the Department of Pathology, University Hospitals of Cleveland, Cleveland, Ohio (Dr Fitzmaurice); the Department of Pathology, University of Washington, Seattle (Dr Reder); the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Clinical Informatics, College of American Pathologists, Northfield, Illinois (Ms Kennedy); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Tearney); and the Department of Pathology and Laboratory Medicine, Weil Cornell Medical College, New York, New York (Dr Shevchuk-Chaban)
| | - Savitri Krishnamurthy
- From the Department of Pathology and Laboratory Medicine Service, VA Medical Center, Kansas City, Missouri (Dr Mathur); the Department of Pathology, University Hospitals of Cleveland, Cleveland, Ohio (Dr Fitzmaurice); the Department of Pathology, University of Washington, Seattle (Dr Reder); the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Clinical Informatics, College of American Pathologists, Northfield, Illinois (Ms Kennedy); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Tearney); and the Department of Pathology and Laboratory Medicine, Weil Cornell Medical College, New York, New York (Dr Shevchuk-Chaban)
| | - Mary Kennedy
- From the Department of Pathology and Laboratory Medicine Service, VA Medical Center, Kansas City, Missouri (Dr Mathur); the Department of Pathology, University Hospitals of Cleveland, Cleveland, Ohio (Dr Fitzmaurice); the Department of Pathology, University of Washington, Seattle (Dr Reder); the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Clinical Informatics, College of American Pathologists, Northfield, Illinois (Ms Kennedy); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Tearney); and the Department of Pathology and Laboratory Medicine, Weil Cornell Medical College, New York, New York (Dr Shevchuk-Chaban)
| | - Guillermo J Tearney
- From the Department of Pathology and Laboratory Medicine Service, VA Medical Center, Kansas City, Missouri (Dr Mathur); the Department of Pathology, University Hospitals of Cleveland, Cleveland, Ohio (Dr Fitzmaurice); the Department of Pathology, University of Washington, Seattle (Dr Reder); the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Clinical Informatics, College of American Pathologists, Northfield, Illinois (Ms Kennedy); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Tearney); and the Department of Pathology and Laboratory Medicine, Weil Cornell Medical College, New York, New York (Dr Shevchuk-Chaban)
| | - Maria M Shevchuk-Chaban
- From the Department of Pathology and Laboratory Medicine Service, VA Medical Center, Kansas City, Missouri (Dr Mathur); the Department of Pathology, University Hospitals of Cleveland, Cleveland, Ohio (Dr Fitzmaurice); the Department of Pathology, University of Washington, Seattle (Dr Reder); the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Clinical Informatics, College of American Pathologists, Northfield, Illinois (Ms Kennedy); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Tearney); and the Department of Pathology and Laboratory Medicine, Weil Cornell Medical College, New York, New York (Dr Shevchuk-Chaban)
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Krishnamurthy S, Ban K, Shaw K, Mills G, Sheth R, Tam A, Gupta S, Sabir S. Confocal Fluorescence Microscopy Platform Suitable for Rapid Evaluation of Small Fragments of Tissue in Surgical Pathology Practice. Arch Pathol Lab Med 2018; 143:305-313. [PMID: 30376375 DOI: 10.5858/arpa.2018-0352-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Rapid advances in the fields of biophotonics, computer science, and instrumentation have allowed for high-resolution imaging of biologic tissues. OBJECTIVE.— To evaluate the quality of images from an optimized confocal fluorescence microscopy (CFM) platform for rapid evaluation of small fragments of tissue, compared with hematoxylin-eosin staining. DESIGN.— Tissue fragments (up to 1.0 × 0.3 cm) were stained with 0.6 mM acridine orange for 60 seconds and imaged using a CFM platform at 488-nm and 785-nm wavelength. The imaged tissues were then fixed in formalin and processed to generate hematoxylin-eosin-stained tissue sections. The quality of CFM images was scored on a scale of 0 to 3 on the basis of the percentage of the CFM images with recognizable tissue architecture (0, 0%; 1, <20%; 2, 20%-50%; 3, >50%). The diagnoses made using CFM images were compared with those made using histopathologic analysis of the hematoxylin-eosin-stained tissue sections. RESULTS.— We imaged 118 tissue fragments obtained from 40 breast, 23 lung, 39 kidney, and 16 liver surgical excision specimens. We acquired CFM images in 2 to 3 minutes; 95.8% (113 of 118) of images showed a quality score of 3, and 4.2% (5 of 118) had a score of 2. We achieved a sensitivity of 95.5%, specificity of 97.3%, positive predictive value of 95.5%, and negative predictive value of 97.3%. CONCLUSIONS.— Our results demonstrate the suitability of the CFM platform for rapid and accurate evaluation of small tissue fragments in surgical pathology practice.
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Affiliation(s)
- Savitri Krishnamurthy
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Kechen Ban
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Kenna Shaw
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Gordon Mills
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Rahul Sheth
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Alda Tam
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Sanjay Gupta
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Sharjeel Sabir
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
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