A Pilot Validation Study Comparing Fluorescence-Imitating Brightfield Imaging, A Slide-Free Imaging Method, With Standard Formalin-Fixed, Paraffin-Embedded Hematoxylin-Eosin-Stained Tissue Section Histology for Primary Surgical Pathology Diagnosis

Real-time histological evaluation of gastrointestinal tissue using non-linear microscopy

AIM

Over the past several decades, optical sectioning technologies have emerged as valuable tools for evaluating tissue histology. Unlike conventional tissue sectioning, these technologies allow for real-time intraoperative assessments and more efficient tissue triage. In the era of digital pathology, the demand for high-quality, high-throughput optical sectioning platforms is increasing, as they eliminate the need for traditional slide preparation and scanning, potentially transforming anatomical pathology workflows. While non-linear microscopy (NLM) has demonstrated promise in histological evaluation across various tissue types, its application in gastrointestinal tissue assessment remains unexplored.

METHODS

This study extends the use of NLM to gastrointestinal histology and develops an image atlas to highlight its potential as an automated digital pathology platform.

RESULTS

Our results indicate that NLM generates diagnostic-quality images comparable to traditional H&E slides. Moreover, NLM provides valuable three-dimensional (3D) spatial information, improving clinical evaluations of key histological features such as depth of invasion, lymphovascular and perineural invasion, tumour budding and margin assessment. Time-lapse videos further demonstrate NLM's capability to capture 3D histological structures up to a depth of approximately 100 µm.

CONCLUSION

Our findings demonstrate that NLM can serve as an optical sectioning platform for gastrointestinal histology, providing both diagnostic-quality imaging and advanced 3D visualisation. The introduction of an NLM-based atlas has the potential to redefine anatomical pathology workflows and advance digital pathology image analysis.

Disrupting prostate cancer research: Challenge accepted; report from the 2023 Coffey-Holden Prostate Cancer Academy Meeting

INTRODUCTION

The 2023 Coffey-Holden Prostate Cancer Academy (CHPCA) Meeting, themed "Disrupting Prostate Cancer Research: Challenge Accepted," was convened at the University of California, Los Angeles, Luskin Conference Center, in Los Angeles, CA, from June 22 to 25, 2023.

METHODS

The 2023 marked the 10th Annual CHPCA Meeting, a discussion-oriented scientific think-tank conference convened annually by the Prostate Cancer Foundation, which centers on innovative and emerging research topics deemed pivotal for advancing critical unmet needs in prostate cancer research and clinical care. The 2023 CHPCA Meeting was attended by 81 academic investigators and included 40 talks across 8 sessions.

RESULTS

The central topic areas covered at the meeting included: targeting transcription factor neo-enhancesomes in cancer, AR as a pro-differentiation and oncogenic transcription factor, why few are cured with androgen deprivation therapy and how to change dogma to cure metastatic prostate cancer without castration, reducing prostate cancer morbidity and mortality with genetics, opportunities for radiation to enhance therapeutic benefit in oligometastatic prostate cancer, novel immunotherapeutic approaches, and the new era of artificial intelligence-driven precision medicine.

DISCUSSION

This article provides an overview of the scientific presentations delivered at the 2023 CHPCA Meeting, such that this knowledge can help in facilitating the advancement of prostate cancer research worldwide.

Current Landscape of Advanced Imaging Tools for Pathology Diagnostics

Histopathology relies on century-old workflows of formalin fixation, paraffin embedding, sectioning, and staining tissue specimens on glass slides. Despite being robust, this conventional process is slow, labor-intensive, and limited to providing two-dimensional views. Emerging technologies promise to enhance and accelerate histopathology. Slide-free microscopy allows rapid imaging of fresh, unsectioned specimens, overcoming slide preparation delays. Methods such as fluorescence confocal microscopy, multiphoton microscopy, along with more recent innovations including microscopy with UV surface excitation and fluorescence-imitating brightfield imaging can generate images resembling conventional histology directly from the surface of tissue specimens. Slide-free microscopy enable applications such as rapid intraoperative margin assessment and, with appropriate technology, three-dimensional histopathology. Multiomics profiling techniques, including imaging mass spectrometry and Raman spectroscopy, provide highly multiplexed molecular maps of tissues, although clinical translation remains challenging. Artificial intelligence is aiding the adoption of new imaging modalities via virtual staining, which converts methods such as slide-free microscopy into synthetic brightfield-like or even molecularly informed images. Although not yet commonplace, these emerging technologies collectively demonstrate the potential to modernize histopathology. Artificial intelligence-assisted workflows will ease the transition to new imaging modalities. With further validation, these advances may transform the century-old conventional histopathology pipeline to better serve 21st-century medicine. This review provides an overview of these enabling technology platforms and discusses their potential impact.