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Kayı Cangır A, Güneş SG, Orhan K, Özakıncı H, Kahya Y, Karasoy D, Dizbay Sak S. Microcomputed tomography as a diagnostic tool for detection of lymph node metastasis in non-small cell lung cancer: A decision-support approach for pathological examination "A pilot study for method validation". J Pathol Inform 2024; 15:100373. [PMID: 38633838 PMCID: PMC11022089 DOI: 10.1016/j.jpi.2024.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background Non-small cell lung cancer (NSCLC) patients without lymph node (LN) metastases (pN0) may exhibit different survival rates, even when their T stage is similar. This divergence could be attributed to the current pathology practice, wherein LNs are examined solely in two-dimensional (2D). Unfortunately, adhering to the protocols of 2D pathological examination does not ensure the exhaustive sampling of all excised LNs, thereby leaving room for undetected metastatic foci in the unexplored depths of tissues. The employment of micro-computed tomography (micro-CT) facilitates a three-dimensional (3D) evaluation of all LNs without compromising sample integrity. In our study, we utilized quantitative micro-CT parameters to appraise the metastatic status of formalin-fixed paraffin-embedded (FFPE) LNs. Methods Micro-CT scans were conducted on 12 FFPEs obtained from 8 NSCLC patients with histologically confirmed mediastinal LN metastases. Simultaneously, whole-slide images from these FFPEs underwent scanning, and 47 regions of interest (ROIs) (17 metastatic foci, 11 normal lymphoid tissues, 10 adipose tissues, and 9 anthracofibrosis) were marked on scanned images. Quantitative structural variables obtained via micro-CT analysis from tumoral and non-tumoral ROIs, were analyzed. Result Significant distinctions were observed in linear density, connectivity, connectivity density, and closed porosity between tumoral and non-tumoral ROIs, as indicated by kappa coefficients of 1, 0.90, 1, and 1, respectively. Receiver operating characteristic analysis substantiated the differentiation between tumoral and non-tumoral ROIs based on thickness, linear density, connectivity, connectivity density, and the percentage of closed porosity. Conclusions Quantitative micro-CT parameters demonstrate the ability to distinguish between tumoral and non-tumoral regions of LNs in FFPEs. The discriminatory characteristics of these quantitative micro-CT parameters imply their potential usefulness in developing an artificial intelligence algorithm specifically designed for the 3D identification of LN metastases while preserving the FFPE tissue.
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Affiliation(s)
- Ayten Kayı Cangır
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
- Medical Design Application and Research Center (MEDITAM), Ankara University, Ankara, Turkey
| | - Süleyman Gökalp Güneş
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kaan Orhan
- Department of Dentoaxillofacial Radiology, Ankara University Faculty of Dentistry, and MEDITAM, Ankara, Turkey
| | - Hilal Özakıncı
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Yusuf Kahya
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Duru Karasoy
- Department of Statistics, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Serpil Dizbay Sak
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
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Dizbay Sak S, Sevim S, Buyuksungur A, Kayı Cangır A, Orhan K. The Value of Micro-CT in the Diagnosis of Lung Carcinoma: A Radio-Histopathological Perspective. Diagnostics (Basel) 2023; 13:3262. [PMID: 37892083 PMCID: PMC10606474 DOI: 10.3390/diagnostics13203262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Micro-computed tomography (micro-CT) is a relatively new imaging modality and the three-dimensional (3D) images obtained via micro-CT allow researchers to collect both quantitative and qualitative information on various types of samples. Micro-CT could potentially be used to examine human diseases and several studies have been published on this topic in the last decade. In this study, the potential uses of micro-CT in understanding and evaluating lung carcinoma and the relevant studies conducted on lung and other tumors are summarized. Currently, the resolution of benchtop laboratory micro-CT units has not reached the levels that can be obtained with light microscopy, and it is not possible to detect the histopathological features (e.g., tumor type, adenocarcinoma pattern, spread through air spaces) required for lung cancer management. However, its ability to provide 3D images in any plane of section, without disturbing the integrity of the specimen, suggests that it can be used as an auxiliary technique, especially in surgical margin examination, the evaluation of tumor invasion in the entire specimen, and calculation of primary and metastatic tumor volume. Along with future developments in micro-CT technology, it can be expected that the image resolution will gradually improve, the examination time will decrease, and the relevant software will be more user friendly. As a result of these developments, micro-CT may enter pathology laboratories as an auxiliary method in the pathological evaluation of lung tumors. However, the safety, performance, and cost effectiveness of micro-CT in the areas of possible clinical application should be investigated. If micro-CT passes all these tests, it may lead to the convergence of radiology and pathology applications performed independently in separate units today, and the birth of a new type of diagnostician who has equal knowledge of the histological and radiological features of tumors.
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Affiliation(s)
- Serpil Dizbay Sak
- Department of Pathology, Faculty of Medicine, Ankara University, Ankara 06230, Turkey
| | - Selim Sevim
- Department of Pathology, Faculty of Medicine, Ankara University, Ankara 06230, Turkey
| | - Arda Buyuksungur
- Department of Basic Medical Sciences, Faculty of Dentistry, Ankara University, Ankara 06560, Turkey
| | - Ayten Kayı Cangır
- Department of Thoracic Surgery Ankara, Faculty of Medicine, Ankara University, Ankara 06230, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 06560, Turkey
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Papazoglou AS, Karagiannidis E, Liatsos A, Bompoti A, Moysidis DV, Arvanitidis C, Tsolaki F, Tsagkaropoulos S, Theocharis S, Tagarakis G, Michaelson JS, Herrmann MD. Volumetric Tissue Imaging of Surgical Tissue Specimens Using Micro-Computed Tomography: An Emerging Digital Pathology Modality for Nondestructive, Slide-Free Microscopy-Clinical Applications of Digital Pathology in 3 Dimensions. Am J Clin Pathol 2023; 159:242-254. [PMID: 36478204 DOI: 10.1093/ajcp/aqac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Micro-computed tomography (micro-CT) is a novel, nondestructive, slide-free digital imaging modality that enables the acquisition of high-resolution, volumetric images of intact surgical tissue specimens. The aim of this systematic mapping review is to provide a comprehensive overview of the available literature on clinical applications of micro-CT tissue imaging and to assess its relevance and readiness for pathology practice. METHODS A computerized literature search was performed in the PubMed, Scopus, Web of Science, and CENTRAL databases. To gain insight into regulatory and financial considerations for performing and examining micro-CT imaging procedures in a clinical setting, additional searches were performed in medical device databases. RESULTS Our search identified 141 scientific articles published between 2000 and 2021 that described clinical applications of micro-CT tissue imaging. The number of relevant publications is progressively increasing, with the specialties of pulmonology, cardiology, otolaryngology, and oncology being most commonly concerned. The included studies were mostly performed in pathology departments. Current micro-CT devices have already been cleared for clinical use, and a Current Procedural Terminology (CPT) code exists for reimbursement of micro-CT imaging procedures. CONCLUSIONS Micro-CT tissue imaging enables accurate volumetric measurements and evaluations of entire surgical specimens at microscopic resolution across a wide range of clinical applications.
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Affiliation(s)
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Liatsos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreana Bompoti
- Diagnostic Imaging, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Arvanitidis
- Institute of Marine Biology, Biotechnology and Aquaculture, Hellenic Centre for Marine Research, Heraklion, Crete, Greece.,LifeWatch ERIC, Sector II-II, Seville, Spain
| | - Fani Tsolaki
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Stamatios Theocharis
- First Department of Pathology, National and Kapoditrian University of Athens, Athens, Greece
| | - Georgios Tagarakis
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Thessaloniki, Greece
| | - James S Michaelson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Markus D Herrmann
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Popova E, Tkachev S, Reshetov I, Timashev P, Ulasov I. Imaging Hallmarks of Sarcoma Progression Via X-ray Computed Tomography: Beholding the Flower of Evil. Cancers (Basel) 2022; 14:cancers14205112. [PMID: 36291896 PMCID: PMC9600487 DOI: 10.3390/cancers14205112] [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: 09/27/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Sarcomas represent the largest group of rare solid tumors that arise from mesenchymal stem cells and are a leading cause of cancer death in individuals younger than 20 years of age. There is an immediate need for the development of an algorithm for the early accurate diagnosis of sarcomas due to the high rate of diagnostic inaccuracy, which reaches up to 30%. X-ray computed tomography is a non-invasive imaging technique used to obtain detailed internal images of the human or animal body in clinical practice and preclinical studies. We summarized the main imaging features of soft tissue and bone sarcomas, and noted the development of new molecular markers to reach tumor type-specific imaging. Also, we demonstrated the possibility of the use X-ray computed microtomography for non-destructive 3D visualization of sarcoma progression in preclinical studies. Finding correlations between X-ray computed tomography modalities and the results of the histopathological specimen examination may significantly increase the accuracy of diagnostics, which leads to the initiation of appropriate management in a timely manner and, consequently, to improved outcomes. Abstract Sarcomas are a leading cause of cancer death in individuals younger than 20 years of age and represent the largest group of rare solid tumors. To date, more than 100 morphological subtypes of sarcomas have been described, among which epidemiology, clinical features, management, and prognosis differ significantly. Delays and errors in the diagnosis of sarcomas limit the number of effective therapeutic modalities and catastrophically worsen the prognosis. Therefore, the development of an algorithm for the early accurate diagnosis of sarcomas seems to be as important as the development of novel therapeutic advances. This literature review aims to summarize the results of recent investigations regarding the imaging of sarcoma progression based on the use of X-ray computed tomography (CT) in preclinical studies and in current clinical practice through the lens of cancer hallmarks. We attempted to summarize the main CT imaging features of soft-tissue and bone sarcomas. We noted the development of new molecular markers with high specificity to antibodies and chemokines, which are expressed in particular sarcoma subtypes to reach tumor type-specific imaging. We demonstrate the possibility of the use of X-ray computed microtomography (micro-CT) for non-destructive 3D visualization of solid tumors by increasing the visibility of soft tissues with X-ray scattering agents. Based on the results of recent studies, we hypothesize that micro-CT enables the visualization of neovascularization and stroma formation in sarcomas at high-resolution in vivo and ex vivo, including the novel techniques of whole-block and whole-tissue imaging. Finding correlations between CT, PET/CT, and micro-CT imaging features, the results of the histopathological specimen examination and clinical outcomes may significantly increase the accuracy of soft-tissue and bone tumor diagnostics, which leads to the initiation of appropriate histotype-specific management in a timely manner and, consequently, to improved outcomes.
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Affiliation(s)
- Elena Popova
- World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Sergey Tkachev
- World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Igor Reshetov
- University Clinical Hospital No. 1, I. M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991 Moscow, Russia
| | - Peter Timashev
- World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Ilya Ulasov
- Group of Experimental Biotherapy and Diagnostic, Institute for Regenerative Medicine, World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Correspondence: ; Tel.: +7-901-797-5406
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Bompoti A, Papazoglou AS, Moysidis DV, Otountzidis N, Karagiannidis E, Stalikas N, Panteris E, Ganesh V, Sanctuary T, Arvanitidis C, Sianos G, Michaelson JS, Herrmann MD. Volumetric Imaging of Lung Tissue at Micrometer Resolution: Clinical Applications of Micro-CT for the Diagnosis of Pulmonary Diseases. Diagnostics (Basel) 2021; 11:diagnostics11112075. [PMID: 34829422 PMCID: PMC8625264 DOI: 10.3390/diagnostics11112075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Micro-computed tomography (micro-CT) is a promising novel medical imaging modality that allows for non-destructive volumetric imaging of surgical tissue specimens at high spatial resolution. The aim of this study is to provide a comprehensive assessment of the clinical applications of micro-CT for the tissue-based diagnosis of lung diseases. This scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews, aiming to include every clinical study reporting on micro-CT imaging of human lung tissues. A literature search yielded 570 candidate articles, out of which 37 were finally included in the review. Of the selected studies, 9 studies explored via micro-CT imaging the morphology and anatomy of normal human lung tissue; 21 studies investigated microanatomic pulmonary alterations due to obstructive or restrictive lung diseases, such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and cystic fibrosis; and 7 studies examined the utility of micro-CT imaging in assessing lung cancer lesions (n = 4) or in transplantation-related pulmonary alterations (n = 3). The selected studies reported that micro-CT could successfully detect several lung diseases providing three-dimensional images of greater detail and resolution than routine optical slide microscopy, and could additionally provide valuable volumetric insight in both restrictive and obstructive lung diseases. In conclusion, micro-CT-based volumetric measurements and qualitative evaluations of pulmonary tissue structures can be utilized for the clinical management of a variety of lung diseases. With micro-CT devices becoming more accessible, the technology has the potential to establish itself as a core diagnostic imaging modality in pathology and to enable integrated histopathologic and radiologic assessment of lung cancer and other lung diseases.
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Affiliation(s)
- Andreana Bompoti
- Department of Radiology, Peterborough City Hospital, Northwest Anglia NHS Foundation Trust, Peterborough PE3 9GZ, UK;
| | - Andreas S. Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Nikolaos Otountzidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Nikolaos Stalikas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Eleftherios Panteris
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center B1.4, 10th km Thessaloniki-Thermi Rd., P.O. Box 8318, GR 57001 Thessaloniki, Greece;
| | | | - Thomas Sanctuary
- Respiratory Department, Medway NHS Foundation Trust, Kent ME7 5NY, UK;
| | - Christos Arvanitidis
- Hellenic Centre for Marine Research (HCMR), Institute of Marine Biology, Biotechnology and Aquaculture (IMBBC), 70013 Heraklion, Greece;
- LifeWatch ERIC, Sector II-II, Plaza de España, 41071 Seville, Spain
| | - Georgios Sianos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - James S. Michaelson
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Markus D. Herrmann
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Correspondence: ; Tel.: +6-17-724-1896
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