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Huang CZ, Ching-Roa VD, Heckman CM, Sipprell WH, Ibrahim SF, Smoller BR, Giacomelli MG. Piston-based specimen holder for rapid surgical and biopsy specimen imaging. BIOMEDICAL OPTICS EXPRESS 2024; 15:2898-2909. [PMID: 38855659 PMCID: PMC11161360 DOI: 10.1364/boe.522379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 06/11/2024]
Abstract
Advanced fluorescence imaging modalities such as confocal microscopy and two photon fluorescence microscopy can provide rapid, real-time histology images, but the mounting of fresh tissue specimens in standard orientations required for diagnosis without embedding and sectioning remains an unsolved problem. Here, we introduce a piston-based specimen holder designed for consistent, even pressure distribution. We improve upon previous designs by incorporating an air piston system with a flexible membrane and wick that extracts fluid during compression. We combine this with support fixtures to aid in the distribution of pressure, enabling imaging of specimens with small surface areas relative to their thickness, such as bisected shave skin biopsies in standard orientation without embedding or sectioning. We image both fresh biopsy specimens and diagnostic Mohs first stage specimens during clinical procedures, demonstrating improved visualization of the tissue surface in real time. Finally, we show that conventional cryosectioning can exaggerate the extent of margin positivity, which can be avoided using the piston-based holder.
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Affiliation(s)
- Chi Z. Huang
- Department of Biomedical Engineering, University of Rochester, 207 Goergen Hall, Box 270168, Rochester, New York 14627, USA
| | - Vincent D. Ching-Roa
- Department of Biomedical Engineering, University of Rochester, 207 Goergen Hall, Box 270168, Rochester, New York 14627, USA
| | - Connor M. Heckman
- Department of Biomedical Engineering, University of Rochester, 207 Goergen Hall, Box 270168, Rochester, New York 14627, USA
| | - William H Sipprell
- Rochester Dermatologic Surgery, PC, 7400 Pittsford Victor Rd Suite A, Victor, New York 14564, USA
| | - Sherrif F. Ibrahim
- Rochester Dermatologic Surgery, PC, 7400 Pittsford Victor Rd Suite A, Victor, New York 14564, USA
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, New York 14620, USA
| | - Bruce R. Smoller
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York 14620, USA
| | - Michael G. Giacomelli
- Department of Biomedical Engineering, University of Rochester, 207 Goergen Hall, Box 270168, Rochester, New York 14627, USA
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2
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Pillar N, Li Y, Zhang Y, Ozcan A. Virtual Staining of Nonfixed Tissue Histology. Mod Pathol 2024; 37:100444. [PMID: 38325706 DOI: 10.1016/j.modpat.2024.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
Surgical pathology workflow involves multiple labor-intensive steps, such as tissue removal, fixation, embedding, sectioning, staining, and microscopic examination. This process is time-consuming and costly and requires skilled technicians. In certain clinical scenarios, such as intraoperative consultations, there is a need for faster histologic evaluation to provide real-time surgical guidance. Currently, frozen section techniques involving hematoxylin and eosin (H&E) staining are used for intraoperative pathology consultations. However, these techniques have limitations, including a turnaround time of 20 to 30 minutes, staining artifacts, and potential tissue loss, negatively impacting accurate diagnosis. To address these challenges, researchers are exploring alternative optical imaging modalities for rapid microscopic tissue imaging. These modalities differ in optical characteristics, tissue preparation requirements, imaging equipment, and output image quality and format. Some of these imaging methods have been combined with computational algorithms to generate H&E-like images, which could greatly facilitate their adoption by pathologists. Here, we provide a comprehensive, organ-specific review of the latest advancements in emerging imaging modalities applied to nonfixed human tissue. We focused on studies that generated H&E-like images evaluated by pathologists. By presenting up-to-date research progress and clinical utility, this review serves as a valuable resource for scholars and clinicians, covering some of the major technical developments in this rapidly evolving field. It also offers insights into the potential benefits and drawbacks of alternative imaging modalities and their implications for improving patient care.
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Affiliation(s)
- Nir Pillar
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Yuzhu Li
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Yijie Zhang
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Aydogan Ozcan
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California.
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3
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Saikia S, Si T, Deb D, Bora K, Mallik S, Maulik U, Zhao Z. Lesion detection in women breast's dynamic contrast-enhanced magnetic resonance imaging using deep learning. Sci Rep 2023; 13:22555. [PMID: 38110462 PMCID: PMC10728155 DOI: 10.1038/s41598-023-48553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023] Open
Abstract
Breast cancer is one of the most common cancers in women and the second foremost cause of cancer death in women after lung cancer. Recent technological advances in breast cancer treatment offer hope to millions of women in the world. Segmentation of the breast's Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) is one of the necessary tasks in the diagnosis and detection of breast cancer. Currently, a popular deep learning model, U-Net is extensively used in biomedical image segmentation. This article aims to advance the state of the art and conduct a more in-depth analysis with a focus on the use of various U-Net models in lesion detection in women's breast DCE-MRI. In this article, we perform an empirical study of the effectiveness and efficiency of U-Net and its derived deep learning models including ResUNet, Dense UNet, DUNet, Attention U-Net, UNet++, MultiResUNet, RAUNet, Inception U-Net and U-Net GAN for lesion detection in breast DCE-MRI. All the models are applied to the benchmarked 100 Sagittal T2-Weighted fat-suppressed DCE-MRI slices of 20 patients and their performance is compared. Also, a comparative study has been conducted with V-Net, W-Net, and DeepLabV3+. Non-parametric statistical test Wilcoxon Signed Rank Test is used to analyze the significance of the quantitative results. Furthermore, Multi-Criteria Decision Analysis (MCDA) is used to evaluate overall performance focused on accuracy, precision, sensitivity, F[Formula: see text]-score, specificity, Geometric-Mean, DSC, and false-positive rate. The RAUNet segmentation model achieved a high accuracy of 99.76%, sensitivity of 85.04%, precision of 90.21%, and Dice Similarity Coefficient (DSC) of 85.04% whereas ResNet achieved 99.62% accuracy, 62.26% sensitivity, 99.56% precision, and 72.86% DSC. ResUNet is found to be the most effective model based on MCDA. On the other hand, U-Net GAN takes the least computational time to perform the segmentation task. Both quantitative and qualitative results demonstrate that the ResNet model performs better than other models in segmenting the images and lesion detection, though computational time in achieving the objectives varies.
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Affiliation(s)
- Sudarshan Saikia
- Information Technology Department, Oil India Limited, Duliajan, Assam, 786602, India
| | - Tapas Si
- AI Innovation Lab, Department of Computer Science & Engineering, University of Engineering & Management, Jaipur, GURUKUL, Jaipur, Rajasthan, 303807, India
| | - Darpan Deb
- Department of Computer Application, Christ University, Bengaluru, 560029, India
| | - Kangkana Bora
- Department of Computer Science and Information Technology, Cotton University, Guwahati, Assam, 781001, India
| | - Saurav Mallik
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Ujjwal Maulik
- Department of Computer Science and Engineering, Jadavpur University, Kolkata, India
| | - Zhongming Zhao
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
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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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Voskuil FJ, Vonk J, van der Vegt B, Kruijff S, Ntziachristos V, van der Zaag PJ, Witjes MJH, van Dam GM. Intraoperative imaging in pathology-assisted surgery. Nat Biomed Eng 2022; 6:503-514. [PMID: 34750537 DOI: 10.1038/s41551-021-00808-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/17/2021] [Indexed: 12/12/2022]
Abstract
The pathological assessment of surgical specimens during surgery can reduce the incidence of positive resection margins, which otherwise can result in additional surgeries or aggressive therapeutic regimens. To improve patient outcomes, intraoperative spectroscopic, fluorescence-based, structural, optoacoustic and radiological imaging techniques are being tested on freshly excised tissue. The specific clinical setting and tumour type largely determine whether endogenous or exogenous contrast is to be detected and whether the tumour specificity of the detected biomarker, image resolution, image-acquisition times or penetration depth are to be prioritized. In this Perspective, we describe current clinical standards for intraoperative tissue analysis and discuss how intraoperative imaging is being implemented. We also discuss potential implementations of intraoperative pathology-assisted surgery for clinical decision-making.
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Affiliation(s)
- Floris J Voskuil
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jasper Vonk
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vasilis Ntziachristos
- Chair for Biological Imaging, Center for Translational Cancer Research, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Pieter J van der Zaag
- Phillips Research Laboratories, Eindhoven, The Netherlands.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Molecular Biophysics, Zernike Institute, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gooitzen M van Dam
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,AxelaRx/TRACER BV, Groningen, The Netherlands.
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6
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Complex refractive index of freshly excised human breast tissue as a marker of disease. Lasers Med Sci 2022; 37:2597-2604. [PMID: 35301608 DOI: 10.1007/s10103-022-03524-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/05/2022] [Indexed: 10/18/2022]
Abstract
We report differences in the refractive index of healthy and tumorous freshly excised human breast tissue as determined from reflectance profile measurements at five wavelengths (432 nm, 532 nm, 633 nm, 964 nm, 1551 nm) in the visible and near-infrared using a standard prism-coupling refractometer. These refractive index differences, particularly in the near-infrared, can be used to distinguish fibroadenomas and cancerous growths not only from normal breast tissue but also from each other.
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Is Real-Time Microscopy on the Horizon? A Brief Review of the Potential Future Directions in Clinical Breast Tumor Microscopy Implementation. Virchows Arch 2022; 480:211-227. [PMID: 35218378 DOI: 10.1007/s00428-022-03300-z] [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: 07/14/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
Abstract
We will briefly review the current paradigm and some recent developments in the area of clinical breast microscopy, highlighting several promising commercially available, and research-based platforms. Confocal microscopy (reflectance, fluorescence, and spectrally encoded), optical coherence tomography (wide field and full field), stereomicroscopy, open-top light sheet microscopy, microscopy with ultraviolet surface excitation, nonlinear microscopy, Raman scattering microscopy, photoacoustic microscopy, and needle microendoscopy will be discussed. Non-microscopic methods for breast pathology assessment are beyond the scope of this review. These microscopic technologies have to varying degrees the potential for transforming breast cancer care, but in order for any of these to be integrated into clinical practice there are several hurdles to overcome. In our review we will focus on what needs to be done in order for the commercially available technologies to become more established, what the technologies in the research domain need to do in order to reach the commercial realm; and finally, what the field of breast pathology might look like if these technologies were to be widely adopted.
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8
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Liu Y, Levenson RM, Jenkins MW. Slide Over: Advances in Slide-Free Optical Microscopy as Drivers of Diagnostic Pathology. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:180-194. [PMID: 34774514 PMCID: PMC8883436 DOI: 10.1016/j.ajpath.2021.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
Conventional analysis using clinical histopathology is based on bright-field microscopy of thinly sliced tissue specimens. Although bright-field microscopy is a simple and robust method of examining microscope slides, the preparation of the slides needed is a lengthy and labor-intensive process. Slide-free histopathology, however, uses direct imaging of intact, minimally processed tissue samples using advanced optical-imaging systems, bypassing the extended workflow now required for the preparation of tissue sections. This article explains the technical basis of slide-free microscopy, reviews common slide-free optical microscopy techniques, and discusses the opportunities and challenges involved in clinical implementation.
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Affiliation(s)
- Yehe Liu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Richard M. Levenson
- Department of Pathology and Laboratory Medicine, University of California–Davis, Sacramento, California,Address correspondence to Richard M. Levenson, M.D., UC Davis Health, Path Building, 4400 V St., Sacramento, CA 95817; or Michael W. Jenkins, Ph.D., 2109 Adelbert Rd., Wood Bldg., WG28, Cleveland, OH 44106.
| | - Michael W. Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio,Address correspondence to Richard M. Levenson, M.D., UC Davis Health, Path Building, 4400 V St., Sacramento, CA 95817; or Michael W. Jenkins, Ph.D., 2109 Adelbert Rd., Wood Bldg., WG28, Cleveland, OH 44106.
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9
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Huang C, Ching-Roa V, Liu Y, Giacomelli MG. High-speed mosaic imaging using scanner-synchronized stage position sampling. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:016502. [PMID: 35075830 PMCID: PMC8786391 DOI: 10.1117/1.jbo.27.1.016502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Two-photon and confocal microscopy can obtain high frame rates; however, mosaic imaging of large tissue specimens remains time-consuming and inefficient, with higher imaging rates leading to a larger fraction of time wasted translating between imaging locations. Strip scanning obtains faster mosaic imaging rates by translating a specimen at constant velocity through a line scanner at the expense of more complex stitching and geometric distortion due to the difficulty of translating at completely constant velocity. AIM We aim to develop an approach to mosaic imaging that can obtain higher accuracy and faster imaging rates while reducing computational complexity. APPROACH We introduce an approach based on scanner-synchronous position sampling that enables subwavelength accurate imaging of specimens moving at a nonuniform velocity, eliminating distortion. RESULTS We demonstrate that this approach increases mosaic imaging rates while reducing computational complexity, retaining high SNR, and retaining geometric accuracy. CONCLUSIONS Scanner synchronous strip scanning enables accurate, high-speed mosaic imaging of large specimens by reducing acquisition and processing time.
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Affiliation(s)
- Chi Huang
- University of Rochester, Department of Biomedical Engineering, Rochester, New York, United States
| | - Vincent Ching-Roa
- University of Rochester, Department of Biomedical Engineering, Rochester, New York, United States
| | - Yihan Liu
- University of Rochester, Institute of Optics, Rochester, New York, United States
| | - Michael G. Giacomelli
- University of Rochester, Department of Biomedical Engineering, Rochester, New York, United States
- University of Rochester, Institute of Optics, Rochester, New York, United States
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10
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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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11
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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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12
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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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13
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Kose K, Fox CA, Rossi A, Jain M, Cordova M, Dusza SW, Ragazzi M, Gardini S, Moscarella E, Diaz A, Pigem R, Gonzalez S, Bennassar A, Carrera C, Longo C, Rajadhyaksha M, Nehal KS. An international 3-center training and reading study to assess basal cell carcinoma surgical margins with ex vivo fluorescence confocal microscopy. J Cutan Pathol 2021; 48:1010-1019. [PMID: 33576022 DOI: 10.1111/cup.13980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Novel solutions are needed for expediting margin assessment to guide basal cell carcinoma (BCC) surgeries. Ex vivo fluorescence confocal microscopy (FCM) is starting to be used in freshly excised surgical specimens to examine BCC margins in real time. Training and educational process are needed for this novel technology to be implemented into clinic. OBJECTIVE To test a training and reading process, and measure diagnostic accuracy of clinicians with varying expertise level in reading ex vivo FCM images. METHODS An international three-center study was designed for training and reading to assess BCC surgical margins and residual subtypes. Each center included a lead dermatologic/Mohs surgeon (clinical developer of FCM) and three additional readers (dermatologist, dermatopathologist, dermatologic/Mohs surgeon), who use confocal in clinical practice. Testing was conducted on 30 samples. RESULTS Overall, the readers achieved 90% average sensitivity, 78% average specificity in detecting residual BCC margins, showing high and consistent diagnostic reading accuracy. Those with expertise in dermatologic surgery and dermatopathology showed the strongest potential for learning to assess FCM images. LIMITATIONS Small dataset, variability in mosaic quality between centers. CONCLUSION Suggested process is feasible and effective. This process is proposed for wider implementation to facilitate wider adoption of FCM to potentially expedite BCC margin assessment to guide surgery in real time.
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Affiliation(s)
- Kivanc Kose
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Anthony Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Manu Jain
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Miguel Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephen W Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moira Ragazzi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
| | - Stefano Gardini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania L Vanvitelli, Naples, Italy
| | - Alba Diaz
- Pathology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ramon Pigem
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Salvador Gonzalez
- Medicine and Medical Specialties Department, Alcalá de Henares University, Madrid, Spain
| | - Antoni Bennassar
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Madrid, Spain
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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14
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Liu JTC, Glaser AK, Bera K, True LD, Reder NP, Eliceiri KW, Madabhushi A. Harnessing non-destructive 3D pathology. Nat Biomed Eng 2021; 5:203-218. [PMID: 33589781 PMCID: PMC8118147 DOI: 10.1038/s41551-020-00681-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
High-throughput methods for slide-free three-dimensional (3D) pathological analyses of whole biopsies and surgical specimens offer the promise of modernizing traditional histology workflows and delivering improvements in diagnostic performance. Advanced optical methods now enable the interrogation of orders of magnitude more tissue than previously possible, where volumetric imaging allows for enhanced quantitative analyses of cell distributions and tissue structures that are prognostic and predictive. Non-destructive imaging processes can simplify laboratory workflows, potentially reducing costs, and can ensure that samples are available for subsequent molecular assays. However, the large size of the feature-rich datasets that they generate poses challenges for data management and computer-aided analysis. In this Perspective, we provide an overview of the imaging technologies that enable 3D pathology, and the computational tools-machine learning, in particular-for image processing and interpretation. We also discuss the integration of various other diagnostic modalities with 3D pathology, along with the challenges and opportunities for clinical adoption and regulatory approval.
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Affiliation(s)
- Jonathan T C Liu
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
| | - Adam K Glaser
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Lawrence D True
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Nicholas P Reder
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Kevin W Eliceiri
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA.
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA.
- Morgridge Institute for Research, Madison, WI, USA.
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA.
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15
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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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16
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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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17
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Chen Y, Xie W, Glaser AK, Reder NP, Mao C, Dintzis SM, Vaughan JC, Liu JTC. Rapid pathology of lumpectomy margins with open-top light-sheet (OTLS) microscopy. BIOMEDICAL OPTICS EXPRESS 2019; 10:1257-1272. [PMID: 30891344 PMCID: PMC6420271 DOI: 10.1364/boe.10.001257] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/11/2019] [Accepted: 01/25/2019] [Indexed: 05/18/2023]
Abstract
Open-top light-sheet microscopy is a technique that can potentially enable rapid ex vivo inspection of large tissue surfaces and volumes. Here, we have optimized an open-top light-sheet (OTLS) microscope and image-processing workflow for the comprehensive examination of surgical margin surfaces, and have also developed a novel fluorescent analog of H&E staining that is robust for staining fresh unfixed tissues. Our tissue-staining method can be achieved within 2.5 minutes followed by OTLS microscopy of lumpectomy surfaces at a rate of up to 1.5 cm2/minute. An image atlas is presented to show that OTLS image quality surpasses that of intraoperative frozen sectioning and can approximate that of gold-standard H&E histology of formalin-fixed paraffin-embedded (FFPE) tissues. Qualitative evidence indicates that these intraoperative methods do not interfere with downstream post-operative H&E histology and immunohistochemistry. These results should facilitate the translation of OTLS microscopy for intraoperative guidance of lumpectomy and other surgical oncology procedures.
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Affiliation(s)
- Ye Chen
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
- These authors contributed equally
| | - Weisi Xie
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
- These authors contributed equally
| | - Adam K. Glaser
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Nicholas P. Reder
- Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Chenyi Mao
- Department of Chemistry, University of Washington Seattle, WA 98195, USA
| | - Suzanne M. Dintzis
- Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Joshua C. Vaughan
- Department of Chemistry, University of Washington Seattle, WA 98195, USA
- Department of Physiology and Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Jonathan T. C. Liu
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
- Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195, USA
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18
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Dintzis SM, Hansen S, Harrington KM, Tan LC, Miller DM, Ishak L, Parrish-Novak J, Kittle D, Perry J, Gombotz C, Fortney T, Porenta S, Hales L, Calhoun KE, Anderson BO, Javid SH, Byrd DR. Real-time Visualization of Breast Carcinoma in Pathology Specimens From Patients Receiving Fluorescent Tumor-Marking Agent Tozuleristide. Arch Pathol Lab Med 2018; 143:1076-1083. [DOI: 10.5858/arpa.2018-0197-oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Resection of breast carcinoma with adequate margins reduces the risk of local recurrence and reoperation. Tozuleristide (BLZ-100) is an investigational peptide-fluorophore agent that may aid in intraoperative tumor detection and margin assessment. In this study, fluorescence imaging was conducted ex vivo on gross breast pathology specimens.
Objectives.—
To determine the potential of tozuleristide to detect breast carcinoma in fresh pathology specimens and the feasibility of fluorescence-guided intraoperative pathology assessment of surgical margins.
Design.—
Twenty-three patients received an intravenous bolus dose of 6 or 12 mg of tozuleristide at least 1 hour before surgery. Fifteen lumpectomy and 12 mastectomy specimens were evaluated for fluorescence by the site's clinical pathology staff using the SIRIS, an investigational near-infrared imaging device. The breast tissue was then processed per usual procedures. Fluorescent patterns were correlated with the corresponding hematoxylin-eosin–stained sections. Clinical pathology reports were used to correlate fluorescent signal to grade, histotype, prognostic marker status, and margin measurements.
Results.—
Tozuleristide fluorescence was readily observed in invasive and in situ breast carcinoma specimens. Most invasive carcinomas were bright and focal, whereas in situ lesions demonstrated a less intense, more diffuse pattern. Tozuleristide was detected in ductal and lobular carcinomas with a similar fluorescent pattern. Fluorescence was detected in high- and low-grade lesions, and molecular marker/hormone receptor status did not affect signal. Fluorescence could be used to identify the relationship of carcinoma to margins intraoperatively.
Conclusions.—
Tumor targeting with tozuleristide allowed visual real-time distinction between pathologically confirmed breast carcinoma and normal tissue.
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Affiliation(s)
- Suzanne M. Dintzis
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Stacey Hansen
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Kristi M. Harrington
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Lennart C. Tan
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Dennis M. Miller
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Laura Ishak
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Julia Parrish-Novak
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - David Kittle
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Jeff Perry
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Carolyn Gombotz
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Tina Fortney
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Stephanie Porenta
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Lisa Hales
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Kristine E. Calhoun
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Benjamin O. Anderson
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - Sara H. Javid
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
| | - David R. Byrd
- From the Departments of Pathology (Dr Dintzis) and Surgery (Ms Hales and Drs Calhoun, Javid, and Byrd), University of Washington Medical Center, Seattle; Breast Surgery Clinic (Dr Harrington), Department of Pathology (Dr Tan), and Clinical Trials (Mses Fortney and Porenta), Overlake Hospital Medical Center, Bellevue, Washington; Development (Dr Miller), Clinical Operations (Mses Ishak and Gombotz
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19
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Allen WM, Foo KY, Zilkens R, Kennedy KM, Fang Q, Chin L, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Clinical feasibility of optical coherence micro-elastography for imaging tumor margins in breast-conserving surgery. BIOMEDICAL OPTICS EXPRESS 2018; 9:6331-6349. [PMID: 31065432 PMCID: PMC6491020 DOI: 10.1364/boe.9.006331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/26/2018] [Accepted: 11/08/2018] [Indexed: 05/08/2023]
Abstract
It has been demonstrated that optical coherence micro-elastography (OCME) provides additional contrast of tumor compared to optical coherence tomography (OCT) alone. Previous studies, however, have predominantly been performed on mastectomy specimens. Such specimens typically differ substantially in composition and geometry from the more clinically relevant wide-local excision (WLE) specimens excised during breast-conserving surgery. As a result, it remains unclear if the mechanical contrast observed is maintained in WLE specimens. In this manuscript, we begin to address this issue by performing a feasibility study of OCME on 17 freshly excised, intact WLE specimens. In addition, we present two developments required to sustain the progression of OCME towards intraoperative deployment. First, to enable the rapid visualization of en face images required for intraoperative assessment, we describe an automated segmentation algorithm to fuse en face micro-elastograms with OCT images to provide dual contrast images. Secondly, to validate contrast in micro-elastograms, we present a method that enables co-registration of en face images with histology of WLE specimens, sectioned in the orthogonal plane, without any modification to the standard clinical workflow. We present a summary of the observations across the 17 specimens imaged in addition to representative micro-elastograms and OCT images demonstrating contrast in a number of tumor margins, including those involved by invasive ductal carcinoma, mucinous carcinoma, and solid-papillary carcinoma. The results presented here demonstrate the potential of OCME for imaging tumor margins.
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Affiliation(s)
- Wes M. Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Ken Y. Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Kelsey M. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Current address: Department of Biomedical Engineering, Columbia University, 622 W 168th St, New York, NY 10025, USA
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Benjamin F. Dessauvagie
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
| | - Christobel M. Saunders
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia, 6000, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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20
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Kang J, Song I, Kim H, Kim H, Lee S, Choi Y, Chang HJ, Sohn DK, Yoo H. Rapid tissue histology using multichannel confocal fluorescence microscopy with focus tracking. Quant Imaging Med Surg 2018; 8:884-893. [PMID: 30505717 PMCID: PMC6218212 DOI: 10.21037/qims.2018.09.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Simplified hematoxylin and eosin (H&E) staining followed by cryo-sectioning enables rapid identification of cancerous tissue within the procedure room during Mohs micrographic surgery. Yet, a faster evaluation method is desirable as the staining protocol requires physically sectioning of the tissue after freezing, which leads to prolonged sectioning time along with the frozen artifacts that may occur in frozen sectioning. METHODS We present a multichannel confocal microscopy system to rapidly evaluate cancerous tissue. Using the optical sectioning capability of the confocal microscope, optically sectioned images of the freshly excised mouse tissue were acquired and converted into images resembling H&E histology. To show details of the nuclei and structure of the tissue, we applied a newly developed rapid tissue staining method using Hoechst 33342 and Eosin-Y. Line scanning and stitching was performed to overcome the limited field of view of the confocal microscope. Unlike previous confocal systems requiring an additional mechanical device to tilt the sample and match the focus of the objective lens, we developed a focus tracking method to rapidly scan large sample area. The focus tracking provides an effective means of keeping the image of the thick tissue in focus without additional devices. We then evaluated the performance of the confocal microscope to obtain optically sectioned images in thick tissue by comparing fluorescence stained slide images. We also obtained the corresponding H&E histology image to assess the potential of the system as a diagnostic tool. RESULTS We successfully imaged freshly excised mouse organs including stomach, tumor, and heart within a few minutes using the developed multichannel confocal microscopy and the tissue staining method. Using the pseudocolor method, colors of the acquired confocal grayscale images are converted to furthermore resemble Hematoxylin and Eosin histology. Due to the focus tracking and the line scanning, optically sectioned images were obtained over the large field of view. Comparisons with H&E histology have shown that the confocal images can acquire large details such as the ventricle as well as small details such as muscle fibers and nuclei. CONCLUSIONS This study confirms the use of confocal fluorescence microscopy technique to acquire rapid pathology results using optical sectioning, line scanning and focus tracking. We anticipate that the presented method will enable intraoperative histology and significantly reduce stress on patients undergoing surgery requiring repeated histology examinations.
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Affiliation(s)
- Juehyung Kang
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Incheon Song
- Nanoscope Systems Inc., Daejeon, Republic of Korea
| | - Hongrae Kim
- Department of Biomedical Engineering, National Cancer Center, Goyang, Republic of Korea
| | - Hyunjin Kim
- Biomarker Branch, National Cancer Center, Goyang, Republic of Korea
| | - Sunhye Lee
- Department of Biomedical Engineering, National Cancer Center, Goyang, Republic of Korea
| | - Yongdoo Choi
- Biomarker Branch, National Cancer Center, Goyang, Republic of Korea
| | - Hee Jin Chang
- Center of Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Dae Kyung Sohn
- Department of Biomedical Engineering, National Cancer Center, Goyang, Republic of Korea
- Center of Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hongki Yoo
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
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21
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Giacomelli MG, Yoshitake T, Cahill LC, Vardeh H, Quintana LM, Faulkner-Jones BE, Brooker J, Connolly JL, Fujimoto JG. Multiscale nonlinear microscopy and widefield white light imaging enables rapid histological imaging of surgical specimen margins. BIOMEDICAL OPTICS EXPRESS 2018; 9:2457-2475. [PMID: 29761001 PMCID: PMC5946802 DOI: 10.1364/boe.9.002457] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 05/07/2023]
Abstract
The ability to histologically assess surgical specimens in real-time is a long-standing challenge in cancer surgery, including applications such as breast conserving therapy (BCT). Up to 40% of women treated with BCT for breast cancer require a repeat surgery due to postoperative histological findings of close or positive surgical margins using conventional formalin fixed paraffin embedded histology. Imaging technologies such as nonlinear microscopy (NLM), combined with exogenous fluorophores can rapidly provide virtual H&E imaging of surgical specimens without requiring microtome sectioning, facilitating intraoperative assessment of margin status. However, the large volume of typical surgical excisions combined with the need for rapid assessment, make comprehensive cellular resolution margin assessment during surgery challenging. To address this limitation, we developed a multiscale, real-time microscope with variable magnification NLM and real-time, co-registered position display using a widefield white light imaging system. Margin assessment can be performed rapidly under operator guidance to image specific regions of interest located using widefield imaging. Using simulated surgical margins dissected from human breast excisions, we demonstrate that multi-centimeter margins can be comprehensively imaged at cellular resolution, enabling intraoperative margin assessment. These methods are consistent with pathology assessment performed using frozen section analysis (FSA), however NLM enables faster and more comprehensive assessment of surgical specimens because imaging can be performed without freezing and cryo-sectioning. Therefore, NLM methods have the potential to be applied to a wide range of intra-operative applications.
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Affiliation(s)
- Michael G Giacomelli
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139,USA
| | - Tadayuki Yoshitake
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139,USA
| | - Lucas C Cahill
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139,USA
| | - Hilde Vardeh
- Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Liza M Quintana
- Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Beverly E Faulkner-Jones
- Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jeff Brooker
- Thorlabs Advanced Imaging Group, 108 Powers Court, Sterling, VA 20166, USA
| | - James L Connolly
- Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - James G Fujimoto
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139,USA
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22
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Boppart SA, Brown JQ, Farah CS, Kho E, Marcu L, Saunders CM, Sterenborg HJCM. Label-free optical imaging technologies for rapid translation and use during intraoperative surgical and tumor margin assessment. JOURNAL OF BIOMEDICAL OPTICS 2017; 23:1-10. [PMID: 29288572 PMCID: PMC5747261 DOI: 10.1117/1.jbo.23.2.021104] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/28/2017] [Indexed: 05/18/2023]
Abstract
The biannual International Conference on Biophotonics was recently held on April 30 to May 1, 2017, in Fremantle, Western Australia. This continuing conference series brought together key opinion leaders in biophotonics to present their latest results and, importantly, to participate in discussions on the future of the field and what opportunities exist when we collectively work together for using biophotonics for biological discovery and medical applications. One session in this conference, entitled "Tumor Margin Identification: Critiquing Technologies," challenged invited speakers and attendees to review and critique representative label-free optical imaging technologies and their application for intraoperative assessment and guidance in surgical oncology. We are pleased to share a summary in this outlook paper, with the intent to motivate more research inquiry and investigations, to challenge these and other optical imaging modalities to evaluate and improve performance, to spur translation and adoption, and ultimately, to improve the care and outcomes of patients.
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Affiliation(s)
- Stephen A. Boppart
- University of Illinois at Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
- Address all correspondence to: Stephen A. Boppart, E-mail:
| | - J. Quincy Brown
- Tulane University, Department of Biomedical Engineering, New Orleans, Louisiana, United States
| | - Camile S. Farah
- University of Western Australia, UWA Dental School, Oral Health Centre of Western Australia, Discipline of Oral Oncology, Nedlands, Western Australia, Australia
| | - Esther Kho
- Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
| | - Laura Marcu
- University of California–Davis, Department of Biomedical Engineering, Comprehensive Cancer Center, Davis, California, United States
| | - Christobel M. Saunders
- The University of Western Australia, Department of Surgical Oncology, Crawley, Western Australia, Australia
| | - Henricus J. C. M. Sterenborg
- Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
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23
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Wang YW, Reder NP, Kang S, Glaser AK, Yang Q, Wall MA, Javid SH, Dintzis SM, Liu JTC. Raman-Encoded Molecular Imaging with Topically Applied SERS Nanoparticles for Intraoperative Guidance of Lumpectomy. Cancer Res 2017; 77:4506-4516. [PMID: 28615226 DOI: 10.1158/0008-5472.can-17-0709] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/28/2017] [Accepted: 06/08/2017] [Indexed: 12/30/2022]
Abstract
Intraoperative identification of carcinoma at lumpectomy margins would enable reduced re-excision rates, which are currently as high as 20% to 50%. Although imaging of disease-associated biomarkers can identify malignancies with high specificity, multiplexed imaging of such biomarkers is necessary to detect molecularly heterogeneous carcinomas with high sensitivity. We have developed a Raman-encoded molecular imaging (REMI) technique in which targeted nanoparticles are topically applied on excised tissues to enable rapid visualization of a multiplexed panel of cell surface biomarkers at surgical margin surfaces. A first-ever clinical study was performed in which 57 fresh specimens were imaged with REMI to simultaneously quantify the expression of four biomarkers HER2, ER, EGFR, and CD44. Combined detection of these biomarkers enabled REMI to achieve 89.3% sensitivity and 92.1% specificity for the detection of breast carcinoma. These results highlight the sensitivity and specificity of REMI to detect biomarkers in freshly resected tissue, which has the potential to reduce the rate of re-excision procedures in cancer patients. Cancer Res; 77(16); 4506-16. ©2017 AACR.
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Affiliation(s)
- Yu Winston Wang
- Department of Mechanical Engineering, University of Washington, Seattle, Washington.
| | - Nicholas P Reder
- Department of Mechanical Engineering, University of Washington, Seattle, Washington.,Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Soyoung Kang
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - Adam K Glaser
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - Qian Yang
- Department of Mechanical Engineering, University of Washington, Seattle, Washington.,Department of Pharmacy, Chengdu Medical College, Chengdu, Sichuan, China
| | - Matthew A Wall
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - Sara H Javid
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Suzanne M Dintzis
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan T C Liu
- Department of Mechanical Engineering, University of Washington, Seattle, Washington.
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