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Wang N, Zhang C, Wei X, Yan T, Zhou W, Zhang J, Kang H, Yuan Z, Chen X. Harnessing the power of optical microscopy for visualization and analysis of histopathological images. BIOMEDICAL OPTICS EXPRESS 2023; 14:5451-5465. [PMID: 37854561 PMCID: PMC10581782 DOI: 10.1364/boe.501893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023]
Abstract
Histopathology is the foundation and gold standard for identifying diseases, and precise quantification of histopathological images can provide the pathologist with objective clues to make a more convincing diagnosis. Optical microscopy (OM), an important branch of optical imaging technology that provides high-resolution images of tissue cytology and structural morphology, has been used in the diagnosis of histopathology and evolved into a new disciplinary direction of optical microscopic histopathology (OMH). There are a number of ex-vivo studies providing applicability of different OMH approaches, and a transfer of these techniques toward in vivo diagnosis is currently in progress. Furthermore, combined with advanced artificial intelligence algorithms, OMH allows for improved diagnostic reliability and convenience due to the complementarity of retrieval information. In this review, we cover recent advances in OMH, including the exploration of new techniques in OMH as well as their applications, and look ahead to new challenges in OMH. These typical application examples well demonstrate the application potential and clinical value of OMH techniques in histopathological diagnosis.
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Affiliation(s)
- Nan Wang
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi 710126, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an, Shaanxi 710126, China
| | - Chang Zhang
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi 710126, China
| | - Xinyu Wei
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi 710126, China
| | - Tianyu Yan
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi 710126, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an, Shaanxi 710126, China
| | - Wangting Zhou
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi 710126, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an, Shaanxi 710126, China
| | - Jiaojiao Zhang
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi 710126, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an, Shaanxi 710126, China
| | - Huan Kang
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi 710126, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an, Shaanxi 710126, China
| | - Zhen Yuan
- Faculty of Health Sciences, University of Macau, Macau, 999078, China
| | - Xueli Chen
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi 710126, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an, Shaanxi 710126, China
- Inovation Center for Advanced Medical Imaging and Intelligent Medicine, Guangzhou Institute of Technology, Xidian University, Guangzhou, Guangdong 510555, China
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2
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Hamed AM, Al-Saeed TA. Reconstruction of images in non-scanned confocal microscope (NSCM) using speckle imaging. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2021. [DOI: 10.1186/s43088-021-00157-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The common formation of images in CSLM assumes mechanically scanned object placed in the common short focus of the objective lenses of the microscope, while in the arrangement under study, the scanning of the object is realized by placing a diffuser behind the collimating lens. A model is suggested in the formation of images in Confocal Scanning Laser Microscope (CSLM) using non-scanned object. Since the illumination and detection are coherent, the obtained image is constructed from the simple product of the Resultant Point Spread Function (RPSF) modulated by the diffuser spread over the object transparency. Hence, the product of the object and the image of the diffuser replace the mechanical scanning of the object.
Results
Reconstructed images using this novel arrangement of CNSM are presented using mammographic X-ray image.
Conclusions
Convolution of the RPSF and the object is realized by the spreading of the diffuser image over the object. A coherent detector captures the whole image affected by a noisy diffused function. It is noted that image processing is necessary to improve noisy images making use of filtration techniques.
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3
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Sabdyusheva Litschauer I, Becker K, Saghafi S, Ballke S, Bollwein C, Foroughipour M, Gaugeler J, Foroughipour M, Schavelová V, László V, Döme B, Brostjan C, Weichert W, Dodt HU. 3D histopathology of human tumours by fast clearing and ultramicroscopy. Sci Rep 2020; 10:17619. [PMID: 33077794 PMCID: PMC7572501 DOI: 10.1038/s41598-020-71737-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/02/2020] [Indexed: 12/31/2022] Open
Abstract
Here, we describe a novel approach that allows pathologists to three-dimensionally analyse malignant tissues, including the tumour-host tissue interface. Our visualization technique utilizes a combination of ultrafast chemical tissue clearing and light-sheet microscopy to obtain virtual slices and 3D reconstructions of up to multiple centimetre sized tumour resectates. For the clearing of tumours we propose a preparation technique comprising three steps: (a) Fixation and enhancement of tissue autofluorescence with formalin/5-sulfosalicylic acid. (b) Ultrafast active chemical dehydration with 2,2-dimethoxypropane and (c) refractive index matching with dibenzyl ether at up to 56 °C. After clearing, the tumour resectates are imaged. The images are computationally post-processed for contrast enhancement and artefact removal and then 3D reconstructed. Importantly, the sequence a–c is fully reversible, allowing the morphological correlation of one and the same histological structures, once visualized with our novel technique and once visualized by standard H&E- and IHC-staining. After reverting the clearing procedure followed by standard H&E processing, the hallmarks of ductal carcinoma in situ (DCIS) found in the cleared samples could be successfully correlated with the corresponding structures present in H&E and IHC staining. Since the imaging of several thousands of optical sections is a fast process, it is possible to analyse a larger part of the tumour than by mechanical slicing. As this also adds further information about the 3D structure of malignancies, we expect that our technology will become a valuable addition for histological diagnosis in clinical pathology.
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Affiliation(s)
- Inna Sabdyusheva Litschauer
- Department of Bioelectronics, TU Wien, Vienna, Austria. .,Center for Brain Research, Medical University of Vienna, Vienna, Austria.
| | - Klaus Becker
- Department of Bioelectronics, TU Wien, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Saiedeh Saghafi
- Department of Bioelectronics, TU Wien, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Simone Ballke
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Christine Bollwein
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Meraaj Foroughipour
- Department of Bioelectronics, TU Wien, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Julia Gaugeler
- Department of Bioelectronics, TU Wien, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Massih Foroughipour
- Department of Bioelectronics, TU Wien, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Viktória Schavelová
- Department of Bioelectronics, TU Wien, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Viktória László
- Department of Surgery, Anna Spiegel Center of Translational Research, Medical University of Vienna, Vienna, Austria
| | - Balazs Döme
- Department of Surgery, Anna Spiegel Center of Translational Research, Medical University of Vienna, Vienna, Austria
| | - Christine Brostjan
- Department of Surgery, Anna Spiegel Center of Translational Research, Medical University of Vienna, Vienna, Austria
| | - Wilko Weichert
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Hans-Ulrich Dodt
- Department of Bioelectronics, TU Wien, Vienna, Austria. .,Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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4
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Kapsokalyvas D, van Zandvoort MAMJ. Molecular Imaging in Oncology: Advanced Microscopy Techniques. Recent Results Cancer Res 2020; 216:533-561. [PMID: 32594398 DOI: 10.1007/978-3-030-42618-7_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Preclinical studies usually require high levels of morphological, functional, and biochemical information at subcellular resolution. This type of information cannot be obtained from clinical imaging techniques, such as MRI, PET/CT, or US. Luckily, many microscopy techniques exist that can offer this information, also for malignant tissues and therapeutic approaches. In this overview, we discuss the various advanced optical microscopy techniques and their applications in oncological research. After a short introduction in Sect. 16.1, we continue in Sect. 16.2 with a discussion on fluorescent labelling strategies, followed in Sect. 16.3 by an in-depth description of confocal, light-sheet, two-photon, and super-resolution microscopy. We end in Sect. 16.4 with a focus on the applications, specifically in oncology.
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Affiliation(s)
- Dimitrios Kapsokalyvas
- School for Oncology and Developmental Biology GROW and School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, The Netherlands
- Institut für Molekulare Kreislaufforschung, Universitätsklinikum Aachen, Aachen, Germany
| | - Marc A M J van Zandvoort
- School for Oncology and Developmental Biology GROW and School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, The Netherlands.
- Institut für Molekulare Kreislaufforschung, Universitätsklinikum Aachen, Aachen, Germany.
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5
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Bağcı IS, Aoki R, Krammer S, Ruzicka T, Sárdy M, Hartmann D. Ex vivo confocal laser scanning microscopy: An innovative method for direct immunofluorescence of cutaneous vasculitis. JOURNAL OF BIOPHOTONICS 2019; 12:e201800425. [PMID: 31021054 DOI: 10.1002/jbio.201800425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/05/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023]
Abstract
Ex vivo confocal laser scanning microscopy (ex vivo CLSM) offers an innovative diagnostic approach through vertical scanning of skin samples with a resolution close to conventional histology. In addition, it enables fluorescence detection in tissues. We aimed to assess the applicability of ex vivo CLSM in the detection of vascular immune complexes in cutaneous vasculitis and to compare its diagnostic accuracy with direct immunofluorescence (DIF) microscopy. Eighty-two sections of 49 vasculitis patients with relevant DIF microscopy findings were examined using ex vivo CLSM following staining with fluorescent-labeled IgG, IgM, IgA, C3 and fibrinogen antibodies. DIF microscopy showed immunoreactivity of vessels with IgG, IgM, IgA, C3 and Fibrinogen in 2.0%, 49.9%, 12.2%, 59.2% and 44.9% of the patients, respectively. Ex vivo CLSM detected positive vessels with the same antibodies in 2.0%, 38.8%, 8.2%, 42.9% and 36.7% of the patients, respectively. The detection rate of positive superficial dermal vessels was significantly higher in DIF microscopy as compared to ex vivo CLSM (P < .05). Whereas, ex vivo CLSM identified positive deep dermal vessels more frequently compared to DIF microscopy. In conclusion, ex vivo CLSM could identify specific binding of the antibodies in vessels and showed a comparable performance to conventional DIF microscopy in diagnosing vasculitis.
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Affiliation(s)
- Işın S Bağcı
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Rui Aoki
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Krammer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Miklós Sárdy
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
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6
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Krishnamurthy S, Ban K, Shaw K, Mills G, Sheth R, Tam A, Gupta S, Sabir S. Confocal Fluorescence Microscopy Platform Suitable for Rapid Evaluation of Small Fragments of Tissue in Surgical Pathology Practice. Arch Pathol Lab Med 2018; 143:305-313. [PMID: 30376375 DOI: 10.5858/arpa.2018-0352-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Rapid advances in the fields of biophotonics, computer science, and instrumentation have allowed for high-resolution imaging of biologic tissues. OBJECTIVE.— To evaluate the quality of images from an optimized confocal fluorescence microscopy (CFM) platform for rapid evaluation of small fragments of tissue, compared with hematoxylin-eosin staining. DESIGN.— Tissue fragments (up to 1.0 × 0.3 cm) were stained with 0.6 mM acridine orange for 60 seconds and imaged using a CFM platform at 488-nm and 785-nm wavelength. The imaged tissues were then fixed in formalin and processed to generate hematoxylin-eosin-stained tissue sections. The quality of CFM images was scored on a scale of 0 to 3 on the basis of the percentage of the CFM images with recognizable tissue architecture (0, 0%; 1, <20%; 2, 20%-50%; 3, >50%). The diagnoses made using CFM images were compared with those made using histopathologic analysis of the hematoxylin-eosin-stained tissue sections. RESULTS.— We imaged 118 tissue fragments obtained from 40 breast, 23 lung, 39 kidney, and 16 liver surgical excision specimens. We acquired CFM images in 2 to 3 minutes; 95.8% (113 of 118) of images showed a quality score of 3, and 4.2% (5 of 118) had a score of 2. We achieved a sensitivity of 95.5%, specificity of 97.3%, positive predictive value of 95.5%, and negative predictive value of 97.3%. CONCLUSIONS.— Our results demonstrate the suitability of the CFM platform for rapid and accurate evaluation of small tissue fragments in surgical pathology practice.
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Affiliation(s)
- Savitri Krishnamurthy
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Kechen Ban
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Kenna Shaw
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Gordon Mills
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Rahul Sheth
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Alda Tam
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Sanjay Gupta
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Sharjeel Sabir
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
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7
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Bertoni L, Azzoni P, Reggiani C, Pisciotta A, Carnevale G, Chester J, Kaleci S, Reggiani Bonetti L, Cesinaro AM, Longo C, Pellacani G. Ex vivo fluorescence confocal microscopy for intraoperative, real-time diagnosis of cutaneous inflammatory diseases: A preliminary study. Exp Dermatol 2018; 27:1152-1159. [PMID: 30033578 DOI: 10.1111/exd.13754] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/18/2018] [Indexed: 12/25/2022]
Abstract
Ex vivo fluorescence confocal microscopy (FCM) is an innovative imaging tool that can be used intraoperatively to obtain real-time images of untreated excised tissue with almost histologic resolution. As inflammatory diseases often share overlapping clinical features, histopathology evaluation is required for dubious cases, delaying definitive diagnoses, and therefore therapy. This study identifies key-features at ex vivo FCM for differential diagnoses of cutaneous inflammatory diseases, in particular, psoriasis, eczema, lichen planus and discoid lupus erythematosus. Retrospective ex vivo FCM and histological evaluations with relevant diagnoses were correlated with prospectively reported histopathologic diagnoses, to evaluate agreement and the level of expertise required for correct diagnoses. We demonstrated that ex vivo FCM enabled the distinction of the main inflammatory features in most cases, providing a substantial concordance to histopathologic diagnoses. Moreover, ex vivo FCM and histological evaluations reached a substantial agreement with histopathologic diagnoses both for all raters and for each operator. After a yet to be defined learning curve, these preliminary results suggest that dermatologists may be able to satisfactorily interpret ex vivo FCM images for correct real-time diagnoses. Despite some limitations mainly related to the equipment of FCM with a single objective lens, our study suggests that ex vivo FCM seems a promising tool in assisting diagnoses of cutaneous inflammatory lesions, with a level of accuracy quite close to that offered by histopathology. This is the first study to investigate ex vivo FCM application in cutaneous inflammatory lesions, and to evaluate the diagnostic capability of this technology.
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Affiliation(s)
- Laura Bertoni
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Azzoni
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Camilla Reggiani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Pisciotta
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Carnevale
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Reggiani Bonetti
- Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Maria Cesinaro
- Anatomic Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Pellacani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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8
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Lahiani A, Klaiman E, Grimm O. Enabling Histopathological Annotations on Immunofluorescent Images through Virtualization of Hematoxylin and Eosin. J Pathol Inform 2018. [PMID: 29531846 PMCID: PMC5841016 DOI: 10.4103/jpi.jpi_61_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Context: Medical diagnosis and clinical decisions rely heavily on the histopathological evaluation of tissue samples, especially in oncology. Historically, classical histopathology has been the gold standard for tissue evaluation and assessment by pathologists. The most widely and commonly used dyes in histopathology are hematoxylin and eosin (H&E) as most malignancies diagnosis is largely based on this protocol. H&E staining has been used for more than a century to identify tissue characteristics and structures morphologies that are needed for tumor diagnosis. In many cases, as tissue is scarce in clinical studies, fluorescence imaging is necessary to allow staining of the same specimen with multiple biomarkers simultaneously. Since fluorescence imaging is a relatively new technology in the pathology landscape, histopathologists are not used to or trained in annotating or interpreting these images. Aims, Settings and Design: To allow pathologists to annotate these images without the need for additional training, we designed an algorithm for the conversion of fluorescence images to brightfield H&E images. Subjects and Methods: In this algorithm, we use fluorescent nuclei staining to reproduce the hematoxylin information and natural tissue autofluorescence to reproduce the eosin information avoiding the necessity to specifically stain the proteins or intracellular structures with an additional fluorescence stain. Statistical Analysis Used: Our method is based on optimizing a transform function from fluorescence to H&E images using least mean square optimization. Results: It results in high quality virtual H&E digital images that can easily and efficiently be analyzed by pathologists. We validated our results with pathologists by making them annotate tumor in real and virtual H&E whole slide images and we obtained promising results. Conclusions: Hence, we provide a solution that enables pathologists to assess tissue and annotate specific structures based on multiplexed fluorescence images.
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Affiliation(s)
- Amal Lahiani
- Roche Pharma Research and Early Development, Pathology and Tissue Analytics, Roche Innovation Center, Munich, Penzberg, Germany
| | - Eldad Klaiman
- Roche Pharma Research and Early Development, Pathology and Tissue Analytics, Roche Innovation Center, Munich, Penzberg, Germany
| | - Oliver Grimm
- Roche Pharma Research and Early Development, Pathology and Tissue Analytics, Roche Innovation Center, Munich, Penzberg, Germany
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9
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Xu X, Wang Y, Xiang J, Liu JTC, Tichauer KM. Rinsing paired-agent model (RPAM) to quantify cell-surface receptor concentrations in topical staining applications of thick tissues. Phys Med Biol 2017; 62:5098-5113. [PMID: 28548970 DOI: 10.1088/1361-6560/aa6cf1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Conventional molecular assessment of tissue through histology, if adapted to fresh thicker samples, has the potential to enhance cancer detection in surgical margins and monitoring of 3D cell culture molecular environments. However, in thicker samples, substantial background staining is common despite repeated rinsing, which can significantly reduce image contrast. Recently, 'paired-agent' methods-which employ co-administration of a control (untargeted) imaging agent-have been applied to thick-sample staining applications to account for background staining. To date, these methods have included (1) a simple ratiometric method that is relatively insensitive to noise in the data but has accuracy that is dependent on the staining protocol and the characteristics of the sample; and (2) a complex paired-agent kinetic modeling method that is more accurate but is more noise-sensitive and requires a precise serial rinsing protocol. Here, a new simplified mathematical model-the rinsing paired-agent model (RPAM)-is derived and tested that offers a good balance between the previous models, is adaptable to arbitrary rinsing-imaging protocols, and does not require calibration of the imaging system. RPAM is evaluated against previous models and is validated by comparison to estimated concentrations of targeted biomarkers on the surface of 3D cell culture and tumor xenograft models. This work supports the use of RPAM as a preferable model to quantitatively analyze targeted biomarker concentrations in topically stained thick tissues, as it was found to match the accuracy of the complex paired-agent kinetic model while retaining the low noise-sensitivity characteristics of the ratiometric method.
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Affiliation(s)
- Xiaochun Xu
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL 60616, United States of America
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10
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Dobbs JL, Shin D, Krishnamurthy S, Kuerer H, Yang W, Richards-Kortum R. Confocal fluorescence microscopy to evaluate changes in adipocytes in the tumor microenvironment associated with invasive ductal carcinoma and ductal carcinoma in situ. Int J Cancer 2016; 139:1140-9. [PMID: 27116366 DOI: 10.1002/ijc.30160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/07/2016] [Indexed: 01/17/2023]
Abstract
Adipose tissue is a dynamic organ that provides endocrine, inflammatory and angiogenic factors, which can assist breast carcinoma cells with invasion and metastasis. Previous studies have shown that adipocytes adjacent to carcinoma, known as cancer-associated adipocytes, undergo extensive changes that correspond to an "activated phenotype," such as reduced size relative to adipocytes in non-neoplastic breast tissue. Optical imaging provides a tool that can be used to characterize adipocyte morphology and other features of the tumor microenvironment. In this study, we used confocal fluorescence microscopy to acquire images of freshly excised breast tissue stained topically with proflavine. We developed a computerized algorithm to identify and quantitatively measure phenotypic properties of adipocytes located adjacent to and far from normal collagen, ductal carcinoma in situ and invasive ductal carcinoma. Adipocytes were measured in confocal fluorescence images of fresh breast tissue collected from 22 patients. Results show that adipocytes adjacent to neoplastic tissue margins have significantly smaller area compared to adipocytes far from the margins of neoplastic lesions and compared to adipocytes adjacent to non-neoplastic collagenous stroma. These findings suggest that confocal microscopic images can be utilized to evaluate phenotypic properties of adipocytes in breast stroma which may be useful in defining alterations in microenvironment that may aid in the development and progression of neoplastic lesions.
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Affiliation(s)
| | - Dongsuk Shin
- Department of Bioengineering, Rice University, Houston, TX
| | | | - Henry Kuerer
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei Yang
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Abstract
First developed in 1957, confocal microscopy is a powerful imaging tool that can be used to obtain near real-time reflected light images of untreated human tissue with nearly histologic resolution. Besides its research applications, in the last decades, confocal microscopy technology has been proposed as a useful device to improve clinical diagnosis, especially in ophthalmology, dermatology, and endomicroscopy settings, thanks to advances in instrument development. Compared with the wider use of the in vivo tissue assessment, ex vivo applications of confocal microscopy are not fully explored. A comprehensive review of the current literature was performed here, focusing on the reliable applications of ex vivo confocal microscopy in surgical pathology and on some potential evolutions of this new technique from pathologists' viewpoint.
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Brachtel EF, Johnson NB, Huck AE, Rice-Stitt TL, Vangel MG, Smith BL, Tearney GJ, Kang D. Spectrally encoded confocal microscopy for diagnosing breast cancer in excision and margin specimens. J Transl Med 2016; 96:459-67. [PMID: 26779830 PMCID: PMC5027883 DOI: 10.1038/labinvest.2015.158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/01/2015] [Accepted: 11/04/2015] [Indexed: 11/09/2022] Open
Abstract
A large percentage of breast cancer patients treated with breast conserving surgery need to undergo multiple surgeries due to positive margins found during post-operative margin assessment. Carcinomas could be removed completely during the initial surgery and additional surgery avoided if positive margins can be determined intraoperatively. Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technology that has a potential to rapidly image the entire surgical margin at subcellular resolution and accurately determine margin status intraoperatively. In this study, in order to test the feasibility of using SECM for intraoperative margin assessment, we have evaluated the diagnostic accuracy of SECM for detecting various types of breast cancers. Forty-six surgically removed breast specimens were imaged with an SECM system. Side-by-side comparison between SECM and histologic images showed that SECM images can visualize key histomorphologic patterns of normal/benign and malignant breast tissues. Small (500 μm × 500 μm) spatially registered SECM and histologic images (n=124 for each) were diagnosed independently by three pathologists with expertise in breast pathology. Diagnostic accuracy of SECM for determining malignant tissues was high, average sensitivity of 0.91, specificity of 0.93, positive predictive value of 0.95, and negative predictive value of 0.87. Intra-observer agreement and inter-observer agreement for SECM were also high, 0.87 and 0.84, respectively. Results from this study suggest that SECM may be developed into an intraoperative margin assessment tool for guiding breast cancer excisions.
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Affiliation(s)
| | | | | | | | - Mark G. Vangel
- Department of Radiology, Massachusetts General Hospital,Biostatistics Center, Massachusetts General Hospital
| | - Barbara L. Smith
- Gillette Center for Women’s Cancers and Department of Surgery, Massachusetts General Hospital
| | - Guillermo J. Tearney
- Department of Pathology, Massachusetts General Hospital,Wellman Center for Photomedicine, Massachusetts General Hospital,Harvard-MIT division of Health Sciences and Technology
| | - Dongkyun Kang
- Wellman Center for Photomedicine, Massachusetts General Hospital,Corresponding author: Dongkyun Kang, 40 Blossom St. BAR802, Boston, MA 02114, , Phone: 617-726-1699, Fax: 617-726-4103
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Dobbs JL, Mueller JL, Krishnamurthy S, Shin D, Kuerer H, Yang W, Ramanujam N, Richards-Kortum R. Micro-anatomical quantitative optical imaging: toward automated assessment of breast tissues. Breast Cancer Res 2015; 17:105. [PMID: 26290094 PMCID: PMC4545917 DOI: 10.1186/s13058-015-0617-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/15/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pathologists currently diagnose breast lesions through histologic assessment, which requires fixation and tissue preparation. The diagnostic criteria used to classify breast lesions are qualitative and subjective, and inter-observer discordance has been shown to be a significant challenge in the diagnosis of selected breast lesions, particularly for borderline proliferative lesions. Thus, there is an opportunity to develop tools to rapidly visualize and quantitatively interpret breast tissue morphology for a variety of clinical applications. METHODS Toward this end, we acquired images of freshly excised breast tissue specimens from a total of 34 patients using confocal fluorescence microscopy and proflavine as a topical stain. We developed computerized algorithms to segment and quantify nuclear and ductal parameters that characterize breast architectural features. A total of 33 parameters were evaluated and used as input to develop a decision tree model to classify benign and malignant breast tissue. Benign features were classified in tissue specimens acquired from 30 patients and malignant features were classified in specimens from 22 patients. RESULTS The decision tree model that achieved the highest accuracy for distinguishing between benign and malignant breast features used the following parameters: standard deviation of inter-nuclear distance and number of duct lumens. The model achieved 81 % sensitivity and 93 % specificity, corresponding to an area under the curve of 0.93 and an overall accuracy of 90 %. The model classified IDC and DCIS with 92 % and 96 % accuracy, respectively. The cross-validated model achieved 75 % sensitivity and 93 % specificity and an overall accuracy of 88 %. CONCLUSIONS These results suggest that proflavine staining and confocal fluorescence microscopy combined with image analysis strategies to segment morphological features could potentially be used to quantitatively diagnose freshly obtained breast tissue at the point of care without the need for tissue preparation.
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Affiliation(s)
- Jessica L Dobbs
- Department of Bioengineering, Rice University, 6500 Main Street, BRC 502, Houston, TX, 77030, USA.
| | - Jenna L Mueller
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Room 136 Hudson Hall, Box 90281, Durham, NC, 27708, USA.
| | - Savitri Krishnamurthy
- Department of Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX, 77030, USA.
| | - Dongsuk Shin
- Department of Bioengineering, Rice University, 6500 Main Street, BRC 502, Houston, TX, 77030, USA.
| | - Henry Kuerer
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0444, Houston, TX, 77030, USA.
| | - Wei Yang
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX, 77030, USA.
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Room 136 Hudson Hall, Box 90281, Durham, NC, 27708, USA.
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, 6500 Main Street, BRC 502, Houston, TX, 77030, USA.
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Das R, Murphy RG, Seibel EJ. Beyond isolated cells: microfluidic transport of large tissue for pancreatic cancer diagnosis. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9320. [PMID: 25914501 DOI: 10.1117/12.2076833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
For cancer diagnoses, core biopsies (CBs) obtained from patients using coring needles (CNs) are traditionally visualized and assessed on microscope slides by pathologists after samples are processed and sectioned. A fundamental gain in optical information (i.e., diagnosis/staging) may be achieved when whole, unsectioned CBs (L = 5-20, D = 0.5-2.0 mm) are analyzed in 3D. This approach preserves CBs for traditional pathology and maximizes the diagnostic potential of patient samples. To bridge CNs/CBs with imaging, our group developed a microfluidic device that performs biospecimen preparation on unsectioned CBs for pathology. The ultimate goal is an automated and rapid point-of-care system that aids pathologists by processing tissue for advanced 3D imaging platforms. An inherent, but essential device feature is the microfluidic transport of CBs, which has not been previously investigated. Early experiments demonstrated proof-of-concept: pancreas CBs (D = 0.3-2.0 mm) of set lengths were transported in straight/curved microchannels, but dimensional tolerance and flow rates were variable, and preservation of CB integrity was uncontrolled. A second study used metal cylinder substitutes (L = 10, D = 1 mm) in microchannels to understand the transport mechanism. However, CBs are imperfectly shaped, rough, porous and viscoelastic. In this study, fresh/formalin-fixed porcine and human pancreas CBs were deposited into our device through a custom interface using clinical CNs. CB integrity (i.e., sample viability) may be assessed at every stage using an optomechanical metric: physical breaks were determined when specimen intensity profile data deviated beyond xavg + 2σ. Flow rates for human CBs were determined for several CNs, and microfluidic transport of fresh and formalin-fixed CBs was analyzed.
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Affiliation(s)
- Ronnie Das
- Human Photonics Laboratory, University of Washington, 4000 Mason Road, Seattle, WA 98195
| | - Rachel G Murphy
- Human Photonics Laboratory, University of Washington, 4000 Mason Road, Seattle, WA 98195
| | - Eric J Seibel
- Human Photonics Laboratory, University of Washington, 4000 Mason Road, Seattle, WA 98195
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Dobbs J, Krishnamurthy S, Kyrish M, Benveniste AP, Yang W, Richards-Kortum R. Confocal fluorescence microscopy for rapid evaluation of invasive tumor cellularity of inflammatory breast carcinoma core needle biopsies. Breast Cancer Res Treat 2014; 149:303-10. [PMID: 25417171 PMCID: PMC4298669 DOI: 10.1007/s10549-014-3182-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/24/2014] [Indexed: 11/27/2022]
Abstract
Tissue sampling is a problematic issue for inflammatory breast carcinoma, and immediate evaluation following core needle biopsy is needed to evaluate specimen adequacy. We sought to determine if confocal fluorescence microscopy provides sufficient resolution to evaluate specimen adequacy by comparing invasive tumor cellularity estimated from standard histologic images to invasive tumor cellularity estimated from confocal images of breast core needle biopsy specimens. Grayscale confocal fluorescence images of breast core needle biopsy specimens were acquired following proflavine application. A breast-dedicated pathologist evaluated invasive tumor cellularity in histologic images with hematoxylin and eosin staining and in grayscale and false-colored confocal images of cores. Agreement between cellularity estimates was quantified using a kappa coefficient. 23 cores from 23 patients with suspected inflammatory breast carcinoma were imaged. Confocal images were acquired in an average of less than 2 min per core. Invasive tumor cellularity estimated from histologic and grayscale confocal images showed moderate agreement by kappa coefficient: κ = 0.48 ± 0.09 (p < 0.001). Grayscale confocal images require less than 2 min for acquisition and allow for evaluation of invasive tumor cellularity in breast core needle biopsy specimens with moderate agreement to histologic images. We show that confocal fluorescence microscopy can be performed immediately following specimen acquisition and could indicate the need for additional biopsies at the initial visit.
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Affiliation(s)
- Jessica Dobbs
- Department of Bioengineering, Rice University, 6500 Main Street, BRC 502, Houston, TX 77030 USA
| | - Savitri Krishnamurthy
- Department of Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030 USA
| | - Matthew Kyrish
- Department of Bioengineering, Rice University, 6500 Main Street, BRC 502, Houston, TX 77030 USA
- Present Address: Fresnel Technologies, 101 West Morningside Drive, Fort Worth, TX 76110 USA
| | - Ana Paula Benveniste
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030 USA
| | - Wei Yang
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030 USA
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, 6500 Main Street, BRC 502, Houston, TX 77030 USA
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Abstract
Rapid intraoperative assessment of breast excision specimens is clinically important because up to 40% of patients undergoing breast-conserving cancer surgery require reexcision for positive or close margins. We demonstrate nonlinear microscopy (NLM) for the assessment of benign and malignant breast pathologies in fresh surgical specimens. A total of 179 specimens from 50 patients was imaged with NLM using rapid extrinsic nuclear staining with acridine orange and intrinsic second harmonic contrast generation from collagen. Imaging was performed on fresh, intact specimens without the need for fixation, embedding, and sectioning required for conventional histopathology. A visualization method to aid pathological interpretation is presented that maps NLM contrast from two-photon fluorescence and second harmonic signals to features closely resembling histopathology using hematoxylin and eosin staining. Mosaicking is used to overcome trade-offs between resolution and field of view, enabling imaging of subcellular features over square-centimeter specimens. After NLM examination, specimens were processed for standard paraffin-embedded histology using a protocol that coregistered histological sections to NLM images for paired assessment. Blinded NLM reading by three pathologists achieved 95.4% sensitivity and 93.3% specificity, compared with paraffin-embedded histology, for identifying invasive cancer and ductal carcinoma in situ versus benign breast tissue. Interobserver agreement was κ = 0.88 for NLM and κ = 0.89 for histology. These results show that NLM achieves high diagnostic accuracy, can be rapidly performed on unfixed specimens, and is a promising method for intraoperative margin assessment.
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Das R, Nguyen TM, Lim SD, O’Donnell M, Wang RK, Seibel EJ. Feasibility of a hybrid elastographic-microfluidic device to rapidly process and assess pancreatic cancer biopsies for pathologists. ... HEALTH INNOVATIONS AND POINT-OF-CARE TECHNOLOGIES CONFERENCE. HEALTH INNOVATIONS AND POINT-OF-CARE TECHNOLOGIES CONFERENCE 2014; 2014:271-275. [PMID: 26110186 PMCID: PMC4476399 DOI: 10.1109/hic.2014.7038927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this study, our collaborative research group explored the possibility of incorporating ultrasound elastography technology with a microfluidic device that is designed to prepare fine needle core biopsies (CBs; L=0.5-2.0 cm, D=0.4-1.2 mm) for pancreatic cancer diagnosis. For the first time, elastographic techniques were employed to measure shear wave velocity in fresh (3.7 m/s) and formalin-fixed (14.7 m/s) pancreatic CBs. Shear wave velocity did not vary whether fixed specimens were free on a microscope slide, or constrained within glass microfluidic channels: 11.5±1.9 v. 11.8±2.1 m/s. 4% agarose inclusions were also embedded within 1% agarose hydrogels to simulate cysts, neoplastic, or necrotic tissue within CBs. Inclusions were successfully visualized and measured using optical coherence elastography. These preliminary experiments demonstrate in a rudimentary fashion that elastographic measurements of pancreatic CBs may be incorporated with our microfluidic device. The rapid mapping of CB stiffness may provide qualitative spatial information for pathologists to determine a more accurate diagnosis for patients.
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Affiliation(s)
- Ronnie Das
- Primary appointment in UW Mechanical Engineering
| | - Thu-Mai Nguyen
- Primary appointment in UW Bioengineering, Seattle, WA 98195 USA
| | | | - Matt O’Donnell
- Primary appointment in UW Bioengineering, Seattle, WA 98195 USA
| | - Ruikang K. Wang
- Primary appointment in UW Bioengineering, Seattle, WA 98195 USA
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18
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Optical segmentation of unprocessed breast tissue for margin assessment. Breast 2014; 23:413-22. [DOI: 10.1016/j.breast.2014.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 02/16/2014] [Accepted: 02/28/2014] [Indexed: 11/22/2022] Open
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Ragazzi M, Piana S, Longo C, Castagnetti F, Foroni M, Ferrari G, Gardini G, Pellacani G. Fluorescence confocal microscopy for pathologists. Mod Pathol 2014; 27:460-71. [PMID: 24030744 DOI: 10.1038/modpathol.2013.158] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 07/07/2013] [Accepted: 07/08/2013] [Indexed: 11/09/2022]
Abstract
Confocal microscopy is a non-invasive method of optical imaging that may provide microscopic images of untreated tissue that correspond almost perfectly to hematoxylin- and eosin-stained slides. Nowadays, following two confocal imaging systems are available: (1) reflectance confocal microscopy, based on the natural differences in refractive indices of subcellular structures within the tissues; (2) fluorescence confocal microscopy, based on the use of fluorochromes, such as acridine orange, to increase the contrast epithelium-stroma. In clinical practice to date, confocal microscopy has been used with the goal of obviating the need for excision biopsies, thereby reducing the need for pathological examination. The aim of our study was to test fluorescence confocal microscopy on different types of surgical specimens, specifically breast, lymph node, thyroid, and colon. The confocal images were correlated to the corresponding histological sections in order to provide a morphologic parallel and to highlight current limitations and possible applications of this technology for surgical pathology practice. As a result, neoplastic tissues were easily distinguishable from normal structures and reactive processes such as fibrosis; the use of fluorescence enhanced contrast and image quality in confocal microscopy without compromising final histologic evaluation. Finally, the fluorescence confocal microscopy images of the adipose tissue were as accurate as those of conventional histology and were devoid of the frozen-section-related artefacts that can compromise intraoperative evaluation. Despite some limitations mainly related to black/white images, which require training in imaging interpretation, this study confirms that fluorescence confocal microscopy may represent an alternative to frozen sections in the assessment of margin status in selected settings or when the conservation of the specimen is crucial. This is the first study to employ fluorescent confocal microscopy on surgical specimens other than the skin and to evaluate the diagnostic capability of this technology from pathologists' viewpoint.
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Affiliation(s)
- Moira Ragazzi
- Pathology Unit, IRCSS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, IRCSS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Caterina Longo
- Skin Cancer Unit, IRCSS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Fabio Castagnetti
- Breast Surgery Unit, IRCSS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Monica Foroni
- Breast Surgery Unit, IRCSS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Guglielmo Ferrari
- Breast Surgery Unit, IRCSS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Giorgio Gardini
- Pathology Unit, IRCSS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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Ductal carcinoma in situ in core needle biopsies and its association with extensive in situ component in the surgical specimen. Int Arch Med 2012; 5:19. [PMID: 22715888 PMCID: PMC3432016 DOI: 10.1186/1755-7682-5-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 05/16/2012] [Indexed: 11/30/2022] Open
Abstract
Background We evaluated the presence of ductal carcinoma in situ (DCIS) in core needle biopsies (CNB) from invasive ductal lesions. Methods Retrospective study, which analyzed 90 cases of invasive ductal carcinoma lesions. The percentage of DCIS was quantified in each specimens obtained from CNB, which were compared to the surgical specimens. CNB and surgical specimens were evaluated by the same pathologist, and the percentage of DCIS in CNB was evaluated (percentage) and divided into categories. We considered the following parameters regarding the amount of DCIS: 1 = 0; 2 = 1 for 5%; 3 = 6 for 24%; 4 = 25 for 50%; 5 = 51 for 75% and 6 = 76 for 99%. The number of fragments and the histological pattern of DCIS was found. Results We found the following results regarding the distribution of the percentage of DCIS in the CNB: 1 = 63.3%; 2 = 12.2%; 3 = 12.2%; 4 = 5.6%; 5 = 1.1% and 6 = 5.6%. The logistic regression analysis showed that CNB percentages above 45% reflected the presence of DCIS in the surgical specimen in 100% of the cases (p < 0.001), with a specificity of 100%, accuracy of 83.3% and false positive rate of 0% (p <0.001). Conclusion There is direct relationship between extensive intraductal component in the surgical specimen when the core biopsy shows 45% or more of the DCI or microinvasive in the material examined.
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Gareau DS, Jeon H, Nehal KS, Rajadhyaksha M. Rapid screening of cancer margins in tissue with multimodal confocal microscopy. J Surg Res 2012; 178:533-8. [PMID: 22721570 DOI: 10.1016/j.jss.2012.05.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/16/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Complete and accurate excision of cancer is guided by the examination of histopathology. However, preparation of histopathology is labor intensive and slow, leading to insufficient sampling of tissue and incomplete and/or inaccurate excision of margins. We demonstrate the potential utility of multimodal confocal mosaicing microscopy for rapid screening of cancer margins, directly in fresh surgical excisions, without the need for conventional embedding, sectioning, or processing. MATERIALS AND METHODS A multimodal confocal mosaicing microscope was developed to image basal cell carcinoma margins in surgical skin excisions, with the resolution that shows nuclear detail. Multimodal contrast is with fluorescence for imaging nuclei and reflectance for cellular cytoplasm and dermal collagen. Thirty-five excisions of basal cell carcinomas from Mohs surgery were imaged, and the mosaics analyzed by comparison with the corresponding frozen pathology. RESULTS Confocal mosaics are produced in about 9 min, displaying tissue in fields of view of 12 mm with ×2 magnification. A digital staining algorithm transforms black and white contrast to purple and pink, which simulates the appearance of standard histopathology. Mosaicing enables rapid digital screening, which mimics the examination of histopathology. CONCLUSIONS Multimodal confocal mosaicing microscopy offers a technology platform to potentially enable real-time pathology at the bedside. The imaging may serve as an adjunct to conventional histopathology to expedite screening of margins and guide surgery toward more complete and accurate excision of cancer.
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Affiliation(s)
- Daniel S Gareau
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York 10022, New York, USA.
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Patel R, Khan A, Wirth D, Kamionek M, Kandil D, Quinlan R, Yaroslavsky AN. Multimodal optical imaging for detecting breast cancer. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:066008. [PMID: 22734764 DOI: 10.1117/1.jbo.17.6.066008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The goal of the study was to evaluate wide-field and high-resolution multimodal optical imaging, including polarization, reflectance, and fluorescence for the intraoperative detection of breast cancer. Lumpectomy specimens were stained with 0.05 mg/ml aqueous solution of methylene blue (MB) and imaged. Wide-field reflectance images were acquired between 390 and 750 nm. Wide-field fluorescence images were excited at 640 nm and registered between 660 and 750 nm. High resolution confocal reflectance and fluorescence images were excited at 642 nm. Confocal fluorescence images were acquired between 670 nm and 710 nm. After imaging, the specimens were processed for hematoxylin and eosin (H&E) histopathology. Histological slides were compared with wide-field and high-resolution optical images to evaluate correlation of tumor boundaries and cellular morphology, respectively. Fluorescence polarization imaging identified the location, size, and shape of the tumor in all the cases investigated. Averaged fluorescence polarization values of tumor were higher as compared to normal tissue. Statistical analysis confirmed the significance of these differences. Fluorescence confocal imaging enabled cellular-level resolution. Evaluation and statistical analysis of MB fluorescence polarization values registered from single tumor and normal cells demonstrated higher fluorescence polarization from cancer. Wide-field high-resolution fluorescence and fluorescence polarization imaging shows promise for intraoperative delineation of breast cancers.
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Affiliation(s)
- Rakesh Patel
- University of Massachusetts Lowell, Advanced Biophotonics Laboratory, 175 Cabot Street, Suite 110-111, Lowell, Massachusetts 01854, USA
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Guitera P, Menzies SW. State of the art of diagnostic technology for early-stage melanoma. Expert Rev Anticancer Ther 2011; 11:715-23. [PMID: 21554047 DOI: 10.1586/era.11.43] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the past few decades, rapid improvements in noninvasive optical technologies have revolutionized the diagnosis of early-stage melanoma. Current knowledge and limitations of these tools will be reviewed in this article. Dermoscopy has been recognized as the 'gold standard' in the screening phase. Digital dermoscopy monitoring and total-body photography are used to identify so-called 'featureless' melanoma only on the criteria of change over time. Automated instruments, as well as optical and nonmorphological methods, are still under development, and offer many opportunities to improve the speed and accuracy of the diagnosis of melanoma and/or to reduce the need for expertise. Despite a penetration depth limited to the upper dermis, the quasi-histological imaging achieved by in vivo reflectance confocal microscopy has been demonstrated to significantly aid diagnostic accuracy for selected melanocytic lesions. Future perspectives on diagnostic instrumentation will also be explored.
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Jeong YJ, Bong JG, Kim HT, Kim JK, Oh HK, Huang JY, Park SH. Evaluation of Phase-Contrast Microscopic Imaging with Synchrotron Radiation in the Diagnosis of Breast Cancer and Differentiation of Various Breast Diseases: Preliminary Results. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.4.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Young Ju Jeong
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Gu Bong
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hong Tae Kim
- Department of Anatomy, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jong Ki Kim
- Department of Radiology and Biomedical Engineering, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hoon Kyu Oh
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jung Yun Huang
- Pohang Accelerator Laboratory, Pohang University of Science and Technology, Pohang, Korea
| | - Sung Hwan Park
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
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