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Behr M, Alizadeh L, Buckner-Baiamonte L, Roberts B, Sholl AB, Brown JQ. Structured illumination microscopy for cancer identification in diagnostic breast biopsies. PLoS One 2024; 19:e0302600. [PMID: 38722960 PMCID: PMC11081287 DOI: 10.1371/journal.pone.0302600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
Breast cancer is the second most common cancer diagnosed in women in the US with almost 280,000 new cases anticipated in 2023. Currently, on-site pathology for location guidance is not available during the collection of breast biopsies or during surgical intervention procedures. This shortcoming contributes to repeat biopsy and re-excision procedures, increasing the cost and patient discomfort during the cancer management process. Both procedures could benefit from on-site feedback, but current clinical on-site evaluation techniques are not commonly used on breast tissue because they are destructive and inaccurate. Ex-vivo microscopy is an emerging field aimed at creating histology-analogous images from non- or minimally-processed tissues, and is a promising tool for addressing this pain point in clinical cancer management. We investigated the ability structured illumination microscopy (SIM) to generate images from freshly-obtained breast tissues for structure identification and cancer identification at a speed compatible with potential on-site clinical implementation. We imaged 47 biopsies from patients undergoing a guided breast biopsy procedure using a customized SIM system and a dual-color fluorescent hematoxylin & eosin (H&E) analog. These biopsies had an average size of 0.92 cm2 (minimum 0.1, maximum 4.2) and had an average imaging time of 7:29 (minimum 0:22, maximum 37:44). After imaging, breast biopsies were submitted for standard histopathological processing and review. A board-certified pathologist returned a binary diagnostic accuracy of 96% when compared to diagnoses from gold-standard histology slides, and key tissue features including stroma, vessels, ducts, and lobules were identified from the resulting images.
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Affiliation(s)
- Madeline Behr
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, United States of America
| | - Layla Alizadeh
- Department of Pathology, Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Brett Roberts
- Department of Radiology, Ochsner Medical Center, New Orleans, LA, United States of America
| | - Andrew B. Sholl
- Department of Pathology, Touro Infirmary, New Orleans, LA, United States of America
| | - J. Quincy Brown
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, United States of America
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郝 哲, 岳 蜀, 周 利. [Application of Raman-based technologies in the detection of urological tumors]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:779-784. [PMID: 35950408 PMCID: PMC9385527 DOI: 10.19723/j.issn.1671-167x.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 06/15/2023]
Abstract
Urinary system tumors affect a huge number of individuals, and are frequently recurrent and progressing following surgery, necessitating lifelong surveillance. As a result, early and precise diagnosis of urinary system cancers is important for prevention and therapy. Histopathology is now the golden stan-dard for the diagnosis, but it is invasive, time-consuming, and inconvenient for initial diagnosis and re-gular follow-up assessment. Endoscopy can directly witness the tumor's structure, but intrusive detection is likely to cause harm to the patient's organs, and it is apt to create other hazards in frequently examined patients. Imaging is a valuable non-invasive and quick assessment tool; however, it can be difficult to define the type of lesions and has limited sensitivity for early tumor detection. The conventional approaches for detecting tumors have their own set of limitations. Thus, detection methods that combine non-invasive detection, label-free detection, high sensitivity and high specificity are urgently needed to aid clinical diagnosis. Optical diagnostics and imaging are increasingly being employed in healthcare settings in a variety of sectors. Raman scattering can assess changes in molecular signatures in cancer cells or tissues based on the interaction with vibrational modes of common molecular bonds. Due to the advantages of label-free, strong chemical selectivity, and high sensitivity, Raman scattering, especially coherent Raman scattering microscopy imaging with high spatial resolution, has been widely used in biomedical research. And quantity studies have shown that it has a good application in the detection and diagnosis of bladder can-cer, renal clear cell carcinoma, prostate cancer, and other cancers. In this paper, several nonlinear imaging techniques based on Raman scattering technology are briefly described, including Raman spectroscopy, coherent anti-Stokes Raman scattering, stimulated Raman scattering, and surface-enhanced Raman spectroscopy. And we will discuss the application of these techniques for detecting urologic malignancy. Future research directions are predicted using the advantages and limitations of the aforesaid methodologies in the research. For clinical practice, Raman scattering technology is intended to enable more accurate, rapid, and non-invasive in early diagnosis, intraoperative margins, and pathological grading basis for clinical practice.
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Affiliation(s)
- 哲 郝
- 北京航空航天大学生物与医学工程学院,北京市生物医学工程高精尖创新中心,生物力学与力生物学教育部重点实验室,医用光子学研究所,北京 100083School of Biological and Medical Engineering, Beihang University, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing 100083, China
| | - 蜀华 岳
- 北京航空航天大学生物与医学工程学院,北京市生物医学工程高精尖创新中心,生物力学与力生物学教育部重点实验室,医用光子学研究所,北京 100083School of Biological and Medical Engineering, Beihang University, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing 100083, China
| | - 利群 周
- 北京航空航天大学生物与医学工程学院,北京市生物医学工程高精尖创新中心,生物力学与力生物学教育部重点实验室,医用光子学研究所,北京 100083School of Biological and Medical Engineering, Beihang University, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing 100083, China
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He C, Wu X, Zhou J, Chen Y, Ye J. Raman optical identification of renal cell carcinoma via machine learning. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2021; 252:119520. [PMID: 33582436 DOI: 10.1016/j.saa.2021.119520] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 05/06/2023]
Abstract
High pathologic tumor-node-metastasis (pTNM) stage grade or Fuhrman grade indicates poor oncological outcome in renal cell carcinoma (RCC). Early diagnosis and screening of these RCCs and adjust surgical planning accordingly are greatly beneficial to patients. Raman spectroscopy is a highly specific fingerprint spectrum on molecular level, pretty appropriate for label-free and noninvasive cancer diagnosis. In this work we established a Raman spectrum-based supporting vector machine (SVM) model to accurately ex vivo distinguish human renal tumor from normal tissues and fat with an accuracy of 92.89%. The model can also be used to determine tumor boundary, showing consistent results to pathological staining analysis. This method can be additionally used to accomplish the classification purposes of renal tumor subtypes and grades with an accuracy of 86.79% and 89.53%, respectively. Therefore, we prove that Raman spectroscopy has great potential in the rapid and accurate clinical diagnosis of renal cancers.
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Affiliation(s)
- Chang He
- State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China
| | - Xiaorong Wu
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, PR China
| | - Jiale Zhou
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, PR China
| | - Yonghui Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, PR China.
| | - Jian Ye
- State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, PR China.
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Ambrosi F, Ricci C, Malvi D, Cillia CD, Ravaioli M, Fiorentino M, Cardillo M, Vasuri F, D'Errico A. Pathological features and outcomes of incidental renal cell carcinoma in candidate solid organ donors. Kidney Res Clin Pract 2020; 39:487-494. [PMID: 32855366 PMCID: PMC7770991 DOI: 10.23876/j.krcp.20.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background We report the findings of a single Italian center in the evaluation of renal lesions in deceased donors from 2001 to 2017. In risk evaluation, we applied the current Italian guidelines, which include donors with small (< 4 cm, stage pT1a) renal carcinomas in the category of non-standard donors with a negligible risk of cancer transmission. Methods From the revision of our registries, 2,406 donors were considered in the Emilia Romagna region of Italy; organs were accepted from 1,321 individuals for a total of 3,406 organs. Results The evaluation of donor safety required frozen section analysis for 51 donors, in which a renal suspicious lesion was detected by ultrasound. Thirty-two primary renal tumors were finally diagnosed 26 identified by frozen sections and 6 in discarded kidneys. The 32 tumors included 13 clear cell renal cell carcinomas (RCCs), 6 papillary RCCs, 6 angiomyolipomas, 5 oncocytomas, 1 chromophobe RCC, and 1 papillary adenoma. No cases of tumor transmission were recorded in follow-up of the recipients. Conclusion Donors with small RCCs can be accepted to increase the donor pool. Collaboration in a multidisciplinary setting is fundamental to accurately evaluate donor candidate risk assessment and to improve standardized protocols for surgeons and pathologists.
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Affiliation(s)
- Francesca Ambrosi
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Costantino Ricci
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Deborah Malvi
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo De Cillia
- Emilia-Romagna Transplant Reference Centre, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Transplant Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | - Francesco Vasuri
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonia D'Errico
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Sheckley F, Nobert C, Stifelman M. Right Renal Pelvis Renal Cell Carcinoma Mimicking Transitional Cell Carcinoma: Case Report. J Endourol Case Rep 2020; 6:536-539. [PMID: 33457723 DOI: 10.1089/cren.2020.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Renal cell carcinoma (RCC) originates from the renal parenchyma, whereas transitional cell carcinoma (TCC) originates from the renal urothelium. Although renal pelvis TCC is relatively rare in terms of urologic malignancies, it is the most common tumor originating in renal pelvis. Case presentation: A 75-year-old woman presented with gross hematuria found to have a filling defect in the renal pelvis with retrograde pyelogram and cytology showed clusters of urothelial cells, with imaging suspicious for TCC. Patient underwent robotic nephroureterectomy with partial cystectomy. Pathology analysis revealed RCC. Conclusion: RCC may occur in the renal pelvis mimicking TCC. Extensive preoperative evaluation to accurately diagnose tumor is key to avoid unnecessary procedures. Intraoperative pathologic evaluation is emphasized with inconclusive preoperative results.
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Affiliation(s)
- Fahad Sheckley
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Craig Nobert
- Department of Urology, Mount Sinai Health System, New York, New York, USA
| | - Michael Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA.,Department of Urology, John Theurer Cancer Center, Hackensack, New Jersey, USA
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Elfer KN, Sholl AB, Wang M, Tulman DB, Mandava SH, Lee BR, Brown JQ. DRAQ5 and Eosin ('D&E') as an Analog to Hematoxylin and Eosin for Rapid Fluorescence Histology of Fresh Tissues. PLoS One 2016; 11:e0165530. [PMID: 27788264 PMCID: PMC5082869 DOI: 10.1371/journal.pone.0165530] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/13/2016] [Indexed: 01/17/2023] Open
Abstract
Real-time on-site histopathology review of biopsy tissues at the point-of-procedure has great potential for significant clinical value and improved patient care. For instance, on-site review can aid in rapid screening of diagnostic biopsies to reduce false-negative results, or in quantitative assessment of biospecimen quality to increase the efficacy of downstream laboratory and histopathology analysis. However, the only currently available rapid pathology method, frozen section analysis (FSA), is too time- and labor-intensive for use in screening large quantities of biopsy tissues and is too destructive for maximum tissue conservation in multiple small needle core biopsies. In this work we demonstrate the spectrally-compatible combination of the nuclear stain DRAQ5 and the anionic counterstain eosin as a dual-component fluorescent staining analog to hematoxylin and eosin intended for use on fresh, unsectioned tissues. Combined with optical sectioning fluorescence microscopy and pseudo-coloring algorithms, DRAQ5 and eosin (“D&E”) enables very fast, non-destructive psuedohistological imaging of tissues at the point-of-acquisition with minimal tissue handling and processing. D&E was validated against H&E on a one-to-one basis on formalin-fixed paraffin-embedded and frozen section tissues of various human organs using standard epi-fluorescence microscopy, demonstrating high fidelity of the staining mechanism as an H&E analog. The method was then applied to fresh, whole 18G renal needle core biopsies and large needle core prostate biospecimen biopsies using fluorescence structured illumination optical sectioning microscopy. We demonstrate the ability to obtain high-resolution histology-like images of unsectioned, fresh tissues similar to subsequent H&E staining of the tissue. The application of D&E does not interfere with subsequent standard-of-care H&E staining and imaging, preserving the integrity of the tissue for thorough downstream analysis. These results indicate that this dual-stain pseudocoloring method could provide a real-time histology-like image at the time of acquisition and valuable objective tissue analysis for the clinician at the time of service.
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Affiliation(s)
- Katherine N. Elfer
- Dept. of Biomedical Engineering, Tulane University, New Orleans, Louisiana, United States of America
| | - Andrew B. Sholl
- Dept. of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Mei Wang
- Dept. of Biomedical Engineering, Tulane University, New Orleans, Louisiana, United States of America
| | - David B. Tulman
- Dept. of Biomedical Engineering, Tulane University, New Orleans, Louisiana, United States of America
| | - Sree H. Mandava
- Dept. of Urology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Benjamin R. Lee
- Dept. of Urology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - J. Quincy Brown
- Dept. of Biomedical Engineering, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail:
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Lieberman L, Barod R, Tapper A, Kumar R, Rogers C. Robotic nephrectomy for central renal tumors with intraoperative evaluation of tumor histology. J Robot Surg 2016; 10:261-5. [PMID: 27146858 DOI: 10.1007/s11701-016-0596-6] [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: 04/03/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
Patients undergoing nephrectomy for central renal tumors suspicious for renal cell carcinoma (RCC) may carry a small risk of having transitional cell carcinoma (TCC) on final pathology, even in the absence of filling defects or abnormal cytology. We describe outcomes in such patients undergoing robotic nephrectomy for suspected RCC, with intraoperative specimen assessment to guide completion ureterectomy if TCC is present. Between September 2010 and August 2015, ten patients had central renal masses suspicious for RCC, which were not amenable to nephron-sparing surgery. Patients underwent a four-arm robotic nephrectomy technique using a GelPOINT(®) access port. Following hilar ligation, the ureter was divided between adjacent hem-o-lok clips, placed in an endocatch bag, and extracted through the GelPOINT incision for the frozen section analysis. If intraoperative assessment confirmed TCC, a robotic completion ureterectomy and a bladder cuff excision were performed. Of the ten patients with central tumors who underwent robotic nephrectomy for suspected RCC, four (40 %) had TCC on the frozen section analysis and underwent completion ureterectomy. Five patients had RCC, and one patient had an oncocytoma. Mean age was 63.1 years (49-76) and mean tumor size was 4.0 cm (1.9-7.6). Mean operating time was 246 min (135-328). All patients had negative margins. Mean length of stay was 2.5 days. No recurrences were documented at median 8.5 months follow-up. For patients undergoing robotic nephrectomy for central renal tumors, intraoperative specimen evaluation can help determine the need for minimally invasive completion ureterectomy.
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Affiliation(s)
- Leedor Lieberman
- Wayne State University School of Medicine, 540 E. Canfield Rd, Detroit, MI, USA
| | - Ravi Barod
- Vattikuti Urology Institute, Henry Ford Health Systems, 2799 W. Grand Blvd, Detroit, MI, USA
| | - Alex Tapper
- Wayne State University School of Medicine, 540 E. Canfield Rd, Detroit, MI, USA
| | - Ramesh Kumar
- Vattikuti Urology Institute, Henry Ford Health Systems, 2799 W. Grand Blvd, Detroit, MI, USA
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Health Systems, 2799 W. Grand Blvd, Detroit, MI, USA.
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8
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Pisarski P, Schleicher C, Hauser I, Becker JU. German recommendations for pretransplantation donor kidney biopsies. Langenbecks Arch Surg 2016; 401:133-40. [PMID: 26994917 DOI: 10.1007/s00423-016-1384-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/12/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE This manuscript reviews the data about the histopathologic and develops recommendations to standardise and improve the biopsy procedure, the biopsy handling, the histopathological evaluation, the communication of results and the collection of data from pretransplantation kidney biopsies of deceased donors in Germany. METHODS The recommendations are based on this literature review, on discussions at two workshops held by the German Society of Pathology and the German Organ Transplantation Foundation and on personal experiences of the authors. RESULTS These German recommendations advocate the use of punch biopsies, paraffin embedding and detailed descriptive reporting of histopathological findings. CONCLUSIONS These recommendations constitute only a starting point. Periodical revisions will help to simplify and optimise the recommendations with the ultimate goal to prospectively gather data for the elaboration of a computer-based algorithm that allows the exact prediction of transplantation outcome for a given match of donor and recipient.
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Affiliation(s)
- Przemyslav Pisarski
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany
| | | | - Ingeborg Hauser
- Medical Clinic III, Nephrology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan U Becker
- Institute of Pathology, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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Reder NP, Maxwell SP, Pambuccian SE, Barkan GA. Diagnostic accuracy of intraoperative frozen sections during radical cystectomy does not affect disease-free or overall survival: a study of 364 patients with urothelial carcinoma of the urinary bladder. Ann Diagn Pathol 2015; 19:107-12. [DOI: 10.1016/j.anndiagpath.2015.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
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El Aouni N, François H, Frangie C, Guettier C, Ferlicot S. [An unusual kidney lesion in a renal transplant]. Ann Pathol 2010; 30:156-8. [PMID: 20451078 DOI: 10.1016/j.annpat.2010.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 01/12/2010] [Accepted: 02/03/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Nadra El Aouni
- Service d'anatomie et de cytologie pathologiques, CHU de Bicêtre, AP-HP, université Paris-Sud 11, 78, rue du Général-Leclerc, 94275 Le Kremlin Bicêtre cedex, France
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Rioux-Leclercq N. [Importance of the macroscopic examination and histologic report in the therapeutic management of kidney tumors]. Ann Pathol 2009; 29 Spec No 1:S40-4. [PMID: 19887249 DOI: 10.1016/j.annpat.2009.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Nathalie Rioux-Leclercq
- Service d'anatomie et cytologie pathologiques, pôle cellules et tissus, CHU Pontchaillou, CNRS/UMR 6061, IFR 140, faculté de médecine, université de Rennes-1, rue Henri-le-Guilloux, Rennes cedex, France.
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12
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Chen VH, Mayes JM, Madden JF, Stein AJ, Mouraviev V, Polascik TJ. The Effect of Cryoablation on the Histologic Interpretation of Intraoperative Biopsy of Small Clear Cell Renal Carcinoma and Renal Oncocytoma. J Endourol 2008; 22:1617-21. [DOI: 10.1089/end.2008.0156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Valerie H. Chen
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Janice M. Mayes
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John F. Madden
- Department of Pathology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alexandra J. Stein
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vladimir Mouraviev
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas J. Polascik
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Lam JS, Bergman J, Breda A, Schulam PG. Importance of surgical margins in the management of renal cell carcinoma. ACTA ACUST UNITED AC 2008; 5:308-17. [DOI: 10.1038/ncpuro1121] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 03/20/2008] [Indexed: 02/02/2023]
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Algaba F, Arce Y, Santaularia JM, Villavicencio Mavrich H. [Frozen section in urological oncology]. Actas Urol Esp 2008; 31:945-56. [PMID: 18257364 DOI: 10.1016/s0210-4806(07)73758-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The indications of Frozen section diagnosis (FS) in surgery due to urologic neoplasia are quite specific, and this explains the fact that they amount to a mere 7.3% of the FSs performed in general hospitals. This also makes the knowledge of their usefulness necessary, and thus we are submitting the present review. Generally speaking, FS is not warranted to identify the nature of a tumoral mass, with the following exceptions: (1) Renal masses of a doubtf ul parenchymal origin, or in the urinary tract: (2) Intesticular neoplasias,when the possibility of a conservative treatment arises; (3) Determination of the presence of a prostate adenocarcinoma in an organ donor with high serum PSA; but even in these circumstances its need is widely controversial. Intraoperative determination of surgical margins is particularly useful in: (1) Partial nephrectomies (it may be limited to inspection after dyeing the margin with Indian ink--bed freezing is very seldom needed); (2) Urethral margins in women with total cystectomies and orthotopic substitution; (3) In partial penectomies (always studying the urethral margin and the cavernosal and spongIosal corpora margins). The study of the nodes is a widely debated issue, and except for those cases in which unexpectedly increased node size is found, systematic FS is indicated neither of the bladder nor of the prostate. The situation regarding penis carcinoma is different, as in the groups with intermediate and high risk of node metastasis, even though there is around 16%-18% of false negatives FS is recommended, particularly of radioisotope-marked sentinel nodes.
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Affiliation(s)
- F Algaba
- Sección de Patología, Fundación Puigvert, Barcelona.
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15
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Miller DC, Shah RB, Bruhn A, Madison R, Saigal CS. Trends in the use of gross and frozen section pathological consultations during partial or radical nephrectomy for renal cell carcinoma. J Urol 2008; 179:461-7; discussion 467. [PMID: 18076929 DOI: 10.1016/j.juro.2007.09.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE There is no consensus regarding the role of intraoperative pathological consultation during kidney cancer surgery. Accordingly intraoperative pathological consultation use is susceptible to variation based on nonclinical factors. We explored this hypothesis by evaluating national trends in the use of intraoperative pathological consultation during radical or partial nephrectomy with time, across regions, and by patient and provider characteristics. MATERIALS AND METHODS Using linked Surveillance, Epidemiology and End Results-Medicare data we identified a cohort of patients who underwent partial or radical nephrectomy from 1991 to 2002. In each case we ascertained corresponding Medicare claims for gross and/or frozen section intraoperative pathological consultation. We assessed variations in the use of intraoperative pathological consultation by year of treatment and geographic region as well as by patient and provider characteristics. RESULTS We identified 7,507 cases treated with partial (600 or 8.0%) or radical (6,907 or 92.0%) nephrectomy from 1991 through 2002. Of cases treated with radical nephrectomy 744 (10.8%) and 843 (12.2%) received gross and frozen section intraoperative pathological consultation, respectively. Of cases treated with partial nephrectomy 67 (11.2%) had an intraoperative gross consultation and 323 (53.8%) had a frozen section evaluation. Use of intraoperative pathological consultation (gross or frozen section) during partial and radical nephrectomy varied based on patient demographics, United States Census region, and Surveillance, Epidemiology and End Results registry (p <0.05). Intraoperative pathological consultation during radical nephrectomy differed by year of treatment (p <0.05). Intraoperative pathological consultation use also varied based on provider characteristics (p <0.05). CONCLUSIONS Intraoperative pathological consultation use during kidney cancer surgery varies with time, across geographic regions and based on patient demographics and broadly defined provider characteristics. These data provide context for future studies seeking to refine the use of intraoperative pathological consultation in this clinical setting.
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Affiliation(s)
- David C Miller
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
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Lum DJ, Upadhyay V, Smith A, McFarlane J. Botryoid fibroepithelial polyp of the urinary bladder. A clinicopathological case report including frozen section findings. Histopathology 2007; 51:704-7. [PMID: 17825058 DOI: 10.1111/j.1365-2559.2007.02817.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D J Lum
- Department of Histopathology, Auckland City Hospital, Auckland, New Zealand
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Breda A, Stepanian SV, Liao J, Lam JS, Guazzoni G, Stifelman M, Perry K, Celia A, Breda G, Fornara P, Jackman S, Rosales A, Palou J, Grasso M, Pansadoro V, Disanto V, Porpiglia F, Milani C, Abbou C, Gaston R, Janetschek G, Soomro NA, de la Rosette J, Laguna MP, Schulam PG. Positive margins in laparoscopic partial nephrectomy in 855 cases: a multi-institutional survey from the United States and Europe. J Urol 2007; 178:47-50; discussion 50. [PMID: 17574057 DOI: 10.1016/j.juro.2007.03.045] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Indexed: 12/17/2022]
Abstract
PURPOSE Open partial nephrectomy has emerged as the standard of care in the management of renal tumors smaller than 4 cm. While laparoscopic radical nephrectomy has been shown to be comparable to open radical nephrectomy with respect to long-term outcomes, important questions remain unanswered regarding the oncological efficacy of laparoscopic partial nephrectomy. We examined the practice patterns and pathological outcomes following laparoscopic partial nephrectomy. MATERIALS AND METHODS A survey was sent to academic medical centers in the United States and in Europe performing laparoscopic partial nephrectomy. The total number of laparoscopic partial nephrectomies, positive margins, indications for intraoperative frozen biopsy as well as tumor size and position were queried. RESULTS Surveys suitable for analysis were received from 17 centers with a total of 855 laparoscopic partial nephrectomy cases. Mean tumor size was 2.7 cm (+/-0.6). There were 21 cases with positive margins on final pathology, giving an overall positive margin rate of 2.4%. Intraoperative frozen sections were performed selectively at 10 centers based on clinical suspicion of positive margins on excised tumor. Random biopsies were routinely performed on the resection bed at 5 centers. Frozen sections were never performed at 2 centers. Of the 21 cases with positive margins 14 underwent immediate radical nephrectomy based on the frozen section and 7 were followed expectantly. CONCLUSIONS Early experience with laparoscopic partial nephrectomy in this multicenter study demonstrates oncological efficacy comparable to that of open partial nephrectomy with respect to the incidence of positive margins. The practice of intraoperative frozen sections varied among centers and is not definitive in guiding the optimal surgical treatment.
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Affiliation(s)
- A Breda
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California 90095, USA, and San Raffaele Hospital, Milan, Italy.
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Abstract
Intraoperative cytopathology is faster, less labor intensive, yields clearer cellular details and can be as accurate as frozen section in the hands of pathologists experienced in the interpretation of cytological preparations. This procedure is particularly valuable for examining small specimens, multiple samples that need to be examined rapidly, and when superior cytological details are required. Nonetheless its use seems to be relatively limited. In this article, we review the general requirements for intraoperative cytology and also detail its value, as well as its limitations and pitfalls.
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Affiliation(s)
- Geneviève Belleannée
- Service d'Anatomie et de Cytologie Pathologiques, CHU Bordeaux, Hôpital Haut-Lévêque, Avenue de Magellan, 33604 Pessac cedex.
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Bozas G, Tassidou A, Moulopoulos LA, Constandinidis C, Bamias A, Dimopoulos MA. Non-Hodgkin's lymphoma of the renal pelvis. ACTA ACUST UNITED AC 2006; 6:404-6. [PMID: 16640818 DOI: 10.3816/clm.2006.n.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Primary lymphoma of the upper urinary tract is an extremely rare entity without specific clinical or laboratory findings. Thus, this particular diagnosis is rarely anticipated and might well be reached only after nephroureterectomy. We describe a patient with primary follicular and diffuse follicle center lymphoma arising in the renal pelvis that was treated with surgery and postoperative immunochemotherapy. Furthermore, we review the literature regarding the treatment and outcome of this rare disease.
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Affiliation(s)
- George Bozas
- Department of Medical Therapeutics, University of Athens, Medical School, Alexandra Hospital, Greece
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