P5-11-03: Real-Time Imaging of Human Breast Tissue with Reflectance Confocal Microscopy: Correlation with Routine Pathology

Background: Near-infrared reflectance confocal microscopy (RCM) allows for immediate noninvasive 3-D optical sectioning of opaque objects, such as human tissue, without using the potentially destructive staining and fixing methods used with routine pathology. Recently, RCM has been used to differentiate between malignant and non-malignant dermatologic conditions. We hypothesize that this technique can be used to efficiently and reliably evaluate human breast tissue for the presence of malignancy without compromising the ability to perform routine immunohistochemical (IHC) analyses that accompany the diagnosis of invasive breast cancer.

Methods: 45 core needle breast biopsies (12mmx2mm) were collected under sonographic guidance. Biopsy specimens were immediately placed in phosphate buffered saline, injected with 5% acetic acid to enhance reflectivity of the nuclei, and imaged within 5–10 minutes. Digital images of the nuclear and cellular morphology from each intact specimen were acquired and catalogued within 1 hour of biopsy using the VivaCell 5000. Tissue samples were then formalin-fixed and sectioned for routine H&E evaluation or IHC assays. A board certified pathologist trained on 16 paired RCM images and H&E slides was given the blinded test set created from these 45 breast biopsies and asked to evaluate the RCM images for the presence of carcinoma. Preliminary evaluation was also done on 5 biopsy samples with known estrogen receptor (ER) and progesterone receptor (PR) status to determine the feasibility of assessing ER/PR on tissue treated with acetic acid for RCM.

Results: Routine H&E staining identified invasive carcinoma 10/45 biopsy samples (9 invasive ductal [IDC], 1 invasive lobular [ILC]); 2 specimens with IDC also contained ductal carcinoma in situ (DCIS). Evaluation of the RCM images led to the same diagnosis of invasive carcinoma vs. not in all 45 samples and correctly identified 6/9 IDC and 1/1 ILC. RCM correctly identified 1/2 specimens known to contain DCIS. RCM misclassified 3 IDC as DCIS (1), ILC (1), or lobular carcinoma in situ (1), and 1 DCIS as ILC. With respect to the determination of ER/PR status, RCM accurately assessed positivity for both receptors in all 5 specimens.

Conclusions: RCM is comparable to standard microscopy for the reliable identification of carcinoma, and the ability to evaluate breast tissue for malignancy using this technology allows for real-time pathology and may negate the need for repeat diagnostic biopsies to ensure adequate sampling for diagnosis. Importantly, the ability to perform routine IHC for ER/PR status after tissue processing for RCM appears to be preserved. Further evaluation applying the existing technology to a larger sample size for histopathologic correlation, assessment of ER/PR status, and evaluation for HER2 status are planned. These encouraging findings support interest in tailoring RCM for breast tissue to improve the ability to distinguish between invasive vs. in situ disease, and ductal vs. lobular histology.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-03.

CD5 immunoreactivity of epithelial cells in thymic carcinoma and CASTLE using paraffin-embedded tissue

Because the histologic features may resemble those of other mediastinal malignancies, thymic carcinoma can be difficult to diagnose, particularly if the primary site is uncertain. In an effort to facilitate this diagnosis, the authors have evaluated the use of immunohistochemistry with an antibody to CD5 (NCL-CD5). Nine thymic carcinomas, 15 thymomas, 8 lymphomas, 10 poorly differentiated lung carcinomas, 10 breast carcinomas, 1 mediastinal seminoma, and 1 thyroid carcinoma showing thymus-like differentiation (CASTLE) were studied. Four of 9 poorly differentiated carcinomas of the thymus were CD5 positive. The one CASTLE was CD5 positive. All other tumors were negative. CD5-positive lymphocytes were internal controls in every case. CD5 labels some thymic carcinomas in paraffin-embedded tissue, whereas other tumors studied were negative. CD5 immunoreactivity of CASTLE appears to support thymic derivation of this tumor.

Cytokeratins 7 and 20 and carcinoembryonic antigen in ovarian and colonic carcinoma

The histologic distinction between adenocarcinoma primary to the ovary and metastatic to the ovary can be difficult. In an effort to facilitate this distinction, we have evaluated the use of immunohistochemical techniques with antibodies to cytokeratins 7 and 20, along with antibodies to carcinoembryonic antigen. We studied 24 primary ovarian adenocarcinomas, 11 colonic adenocarcinomas metastatic to the ovary, and 10 primary adenocarcinomas of the colon. Four ovarian adenocarcinomas metastatic to the colon were also studied. All but one of the primary and metastatic colonic carcinomas were negative for cytokeratin 7, whereas all the primary and metastatic ovarian carcinomas were positive for cytokeratin 7. The tumors metastatic to the ovary were all positive for cytokeratin 20 and carcinoembryonic antigen. Among the primary ovarian carcinomas, none of six serous tumors, three of seven endometrioid tumors, and three of 11 mucinous tumors were positive for cytokeratin 20. Ten of the primary ovarian tumors were negative for carcinoembryonic antigen using both monoclonal and polyclonal antibodies. One of the ovarian tumors was negative for carcinoembryonic antigen with the monoclonal antibody but positive using the polyclonal antibody. Cytokeratin 7 is the most helpful marker in the distinction between primary ovarian carcinoma and colonic carcinoma metastatic to the ovary.

Quantitative measurement of normal and excessive (cor adiposum) subepicardial adipose tissue, its clinical significance, and its effect on electrocardiographic QRS voltage

In summary, adipose tissue in the heart may constitute up to 50% of the cardiac weight. The greater amounts of cardiac adipose tissue are associated with lower total 12-lead QRS voltages.

Degrees of coronary arterial narrowing at necropsy in men with large fusiform abdominal aortic aneurysm

In 27 patients (mean age at death 72 +/- 9 years) with abdominal aortic aneurysm (AAA) > or = 5.0 cm in its widest transverse diameter, the amounts of narrowing at necropsy in the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries were determined. During life, 12 of the 27 patients (44%) had symptoms of myocardial ischemia: angina pectoris alone in 2, acute myocardial infarction alone in 3, angina pectoris and acute myocardial infarction in 5, and sudden coronary death in 2. Ten of the 27 patients (37%) died from consequences of myocardial ischemia. Six (22%) died from rupture of the AAA. Grossly visible left ventricular necrosis or fibrosis, or both, was present in 15 patients (56%). Of the 27 patients, 23 (85%) had narrowing 76 to 100% in cross-sectional area of 1 or more major coronary arteries by atherosclerotic plaque. The mean number of coronary arteries per patient severely (> 75%) narrowed was 2.0 +/- 1.3/4.0. Of the 108 major coronary arteries in the 27 patients, 55 (51%) were narrowed > 75% in cross-sectional area by plaque. The 4 major coronary arteries in the 27 patients were divided into 5-mm segments and a histologic section, stained by the Movat method, was prepared from each segment. The mean percentages of the resulting 1,475 five-mm segments narrowed in cross-sectional area 0 to 25%, 26 to 50%, 51 to 75%, 76 to 95% and 96 to 100% were 17, 37, 28, 15 and 3%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)