Rapid On-Site Microscopy and Mapping of Diagnostic Biopsies for See-And-Treat Guidance of Localized Prostate Cancer Therapy.
Rapid On-Site Microscopy and Mapping of Diagnostic Biopsies for See-And-Treat Guidance of Localized Prostate Cancer Therapy.
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局部消融是一种新兴的前列腺癌治疗方法，可最大限度地缩短恢复时间并改善功能保留。然而，诊断性前列腺活检的标准组织学处理目前进行得太晚，以至于不能在诊断性活检程序时通知局部病变的治疗。我们研究了结构照明显微镜（SIM）作为一种辅助工具，以确认恶性肿瘤的新鲜前列腺活检的局部前列腺癌的未来“看和治疗”的范例的可行性。两名病理学家对46例活检进行了评估，结果分别为92%和87%的总体诊断准确率。在提出的“临床决策树”中，将来自MRI融合图像的泌尿科医生预测与来自SIM图像的诊断进行比较，这表明SIM反馈将建设性地告知局部前列腺癌的现场干预并确认边缘。我们证明，通过SIM生成和诊断假苏木精和伊红活检图像所需的过程可以在15分钟内完成。前列腺癌仍然是男性中诊断最多的非皮肤恶性肿瘤。虽然多达八分之一的男性在其一生中会被诊断出患有此病，但大多数诊断并不致命。更好的病变定位准确性与新兴的局部治疗方法相结合，越来越多地被用作一种治疗选择，以保护合格患者的健康功能。在定位前列腺内通常<2cc的病变（平均尺寸45cc）时，MRI确定的边界的小变化、肿瘤异质性、包括病变位置和前列腺钙化的患者特征以及手术期间的患者运动可能会抑制用于诊断的准确采样。活检的位置被记录下来，然后通过组织学进行全面处理，并通过病理学进行诊断，通常是几天到几周后。利用实时反馈可以提高准确性，可能防止重复手术，并允许患者在早期阶段接受临床局部疾病的治疗。不幸的是，目前没有可靠的实时反馈过程来确认活检样本的诊断。我们研究了实施结构照明显微镜（SIM）作为现场诊断活检成像方法的可行性，以潜在地联合收割机前列腺癌患者的诊断和治疗预约，或确认肿瘤边缘的局部消融手术。我们使用定制的SIM系统和双色荧光苏木精和伊红（H&E）类似物对39例接受图像引导诊断活检的患者的活检组织进行成像。活检图像的平均尺寸为342兆像素（最小78.1，最大842），平均成像持续时间为145秒（最小56，最大322）。比较泌尿科医师基于MRI的恶性肿瘤怀疑与病理学家在真实的时间内获得的活检图像的诊断，揭示了实时活检成像可以显著改善恶性肿瘤或肿瘤边缘的确认，而不是单独的医学成像。
Localized ablation is an emerging treatment for prostate cancer that minimizes recovery time and improves functional retention. However, standard histological processing of diagnostic prostate biopsies is currently performed too late to inform the treatment of localized lesions at the time of the diagnostic biopsy procedure. We investigated the feasibility of structured illumination microscopy (SIM) as an adjunct tool to confirm malignancy in fresh prostate biopsies for a future “see-and-treat” paradigm of localized prostate cancer. Forty-six biopsies were assessed by two pathologists, resulting in 92% and 87% overall diagnostic accuracies, respectively. In a proposed “clinical decision tree”, urologist predictions from MRI fusion images were compared to diagnoses from SIM images, which demonstrated that SIM feedback would constructively inform on-site intervention of localized prostate cancer and confirm margins. We demonstrated that the process necessary to generate and diagnose pseudo-hematoxylin and eosin biopsy images via SIM can be achieved in well under 15 minutes. Prostate cancer continues to be the most diagnosed non-skin malignancy in men. While up to one in eight men will be diagnosed in their lifetimes, most diagnoses are not fatal. Better lesion location accuracy combined with emerging localized treatment methods are increasingly being utilized as a treatment option to preserve healthy function in eligible patients. In locating lesions which are generally <2cc within a prostate (average size 45cc), small variance in MRI-determined boundaries, tumoral heterogeneity, patient characteristics including location of lesion and prostatic calcifications, and patient motion during the procedure can inhibit accurate sampling for diagnosis. The locations of biopsies are recorded and are then fully processed by histology and diagnosed via pathology, often days to weeks later. Utilization of real-time feedback could improve accuracy, potentially prevent repeat procedures, and allow patients to undergo treatment of clinically localized disease at earlier stages. Unfortunately, there is currently no reliable real-time feedback process for confirming diagnosis of biopsy samples. We examined the feasibility of implementing structured illumination microscopy (SIM) as a method for on-site diagnostic biopsy imaging to potentially combine the diagnostic and treatment appointments for prostate cancer patients, or to confirm tumoral margins for localized ablation procedures. We imaged biopsies from 39 patients undergoing image-guided diagnostic biopsy using a customized SIM system and a dual-color fluorescent hematoxylin & eosin (H&E) analog. The biopsy images had an average size of 342 megapixels (minimum 78.1, maximum 842) and an average imaging duration of 145 s (minimum 56, maximum 322). Comparison of urologist’s suspicion of malignancy based on MRI, to pathologist diagnosis of biopsy images obtained in real time, reveals that real-time biopsy imaging could significantly improve confirmation of malignancy or tumoral margins over medical imaging alone.
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影响因子：
3.7
作者：
Giacomelli MG;Husvogt L;Vardeh H;Faulkner-Jones BE;Hornegger J;Connolly JL;Fujimoto JG
通讯作者：
Fujimoto JG
影响因子：
6.6
作者：
Lopez, Aristeo;Zlatev, Dimitar V.;Liao, Joseph C.
通讯作者：
Liao, Joseph C.
影响因子：
5.4
作者：
Marenco, Jose;Calatrava, Ana;Rubio, Jose
通讯作者：
Rubio, Jose
影响因子：
3.5
作者：
Gareau DS
通讯作者：
Gareau DS
影响因子：
3.5
作者：
Bertoni, Laura;Puliatti, Stefano;Montironi, Rodolfo
通讯作者：
Montironi, Rodolfo