Nondestructive Diagnosis of Kidney Cancer on 18-gauge Core Needle Renal Biopsy Using Dual-color Fluorescence Structured Illumination Microscopy.
Nondestructive Diagnosis of Kidney Cancer on 18-gauge Core Needle Renal Biopsy Using Dual-color Fluorescence Structured Illumination Microscopy.
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DOI：
10.1016/j.urology.2016.08.036
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发表时间：
2016-12
期刊：
影响因子：
2.1
通讯作者：
Lee BR
中科院分区：
文献类型：
--
作者：
Liu J;Wang M;Tulman D;Mandava SH;Elfer KN;Gabrielson A;Lai W;Abshire C;Sholl AB;Brown JQ;Lee BR
肾活检在肾肿瘤评估中的作用不断发展，特别是随着精准医学和分子诊断测试的日益关注。我们提出了一种新颖的成像技术，使用双组分荧光染色和结构照明显微镜（SIM）对肾肿瘤进行快速、非破坏性的组织学评估。经机构审查委员会批准后，从 19 名接受部分或根治性肾切除术的患者体内切除的肾组织中获得了总共 65 份活检样本。活检标本用双组分荧光染料染色，并从完整活检表面获得光学切片 SIM 图像。随后使用标准苏木精和伊红 (H&E) 组织病理学方法对标本进行固定和分析，并与 SIM 图像进行比较。一位经过委员会认证的病理学家对标本不知情，检查了所有 SIM 图像和 H&E 载玻片，并确定是否存在肿瘤。 SIM 盲法诊断结果经过传统病理学验证。在 19 名患者中，15 名因临床 T1a/b 肾肿块接受机器人肾部分切除术，4 名患者接受腹腔镜根治性/单纯性肾切除术。适应症包括临床怀疑肾细胞癌，以及对肾脏无功能的患者进行医学肾脏疾病评估。总共 65 份活检标本可供审查。 H&E 确定 21 个标本为肿瘤，而 41 个标本为良性肾组织。我们研究的最终敏感性和特异性分别为 79.2% 和 95.1%。 SIM 是一项有前途的快速近患者离体肾活检评估技术。通过提高快速评估活检标本充足性的能力并实现即时诊断能力，SIM 有助于更有效地进行活检、组织分类以及有关管理选项的患者咨询。此外，由于组织被保存，下游诊断测试和分子评估的有效利用是可能的。
The role of renal biopsies has continually evolved in the assessment of renal tumors, particularly with the growing focus on precision medicine and molecular diagnostic tests. We present a novel imaging technique used for rapid, non-destructive histological assessment of renal neoplasia using a dual component fluorescence stain and structured illumination microscopy (SIM). After institutional review board approval, 65 total biopsies were obtained from 19 patients undergoing either partial or radical nephrectomy, from the ex-vivo resected renal tissue. Biopsy specimens were stained with a dual-component fluorescent stain and optically sectioned SIM images were obtained from the surface of the intact biopsies. Specimens were subsequently fixed and analyzed using standard hematoxylin and eosin (H&E) histopathologic methods and compared with the SIM images. A single, board-certified pathologist blinded to specimens reviewed all SIM images and H&E slides and determined presence or absence of neoplasia. Results of blinded diagnosis on SIM were validated against traditional pathology. Of the 19 patients, 15 underwent robotic partial nephrectomy for clinical T1a/b renal masses and 4 laparoscopic radical /simple nephrectomies. Indications included clinical suspicion of renal cell carcinoma, as well as a patient with non-functioning kidney to determine assessment of medical renal disease. In total 65 biopsy specimens were available for review. 21 specimens were determined to be neoplastic on H&E, while 41 represented benign renal tissue. The final sensitivity and specificity of our study was 79.2% and 95.1%, respectively. SIM is a promising technology for rapid- near-patient ex-vivo renal biopsy assessment. By improving the ability to rapidly assess sufficiency of biopsy specimens and enabling immediate diagnostic capability SIM aids in more effective biopsy performance, tissue triage, and patient counseling regarding management options. Additionally, because tissue is preserved, effective utilization of downstream diagnostic tests and molecular assessments are possible.
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