Rapid assessment of prostate core biopsy pathology at the point-of-procedure could provide benefit in a variety of clinical situations. Even with advanced trans-rectal ultrasound guidance and saturation biopsy protocols, prostate cancer can be missed in up to half of all initial biopsy procedures.
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In addition, collection of tumor specimens for downstream histological, molecular, and genetic analysis is hindered by low tumor yield due to inability to identify prostate cancer grossly. However, current point-of-procedure pathology protocols such as frozen section analysis (FSA) are destructive, and too time- and labor-intensive to be practical or economical. Ex vivo microscopy of the excised specimens, stained with fast-acting fluorescent histology dyes, could be an attractive non-destructive alternative to FSA. In this work, we report the first demonstration of video-rate structured illumination microscopy (VR-SIM) for rapid high-resolution diagnostic imaging of prostate biopsies in realistic point-of-procedure timeframes. Large mosaic images of prostate biopsies stained with acridine orange are rendered in seconds, and contain excellent contrast and detail, exhibiting close correlation with corresponding H&E histology. A clinically-relevant review of VR-SIM images of 34 unfixed and uncut prostate core biopsies by two independent pathologists resulted in an area under the ROC curve (AUC) of 0.82-0.88, with a sensitivity ranging from 63-88% and a specificity ranging from 78-89%. When biopsies contained more than 5% tumor content, the sensitivity improved to 75-92%. The image quality, speed, minimal complexity, and ease of use of VR-SIM could prove to be features in favor of adoption as an alternative to destructive pathology at the point-of-procedure.
Cancer research 2015 Aug 17 [Epub ahead of print]
Mei Wang, Hillary Z Kimbrell, Andrew B Sholl, David B Tulman, Katherine N Elfer, Tyler C Schlichenmeyer, Benjamin R Lee, Michelle Lacey, J Quincy Brown
Biomedical Engineering, Tulane University , Pathology and Laboratory Medicine, Tulane University School of Medicine , Pathology and Laboratory Medicine, Tulane University School of Medicine , Bioinnovation Program, Tulane University , Biomedical Engineering, Tulane University , Biomedical Engineering, Tulane University , Urology, Tulane University School of Medicine , Mathematics, Tulane University , Department of Biomedical Engineering, Tulane University