Partial nephrectomy margin imaging using structured illumination microscopy

Partial nephrectomy (PN) is the recommended procedure over radical nephrectomy (RN) for patients with renal masses < 4 cm in diameter (Stage T1a). Patients with > 4 cm renal masses can also be treated with PN, but have a higher risk for positive surgical margins. Positive surgical margins (PSM), when present, are indicative of poor clinical outcomes. The current gold-standard histopathology method is not well-suited for the identification of PSM intra-operatively due to processing time and destructive nature. Here, video-rate structured illumination microscopy (VR-SIM) was investigated as a potential tool for PSM detection during PN. A clinical image atlas assembled from ex vivo renal biopsies provided diagnostically useful images of benign and malignant kidney, similar to permanent histopathology. VR-SIM was then used to image entire parenchymal margins of tumor resection covering up to >1,800× more margin surface area than standard histology. Aided by the image atlas, the study pathologist correctly classified all parenchymal margins as negative for PSM with VR-SIM, compared to standard post-operative pathology. The ability to evaluate large surgical margins in a short timeframe with VR-SIM may allow it to be used intra-operatively as a "safety net" for PSM detection, allowing more patients to undergo PN over RN.

Journal of biophotonics. 2017 Aug 21 [Epub ahead of print]

Mei Wang, David B Tulman, Andrew B Sholl, Sree H Mandava, Michael M Maddox, Benjamin R Lee, J Quincy Brown

Department of Biomedical Engineering, Tulane University, New Orleans, LA, 70118., Bioinnovation Program, Tulane University, New Orleans, LA, 70118., Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA, 70112., Department of Urology, Tulane University School of Medicine, New Orleans, LA, 70112., Division of Urology, University of Arizona College of Medicine, Tucson, AZ, 85724.