title: Gigapixel surface imaging of radical prostatectomy specimens for comprehensive detection of cancer-positive surgical margins using structured illumination microscopy.
abstract: Achieving cancer-free surgical margins in oncologic surgery is critical to reduce the need for additional adjuvant treatments and minimize tumor recurrence; however, there is a delicate balance between completeness of tumor removal and preservation of adjacent tissues critical for normal post-operative function. We sought to establish the feasibility of video-rate structured illumination microscopy (VR-SIM) of the intact removed tumor surface as a practical and non-destructive alternative to intra-operative frozen section pathology, using prostate cancer as an initial target. We present the first images of the intact human prostate surface obtained with pathologically-relevant contrast and subcellular detail, obtained in 24 radical prostatectomy specimens immediately after excision. We demonstrate that it is feasible to routinely image the full prostate circumference, generating gigapixel panorama images of the surface that are readily interpreted by pathologists. VR-SIM confirmed detection of positive surgical margins in 3 out of 4 prostates with pathology-confirmed adenocarcinoma at the circumferential surgical margin, and furthermore detected extensive residual cancer at the circumferential margin in a case post-operatively classified by histopathology as having negative surgical margins. Our results suggest that the increased surface coverage of VR-SIM could also provide added value for detection and characterization of positive surgical margins over traditional histopathology.
authors.affiliation: Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA.
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.affiliation: Bioinnovation Program, Tulane University, New Orleans, LA 70118, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Tulman
authors.affiliation: Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Sholl
authors.affiliation: Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Hillary Z
authors.initials: HZ
authors.lastname: Kimbrell
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Sree H
authors.initials: SH
authors.lastname: Mandava
authors.affiliation: Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA.
authors.forename: Katherine N
authors.initials: KN
authors.lastname: Elfer
authors.affiliation: Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Luethy
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Maddox
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Weil
authors.initials: W
authors.lastname: Lai
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Lee
authors.affiliation: Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA.
authors.forename: J Quincy
authors.initials: JQ
authors.lastname: Brown
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D005629:Frozen Sections / Q000379:methods; D006801:Humans; D008029:Lighting / Q000379:methods; D008297:Male; D000072662:Margins of Excision; D008853:Microscopy / Q000379:methods; D018715:Microscopy, Video / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology*