Nondestructive Diagnosis of Kidney Cancer on 18-gauge Core Needle Renal Biopsy Using Dual-color Fluorescence Structured Illumination Microscopy.
OBJECTIVE
To present a novel imaging technique used for rapid, nondestructive histological assessment of renal neoplasias using a dual-component fluorescence stain and structured illumination microscopy (SIM).


METHODS
After Institutional Review Board approval, 65 total biopsies were obtained from 19 patients undergoing partial or radical nephrectomy. Biopsies were stained with a dual-component fluorescent, and optically sectioned SIM images were obtained from the surface of the intact biopsies. Specimens were subsequently fixed and analyzed using hematoxylin and eosin (H&E) histopathologic methods and compared with SIM images. A single, board-certified pathologist blinded to specimens reviewed all SIM images and H&E slides, and determined the presence or absence of neoplasias. Results of blinded diagnosis of SIM were validated against traditional pathology.


RESULTS
Of the 19 patients, 15 underwent robotic partial nephrectomies and 4 underwent laparoscopic nephrectomies. Indications included clinical suspicion of renal cell carcinoma. In total, 65 biopsy specimens were available for review. Twenty-one specimens were determined to be neoplastic on H&E, whereas 41 represented benign renal tissue. The final sensitivity and specificity of our study were 79.2% and 95.1%, respectively.


CONCLUSIONS
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.
Department of Urology, Tulane University School of Medicine, New Orleans, LA.
James
J
Liu
Department of Biomedical Engineering, Tulane University, New Orleans, LA.
Mei
M
Wang
Department of Biomedical Engineering, Tulane University, New Orleans, LA.
David
D
Tulman
Department of Urology, Tulane University School of Medicine, New Orleans, LA.
Sree H
SH
Mandava
Department of Biomedical Engineering, Tulane University, New Orleans, LA.
Katherine N
KN
Elfer
Department of Urology, Tulane University School of Medicine, New Orleans, LA.
Andrew
A
Gabrielson
Department of Urology, Tulane University School of Medicine, New Orleans, LA.
Weil
W
Lai
Department of Urology, Tulane University School of Medicine, New Orleans, LA.
Caleb
C
Abshire
Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA.
Andrew B
AB
Sholl
Department of Biomedical Engineering, Tulane University, New Orleans, LA.
J Quincy
JQ
Brown
Division of Urology, University of Arizona College of Medicine, Tucson, AZ. Electronic address: brlee@surgery.arizona.edu.
Benjamin R
BR
Lee
D000328:Adult; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004867:Equipment Design; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007680:Kidney Neoplasms / Q000175:diagnosis*; D008297:Male; D008856:Microscopy, Fluorescence / Q000379:methods*; D008875:Middle Aged