Study shows potential for digital microscopy for real-time accurate evaluation to aid acquisition of high quality tissue
Strategies to procure high-quality core-needle biopsy (CNB) specimens are critical for making basic tissue diagnoses and for ancillary testing. A study at MD Anderson shows the potential of a diagnostic tool called fluorescence confocal digital microscopy (FCM) for rapid and accurate diagnosis.
Results from the study, published in the March 5 issue of JAMA Network Open, demonstrated the utility of next-generation digital microscopy for providing fast and accurate evaluation of core-needle biopsy.
“Interventional radiology (IR)-guided core-needle biopsy is the most commonly used procedure for procuring tissue for the investigation of radiologically identified abnormalities in solid organs,” says Savitri Krishnamurthy, M.D., professor of Pathology, and lead author on the paper. “A high-quality core-needle biopsy specimen with adequate cellularity representative of the lesion lays the foundation for success with basic diagnostic pathology reporting and for completion of the validated ancillary genomic and immunohistochemical testing that maybe required in selected patients for personalized medicine.”
Krishnamurthy’s prospective study is the first in medical practice to evaluate the use of fluorescence confocal digital microscopy for real-time, bedside ex vivo tissue imaging of IR-guided core-needle biopsy. The primary objectives of the study were to assess the ability to acquire fluorescence confocal digital microscopy images of core-needle biopsy tissue at the bedside in the radiology suite, and the accuracy of the diagnoses made using those FCM images compared with the criterion standard of histopathological examination of hematoxylin-eosin-stained CNB tissue sections.
The use of fluorescence confocal digital microscopy for real time bedside tissue evaluation warrants more research
Savitri Krishnamurthy, M.D.
The study assessed 105 patients between August 2016 and April 2019 who underwent IR-guided core-needle biopsies. The fluorescence confocal digital microscopy images were accurately interpreted in 101 of 105 cases (accuracy of 96.2%). Patients included 57 men and 48 women, with a mean age of 63 years. FCM imaging of IR-guided core-needle biopsies were from a variety of cancer sites including lung, liver, adrenal gland, kidney, bone, pleura, lymph node and soft tissue. The mean time from receipt of the specimen from the interventional radiologist to acquisition of fluorescence confocal digital microscopy images was 7 minutes.
“The ease of acquisition of FCM images of acceptable quality and the high accuracy of the diagnoses suggest that they may be useful for rapid evaluation of IR-guided core-needle biopsies in real-time at the bedside,” says Krishnamurthy. “This approach warrants further investigation.”
MD Anderson study participants included Rahul Sheth, M.D.; Alda Tam, M.D.; Marshall Hicks and Sanjay Gupta, M.D., all of Interventional Radiology; Kechen Ban, Ph.D.; Yun Wu, M.D., Ph.D.; of Pathology; Funda Meric-Bernstam, M.D., of Investigational Cancer Therapeutics; Kenna Shaw, Ph.D., of the Institute for Personalized Cancer Therapy; and Roland Bassett of Biostatistics. Researchers from Scripps Mercy Hospital, Oregon Health and Science University Knight Cancer Institute and City of Hope also participated in the study.
Fluorescence confocal digital microscopy pseudo-colored image of core needle biopsy of liver with metastatic adenocarcinoma that was acquired in three minutes in real-time at the bedside in the Interventional Radiology suite.