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Investigation of confocal microscopy for differentiation of renal cell carcinoma versus benign tissue. Can an optical biopsy be performed?

Authors :
Michael C. Phung
Andrew R. Rouse
Jayce Pangilinan
Robert C. Bell
Erika R. Bracamonte
Sharfuddeen Mashi
Arthur F. Gmitro
Benjamin R. Lee
Source :
Asian Journal of Urology, Vol 7, Iss 4, Pp 363-368 (2020)
Publication Year :
2020
Publisher :
Elsevier, 2020.

Abstract

Objective: Novel optical imaging modalities are under development with the goal of obtaining an “optical biopsy” to efficiently provide pathologic details. One such modality is confocal microscopy which allows in situ visualization of cells within a layer of tissue and imaging of cellular-level structures. The goal of this study is to validate the ability of confocal microscopy to quickly and accurately differentiate between normal renal tissue and cancer. Methods: Specimens were obtained from patients who underwent robotic partial nephrectomy for renal mass. Samples of suspected normal and tumor tissue were extracted from the excised portion of the kidney and stained with acridine orange. The stained samples were imaged on a Nikon E600 C1 Confocal Microscope. The samples were then submitted for hematoxylin and eosin processing and read by an expert pathologist to provide a gold-standard diagnosis that can later be compared to the confocal images. Results: This study included 11 patients, 17 tissue samples, and 118 confocal images. Of the 17 tissue samples, 10 had a gold-standard diagnosis of cancer and seven were benign. Of 118 confocal images, 66 had a gold-standard diagnosis of cancer and 52 were benign. Six confocal images were used as a training set to train eight observers. The observers were asked to rate the test images on a six point scale and the results were analyzed using a web based receiver operating characteristic curve calculator. The average accuracy, sensitivity, specificity, and area under the empirical receiver operating characteristic curve for this study were 91%, 98%, 81%, and 0.94 respectively. Conclusion: This preliminary study suggest that confocal microscopy can be used to distinguish cancer from normal tissue with high sensitivity and specificity. The observers in this study were trained quickly and on only six images. We expect even higher performance as observers become more familiar with the confocal images.

Details

Language :
English
ISSN :
22143882 and 95874933
Volume :
7
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Asian Journal of Urology
Publication Type :
Academic Journal
Accession number :
edsdoj.10bf46159a4d95874933096d797408
Document Type :
article
Full Text :
https://doi.org/10.1016/j.ajur.2019.12.008