Schiffhauer Linda M, Boger J Neil, Bonfiglio Thomas A, Zavislan James M, Zuley Margarita, Fox Christi Alessi
Lucid, Inc,, 2320 Brighton Henrietta Town Line Road, Rochester, NY 14623, USA.
BMC Cancer. 2009 Aug 3;9:265. doi: 10.1186/1471-2407-9-265.
Needle core biopsy, often in conjunction with ultrasonic or stereotactic guided techniques, is frequently used to diagnose breast carcinoma in women. Confocal scanning laser microscopy (CSLM) is a technology that provides real-time digital images of tissues with cellular resolution. This paper reports the progress in developing techniques to rapidly screen needle core breast biopsy and surgical specimens at the point of care. CSLM requires minimal tissue processing and has the potential to reduce the time from excision to diagnosis. Following imaging, specimens can still be submitted for standard histopathological preparation.
Needle core breast specimens from 49 patients were imaged at the time of biopsy. These lesions had been characterized under the Breast Imaging Reporting And Data System (BI-RADS) as category 3, 4 or 5. The core biopsies were imaged with the CSLM before fixation. Samples were treated with 5% citric acid and glycerin USP to enhance nuclear visibility in the reflectance confocal images. Immediately following imaging, the specimens were fixed in buffered formalin and submitted for histological processing and pathological diagnosis. CSLM images were then compared to the standard histology.
The pathologic diagnoses by standard histology were 7 invasive ductal carcinomas, 2 invasive lobular carcinomas, 3 ductal carcinomas in-situ (CIS), 21 fibrocystic changes/proliferative conditions, 9 fibroadenomas, and 5 other/benign; two were excluded due to imaging difficulties. Morphologic and cellular features of benign and cancerous lesions were identified in the confocal images and were comparable to standard histologic sections of the same tissue.
CSLM is a technique with the potential to screen needle core biopsy specimens in real-time. The confocal images contained sufficient information to identify stromal reactions such as fibrosis and cellular proliferations such as intra-ductal and infiltrating carcinoma, and were comparable to standard histologic sections of the same tissue. Morphologic and cellular features of benign and cancerous lesions were identified in the confocal images. Additional studies are needed to 1.) establish correlation of the confocal and traditional histologic images for the various diseases of the breast; 2.) validate diagnostic use of CSLM and; 3.) further define features of borderline lesions such as well-differentiated ductal CIS vs. atypical hyperplasia.
针芯活检通常结合超声或立体定向引导技术，常用于诊断女性乳腺癌。共聚焦扫描激光显微镜（CSLM）是一种能提供细胞分辨率的组织实时数字图像的技术。本文报告了在即时护理点快速筛查针芯乳腺活检和手术标本技术的进展。CSLM所需的组织处理极少，有可能缩短从切除到诊断的时间。成像后，标本仍可送去进行标准的组织病理学制备。
对49例患者的针芯乳腺标本在活检时进行成像。这些病变在乳腺影像报告和数据系统（BI-RADS）中被归类为3类、4类或5类。在固定前，用CSLM对针芯活检标本进行成像。样本用5%柠檬酸和美国药典甘油处理，以增强反射共聚焦图像中细胞核的可见性。成像后立即将标本固定在缓冲福尔马林中，送去进行组织学处理和病理诊断。然后将CSLM图像与标准组织学图像进行比较。
标准组织学的病理诊断为7例浸润性导管癌、2例浸润性小叶癌、3例导管原位癌（CIS）、21例纤维囊性变/增生性病变、9例纤维腺瘤和5例其他/良性病变；2例因成像困难被排除。在共聚焦图像中识别出了良性和癌性病变的形态学和细胞特征，且与同一组织的标准组织学切片相当。
CSLM是一种有潜力实时筛查针芯活检标本的技术。共聚焦图像包含了足够的信息来识别诸如纤维化等间质反应以及诸如导管内癌和浸润性癌等细胞增殖情况，且与同一组织的标准组织学切片相当。在共聚焦图像中识别出了良性和癌性病变的形态学和细胞特征。还需要进一步研究来：1. 建立共聚焦图像与传统组织学图像在各种乳腺疾病中的相关性；2. 验证CSLM的诊断用途；3. 进一步明确交界性病变的特征，如高分化导管原位癌与非典型增生的区别。
