van Manen Labrinus, Stegehuis Paulien L, Fariña-Sarasqueta Arantza, de Haan Lorraine M, Eggermont Jeroen, Bonsing Bert A, Morreau Hans, Lelieveldt Boudewijn P F, van de Velde Cornelis J H, Vahrmeijer Alexander L, Dijkstra Jouke, Mieog J Sven D
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
PLoS One. 2017 Apr 17;12(4):e0175862. doi: 10.1371/journal.pone.0175862. eCollection 2017.
Pancreatic cancer is the fourth leading cause of cancer-related mortality in the United States. The minority of patients can undergo curative-intended surgical therapy due to progressive disease stage at time of diagnosis. Nonetheless, tumor involvement of surgical margins is seen in up to 70% of resections, being a strong negative prognostic factor. Real-time intraoperative imaging modalities may aid surgeons to obtain tumor-free resection margins. Full-field optical coherence tomography (FF-OCT) is a promising diagnostic tool using high-resolution white-light interference microscopy without tissue processing. Therefore, we composed an atlas of FF-OCT images of malignant and benign pancreatic tissue, and investigated the accuracy with which the pathologists could distinguish these.
One hundred FF-OCT images were collected from specimens of 29 patients who underwent pancreatic resection for various indications between 2014 and 2016. One experienced gastrointestinal pathologist and one pathologist in training scored independently the FF-OCT images as malignant or benign blinded to the final pathology conclusion. Results were compared to those obtained with standard hematoxylin and eosin (H&E) slides.
Overall, combined test characteristics of both pathologists showed a sensitivity of 72%, specificity of 74%, positive predictive value of 69%, negative predictive value of 79% and an overall accuracy of 73%. In the subset of pancreatic ductal adenocarcinoma patients, 97% of the FF-OCT images (n = 35) were interpreted as tumor by at least one pathologist. Moreover, normal pancreatic tissue was recognised in all cases by at least one pathologist. However, atrophy and fibrosis, serous cystadenoma and neuroendocrine tumors were more often wrongly scored, in 63%, 100% and 25% respectively.
FF-OCT could distinguish normal pancreatic tissue from pathologic pancreatic tissue in both processed as non-processed specimens using architectural features. The accuracy in pancreatic ductal adenocarcinoma is promising and warrants further evaluation using improved assessment criteria.
胰腺癌是美国癌症相关死亡的第四大主要原因。由于诊断时疾病进展至晚期，少数患者能够接受旨在治愈的手术治疗。尽管如此，高达70%的切除术可见手术切缘有肿瘤累及，这是一个强有力的负面预后因素。实时术中成像模式可能有助于外科医生获得无肿瘤的手术切缘。全场光学相干断层扫描（FF-OCT）是一种很有前景的诊断工具，它使用高分辨率白光干涉显微镜，无需进行组织处理。因此，我们编制了一份恶性和良性胰腺组织的FF-OCT图像图谱，并研究了病理学家区分这些图像的准确性。
从2014年至2016年间因各种适应证接受胰腺切除术的29例患者的标本中收集了100张FF-OCT图像。一位经验丰富的胃肠病理学家和一位正在接受培训的病理学家在不知道最终病理结论的情况下，独立将FF-OCT图像评为恶性或良性。将结果与标准苏木精和伊红（H&E）切片的结果进行比较。
总体而言，两位病理学家的综合检测特征显示，敏感性为72%，特异性为74%，阳性预测值为69%，阴性预测值为79%，总体准确率为73%。在胰腺导管腺癌患者亚组中，至少一位病理学家将97%的FF-OCT图像（n = 35）解释为肿瘤。此外，至少一位病理学家在所有病例中都识别出了正常胰腺组织。然而，萎缩和纤维化、浆液性囊腺瘤和神经内分泌肿瘤被错误评分的情况更为常见，分别为63%、100%和25%。
FF-OCT可以利用结构特征在处理和未处理的标本中区分正常胰腺组织和病理性胰腺组织。胰腺导管腺癌的准确性很有前景，值得使用改进的评估标准进行进一步评估。
