使用即时诊断的低成本显微镜扫描器检测冷冻切片中的乳腺癌淋巴结转移。
Detection of breast cancer lymph node metastases in frozen sections with a point-of-care low-cost microscope scanner.
机构信息
Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
Department of Women's and Children's Health, International Maternal and Child health, Uppsala University, Uppsala, Sweden.
出版信息
PLoS One. 2019 Mar 19;14(3):e0208366. doi: 10.1371/journal.pone.0208366. eCollection 2019.
BACKGROUND
Detection of lymph node metastases is essential in breast cancer diagnostics and staging, affecting treatment and prognosis. Intraoperative microscopy analysis of sentinel lymph node frozen sections is standard for detection of axillary metastases but requires access to a pathologist for sample analysis. Remote analysis of digitized samples is an alternative solution but is limited by the requirement for high-end slide scanning equipment.
OBJECTIVE
To determine whether the image quality achievable with a low-cost, miniature digital microscope scanner is sufficient for detection of metastases in breast cancer lymph node frozen sections.
METHODS
Lymph node frozen sections from 79 breast cancer patients were digitized using a prototype miniature microscope scanner and a high-end slide scanner. Images were independently reviewed by two pathologists and results compared between devices with conventional light microscopy analysis as ground truth.
RESULTS
Detection of metastases in the images acquired with the miniature scanner yielded an overall sensitivity of 91% and specificity of 99% and showed strong agreement when compared to light microscopy (k = 0.91). Strong agreement was also observed when results were compared to results from the high-end slide scanner (k = 0.94). A majority of discrepant cases were micrometastases and sections of which no anticytokeratin staining was available.
CONCLUSION
Accuracy of detection of metastatic cells in breast cancer sentinel lymph node frozen sections by visual analysis of samples digitized using low-cost, point-of-care microscopy is comparable to analysis of digital samples scanned using a high-end, whole slide scanner. This technique could potentially provide a workflow for digital diagnostics in resource-limited settings, facilitate sample analysis at the point-of-care and reduce the need for trained experts on-site during surgical procedures.
背景
在乳腺癌的诊断和分期中，检测淋巴结转移至关重要，这会影响治疗和预后。术中对前哨淋巴结冷冻切片进行显微镜分析是检测腋窝转移的标准方法，但需要病理学家进行样本分析。数字化样本的远程分析是一种替代解决方案，但受到需要高端幻灯片扫描设备的限制。
目的
确定使用低成本、微型数字显微镜扫描仪获得的图像质量是否足以检测乳腺癌淋巴结冷冻切片中的转移。
方法
使用原型微型显微镜扫描仪和高端幻灯片扫描仪对 79 例乳腺癌患者的淋巴结冷冻切片进行数字化处理。由两名病理学家独立对图像进行审查，并将结果与常规光镜分析作为金标准的两种设备进行比较。
结果
使用微型扫描仪获取的图像中转移的检测总灵敏度为 91%，特异性为 99%，与光镜相比具有很强的一致性（k = 0.91）。与高端幻灯片扫描仪的结果相比，也观察到强烈的一致性（k = 0.94）。大多数不一致的病例为微转移和缺乏抗细胞角蛋白染色的切片。
结论
使用低成本、即时护理显微镜对数字化样本进行视觉分析，对乳腺癌前哨淋巴结冷冻切片中转移性细胞的检测准确性与使用高端、全幻灯片扫描仪扫描数字样本的分析相当。这项技术有可能为资源有限的环境提供数字化诊断的工作流程，在即时护理点促进样本分析，并减少手术过程中对现场训练有素专家的需求。
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