Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston.
Department of Radiology, Scripps Mercy Hospital, San Diego, California.
JAMA Netw Open. 2020 Mar 2;3(3):e200476. doi: 10.1001/jamanetworkopen.2020.0476.
Strategies to procure high-quality core-needle biopsy (CNB) specimens are critical for making basic tissue diagnoses and for ancillary testing.
To investigate acquisition of fluorescence confocal microscopy (FCM) images of interventional radiology (IR)-guided CNB in real time in the radiology suite and to compare the accuracy of FCM diagnoses with those of hematoxylin-eosin (H&E)-stained CNB sections.
DESIGN, SETTING, AND PARTICIPANTS: In this diagnostic study, FCM imaging of IR-guided CNBs was performed in the radiology suite at a major cancer center for patients with an imaging abnormality from August 1, 2016, to April 30, 2019. The time taken to acquire FCM images and the quality of FCM images based on percentage of interpretable tissue with optimal resolution was recorded. The FCM images were read by 2 pathologists and categorized as nondiagnostic, benign/atypical, or suspicious/malignant; these diagnoses were compared with those made using H&E-stained tissue sections. Cases with discrepant diagnosis were reassessed by the pathologists together for a consensus diagnosis. Data were analyzed from June 3 to July 19, 2019.
Each IR-guided CNB was stained with 0.6mM acridine orange, subjected to FCM imaging, and then processed to generate H&E-stained sections.
Mean time taken for acquisition of FCM images, quality of FCM images based on interpretable percentage of the image, and accuracy of diagnostic categorization based on FCM images compared with H&E-stained sections.
A total of 105 patients (57 male [54.3%]; mean [SD] age, 63 [13] years) underwent IR-guided CNBs in a mean (SD) of 7 (2) minutes each. The FCM images showed at least 20% of the tissue with optimal quality in 101 CNB specimens (96.2%). The FCM images were accurately interpreted by the 2 pathologists in 100 of 105 cases (95.2%) (2 false-positive and 3 false-negative) and 90 of 105 cases (85.7%) (6 false-positive and 9 false-negative). A reassessment of 14 discordant diagnoses resulted in consensus diagnoses that were accurate in 101 of 105 cases (96.2%) (1 false-positive and 3 false-negative).
The ease of acquisition of FCM images of acceptable quality and the high accuracy of the diagnoses suggest that FCM may be useful for rapid evaluation of IR-guided CNBs. This approach warrants further investigation.
获取高质量的核心针活检 (CNB) 标本的策略对于进行基本组织诊断和辅助检测至关重要。
研究实时获取放射科介入放射学 (IR) 引导的 CNB 的荧光共聚焦显微镜 (FCM) 图像，并比较 FCM 诊断与苏木精-伊红 (H&E) 染色 CNB 切片的准确性。
设计、地点和参与者：在这项诊断研究中，2016 年 8 月 1 日至 2019 年 4 月 30 日，在一家主要癌症中心的放射科对因影像学异常而就诊的患者进行了 IR 引导的 CNB 的 FCM 成像。记录了获取 FCM 图像的时间和基于具有最佳分辨率的可解释组织百分比的 FCM 图像质量。2 位病理学家对 FCM 图像进行了阅读，并将其分类为非诊断性、良性/非典型或可疑/恶性；这些诊断与 H&E 染色组织切片的诊断进行了比较。对具有不同诊断的病例进行了重新评估，由病理学家共同做出共识诊断。数据分析于 2019 年 6 月 3 日至 7 月 19 日进行。
每个 IR 引导的 CNB 均用 0.6mM 吖啶橙染色，进行 FCM 成像，然后进行处理以生成 H&E 染色切片。
比较基于可解释图像百分比的 FCM 图像质量、基于 FCM 图像的诊断分类准确性与 H&E 染色切片的平均时间、FCM 图像采集时间。
共有 105 例患者（57 例男性 [54.3%]；平均 [标准差]年龄 63 [13] 岁）进行了 IR 引导的 CNB，平均（标准差）为 7 （2）分钟。FCM 图像在 101 个 CNB 标本中至少显示了 20%具有最佳质量的组织（96.2%）。2 位病理学家准确地解释了 105 例中的 100 例（95.2%）（2 例假阳性和 3 例假阴性）和 105 例中的 90 例（85.7%）（6 例假阳性和 9 例假阴性）的 FCM 图像。对 14 个不一致的诊断进行了重新评估，得出了 101 例中的 105 例（96.2%）（1 例假阳性和 3 例假阴性）的准确共识诊断。
易于获取可接受质量的 FCM 图像和诊断的高度准确性表明，FCM 可能有助于快速评估 IR 引导的 CNB。这种方法值得进一步研究。
