The Department of Laboratory Medicine (Torres, Olson), Yale School of Medicine, New Haven, Connecticut.
The Department of Pathology (Homer, Perincheri, Humphrey), Yale School of Medicine, New Haven, Connecticut.
Arch Pathol Lab Med. 2021 May 1;145(5):583-591. doi: 10.5858/arpa.2020-0037-OA.
CONTEXT.—: Pathologist interobserver discordance is significant in grading of prostate cancer, limiting reliability. Diagnostic reproducibility may be improved with digital images, but adoption faces workflow, cost, and quality challenges. A novel digital method using an alternative tissue processing approach and novel laser microscopy system potentially addresses these issues.
OBJECTIVE.—: To evaluate the capability of this new method for primary diagnostic interpretation in clinical prostate biopsy specimens.
DESIGN.—: Forty patients with a high likelihood of prostate cancer based on magnetic resonance imaging consented to investigational core biopsy. A subset of samples was used for direct comparison of physical slide preparation effects and time-tracking determination with multiphoton microscopy. Twenty samples were processed for diagnostic comparison between multilevel digital slides and subsequently produced physical slides. A reference diagnosis based on all data was established using grade groups. Level of diagnostic match and requests for immunohistochemistry were compared between physical and digital diagnoses. Immunohistochemical staining and length measurements were secondary outcomes.
RESULTS.—: Interpretations based on direct multiphoton imaging yielded diagnoses that were at least as accurate as standard histology; cancer diagnosis correlation was 89% (51 of 57) by physical slides and 95% (53 of 56) by multiphoton microscopy. Grade-level concordance was 73% (44 of 60) by either method. Immunohistochemistry for routine prostate cancer-associated markers on these alternatively processed tissues was unaffected. Alternatively processed tissues resulted in longer measured core and cancer lengths, suggestive of improved orientation and visualization.
CONCLUSIONS.—: Findings support high potential for complete interpretation of prostate core biopsies using solely multiphoton microscopy of intact specimens, with potential diagnostic benefits as well as reduced processing time and reduced processing complexity.
病理学家在前列腺癌分级方面的意见不一致，这限制了其可靠性。通过数字图像可以提高诊断的可重复性，但采用这种方法会面临工作流程、成本和质量方面的挑战。一种新的数字方法使用了一种替代的组织处理方法和新的激光显微镜系统，可能解决了这些问题。
评估这种新方法在临床前列腺活检标本的主要诊断解读中的能力。
40 名基于磁共振成像的前列腺癌高危患者同意进行研究性核心活检。一部分样本用于直接比较物理切片制备效果和多光子显微镜的时间跟踪测定。20 个样本用于多水平数字切片和随后制作的物理切片之间的诊断比较。基于所有数据建立基于分级组的参考诊断。比较物理和数字诊断之间的诊断匹配程度和对免疫组织化学的要求。免疫组织化学染色和长度测量是次要结果。
直接多光子成像的解释结果与标准组织学至少一样准确；物理切片的癌症诊断相关性为 89%（57 例中的 51 例），多光子显微镜为 95%（56 例中的 53 例）。两种方法的分级水平一致性均为 73%（60 例中的 44 例）。对这些经替代处理的组织进行常规前列腺癌相关标志物的免疫组织化学染色不受影响。经替代处理的组织导致核心和癌症长度的测量值更长，提示其方向和可视化效果得到了改善。
研究结果支持仅使用完整标本的多光子显微镜对前列腺核心活检进行完整解读的巨大潜力，具有潜在的诊断益处，同时还可以减少处理时间和降低处理复杂性。
