Department of Urology, NYU Langone Health, New York, NY; Department of Urologic Sciences, University of British Columbia, Vancouver Prostate Centre, Vancouver, British Columbia, Canada.
Department of Pathology, NYU Langone Health, New York, NY.
Urol Oncol. 2023 Jul;41(7):328.e9-328.e13. doi: 10.1016/j.urolonc.2023.04.008. Epub 2023 May 23.
Renal tumor biopsy requires adequate tissue sampling to aid in the investigation of small renal masses. In some centers the contemporary nondiagnostic renal mass biopsy rate may be as high as 22% and may be as high as 42% in challenging cases. Stimulated Raman Histology (SRH) is a novel microscopic technique which has created the possibility for rapid, label-free, high-resolution images of unprocessed tissue which may be viewed on standard radiology viewing platforms. The application of SRH to renal biopsy may provide the benefits of routine pathologic evaluation during the procedure, thereby reducing nondiagnostic results. We conducted a pilot feasibility study, to assess if renal cell carcinoma (RCC) subtypes may be imaged and to see if high-quality hematoxylin and eosin (H&E) could subsequently be generated.
METHODS/MATERIALS: An 18-gauge core needle biopsy was taken from a series of 25 ex vivo radical or partial nephrectomy specimens. Histologic images of the fresh, unstained biopsy samples were obtained using a SRH microscope using 2 Raman shifts: 2,845 cm and 2,930 cm. The cores were then processed as per routine pathologic protocols. The SRH images and hematoxylin and eosin (H&E) slides were then viewed by a genitourinary pathologist.
The SRH microscope took 8 to 11 minutes to produce high-quality images of the renal biopsies. Total of 25 renal tumors including 1 oncocytoma, 3 chromophobe RCC, 16 clear cells RCC, 4 papillary RCC, and 1 medullary RCC were included. All renal tumor subtypes were captured, and the SRH images were easily differentiated from adjacent normal renal parenchyma. High quality H&E slides were produced from each of the renal biopsies after SRH was completed. Immunostains were performed on selected cases and the staining was not affected by the SRH image process.
SRH produces high quality images of all renal cell subtypes that can be rapidly produced and easily interpreted to determine renal mass biopsy adequacy, and on occasion, may allow renal tumor subtype identification. Renal biopsies remained available to produce high quality H&E slides and immunostains for confirmation of diagnosis. Procedural application has promise to decrease the known rate of renal mass nondiagnostic biopsies, and application of convolutional neural network methodology may further improve diagnostic capability and increase utilization of renal mass biopsy among urologists.
肾肿瘤活检需要足够的组织样本以帮助研究小的肾肿块。在一些中心，当代非诊断性肾肿块活检率可能高达 22%，在具有挑战性的病例中可能高达 42%。受激拉曼组织学（SRH）是一种新的微观技术，它为快速、无标记、高分辨率的未处理组织图像创造了可能，这些图像可以在标准放射学观察平台上查看。SRH 在肾活检中的应用可能提供了在手术过程中进行常规病理评估的好处，从而减少了非诊断结果。我们进行了一项试点可行性研究，以评估是否可以成像肾细胞癌（RCC）亚型，以及是否可以随后生成高质量的苏木精和伊红（H&E）。
方法/材料：对一系列 25 例离体根治性或部分肾切除术标本进行了 18 号针芯活检。使用 SRH 显微镜，通过 2 个拉曼位移：2845cm 和 2930cm 获得新鲜、未经染色的活检样本的组织学图像。然后按照常规病理方案对核心进行处理。然后由泌尿生殖病理学家观察 SRH 图像和苏木精和伊红（H&E）载玻片。
SRH 显微镜需要 8 到 11 分钟才能生成高质量的肾活检图像。共包括 25 个肾肿瘤，包括 1 个嗜酸细胞瘤、3 个嫌色细胞 RCC、16 个透明细胞 RCC、4 个乳头状 RCC 和 1 个髓质 RCC。所有肾肿瘤亚型均被捕获，SRH 图像易于与相邻的正常肾实质区分。在完成 SRH 后，从每个肾活检中都产生了高质量的 H&E 幻灯片。对选定病例进行了免疫染色，SRH 图像处理并未影响染色。
SRH 可生成所有肾细胞亚型的高质量图像，可快速生成，易于解释，以确定肾肿块活检的充分性，并且有时可能允许鉴定肾肿瘤亚型。肾活检仍然可以产生高质量的 H&E 幻灯片和免疫染色以确认诊断。该程序的应用有希望降低已知的肾肿块非诊断性活检率，并且卷积神经网络方法的应用可能进一步提高诊断能力，并增加泌尿科医生对肾肿块活检的利用。
