Ye Qiqi, Law Timothy, Klippel Dianna, Albarracin Constance, Chen Hui, Contreras Alejandro, Ding Qingqing, Huo Lei, Khazai Laila, Middleton Lavinia, Resetkova Erika, Sahin Aysegul, Sun Hongxia, Sweeney Keith, Symmans William Fraser, Wu Yun, Yoon Esther, Krishnamurthy Savitri
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Pathology, Affiliated Pathologists Medical Group, Saddleback Medical Center, Laguna Hills, California.
Mod Pathol. 2025 Apr;38(4):100708. doi: 10.1016/j.modpat.2025.100708. Epub 2025 Jan 7.
Different digital modalities are currently available for frozen section (FS) evaluation in surgical pathology practice. However, there are limited studies that demonstrate the potential of whole-slide imaging (WSI) as a robust digital pathology option for FS diagnosis. In the current study, we compared the diagnostic accuracy achieved with WSI to that achieved with light microscopy (LM) for evaluating FSs of axillary sentinel lymph nodes (SLNs) and clipped lymph nodes (LNs) from patients with breast cancer using 2 modalities. Initially, a retrospective analysis evaluated hematoxylin and eosin (H&E)-stained FSs of 109 SLNs using WSI followed by LM after a washout period ranging from 2 to 6 weeks. Subsequently, a prospective analysis assessed FSs of 132 SLNs using LM by the first pathologist, and then H&E-stained FSs were scanned and interpreted remotely in real time by a different pathologist. In the retrospective analysis, the diagnostic accuracy utilizing WSI ranged from 96% to 99% and exhibited similarity to those achieved with LM, ranging from 94% to 99%. Similarly, the prospective analysis also demonstrated comparable diagnostic accuracy between WSI (96.2%) and LM (97%). Pathologists in the retrospective study required an additional 0.8 to 5.4 minutes to render diagnoses using WSI compared with LM (P < .0001). In the prospective study conducted 2 years later, pathologists only took slightly longer to provide WSI FS diagnoses (3.95 minutes) compared with LM (3.51 minutes) (P > .05). In conclusion, our study indicated that WSI-based evaluation showed comparable diagnostic accuracy to LM for assessing LN FSs. Furthermore, the prospective study demonstrated the feasibility of real-time acquisition of high-quality WSIs for remote FS diagnosis of SLNs. These findings substantiate the promising potential of using WSIs of SLNs and clipped LNs in real-time FS evaluation of patients with breast cancer as a standard-of-care in surgical pathology practice.
目前在外科病理学实践中，不同的数字模式可用于冰冻切片（FS）评估。然而，仅有有限的研究证明了全切片成像（WSI）作为FS诊断的可靠数字病理学选项的潜力。在本研究中，我们使用两种模式比较了WSI与光学显微镜（LM）在评估乳腺癌患者腋窝前哨淋巴结（SLN）和切除淋巴结（LN）的FS时所达到的诊断准确性。最初，进行了一项回顾性分析，使用WSI评估109个SLN的苏木精和伊红（H&E）染色的FS，在2至6周的洗脱期后再用LM评估。随后，进行了一项前瞻性分析，由第一位病理学家使用LM评估132个SLN的FS，然后由另一位病理学家对H&E染色的FS进行实时远程扫描和解读。在回顾性分析中，使用WSI的诊断准确性范围为96%至99%，与使用LM的诊断准确性范围（94%至99%）相似。同样，前瞻性分析也显示WSI（96.2%）和LM（97%）之间的诊断准确性相当。回顾性研究中的病理学家使用WSI进行诊断比使用LM需要额外0.8至5.4分钟（P <.0001）。在两年后进行的前瞻性研究中，与LM（3.51分钟）相比，病理学家提供WSI FS诊断所需的时间仅略长（3.95分钟）（P>.05）。总之，我们的研究表明，基于WSI的评估在评估LN FS时显示出与LM相当的诊断准确性。此外，前瞻性研究证明了实时获取高质量WSI用于SLN远程FS诊断的可行性。这些发现证实了在乳腺癌患者的实时FS评估中使用SLN和切除LN的WSI作为外科病理学实践中的标准治疗方法的巨大潜力。
