Comparative analysis of confocal microscopy on fresh breast core needle biopsies and conventional histology

Abstract

Background Evaluation of core needle biopsies (CNB) is a standard procedure for the diagnosis of breast cancer. However, tissue processing and image preparation is a time- consuming procedure and instant on-site availability of high-quality images could substantially improve the efficacy of the diagnostic procedure. Conventional microscopic methods, such as frozen section analysis (FSA) for detection of malignant cells still have clear disadvantages. In the present study, we tested a confocal microscopy scanner on fresh tissue from CNB with intention to develop an alternative device to FSA in clinical practice. Patients and methods In 24 patients with suspicious breast lesions standard of care image-guided biopsies were performed. Confocal images have been obtained using the Histolog™ Scanner and evaluated by two independent pathologists. Hematoxylin-Eosin (H&E) histological sections of the biopsies were routinely processed in a blinded fashion with respect to the confocal images. Results In total 42 confocal images were generated from 24 biopsy specimens, and available for analysis within a few minutes of taking the biopsy. This resulted in 2 × 42 = 84 pathologic evaluations. In four cases, a pathologic diagnosis was not possible with confocal microscopy. An exact correlation based on the B-classification was reached in 41 out of 80 examinations and in another 35 cases in a broader sense of correspondence definition (i.e. malignant vs. benign). Conclusions As a reliable on-site method, the Histolog™ Scanner provides a visualization of cellular details equivalent to the H&E standards, permitting rapid and accurate diagnosis of malignant and benign breast lesions. Furthermore, this device offers great potential for immediate margin analysis of specimen in breast conserving therapy.

Comparison of Real-Time Fluorescence Confocal Digital Microscopy With Hematoxylin-Eosin–Stained Sections of Core-Needle Biopsy Specimens

“…Preservation of tissue integrity of acridine orange-stained and imaged tissue for conventional histopathologic examination has been demonstrated by other investigators, with findings similar to ours. [31][32][33] In addition, optimal preservation of acridine orange-stained and imaged tissue for subsequent immunohistochemistry and genomic studies has been established recently. 32,34 The imaged CNBs can potentially be used for immunohistochemical analysis and genomic testing after formalin fixation and routine processing.…”

Feasibility of using digital confocal microscopy for cytopathological examination in clinical practice

“…The importance of high-quality cell blocks cannot be overemphasized in the today’s era of personalized cancer treatment, particularly when concurrent tissue procurement based on core needle biopsy is either not performed or is suboptimal or nondiagnostic for determining the status of various biomarkers for targeted therapy of the tumor. The integrity of the procured material exposed to fluorescent dyes such as acridine orange for subsequent immunohistochemical and molecular testing has been demonstrated in previous reports with use of surgical pathology material 21 , 22 . With use of technological advancements, the quality and pseudocoloring of the digital CM images that could be obtained from cytology specimens in our study, specifically the resolution and digital staining, can be further improved to appear much better than what was achieved in our study.…”

Ex vivo fluorescence confocal microscopy: chances and changes in the analysis of breast tissue

“…As our center receives frequent breast specimen for analysis, we chose breast tissue for our study comparing FCM to standard frozen sections to evaluate whether the procedure can be performed in a satisfactorily fashion and in a time frame comparable to frozen sections. A study by Elfgen et al showed promising results for comparing breast specimen biopsies to H&E images utilising a different FCM platform [ 10 ].…”