Detection and assessment of capsular invasion, vascular invasion and lymph node metastasis volume in thyroid carcinoma using microCT scanning of paraffin tissue blocks (3D whole block imaging): a proof of concept

Abstract

In the modern era, detailed pathologic characteristics of a thyroid tumor are crucial to achieve accurate diagnosis and guide treatment. The presence of capsular invasion (CI) is diagnostic for carcinoma, whereas vascular invasion (VI) and nodal metastasis (NM) are included in risk stratification. However, the very definition of CI and VI is surrounded by controversies and an accurate assessment of NM is lacking. Whole Block Imaging (WBI) by microCT is a new imaging modality to create 3D reconstruction of whole tissue block with microscopic level resolution without the need for tissue sectioning. In this study, we aimed to define CI, VI, and NM volume using WBI by microCT. Twenty-eight paraffin blocks (PBs) from 26 thyroid tumors were scanned. Ten PBs contained CI, whereas 7 had VI. 3D microCT images were compared with whole slide images (WSI) of corresponding H&E slides. In 2 cases with VI and/or CI, WSI of serial H&E slides were obtained and underwent 3D-reconstruction to be compared with the WBI. Satellite tumor nodules beyond tumor capsule were shown to be CI by demonstrating the point of penetration using microCT and 3D reconstruction. Additional foci of CI were detected using microCT. VI was seen using microCT. Fibrin associated with tumor thrombus was not always present on serially sectioned H&E slides. WBI by microCT scanner was able to assess the volume of NM. In conclusion, WBI is able to detect CI, VI, and assess the volume of NM in thyroid carcinoma without tissue sectioning. It is the ultimate method for the complete sampling of the tumor capsule. It has the potential to increase the detection rate of CI, better define criteria for CI and VI and provide an accurate assessment of the volume of nodal disease. This technology may impact the future practice of surgical pathology. Keywordswhole block imaging; microCT; thyroid carcinoma; capsular invasion; vascular invasion Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:http://www.nature.com/authors/editorial_policies/license.html#terms

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“…However, combining WSI and micro-CT image has great potential to improve the histopathologic diagnosis because 3D morphologic structure can be also evaluated easily without additional resection and tissue exhaustion. Xu et al 13 mentioned that micro-CT image can detect additional foci of capsular invasion of thyroid carcinoma missed by the initial H&E slide, and volume of nodal metastasis measured on micro-CT image was most accurate compared with the conventional two-dimensional measurement on WSI. In addition, they suggested that among other things, micro-CT has the potential to increase the detection rate of capsular invasion and better define criteria for capsular invasion and vascular invasion.…”

“…In their study of interstitial pneumonia, Ketsamenis et al 8 demonstrated that the small airways, blood vessels, and alveoli of the lungs could be clearly visualized on micro-CT. Albers et al 10 scanned murine lung samples with free-propagation phase-contrast micro-CT and reported that micro-CT has the potential to improve workflow aspects of histologic analysis, such as determination of the cutting position. Xu et al 13 assessed thyroid carcinoma using micro-CT images of paraffin tissue blocks. According to their report, capsular invasion and vascular invasion could be detected and volume of nodal metastasis could be assessed by micro-CT images, even if the images were not present on serially sectioned hematoxylin and eosin (H&E)estained slides.…”

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