Savitri Krishnamurthy , MD , 1 , Sharjeel Sabir , MD 2 , Kechen Ban , PhD 1 , Yun Wu , MD, PhD 1 , Rahul Sheth , MD 3 , Alda Tam , MD 3 , Funda Meric-Bernstam , MD 4 , 5 , Kenna Shaw , PhD 5 , Gordon Mills , MD, PhD 6 , Roland Bassett , MS 7 , Stanley Hamilton , MD 1 , Marshall Hicks , MD 3 , Sanjay Gupta , MD 3
5 March 2020
This diagnostic study investigates real-time acquisition of fluorescence confocal microscopy of interventional radiology–guided specimens in the radiology suite and compares accuracy of diagnoses with hematoxylin-eosin (H&E)–stained sections among patients undergoing core-needle biopsy.
Can fluorescence confocal microscopy be used for immediate evaluation of interventional radiology–guided core-needle biopsy in real time at the bedside in the radiology suite?
In this diagnostic study of 105 patients undergoing core-needle biopsy, fluorescence confocal microscopy images were acquired in a mean of 7 minutes, were similar to hematoxylin-eosin–stained tissue sections, and were of acceptable quality in 101 (96.2%). The accuracy of fluorescence confocal microscopy diagnosis compared with the criterion standard of hematoxylin-eosin–stained tissue sections was 95.2% for pathologist 1, 85.7% for pathologist 2, and 96.2% for consensus between them.
Strategies to procure high-quality core-needle biopsy (CNB) specimens are critical for making basic tissue diagnoses and for ancillary testing.
To investigate acquisition of fluorescence confocal microscopy (FCM) images of interventional radiology (IR)–guided CNB in real time in the radiology suite and to compare the accuracy of FCM diagnoses with those of hematoxylin-eosin (H&E)–stained CNB sections.
In this diagnostic study, FCM imaging of IR-guided CNBs was performed in the radiology suite at a major cancer center for patients with an imaging abnormality from August 1, 2016, to April 30, 2019. The time taken to acquire FCM images and the quality of FCM images based on percentage of interpretable tissue with optimal resolution was recorded. The FCM images were read by 2 pathologists and categorized as nondiagnostic, benign/atypical, or suspicious/malignant; these diagnoses were compared with those made using H&E-stained tissue sections. Cases with discrepant diagnosis were reassessed by the pathologists together for a consensus diagnosis. Data were analyzed from June 3 to July 19, 2019.
Each IR-guided CNB was stained with 0.6mM acridine orange, subjected to FCM imaging, and then processed to generate H&E-stained sections.
Mean time taken for acquisition of FCM images, quality of FCM images based on interpretable percentage of the image, and accuracy of diagnostic categorization based on FCM images compared with H&E-stained sections.
A total of 105 patients (57 male [54.3%]; mean [SD] age, 63  years) underwent IR-guided CNBs in a mean (SD) of 7 (2) minutes each. The FCM images showed at least 20% of the tissue with optimal quality in 101 CNB specimens (96.2%). The FCM images were accurately interpreted by the 2 pathologists in 100 of 105 cases (95.2%) (2 false-positive and 3 false-negative) and 90 of 105 cases (85.7%) (6 false-positive and 9 false-negative). A reassessment of 14 discordant diagnoses resulted in consensus diagnoses that were accurate in 101 of 105 cases (96.2%) (1 false-positive and 3 false-negative).