Rapid evaluation of fresh ex vivo kidney tissue with full-field optical coherence tomography

Manu Jain, Brian D Robinson, Bekheit Salamoon, Olivier Thouvenin, Claude Boccara, Sushmita Mukherjee, Manu Jain, Brian D Robinson, Bekheit Salamoon, Olivier Thouvenin, Claude Boccara, Sushmita Mukherjee

Abstract

Background: Full-field optical coherence tomography (FFOCT) is a real-time imaging technique that rapidly generates images reminiscent of histology without any tissue processing, warranting its exploration for evaluation of ex vivo kidney tissue.

Methods: Fresh tissue sections from tumor and adjacent nonneoplastic kidney (n = 25 nephrectomy specimens; clear cell renal cell carcinoma (CCRCC) = 12, papillary RCC (PRCC) = 4, chromophobe RCC (ChRCC) = 4, papillary urothelial carcinoma (PUC) = 1, angiomyolipoma (AML) = 2 and cystic nephroma = 2) were imaged with a commercial FFOCT device. Sections were submitted for routine histopathological diagnosis.

Results: Glomeruli, tubules, interstitium, and blood vessels were identified in nonneoplastic tissue. In tumor sections, the normal architecture was completely replaced by either sheets of cells/trabeculae or papillary structures. The former pattern was seen predominantly in CCRCC/ChRCC and the latter in PRCC/PUC (as confirmed on H&E). Although the cellular details were not very prominent at this resolution, we could identify unique cytoplasmic signatures in some kidney tumors. For example, the hyper-intense punctate signal in the cytoplasm of CRCC represents glycogen/lipid, large cells with abundant hyper-intense cytoplasm representing histiocytes in PRCC, and signal-void large polygonal cell representing adipocytes in AML. According to a blinded analysis was performed by an uropathologist, all nonneoplastic tissues were differentiated from neoplastic tissues. Further, all benign tumors were called benign and malignant were called malignant. A diagnostic accuracy of 80% was obtained in subtyping the tumors.

Conclusion: The ability of FFOCT to reliably differentiate nonneoplastic from neoplastic tissue and identify some tumor types makes it a valuable tool for rapid evaluation of ex vivo kidney tissue e.g. for intraoperative margin assessment and kidney biopsy adequacy. Recently, higher resolution images were achieved using an experimental FFOCT setup. This setup has the potential to further increase the diagnostic accuracy of FFOCT.

Keywords: Ex vivo microscopy; full-field optical coherence tomography; histopathology; kidney; tumors.

Figures

Figure 1
Figure 1
Full-field optical coherence tomography showing (a) schematic diagram of the optical pathway and (b) photograph of the system used
Figure 2
Figure 2
Full-field optical coherence tomography (a-c) and corresponding H&E image (d-f) of nonneoplastic kidney. (a) Cortex with glomerulus (arrow) and tubules (arrowheads). Inset shows zoomed in images of the tubules. (b) Medulla with medullary rays (arrows). Inset shows zoomed in images of the tubules. And (c) large caliber blood vessel (arrow) surrounded by bright interstitium (arrowhead). Full-field optical coherence tomography (a-c); scale bars = 0.5 mm. Insets × 2.5, zoom of images a and b, respectively. H&E (d-f); total magnifications = ×100
Figure 3
Figure 3
Full-field optical coherence tomography (a and b) and corresponding H&E images of (c and d) of nonpapillary kidney tumors. (a) Clear cell renal cell carcinoma with sheets of cells (arrow) and stroma (arrowhead). Cells have bright punctate structures in cytoplasm (inset; arrowhead). (b) Chromophobe renal cell carcinoma with sheets of cells (arrow) and bright stroma (arrowheads). Cells have abundant homogenous cytoplasm (inset; arrowhead). Full-field optical coherence tomography (a and b); scale bars = 0.5 mm. Insets = ×3 zoom of images a and b, respectively. H&E (c and d); total magnifications = ×100
Figure 4
Figure 4
Full-field optical coherence tomography (a-c) and corresponding H&E images of (d-f) of papillary kidney tumors. (a) Papillary renal cell carcinoma showing papillae (arrows). (b) Papillary renal cell carcinoma showing papillae (arrow) filled with large bright cells (arrowhead; inset) confirmed as histiocytes (arrow) on corresponding H&E (e). (c) Papillary urothelial carcinoma showing thick papillae with fibrovascular core; collagen bright signal adjacent to signal void oval blood vessel (arrow; inset with arrowhead). Full-field optical coherence tomography (a-c); scale bars = 0.25 mm. Insets = 2× zoom of images b and c, respectively, H&E (d-f); total magnifications = ×200
Figure 5
Figure 5
Full-field optical coherence tomography (a and b) and corresponding H&E images of (c and d) of benign kidney tumors. (a) Angiomyolipoma showing signal void polygonal adipocytes (arrows) and bright connective tissue from collagen (arrowhead). (b) Cystic nephroma showing large signal void cyst (*) lined by single layered epithelium with dull gray signal (arrow and inset with arrowhead) embedded in thick collagenous tissue (bright signal; arrowhead). Full-field optical coherence tomography; scale bars (a) = 0.25 mm, (b) = 0.5 mm. Inset 2 × zoom of images B. H&E (c and d); total magnifications = ×200
Figure 6
Figure 6
Full-field optical coherence tomography image from rat's kidney showing tubules (arrows) at a relatively higher resolution, acquired by an experimental Full-field optical coherence tomography system equipped with a × 30 Olympus objective (NA; 1.05). Field of view = 260 μ ×260 μ

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