Presented by: Angela Estevez MD
Beth Israel Deaconess Medical Center

Introduction

Nonlinear microscopy (NLM) is an emerging imaging technology able to rapidly produce H&E histology-like digital images in fresh surgical specimens. Our group has previously demonstrated the ability of NLM to accurately detect prostate cancer suggesting it might be a useful tool for intraoperative evaluation of margin status in nerve-sparing radical prostatectomy (Cahill et al. 2020). We present preliminary data on feasibility and accuracy of NLM to evaluate margin status compared to paraffin-embedded H&E histology. 

Materials

Nerve sparing status is determined based on standard of care. The specimen is marked with tissue marking dyes and fluorescent plastic beads, allowing visualization under NLM. The surgeon performs ex vivo resection of the neurovascular bundle, to simulate bilateral nerve-sparing, and this margin is inked separately. The specimen is then grossed into slices, stained, and placed for evaluation. A genitourinary pathologist evaluates the posterior margins of the specimen using NLM, after which the specimen is submitted for standard histology.

Results

,

20 participants were included in the analysis. The average time of specimen preparation (inking, ex-vivo resection, grossing) and NLM evaluation was 43 minutes. A total of 40 margins were evaluated by NLM, out of which 8 were reported as positive, 25 as negative, and 7 as indeterminate (Table 1). Among the positive margins 3 were later confirmed to be positive by H&E (Figure 1), while 5 were false positive. 1 case was false negative and 6 out of the 7 indeterminate margins were later confirmed to be negative by H&E. 

Conclusion

NLM has the potential to evaluate margin status without compromising final H&E evaluation. It may be a higher throughput alternative to time and labor-intensive techniques, such as frozen section analysis (Schlomm et al. 2012). However, it is necessary to improve timing and efficiency with further pilot cases. 

Funding

NIH R01 CA249151

Co-Authors

Timothy D. Weber, PHD
Massachusetts Institute of Technology

Utsav Bansal, MD
Beth Israel Deaconess Medical Center

Philip Kim, MD
Beth Israel Deaconess Medical Center

Yue Sun, MD
Beth Israel Deaconess Medical Center

Seymour Rosen, MD
Beth Israel Deaconess Medical Center

Taylor St Jacques, MS
Beth Israel Deaconess Medical Center

James G. Fujimoto, PHD
Massachusetts Institute of Technology

Jeffrey Sun, BS
Beth Israel Deaconess Medical Center

Gabriela Nieto-Blanco, MS
Beth Israel Deaconess Medical Center

Peter Chang, MD, MPH
Beth Israel Deaconess Medical Center

Andrew A Wagner, MD
Beth Israel Deaconess Medical Center