Multiphoton Microscopy in the Evaluation of Kidney Tumors
Manu Jain, Maria M Shevchuk, Brian D Robinson, Amit Aggarwal, Sushmita Mukherjee, Douglas S Scherr. Weill Medical College of Cornell University, New York, NY
Background: Multiphoton microscopy (MPM) an optical imaging technique generates subcellular resolution images from intrinsic tissue signals. While miniaturization of MPM for in vivo use is in progress, we assess its diagnostic potential using a bench-top system for identifying and differentiating common kidney carcinomas.
Design: Fresh sections (unprocessed and unstained) from 25 nephrectomy specimens were imaged with MPM and then compared with corresponding H&E sections. Specimens consisted of 12 clear cell RCC (7 low grade and 5 high grade), 4 chromophobe RCC, 5 papillary RCC, and 4 urothelial carcinomas.
Results: We could clearly differentiate urothelial carcinomas with broad papillary structures from renal cell carcinomas (RCC). We could further classify RCC into papillary and non-papillary (clear cell and chromophobe) subtypes based on their architecture: small papillae filled with histiocytes versus sheets of cells, respectively. Clear cell and chromophobe RCC had unique cytoplasmic MPM signatures. Lipidic cytoplasm (corresponding to clear cells on H&E) was seen in low grade and some high grade clear cell RCC. Homogeneous cytoplasm (corresponding to eosinophilic cells on H&E) was usually seen in high grade clear cell RCC and chromophobe tumors. In addition, intra-cytoplasmic granules (color coded blue and hypothesized to correspond to cytoplasmic vesicles) were seen in most of the chromophobe tumors. Thus, by combining nuclear criteria and unique MPM cytoplasmic signatures, we could distiguish and also grade these tumors.
Conclusions: Our study demonstrated the ability of MPM to distinguish between various kidney carcinomas and grade them. We thus foresee future real-time applications where miniaturized instruments can guide intra-operative decision-making based on cancer type and grade for a given tumor. For example, MPM may help surgeons determine the extent (partial vs. radical) and number (in case of multiple tumors) of tumor resections. This would be especially beneficial in high risk patients with compromised renal function.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 136, Wednesday Morning