Lugol’s Iodine-Enhanced Micro-CT: A Potential 3-D Imaging Method for Detecting Tongue Squamous Cell Carcinoma Specimens in Surgery

Abstract

Background: A positive surgical margin (PSM) following oral cancer resection results in local recurrence and poor prognosis. Mono-block tumor specimens, especially from the tumor base, are difficult to evaluate. This inaccurate sampling ultimately leads to a false pathological diagnosis. Lugol's iodine (I 2-IK)-enhanced micro-CT is an emerging method to image tumor specimens. This study explores the feasibility of I 2-IK-enhanced micro-CT to evaluate the surgical margin for tongue squamous cell carcinoma (TSCC) specimens and to further seek optimal staining parameters. Methods: Rabbit tongue tissues and human TSCC samples were imaged via I 2-IKenhanced micro-CT. The optimal I 2-IK concentration and staining time were determined before clinical application using tissue shrinkage, micro-CT image quality, and effect on pathological diagnosis as assessment criteria. Next, 6 TSCC specimens were used to verify the process feasibility of surgical margin imaging with the optimal parameters. Finally, the possible reason by which I 2-IK could enhance micro-CT imaging was validated in vitro. Results: I 2-IK staining influenced specimen shrinkage, micro-CT image quality, and pathological image quality in a concentration-and time-dependent manner. After comprehensively considering these indicators, 3% I 2-IK staining for 48 and 12 h were found to be optimal for rabbit tongue tissues and TSCC samples, respectively. This method could provide a detailed 3-D structure of TSCC samples compared with H&E sections. Moreover, tumor and normal tissues could be differentiated by their glycogen content, which has high affinity with I 2-IK. Conclusions: I 2-IK-enhanced micro-CT could, thus, indicate the tumor margin and assist pathological sampling in patients with TSCC postoperation.

Accurately Locating Metastatic Foci in Lymph Nodes With Lugol’s Iodine-Enhanced Micro-CT Imaging

“…This is in accord with the fact that muscles are rich in glycogen. In addition, in our previous study, we also found that I 2 -IK has different affinity for OSCC cells in culture with high and low glycogen ( 25 ). It reminded us that the glycogen content of tumor tissues maybe richer than that in normal tissue in LNs.…”

“…Due to the low price, Lugol’s iodine (I 2 -IK) has already been widely used to assist micro-CT to delineate the internal fine anatomic structure of various soft tissue samples ( 19 – 23 ). In oncology, I 2 -IK-enhanced micro-CT imaging has also been used to provide the 3D structural information in adamantinomatous craniopharyngioma ( 24 ) and OSCC ( 25 ). However, no study has reported the use of I 2 -IK enhanced micro-CT imaging to accurately locate the metastatic foci.…”

A pilot study of micro-CT-based whole tissue imaging (WTI) on endoscopic submucosal dissection (ESD) specimens

“…To achieve this, it is necessary to produce a clear WTI with no staining defects. Xia et al reported that favorable Micro-CT images were obtained by staining tongue squamous cell carcinoma specimens with 3% Lugol's iodine solution for 12 h 20 . The ESD specimens used in this study were collected in routine clinical practice, and we cannot perform any protocol that would affect the conventional pathological diagnosis.…”

Feasibility study of positronium application for blood clots structural characteristics

“…µCT has been used as an X-rays based imaging techniques, to characterize blood clot composition, its etiology and its amenability for pharmacological treatment, and a better understanding of thrombus structure and composition. In this study, we stained the blood clot with Lugol's iodine solution which increases and enhance µCT to evaluate blood clot imaging [16].…”