Validation of full-field optical coherence tomography in distinguishing malignant and benign tissue in resected pancreatic cancer specimens

Abstract

BackgroundPancreatic cancer is the fourth leading cause of cancer-related mortality in the United States. The minority of patients can undergo curative-intended surgical therapy due to progressive disease stage at time of diagnosis. Nonetheless, tumor involvement of surgical margins is seen in up to 70% of resections, being a strong negative prognostic factor. Real-time intraoperative imaging modalities may aid surgeons to obtain tumor-free resection margins. Full-field optical coherence tomography (FF-OCT) is a promising diagnostic tool using high-resolution white-light interference microscopy without tissue processing. Therefore, we composed an atlas of FF-OCT images of malignant and benign pancreatic tissue, and investigated the accuracy with which the pathologists could distinguish these.Materials and methodsOne hundred FF-OCT images were collected from specimens of 29 patients who underwent pancreatic resection for various indications between 2014 and 2016. One experienced gastrointestinal pathologist and one pathologist in training scored independently the FF-OCT images as malignant or benign blinded to the final pathology conclusion. Results were compared to those obtained with standard hematoxylin and eosin (H&E) slides.ResultsOverall, combined test characteristics of both pathologists showed a sensitivity of 72%, specificity of 74%, positive predictive value of 69%, negative predictive value of 79% and an overall accuracy of 73%. In the subset of pancreatic ductal adenocarcinoma patients, 97% of the FF-OCT images (n = 35) were interpreted as tumor by at least one pathologist. Moreover, normal pancreatic tissue was recognised in all cases by at least one pathologist. However, atrophy and fibrosis, serous cystadenoma and neuroendocrine tumors were more often wrongly scored, in 63%, 100% and 25% respectively.ConclusionFF-OCT could distinguish normal pancreatic tissue from pathologic pancreatic tissue in both processed as non-processed specimens using architectural features. The accuracy in pancreatic ductal adenocarcinoma is promising and warrants further evaluation using improved assessment criteria.

The clinical usefulness of optical coherence tomography during cancer interventions

“…Van Manen et al ( 2017 ) evaluated the accuracy of FF-OCT in detecting pancreatic tumors in resected surgical specimens. Two pathologists were asked to evaluate 100 FF-OCT images after a training set, which resulted in a combined sensitivity and specificity of 72 and 74%, respectively, compared to histologic diagnosis.…”

Spectroscopic imaging with spectral domain visible light optical coherence microscopy in Alzheimer’s disease brain samples

“…For instance, the microstructure of tumors was investigated with the help of an OCM system. In several studies, OCM provided contrast between healthy and cancerous tissues based on the difference in the backscattered and backreflected light intensity as well as on the assessment of the attenuation coefficients [ 7 , 16 , 17 ]. These OCM systems provided an axial resolution of 5.0 μm , 6.4 μm and 1.5 μm , respectively.…”

New intraoperative imaging technologies: Innovating the surgeon’s eye toward surgical precision

“…Optical coherence tomography (OCT) uses coherent light interferometry to image optical scattering media, similarly to how ultrasonography studies echoed sound waves. Typically, OCT uses near‐infrared (NIR) light (wavelength range of 700 to 1500 nm) enabling micrometric resolution (around 1.5 μm) and millimetric imaging depth …”