Detection of breast cancer lymph node metastases in frozen sections with a point-of-care low-cost microscope scanner

Detection of lymph node metastases is essential in breast cancer diagnostics and staging, affecting treatment and prognosis. Intraoperative microscopy analysis of sentinel lymph node frozen sections is standard for detection of axillary metastases but requires access to a pathologist for sample anal...

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Veröffentlicht in:	PloS one Jg. 14; H. 3; S. e0208366
Hauptverfasser:	Holmström, Oscar, Linder, Nina, Moilanen, Hannu, Suutala, Antti, Nordling, Stig, Ståhls, Anders, Lundin, Mikael, Diwan, Vinod, Lundin, Johan
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Public Library of Science 19.03.2019 Public Library of Science (PLoS)
Schlagworte:	Biology and Life Sciences Biopsy Breast cancer Breast Neoplasms - pathology Cancer Cancer diagnosis Cancer metastasis Cancer patients Cancer surgery Care and treatment Cost analysis Diagnosis Digital imaging Digitization Engineering and Technology Female Frozen Sections Frozen sections (Histology) Ground truth Health sciences Histopathology Hospitals Humans Image acquisition Image detection Image quality Laboratories Light microscopy Low cost Lymph node biopsy Lymph nodes Lymph Nodes - pathology Lymphatic Metastasis - diagnostic imaging Lymphatic Metastasis - pathology Lymphatic system Maternal & child health Medical diagnosis Medical imaging Medical prognosis Medicine Medicine and Health Sciences Metastases Metastasis Methods Microscopy Microscopy - economics Microscopy - instrumentation Miniaturization Onsite Pathology Point-of-Care Systems - economics Prognosis Public health Research and Analysis Methods Retrospective Studies Scanners Sensitivity and Specificity Smartphones Studies Surgery Womens health Workflow Workflow software Sweden Finland
ISSN:	1932-6203, 1932-6203
Online-Zugang:	Volltext
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Zusammenfassung:	Detection of lymph node metastases is essential in breast cancer diagnostics and staging, affecting treatment and prognosis. Intraoperative microscopy analysis of sentinel lymph node frozen sections is standard for detection of axillary metastases but requires access to a pathologist for sample analysis. Remote analysis of digitized samples is an alternative solution but is limited by the requirement for high-end slide scanning equipment. To determine whether the image quality achievable with a low-cost, miniature digital microscope scanner is sufficient for detection of metastases in breast cancer lymph node frozen sections. Lymph node frozen sections from 79 breast cancer patients were digitized using a prototype miniature microscope scanner and a high-end slide scanner. Images were independently reviewed by two pathologists and results compared between devices with conventional light microscopy analysis as ground truth. Detection of metastases in the images acquired with the miniature scanner yielded an overall sensitivity of 91% and specificity of 99% and showed strong agreement when compared to light microscopy (k = 0.91). Strong agreement was also observed when results were compared to results from the high-end slide scanner (k = 0.94). A majority of discrepant cases were micrometastases and sections of which no anticytokeratin staining was available. Accuracy of detection of metastatic cells in breast cancer sentinel lymph node frozen sections by visual analysis of samples digitized using low-cost, point-of-care microscopy is comparable to analysis of digital samples scanned using a high-end, whole slide scanner. This technique could potentially provide a workflow for digital diagnostics in resource-limited settings, facilitate sample analysis at the point-of-care and reduce the need for trained experts on-site during surgical procedures.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Johan Lundin and Mikael Lundin are founders and co-owners of Fimmic Oy, Helsinki, Finland. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0208366