PATHOLOGY VISIONS 2014 PRESENTER
Maria Shevchuk, MD, FCAP
Weill Cornell Medical College
In Vivo Microscopy Applications in Pathology
Biography: Maria Shevchuk, MD, FCAP is Associate Professor of Pathology at Weill Cornell Medical College and chair of the In Vivo Microscopy Committee of the College of American Pathologists. She completed her MD degree with honors at Upstate Medical Center, and a residency in pathology, followed by two fellowships in gynecologic and urological pathology at Columbia Presbyterian Medical Center in New York City. Dr Shevchuk is an internationally recognized expert in urological pathology. She has been an invited speaker at numerous national and international meetings, and for 15 years chaired the uropathology course at the annual AUA meetings. She has also been involved in multiple international consensus conferences. Her bibliography includes section editor of a urology textbook, multiple chapters in pathology textbooks and numerous peer-reviewed papers. Her research includes work with in vivo microscopy technologies to image various organs. Other research involves studies of carcinogenesis and precision medicine.
Abstract: Maria Shevchuk, MD, FCAP, Manu Jain, MD, Sushmita Mukerjee, PhD, MS. Weill Cornell Medical College, NY, NY.
Background In vivo microscopy (IVM) encompasses several new technologies, in which light/lasers of various wavelengths are used to produce histologic images in living/unprocessed tissues. The purpose of this study is to describe the uses of these technologies in the practice of pathology, using ex vivo applications.
Methods Unprocessed human tissues from various organs were imaged by two technologies: multiphoton microscopy (MPM) and ff-OCT immediately after removal in surgery or by biopsy.
Results Tissues were imaged from the following organs: GI tract—esophagus, stomach, small intestine, and colon; GU tract—prostate and periprostatic tissues, bladder, kidney and testis; Pulmonary system—lungs. In these organs, the normal tissues were imaged, as well as premalignant/in situ lesions and malignant neoplasms. The ex vivo images obtained were comparable to histopathology. Based on this experience, we suggest that these technologies could be used currently in the pathology laboratory in the following settings:
1. Intraoperative ex vivo imaging can be performed faster, either replacing frozen sections or by identifying the most significant area for frozen section. The surgical margins, sentinel lymph nodes, and other intraoperative biopsies often contain abundant adipose tissue, which does not yield good frozen sections. In these cases, ex vivo imaging would be superior to frozen sections.
2. Ex vivo imaging would be very useful intraprocedurally to evaluate adequacy of needle biopsies, similarly to the adequacy evaluations performed by cytopathologists during needle aspirations. This would save tissue and time (often frozen sections would not be required), and money if another procedure is avoided.
3. Pathologists select tissues to be sent for genetic/molecular studies. Ex vivo imaging would preserve tissue, provide a permanent digital record of the tissue submitted, and could be used to quantitate the percent of tumor.
4. In the pathology gross room, ex vivo imaging can facilitate sectioning of the most significant areas of the specimens, particularly for margin evaluations.
Conclusions Ex vivo applications of IVM technology can be integrated into the current practice of pathology, requiring a short learning curve on the part of pathologists, and requiring further refinements in the technology for specific uses in the pathology laboratory. The above mentioned applications will find their niche in the practice of pathology and will become the “best practices” in these settings.