Bridging the Gap Between Radiology and Microscopy Using microCT

Journal of Thoracic Imaging, vol. 40

Abstract

PURPOSE: Accurate lung cancer TNM staging depends on macroscopic and microscopic tumor evaluation of resection specimens. However, small nodules (<1 cm) are difficult to extract and correlate with in vivo imaging. We investigated whether microCT could better localize lesions or guide pathology to otherwise undetected abnormalities. MATERIALS AND METHODS: Paired ex vivo CT and microCT were performed after inflating and freezing surgically removed lung lobes (resolution 80 to 120 µm). Rigorous matching between CT, microCT, and histopathology was performed on areas containing abnormalities on microCT. RESULTS: A total of 57 lobectomy specimens were analyzed. MicroCT-guided microscopic examination led to 2 additional primary carcinomas, 2 separate tumor nodules from the primary lung tumor, and 1 atypical adenomatous hyperplasia lesion that were not evident before surgery. For both patients with separate tumor nodules, the cT1 stage was upgraded to a pT3. In addition, the microCT provided insight into underlying structural disease (ie, emphysema and fibrosis). CONCLUSIONS: In 5 out of 57 resection specimens (9%), microCT showed additional (pre-)cancerous lesions. This explorative study suggests that lobar microCT could serve as a valuable guide for pathologists by pointing them toward areas that may warrant further investigation. In this way, it is a practical and beneficial tool, capable of facilitating a more precise TNM classification in tumor resection specimens, which needs further validation in a prospective study.

Authors 12

1. Stijn E. Verleden corresponding
   Affiliation as printed

   Antwerp Surgical Training, Anatomy and Research Centre (ASTARC)

   Pulmonology

   Thoracic and Vascular Surgery

2. Annemiek Snoeckx
   Affiliation as printed

   Molecular-Morphology-Microscopy (mVISION)

   Radiology

3. Dieter J. E. Peeters
   Affiliation as printed

   Pathology

4. Wen Wen
   Affiliation as printed

   Thoracic and Vascular Surgery

5. Reinier R.L. Wener

   Antwerp University Hospital

   Affiliation as printed

   Pulmonology

   Thoracic Oncology, University Hospital Antwerp, Edegem, Belgium

6. Paul E. Van Schil corresponding
   Affiliation as printed

   Antwerp Surgical Training, Anatomy and Research Centre (ASTARC)

   Thoracic and Vascular Surgery

7. Senada Koljenović
   Affiliation as printed

   Pathology

8. Annelies Janssens

   Antwerp University Hospital

   Affiliation as printed

   Thoracic Oncology, University Hospital Antwerp, Edegem, Belgium

9. Danny David Jonigk corresponding Aachen Institute for Pathology, University Medical Center

   Universitätsklinikum Aachen · German Center for Lung Research · RWTH Aachen University

   Affiliation as printed

   German Center for Lung Research (DZL), BREATH Hannover, Hanover

   Institute for Pathology, University Medical Center RWTH Aachen, Aachen

10. Maximilian Ackermann corresponding Aachen Institute for Pathology, University Medical Center

    Helios Universitätsklinikum Wuppertal · Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Institute for Pathology, Helios University Hospital, Wuppertal, Germany

    Institute for Pathology, University Medical Center RWTH Aachen, Aachen

11. Therese Sophie Lapperre

    University of Antwerp

    Affiliation as printed

    Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium

    Pulmonology

12. Jeroen M. Hendriks corresponding
    Affiliation as printed

    Antwerp Surgical Training, Anatomy and Research Centre (ASTARC)

    Thoracic and Vascular Surgery