在体内 ，经皮，基于针，肾群众的光学相干断层扫描
Summary
Optical coherence tomography (OCT) is a high resolution imaging technique that allows analysis of tissue specific optical properties providing the means for tissue differentiation. We developed needle based OCT, providing real-time imaging combined with on-the-spot tumor differentiation. This publication describes a method for percutaneous, needle based OCT of renal masses.
Abstract
Optical coherence tomography (OCT) is the optical equivalent of ultrasound imaging, based on the backscattering of near infrared light. OCT provides real time images with a 15 µm axial resolution at an effective tissue penetration of 2-3 mm. Within the OCT images the loss of signal intensity per millimeter of tissue penetration, the attenuation coefficient, is calculated. The attenuation coefficient is a tissue specific property, providing a quantitative parameter for tissue differentiation.
Until now, renal mass treatment decisions have been made primarily on the basis of MRI and CT imaging characteristics, age and comorbidity. However these parameters and diagnostic methods lack the finesse to truly detect the malignant potential of a renal mass. A successful core biopsy or fine needle aspiration provides objective tumor differentiation with both sensitivity and specificity in the range of 95-100%. However, a non-diagnostic rate of 10-20% overall, and even up to 30% in SRMs, is to be expected, delaying the diagnostic process due to the frequent necessity for additional biopsy procedures.
We aim to develop OCT into an optical biopsy, providing real-time imaging combined with on-the-spot tumor differentiation. This publication provides a detailed step-by-step approach for percutaneous, needle based, OCT of renal masses.
Introduction
在过去几十年已经表明肾群众1,2的发病率稳步上升。到现在为止，肾传治疗决策已经作出主要根据MRI和CT成像特性，年龄和合并症的基础。然而，这些诊断方法和临床参数缺乏技巧，真正检测肾质量的恶性潜能。核心活检或细针穿刺有足够的组织进行病理评估（诊断）提供了客观的肿瘤分化程度与敏感性和特异性在95-100％3的范围内。因此活检获得接受可疑肾群众4,5的评价。然而，活组织检查没有足够的组织建立了诊断或具有在10-20％的速度正常肾实质（非诊断）发生整体，甚至高达30％的在肾脏小块（<4厘米，的SRM），延迟由于频繁必要性额外诊断过程活检手术3,5。
光学相干断层扫描（OCT）是一种新型的成像模态具有克服在肾传分化上述障碍的可能性。根据近红外光的散射，十月提供了一个15微米的轴向分辨率的图像在2-3毫米的有效组织渗透（ 图1，2）。每组织渗透，组织特异性光散射的所得中，毫米波信号强度的损失被表示为衰减系数（μ 十月 ：毫米-1）所描述的费伯等人6。组织学特征可以与可μ 十月值提供用于组织的分化（ 图3）的定量参数。
期间发生，恶性细胞显示增加的数目，以及更大和更不规则形状的核更高的折射率，更积极的线粒体。由于这种过表达细胞成分，在μ 十月的变化是比较恶性肿瘤良性肿瘤或未受影响的组织7时可以预期的。
最近我们研究了浅表华侨城良性和恶性肾群众8,9区分的能力。在16名患者，使用外部放置十月探针获得肿瘤组织的手术中十月测量。该控制臂由未受影响的组织中的同一患者的OCT测量。正常组织呈显著较低位数衰减系数相比恶性组织，证实OCT的肿瘤分化的潜力。这种定量分析是在一个类似的方式向分级其他类型的恶性组织中，被施加如尿路上皮癌10,11和外阴上皮瘤分化12。
ENT“>我们的目标是发展成为十月的光学活检，提供实时影像结合在现场肿瘤分化。目前研究的目的是来形容一个经皮，针基础，华侨城患者的方法诊断为固体增强肾质量，这种方法的描述是，就我们所知，在第一评估针的肾肿瘤的可能性基于十月。Protocol
Representative Results
Discussion
在本出版物中，我们报告了经皮，针根据肾，华侨城的可行性。这是华侨城发展的至关重要的第一步成肿瘤的分化临床应用技术，称为“光活检”。我们的第25例患者表现出经皮华侨城是一个简单而安全的过程。光学活检有两个好处比传统的核心活检。首先，将实时采集的OCT数据和分析将提供即时诊断的结果，相对于5-10天的常规病理学的处理时间。第二，OCT具有减少的非诊断的程序，这是常?…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
This work is funded by the Cure for Cancer Foundation, Dutch Technology Foundation (STW) and The Netherlands Organisation for Health Research and Development (ZonMw).
Materials
| 15G / 7.5cm Co-Axial Introducer Needle | Angiotech, Gainesville, USA | MCXS1612SX | |
| 18G / 20cm Trocar Needle | Cook medical, Bloomington, USA | DTN-18-20.0-U | |
| 16G / 20cm Quick-Core Biopsy Gun | Cook Medical, Bloomington, USA | G07827 | |
| Ilumien Optis PCI Optimization System (OCT & FFR) | St. Jude medical, St. Paul, USA | C408650 | Part of Dragonfly Kit. St. Jude medical, St. Paul, USA. (C4088643) |
| Dragonfly Duo Imaging Catheter | LightLab Imaging, Westford, USA | C408644 | Part of Dragonfly Kit. St. Jude medical, St. Paul, USA. (C4088643) |
| Sterile Dock Cover | CFI Med. Solutions, Fenton, USA | 200-700-00 | Part of Dragonfly Kit. St. Jude medical, St. Paul, USA. (C4088643) |
| 5ml Luer-lock Syringe | Merit Med. Syst., South Jordan, USA | C408647 | |
| 10ml Syringe | BD, Franklin Lakes, USA | 300912 | |
| 18G Blunt Fill Needle | BD, Franklin Lakes, USA | 305180 | |
| 21G Injection Needle | BD, Franklin Lakes, USA | 301155 | |
| Sterile scalpel | BD, Franklin Lakes, USA | 372611 | |
| NaCl 0,9% solution | Braun, Melsungen AG, Germany | 222434 | |
| Lidocaïne HCl 2% (20mg/ml) solution | Braun, Melsungen AG, Germany | 3624480 | |
| Sterile Ultrasound Gel, Aquasonic 100 | Parker Lab. Inc., Fairfield, USA | GE424609 | |
| Sterile Ultrasound Cover | Microtek Med., Alpharetta, USA | PC1289EU | |
| Pathology Container | |||
| AMIRA software package | FEI Visualization Sciences Group, Hillsboro, USA | Software platform for 3D data analysis | |
| FIJI software package (open source) | Open source, http://fiji.sc/Fiji | Open source image processing software | |
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