Feasibility and preliminary accuracy of high-resolution imaging of the liver and pancreas using FNA compatible microendoscopy (with video).

BACKGROUND: EUS-guided FNA is one of the few techniques that can obtain cells and tissue from the liver and pancreas. However, the technique remains vulnerable to poor specimen quality and sampling error. OBJECTIVE: To evaluate the ability of a high-resolution microendoscope (HRME) to visualize the cellular and architectural features of normal and malignant liver and pancreatic tissue ex vivo, to assess the ability of endosonographers to identify normal and neoplastic tissue by using HRME images, and to demonstrate preliminary technical feasibility of in vivo HRME imaging via EUS fine-needle puncture (FNP). DESIGN: Ex vivo pilot feasibility study in human tissue; in vivo swine model. SETTING: Two academic medical centers. PATIENTS: Co-registered HRME images and biopsies were obtained from surgically resected hepatic and pancreatic tissues from 44 patients. INTERVENTION: Images were divided into training (12 images) and test (80 images) sets containing a range of normal and pathologic conditions for each organ. After viewing the training sets, 9 endosonographers attempted to distinguish malignant tissue from normal or benign lesions in the test sets, each of which contained 40 unique images with individual diagnoses from pathology. MAIN OUTCOME MEASUREMENTS: Image acquisition feasibility, ex vivo and in vivo. Ability of endosonographers to recognize features of normal/benign or malignant tissue from the liver and pancreas. RESULTS: Overall, the 9 endosonographers achieved median accuracy figures of 85% in the liver and 90% in the pancreas. The endosonographers with prior experience in reading HRME images achieved accuracy rates between 90% and 95%. Technical feasibility of HRME imaging through a 19-gauge EUS-FNP needle was demonstrated in an in vivo swine model. LIMITATIONS: Ex vivo study. CONCLUSION: High-resolution microendoscopy allows real-time imaging of cellular-level morphology and tissue architecture in the liver and pancreas. The technique appears to have a short learning curve, after which endosonographers achieved high accuracy rates in distinguishing malignant tissue from normal and benign pathology in both organs. Translating this imaging platform to the in vivo setting appears technically feasible.

Perineal swellings in two strains of mice.

Seven adult male mice of two different strains and from two different animal housing facilities were submitted for necropsy to evaluate unilateral or bilateral swellings in the ventral perineal area. On dissection, the swellings were oval to spherical cystic structures located near the base of the penis. Striated muscle and a delicate stroma encapsulated all cystic structures. Cysts were firm, tan, and filled with clear, yellow fluid, or were softer and filled with white, amorphous, marbled material and a smaller amount of clear, yellow fluid. Evaluation of the cysts led us to a diagnosis of cystic bulbourethral (or Cowper s) glands. Possible causes and the incidence of this condition in other species are discussed.

Demodex musculi in the Skin of Transgenic Mice.

Although infestations by a number of Demodex mite species have been described in mice, the occurrence of Demodex musculi infestation was last reported by Hirst in 1917. This communication describes the occurrence of D. musculi infestation in two lines of transgenic mice and their F1-hybrid offspring. We first found the Demodex mite in mouse hair samples collected during efficacy screenings in an ongoing ectoparasite treatment trial for the fur mite Radfordia affinis. An investigation was undertaken to determine the extent of the Demodex infestation within the facility and the original source of the parasite. D. musculi was found in three of the four mouse genotypes present in the index room and in one of these genotypes in two other rooms. The mite was not found in sentinel mice, other strains, or stocks within the facility. The mites were more easily recovered from the immunodeficient B6,CBA-TgN(CD3E)26Cpt transgenic (Tg) and the hybrid double-Tg (B6,CBA-TgN(CD3E)26Cpt x B6,SENCARB-TgN(pk5prad1)7111Sprd)F1 mice than from the B6,SENCARB-TgN(pk5prad1)7111Sprd Tg mouse, which is believed to be immunocompetent despite its thymic abnormalities. Histopathologic examination showed D. musculi superficially in hair follicles but not in the preputial or clitoral gland or in serial sections of the head, eyelids, or ears, the locations favored by other mouse demodicids. Physical and microscopic examination revealed no dermatitis. The immune deficiency in the B6,CBA-TgN(CD3E)26Cpt mouse probably provided the permissive host conditions that contributed to the proliferation and subsequent detection of the Demodex. Preliminary transmission experiments conducted with other immunologic mutant mice and our sentinel strain demonstrated variation in mite transfer and in either detection or maintenance of infestation when na ve mice were housed with those carrying D. musculi. The original source of D. musculi was not conclusively identified, but this parasite appears to be of low pathogenicity in the examined genotypes.

Dual-mode reflectance and fluorescence near-video-rate confocal microscope for architectural, morphological and molecular imaging of tissue.

We have developed a near-video-rate dual-mode reflectance and fluorescence confocal microscope for the purpose of imaging ex vivo human specimens and in vivo animal models. The dual-mode confocal microscope (DCM) has light sources at 488, 664 and 784 nm, a frame rate of 15 frames per second, a maximum field of view of 300 x 250 mum and a resolution limit of 0.31 mum laterally and 1.37 mum axially. The DCM can image tissue architecture and cellular morphology, as well as molecular properties of tissue, using reflective and fluorescent molecular-specific optical contrast agents. Images acquired with the DCM demonstrate that the system has the sub-cellular resolution needed to visualize the morphological and molecular changes associated with cancer progression and has the capability to image animal models of disease in vivo. In the hamster cheek pouch model of oral carcinogenesis, the DCM was used to image the epithelium and stroma of the cheek pouch; blood flow was visible and areas of dysplasia could be distinguished from normal epithelium using 6% acetic acid contrast. In human oral cavity tissue slices, DCM reflectance images showed an increase in the nuclear-to-cytoplasmic ratio and density of nuclei in neoplastic tissues as compared to normal tissue. After labelling tissue slices with fluorescent contrast agents targeting the epidermal growth factor receptor, an increase in epidermal growth factor receptor expression was detected in cancerous tissue as compared to normal tissue. The combination of reflectance and fluorescence imaging in a single system allowed imaging of two different parameters involved in neoplastic progression, providing information about both the morphological and molecular expression changes that occur with cancer progression. The dual-mode imaging capabilities of the DCM allow investigation of both morphological changes as well as molecular changes that occur in disease processes. Analyzing both factors simultaneously may be advantageous when trying to detect and diagnose disease. The DCM's high resolution and near-video-rate image acquisition and the growing inventory of molecular-specific contrast agents and disease-specific molecular markers holds significant promise for in vivo studies of disease processes such as carcinogenesis.