3D-printed specimen boxes aid explanted-liver sectioning

Last Updated: 2017-06-29

By David Douglas

NEW YORK (Reuters Health) - Following resection, 3D-printed specimen boxes based on preoperative cross-sectional imaging of the liver are helping improve tumor mapping, according to Ohio-based researchers.

As Dr. Andrew T. Trout explained in an email to Reuters Health, "With this work we are trying to facilitate and strengthen the connection between imaging and pathology by allowing us to systematically match the two up."

"Imaging like CT and MRI,�€ he added, is "obtained in standard regimented planes. Previously while pathologic sectioning was done systematically, there was no good way to section specimens so they would match the regimented imaging planes. So lining the two up was really difficult."

In a paper online in the Journal of Clinical Pathology, Dr. Trout of Cincinnati Children�€™s Hospital Medical Center and colleagues note the procedure is a modification of an approach that was initially developed to allow a precise comparison of MRI images and histopathology in postmortem brain specimens.

In the current study, the researchers say, "routine preoperative imaging of patients with liver disease, generally tumours, is used to create 3D-printed liver specimen boxes that facilitate sectioning immediately on hepatic resection."

"With 3D printing," Dr. Trout added, "we are able to rapidly create customized molds that fit individual patient's organs and hold them in near perfect alignment with imaging planes."

So far they have used the process in 13 young patients. Of these, 10 underwent transplant and three had partial hepatectomy. Among conditions involved were Abernethy malformation with liver lesions and hepatoblastoma.

Depending on the size of the liver, say the researchers, a single box takes from 48 to 72 hours to produce. The time can be halved by running two printers simultaneously and gluing the sections together.

Correlation of imaging and pathology is important, Dr. Trout stressed, "Because if we can carefully match the two, there is the opportunity to improve the interpretation of both - and we have seen this since starting this program. We are able to direct our pathology colleagues to areas of interest that they might not have specifically targeted and when they find something unexpected or interesting we can go back to the imaging to see if it's visible and if so what it looked like. This not only maximizes our diagnostic performance for individual cases, helping those specific patients, but makes us all better for the next case and next patient that comes along."

"On a more advanced level," he continued, "there is a strong push toward radiomic/radiogenomics. The idea of radiomics/radiogenomics is that through a systematic process of correlating imaging with pathology that we will recognize things on imaging that we didn't realize were there or didn't realize were important and that ultimately imaging might replace biopsy in some cases. To do really good radiomic/radiogenomic work you need to do careful, systematic analysis of both the imaging and pathology. The 3D printing process we have developed facilitates this."

Dr. Trout and colleagues concede that the process is time consuming and requires a dedicated team but they conclude that "there is value in continuing this technique for liver and potentially adapting it for other organs, particularly those that are often removed en bloc such as kidney and prostate."

SOURCE: http://bit.ly/2sl4JmT

J Clin Pathol 2017.