Direct Radiologic-Pathologic Correlation of Colorectal Liver Metastases with MR-Compatible Sectioning and Localization Device

University Of Wisconsin-Madison, Madison WI

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Abstract

Patients with colorectal cancer (CRC) liver metastases derive a significant survival benefit from surgical resection of liver metastases. However, accurate pre-operative detection of all metastatic lesions is essential to achieve a survival benefit. Lesions described as ?indeterminate? are problematic for pre-operative planning. Advances in imaging technologies, particularly with gadoxetic acid-enhanced magnetic resonance (MR) imaging, have improved sensitivity for small liver lesion detection. However, significant limitations exist for characterizing these lesions. Accurate radiologic-pathologic correlation of lesions, the gold standard, remains challenging. In order to improve characterization of small liver lesions with accurate histopathologic diagnoses, our group developed an MR-compatible sectioning device for ex vivo imaging of liver specimens. The specimens are stabilized and imaged in the device and then sectioned according to the device's radio-opaque grid, performing precise radiologic-pathologic correlation of liver lesions. Our group previously validated our design using swine liver and demonstrated 100% accuracy of lesion identification in this feasibility study. Our long-term goal is to establish definitive histologic characterization of radiologically indeterminate liver lesions in CRC patients. In the current project, our objective is to validate our novel method for radiologic- pathologic correlation in the characterization of liver lesions in CRC patients. Specifically, we aim to establish rigorous one-to-one correlation of radiologic lesions with lesions identified on pathology in resected human liver specimens. Secondly, we aim to determine the accuracy of ex vivo MR imaging liver lesion diagnosis using direct pathologic correlation as the reference standard. We expect our device will provide precise correlation of liver lesions and identify radiologic inaccuracies in lesion characterization. The applicant, Victoria Rendell, MD, is a general surgery resident at the University of Wisconsin-Madison pursuing dedicated research time to achieve her goal of becoming an independent translational researcher and surgical oncologist. This award would support a second year of research. The proposed training plan will provide Dr. Rendell with a mentored experience in translational research involving the disciplines of Radiology, Surgery, and Pathology to improve the care of CRC patients, formal coursework and professional development activities. Her sponsor, radiologist Dr. Scott Reeder, and co-sponsor, hepatobiliary surgical oncologist Dr. Emily Winslow, have a history of research collaboration and will form the ideal mentoring team for Dr. Rendell. This project will provide the training and experience Dr. Rendell needs to become a funded researcher and surgical oncologist. Additionally, improved characterization of indeterminate lesions from this project will improve pre-operative planning for patients with metastatic CRC and ultimately survival. This method can be applied for malignancies in other solid organs where radiologic advances have outpaced the resolution of standard gross anatomic sectioning techniques, a critical innovation in the care of oncology patients