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Kidney Week

Abstract: TH-PO563

Feasibility and Utility of Intraprocedural Kidney Biopsy Specimen Adequacy Verification With a Portable Digital Microscope

Session Information

  • Pathology and Lab Medicine
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

  • 1700 Pathology and Lab Medicine

Authors

  • Shueib, Ali, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Martinez Pitre, Pedro J., Ochsner Medical Center, New Orleans, Louisiana, United States
  • Mohamed, Muner, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Ochsner Medical Center, New Orleans, Louisiana, United States

Group or Team Name

  • Ochsner Nephrology
Background

Retrieval of optimal tissue specimens during a percutaneous kidney biopsy (PKB) is critical for establishing diagnoses. Lack of widespread availability of a pathologist during the procedure or of a regular light microscope in the procedural room are barriers that may result in submission of inadequate specimens, often aglomerular, impairing the ability to make a diagnosis. We examined the feasibility and utility of using a portable digital microscope (pDigMICRO) for intraprocedural verification of kidney tissue biopsy specimen adequacy.

Methods

We reviewed cases at Ochsner Medical Center in which a PKB was performed by a nephrologist and a pocket-size battery-operated pDigMICRO was used for verification of specimen adequacy immediately upon each tissue core retrieval. Images obtained at 50X and 1000X magnification were wirelessly captured in a smartphone and transferred to a secure server for storage. Demographics, clinical data, and pathology reports were collected. Based on total number of retrieved glomeruli examined under light microscopy, immunofluorescence, and electron microscopy, optimal PKB was defined as ≥ 15.

Results

A total of 20 patients were included, median age 58 (31-70), 40% women, 40% self-identified black, median BMI 28 (25-38). Median serum creatinine at the time of PKB 1.5 (0.7-5.2) mg/dL. Indications for PKB were proteinuria (90%), AKI (30%) and hematuria (20%). All PKBs were performed with a 16 g needle. An average of 2.6 cores were obtained after an average of 3.8 needle passes. Glomeruli were visualized with pDigMICRO in all cases (100%). A pathological diagnosis was achieved in all cases (100%). Nineteen (95%) cases were optimal for diagnosis, none (0%) were aglomerular. Median number of glomeruli retrieved per biopsy was 26 (6-53). No patient required an intervention or blood transfusion. One patient developed gross hematuria that resolved spontaneously.

Conclusion

Use of pDigMICRO allowed for verification of tissue adequacy in a similar manner to that previously reported utilizing standard methods of adequacy verification. This approach may be a viable tool to improve performance of PKB in centers without access to a pathologist or a regular light microscope, such as in those performed by interventional radiologists.