Background/Objectives: Wilms tumors, the most common pediatric renal tumors, are heterogeneous and consist of varying amounts of three components: blastema, epithelium, and stroma. Postoperative chemotherapy is tailored based on risk group classification and stage. Due to this heterogeneity, pathologists perform extensive tumor sampling to ensure accurate classification. Higher-harmonic-generation microscopy (HHGM) is an innovative imaging technique that enables rapid visualization of fresh tissue without preparation or staining. This makes it particularly valuable for sample selection, as the tissue can be reused for further analysis. This study aims to evaluate the accuracy of pathologists in distinguishing normal renal tissue, abnormal renal tissue, and three types of pediatric renal tumors, Wilms tumor, renal cell carcinoma, and congenital mesoblastic nephroma, in HHGM images. Methods: Twenty-nine samples from eighteen patients with a pediatric renal tumor were imaged using an HHG microscope and subsequently processed for histological analysis. Overview images of the samples were acquired at a rate of 10 s per mm2, while high-quality images took 1 min per mm2. A multi-observer study involving ten international expert pathologists of the SIOP-RTSG was conducted. Results: Pathologists were able to differentiate between normal and abnormal tissue with 100% (29/29) accuracy and correctly identified tumor versus non-tumor tissue with 97% (28/29) accuracy. Conclusions: These results show that HHGM is a highly promising technique for the rapid assessment of pediatric renal tumor samples, particularly for evaluating sample representativeness.
背景/目的：肾母细胞瘤作为最常见的儿童肾脏肿瘤，具有高度异质性，由胚芽、上皮和间质三种成分以不同比例构成。术后化疗方案需根据风险组分类及分期进行个体化制定。鉴于其异质性特点，病理医师需进行广泛肿瘤取样以确保准确分型。高次谐波显微成像技术是一种创新的成像方法，无需样本制备或染色即可快速实现新鲜组织的可视化观察，这一特性使其在样本选择方面具有独特价值，因为组织可重复用于后续分析。本研究旨在评估病理医师利用高次谐波显微图像区分正常肾组织、异常肾组织以及三种儿童肾脏肿瘤（肾母细胞瘤、肾细胞癌和先天性中胚层肾瘤）的准确性。方法：对18例儿童肾脏肿瘤患者的29份样本进行高次谐波显微成像，随后进行组织学分析处理。样本概览图像以每平方毫米10秒的速度采集，高质量图像则需每平方毫米1分钟。研究邀请了国际儿童肿瘤学会肾肿瘤研究组的十位国际病理学专家参与多观察者评估。结果：病理医师区分正常与异常组织的准确率达100%（29/29），识别肿瘤与非肿瘤组织的准确率达97%（28/29）。结论：这些结果表明高次谐波显微成像技术是一种极具前景的儿童肾脏肿瘤样本快速评估方法，尤其在评估样本代表性方面具有重要价值。
肿瘤(癌症)患者之家