Improving Frozen Kidney Biopsy Interpretation Using DUET-Generated Virtual PAS Stains.

Area of Science:

• Nephrology
• Pathology
• Medical Imaging

Background:

• Standard Hematoxylin & Eosin (H&E) staining of frozen donor kidney biopsies faces challenges like freezing artifacts and limited pathologist expertise.
• Current methods lack rapid, cost-effective ways to generate virtual special stains for quantifying histopathological features in frozen sections.

Purpose of the Study:

• To evaluate the utility of DUET-generated virtual Periodic acid-Schiff (vPAS) stains for assessing donor kidney viability using frozen biopsies.
• To compare pathologist diagnostic consistency using H&E alone versus H&E combined with vPAS stains.

Main Methods:

• DUET software generated vPAS stains by combining brightfield and fluorescence images from H&E-stained frozen kidney biopsies.
• Renal and general pathologists assessed interstitial fibrosis/tubular atrophy (IF/TA), inflammation, and arteriosclerosis on 29 kidney biopsies.
• Evaluations were compared between H&E images alone and H&E with vPAS images.

Main Results:

• Pathologist consistency (ICC scores) improved for IF/TA percentage, inflammation percentage, and arteriosclerosis number when using vPAS stains.
• Renal pathologists also showed improved consistency for sclerotic glomeruli percentage.
• No improvement was observed for arteriolar hyalinosis assessment.

Conclusions:

• Virtual PAS stains on frozen kidney biopsies enhance inter-pathologist consistency for key viability metrics compared to H&E alone.
• This technique has the potential to reduce diagnostic variability and improve donor kidney utilization and transplant decision-making.