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. 2025 Jul 18;410(1):227.
doi: 10.1007/s00423-025-03810-9.

Intraoperative differentiation of pancreatic neoplastic lesions using optical coherence tomography (OCT)

Markus Kist #  1 , Paul Strenge #  2 , Tobias Keck  3 , Andreas Weber  4 , Peter Bronsert  4 , Thaer S A Abdalla  5 , Ulrich Friedrich Wellner  5 , Michael Thomaschewski  5
Affiliations

Intraoperative differentiation of pancreatic neoplastic lesions using optical coherence tomography (OCT)

Markus Kist et al. Langenbecks Arch Surg. .

Abstract

Purpose: The diagnostic methods for accurately differentiating the dignity of pancreatic neoplasms are limited. Worrisome features on MRI and endosonography guide the way to resection or conservative treatment with a relevant rate of failure. Intraoperative minimal invasive optical coherence tomography could be a solution for this challenge. The aim of this study is to investigate whether optical coherence tomography is suitable for differentiating of pancreatic neoplastic lesions.

Methods: In this exploratory study, four patient's specimens of pancreatic resections (white adipose tissue, intraductal papillary mucinous neoplasm (IPMN), pancreatic ductal adenocarcinoma (PDAC) based on IPMN and neuroendocrine pancreatic carcinoma) were prospectively examined ex vivo immediately after resection in the operating room using an optical coherence tomography system (Callisto 930nm, Thorlabs GmbH). In detail, the study investigated whether and in what way endocrine tumors, adenocarcinomas, premalignant and benign cysts differ morphologically in optical coherence tomography imaging compared to healthy pancreatic tissue. The final histopathological findings of the pancreatic specimens served as a reference and were correlated.

Results: The samples examined ranged from typical fatty tissue, intraductal papillary mucinous neoplasm (IPMN), a moderate differentiated (G2) pancreatic ductal adenocarcinoma (PDAC) based on an intraductal papillary mucinous neoplasm (IPMN) and a neuroendocrine pancreatic carcinoma. Optical coherence tomography was feasible to replicate key histological characteristics and tissue architecture in correlation to conventional Hematoxylin-eosin histology.

Conclusion: Optical coherence tomography imaging has the potential to differentiate between benign, pre-malignant and malignant pancreatic pathologies by morphology and should be examined in larger collectives.

Keywords: IPMN; Optical coherence tomography; PDAC; PanNET.

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Conflict of interest statement

Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University of Lübeck, Schleswig-Holstein, Germany (#2023 − 362). Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: The authors affirm that human research participants provided informed consent for publication of all Figures. Conflict of interest: The authors declare that they have no conflict of interest. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
White adipose tissue: a) White light image of the specimen, showing the scanning area (red square) and scanning direction (red arrow). b) OCT B-scan from the acquired volume. c) Top-view slice extracted 120 µm below the tissue surface (red line in b). d) Detailed view of the scanning area, corresponding to (c). e) HE section of the specimen corresponding to (c) (detailed view bottom right). The green arrow highlights corresponding vessel structures between OCT and HE
Fig. 2
Fig. 2
IPMN: a) White light image of the specimen, showing the scanning area (red square) and scanning direction (red arrow). b) OCT B-scan from the acquired volume. c) Top-view slice extracted 50 µm below the tissue surface (red line in b). d) Detailed view of the scanning area, corresponding to (c). e) HE section of the specimen corresponding to (c) (detailed view bottom right). The green arrow highlights groups of columnar mucin-producing cells visible in OCT and HE
Fig. 3
Fig. 3
PDAC based on an IPMN: a) White light image of the specimen, showing the scanning area (red square) and scanning direction (red arrow). b) OCT B-scan from the acquired volume. c) Top-view slice extracted 240 µm below the tissue surface (red line in b). d) Detailed view of the scanning area, corresponding to (c). e) HE section of the specimen corresponding to (b) (detailed view bottom right). The green arrow highlights ductal adenocarcinoma with surrounding desmoplastic stromal response visible in OCT and HE
Fig. 4
Fig. 4
NET G2: a) White light image of the specimen, showing the scanning area (red square) and scanning direction (red arrow). b) OCT B-scan from the acquired volume. c) Top-view slice extracted 120 µm below the tissue surface (red line in b). d) Detailed view of the scanning area, corresponding to (c). e) HE section of the specimen (detailed view bottom right). The green arrow highlights NET with trabecular architecture visible in OCT and HE; *: fatty tissue; o: fibrotic tissue; arrow: NET
See this image and copyright information in PMC

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