PS2-05-25: Slide-free histology for breast cancer core-needle-biopsy diagnostics at point-of care in Ghana

Abstract Fluorescence imitating brightfield imaging (FIBI) and related modes provide near-instantaneous slide-free histology. Benefits include greatly accelerated patient-lesion assessment in major clinical center, but also accessible diagnostics for lower- and middle-income countries. In addition, the technology can be an improvement over standard histology, as it achieves visualization of novel tissue features not readily assessed on standard slides. The approach used is termed FIBI (fluorescence imitating brightfield imaging), which features inexpensive and robust hardware, automated specimen scanning and forthcoming computer-aided diagnosis. This innovative, non-destructive technique employs affordable optics and sensors to image intact tissues within seconds to minutes. A previously published preliminary validation study demonstrated approximately 97% clinical concordance across diverse tumor types. Complementing FIBI, we are developing a sample management platform to stain and image core-needle biopsy specimens with minimal physical manipulation, preserving tissue integrity. While this set of features will be helpful in well-resourced medical centers, they are also well-suited to responding to patient care needs in lower resource settings. One example: lower- and middle-income countries (LMICs) face an urgent need for point-of-care breast cancer diagnosis and treatment planning. With no mammography screening available, many patients present with late-stage tumors that are typically evaluated using core-needle biopsies. However, it is not possible to obtain complete time-of-procedure diagnostic feed-back, as formalin-fixation, embedding, sectioning, and pathologist examination are typically involved, and the facilities required are scarce and unevenly distributed. Even when presenting with large lesions, patients often endure weeks to months of waiting before receiving a diagnosis and commencing appropriate treatment. FIBI can be implemented with automated specimen scanning and, soon, computer-aided diagnosis. A prototype system for needle biopsy staining and automated specimen scanning using FIBI slide-free surface imaging has been developed at UC Davis in conjunction with Emory University, and a version of this designed at the University of Washington has been deployed to the Peace & Love Hospital in Kumasi, Ghana. Images are captured within a few minutes after core-needle biopsy acquisition and have similar appearance to standard 20X H&E-stained slides. However, while the main histological features in FIBI derive from optical absorbance of superficial hematoxylin and eosin stains, there is information also being detected arising from the simultaneous fluorescence of tissue features such as elastin and collagen. This gives rise to images with a color gamut that goes beyond the pinks and blues usually visible in standard H&E-stained slides. In addition, because FIBI images thick specimens, some extended structures, such as blood vessels, are captured with much improved structural fidelity. Citation Format: R. Levenson, E. Seibel, B. Wiafe-Addai, F. Fereidouni. Slide-free histology for breast cancer core-needle-biopsy diagnostics at point-of care in Ghana [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-05-25.