Surgical margin analysis (SMA), which requires an examination of tissue specimens under a microscope, is an essential procedure to determine whether all cancer cells are removed from a patient's body in a resection surgery1. Therefore, a microscope that can rapidly provide histological images is vitally important for SMA to avoid repeated surgeries caused by incomplete removal of cancer cells. However, according to the current gold-standard method based on bright-field optical microscopy, the excised tissue is required to be fixed in formalin, embedded in paraffin, sectioned into thin slices (4-7 µm), and then stained by hematoxylin and eosin (H&E) before imaging, which is time-consuming (3-7 days) and laborious2,3. A frozen section is a rapid alternative for SMA by quickly freezing, slicing, and staining the tissue, which can provide histological images in 20-30 min4. However, the histological features are often distorted and required skillful training, which hinders the applicability of the technique to multiple types of organs5.
Optical microscopy techniques that can provide cellular images without or with a few steps of tissue processing have been developed for SMA. However, each of them suffers from different issues. For example, optical coherence tomography6 and confocal reflectance microscopy7 suffer from low specificity because of their low intrinsic scattering contrast. Although microscopy with ultraviolet surface excitation8 and light-sheet microscopy9 can provide high-resolution and high-contrast images for SMA, the toxic and volatile staining procedure usually cannot be performed in an operating room, which prolongs the turnaround time. Multi-photon microscopy10 and stimulated Raman microscopy11 can provide rich information for SMA. Yet, the high cost of the required ultrafast lasers that are used to generate nonlinear effects prevents their wide applicability.
Recently, by taking advantage of intrinsic optical absorption, label-free ultraviolet photoacoustic microscopy (UV-PAM) has been developed to provide high-resolution histological images12. In UV-PAM, the photon energy of the excitation UV light (e.g., 266 nm) is first absorbed by the DNA/RNA in cell nuclei13 and then converted into heat, inducing acoustic wave emission through thermal-elastic expansion14. By detecting the generated acoustic waves, two-dimensional (2D) UV-PAM images of cell nuclei can be obtained via maximum amplitude projection of the acoustic signals, providing histological information for SMA. To enable the clinical applications of UV-PAM, high-speed UV-PAM based on galvanometer mirror scanning has been developed to provide histological images for a brain biopsy sample (5 mm x 5 mm) within 18 min, showing great potential in time-sensitive applications15. To further validate the possibility of UV-PAM for thick tissue imaging, a reflection-mode UV-PAM system with a waterproof one-axis microelectromechanical systems scanner was proposed, successfully demonstrating intraoperative histopathological examination of human colon and liver tissues16. Since the original UV-PAM image is in grayscale while the gold standard H&E-stained image is in pink and purple colors, it is difficult for pathologists to interpret UV-PAM images directly. To address this issue, a deep-learning algorithm was proposed to transfer grayscale UV-PAM images into virtual H&E-stained images in near real-time so that pathologists can understand the images without any additional training17.
This work reports a high-speed and open-top UV-PAM system that can be operated similar to conventional optical microscopies, providing both original grayscale histological images and virtually stained images assisted by a deep-learning algorithm. A formalin-fixed and paraffin-embedded (FFPE) mouse brain slice is imaged by the UV-PAM system to demonstrate the similarity between our virtually stained UV-PAM and standard H&E-stained images, showing its potential for SMA applications.