Authors
Pisarovic, U., van Nijnatten, T. J. A., Kooreman, L. F. S., Hildebrand, S., Schueth, A. A.
Abstract
Background: Breast cancer remains the most frequently diagnosed cancer among women worldwide, with invasive ductal carcinoma (IDC) representing the most common subtype. Despite its high prevalence, current diagnostic workflows rely on 5um-thin hematoxylin and eosin-stained sections, inherently limiting spatial insight into tumor architecture and extracellular matrix (ECM) organization. As the interest in studying intratumoral heterogeneity increases, three-dimensional (3D) imaging is becoming an increasingly valuable tool. Methods: This study applied a tissue clearing and imaging pipeline to large formalin-fixed paraffin-embedded (FFPE) breast and lymph node tissue from patients with IDC from Maastricht University Medical Centre+. Deparaffinized samples were processed using a modified MASH protocol. Tissues were labelled with Neutral Red, Eosin Y, Methyl Green, and DAPI. Tissue shrinkage was analysed across all processed samples. Two-photon (2P) microscopy was used to image malignant and non-malignant breast tissue, and matched axillary lymph nodes from a patient with grade I IDC to depths of up to 1000 um via DAPI and second harmonic generation (SHG) channels. Image analysis included assessments of dye penetration, nuclear and collagen content, and fiber orientation using FIJI software. Results: Clearing and staining preserved tissue structure and achieved high transparency across millimetre-scale volumes. 2D surface shrinkage averaged 6.7% (p < 0.001). DAPI signal penetration was consistent with SHG signal profiles up to approximately 600um of tissue depth. Structures such as terminal ductal lobular units, adipocytes, vasculature, and lymphoid follicles were clearly visualized in 3D. Quantitative and qualitative analysis in grade I IDC tissue revealed regional differences in cell size and shape, collagen content, and fiber coherency, indicating localized early-stage ECM remodelling. Conclusion: This is the first study to apply 2P microscopy with MASH clearing to large FFPE IDC breast and lymph node samples. The protocol enables reproducible high-resolution volumetric imaging and lays the groundwork for future research applications, leading to potential diagnostic applications.
Preprint server:
bioRxiv
The authors list and abstract were imported from bioRxiv on 11 Nov 2025.
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