The use of high resolution optical coherence tomography to evaluate robotic radical prostatectomy specimens

Dangle, Pankaj P.; Shah, Ketul; Kaffenberger, Benjamin H.; Patel, Vipul

doi:10.1590/s1677-55382009000300011

Cited by 34 publications

(35 citation statements)

References 17 publications

(14 reference statements)

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“…The few studies performed regarding OCT in the prostate focus on the qualitative interpretation of optical findings to identify surgical margins and neurovascular bundles. [43][44][45][46] One manuscript described a difference between malignant and benign prostate tissue structures visualized with OCT; however, these results were not quantitatively analyzed. 47 When the OCT technology further improves (smaller, higher-resolution, faster machines) and analysis software evolves (e.g., structure recognition, automatic learning, etc.…”

Section: Discussionmentioning

confidence: 99%

Prostate cancer diagnosis: the feasibility of needle-based optical coherence tomography

et al. 2015

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Abstract. The objective of this study is to demonstrate the feasibility of needle-based optical coherence tomography (OCT) and functional analysis of OCT data along the full pullback trajectory of the OCT measurement in the prostate, correlated with pathology. OCT images were recorded using a commercially available C7-XR™ OCT Intravascular Imaging System interfaced to a C7 Dragonfly™ intravascular 0.9-mm-diameter imaging probe. A computer program was constructed for automated image attenuation analysis. First, calibration of the OCT system for both the point spread function and the system roll-off was achieved by measurement of the OCT signal attenuation from an extremely weakly scattering medium (Intralipid® 0.0005 volume%). Second, the data were arranged in 31 radial wedges (pie slices) per circular segments consisting of 16 A-scans per wedge and 5 axial B-scans, resulting in an average A-scan per wedge. Third, the decay of the OCT signal is analyzed over 50 pixels (500 μm) in depth, starting from the first found maximum data point. Fourth, for visualization, the data were grouped with a corresponding color representing a specific μ oct range according to their attenuation coefficient. Finally, the analyses were compared to histopathology. To ensure that each single use sterile imaging probe is comparable to the measurements of the other imaging probes, the probe-to-probe variations were analyzed by measuring attenuation coefficients of 0.03, 6.5, 11.4, 17, and 22.7 volume% Intralipid®. Experiments were repeated five times per probe for four probes. Inter-and intraprobe variation in the measured attenuation of Intralipid samples with scattering properties similar to that of the prostate was <8% of the mean values. Mean attenuation coefficients in the prostate were 3.8 mmfor parts of the tissue that were classified as benign (SD: 0.8 mm −1 , minimum: 2.2 mm −1 , maximum: 8.9 mm −1 ) and 4.1 mm −1 for parts of tissue that were classified as malignant (SD: 1.2 mm −1 , minimum: 2.5 mm −1 , maximum: 9.0 mm −1 ). In benign areas, the tissue looked homogeneous, whereas in malignant areas, small glandular structures were seen. However, not all areas in which a high attenuation coefficient became apparent corresponded to areas of prostate cancer. This paper describes the first in-tissue needle-based OCT imaging and three-dimensional optical attenuation analysis of prostate tissue that indicates a correlation with pathology. Fully automated attenuation coefficient analysis was performed at 1300 nm over the full pullback. Correlation with pathology was achieved by coregistration of three-dimensional (3-D) OCT attenuation maps with 3-D pathology of the prostate. This may contribute to the current challenge of prostate imaging and the rising interest in focal therapy for reduction of side effects occurring with current therapies.

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Section: Discussionmentioning

confidence: 99%

Prostate cancer diagnosis: the feasibility of needle-based optical coherence tomography

et al. 2015

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“…Dangle et al correlated OCT images of postprostatectomy ex vivo specimens to detect positive margins and found a sensitivity, specificity, and negative predictive value of 70, 84, and 96 %, respectively [32]. They noted a low positive predictive value for detecting positive margins, however, which could be due to the heterogeneous appearance of the tumor and the low depth of penetration (2-3 mm) with OCT. Based on the high negative predictive value though they concluded that OCT could be useful for ruling out positive surgical margin, extraprostatic extension, and seminal vesicle invasion.…”

Section: Oct Of the Prostatementioning

confidence: 99%

Current and Evolving Uses of Optical Coherence Tomography in the Genitourinary Tract

Gupta

2015

Curr Urol Rep

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Optical coherence tomography is an emerging imaging modality that provides high-resolution, real-time, cross-sectional visualization of urologic tissue with promising results. Early studies have demonstrated detailed, accurate histologic information of tissues sampled. Optical coherence tomography (OCT) has also been applied in evaluating malignancy of the bladder, prostate, and kidney. In the bladder, it can assist in the identification, biopsy, and intraoperative resection of lesions suspicious for bladder cancer. Intraoperative use of OCT during radical prostatectomy can improve visualization of the neurovascular bundle and surgical margins. Several small, ex vivo studies have also shown promising results in the ability of OCT to demonstrate histopathologic alterations to renal morphology such as in renal ischemia and malignancy. In men with non-obstructive azoospermia, OCT has also been used in improving sperm retrieval rates by assisting in the identification of tubules with isolated foci of spermatogenesis. Common limitations of OCT include limited depth of penetration and limited number of current clinical studies.

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“…The surgical dilemma however is that an ambitious nerve sparing might lead to higher positive surgical margin (PSM) rate. Although some recent studies have shown the feasibility of using Optical Coherence Tomography (OCT) on the pathological specimen and predicting the PSM and Extra capsular Extension (ECE) rate, this technology has not yet diffused into the clinical practice (22). Hence a wise clinical decision should be made before proceeding with the nerve sparing.…”

Section: Techniques Of Nerve Sparing and Potency Outcomes Following Ralpmentioning

confidence: 99%

Techniques of nerve-sparing and potency outcomes following robot-assisted laparoscopic prostatectomy

et al. 2010

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Purpose: Nerve sparing radical prostatectomy is the gold standard for the treatment of prostate cancer. Over the past decade, more and more surgeons and patients are opting for a robot-assisted procedure. The purpose of this paper is to briefly review different techniques and outcomes of nerve sparing robot assisted laparoscopic prostatectomy (RALP). Materials and Methods:We performed a MEDLINE search from 2001 to 2009 using the keywords "robotic prostatectomy", "cavernosal nerve", "pelvic neuroanatomy", "potency", "outcomes" and "comparison". Extended search was also performed using the references from these articles. Results: Several techniques of nerve sparing are available in literature for RALP, which have been described in this manuscript. These include, "the veil of Aphrodite", "athermal retrograde neurovascular release", "clipless antegrade nerve sparing" and "clipless cautery free technique". The comparative and the non comparative series showing outcomes of RALP have been described in the manuscript. Conclusions: The basic principles for nerve sparing revolve around minimal traction, athermal dissection, and approaching the correct planes. It has not been documented if any one technique is better than the other. Regardless of technique, patient selection, wise clinical judgment and a careful dissection are the keys to achieve optimal oncological outcomes following RALP.

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The use of high resolution optical coherence tomography to evaluate robotic radical prostatectomy specimens

Cited by 34 publications

References 17 publications

Prostate cancer diagnosis: the feasibility of needle-based optical coherence tomography

Prostate cancer diagnosis: the feasibility of needle-based optical coherence tomography

Current and Evolving Uses of Optical Coherence Tomography in the Genitourinary Tract

Techniques of nerve-sparing and potency outcomes following robot-assisted laparoscopic prostatectomy

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