Ex-vivo confocal fluorescence microscopy for rapid evaluation of renal core biopsy

Mir, Maria Carmen; Bancalari, Bernardo; Casanova, J.; Escrig, Jose-Luis Dominguez; Ramírez‐Backhaus, M.; Gómez-Ferrer, Á.; Collado, A.; Wong, Augusto; Iborra, I.; Sanmarti, Onofre; Rubio‐Briones, J.

doi:10.23736/s0393-2249.19.03627-0

Cited by 14 publications

(8 citation statements)

References 10 publications

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“…While currently the diagnostic accuracy of a preoperative biopsy in suspected renal masses is estimated at around 98%, with less than 1% risk of bleeding, this management strategy remains underutilized [ 10 ]. This high diagnostic yield is estimated to solidify, as more technological breakthroughs are implemented, i.e., confocal fluorescence microscopy, specifically for preoperative biopsies in urological cancers, this, however, would only be implementable in urological centers with high resources and solid surgical infrastructures [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Unique Growth Pattern Presentation of a Papillary Renal Cell Carcinoma

et al. 2022

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Papillary renal cell carcinoma (PRCC) is defined by the WHO 2022 classification as a malignant tumor derived from the renal tubular epithelium. However, the WHO 2016 classification subdivided PRCC into two types, with type 1 PRCC showing papillae covered by a single layer of neoplastic cells, and type II PRCC, which can show multiple types of histologies and is more aggressive. The WHO 2022 classification eliminated the subcategorization of PRCC. Here, we present a histopathological case study with a 4-year follow-up diagnosed in 2018 as type I PRCC (WHO 2016) with intra-pyelocalyceal growth pattern in a 59-year-old male patient with a history of Type II diabetes mellitus, left-sided renal–ureteral lithiasis, and benign hypertrophy of the prostate. Microscopically the tumor was composed of small cuboidal cells with inconspicuous nucleoli, arranged on a single layer of tubulo-papillary cores, and scant, foamy macrophages. The tumor had a non-infiltrative, expansive pyelocalyceal growth pattern. Immunohistochemically (IHC), the tumor cells were CK7-intense and diffusely positive, and stained granular for AMACR. Next-generation sequencing (NGS) was performed for the tumor and the normal adjacent tissue for in-depth pathological characterization. To our knowledge, this is the first reported case where a PRCC displays this unique intra-pyelocalyceal growth pattern, mimicking a urothelial cell carcinoma of the renal pelvis system.

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Section: Discussionmentioning

confidence: 99%

Unique Growth Pattern Presentation of a Papillary Renal Cell Carcinoma

et al. 2022

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“…11 Ex vivo FCM analysis was used by Mir et al to tailor renal biopsies and determine the quality of biopsy cores. 13 It is recognized that an inadequate sampling is the basis of the high non-diagnostic rate of renal biopsy: FCM was able to confirm the quality of renal cores and distinguish benign and neoplastic renal tissue too. 13 To the best of our knowledge, this is the first case series focusing on FCM for the interpretation of the urothelium and for training purposes.…”

Section: Discussionmentioning

confidence: 99%

Digital real-time microscopy of ex-vivo tissues: A novel strategy to control surgical accuracy

et al. 2022

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Introduction: Ex-vivo FCM is a novel digital optical technique that provides images of fresh tissues in a real-time fashion with magnification to subcellular details of a flattened unprocessed sample. Digital images are hematoxylin-eosin-like and can be shared and interpreted remotely. In urology, FCM has been successfully applied for prostate tissue interpretation, either during biopsy and radical prostatectomy. Possible applications of FCM may reflect those of frozen section analysis and can be extended to all fields in which the intra-operative microscopical control is advisable. Materials and methods: This is an investigative prospective case series that aims to explore FCM feasibility in novel surgical settings and provide a depiction of FCM digital images in those fields. The definite purpose is to check the accuracy of surgical specimen during the following interventions: (a) trans-urethral resection of bladder tumors, to confirm the presence of muscular layer; (b) biopsy of a retroperitoneal mass, to check for the location and quality of cores; (c) training in robotic radical prostatectomy, to control surgical margins after a nerve sparing performed by a trainee. To this aim, we collected FCM images during seven surgical procedures. FCM findings were compared to those from the final histopathological analysis and the agreement was assessed.Results: In all cases, FCM digital images were obtained in the OR. FCM was able to confirm the presence of muscular layer in TURB specimen, the presence of lymphomatous tissue, surgical margins at prostate specimen. FCM intraoperative interpretation was consistent with final histopathology in all cases. Conclusions: Ex vivo FCM may represent a novel approach to control the quality of specimens, likely to tailor surgical strategy in a real-time fashion. Moreover, digitalization represents a step toward the implementation of telepathology in clinical practice.

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“…Percutaneous renal biopsy, on the other hand, is often not considered a reliable diagnostic tool because of RCC heterogenicity and due to the invasiveness of the procedure with a nonnegligible risk of infections and bleeding after biopsy [ 23 ]. Recently, confocal microscopy has been proposed as an additive platform for RCC diagnosis and has been tested in both RCC and prostate cancer settings [ 24 , 25 ]. Future trials will reveal the clinical impact of this technique.…”

Section: Diagnosismentioning

confidence: 99%

The Role of Circulating Biomarkers in the Oncological Management of Metastatic Renal Cell Carcinoma: Where Do We Stand Now?

Cinque¹,

Capasso

Vago

et al. 2021

Biomedicines

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Renal cell carcinoma (RCC) is an increasingly common malignancy that can progress to metastatic renal cell carcinoma (mRCC) in approximately one-third of RCC patients. The 5-year survival rate for mRCC is abysmally low, and, at the present time, there are sparingly few if any effective treatments. Current surgical and pharmacological treatments can have a long-lasting impact on renal function, as well. Thus, there is a compelling unmet need to discover novel biomarkers and surveillance methods to improve patient outcomes with more targeted therapies earlier in the course of the disease. Circulating biomarkers, such as circulating tumor DNA, noncoding RNA, proteins, extracellular vesicles, or cancer cells themselves potentially represent a minimally invasive tool to fill this gap and accelerate both diagnosis and treatment. Here, we discuss the clinical relevance of different circulating biomarkers in metastatic renal cell carcinoma by clarifying their potential role as novel biomarkers of response or resistance to treatments but also by guiding clinicians in novel therapeutic approaches.

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Ex-vivo confocal fluorescence microscopy for rapid evaluation of renal core biopsy

Cited by 14 publications

References 10 publications

Unique Growth Pattern Presentation of a Papillary Renal Cell Carcinoma

Unique Growth Pattern Presentation of a Papillary Renal Cell Carcinoma

Digital real-time microscopy of ex-vivo tissues: A novel strategy to control surgical accuracy

The Role of Circulating Biomarkers in the Oncological Management of Metastatic Renal Cell Carcinoma: Where Do We Stand Now?

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