Ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve

Abstract

Ex vivo fluorescence confocal microscopy (FCM) is an optical technology that provides fast H&E-like images of freshly excised tissues, and it has been mainly used for "real-time" pathological examination of dermatological malignancies. It has also shown to be a promising tool for fast pathological examination of prostatic tissues. We aim to create an atlas for FCM images of prostatic and periprostatic tissues to facilitate the interpretation of these images. Furthermore, we aimed to evaluate the learning curve of images interpretation of this new technology. Eighty fresh and unprepared biopsies obtained from radical prostatectomy specimens were evaluated using the FCM VivaScope® 2500 M-G4 (Mavig GmbH, Munich, Germany; Caliber I.D.; Rochester NY, USA) by two pathologists. Images of FCM with the corresponding H&E are illustrated to create the atlas. Furthermore, the two pathologists were asked to re-evaluate the 80 specimens after 90 days interval in order to assess the learning curve of images' interpretation of FCM. FCM was able to differentiate between different types of prostatic and periprostatic tissues including benign prostatic glands, benign prostatic hyperplasia, high-grade intraepithelial neoplasm, and prostatic adenocarcinoma. As regards the learning curve, FCM demonstrated a short learning curve. We created an atlas that can serve as the base for urologists and pathologists for learning and interpreting FCM images of prostatic and periprostatic tissues. Furthermore, FCM images is easily interpretable; however, further studies are required to explore the potential applications of this new technology in prostate cancer diagnosis and management.

Digital Biopsy with Fluorescence Confocal Microscope for Effective Real-time Diagnosis of Prostate Cancer: A Prospective, Comparative Study

“…Similarly, real-time control of surgical margins could be useful during radical prostatectomy to spare neurovascular bundle tissue as much as possible, while ensuring negative surgical margins [23][24][25][26][27].…”

“…Moreover, does not seem that FCM requires specific competence in uropathology, since one pathologist from the panel (A.C.) completed the residency program during the study period. The HE-like appearance makes the pathologists confident with FCM interpretation, according to preliminary studies [10,27].…”

Digital frozen section of the prostate surface during radical prostatectomy: a novel approach to evaluate surgical margins

“…Technically, Vivascope enables optical sectioning at different depths of a slice; from preliminary studies, FCM provides an excellent discriminative performance compared to H&E for prostate and peri‐prostatic tissue evaluation [5,6]. Furthermore, the FCM images can be easily interpreted by pathologists without the requirement for extensive training because they are similar to the H&E images that are familiar to them [7].…”

“…Tracking a positive SM on the spared NVB represents an unaddressed issue of the NeuroSAFE approach. Only 23-42% of NeuroSAFE series had positive secondary resections at the final pathological examination, showing that the majority of re-resections were not actually justified [8].…”

An intraoperative study with ex vivo fluorescence confocal microscopy: diagnostic accuracy of the three visualization modalities

“…A retrospective analysis of consecutive patients with clinical diagnoses of BCC or BCC recurrence, scheduled for 9 Slides were then sent for H&E frozen section examination. BW, GW and H&E-like images were assessed (presence or absence of BCC) by two pathologists and two dermatologists according to previously described FCM criteria.…”