<i>Ex vivo</i> fluorescence confocal microscopy: the first application for real‐time pathological examination of prostatic tissue

Puliatti, Stefano; Bertoni, Laura; Pirola, Giacomo Maria; Azzoni, Paola; Bevilacqua, L.; Eissa, Ahmed; Elsherbiny, Ahmed; Sighinolfi, Maria Chiara; Chester, Johanna; Kaleci, Shaniko; Micali, Salvatore; Bagni, I.; Bonetti, Luca Reggiani; Maiorana, Antonino; Malvehy, Josep; Longo, Caterina; Montironi, Rodolfo; Bianchi, Giampaolo; Pellacani, Giovanni

doi:10.1111/bju.14754

Cited by 64 publications

(68 citation statements)

References 24 publications

(35 reference statements)

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“…Other options include light reflectance spectroscopy [21], multiphoton microscopy [30], confocal laser endomicroscopy [18], and video-rate fluorescence structured illumination microscopy [32]. Furthermore, we have previously proved that FCM has a diagnostic accuracy of 91% compared to the standard histopathological examination with AUC, sensitivity, and specificity of 0.884, 83.33%, and 93.53% for the pathological examination of prostatic tissues [24], which render FCM as a promising option for "real-time" pathological examination of prostatic tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there is an increased interest in "real-time" pathological examination of prostatic tissues either during prostate biopsies or during radical prostatectomy [28,31]. In this setting, several options were introduced for "real time" pathological examination of prostatic and periprostatic tissues including frozen section [28], light reflectance spectroscopy [21], multiphoton microscopy [30], confocal laser endomicroscopy [18], video-rate fluorescencestructured illumination microscopy [32], and FCM [24].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…In recent years, several techniques have been proposed to assess SM status intraoperatively and to guide a real‐time diagnosis of the excised surface including: the neurovascular structure‐adjacent frozen‐section examination (NeuroSAFE) approach , augmented reality , and fluorescence confocal microscopy ; however, little is known on how to manage the finding of a PSM and how to obtain a safe radical excision of the periprostatic tissue.…”

Section: Introductionmentioning

confidence: 99%

Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles

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ConclusionsThere is no homogeneity in prostate sampling for FS analysis, although most recent evidence is moving toward a systematic sampling of the entire NS area. The management of a PSM is variable and can be affected by the sampling strategy (difficult localisation of the persisting tumour at the NVB). The difficult identification of the exact soft tissue location contiguous to a PSM could be considered as the critical point of FS analysis and of spared-NVB management.

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“…100 FCM has been used for "real-time" pathologic examination of prostatic tissues, with a 91% diagnostic accuracy compared with histopathologic examination and 83.33% sensitivity and 93.53% specificity. 101 Furthermore, FCM has been applied for the first time in the assessment of the surgical margins during robotic RP in the European Section of Uro-Technology (ESUT) -Italian 102 However, further studies are required to prove the feasibility of this technology in patients with PCa.…”

Section: Ex Vivo Fcmmentioning

confidence: 99%

“Real-time” Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art

Eissa

Zoeir

Sighinolfi

et al. 2020

Clinical Genitourinary Cancer

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Histopathologic examination of the pathologic specimens using hematoxylin & eosin stains represents the backbone of the modern pathology. It is time-consuming; thus, "real-time" assessment of prostatic and periprostatic tissue has gained special interest in the diagnosis and management of prostate cancer. The current study focuses on the review of the different available techniques for "real-time" evaluation of surgical margins during radical prostatectomy (RP). We performed a comprehensive search of the Medline database to identify all the articles discussing "real-time" or intraoperative assessment of surgical margins during RP. Several filters were applied to the search to include only English articles performed on human subjects and published between January 2000 and March 2019. The search revealed several options for pathologic assessment of surgical margins including intraoperative frozen sections, confocal laser endomicroscopy, optical spectroscopy, photodynamic diagnosis, optical coherence tomography, multiphoton microscopy, structured illumination microscopy, 3D augmented reality, and ex vivo fluorescence confocal microscope. Frozen section represents the gold standard technique for real-time pathologic examinations of surgical margins during RP; however, several other options showed promising results in the initial clinical trials, and considering the rapid development in the field of molecular and cellular imaging, some of these options may serve as an alternative to frozen section.

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Ex vivo fluorescence confocal microscopy: the first application for real‐time pathological examination of prostatic tissue

Abstract: ConclusionFCM seems to be a promising tool for enhanced specimens' reporting performance, given its simple application and very rapid microscopic image generation (<5 min/specimen). This technique may potentially be used for intraoperative pathological specimens' analysis.

Cited by 64 publications

References 24 publications

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

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

Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles

“Real-time” Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art

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