Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) Increases Nerve-sparing Frequency and Reduces Positive Surgical Margins in Open and Robot-assisted Laparoscopic Radical Prostatectomy: Experience After 11 069 Consecutive Patients

Schlomm, Thorsten; Tennstedt, Pierre; Huxhold, Caroline; Steuber, Thomas; Salomon, Georg; Michl, Uwe; Heinzer, Hans; Hansen, Jens; Budäus, Lars; Steurer, Stefan; Wittmer, Corinna; Minner, Sarah; Haese, Alexander; Sauter, Guido; Graefen, Markus; Huland, Hartwig

doi:10.1016/j.eururo.2012.04.057

Cited by 221 publications

(214 citation statements)

References 31 publications

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“…In contrast, no such tradeoff is required with the multiscale NLM approach presented here because NLM enables thin axial sectioning of fresh tissue. Furthermore, a large study of FSA margin evaluation in nerve sparing prostatectomy reported substantial improvements in rates of nerve sparing surgeries, but required 5 cryostats and 4 histotechs working in parallel to evaluate 10 to 24 specimens per patient in an average of 35 minutes [54]. In contrast, multiscale NLM scales much more favorably with increasing numbers of bread loaf specimens, because after inking and grossing, multiple bread loaf specimens can be stained simultaneously and then examined without physical sectioning as shown in Figs.…”

Section: Discussionmentioning

confidence: 99%

Multiscale nonlinear microscopy and widefield white light imaging enables rapid histological imaging of surgical specimen margins

Giacomelli¹,

Yoshitake²,

Cahill³

et al. 2018

Biomed. Opt. Express

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The ability to histologically assess surgical specimens in real-time is a long-standing challenge in cancer surgery, including applications such as breast conserving therapy (BCT). Up to 40% of women treated with BCT for breast cancer require a repeat surgery due to postoperative histological findings of close or positive surgical margins using conventional formalin fixed paraffin embedded histology. Imaging technologies such as nonlinear microscopy (NLM), combined with exogenous fluorophores can rapidly provide virtual H&E imaging of surgical specimens without requiring microtome sectioning, facilitating intraoperative assessment of margin status. However, the large volume of typical surgical excisions combined with the need for rapid assessment, make comprehensive cellular resolution margin assessment during surgery challenging. To address this limitation, we developed a multiscale, real-time microscope with variable magnification NLM and real-time, co-registered position display using a widefield white light imaging system. Margin assessment can be performed rapidly under operator guidance to image specific regions of interest located using widefield imaging. Using simulated surgical margins dissected from human breast excisions, we demonstrate that multi-centimeter margins can be comprehensively imaged at cellular resolution, enabling intraoperative margin assessment. These methods are consistent with pathology assessment performed using frozen section analysis (FSA), however NLM enables faster and more comprehensive assessment of surgical specimens because imaging can be performed without freezing and cryo-sectioning. Therefore, NLM methods have the potential to be applied to a wide range of intra-operative applications.

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Section: Discussionmentioning

confidence: 99%

Multiscale nonlinear microscopy and widefield white light imaging enables rapid histological imaging of surgical specimen margins

Giacomelli¹,

Yoshitake²,

Cahill³

et al. 2018

Biomed. Opt. Express

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“…14,15 The tissue microarray manufacturing process was described earlier in detail. 16 In short, one 0.6 mm core was taken from a representative tissue block from each patient.…”

Section: Patientsmentioning

confidence: 99%

Cysteine-rich secretory protein 3 overexpression is linked to a subset of PTEN-deleted ERG fusion-positive prostate cancers with early biochemical recurrence

et al. 2013

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The aim of this study was to determine whether cysteine-rich secretory protein 3 (CRISP3) expression is linked to clinically or molecularly relevant subgroups of prostate cancer. A tissue microarray representing samples from 410 000 prostate cancers from radical prostatectomy specimens with clinical follow-up data were analyzed for CRISP3 expression by immunohistochemistry. CRISP3 expression was also compared with key genomic alterations of prostate cancer. CRISP3 staining was found as weak in 15%, moderate in 8.5%, and strong in 7.2% of prostate cancers, whereas no expression was detected in normal prostate. Strong CRISP3 expression was linked to advanced tumor stage, high Gleason score, and positive surgical margin status (Po0.0001 each). There was a marked accumulation of high CRISP3 expression in PTEN-deleted ERG-positive tumors (Po0.0001). A total of, 21.7% of ERG-positive and PTEN-deleted cancers had strong CRISP3 expression, but only 10.4% of ERG-positive cancers without PTEN deletion (Po0.0001). The rate of high CRISP3 expression was 2.5% in ERG-negative cancers (P ¼ 0.0001; vs ERG-positive cancers). Accordingly, CRISP3 overexpression was associated with early prostate-specific antigen recurrence in all tumors (P ¼ 0.0013) as well as in ERGnegative (P ¼ 0.004) and ERG-positive cancers (P ¼ 0.0318). CRISP3 expression did not retain prognostic significance in models also involving PTEN deletions. Strong CRISP3 expression is associated with unfavorable tumor phenotype and early recurrence in prostate cancers. The tight link of strong CRISP3 expression to the ERG fusion-positive prostate cancers with PTEN deletions provides further evidence for the existence of molecularly distinct subgroups of prostate cancers.

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“…Since the introduction of a neurovascular structure-adjacent frozen-section examination (NeuroSAFE) in our institution, most RPs were performed using a NS approach with secondary resection of the NVBs in case of positive frozen section [7].…”

Section: Introductionmentioning

confidence: 99%

Nerve-sparing Surgery Technique, Not the Preservation of the Neurovascular Bundles, Leads to Improved Long-term Continence Rates After Radical Prostatectomy

et al. 2016

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Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) Increases Nerve-sparing Frequency and Reduces Positive Surgical Margins in Open and Robot-assisted Laparoscopic Radical Prostatectomy: Experience After 11 069 Consecutive Patients

Cited by 221 publications

References 31 publications

Multiscale nonlinear microscopy and widefield white light imaging enables rapid histological imaging of surgical specimen margins

Multiscale nonlinear microscopy and widefield white light imaging enables rapid histological imaging of surgical specimen margins

Cysteine-rich secretory protein 3 overexpression is linked to a subset of PTEN-deleted ERG fusion-positive prostate cancers with early biochemical recurrence

Nerve-sparing Surgery Technique, Not the Preservation of the Neurovascular Bundles, Leads to Improved Long-term Continence Rates After Radical Prostatectomy

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