Real‐time assessment of surgical margins during radical prostatectomy: a novel approach that uses fluorescence confocal microscopy for the evaluation of peri‐prostatic soft tissue

Detection of oral squamous cell carcinoma with ex vivo fluorescence confocal microscopy: Sensitivity and specificity compared to histopathology

“…This technology enables therefore an intraoperative real‐time assessment of freshly excised tissue [2]. An example of this procedure was recently demonstrated by Rocco et al for radical prostatectomy with an ex vivo FCM [12]. In a study by Ragazzi et al [13], a previous generation of FCM was tested on solid tissues and organs: breast, lymph node, thyroid and colon.…”

Reply to Alessia Cimadamore, Marina Scarpelli, Liang Cheng, et al’s Letter to the Editor, re: Maria Chiara Sighinolfi, Bernardo Rocco’s Words of Wisdom re: EAU Guidelines: Prostate Cancer 2019. Mottet N, van den Bergh RCN, Briers E, et al. https://uroweb.org/guideline/prostate-Cancer/. Eur Urol 2019, 76:871

“…As suggested by 2019 European Association of Urology guidelines [3], frozen section (FS) analysis is able to rule out the inadvertent excision into the tumor. However, prostate FS is limited by a number of factors, such as the absence of standard sampling [5] and the need for a fully equipped setup, consisting of cryostats, technicians, and pathologists on site, to prepare specimen and interpret glass slides with an analog microscope [6]. Thus, FS is hardly affordable at all institutions, especially in view of the contraction of pathologists' workforce.…”

“…Intraoperative analysis could be simplified with fluorescence confocal microscopy (FCM) [6]. FCM provides microscopic analysis of freshly excised tissues, with straight acquisition of digital images without conventional processing, dedicated setup, or an on-site pathologist, since images could be shared remotely.…”

“…The ability of FCM to discriminate between prostate and periprostatic soft tissues has been evaluated on samples retrieved during radical prostatectomy from suspicious periprostatic areas [6]. FCM agreement with hematoxylineosin for the interpretation of periprostatic components is almost perfect, and nerves could be distinguished with a rate of 97.14% of correct diagnosis (Fig.…”

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

“…FCM (VivaScope â 2500 M-G4; Caliber Imaging and Diagnostics, Rochester, NY, USA) is a novel technology allowing immediate acquisition of digital images in an H&E-like fashion without conventional processing and its attendant time and resource requirements. 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].…”