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Loth AG, Fassl A, Chun FKH, Köllermann J, Hartmann S, Gretser S, Ziegler PK, Flinner N, Schulze F, Wild PJ, Kinzler MN. [Fluorescence confocal microscopy-complete digitization of pathology]. PATHOLOGIE (HEIDELBERG, GERMANY) 2024; 45:211-217. [PMID: 38446176 PMCID: PMC11045597 DOI: 10.1007/s00292-024-01311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Fluorescence-based confocal microscopy (FCM) can be used to create virtual H&E sections in real time. So far, FCM has been used in dermato-, uro-, and gynecopathology. FCM allows the creation of a completely digitized frozen section, which could potentially replace conventional frozen sections in the future. OBJECTIVE The aim of the current work is to implement FCM technology as a component of fully digitized processes in the pathological workflow. For this purpose, the current use of FCM in liver transplant pathology will be extended to other disciplines such as urology and otorhinolaryngology. MATERIALS AND METHODS The FCM technique continues to be used prospectively on native tissue samples from potential donor livers. Conventional frozen sections are used comparatively to virtual FCM scans. RESULTS The data show a nearly perfect agreement for the detection of cholangitis, fibrosis, and malignancy, and a high level of agreement for, e.g., macrovesicular steatosis, inflammation, steatohepatitis, and necrosis between virtual FCM scans and conventional routine diagnostic frozen sections. CONCLUSION Since the availability of time- and cost-intensive frozen section diagnostics in the context of transplant pathology in continuous operation (24/7) is now only established at very few university centers in Germany due to an increasing shortage of specialists, the use of FCM could be an important building block in the current process leading towards a fully digitized pathology workflow and should thus be extended to various disciplines.
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Affiliation(s)
- Andreas G Loth
- Universitätsklinikum Frankfurt, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Anne Fassl
- Universitätsklinikum Frankfurt, Klinik für Urologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Deutschland
| | - Felix K H Chun
- Universitätsklinikum Frankfurt, Klinik für Urologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Jens Köllermann
- Universitätsklinikum Frankfurt, Dr. Senckenbergisches Institut für Pathologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Sylvia Hartmann
- Universitätsklinikum Frankfurt, Dr. Senckenbergisches Institut für Pathologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Steffen Gretser
- Universitätsklinikum Frankfurt, Dr. Senckenbergisches Institut für Pathologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Paul K Ziegler
- Universitätsklinikum Frankfurt, Dr. Senckenbergisches Institut für Pathologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Nadine Flinner
- Universitätsklinikum Frankfurt, Dr. Senckenbergisches Institut für Pathologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Deutschland
| | - Falko Schulze
- Universitätsklinikum Frankfurt, Dr. Senckenbergisches Institut für Pathologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Peter J Wild
- Universitätsklinikum Frankfurt, Dr. Senckenbergisches Institut für Pathologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Deutschland
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Deutschland
| | - Maximilian N Kinzler
- Universitätsklinikum Frankfurt, Medizinische Klinik 1, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland.
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Pillar N, Li Y, Zhang Y, Ozcan A. Virtual Staining of Nonfixed Tissue Histology. Mod Pathol 2024; 37:100444. [PMID: 38325706 DOI: 10.1016/j.modpat.2024.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
Surgical pathology workflow involves multiple labor-intensive steps, such as tissue removal, fixation, embedding, sectioning, staining, and microscopic examination. This process is time-consuming and costly and requires skilled technicians. In certain clinical scenarios, such as intraoperative consultations, there is a need for faster histologic evaluation to provide real-time surgical guidance. Currently, frozen section techniques involving hematoxylin and eosin (H&E) staining are used for intraoperative pathology consultations. However, these techniques have limitations, including a turnaround time of 20 to 30 minutes, staining artifacts, and potential tissue loss, negatively impacting accurate diagnosis. To address these challenges, researchers are exploring alternative optical imaging modalities for rapid microscopic tissue imaging. These modalities differ in optical characteristics, tissue preparation requirements, imaging equipment, and output image quality and format. Some of these imaging methods have been combined with computational algorithms to generate H&E-like images, which could greatly facilitate their adoption by pathologists. Here, we provide a comprehensive, organ-specific review of the latest advancements in emerging imaging modalities applied to nonfixed human tissue. We focused on studies that generated H&E-like images evaluated by pathologists. By presenting up-to-date research progress and clinical utility, this review serves as a valuable resource for scholars and clinicians, covering some of the major technical developments in this rapidly evolving field. It also offers insights into the potential benefits and drawbacks of alternative imaging modalities and their implications for improving patient care.
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Affiliation(s)
- Nir Pillar
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Yuzhu Li
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Yijie Zhang
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Aydogan Ozcan
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California.
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3
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Ongaro L, Rossin G, Biasatti A, Pacini M, Rizzo M, Traunero F, Piasentin A, Perotti A, Trombetta C, Bartoletti R, Zucchi A, Simonato A, Pavan N, Liguori G, Claps F. Fluorescence Confocal Microscopy in Urological Malignancies: Current Applications and Future Perspectives. Life (Basel) 2023; 13:2301. [PMID: 38137902 PMCID: PMC10744992 DOI: 10.3390/life13122301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
Fluorescence confocal microscopy (FCM) represents a novel diagnostic technique able to provide real-time histological images from non-fixed specimens. As a consequence of its recent developments, FCM is gaining growing popularity in urological practice. Nevertheless, evidence is still sparse, and, at the moment, its applications are heterogeneous. We performed a narrative review of the current literature on this topic. Papers were selected from the Pubmed, Embase, and Medline archives. We focused on FCM applications in prostate cancer (PCa), urothelial carcinoma (UC), and renal cell carcinoma (RCC). Articles investigating both office and intraoperative settings were included. The review of the literature showed that FCM displays promising accuracy as compared to conventional histopathology. These results represent significant steps along the path of FCM's formal validation as an innovative ready-to-use diagnostic support in urological practice. Instant access to a reliable histological evaluation may indeed significantly influence physicians' decision-making process. In this regard, FCM addresses this still unmet clinical need and introduces intriguing perspectives into future diagnostic pathways. Further studies are required to thoroughly assess the whole potential of this technique.
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Affiliation(s)
- Luca Ongaro
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy; (L.O.); (G.R.); (A.B.); (M.R.); (F.T.); (A.P.); (C.T.); (G.L.)
| | - Giulio Rossin
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy; (L.O.); (G.R.); (A.B.); (M.R.); (F.T.); (A.P.); (C.T.); (G.L.)
| | - Arianna Biasatti
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy; (L.O.); (G.R.); (A.B.); (M.R.); (F.T.); (A.P.); (C.T.); (G.L.)
| | - Matteo Pacini
- Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.P.); (A.P.); (R.B.); (A.Z.)
| | - Michele Rizzo
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy; (L.O.); (G.R.); (A.B.); (M.R.); (F.T.); (A.P.); (C.T.); (G.L.)
| | - Fabio Traunero
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy; (L.O.); (G.R.); (A.B.); (M.R.); (F.T.); (A.P.); (C.T.); (G.L.)
| | - Andrea Piasentin
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy; (L.O.); (G.R.); (A.B.); (M.R.); (F.T.); (A.P.); (C.T.); (G.L.)
| | - Alessandro Perotti
- Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.P.); (A.P.); (R.B.); (A.Z.)
| | - Carlo Trombetta
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy; (L.O.); (G.R.); (A.B.); (M.R.); (F.T.); (A.P.); (C.T.); (G.L.)
| | - Riccardo Bartoletti
- Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.P.); (A.P.); (R.B.); (A.Z.)
| | - Alessandro Zucchi
- Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.P.); (A.P.); (R.B.); (A.Z.)
| | - Alchiede Simonato
- Urology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90127 Palermo, Italy; (A.S.); (N.P.)
| | - Nicola Pavan
- Urology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90127 Palermo, Italy; (A.S.); (N.P.)
| | - Giovanni Liguori
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy; (L.O.); (G.R.); (A.B.); (M.R.); (F.T.); (A.P.); (C.T.); (G.L.)
| | - Francesco Claps
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy; (L.O.); (G.R.); (A.B.); (M.R.); (F.T.); (A.P.); (C.T.); (G.L.)
- Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.P.); (A.P.); (R.B.); (A.Z.)
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Puliatti S, Eissa A, Ferretti S, Micali S, Bianchi G. Fluorescence laser confocal microscopy: a glimpse from the future. Minerva Urol Nephrol 2023; 75:786-787. [PMID: 38126294 DOI: 10.23736/s2724-6051.23.05641-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Urology, Faculty of Medicine, University of Tanta, Tanta, Egypt
| | - Stefania Ferretti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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5
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Bianchi G, Puliatti S, Rodriguez Peñaranda N, Micali S, Bertoni L, Reggiani Bonetti L, Caramaschi S, Bolelli F, Pinamonti M, Rozze D, Grana C. Artificial intelligence evaluation of confocal microscope prostate images: our preliminary experience. Minerva Urol Nephrol 2023; 75:545-547. [PMID: 37728490 DOI: 10.23736/s2724-6051.23.05538-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
| | | | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bertoni
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, Modena, Italy
| | - Luca Reggiani Bonetti
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena Polyclinic Hospital, Modena, Italy
| | - Stefania Caramaschi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena Polyclinic Hospital, Modena, Italy
| | - Federico Bolelli
- Enzo Ferrari Department of Engineering, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Davide Rozze
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Costantino Grana
- Enzo Ferrari Department of Engineering, University of Modena and Reggio Emilia, Modena, Italy
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6
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Gobbo S, Eccher A, Gallina S, D'Aietti D, Princiotta A, Ditonno F, Tafuri A, Cerruto MA, Marletta S, Sanguedolce F, Scarpa A, Brunelli M, Antonelli A. Validation of real-time prostatic biopsies evaluation with fluorescence laser confocal microscopy. Minerva Urol Nephrol 2023; 75:577-582. [PMID: 37486217 DOI: 10.23736/s2724-6051.23.05352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Routine processing of prostate biopsies requires conventional steps that usually take a few days. The aim of this study was to validate the use of fluorescence laser confocal microscopy (FCM) for real-time diagnostics. METHODS We prospectively tested images from prostate needle biopsies (75 images were evaluated by FCM and conventional slides). Two pathologists reviewed the images and assessed agreements between FCM versus conventional slides and between pathologists (κ-values). Interpretation was performed on digital images from the VivaScope 2500 confocal microscope (MAVIG GmbH, Munich, Germany; Caliber I.D., Rochester, NY, USA) placed in the urological operating room. Cancerous versus benign tissue was the primary focus, then the application of the grading system. RESULTS Cancer was diagnosed in 24 conventional slides (on 75 images) in which agreement among pathologists was high for both conventional (κ=0.96) and FMC (κ=0.84). 1/24 (4%) was ISUP/WHO grade group I, 12/24 (50%) II, 8/24 (33%) III, 2/24 (8%) IV and 1/24 (4%) grade V. Near perfect agreement was obtained for grades I, IV and V (κ=0.85). Grade III values achieved a moderate agreement (κ=0.55). The mean time for laser scanning was 9 minutes. For the remaining non-tumor images, agreement was nearly perfect (κ=0.81). CONCLUSIONS We validated the use of FCM for real-time cancer detection in prostate biopsies.
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Affiliation(s)
- Stefano Gobbo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy -
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy -
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Sebastian Gallina
- Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Damiano D'Aietti
- Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Alessandro Princiotta
- Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Francesco Ditonno
- Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Maria A Cerruto
- Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Stefano Marletta
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
- Unit of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Francesca Sanguedolce
- Unit of Pathology, Ospedali Riuniti University Hospital, University of Foggia, Foggia, Italy
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy
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Kinzler MN, Schulze F, Reitz A, Gretser S, Ziegler P, Shmorhun O, Friedrich-Rust M, Bojunga J, Zeuzem S, Schnitzbauer AA, Bechstein WO, Reis H, Barreiros AP, Wild PJ. Fluorescence confocal microscopy on liver specimens for full digitization of transplant pathology. Liver Transpl 2023; 29:940-951. [PMID: 37016761 DOI: 10.1097/lvt.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/01/2023] [Indexed: 04/06/2023]
Abstract
Fluorescence confocal microscopy (FCM) is a rapidly evolving tool that provides real-time virtual HE images of native tissue. Data about the potential of FCM as an alternative to frozen sections for the evaluation of donor liver specimens are lacking so far. The aim of the current study was to determine the value of FCM in liver specimens according to the criteria of the German Society for Organ Procurement. In this prospective study, conventional histology and FCM scans of 50 liver specimens (60% liver biopsies, 26% surgical specimens, and 14% donor samples) were evaluated according to the German Society for Organ Procurement. A comparison of FCM scans and conventional frozen sections revealed almost perfect levels of agreement for cholangitis (κ = 0.877), fibrosis (κ = 0.843), and malignancy (κ = 0.815). Substantial levels of agreement could be obtained for macrovesicular steatosis (κ = 0.775), inflammation (κ = 0.763), necrosis (κ = 0.643), and steatohepatitis (κ = 0.643). Levels of agreement were moderate for microvesicular steatosis (κ = 0.563). The strength of agreement between frozen sections and FCM was superior to the comparison of conventional HE and FCM imaging. We introduce FCM as a potential alternative to the frozen section that may represent a novel approach to liver transplant pathology where timely feedback is crucial and the deployment of human resources is becoming increasingly difficult.
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Affiliation(s)
- Maximilian N Kinzler
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Falko Schulze
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Alexandra Reitz
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Steffen Gretser
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Paul Ziegler
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Oleksandr Shmorhun
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Andreas A Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Wolf Otto Bechstein
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Henning Reis
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Ana Paula Barreiros
- German Organ Procurement Organization (DSO), 60594 Frankfurt am Main, Germany
| | - Peter J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
- Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
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8
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Verri M, Scarpino S, Naciu AM, Lopez G, Tabacco G, Taffon C, Pilozzi E, Palermo A, Crescenzi A. Real-Time Evaluation of Thyroid Cytology Using New Digital Microscopy Allows for Sample Adequacy Assessment, Morphological Classification, and Supports Molecular Analysis. Cancers (Basel) 2023; 15:4215. [PMID: 37686491 PMCID: PMC10486817 DOI: 10.3390/cancers15174215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
Thyroid cytological examination, a key tool in preoperative thyroid nodule evaluation, is specific and accurate; some drawbacks are due to inadequate or indeterminate cytological reports and there is a need for an innovative approach overcoming the limits of traditional cytological diagnostics. Fluorescence laser confocal microscopes (FCM) is a new optical technique for allowing immediate digital imaging of fresh unfixed tissues and real-time assessment of sample adequacy and diagnostic evaluation for small biopsies and cytological samples. Currently, there are no data about the use of FCMs in the field of thyroid nodular pathology. The aims of this study were to test FCM technology for evaluating the adequacy of FNA samples at the time of the procedure and to assess the level of concordance between FCM cytological evaluations, paired conventional cytology, and final surgical histology. The secondary aim was to define the integrity of nucleic acids after FCM evaluation through NGS molecular analysis. Sample adequacy was correctly stated. Comparing FCM evaluation with the final histology, all cases resulting in malignant or suspicious for malignancy at FCM, were confirmed to be carcinomas (PPV 100%). In conclusion, we describe a successful application of FCM in thyroid preoperative cytological evaluation, with advantages in immediate adequacy assessment and diagnostic information, while preserving cellular specimens for permanent morphology and molecular analysis, thus improving timely and accurate patient management.
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Affiliation(s)
- Martina Verri
- Unit of Endocrine Organs and Neuromuscular Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (C.T.); (A.C.)
| | - Stefania Scarpino
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea University Hospital, 00189 Rome, Italy; (S.S.); (G.L.); (E.P.)
| | - Anda Mihaela Naciu
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.M.N.); (G.T.); (A.P.)
| | - Gianluca Lopez
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea University Hospital, 00189 Rome, Italy; (S.S.); (G.L.); (E.P.)
| | - Gaia Tabacco
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.M.N.); (G.T.); (A.P.)
| | - Chiara Taffon
- Unit of Endocrine Organs and Neuromuscular Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (C.T.); (A.C.)
| | - Emanuela Pilozzi
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea University Hospital, 00189 Rome, Italy; (S.S.); (G.L.); (E.P.)
| | - Andrea Palermo
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.M.N.); (G.T.); (A.P.)
| | - Anna Crescenzi
- Unit of Endocrine Organs and Neuromuscular Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (C.T.); (A.C.)
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9
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De Benedetto L, Moffa A, Baptista P, Di Giovanni S, Giorgi L, Verri M, Taffon C, Crescenzi A, Casale M. Potential Use of Vivascope for Real-Time Histological Evaluation in Endoscopic Laryngeal Surgery. J Pers Med 2023; 13:1252. [PMID: 37623502 PMCID: PMC10455566 DOI: 10.3390/jpm13081252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
We aimed to assess the feasibility of using confocal laser scanning microscopy (CLSM) for the real-time ex vivo examination of histological samples of laryngeal lesions and to evaluate the correlation between CLSM and definitive histological results. This preliminary study included eight consecutive patients with "suspected" laryngeal lesions who were candidates for endoscopic laryngeal surgery. The obtained samples were evaluated using CLSM and classified as "inadequate" or "adequate" (high- and low-grade dysplasia, in situ and invasive carcinoma, positive surgical margin, and inflammatory outbreaks). CLSM showed the macro image in all cases and generated a digital version. All the samples were defined as adequate during CLSM and confirmed at histopathology: low-grade dysplasia (n = 5), low- and high-grade dysplasia (n = 2), and high-grade dysplasia (n = 1). Four samples had an involved resection margin, and three samples revealed the presence of inflammatory outbreaks. CLSM can be applied to larynx pathology with excellent agreement with final histological results.
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Affiliation(s)
- Luigi De Benedetto
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy (M.C.)
| | - Antonio Moffa
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy (M.C.)
- School of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Peter Baptista
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
- ENT Department, Al Zahra Private Hospital Dubai, Dubai 23614, United Arab Emirates
| | - Simone Di Giovanni
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy (M.C.)
- School of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Lucrezia Giorgi
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy (M.C.)
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Martina Verri
- Unit of Endocrine Organs and Neuromuscolar Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Chiara Taffon
- Pathology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Anna Crescenzi
- Unit of Endocrine Organs and Neuromuscolar Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Manuele Casale
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy (M.C.)
- School of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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10
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Villarreal JZ, Pérez-Anker J, Puig S, Xipell M, Espinosa G, Barnadas E, Larque AB, Malvehy J, Cervera R, Pereira A, Martinez-Pozo A, Quintana LF, García-Herrera A. Ex vivo confocal microscopy detects basic patterns of acute and chronic lesions using fresh kidney samples. Clin Kidney J 2023; 16:1005-1013. [PMID: 37260998 PMCID: PMC10229294 DOI: 10.1093/ckj/sfad019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Ex vivo confocal microscopy is a real-time technique that provides high-resolution images of fresh, non-fixed tissues, with an optical resolution comparable to conventional pathology. The objective of this study was to investigate the feasibility of using ex vivo confocal microscopy in fusion mode (FuCM) and the haematoxylin and eosin (H&E)-like digital staining that results for the analysis of basic patterns of lesion in nephropathology. METHODS Forty-eight renal samples were scanned in a fourth-generation ex vivo confocal microscopy device. Samples were subjected to confocal microscopy imaging and were then processed using conventional pathology techniques. Concordance between the techniques was evaluated by means of the percentage of agreement and the κ index. RESULTS Agreement between conventional microscopy and H&E-like digital staining was strong (κ = 0.88) in the evaluation of acute tubular damage and was substantial (κ = 0.79) in the evaluation of interstitial fibrosis, interstitial inflammation, arterial and arteriolar lesions. H&E-like digital staining also allows rapid identification of extracapillary proliferation (κ = 0.88), necrosis and segmental sclerosis (κ = .88) in the glomerular compartment, but the results reported here are limited because of the small number of cases with these glomerular findings. CONCLUSIONS FuCM proved to be as effective as conventional techniques in evaluating the presence of acute tubular necrosis and interstitial fibrosis changes, but in fresh tissue. The ease of acquisition of ex vivo confocal microscopy images suggests that FuCM may be useful for rapid evaluation of kidney biopsies and to restructure the clinical workflow in renal histopathology.
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Affiliation(s)
- Jesús Z Villarreal
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Fundación Hospital Clinic, Barcelona, Spain
| | - Javiera Pérez-Anker
- Fundación Hospital Clinic, Barcelona, Spain
- Department of Dermatology, Melanoma Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Susana Puig
- Department of Dermatology, Melanoma Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Marc Xipell
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Esther Barnadas
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - Ana B Larque
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - J Malvehy
- Department of Dermatology, Melanoma Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Arturo Pereira
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - Antonio Martinez-Pozo
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
| | - Adriana García-Herrera
- Pathology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Reference Centre for Complex Glomerular Diseases of the Spanish Health System, Hospital Clínic de Barcelona, Barcelona,Spain
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11
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Prata F, Anceschi U, Taffon C, Rossi SM, Verri M, Iannuzzi A, Ragusa A, Esperto F, Prata SM, Crescenzi A, Scarpa RM, Simone G, Papalia R. Real-Time Urethral and Ureteral Assessment during Radical Cystectomy Using Ex-Vivo Optical Imaging: A Novel Technique for the Evaluation of Fresh Unfixed Surgical Margins. Curr Oncol 2023; 30:3421-3431. [PMID: 36975472 PMCID: PMC10047830 DOI: 10.3390/curroncol30030259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Our study aims to assess the feasibility and the reproducibility of fluorescent confocal microscopy (FCM) real-time assessment of urethral and ureteral margins during open radical cystectomy (ORC) for bladder cancer (BCa). Methods: From May 2020 to January 2022, 46 patients underwent ORC with intraoperative FCM evaluation. Each specimen was intraoperatively stained for histopathological analysis using FCM, analyzed as a frozen section (FSA), and sent for traditional H&E examination. Sensitivity, specificity, positive predictive value (PPV), and the negative predictive value (NPV) of FCM and FSA were assessed and compared with H&E for urethral and ureteral margins separately. Results: The agreement was evaluated through Cohen’s κ statistic. Urethral diagnostic agreement between FCM and FSA showed a κ = 0.776 (p < 0.001), while between FCM and H&E, the agreement was κ = 0.691 (p < 0.001). With regard to ureteral margins, an overall agreement of κ = 0.712 (p < 0.001) between FCM and FSA and of κ = 0.481 (p < 0.001) between FCM and H&E was found. Conclusions: FCM proved to be a safe, feasible, and reproducible method for the intraoperative assessment of urethral and ureteral margins during ORC. Compared to standard FSA, FCM showed adequate diagnostic performance in detecting urethral and ureteral malignant involvement.
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Affiliation(s)
- Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Correspondence: ; Tel.: +39-3934373027; Fax: +39-06225411995
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Chiara Taffon
- Pathology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Silvia Maria Rossi
- Pathology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Martina Verri
- Unit of Endocrine Organs and Neuromuscular Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Francesco Esperto
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Salvatore Mario Prata
- Simple Operating Unit of Lower Urinary Tract Surgery, SS. Trinità Hospital, 03039 Sora, Italy
| | - Anna Crescenzi
- Pathology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
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12
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Rapid On-Site Microscopy and Mapping of Diagnostic Biopsies for See-And-Treat Guidance of Localized Prostate Cancer Therapy. Cancers (Basel) 2023; 15:cancers15030792. [PMID: 36765751 PMCID: PMC9913800 DOI: 10.3390/cancers15030792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Prostate cancer continues to be the most diagnosed non-skin malignancy in men. While up to one in eight men will be diagnosed in their lifetimes, most diagnoses are not fatal. Better lesion location accuracy combined with emerging localized treatment methods are increasingly being utilized as a treatment option to preserve healthy function in eligible patients. In locating lesions which are generally <2cc within a prostate (average size 45cc), small variance in MRI-determined boundaries, tumoral heterogeneity, patient characteristics including location of lesion and prostatic calcifications, and patient motion during the procedure can inhibit accurate sampling for diagnosis. The locations of biopsies are recorded and are then fully processed by histology and diagnosed via pathology, often days to weeks later. Utilization of real-time feedback could improve accuracy, potentially prevent repeat procedures, and allow patients to undergo treatment of clinically localized disease at earlier stages. Unfortunately, there is currently no reliable real-time feedback process for confirming diagnosis of biopsy samples. We examined the feasibility of implementing structured illumination microscopy (SIM) as a method for on-site diagnostic biopsy imaging to potentially combine the diagnostic and treatment appointments for prostate cancer patients, or to confirm tumoral margins for localized ablation procedures. We imaged biopsies from 39 patients undergoing image-guided diagnostic biopsy using a customized SIM system and a dual-color fluorescent hematoxylin & eosin (H&E) analog. The biopsy images had an average size of 342 megapixels (minimum 78.1, maximum 842) and an average imaging duration of 145 s (minimum 56, maximum 322). Comparison of urologist's suspicion of malignancy based on MRI, to pathologist diagnosis of biopsy images obtained in real time, reveals that real-time biopsy imaging could significantly improve confirmation of malignancy or tumoral margins over medical imaging alone.
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13
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New digital confocal laser microscopy may boost real-time evaluation of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) from solid pancreatic lesions: Data from an international multicenter study. EBioMedicine 2022; 86:104377. [PMID: 36436280 PMCID: PMC9706538 DOI: 10.1016/j.ebiom.2022.104377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pancreatic cancer is an aggressive malignancy and a leading cause of cancer death worldwide; its lethality is partly linked to the difficulty of early diagnosis. Modern devices for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) were recently developed to improve targeting and sampling of small lesions, but innovative technologies for microscopic assessment are still lacking. Ex vivo fluorescence confocal laser microscopy (FCM) is a new digital tool for real-time microscopic assessment of fresh unfixed biological specimens, avoiding conventional histological slide preparation and potentially being highly appealing for EUS-FNB specimens. METHODS This study evaluated the possible role of FCM for immediate evaluation of pancreatic specimens from EUS-FNB. It involved comparison of the interobserver agreement between the new method and standard histological analysis during international multicenter sharing of digital images. Digital images from 25 cases of EUS-FNB obtained with real-time FCM technology and 25 paired digital whole-slide images from permanent conventional paraffin sections were observed by 10 pathologists from different Institutions in Europe, Japan, and the United States, in a blinded manner. The study evaluated 500 observations regarding adequacy, morphological clues, diagnostic categories, and final diagnosis. FINDINGS Statistical analysis showed substantial equivalence in the interobserver agreement among pathologists using the two techniques. There was also good inter-test agreement in determining sample adequacy and when assigning a diagnostic category. Among morphological features, nuclear enlargement was the most reproducible clue, with very good inter-test agreement. INTERPRETATION Findings in this study are from international multicenter digital sharing and are published here for the first time. Considering the advantages of FCM digital diagnostics in terms of reduced time and unaltered sample maintenance, the ex vivo confocal laser microscopy may effectively improve traditional EUS-FNB diagnostics, with significant implications for planning modern diagnostic workflow for pancreatic tumors. FUNDING This study was not supported by any funding source.
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14
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Sighinolfi MC, Cimadamore A, Cassani A, Assumma S, Sarchi L, Filippi B, Turri F, Reggiani Bonetti L, Maiorana A, Eissa A, Micali S, Montironi R, Rocco B. Digital real-time microscopy of ex-vivo tissues: A novel strategy to control surgical accuracy. Urologia 2022; 90:146-150. [PMID: 37014088 DOI: 10.1177/03915603221122731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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 intra-operative 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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Affiliation(s)
- Maria Chiara Sighinolfi
- ASST Santi Paolo e Carlo, Università di Milano, Milano, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Cimadamore
- Institute of Pathological Anatomy, Polytechnic University of the Marche Region, Ancona, Italy
| | - Alessandra Cassani
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Assumma
- ASST Santi Paolo e Carlo, Università di Milano, Milano, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sarchi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Beatrice Filippi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Turri
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonino Maiorana
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Department of Urology, Tanta University, Tanta, Egypt
| | - Salvatore Micali
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Rodolfo Montironi
- Institute of Pathological Anatomy, Polytechnic University of the Marche Region, Ancona, Italy
| | - Bernardo Rocco
- ASST Santi Paolo e Carlo, Università di Milano, Milano, Italy
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15
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Puliatti S, Eissa A, Checcucci E, Piazza P, Amato M, Scarcella S, Rivas JG, Taratkin M, Marenco J, Rivero IB, Kowalewski KF, Cacciamani G, El-Sherbiny A, Zoeir A, El-Bahnasy AM, De Groote R, Mottrie A, Micali S. New imaging technologies for robotic kidney cancer surgery. Asian J Urol 2022; 9:253-262. [PMID: 36035346 PMCID: PMC9399539 DOI: 10.1016/j.ajur.2022.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/19/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Kidney cancers account for approximately 2% of all newly diagnosed cancer in 2020. Among the primary treatment options for kidney cancer, urologist may choose between radical or partial nephrectomy, or ablative therapies. Nowadays, robotic-assisted partial nephrectomy (RAPN) for the management of renal cancers has gained popularity, up to being considered the gold standard. However, RAPN is a challenging procedure with a steep learning curve. Methods In this narrative review, different imaging technologies used to guide and aid RAPN are discussed. Results Three-dimensional visualization technology has been extensively discussed in RAPN, showing its value in enhancing robotic-surgery training, patient counseling, surgical planning, and intraoperative guidance. Intraoperative imaging technologies such as intracorporeal ultrasound, near-infrared fluorescent imaging, and intraoperative pathological examination can also be used to improve the outcomes following RAPN. Finally, artificial intelligence may play a role in the field of RAPN soon. Conclusion RAPN is a complex surgery; however, many imaging technologies may play an important role in facilitating it.
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16
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Sievert KD, Hansen T, Titze B, Schulz B, Omran A, Brockkötter L, Gunnemann A, Titze U. Ex Vivo Fluorescence Confocal Microscopy (FCM) of Prostate Biopsies Rethought: Opportunities of Intraoperative Examinations of MRI-Guided Targeted Biopsies in Routine Diagnostics. Diagnostics (Basel) 2022; 12:diagnostics12051146. [PMID: 35626301 PMCID: PMC9140526 DOI: 10.3390/diagnostics12051146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. Detection rates of clinically relevant tumors were determined in both groups. A retrospective blinded trial was performed to determine how many tumors requiring intervention were detectable via FCM analysis of MRI-guided targeted biopsies alone. Results: MRI-guided targeted biopsies revealed tumors more frequently than systematic biopsies. Carcinomas in need of intervention were reliably represented in the MRI-guided biopsies and were identified in intraoperative FCM microscopy. Combined with serum PSA levels and clinical presentation, 91% of the carcinomas in need of intervention were identified. Conclusions: Intraoperative FCM analysis of MRI-guided biopsies is a promising approach for the efficient diagnosis of PCa. The method allows a timely assessment of whether a tumor disease requiring intervention is present and can reduce the psychological stress of the patient in the waiting period of the histological finding. Furthermore, this technique can lead to reduction of the total number of biopsies needed for the diagnosis of PCa.
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Affiliation(s)
- Karl-Dietrich Sievert
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Torsten Hansen
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Barbara Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Birte Schulz
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Ahmad Omran
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Lukas Brockkötter
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Alfons Gunnemann
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Ulf Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
- Correspondence: ; Tel.: +49-05231-72-3451
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17
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Cahill LC, Rosen S, Yoshitake T, Wu Y, York L, Tsai LL, Gershman B, Fujimoto JG, Sun Y. Real-time diagnosis and Gleason grading of prostate core needle biopsies using nonlinear microscopy. Mod Pathol 2022; 35:539-548. [PMID: 34725447 PMCID: PMC8560363 DOI: 10.1038/s41379-021-00960-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/09/2022]
Abstract
Rapid histologic assessment of fresh prostate biopsies may reduce patient anxiety, aid in biopsy sampling, and enable specimen triaging for molecular/genomic analyses and research that could benefit from fresh tissue analysis. Nonlinear microscopy (NLM) is a fluorescence microscopy technique that can produce high-resolution images of freshly excised tissue resembling formalin-fixed paraffin-embedded (FFPE) H&E. NLM enables evaluation of tissue up to ~100 µm below the surface, analogous to serial sectioning, but without requiring microtome sectioning. One hundred and seventy biopsies were collected from 63 patients who underwent in-bore MRI or MRI/ultrasound fusion biopsy procedures. Biopsies were stained in acridine orange and sulforhodamine 101, a nuclear and cytoplasmic/stromal fluorescent dye, for 45 s. Genitourinary pathologists evaluated the biopsies using NLM by translating the biopsies in real time to areas of interest and NLM images were recorded. After NLM evaluation, the biopsies were processed for standard FFPE H&E and similarities and differences between NLM and FFPE H&E were investigated. Accuracies of NLM diagnoses and Gleason scores were calculated using FFPE histology as the gold standard. Pathologists achieved a 92.4% sensitivity (85.0-96.9%, 95% confidence intervals) and 100.0% specificity (94.3-100.0%) for detecting carcinoma compared to FFPE histology. The agreement between the Grade Group determined by NLM versus FFPE histology had an unweighted Cohen's Kappa of 0.588. The average NLM evaluation time was 2.10 min per biopsy (3.08 min for the first 20 patients, decreasing to 1.54 min in subsequent patients). Further studies with larger patient populations, larger number of pathologists, and multiple institutions are warranted. NLM is a promising method for future rapid evaluation of prostate needle core biopsies.
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Affiliation(s)
- Lucas C Cahill
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tadayuki Yoshitake
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yubo Wu
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Linda York
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Leo L Tsai
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yue Sun
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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18
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Bishop KW, Maitland KC, Rajadhyaksha M, Liu JTC. In vivo microscopy as an adjunctive tool to guide detection, diagnosis, and treatment. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-220032-PER. [PMID: 35478042 PMCID: PMC9043840 DOI: 10.1117/1.jbo.27.4.040601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 05/05/2023]
Abstract
SIGNIFICANCE There have been numerous academic and commercial efforts to develop high-resolution in vivo microscopes for a variety of clinical use cases, including early disease detection and surgical guidance. While many high-profile studies, commercialized products, and publications have resulted from these efforts, mainstream clinical adoption has been relatively slow other than for a few clinical applications (e.g., dermatology). AIM Here, our goals are threefold: (1) to introduce and motivate the need for in vivo microscopy (IVM) as an adjunctive tool for clinical detection, diagnosis, and treatment, (2) to discuss the key translational challenges facing the field, and (3) to propose best practices and recommendations to facilitate clinical adoption. APPROACH We will provide concrete examples from various clinical domains, such as dermatology, oral/gastrointestinal oncology, and neurosurgery, to reinforce our observations and recommendations. RESULTS While the incremental improvement and optimization of IVM technologies should and will continue to occur, future translational efforts would benefit from the following: (1) integrating clinical and industry partners upfront to define and maintain a compelling value proposition, (2) identifying multimodal/multiscale imaging workflows, which are necessary for success in most clinical scenarios, and (3) developing effective artificial intelligence tools for clinical decision support, tempered by a realization that complete adoption of such tools will be slow. CONCLUSIONS The convergence of imaging modalities, academic-industry-clinician partnerships, and new computational capabilities has the potential to catalyze rapid progress and adoption of IVM in the next few decades.
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Affiliation(s)
- Kevin W. Bishop
- University of Washington, Department of Bioengineering, Seattle, Washington, United States
- University of Washington, Department of Mechanical Engineering, Seattle, Washington, United States
| | - Kristen C. Maitland
- Texas A&M University, Department of Biomedical Engineering, College Station, Texas, United States
| | - Milind Rajadhyaksha
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York, United States
| | - Jonathan T. C. Liu
- University of Washington, Department of Bioengineering, Seattle, Washington, United States
- University of Washington, Department of Mechanical Engineering, Seattle, Washington, United States
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
- Address all correspondence to Jonathan T.C. Liu,
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19
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Li J, Garfinkel J, Zhang X, Wu D, Zhang Y, de Haan K, Wang H, Liu T, Bai B, Rivenson Y, Rubinstein G, Scumpia PO, Ozcan A. Biopsy-free in vivo virtual histology of skin using deep learning. LIGHT, SCIENCE & APPLICATIONS 2021; 10:233. [PMID: 34795202 PMCID: PMC8602311 DOI: 10.1038/s41377-021-00674-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 05/09/2023]
Abstract
An invasive biopsy followed by histological staining is the benchmark for pathological diagnosis of skin tumors. The process is cumbersome and time-consuming, often leading to unnecessary biopsies and scars. Emerging noninvasive optical technologies such as reflectance confocal microscopy (RCM) can provide label-free, cellular-level resolution, in vivo images of skin without performing a biopsy. Although RCM is a useful diagnostic tool, it requires specialized training because the acquired images are grayscale, lack nuclear features, and are difficult to correlate with tissue pathology. Here, we present a deep learning-based framework that uses a convolutional neural network to rapidly transform in vivo RCM images of unstained skin into virtually-stained hematoxylin and eosin-like images with microscopic resolution, enabling visualization of the epidermis, dermal-epidermal junction, and superficial dermis layers. The network was trained under an adversarial learning scheme, which takes ex vivo RCM images of excised unstained/label-free tissue as inputs and uses the microscopic images of the same tissue labeled with acetic acid nuclear contrast staining as the ground truth. We show that this trained neural network can be used to rapidly perform virtual histology of in vivo, label-free RCM images of normal skin structure, basal cell carcinoma, and melanocytic nevi with pigmented melanocytes, demonstrating similar histological features to traditional histology from the same excised tissue. This application of deep learning-based virtual staining to noninvasive imaging technologies may permit more rapid diagnoses of malignant skin neoplasms and reduce invasive skin biopsies.
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Affiliation(s)
- Jingxi Li
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | | | - Xiaoran Zhang
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
| | - Di Wu
- Computer Science Department, University of California, Los Angeles, CA, 90095, USA
| | - Yijie Zhang
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Kevin de Haan
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Hongda Wang
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Tairan Liu
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Bijie Bai
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Yair Rivenson
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | | | - Philip O Scumpia
- Division of Dermatology, University of California, Los Angeles, CA, 90095, USA.
- Department of Dermatology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, 90073, USA.
| | - Aydogan Ozcan
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA.
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA.
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA.
- Department of Surgery, University of California, Los Angeles, CA, 90095, USA.
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20
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Shavlokhova V, Sandhu S, Flechtenmacher C, Koveshazi I, Neumeier F, Padrón-Laso V, Jonke Ž, Saravi B, Vollmer M, Vollmer A, Hoffmann J, Engel M, Ristow O, Freudlsperger C. Deep Learning on Oral Squamous Cell Carcinoma Ex Vivo Fluorescent Confocal Microscopy Data: A Feasibility Study. J Clin Med 2021; 10:5326. [PMID: 34830608 PMCID: PMC8618824 DOI: 10.3390/jcm10225326] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ex vivo fluorescent confocal microscopy (FCM) is a novel and effective method for a fast-automatized histological tissue examination. In contrast, conventional diagnostic methods are primarily based on the skills of the histopathologist. In this study, we investigated the potential of convolutional neural networks (CNNs) for automatized classification of oral squamous cell carcinoma via ex vivo FCM imaging for the first time. MATERIAL AND METHODS Tissue samples from 20 patients were collected, scanned with an ex vivo confocal microscope immediately after resection, and investigated histopathologically. A CNN architecture (MobileNet) was trained and tested for accuracy. RESULTS The model achieved a sensitivity of 0.47 and specificity of 0.96 in the automated classification of cancerous tissue in our study. CONCLUSION In this preliminary work, we trained a CNN model on a limited number of ex vivo FCM images and obtained promising results in the automated classification of cancerous tissue. Further studies using large sample sizes are warranted to introduce this technology into clinics.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Sameena Sandhu
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | | | | | | | | | - Žan Jonke
- Munich Innovation Labs GmbH, 80336 Munich, Germany; (V.P.-L.); (Ž.J.)
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany;
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (M.E.); (O.R.); (C.F.)
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21
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Titze U, Hansen T, Brochhausen C, Titze B, Schulz B, Gunnemann A, Rocco B, Sievert KD. Diagnostic Performance of Ex Vivo Fluorescence Confocal Microscopy in the Assessment of Diagnostic Biopsies of the Prostate. Cancers (Basel) 2021; 13:cancers13225685. [PMID: 34830839 PMCID: PMC8616222 DOI: 10.3390/cancers13225685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. In this study, we compare intraoperative diagnoses from the real-time application of FCM in pre-therapeutic prostate biopsies with the final diagnoses from conventional histology. We found FCM to be an effective tool for the timely assessment of prostate biopsies enabling reliable real-time diagnosis of prostate cancer in patients requiring therapy. Abstract Background: Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. The method has been well established for the diagnosis of tumors in dermatological specimens. Methods: We compare intraoperative diagnoses of the real-time application of FCM in pre-therapeutic prostate biopsies (35 patients, total number of biopsy specimens: n = 438) with the findings of conventional histology. Results: Prostate carcinoma was reliably diagnosed in all patients. Depending on scan quality and experience of the examiner, smaller lesions of well differentiated carcinoma (ISUP1) could not be consistently differentiated from reactive changes. Furthermore, in some cases there was difficulty to distinguish ISUP grade 2 from ISUP grade 1 tumors. ISUP grades 3–5 were reliably detected in FCM. Conclusions: Despite some limitations, FCM seems to be an effective tool for the timely assessment of prostate biopsies enabling reliable diagnosis of prostate cancer in patients requiring therapy.
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Affiliation(s)
- Ulf Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
- Correspondence: ; Tel.: +49-05231-72-3451
| | - Torsten Hansen
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Christoph Brochhausen
- Institute of Pathology, University of Regensburg, 93053 Regensburg, Germany;
- Central Biobank Regensburg, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Barbara Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Birte Schulz
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Alfons Gunnemann
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (A.G.); (K.-D.S.)
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Karl-Dietrich Sievert
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (A.G.); (K.-D.S.)
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22
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Ruini C, Schlingmann S, Jonke Ž, Avci P, Padrón-Laso V, Neumeier F, Koveshazi I, Ikeliani IU, Patzer K, Kunrad E, Kendziora B, Sattler E, French LE, Hartmann D. Machine Learning Based Prediction of Squamous Cell Carcinoma in Ex Vivo Confocal Laser Scanning Microscopy. Cancers (Basel) 2021; 13:cancers13215522. [PMID: 34771684 PMCID: PMC8583634 DOI: 10.3390/cancers13215522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 01/02/2023] Open
Abstract
Image classification with convolutional neural networks (CNN) offers an unprecedented opportunity to medical imaging. Regulatory agencies in the USA and Europe have already cleared numerous deep learning/machine learning based medical devices and algorithms. While the field of radiology is on the forefront of artificial intelligence (AI) revolution, conventional pathology, which commonly relies on examination of tissue samples on a glass slide, is falling behind in leveraging this technology. On the other hand, ex vivo confocal laser scanning microscopy (ex vivo CLSM), owing to its digital workflow features, has a high potential to benefit from integrating AI tools into the assessment and decision-making process. Aim of this work was to explore a preliminary application of CNN in digitally stained ex vivo CLSM images of cutaneous squamous cell carcinoma (cSCC) for automated detection of tumor tissue. Thirty-four freshly excised tissue samples were prospectively collected and examined immediately after resection. After the histologically confirmed ex vivo CLSM diagnosis, the tumor tissue was annotated for segmentation by experts, in order to train the MobileNet CNN. The model was then trained and evaluated using cross validation. The overall sensitivity and specificity of the deep neural network for detecting cSCC and tumor free areas on ex vivo CLSM slides compared to expert evaluation were 0.76 and 0.91, respectively. The area under the ROC curve was equal to 0.90 and the area under the precision-recall curve was 0.85. The results demonstrate a high potential of deep learning models to detect cSCC regions on digitally stained ex vivo CLSM slides and to distinguish them from tumor-free skin.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence:
| | - Sophia Schlingmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Žan Jonke
- Munich Innovation Labs GmbH, 80336 Munich, Germany; (Ž.J.); (V.P.-L.)
| | - Pinar Avci
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | | | - Florian Neumeier
- M3i Industry-in-Clinic-Platform GmbH, 80336 Munich, Germany; (F.N.); (I.K.); (I.U.I.)
| | - Istvan Koveshazi
- M3i Industry-in-Clinic-Platform GmbH, 80336 Munich, Germany; (F.N.); (I.K.); (I.U.I.)
| | - Ikenna U. Ikeliani
- M3i Industry-in-Clinic-Platform GmbH, 80336 Munich, Germany; (F.N.); (I.K.); (I.U.I.)
| | - Kathrin Patzer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Elena Kunrad
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Benjamin Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Elke Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
| | - Lars E. French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (S.S.); (P.A.); (K.P.); (E.K.); (B.K.); (E.S.); (L.E.F.); (D.H.)
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23
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Guerrero JA, Pérez-Anker J, Fernández-Esparrach G, Archilla I, Diaz A, Lopez-Prades S, Rodrigo-Calvo M, Lahoz S, Camps J, Puig S, Malvehy J, Cuatrecasas M. Ex vivo Fusion Confocal Microscopy of Colorectal Polyps: A Fast Turnaround Time of Pathological Diagnosis. Pathobiology 2021; 88:392-399. [PMID: 34407541 DOI: 10.1159/000517190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/11/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Colorectal cancer screening programs have accomplished a mortality reduction from the disease but have created bottlenecks in endoscopy units and pathology departments. We aimed to explore the feasibility of ex vivo fusion confocal microscopy (FuCM) to improve the histopathology diagnostic efficiency and reduce laboratory workload. METHODS Consecutive fresh polyps removed at colonoscopy were scanned using ex vivo FuCM, then went through histopathologic workout and hematoxylin and eosin (H&E) diagnosis. Two pathologists blinded to H&E diagnosis made a diagnosis based on FuCM scanned images. RESULTS Thirty-six fresh polyps from 22 patients were diagnosed with FuCM and H&E. Diagnostic agreement between H&E and FuCM was 97.2% (kappa = 0.96) for pathologist #1 and 91.7% (kappa = 0.87) for pathologist #2. Diagnostic performance concordance between FuCM and H&E to discern adenomatous from nonadenomatous polyps was 100% (kappa = 1) for pathologist #1 and 97.2% (kappa = 0.94) for pathologist #2. Global interobserver agreement was 94.44% (kappa = 0.91) and kappa = 0.94 to distinguish adenomatous from nonadenomatous polyps. CONCLUSIONS Ex vivo FuCM shows an excellent correlation with standard H&E for the diagnosis of colorectal polyps. The clinical direct benefit for patients, pathologists, and endoscopists allows adapting personalized surveillance protocols after colonoscopy and a workload decrease in pathology departments.
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Affiliation(s)
- Jose Andres Guerrero
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain
| | | | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain
| | - Ivan Archilla
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alba Diaz
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sandra Lopez-Prades
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maite Rodrigo-Calvo
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Lahoz
- University of Barcelona, Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Gastrointestinal and Pancreatic Oncology Team, Hospital Clínic, Barcelona, Spain
| | - Jordi Camps
- University of Barcelona, Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Gastrointestinal and Pancreatic Oncology Team, Hospital Clínic, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Faculty of Medicine, University Autonomous of Barcelona, Bellaterra, Spain
| | - Susana Puig
- Dermatology Department, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Banc de Teixits-Biobanc Clinic-IDIBAPS, Barcelona, Spain
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24
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Ruini C, Vladimirova G, Kendziora B, Salzer S, Ergun E, Sattler E, French LE, Hartmann D. Ex-vivo fluorescence confocal microscopy with digital staining for characterizing basal cell carcinoma on frozen sections: A comparison with histology. JOURNAL OF BIOPHOTONICS 2021; 14:e202100094. [PMID: 33991061 DOI: 10.1002/jbio.202100094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
Ex-vivo fluorescence confocal microscopy (FCM) has been used on fresh tissue, but there is little experience on frozen sections. We evaluated the applicability of FCM on frozen sections of basal cell carcinomas (BCCs), stained with acridine orange and digitally colored to simulate hematoxylin and eosin (H&E) dyes. We compared our diagnostic accuracy in detecting and subtyping BCCs with FCM to our gold standard (H&E stained frozen sections used in 3D horizontal micrographic surgery). Fourty-six primary BCCs were analyzed for free margins as well as histological subtype with all FCM modes and conventional H&E staining. Adnexa, artifacts and diagnostic confidence were evaluated. Free margins were identified with a sensitivity and specificity of 92% and 91%. Concordance for tumor subtype was 88%. FCM may be used on both fresh tissue and frozen samples, although with reduced performance and different artifacts. The device is useful for the intraoperative diagnosis, subtyping and margin-mapping of BCCs.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Italy
| | | | - Benjamin Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - Suzanna Salzer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - Ecem Ergun
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - Elke Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
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25
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Rocco B, Sarchi L, Assumma S, Cimadamore A, Montironi R, Reggiani Bonetti L, Turri F, De Carne C, Puliatti S, Maiorana A, Pellacani G, Micali S, Bianchi G, Sighinolfi MC. Digital Frozen Sections with Fluorescence Confocal Microscopy During Robot-assisted Radical Prostatectomy: Surgical Technique. Eur Urol 2021; 80:724-729. [PMID: 33965288 DOI: 10.1016/j.eururo.2021.03.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) involves a tradeoff between oncological control and functional outcomes. Intraoperative control of surgical margins (SMs) may help in ensuring the safety of the dissection. Fluorescence confocal microscopy (FCM) is an effective method for interpretation of prostate tissue and provides digital images with an appearance similar to hematoxylin-eosin staining. OBJECTIVE To describe an alternative technique to NeuroSAFE for intraoperative evaluation of neurovascular-adjacent margins shaved from ex vivo specimens using FCM analysis. DESIGN, SETTING, AND PARTICIPANTS This was a prospective study of 24 patients undergoing RARP with intraoperative FCM control of margin status. SURGICAL PROCEDURE After surgical dissection, SMs are sectioned from the fresh prostate using the Mohs technique (shaving): three slices from the apex and the right and left posterolateral aspects are obtained. Digital images of the shavings are immediately acquired via FCM and shared with a remote pathologist. In the case of a positive SM, a focal secondary resection of the bundle can be performed owing to the ability of FCM to locate a region of interest on the flat sample. MEASUREMENTS The primary outcome measure was the rate of negative margins at neurovascular-adjacent sites. Oncological and functional outcomes for patients with 1 yr of follow-up are also reported. RESULTS AND LIMITATIONS All patients had negative SMs in shavings from neurovascular-adjacent areas at final histopathology; four underwent a secondary resection with final conversion to negative SM status. Nine of ten patients with 1-yr follow-up are free of biochemical recurrence (prostate-specific antigen persistence in one pN1 case), nine are fully continent, and four of the five with preoperative potency have recovered their sexual function. CONCLUSIONS Digital frozen sections with FCM during RARP may represent an alternative to NeuroSAFE for possible optimization of functional outcomes without compromising oncological safety. PATIENT SUMMARY We developed a technique to ensure complete removal of cancer tissue during surgical removal of the prostate. Tissue specimens are examined via digital microscopy in real time during the operation. This allows the surgeon to remove more tissue if cancer is detected at the margins of a specimen, while avoiding unnecessary removal of healthy tissue.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sarchi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.
| | - Simone Assumma
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Cimadamore
- Institute of Pathological Anatomy, Polytechnic University of the Marche Region, Ancona, Italy
| | - Rodolfo Montironi
- Institute of Pathological Anatomy, Polytechnic University of the Marche Region, Ancona, Italy
| | | | - Filippo Turri
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Cosimo De Carne
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonino Maiorana
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
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Titze U, Hansen T, Titze B, Schulz B, Gunnemann A, Rocco B, Sievert KD. Feasibility study for ex vivo fluorescence confocal microscopy (FCM) on diagnostic prostate biopsies. Quant Imaging Med Surg 2021; 11:1322-1332. [PMID: 33816171 DOI: 10.21037/qims-20-895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. The method has been well established for the diagnosis of tumours in dermatological specimens. Preliminary results found good feasibility when this technique was used to examine prostate cancer (PCa) specimens. Methods We report on the application of FCM in magnet resonance imaging (MRI)-fused prostate biopsies (10 patients, total number of biopsy specimens: n=121) and compare the results to conventional histology. Results Specific structures of the prostatic tissue were very well represented in the FCM images comparable to conventional histology. Prostate carcinoma was diagnosed with good sensitivity (79/68%) and high specificity (100%) by two pathologists with substantial/almost perfect levels of agreement with the results of conventional histology (kappa 0.79/0.86). Depending on the quality of the scans, malignant lesions of 1.8 mm and more in diameter were reliably diagnosed. Smaller lesions were rated as suspect for malignancy, but could not be consistently differentiated from reactive changes. Optimal image qualities were achieved in focus depths of up to 50 µm, whereas deeper scans led to insufficient representation of cytological features. Pre-treatment with acridine orange (AO) did not alter immunoreactivity of the tissue or its feasibility for fluorescence in situ hybridization (FISH) analyses and adequate amounts of DNA could be extracted for further polymerase chain reaction (PCR)-based examinations. Conclusions FCM seems to be a promising tool for the timely diagnosis in cases of PCa in patients requiring therapy. In particular, this technique is a material-sparing method that conserves the biopsies as unfixed material for further analysis such as molecular tumour companion diagnosis.
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Affiliation(s)
- Ulf Titze
- Department of Pathology, Klinikum Lippe GmbH, Detmold, Germany
| | - Torsten Hansen
- Department of Pathology, Klinikum Lippe GmbH, Detmold, Germany
| | - Barbara Titze
- Department of Pathology, Klinikum Lippe GmbH, Detmold, Germany
| | - Birte Schulz
- Department of Pathology, Klinikum Lippe GmbH, Detmold, Germany
| | | | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Ortner VK, Sahu A, Cordova M, Kose K, Aleissa S, Alessi-Fox C, Haedersdal M, Rajadhyaksha M, Rossi AM. Exploring the utility of Deep Red Anthraquinone 5 for digital staining of ex vivo confocal micrographs of optically sectioned skin. JOURNAL OF BIOPHOTONICS 2021; 14:e202000207. [PMID: 33314673 PMCID: PMC8274380 DOI: 10.1002/jbio.202000207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 05/11/2023]
Abstract
We investigated the utility of the fluorescent dye Deep Red Anthraquinone 5 (DRAQ5) for digital staining of optically sectioned skin in comparison to acridine orange (AO). Eight fresh-frozen thawed Mohs discard tissue specimens were stained with AO and DRAQ5, and imaged using an ex vivo confocal microscope at three wavelengths (488 nm and 638 nm for fluorescence, 785 nm for reflectance). Images were overlaid (AO + Reflectance, DRAQ5 + Reflectance), digitally stained, and evaluated by three investigators for perceived image quality (PIQ) and histopathological feature identification. In addition to nuclear staining, AO seemed to stain dermal fibers in a subset of cases in digitally stained images, while DRAQ5 staining was more specific to nuclei. Blinded evaluation showed substantial agreement, favoring DRAQ5 for PIQ (82%, Cl 75%-90%, Gwet's AC 0.74) and for visualization of histopathological features in (81%, Cl 73%-89%, Gwet's AC 0.67), supporting its use in digital staining of multimodal confocal micrographs of skin.
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Affiliation(s)
- Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - Aditi Sahu
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kivanc Kose
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saud Aleissa
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony Mario Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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28
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Kose K, Fox CA, Rossi A, Jain M, Cordova M, Dusza SW, Ragazzi M, Gardini S, Moscarella E, Diaz A, Pigem R, Gonzalez S, Bennassar A, Carrera C, Longo C, Rajadhyaksha M, Nehal KS. An international 3-center training and reading study to assess basal cell carcinoma surgical margins with ex vivo fluorescence confocal microscopy. J Cutan Pathol 2021; 48:1010-1019. [PMID: 33576022 DOI: 10.1111/cup.13980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Novel solutions are needed for expediting margin assessment to guide basal cell carcinoma (BCC) surgeries. Ex vivo fluorescence confocal microscopy (FCM) is starting to be used in freshly excised surgical specimens to examine BCC margins in real time. Training and educational process are needed for this novel technology to be implemented into clinic. OBJECTIVE To test a training and reading process, and measure diagnostic accuracy of clinicians with varying expertise level in reading ex vivo FCM images. METHODS An international three-center study was designed for training and reading to assess BCC surgical margins and residual subtypes. Each center included a lead dermatologic/Mohs surgeon (clinical developer of FCM) and three additional readers (dermatologist, dermatopathologist, dermatologic/Mohs surgeon), who use confocal in clinical practice. Testing was conducted on 30 samples. RESULTS Overall, the readers achieved 90% average sensitivity, 78% average specificity in detecting residual BCC margins, showing high and consistent diagnostic reading accuracy. Those with expertise in dermatologic surgery and dermatopathology showed the strongest potential for learning to assess FCM images. LIMITATIONS Small dataset, variability in mosaic quality between centers. CONCLUSION Suggested process is feasible and effective. This process is proposed for wider implementation to facilitate wider adoption of FCM to potentially expedite BCC margin assessment to guide surgery in real time.
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Affiliation(s)
- Kivanc Kose
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Anthony Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Manu Jain
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Miguel Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephen W Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moira Ragazzi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
| | - Stefano Gardini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania L Vanvitelli, Naples, Italy
| | - Alba Diaz
- Pathology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ramon Pigem
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Salvador Gonzalez
- Medicine and Medical Specialties Department, Alcalá de Henares University, Madrid, Spain
| | - Antoni Bennassar
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Madrid, Spain
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Rocco B, Cimadamore A, Sarchi L, Bonetti LR, Bertoni L, Azzoni P, Assumma S, Turri F, Bozzini G, Eissa A, Micali S, Bianchi G, Maiorana A, Montironi R, Pellacani G, Sighinolfi MC. Current and future perspectives of digital microscopy with fluorescence confocal microscope for prostate tissue interpretation: a narrative review. Transl Androl Urol 2021; 10:1569-1580. [PMID: 33850791 PMCID: PMC8039586 DOI: 10.21037/tau-20-1237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Fluorescence confocal microscopy (FCM) is an optical imaging technique providing digital microscopical images of fresh tissue in a real time fashion, without conventional processing. FCM has been widely applied in several fields of dermatology, including the detection of basal cell carcinoma and of cutaneous inflammatory diseases. The aim of the paper is to provide an overview of FCM applications in the field of prostate tissue interpretation and prostate cancer (PCa) detection. A Literature search (PubMed & Web of Science) was performed to identify articles concerned with the clinical and surgical applications of FCM in prostatic and periprostatic tissues interpretation. Overall, six articles were identified. All articles investigated the level of agreement between FCM and conventional histopathological analysis (hematoxylin-eosin, HE) for the discrimination between normal and PCa tissues. An investigative article on prostate samples retrieved from radical prostatectomy (RP) specimens and an atlas of FCM digital images from the same series were found. Two prospective clinical trials, comparing FCM and HE, pointed out a “substantial” to “almost perfect” discriminative performance of FCM for the diagnosis of PCa on prostate biopsy core. Finally, two studies investigated the intra-operative role of FCM during RP for the control of surgical dissection. In this setting, FCM could be used to analyse samples retrieved from suspicious peri-prostatic areas; FCM has also been tested for an en-face evaluation of flat slices obtained from the systematic sampling of the posterolateral aspects of the prostate, in a NeuroSAFE-like approach. Generally, FCM provides digital microscopical images of fresh tissue in a real time fashion, without requiring conventional processing. Currently, available studies confirmed a high concordance with conventional pathology for the detection of PCa. Further studies are required to validate the technology, to evaluate ISUP score attribution and to implement the fields of application of FCM for the treatment of prostate diseases.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Cimadamore
- Department of Pathology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Laura Bertoni
- Department of Human Anatomy, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Azzoni
- Department of Human Anatomy, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Assumma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Turri
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonino Maiorana
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Rodolfo Montironi
- Department of Pathology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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30
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Clinical Applications of In Vivo and Ex Vivo Confocal Microscopy. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11051979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Confocal laser scanning microscopy (CLSM) has been introduced in clinical settings as a tool enabling a quasi-histologic view of a given tissue, without performing a biopsy. It has been applied to many fields of medicine mainly to the skin and to the analysis of skin cancers for both in vivo and ex vivo CLSM. In vivo CLSM involves reflectance mode, which is based on refractive index of cell structures serving as endogenous chromophores, reaching a depth of exploration of 200 μm. It has been proven to increase the diagnostic accuracy of skin cancers, both melanoma and non-melanoma. While histopathologic examination is the gold standard for diagnosis, in vivo CLSM alone and in addition to dermoscopy, contributes to the reduction of the number of excised lesions to exclude a melanoma, and to improve margin recognition in lentigo maligna, enabling tissue sparing for excisions. Ex vivo CLSM can be performed in reflectance and fluorescent mode. Fluorescence confocal microscopy is applied for “real-time” pathological examination of freshly excised specimens for diagnostic purposes and for the evaluation of margin clearance after excision in Mohs surgery. Further prospective interventional studies using CLSM might contribute to increase the knowledge about its application, reproducing real-life settings.
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31
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Pérez-Anker J, Toll A, Puig S, Malvehy J. Six steps to reach optimal scanning in ex vivo confocal microscopy. J Am Acad Dermatol 2021; 86:188-189. [PMID: 33476729 DOI: 10.1016/j.jaad.2021.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Javiera Pérez-Anker
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunye, Universitat de Barcelona, Barcelona, Spain.
| | - Agustí Toll
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunye, Universitat de Barcelona, Barcelona, Spain
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunye, Universitat de Barcelona, Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunye, Universitat de Barcelona, Barcelona, Spain
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32
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Rocco B, Sighinolfi MC, Cimadamore A, Reggiani Bonetti L, Bertoni L, Puliatti S, Eissa A, Spandri V, Azzoni P, Dinneen E, Shaw G, Nathan S, Micali S, Bianchi G, Maiorana A, Pellacani G, Montironi R. Digital frozen section of the prostate surface during radical prostatectomy: a novel approach to evaluate surgical margins. BJU Int 2021; 126:336-338. [PMID: 32401370 DOI: 10.1111/bju.15108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Alessia Cimadamore
- Department of Pathology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Reggiani Bonetti
- Department of Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, Ancona, Italy
| | - Laura Bertoni
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Valentina Spandri
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Azzoni
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Eoin Dinneen
- Department of Urology, University College Hospital London, London, UK.,Division of Surgery and Interventional Science, University College London Medical School, London, UK
| | - Gregg Shaw
- Department of Urology, University College Hospital London, London, UK.,Division of Surgery and Interventional Science, University College London Medical School, London, UK
| | - Senthil Nathan
- Department of Urology, University College Hospital London, London, UK
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonino Maiorana
- Department of Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Rodolfo Montironi
- Department of Pathology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
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Morozov A, Barret E, Veneziano D, Grigoryan V, Salomon G, Fokin I, Taratkin M, Poddubskaya E, Gomez Rivas J, Puliatti S, Okhunov Z, Cacciamani GE, Checcucci E, Marenco Jiménez JL, Enikeev D. A systematic review of nerve-sparing surgery for high-risk prostate cancer. Minerva Urol Nephrol 2021; 73:283-291. [PMID: 33439578 DOI: 10.23736/s2724-6051.20.04178-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION We provide a systematic analysis of nerve-sparing surgery (NSS) to assess and summarize the risks and benefits of NSS in high-risk prostate cancer (PCa). EVIDENCE ACQUISITION We have undertaken a systematic search of original articles using 3 databases: Medline/PubMed, Scopus, and Web of Science. Original articles in English containing outcomes of nerve-sparing radical prostatectomy (RP) for high-risk PCa were included. The primary outcomes were oncological results: the rate of positive surgical margins and biochemical relapse. The secondary outcomes were functional results: erectile function (EF) and urinary continence. EVIDENCE SYNTHESIS The rate of positive surgical margins differed considerably, from zero to 47%. The majority of authors found no correlation between NSS and a positive surgical margin rate. The rate of biochemical relapse ranged from 9.3% to 61%. Most of the articles lacked data on odds ratio (OR) for positive margin and biochemical relapse. The presented results showed no effect of nerve sparing (NS) on positive margin (OR=0.81, 0.6-1.09) or biochemical relapse (hazard ratio [HR]=0.93, 0.52-1.64). A strong association between NSS and potency rate was observed. Without NSS, between 0% and 42% of patients were potent, with unilateral 79-80%, with bilateral - up to 90-100%. Urinary continence was not strongly associated with NSS and was relatively good in both patients with and without NSS. CONCLUSIONS NSS may provide benefits for patients with urinary continence and significantly improves EF in high-risk patients. Moreover, it is not associated with an increased risk of relapse in short- and middle-term follow-up. However, the advantages of using such a surgical technique are unclear.
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Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Eric Barret
- Department of Urology, Institute Mutualiste Montsouris, Paris, France
| | - Domenico Veneziano
- Department of Urology and Kidney Transplant, G.O.M. Reggio Calabria, Reggio Calabria, Italy.,Hofstra University, New York, NY, USA
| | - Vagarshak Grigoryan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Georg Salomon
- Martini Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Igor Fokin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia - .,European Association of Urology (EAU), Arnhem, the Netherlands
| | | | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | - Giovanni E Cacciamani
- Keck School of Medicine, Department of Urology, Catherine & Joseph Aresty Foundation, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Enrico Checcucci
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Section of Urotechnology, European Association of Urology (EAU), Arnhem, the Netherlands
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Urinary proteomic profiles of prostate cancer with different risk of progression and correlation with histopathological features. Ann Diagn Pathol 2021; 51:151704. [PMID: 33460996 DOI: 10.1016/j.anndiagpath.2021.151704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/28/2020] [Accepted: 12/30/2020] [Indexed: 11/22/2022]
Abstract
Prostate cancer (PCa) is the most common tumor in men with extremely variable outcome, varying from latent or indolent form to very aggressive behavior. High grade tumors, expansions exceeding the prostatic capsule into the surrounding soft tissues and spreading through lymph vascular channels, represent the most consistent unfavorable prognostic factors. However, accuracy in the prediction of the disease progression is sometimes difficult. Along with new molecular diagnostic techniques and more accurate histopathological approaches, proteomic studies challenge to identify potential biomarkers predictive of PCa progression. In our study we analyzed the urinary proteomes of 42 patients affected by PCa through two-dimensional electrophoresis associated with mass spectrometry. Proteomic profiles were correlated to histopathological features including pTNM stage and tumor differentiation in order to provide new promising markers able to define more accurately the PCa aggressiveness and driving new therapeutic approaches.
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35
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Rocco B, Sighinolfi MC, Sandri M, Spandri V, Cimadamore A, Volavsek M, Mazzucchelli R, Lopez-Beltran A, Eissa A, Bertoni L, Azzoni P, Reggiani Bonetti L, Maiorana A, Puliatti S, Micali S, Paterlini M, Iseppi A, Rocco F, Pellacani G, Chester J, Bianchi G, Montironi R. Digital Biopsy with Fluorescence Confocal Microscope for Effective Real-time Diagnosis of Prostate Cancer: A Prospective, Comparative Study. Eur Urol Oncol 2020; 4:784-791. [PMID: 32952095 DOI: 10.1016/j.euo.2020.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A microscopic analysis of tissue is the gold standard for cancer detection. Hematoxylin-eosin (HE) for the reporting of prostate biopsy (PB) is conventionally based on fixation, processing, acquisition of glass slides, and analysis with an analog microscope by a local pathologist. Digitalization and real-time remote access to images could enhance the reporting process, and form the basis of artificial intelligence and machine learning. Fluorescence confocal microscopy (FCM), a novel optical technology, enables immediate digital image acquisition in an almost HE-like resolution without requiring conventional processing. OBJECTIVE The aim of this study is to assess the diagnostic ability of FCM for prostate cancer (PCa) identification and grading from PB. DESIGN, SETTING, AND PARTICIPANTS This is a prospective, comparative study evaluating FCM and HE for prostate tissue interpretation. PBs were performed (March to June 2019) at a single coordinating unit on consecutive patients with clinical and laboratory indications for assessment. FCM digital images (n = 427) were acquired immediately from PBs (from 54 patients) and stored; corresponding glass slides (n = 427) undergoing the conventional HE processing were digitalized and stored as well. A panel of four international pathologists with diverse background participated in the study and was asked to evaluate all images. The pathologists had no FCM expertise and were blinded to clinical data, HE interpretation, and each other's evaluation. All images, FCM and corresponding HE, were assessed for the presence or absence of cancer tissue and cancer grading, when appropriate. Reporting was gathered via a dedicated web platform. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint is to evaluate the ability of FCM to identify cancer tissue in PB cores (per-slice analysis). FCM outcomes are interpreted by agreement level with HE (K value). Additionally, either FCM or HE outcomes are assessed with interobserver agreement for cancer detection (presence vs absence of cancer) and for the discrimination between International Society of Urologic Pathologists (ISUP) grade = 1 and ISUP grade > 1 (secondary endpoint). RESULTS AND LIMITATIONS Overall, 854 images were evaluated from each pathologist. PCa detection of FCM was almost perfectly aligned with HE final reports (95.1% of correct diagnosis with FCM, κ = 0.84). Inter-rater agreement between pathologists was almost perfect for both HE and FCM for PCa detection (0.98 for HE, κ = 0.95; 0.95 for FCM, κ = 0.86); for cancer grade attribution, only a moderate agreement was reached for both HE and FCM (HE, κ = 0.47; FCM, κ = 0.49). CONCLUSIONS FCM provides a microscopic, immediate, and seemingly reliable diagnosis for PCa. The real-time acquisition of digital images-without requiring conventional processing-offers opportunities for immediate sharing and reporting. FCM is a promising tool for improvements in cancer diagnostic pathways. PATIENT SUMMARY Fluorescence confocal microscopy may provide an immediate, microscopic, and apparently reliable diagnosis of prostate cancer on prostate biopsy, overcoming the standard turnaround time of conventional processing and interpretation.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.
| | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Valentina Spandri
- School of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Cimadamore
- Department of Pathology, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Metka Volavsek
- Department of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Roberta Mazzucchelli
- Department of Pathology, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | | | - Ahmed Eissa
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy; Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Laura Bertoni
- Department of Human Anatomy, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Azzoni
- Department of Human Anatomy, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonino Maiorana
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Paterlini
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Iseppi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giovanni Pellacani
- Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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Marenco J, Calatrava A, Casanova J, Claps F, Mascaros J, Wong A, Barrios M, Martin I, Rubio J. Evaluation of Fluorescent Confocal Microscopy for Intraoperative Analysis of Prostate Biopsy Cores. Eur Urol Focus 2020; 7:1254-1259. [PMID: 32912840 DOI: 10.1016/j.euf.2020.08.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Diagnosis of prostate cancer is based on histopathological evaluation, which is time-consuming. Fluorescent confocal microscopy (FCM) is a novel technique that allows rapid tissue analysis. OBJECTIVE To determine if FCM could be used for real-time diagnosis of prostate cancer and evaluate concordance with traditional analysis. DESIGN, SETTING, AND PARTICIPANTS From January 2019 to March 2020, 182 magnetic resonance imaging-targeted prostate biopsy cores from 57 consecutive biopsy-naïve men with suspected prostate cancer were taken. These were intraoperatively stained with acridine orange for analysis using FCM (VivaScope; MAVIG, Munich, Germany) and subsequently sent for traditional haematoxylin-eosin histopathological (HEH) examination. Two expert uropathologists analysed the FCM and HEH cores blinded to the counterpart results in a single institution. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Agreement between FCM and HEH analysis in terms of the presence of cancer was analysed at biopsy core and region of interest (ROI) levels, considering HEH as the reference test. RESULTS AND LIMITATIONS FCM allowed intraoperative assessment of prostate biopsy cores with strong histopathological evaluation agreement: Cohen's κ for agreement was 0.81 at the biopsy core level and 0.69 for the ROI level. Positive predictive values (85% and 83.78%) and negative predictive values (95.1% and 85.71%) were high at the biopsy core and ROI levels. These initial results are encouraging, but given the single-centre and preliminary nature of the study, further confirmation is required. CONCLUSIONS FCM allowed rapid evaluation of prostate biopsy cores. This technique is feasible and achieves rapid closure with a reliable diagnosis, parallel to the gold standard analysis. Initial results are promising but further studies are needed to validate and define the role of this technique. PATIENT SUMMARY A novel microscopic technique reduces the time needed to obtain a prostate cancer diagnosis by speeding up biopsy processing. Although the initial results are promising; this development needs to be confirmed in further studies.
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Affiliation(s)
- Jose Marenco
- Urology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
| | - Ana Calatrava
- Pathology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Juan Casanova
- Urology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Francesco Claps
- Urology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Juan Mascaros
- Urology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Augusto Wong
- Urology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Maria Barrios
- Radiology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Isabel Martin
- Radiology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Jose Rubio
- Urology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
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Villarreal JZ, Pérez-Anker J, Puig S, Pellacani G, Solé M, Malvehy J, Quintana LF, García-Herrera A. Ex vivo confocal microscopy performs real-time assessment of renal biopsy in non-neoplastic diseases. J Nephrol 2020; 34:689-697. [PMID: 32876939 DOI: 10.1007/s40620-020-00844-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ex vivo confocal microscopy is a technique for tissue examination, which generates images of fresh samples with an optical resolution comparable to those obtained by conventional pathology. The objective of this study was to evaluate the feasibility of using ex vivo confocal microscopy in fusion mode (reflectance and fluorescence) and the H&E-like digital staining that is obtained for the analysis of non-neoplastic kidney biopsies. METHODS Twenty-four renal samples acquired from autopsies were scanned in a 4th generation ex vivo confocal microscopy device. The imaging process was completed in an average of three minutes. RESULTS Confocal images correlated very well to the corresponding conventional histological sections, both in normal tissue and in chronic lesions (glomerulosclerosis, fibrosis and tubular atrophy). The ex vivo confocal microscopy protocol did not add artifacts to the sample for the ulterior study with light microscopy, nor to the histochemical or immunohistochemical studies. CONCLUSION The ease and speed of grayscale and fluorescence image acquisition, together with the quality of the H&E-like digitally stained images obtained with this approach, suggest that this technique shows promise for use in clinical nephrology and renal transplantation.
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Affiliation(s)
- Jesús Z Villarreal
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - J Pérez-Anker
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - S Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M Solé
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
| | - J Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. .,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain.
| | - A García-Herrera
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
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38
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Shavlokhova V, Flechtenmacher C, Sandhu S, Pilz M, Vollmer M, Hoffmann J, Engel M, Freudlsperger C. Detection of oral squamous cell carcinoma with ex vivo fluorescence confocal microscopy: Sensitivity and specificity compared to histopathology. JOURNAL OF BIOPHOTONICS 2020; 13:e202000100. [PMID: 32418329 DOI: 10.1002/jbio.202000100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
Real-time microscopic imaging of freshly excised tissue enables a rapid bedside-pathology. A possible application of interest is the detection of oral squamous cell carcinomas (OSCCs). The aim of this study was to analyze the sensitivity and specificity of ex vivo fluorescence confocal microscopy (FCM) for OSCCs and to compare confocal images visually and qualitatively with gold standard histopathology. Two hundred eighty ex vivo FCM images were prospectively collected and evaluated immediately after excision. Every confocal image was blindly assessed for the presence or absence of malignancy by two clinicians and one pathologist. The results were compared with conventional histopathology with hematoxylin and eosin staining. OSCCs were detected with a very high sensitivity of 0.991, specificity of 0.9527, positive predictive value of 0.9322 and negative predictive value of 0.9938. The results demonstrate the potential of ex vivo FCM in fresh tissue for rapid real-time surgical pathology.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Sameena Sandhu
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Pilz
- Department of Medical Biometry at the Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
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39
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Kumar A, Patel VR, Panaiyadiyan S, Seetharam Bhat KR, Moschovas MC, Nayak B. Nerve-sparing robot-assisted radical prostatectomy: Current perspectives. Asian J Urol 2020; 8:2-13. [PMID: 33569267 PMCID: PMC7859364 DOI: 10.1016/j.ajur.2020.05.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/16/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022] Open
Abstract
Robotic-assisted radical prostatectomy (RARP) is the current standard of care with long term cure in organ-confined disease. The introduction of nerve-sparing (NS) to standard RARP has shown positive results in terms of functional outcomes in addition to the oncological outcomes. This article reviews the current perspectives of NS-RARP in terms of applied anatomy of the prostatic fascial planes, the neurovascular bundle (NVB), various NS techniques and postoperative functional outcomes. A non-systematic review was done using PubMed, Embase and Medline databases to retrieve and analyse articles in English, with following keywords "prostate cancer", "robotic radical prostatectomy", "nerve-sparing". The Delphi method was used with an expert panel of robotic surgeons in urology to analyse the potency outcomes of various published comparative and non-comparative studies. The literature has shown that NS-RARP involves various techniques and approaches while there is a lack of randomized studies to suggest the superiority of one over the other. Variables such as preoperative risk assessments, baseline potency, surgical anatomy of individual patients and surgeons' expertise play a major role in the outcomes. A tailored approach for each patient is required for applying the NS approach during RARP.
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Affiliation(s)
- Anup Kumar
- Department of Urology,Robotics and Renal Transplant, Vardhman Mahaveer Medical College and Safdarjang Hospital, New Delhi, India
| | - Vipul R Patel
- Department of Robotic Surgery, AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Sridhar Panaiyadiyan
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Marcio Covas Moschovas
- Department of Robotic Surgery, AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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40
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Malvehy J, Pérez-Anker J, Toll A, Pigem R, Garcia A, Alos LL, Puig S. Ex vivo confocal microscopy: revolution in fast pathology in dermatology. Br J Dermatol 2020; 183:1011-1025. [PMID: 32134506 DOI: 10.1111/bjd.19017] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
Abstract
Confocal microscopy with in vivo and ex vivo modalities has been used in the evaluation of skin cancer and other dermatological disorders. Recent developments in ex vivo confocal microscopy allow for faster pathology assessment with greater accuracy by the visualization of cellular and architectural details, similarly to standard pathology, in either paraffin-embedded or frozen samples. They include the possibility of multimodal confocal microscopy using different lasers and fusion images. New staining protocols including immunostaining, with no damage to conventional histopathology preparation, have been recently described in melanocytic tumours and inflammatory skin diseases. Digital staining with haematoxylin and eosin is also incorporated in the new devices. In this review the applications of ex vivo confocal microscopy will be presented with the description of the technique and the technology, clinical evidence in dermatology and other fields, and further applications.
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Affiliation(s)
- J Malvehy
- Dermatology Department, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - J Pérez-Anker
- Dermatology Department, University of Barcelona, Barcelona, Spain
| | - A Toll
- Dermatology Department, University of Barcelona, Barcelona, Spain
| | - R Pigem
- Dermatology Department, University of Barcelona, Barcelona, Spain
| | - A Garcia
- Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - L L Alos
- Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - S Puig
- Dermatology Department, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
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41
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Cahill LC, Wu Y, Yoshitake T, Ponchiardi C, Giacomelli MG, Wagner AA, Rosen S, Fujimoto JG. Nonlinear microscopy for detection of prostate cancer: analysis of sensitivity and specificity in radical prostatectomies. Mod Pathol 2020; 33:916-923. [PMID: 31745288 PMCID: PMC7195230 DOI: 10.1038/s41379-019-0408-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 01/26/2023]
Abstract
Intraoperative evaluation of specimens during radical prostatectomy using frozen sections can be time and labor intensive. Nonlinear microscopy (NLM) is a fluorescence microscopy technique that can rapidly generate images that closely resemble H&E histology in freshly excised tissue, without requiring freezing or microtome sectioning. Specimens are stained with nuclear and cytoplasmic/stromal fluorophores, and NLM evaluation can begin within 3 min of grossing. Fluorescence signals can be displayed using an H&E color scale, facilitating pathologist interpretation. This study evaluates the accuracy of prostate cancer detection in a blinded reading of NLM images compared with the gold standard of formalin-fixed, paraffin-embedded H&E histology. A total of 122 freshly excised prostate specimens were obtained from 40 patients undergoing radical prostatectomy. The prostates were grossed, dissected into specimens of ~10 × 10 mm with 1-4 mm thickness, stained for 2 min for nuclear and cytoplasmic/stromal contrast, and then rinsed with saline for 30 s. NLM images were acquired and multiple images were stitched together to generate large field of view, centimeter-scale digital images suitable for reading. Specimens were then processed for standard paraffin H&E. The study protocol consisted of training, pretesting, and blinded reading phases. After a washout period, pathologists read corresponding paraffin H&E slides. Three pathologists achieved a 95% or greater sensitivity with 100% specificity for detecting cancer on NLM compared with paraffin H&E. Pooled sensitivity and specificity was 97.3% (93.7-99.1%; 95% confidence interval) and 100.0% (97.0-100.0%), respectively. Interobserver agreement for NLM reading had a Fleiss κ = 0.95. The high cancer detection accuracy and rapid specimen preparation suggest that NLM may be useful for intraoperative evaluation in radical prostatectomy.
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Affiliation(s)
- Lucas C. Cahill
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Cambridge, MA, USA,Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yubo Wu
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tadayuki Yoshitake
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Cecilia Ponchiardi
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael G. Giacomelli
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Andrew A. Wagner
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James G. Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
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42
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Dahroug B, Tamadazte B, Andreff N. PCA-Based Visual Servoing Using Optical Coherence Tomography. IEEE Robot Autom Lett 2020. [DOI: 10.1109/lra.2020.2977259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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43
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Krishnamurthy S, Sabir S, Ban K, Wu Y, Sheth R, Tam A, Meric-Bernstam F, Shaw K, Mills G, Bassett R, Hamilton S, Hicks M, Gupta S. Comparison of Real-Time Fluorescence Confocal Digital Microscopy With Hematoxylin-Eosin-Stained Sections of Core-Needle Biopsy Specimens. JAMA Netw Open 2020; 3:e200476. [PMID: 32134465 PMCID: PMC7059022 DOI: 10.1001/jamanetworkopen.2020.0476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Strategies to procure high-quality core-needle biopsy (CNB) specimens are critical for making basic tissue diagnoses and for ancillary testing. OBJECTIVES To investigate acquisition of fluorescence confocal microscopy (FCM) images of interventional radiology (IR)-guided CNB in real time in the radiology suite and to compare the accuracy of FCM diagnoses with those of hematoxylin-eosin (H&E)-stained CNB sections. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic study, FCM imaging of IR-guided CNBs was performed in the radiology suite at a major cancer center for patients with an imaging abnormality from August 1, 2016, to April 30, 2019. The time taken to acquire FCM images and the quality of FCM images based on percentage of interpretable tissue with optimal resolution was recorded. The FCM images were read by 2 pathologists and categorized as nondiagnostic, benign/atypical, or suspicious/malignant; these diagnoses were compared with those made using H&E-stained tissue sections. Cases with discrepant diagnosis were reassessed by the pathologists together for a consensus diagnosis. Data were analyzed from June 3 to July 19, 2019. INTERVENTIONS Each IR-guided CNB was stained with 0.6mM acridine orange, subjected to FCM imaging, and then processed to generate H&E-stained sections. MAIN OUTCOMES AND MEASURES Mean time taken for acquisition of FCM images, quality of FCM images based on interpretable percentage of the image, and accuracy of diagnostic categorization based on FCM images compared with H&E-stained sections. RESULTS A total of 105 patients (57 male [54.3%]; mean [SD] age, 63 [13] years) underwent IR-guided CNBs in a mean (SD) of 7 (2) minutes each. The FCM images showed at least 20% of the tissue with optimal quality in 101 CNB specimens (96.2%). The FCM images were accurately interpreted by the 2 pathologists in 100 of 105 cases (95.2%) (2 false-positive and 3 false-negative) and 90 of 105 cases (85.7%) (6 false-positive and 9 false-negative). A reassessment of 14 discordant diagnoses resulted in consensus diagnoses that were accurate in 101 of 105 cases (96.2%) (1 false-positive and 3 false-negative). CONCLUSIONS AND RELEVANCE The ease of acquisition of FCM images of acceptable quality and the high accuracy of the diagnoses suggest that FCM may be useful for rapid evaluation of IR-guided CNBs. This approach warrants further investigation.
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Affiliation(s)
- Savitri Krishnamurthy
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Sharjeel Sabir
- Department of Radiology, Scripps Mercy Hospital, San Diego, California
| | - Kechen Ban
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Yun Wu
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Rahul Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Alda Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston
| | - Kenna Shaw
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston
| | - Gordon Mills
- Oregon Health and Science University Knight Cancer Institute, Portland
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Stanley Hamilton
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Marshall Hicks
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston
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44
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Sighinolfi MC, Eissa A, Spandri V, Puliatti S, Micali S, Reggiani Bonetti L, Bertoni L, Bianchi G, Rocco B. Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles. BJU Int 2020; 125:656-663. [PMID: 32012426 DOI: 10.1111/bju.15024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of the paper is to provide an overview of intraoperative sampling methods for frozen section (FS) analysis and of surgical techniques for a secondary neurovascular bundle (NVB) resection, as the method of surgical margin (SM) sampling and the management of a positive SM (PSM) at the nerve-sparing (NS) area are under evaluated issues. FS analysis during radical prostatectomy (RP) can help to tailor the plane of dissection based on cancer extension and thus extend the indications for NS surgery. EVIDENCE ACQUISITION We performed a PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Cochrane Library, and Elton B. Stephens Co. (EBSCO)host search to include articles published in the last decade, evaluating FS analysis in the NS area and surgical attempts to convert a PSM to a negative status. EVIDENCE SYNTHESIS Overall, 19 papers met our inclusion criteria. The ways to collect samples for FS analysis included: systematic (analysing the whole posterolateral aspect of the prostate specimen, i.e., neurovascular structure-adjacent frozen-section examination [NeuroSAFE]); magnetic resonance imaging (MRI)-guided (biopsies from MRI-suspicious areas, retrieved by the surgeon in a cognitive way); and random biopsies from the soft periprostatic tissues. Techniques to address a PSM in the NS area included: full resection of the spared NVB, from its caudal to cranial aspect, often including the rectolateral part of the Denonvilliers' fascia; partial resection of the NVB, in cases where sampling attempts to localise a PSM; incremental approach, meaning a partial or full resection that extends until no prostate tissue is found in the soft periprostatic environment. CONCLUSIONS There 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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Affiliation(s)
| | - Ahmed Eissa
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Valentina Spandri
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | | | - Laura Bertoni
- Pathology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
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45
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Rocco B, Sighinolfi MC, Bertoni L, Spandri V, Puliatti S, Eissa A, Reggiani Bonetti L, Azzoni P, Sandri M, De Carne C, Turri F, Cimadamore A, Montironi R, Maiorana A, Micali S, Bianchi G, Pellacani G. 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. BJU Int 2020; 125:487-489. [PMID: 31971342 DOI: 10.1111/bju.15000] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria C Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bertoni
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Spandri
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Paola Azzoni
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Cosimo De Carne
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Turri
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Antonino Maiorana
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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46
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Bertoni L, Puliatti S, Reggiani Bonetti L, Maiorana A, Eissa A, Azzoni P, Bevilacqua L, Spandri V, Kaleci S, Zoeir A, Sighinolfi MC, Micali S, Bianchi G, Pellacani G, Rocco B, Montironi R. Ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve. Virchows Arch 2020; 476:511-520. [PMID: 31907606 DOI: 10.1007/s00428-019-02738-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- Laura Bertoni
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy. .,Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
| | - Luca Reggiani Bonetti
- Department of Pathology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonino Maiorana
- Department of Pathology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Paola Azzoni
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Bevilacqua
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Spandri
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Zoeir
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Rodolfo Montironi
- Department of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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47
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Sighinolfi MC, Rocco B. Re: EAU Guidelines: Prostate Cancer 2019. Eur Urol 2019; 76:871. [PMID: 31350067 DOI: 10.1016/j.eururo.2019.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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48
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Eissa A, Zoeir A, Sighinolfi MC, Puliatti S, Bevilacqua L, Del Prete C, Bertoni L, Azzoni P, Reggiani Bonetti L, Micali S, Bianchi G, Rocco B. "Real-time" Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art. Clin Genitourin Cancer 2019; 18:95-104. [PMID: 31784282 DOI: 10.1016/j.clgc.2019.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 01/18/2023]
Abstract
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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Affiliation(s)
- Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Zoeir
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Bevilacqua
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Del Prete
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bertoni
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Azzoni
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
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