Evaluation of Fluorescent Confocal Microscopy for Intraoperative Analysis of Prostate Biopsy Cores
Evaluation of Fluorescent Confocal Microscopy for Intraoperative Analysis of Prostate Biopsy Cores
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DOI：
10.1016/j.euf.2020.08.013
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发表时间：
2021-12-04
影响因子：
5.4
通讯作者：
Rubio, Jose
中科院分区：
文献类型：
--
作者：
Marenco, Jose;Calatrava, Ana;Rubio, Jose
背景：前列腺癌的诊断建立在组织病理学评估的基础上，这是一项耗时的工作。荧光共聚焦显微镜(FCM)是一种可以进行快速组织分析的新技术。目的：确定FCM是否可以用于前列腺癌的实时诊断，并评估其与传统分析的一致性。设计、设置和对象：从2019年1月到2020年3月，连续57名疑似前列腺癌患者进行了182个磁共振成像靶向前列腺活检。术中用吖啶橙染色，用流式细胞仪(Vivascope；MAVIG，德国慕尼黑)进行分析，然后送去做传统的苏木精-伊红组织病理学(HEH)检查。两位专业的尿路病理学家对同一机构的FCM和HEH芯点进行了盲法分析。结果测量和统计分析：以HEH为参考，在活检芯点和感兴趣区(ROI)水平分析了FCM和HEH分析在癌症存在方面的一致性。结果和局限性：FCM允许术中评估前列腺活检芯点与组织病理学评估高度一致：Cohen的K值在活检核心水平为0.81，ROI水平为0.69。活检中心和ROI水平的阳性预测值(85%和83.78%)和阴性预测值(95.1%和85.71%)较高。这些初步结果令人鼓舞，但考虑到该研究的单中心和初步性质，还需要进一步证实。结论：FCM可以快速评估前列腺活检核心。这项技术是可行的，并实现了快速闭合和可靠的诊断，平行于金标准分析。初步结果是有希望的，但还需要进一步的研究来验证和确定这项技术的作用。患者概述：一种新的显微技术通过加快活检过程减少了获得前列腺癌诊断所需的时间。虽然初步结果是有希望的，但这一进展需要在进一步的研究中得到证实。(C)2020年，爱思唯尔公司代表欧洲泌尿学协会出版。
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-naive 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 K 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. (C) 2020 Published by Elsevier B.V. on behalf of European Association of Urology.