Intraoperative Digital Analysis of Ablation Margins (DAAM) by Fluorescent Confocal Microscopy to Improve Partial Prostate Gland Cryoablation Outcomes

Selvaggio, Oscar; Falagario, Ugo Giovanni; Bruno, Salvatore; Recchia, Marco; Sighinolfi, Maria Chiara; Sanguedolce, Francesca; Milillo, Paola; Macarini, Luca; Rastinehad, Ardeshir R.; Sánchez-Salas, Rafael; Barret, Éric; Lugnani, Franco; Rocco, Bernardo; Cormio, Luigi; Carrieri, Giuseppe

doi:10.3390/cancers13174382

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…Third, it provides novel perspectives on focal therapies. Patients diagnosed with PCa may potentially be treated in the same session and real-time detection of PCa from suspicious areas could make any prostate-sparing treatment easier and faster [ 29 ]. It offers the unique opportunity to improve the diagnostic pathway of PCa by linking together, with immediate feedbacks, urologists, radiologists, and pathologists.…”

Section: Discussionmentioning

confidence: 99%

One-Day Prostate Cancer Diagnosis: Biparametric Magnetic Resonance Imaging and Digital Pathology by Fluorescence Confocal Microscopy

et al. 2022

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In this prospective observational study, we tested the feasibility and efficacy of a novel one-day PCa diagnosis path based on biparametric magnetic resonance (bpMRI) and digital pathology by fluorescence confocal microscopy (FCM). Patients aged 55–70 years scheduled for PBx due to increased PSA levels (3–10 ng/mL) and/or abnormal digitorectal examination were enrolled. All patients underwent bpMRI and PBx with immediate FCM evaluation of biopsy cores. Patients were asked to fill out a dedicated Patient Satisfaction Questionnaire. Patients’ satisfaction rates and concordance between digital pathology and standard HE evaluation were the outcomes of interest. Twelve patients completed our one-day PCa diagnosis path. BpMRI showed suspicious lesions in 7 patients. Digital pathology by FCM identified PCa in 5 (41.7%) of the 12 patients. Standard pathology confirmed the diagnosis made through digital pathology in all the cases. At a per patient level, high concordance between the methods was achieved in Gleason Grading (4 out of 5 patients). The level of agreement in the number of positive cores was lower but did not affect the choice of treatment in any of the 5 PCa cases. At a per core level, the agreement was very high for the diagnosis of anyPCa (96.2%) and csPCa (97.3%), with a k coefficient of 0.90 and 0.92, respectively (near perfect agreement). In conclusion, one-day PCa diagnosis by FCM represents a feasible, reliable, and fast diagnostic method that provides significant advantages in optimizing time and resources, leading to patients having a higher quality standard of care perception.

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Section: Discussionmentioning

confidence: 99%

One-Day Prostate Cancer Diagnosis: Biparametric Magnetic Resonance Imaging and Digital Pathology by Fluorescence Confocal Microscopy

et al. 2022

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“…10,11 Furthermore, FCM has been recently applied to guide the partial treatment of the prostate, by analyzing ablation margins during cryosurgery and thus aiming to reduce the risk of missing areas of PCa during the procedure. 12 The microscopical magnification and digitalization of a specimen straightly in the OR-as obtained with FCM-allow for remote sharing and reporting and raise opportunities to extend the intra-operative analysis to novel purposes too, such as training.…”

Section: Discussionmentioning

confidence: 99%

Digital real-time microscopy of ex-vivo tissues: A novel strategy to control surgical accuracy

et al. 2022

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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 intraoperative 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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“…They have observed that this model is able to reduce the number of unnecessary biopsies by 35% when compared with current standards of care. Selvaggio et al [14] use a fluorescent confocal microscope to intraoperatively analyze the ablation margins in 10 patients to improve partial prostate gland cryoablation outcomes. They conclude that this technique is feasible and reliable to reduce disease recurrence and functional complications of focal therapy in prostate cancer.…”

Section: Prostate Cancermentioning

confidence: 99%

Urological Cancer Panorama in the Second Year of the COVID-19 Pandemic

López-Fernández

Angulo

López

et al. 2022

Cancers

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Intraoperative Digital Analysis of Ablation Margins (DAAM) by Fluorescent Confocal Microscopy to Improve Partial Prostate Gland Cryoablation Outcomes

Cited by 10 publications

References 25 publications

One-Day Prostate Cancer Diagnosis: Biparametric Magnetic Resonance Imaging and Digital Pathology by Fluorescence Confocal Microscopy

One-Day Prostate Cancer Diagnosis: Biparametric Magnetic Resonance Imaging and Digital Pathology by Fluorescence Confocal Microscopy

Digital real-time microscopy of ex-vivo tissues: A novel strategy to control surgical accuracy

Urological Cancer Panorama in the Second Year of the COVID-19 Pandemic

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