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Ex vivo fluorescence confocal microscopy: the first application for real-time pathological examination of prostatic tissue

By 19 Settembre 2019Febbraio 3rd, 2022No Comments

Stefano Puliatti, Laura Bertoni, Giacomo M Pirola, Paola Azzoni, Luigi Bevilacqua, Ahmed Eissa, Ahmed Elsherbiny, Maria C Sighinolfi, Johanna Chester, Shaniko Kaleci, Bernardo Rocco, Salvatore Micali, Ilaria Bagni, Luca Reggiani Bonetti, Antonino Maiorana, Josep Malvehy, Caterina Longo, Rodolfo Montironi, Giampaolo Bianchi, Giovanni Pellacani

Abstract

Objective: To report the first application of ex vivo fluorescence confocal microscopy (FCM) – a novel optical technology that is capable of providing fast microscopic imaging of unfixed tissue specimens- in the urological field assessing its diagnostic accuracy for non neoplastic and cancerous prostate tissue (prostatic adenocarcinoma) compared to the ‘gold standard’ histopathological diagnoses.

Patients and methods: In all, 89 specimens from 13 patients with clinically localised prostate cancer were enrolled into the study. All patients underwent robot-assisted laparoscopic radical prostatectomy with fresh prostatic tissue biopsies taken at the end of each intervention using an 18-G biopsy punch. Specimens were randomly assigned to the three collaborating pathologists for evaluation. Intra- and inter-observer agreement was tested by the means of Cohen’s κ. The diagnostic performance was evaluated on receiver operating characteristic curve analysis.

Results: The overall diagnostic agreement between FCM and histopathological diagnoses was substantial with a 91% correct diagnosis (κ = 0.75) and an area under the curve of 0.884 (95% confidence interval 0.840-0.920), 83.33% sensitivity, and 93.53% specificity.

Conclusion: FCM seems to be a promising tool for enhanced specimens’ reporting performance, given its simple application and very rapid microscopic image generation (<5 min/specimen). This technique may potentially be used for intraoperative pathological specimens’ analysis.

Keywords: RALP; #PCSM; #Prostate cancer; digital pathology; fluorescence confocal microscopy.

© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd.

Stefano Puliatti

Stefano Puliatti

Il Dr. Puliatti si è laureato in Medicina e chirurgia nel 2012 presso l’Università degli Studi di Modena ed ha poi conseguito il titolo di specialista in Urologia con il massimo dei voti presso lo stesso Ateneo. Da Luglio 2019 ricopre il ruolo di Assistant Professor in Urologia presso l'Università di Modena e Reggio Emilia. Da Luglio 2019 ricopre anche il ruolo di Deputy Medical Director of ORSI Academy, Melle, Belgio e svolge attività clinica e chirurgica presso OLV (Onze Lieve Vrouwziekenhuis) Hospital in Aalst, Belgio (direttore: Prof. Alex Mottrie). La sua formazione si è incentrata in particolare sulla Chirurgia robotica e oncologica delle vie urinarie, avendo come principali campi di applicazione anche tumori e malattie della prostata, tumori del rene e delle alte vie urinarie, disturbi minzionali, calcolosi delle vie urinarie. È inoltre autore e coautore di articoli scientifici e capitoli di libro in ambito urologico. Attualmente svolge attività in libera professione presso diverse strutture situate a Modena e Provincia.