Ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve.

Laura Bertoni,Maria Chiara Sighinolfi,Bernardo Rocco,Ahmed Zoeir,Luigi Bevilacqua,Ahmed Eissa,Rodolfo Montironi,Antonino Maiorana,Paola Azzoni,Giovanni Pellacani,Salvatore Micali,Valentina Spandri,Stefano Puliatti,Giampaolo Bianchi,Shaniko Kaleci,Luca Reggiani Bonetti

doi:10.1007/s00428-019-02738-y

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® 2500M-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 90days 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.

Highlights

Material and methodsEx vivo fluorescence confocal microscopy (FCM) is a novel optical technology that allows the examination of freshly excised tissue to provide a quasi-histological view of the tissues in few minutes
The main advantage of the FCM is its ability to provide quasi-histological images that are similar to hematoxylin and eosin (H&E) images, which render the interpretation of images easier for pathologist novice to this technology
Samples from the biopsies were classified as non-neoplastic tissue (NNT), high-grade prostatic intraepithelial neoplasia (HG-PIN), and prostatic acinar adenocarcinoma (PAA)

Summary

Introduction

Ex vivo fluorescence confocal microscopy (FCM) is a novel optical technology that allows the examination of freshly excised tissue to provide a quasi-histological view of the tissues in few minutes. FCM has been used in healthy skin [12] as well as in cutaneous lesions such as melanoma [10, 11], basal cell carcinoma, and squamous cell carcinoma [9, 17]. It was used for diagnosis of cutaneous inflammatory skin lesions [3]. Ragazzi M et al [26] examined the use of FCM on different surgical specimens such as breast, lymph node, thyroid, and colon, demonstrating that neoplastic tissues were distinguishable from normal structures.

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