Confocal laser microscopy for assessment of surgical margins during radical prostatectomy.

Autor: Baas DJH; Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.; Prosper Prostate Cancer Clinics, Nijmegen, Eindhoven, The Netherlands., Vreuls W; Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., Sedelaar JPM; Prosper Prostate Cancer Clinics, Nijmegen, Eindhoven, The Netherlands.; Department of Urology, Radboudumc, Nijmegen, The Netherlands., Vrijhof HJEJ; Prosper Prostate Cancer Clinics, Nijmegen, Eindhoven, The Netherlands.; Department of Urology, Catharina Hospital, Eindhoven, The Netherlands., Hoekstra RJ; Prosper Prostate Cancer Clinics, Nijmegen, Eindhoven, The Netherlands.; Department of Urology, Catharina Hospital, Eindhoven, The Netherlands., Zomer SF; Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., van Leenders GJLH; Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands., van Basten JA; Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.; Prosper Prostate Cancer Clinics, Nijmegen, Eindhoven, The Netherlands., Somford DM; Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.; Prosper Prostate Cancer Clinics, Nijmegen, Eindhoven, The Netherlands.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2023 Jul; Vol. 132 (1), pp. 40-46. Date of Electronic Publication: 2022 Dec 18.
DOI: 10.1111/bju.15938
Abstrakt: Objective: To evaluate the feasibility of confocal laser microscopy (CLM) for intraoperative margin assessment as faster alternative to neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during robot-assisted radical prostatectomy (RARP).
Patients and Methods: Surgical margins were assessed during 50 RARP procedures in patients scheduled for NeuroSAFE. Posterolateral sections were cut and imaged with CLM and further processed to conform with the NeuroSAFE protocol. Secondary resection (SR) was performed in case a positive surgical margin (PSM) was observed with NeuroSAFE. Afterwards, the CLM images were non-blinded assessed for the presence of PSMs. The accuracy of both NeuroSAFE and CLM was compared with conventional histopathology. Agreement for detection of PSMs between NeuroSAFE and CLM was evaluated with Cohen's kappa coefficient. Procedure times were compared with a Wilcoxon signed-ranks test.
Results: In total, 96 posterolateral sections of RP specimens were evaluated for the presence of PSMs. CLM identified 15 (16%) PSMs and NeuroSAFE identified 14 (15%) PSMs. CLM had a calculated sensitivity, specificity, positive predictive value and negative predictive value of 86%, 96%, 80% and 98% respectively for the detection of PSMs compared to definite pathology. After SR, residual tumour was found in six of 13 cases (46%), which were all identified by both techniques. There was a substantial level of agreement between CLM and NeuroSAFE (κ = 0.80). The median procedure time for CLM was significantly shorter compared to NeuroSAFE (8 vs 50 min, P < 0.001). The main limitation of this study was the non-blinded assessment of the CLM images.
Conclusions: Compared to NeuroSAFE, CLM is a promising technique for intraoperative margin assessment and is able to reduce the time of intraoperative margin assessment.
(© 2022 BJU International.)
Databáze: MEDLINE
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