Evaluation of margins during radical prostatectomy: confocal microscopy vs frozen section analysis.

Autor: Musi G; Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., Mistretta FA; Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., Ivanova M; Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., de Cobelli O; Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., Bellin A; Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., Vago GG; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., Pravettoni G; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), IRCCS, Milan, Italy.; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., Pala O; Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., Lepanto D; Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., Bottero D; Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., Piccinelli ML; Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., Tallini M; Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., Marvaso G; Department of Radiation Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., Ferro M; Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., Petralia G; Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, European Institute of Oncology (IEO), IRCCS, Milan, Italy.; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., Jereczek-Fossa BA; Department of Radiation Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., Fusco N; Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., Renne G; Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., Luzzago S; Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2024 Nov; Vol. 134 (5), pp. 773-780. Date of Electronic Publication: 2024 Jun 18.
DOI: 10.1111/bju.16441
Abstrakt: Objectives: To test the performance of ex vivo fluorescence confocal microscopy (FCM; Vivascope 2500M-G4), as compared to intra-operative frozen section (IFS) analysis, to evaluate surgical margins during robot-assisted radical prostatectomy (RARP), with final pathology as the reference standard.
Methods: Overall, 54 margins in 45 patients treated with RARP were analysed with: (1) ex vivo FCM; (2) IFS analysis; and (3) final pathology. FCM margins were evaluated by two different pathologists (experienced [M.I.: 10 years] vs highly experienced [G.R.: >30 years]) as strongly negative, probably negative, doubtful, probably positive, or strongly positive. First, inter-observer agreement (Cohen's κ) between pathologists was tested. Second, we reported the sensitivity, specificity, positive predictive (PPV) and negative predictive value (NPV) of ex vivo FCM. Finally, agreement between ex vivo FCM and IFS analysis (Cohen's κ) was reported. For all analyses, four combinations of FCM results were evaluated.
Results: At ex vivo FCM, the inter-observer agreement between pathologists ranged from moderate (κ = 0.74) to almost perfect (κ = 0.90), according to the four categories of results. Indeed, at ex vivo FCM, the highly experienced pathologist reached the best balance between sensitivity (70.5%) specificity (91.8%), PPV (80.0%) and NPV (87.1%). Conversely, on IFS analysis, the sensitivity, specificity, PPV and NPV were, respectively, 88.2% vs 100% vs 100% vs 94.8%. The agreement between the ex vivo FCM and IFS analyses ranged from moderate (κ = 0.62) to strong (κ = 0.86), according to the four categories of results.
Conclusion: Evaluation of prostate margins at ex vivo FCM appears to be feasible and reliable. The agreement between readers encourages its widespread use in daily practice. Nevertheless, as of today, the performance of FCM seems to be sub-par when compared to the established standard of care (IFS analysis).
(© 2024 BJU International.)
Databáze: MEDLINE
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