Confocal microscopy for immediate analysis of prostate biopsies

Area of Science:

• Uropathology
• Medical Imaging
• Oncology

Background:

• Prostate cancer (PC) diagnosis relies on time-consuming hematoxylin-eosin (HE) staining.
• Fluorescent confocal microscopy (FCM) enables simultaneous tissue analysis and sample collection.
• Evaluating FCM's concordance with HE and the impact of a second pathologist is crucial.

Purpose of the Study:

• To assess the agreement between HE staining and FCM for prostate biopsy analysis.
• To determine the added value of a second pathologist in FCM-based diagnosis.
• To evaluate the concordance of International Society of Uropathology (ISUP) grading between methods.

Main Methods:

• Intraoperative analysis of 297 prostate biopsy cores using FCM (VivaScope).
• Subsequent conventional HE examination of the same cores.
• Diagnosis by two pathologists using FCM, with evaluation of ISUP grade agreement and ROI-level concordance with HE.

Main Results:

• FCM demonstrated strong agreement with histopathological evaluation for intraoperative assessment.
• Cohen's Kappa for PC detection ranged from 0.79 to 0.85, indicating substantial to almost perfect agreement.
• High positive (up to 100%) and negative (up to 95.5%) predictive values were observed, especially with combined pathologist input.

Conclusions:

• FCM provides rapid and accurate evaluation of prostate biopsies.
• There is a good correlation between FCM and HE analysis, enhanced by pathologist collaboration.
• FCM shows significant potential for improving the efficiency and accuracy of prostate cancer diagnosis.