Intraoperative margin assessment using fluorescence confocal microscopy during robot-assisted radical prostatectomy:...

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Accurate intraoperative assessment of positive surgical margins (PSMs) is crucial during robot-assisted radical prostatectomy (RARP) to optimize oncological outcomes.
• Current methods for margin assessment can be time-consuming, potentially delaying surgical decisions.
• Fluorescence confocal microscopy (FCM) offers a potential solution for rapid, real-time margin evaluation.

Purpose of the Study:

• To evaluate the feasibility of adopting fluorescence confocal microscopy (FCM) for intraoperative assessment of PSMs in a real-world RARP setting.
• To determine the diagnostic performance of FCM compared to final histopathology for identifying PSMs.

Main Methods:

• A prospective observational study included 101 patients undergoing RARP with intraoperative ex vivo FCM scanning of prostate specimens.
• Digital FCM images were reviewed in real-time by a pathologist blinded to final pathology results.
• Diagnostic metrics (sensitivity, specificity, PPV, NPV, accuracy) were calculated for any PSM and clinically significant PSMs (≥3 mm).

Main Results:

• FCM demonstrated high diagnostic accuracy for any PSM (91.1%) and clinically significant PSMs (92.1%).
• Sensitivity and specificity were robust for both any PSM (88.2% and 91.7%) and significant PSMs (93.8% and 91.8%).
• The median time from prostate extraction to intraoperative report was 13 minutes, compatible with surgical workflows.

Conclusions:

• Intraoperative margin assessment using FCM is feasible in RARP, offering good diagnostic accuracy and rapid turnaround times.
• Diagnostic performance is enhanced when focusing on clinically significant PSMs (≥3 mm).
• Further multicenter and randomized trials are needed to confirm the impact of FCM on oncological and functional outcomes.