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Margin evaluation with fluorescence confocal microscopy during minimally invasive radical prostatectomy
Josep M Gaya1,2,3, Paolo Verri1, Andrea Gallioli1,2
1Department of Urology, Fundació Puigvert, Barcelona, Spain.
BJU International
|March 31, 2026
Summary
Fluorescence confocal microscopy (FCM) shows feasibility for analyzing surgical margins during radical prostatectomy (RP). This technique offers good diagnostic accuracy, aiding surgeons without altering final pathology results.
Area of Science:
- Urology
- Surgical Pathology
- Medical Imaging
Background:
- Surgical margin status is critical in radical prostatectomy (RP) outcomes.
- Accurate, real-time margin assessment can improve oncological control.
- Minimally invasive RP necessitates reliable intraoperative margin evaluation techniques.
Purpose of the Study:
- To evaluate the diagnostic accuracy and reliability of fluorescence confocal microscopy (FCM) for surgical margin assessment during RP.
- To compare FCM analysis with final anatomical pathology (AP) results.
- To determine the inter-rater agreement among pathologists using FCM.
Main Methods:
- Prospective, non-randomized trial involving 100 patients undergoing RP.
- Intraoperative analysis of posterolateral prostatic margins using VivaScope® 2500M-G4 FCM.
- Comparison of FCM findings with post-operative AP results and calculation of diagnostic metrics (sensitivity, specificity, PPV, NPV).
- Assessment of inter-rater agreement using Cohen's kappa.
Main Results:
- Of 200 margins analyzed, FCM identified 37 positive margins, while AP confirmed 38 positive specimens.
- Per-patient analysis yielded sensitivity of 65.5%, specificity of 80.2%, PPV of 57.5%, and NPV of 85.0%.
- Per-margin analysis showed sensitivity of 60.5%, specificity of 91.3%, PPV of 62.1%, and NPV of 90.7%.
Conclusions:
- Fluorescence confocal microscopy is a feasible technology for intraoperative margin assessment in RP.
- FCM demonstrates good diagnostic accuracy and reliability in identifying positive surgical margins.
- The technology can be integrated into RP procedures without compromising final AP evaluation.
