Real Time Urethral and Ureteral Assessment During Radical Cystectomy Using Ex Vivo Optical Imaging

You have accessJournal of UrologyBladder & Urethra: Anatomy, Physiology & Pharmacology (MP08)1 Sep 2021MP08-18 REAL TIME URETHRAL AND URETERAL ASSESSMENT DURING RADICAL CYSTECTOMY USING EX VIVO OPTICAL IMAGING Francesco Esperto, Francesco Prata, Angelo Civitella, Piergiorgio Tuzzolo, Luca Romei, Vito Giuseppe Crimi, Loris Cacciatore, Chiara Taffon, Anna Crescenzi, Roberto Mario Scarpa, and Rocco Papalia Francesco EspertoFrancesco Esperto More articles by this author , Francesco PrataFrancesco Prata More articles by this author , Angelo CivitellaAngelo Civitella More articles by this author , Piergiorgio TuzzoloPiergiorgio Tuzzolo More articles by this author , Luca RomeiLuca Romei More articles by this author , Vito Giuseppe CrimiVito Giuseppe Crimi More articles by this author , Loris CacciatoreLoris Cacciatore More articles by this author , Chiara TaffonChiara Taffon More articles by this author , Anna CrescenziAnna Crescenzi More articles by this author , Roberto Mario ScarpaRoberto Mario Scarpa More articles by this author , and Rocco PapaliaRocco Papalia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001981.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Histopathological examination of urethral and ureteral specimens using hematoxylin and eosin (H&E) is the gold standard for cancer detection. It is time-consuming and does not provide a rapid evaluation of fresh tissue. Fluorescent confocal microscopy (FCM) is an ex vivo technique that has been widely used for ex vivo imaging in research studies, but there is limited evidence on the feasibility of its use in routine surgical practice. Aim of our study was to assess the feasibility and the reproducibility of FCM real-time assessment of urethral and ureteral margins during open radical cystectomy (ORC). METHODS: This is a prospective, comparative study evaluating FCM, frozen sections and H&E for urethral and ureteral tissues interpretation during ORC. From September 2020 to December 2020, 15 urethral and 29 ureteral surgical specimens from 15 consecutive patients who underwent radical cystectomy for bladder cancer (one with solitary kidney) were collected at our institution. Each specimen was intraoperatively stained with acridine orange for histopathological analysis using FCM (VivaScope; MAVIG, Munich, Germany), analysed as frozen section and sent for traditional H&E examination. One expert uro-pathologist analysed all specimens to assess cancer infiltration. Diagnostic accuracy, sensitivity and specificity of FCM and frozen sections were assessed comparing with traditional H&E examination diagnoses for urethral and ureteral margins respectively. RESULTS: FCM (figure 1) and frozen section specimens analysis showed the same sensitivity, specificity and diagnostic accuracy for both ureteral and urethral margins. A 100% sensitivity, specificity and diagnostic accuracy was showed for urethral margins; 87.5% sensitivity, 80.9% specificity and 82.7% diagnostic accuracy for ureteral margins when compared to H&E final examination diagnoses. CONCLUSIONS: FCM resulted to be a safe, feasible and reproducible method for the intraoperative assessment of urethral and ureteral surgical margins during ORC. Unlike frozen sections, FCM can generate optical sections of biologic specimens allowing real-time microscopic evaluation of fresh unfixed tissue, requiring minimal tissue preparation and preserving specimens from any damage, distortion or loss. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e157-e158 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Esperto More articles by this author Francesco Prata More articles by this author Angelo Civitella More articles by this author Piergiorgio Tuzzolo More articles by this author Luca Romei More articles by this author Vito Giuseppe Crimi More articles by this author Loris Cacciatore More articles by this author Chiara Taffon More articles by this author Anna Crescenzi More articles by this author Roberto Mario Scarpa More articles by this author Rocco Papalia More articles by this author Expand All Advertisement Loading ...