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Ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve

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A Commentary to this article was published on 31 January 2020

Abstract

Ex vivo fluorescence confocal microscopy (FCM) is an optical technology that provides fast H&E-like images of freshly excised tissues, and it has been mainly used for “real-time” pathological examination of dermatological malignancies. It has also shown to be a promising tool for fast pathological examination of prostatic tissues. We aim to create an atlas for FCM images of prostatic and periprostatic tissues to facilitate the interpretation of these images. Furthermore, we aimed to evaluate the learning curve of images interpretation of this new technology. Eighty fresh and unprepared biopsies obtained from radical prostatectomy specimens were evaluated using the FCM VivaScope® 2500 M-G4 (Mavig GmbH, Munich, Germany; Caliber I.D.; Rochester NY, USA) by two pathologists. Images of FCM with the corresponding H&E are illustrated to create the atlas. Furthermore, the two pathologists were asked to re-evaluate the 80 specimens after 90 days interval in order to assess the learning curve of images’ interpretation of FCM. FCM was able to differentiate between different types of prostatic and periprostatic tissues including benign prostatic glands, benign prostatic hyperplasia, high-grade intraepithelial neoplasm, and prostatic adenocarcinoma. As regards the learning curve, FCM demonstrated a short learning curve. We created an atlas that can serve as the base for urologists and pathologists for learning and interpreting FCM images of prostatic and periprostatic tissues. Furthermore, FCM images is easily interpretable; however, further studies are required to explore the potential applications of this new technology in prostate cancer diagnosis and management.

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Author notes

  1. Laura Bertoni and Stefano Puliatti contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy

    Laura Bertoni, Paola Azzoni & Shaniko Kaleci

  2. Department of Urology, University of Modena and Reggio Emilia, Modena, Italy

    Stefano Puliatti, Ahmed Eissa, Luigi Bevilacqua, Valentina Spandri, Ahmed Zoeir, Maria Chiara Sighinolfi, Salvatore Micali, Giampaolo Bianchi & Bernardo Rocco

  3. Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy

    Stefano Puliatti

  4. Department of Pathology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy

    Luca Reggiani Bonetti & Antonino Maiorana

  5. Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Ahmed Eissa & Ahmed Zoeir

  6. Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy

    Giovanni Pellacani

  7. Department of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy

    Rodolfo Montironi

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  1. Laura Bertoni
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Contributions

Bertoni L., Puliatti S., Eissa A., Sighinolfi MC, Bianchi G, Pellacani G, Rocco B, Montironi R: Conception and Design. Bertoni L, Puliatti S, Regianni Bonetti L, Maiorana A, Azzoni P, Bevilacqua L, Spandri V, Montironi R: Acquisition of Data. Kaleci S: Data Analysis. Bertoni L, Puliatti S, Regianni Bonetti L, Maiorana A, Eissa A, Azzoni P, Sighinolfi MC, Micali S, Rocco B, Montironi R: Interpretation of Data. Bertoni L, Puliatti S, Regianni Bonetti L, Eissa A, Zoeir A, Sighinolfi MC: Drafting and writing. Micali S, Bianchi G, Pellacani G, Rocco B, Montironi R: Revision

Corresponding author

Correspondence to Stefano Puliatti.

Ethics declarations

This study was approved by the Ethical Committee in the university of Modena & Reggio Emilia (protocol number 0018091/18) and written informed consent was obtained from all patients.

Conflict of interest

Eissa A has a temporary contract of consultation with MAVIG GmbH.

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Supplementary Fig. 1

Misdiagnosed prostatic adenocarcinoma (A-F). In histological image of focus of Prostatic Acinar Adenocarcinoma Grade Group 1, nuclei were enlarged and nucleoli were evident (A), differently from FCM correlate in which glands exhibited mild atypia and pluristratified crowded nuclei resembling HG-PIN and the atypia was not correctly evidenced (B). Adenocarcinoma was masqueraded by technical artifact: in histological image, the atypical glands were recognizable (C), but not distinguishable in FCM images (D). Cord and single cell of undifferentiated Grade Group 4 adenocarcinoma were visible in histological image (E) differently from FCM corresponding imagine that showed little and pale nuclei misdiagnosed as inflammatory infiltrate (F). (Scale bar = 50 μm) (PDF 13936 kb)

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Bertoni, L., Puliatti, S., Reggiani Bonetti, L. et al. Ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve. Virchows Arch 476, 511–520 (2020). https://doi.org/10.1007/s00428-019-02738-y

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