Fluorescence Confocal Microscopy (FCM)- optyczna intra-RARP

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Pamiętaj o podawaniu tytułów artykułów i ew. cytowaniu abstraktów (co niżej uczyniłam, podkreślenia moje, -zb).
Link # 1 prowadzi do artykułu dot. zastosowania śródoperacyjne optycznej biopsji podczas RARP (u 21 pacjentów).


Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy

Purpose
Intraoperative optical biopsy technologies may aid in the identification of important anatomical landmarks and improve surgical outcomes of robotic assisted radical prostatectomy. We evaluate the feasibility of confocal laser endomicroscopy during robotic assisted radical prostatectomy.

Materials and Methods
A total of 21 patients with biopsy proven prostate cancer scheduled for robotic assisted radical prostatectomy were recruited.
After intravenous administration of fluorescein 15 patients underwent in vivo intraoperative confocal laser endomicroscopy of prostatic and periprostatic structures using a 2.6 or 0.85 mm imaging probe. Standard robotic instruments were used to grasp and maneuver the confocal laser endomicroscopy probes for image acquisition.
Confocal laser endomicroscopy imaging was performed ex vivo on fresh prostate specimens from 20 patients. (...)
Processed confocal images were compared with standard hematoxylin and eosin analysis of imaged regions.

Results
Confocal laser endomicroscopy was successfully integrated with robotic surgery, including co-registration of confocal video sequences with white light and probe handling with standard robotic instrumentation.
Intraoperative confocal laser endomicroscopy imaging of the neurovascular bundle before and after nerve sparing dissection revealed characteristic features including dynamic vascular flow and intact axon fibres.
Ex vivo confocal imaging of the prostatic parenchyma demonstrated normal prostate glands, stroma and prostatic carcinoma.

Conclusions
We report the initial feasibility of optical biopsy of prostatic and periprostatic tissue during robotic assisted radical prostatectomy.
Image guidance and tissue interrogation using confocal laser endomicroscopy offer a new intraoperative imaging method that has the potential to improve the functional and oncologic outcomes of prostate cancer surgery.
https://www.sciencedirect.com/science/a ... 4715053112





Link #2 prowadzi do holenderskiego nierandomizowanego badania klinicznego z 2018 roku, które miało się zakończyć w zeszłym roku, ale na stronie clinicaltrials.gov nie ma żadnej wzmianki na ten temat.


Confocal Laser Endomicroscopy and Optical Coherence Tomography for the Diagnosis of Prostate Cancer: A Needle-Based, In Vivo Feasibility Study Protocol (IDEAL Phase 2A)
Swaan A, Mannaerts CK, Scheltema MJV, Nieuwenhuijzen JA, Savci-Heijink CD, de la Rosette JJMCH, van Moorselaar RJA, van Leeuwen TG, de Reijke TM, de Bruin DM
JMIR Res Protoc 2018;7(5):e132

Objective: This study has 2 separate primary objectives.
The first is to assess the technical feasibility and safety of in vivo focal imaging with confocal laser endomicroscopy and optical coherence tomography.
The second is to identify and define characteristics of prostate cancer and normal prostate tissue in confocal laser endomicroscopy and optical coherence tomography imaging by comparing these images with the corresponding histopathology.

Conclusions: Confocal laser endomicroscopy and optical coherence tomography are promising optical imaging techniques that can visualize and analyze tissue structure, possible tumor grade, and architecture in real time. They can potentially provide real-time, high-resolution microscopic imaging and tissue characteristics of prostate cancer in conjunction with magnetic resonance imaging or transrectal ultrasound fusion-guided biopsy procedures.
This study will provide insight into the feasibility and tissue-specific characteristics of confocal laser endomicroscopy and optical coherence tomography for real-time optical analysis of prostate cancer.
Trial Registration: ClinicalTrials.gov NCT03253458
https://www.researchprotocols.org/2018/ ... _TrendMD_0


O robotach to jeszcze coś wiem, o RARP trochę czytałem, ale analiza histpatów, to już jest poza moimi możliwościami.
Urządzenie to jedno a praktyka, to drugie. Szkolenia, utrzymanie, używanie to dodatkowe koszty, ale określenie zakresu operacji i marginesów cięcia to chyba dobre wieści dla chorych. No i dosyć kompaktowe urządzenie, ceny nie znam, ale chyba warto inwestować by profilaktycznie nie wycinać zbyt dużo, jak nie ma potrzeby.



Jak zacząłem szperać w Internecie to znalazłem jeszcze inne artykuły:

EX-VIVO FLUORESCENCE CONFOCAL MICROSCOPY: EVALUATION OF THE LEARNING CURVE FOR INTERPRETATION OF PROSTATIC BENIGN AND MALIGNANT TISSUES

INTRODUCTION AND OBJECTIVE: 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.
Its role for the detection of prostate cancer has been recently described in a feasibility study on 89 prostate tissue samples, displaying a 91% of overall agreement with conventional pathological analysis.
The aim of the current study is to evaluate the learning curve of images interpretation of this new technology.

METHODS: Eighty fresh and unprepared biopsies obtained from radical prostatectomy specimens were evaluated using the FCM VivaScope
2500M-G4 (Mavig GmbH, Munich, Germany; Caliber I.D.; Rochester NY, USA) by two pathologists. All FCM images were stored in a dedicated database.

Two pathologists (general pathologist and an expert genitouro-pathologist) from two different centers were considered for the assessment of the FCM learning curve. The images were randomly displayed to each of the two pathologists while being blinded to the histopathologic diagnoses.
After more than 90 days, they were asked to re-evaluate the specimens. All examinations were performed independently and included the evaluation of the tumor and non-neoplastic tissue comprised in the samples with particular regard to normal prostatic glands and soft tissue components (muscle bundles, nerve, adipocytes, vessels) as well as other non-neoplastic conditions such as inflammation and benign glandular hyperplasia.

RESULTS: FCM demonstrated a simple learning curve. Both pathologists achieved very encouraging levels of agreement between FCM evaluation and the gold standard histopathological diagnosis of prostatic biopsies. The percentages of agreement become higher from the first evaluation 86% and 92% (k [ 0.68 and k [ 0.79 substantial agreement) to the second one, reaching 95% (k [ 0.87 almost perfect agreement) for both the pathologists. Furthermore, the reproducibility was excellent (k>0.75) for both raters in the second evaluation. Besides high accuracy, the result in terms of specificity and sensitivity are promising with a ROC area set at 0,87 for the first evaluation and at 0,93 for the second one.

CONCLUSIONS: FCM images could be easily interpreted from both general pathologists and the ones specialized in urological malignancies.
The appearance of images resembles hematoxilyn eosin and is therefore easily interpreted also from beginners. FCM provides the potential of digital imaging that can be sent online to a remote pathologist for interpretation; this advantage together with the easy learning curve makes it an attractive perspective for microscopical fast diagnosis.

https://bjui-journals.onlinelibrary.wil ... /bju.14754


Z opisu wynika, że w RARP też się przydaje i stosunkowo łatwo się nauczyć go wykorzystywać a zgodność z badaniami tradycyjnymi jest wysoka.
Google Scholar znalazł 7 artykułów na hasło: VivaScope 2500M-G4 prostatectomy.

RARP i badania śródoperacyjne wkroczyły do Polski, no jeszcze, żeby NFZ refundował, bo ośrodków z da Vinci też przybywa.


U mnie, jak dotąd, chyba śródoperacyjne nie jest konieczne, bo węzły chłonne są ok i rak jest w środku prostaty i nie nacieka.
Ale dla Gleasona >6 to już może być bardzo pomocne.

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Połączenie da Vinci z Vivascopem
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RARP Vivascop.jpg

https://twitter.com/bernardorocco73/sta ... 10529?s=20