1
|
Titze U, Titze B, Hansen T, Barth PJ, Ali FA, Schneider F, Benndorf M, Sievert KD. Ex Vivo Fluorescence Confocal Microscopy of MRI-Guided Targeted Prostate Biopsies for Rapid Detection of Clinically Significant Carcinomas-A Feasibility Study. Cancers (Basel) 2024; 16:873. [PMID: 38473235 DOI: 10.3390/cancers16050873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND MRI-guided prostate biopsies from visible tumor-specific lesions (TBx) can be used to diagnose clinically significant carcinomas (csPCa) requiring treatment more selectively than conventional systematic biopsies (SBx). Ex vivo fluorescence confocal microscopy (FCM) is a novel technique that can be used to examine TBx prior to conventional histologic workup. METHODS TBx from 150 patients were examined with FCM on the day of collection. Preliminary findings were reported within 2 h of collection. The results were statistically compared with the final histology. RESULTS 27/40 (68%) of the csPCa were already recognized in the intraday FCM in accordance with the results of conventional histology. Even non-significant carcinomas (cisPCa) of the intermediate and high-risk groups (serum prostate-specific antigen (PSA) > 10 or 20 ng/mL) according to conventional risk stratifications were reliably detectable. In contrast, small foci of cisPCa were often not detected or were difficult to distinguish from reactive changes. CONCLUSION The rapid reporting of preliminary FCM findings helps to reduce the psychological stress on patients, and can improve the clinical management of csPCa. Additional SBx can be avoided in individual cases, leading to lower rates of complications and scarring in the future surgical area. Additional staging examinations can be arranged without losing time. FCM represents a promising basis for future AI-based diagnostic algorithms.
Collapse
Affiliation(s)
- Ulf Titze
- Department of Pathology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Barbara Titze
- Department of Pathology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Torsten Hansen
- Department of Pathology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
- MVZ for Histology, Cytology and Molecular Diagnostics Trier GmbH, 54296 Trier, Germany
| | - Peter J Barth
- Gerhard-Domagk-Institute of Pathology, Münster University Hospital, University of Münster, 48149 Münster, Germany
| | - Furat Abd Ali
- Department of Urology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Fried Schneider
- Department of Urology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Matthias Benndorf
- Department of Diagnostic and Interventional Radiology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Karl-Dietrich Sievert
- Department of Urology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| |
Collapse
|
2
|
Kinzler MN, Schulze F, Reitz A, Gretser S, Ziegler P, Shmorhun O, Friedrich-Rust M, Bojunga J, Zeuzem S, Schnitzbauer AA, Bechstein WO, Reis H, Barreiros AP, Wild PJ. Fluorescence confocal microscopy on liver specimens for full digitization of transplant pathology. Liver Transpl 2023; 29:940-951. [PMID: 37016761 DOI: 10.1097/lvt.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/01/2023] [Indexed: 04/06/2023]
Abstract
Fluorescence confocal microscopy (FCM) is a rapidly evolving tool that provides real-time virtual HE images of native tissue. Data about the potential of FCM as an alternative to frozen sections for the evaluation of donor liver specimens are lacking so far. The aim of the current study was to determine the value of FCM in liver specimens according to the criteria of the German Society for Organ Procurement. In this prospective study, conventional histology and FCM scans of 50 liver specimens (60% liver biopsies, 26% surgical specimens, and 14% donor samples) were evaluated according to the German Society for Organ Procurement. A comparison of FCM scans and conventional frozen sections revealed almost perfect levels of agreement for cholangitis (κ = 0.877), fibrosis (κ = 0.843), and malignancy (κ = 0.815). Substantial levels of agreement could be obtained for macrovesicular steatosis (κ = 0.775), inflammation (κ = 0.763), necrosis (κ = 0.643), and steatohepatitis (κ = 0.643). Levels of agreement were moderate for microvesicular steatosis (κ = 0.563). The strength of agreement between frozen sections and FCM was superior to the comparison of conventional HE and FCM imaging. We introduce FCM as a potential alternative to the frozen section that may represent a novel approach to liver transplant pathology where timely feedback is crucial and the deployment of human resources is becoming increasingly difficult.
Collapse
Affiliation(s)
- Maximilian N Kinzler
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Falko Schulze
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Alexandra Reitz
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Steffen Gretser
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Paul Ziegler
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Oleksandr Shmorhun
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Andreas A Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Wolf Otto Bechstein
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Henning Reis
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Ana Paula Barreiros
- German Organ Procurement Organization (DSO), 60594 Frankfurt am Main, Germany
| | - Peter J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
- Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| |
Collapse
|
3
|
Ex Vivo Fluorescence Confocal Microscopy (FCM) Ensures Representative Tissue in Prostate Cancer Biobanking: A Feasibility Study. Int J Mol Sci 2022; 23:ijms232012103. [PMID: 36292970 PMCID: PMC9603154 DOI: 10.3390/ijms232012103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Biobanking of prostate carcinoma is particularly challenging due to the actual cancer within the organ often without clear margins. Frozen sections are to date the only way to examine the biobank material for its tumor content. We used ex vivo fluorescence confocal microscopy (FCM) to analyze biobank samples prior to cryoasservation. Methods: 127 punch biopsies were acquired from prostatectomy-specimens from 40 patients. These biopsies were analyzed with a Vivascope 2500-G4 prior to their transfer to the biobank. In difficult cases, larger samples of the prostatectomy specimens were FCM scanned in order to locate tumor foci. After patient acquisition, all samples were taken from the biobank and analyzed. We compared the results of the FCM examinations with the results of conventional histology and measured the DNA content. Results: With upstream FCM, the tumor content of biobank samples could be determined with high confidence. The detection rate of representative biobank samples was increased due to the rapid feedback. The biobank samples were suitable for further molecular analysis. Conclusion: FCM allows for the first time lossless microscopic analysis of biobank samples prior to their cryoasservation and guarantees representative tumor and normal tissue for further molecular analysis.
Collapse
|
4
|
Sievert KD, Hansen T, Titze B, Schulz B, Omran A, Brockkötter L, Gunnemann A, Titze U. Ex Vivo Fluorescence Confocal Microscopy (FCM) of Prostate Biopsies Rethought: Opportunities of Intraoperative Examinations of MRI-Guided Targeted Biopsies in Routine Diagnostics. Diagnostics (Basel) 2022; 12:diagnostics12051146. [PMID: 35626301 PMCID: PMC9140526 DOI: 10.3390/diagnostics12051146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. Detection rates of clinically relevant tumors were determined in both groups. A retrospective blinded trial was performed to determine how many tumors requiring intervention were detectable via FCM analysis of MRI-guided targeted biopsies alone. Results: MRI-guided targeted biopsies revealed tumors more frequently than systematic biopsies. Carcinomas in need of intervention were reliably represented in the MRI-guided biopsies and were identified in intraoperative FCM microscopy. Combined with serum PSA levels and clinical presentation, 91% of the carcinomas in need of intervention were identified. Conclusions: Intraoperative FCM analysis of MRI-guided biopsies is a promising approach for the efficient diagnosis of PCa. The method allows a timely assessment of whether a tumor disease requiring intervention is present and can reduce the psychological stress of the patient in the waiting period of the histological finding. Furthermore, this technique can lead to reduction of the total number of biopsies needed for the diagnosis of PCa.
Collapse
Affiliation(s)
- Karl-Dietrich Sievert
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Torsten Hansen
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Barbara Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Birte Schulz
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Ahmad Omran
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Lukas Brockkötter
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Alfons Gunnemann
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Ulf Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
- Correspondence: ; Tel.: +49-05231-72-3451
| |
Collapse
|
5
|
Titze U, Sievert KD, Titze B, Schulz B, Schlieker H, Madarasz Z, Weise C, Hansen T. Ex Vivo Fluorescence Confocal Microscopy in Specimens of the Liver: A Proof-of-Concept Study. Cancers (Basel) 2022; 14:590. [PMID: 35158859 PMCID: PMC8833349 DOI: 10.3390/cancers14030590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Ex vivo Fluorescence Confocal Microscopy (FCM) is a technique providing high-resolution images of native tissues. The method is increasingly used in surgical settings in areas of dermatology and urology. Only a few publications exist about examinations of tumors and non-neoplastic lesions of the liver. We report on the application of FCM in biopsies, surgical specimens and autopsy material (33 patients, 39 specimens) of the liver and compare the results to conventional histology. Our preliminary examinations indicated a perfect suitability for tumor diagnosis (ĸ = 1.00) and moderate/good suitability for the assessment of inflammation (ĸ = 0.4-0.6) with regard to their severity and localization. Macro-vesicular steatosis was reliably detected, micro-vesicular steatosis tended to be underestimated. Cholestasis and eosinophilic granules in granulocytes were not represented in the scans. The tissue was preserved as native material and maintained its quality for downstream histological, immunohistological and molecular examinations. In summary, FCM is a material sparing method that provides rapid feedback to the clinician about the presence of tumor, the degree of inflammation and structural changes. This can lead to faster therapeutic decisions in the management of liver tumors, treatment of hepatitis or in liver transplant medicine.
Collapse
Affiliation(s)
- Ulf Titze
- Institute of Pathology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany; (B.T.); (B.S.); (T.H.)
| | - Karl-Dietrich Sievert
- Department of Urology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany;
| | - Barbara Titze
- Institute of Pathology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany; (B.T.); (B.S.); (T.H.)
| | - Birte Schulz
- Institute of Pathology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany; (B.T.); (B.S.); (T.H.)
| | - Heiko Schlieker
- Department of Gastroenterology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany;
| | - Zsolt Madarasz
- Department of General Surgery, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany;
| | - Christian Weise
- Department of Pediatrics, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany;
| | - Torsten Hansen
- Institute of Pathology, Campus Lippe, University Hospital OWL of the University of Bielefeld, 32756 Detmold, Germany; (B.T.); (B.S.); (T.H.)
| |
Collapse
|
6
|
Titze U, Hansen T, Brochhausen C, Titze B, Schulz B, Gunnemann A, Rocco B, Sievert KD. Diagnostic Performance of Ex Vivo Fluorescence Confocal Microscopy in the Assessment of Diagnostic Biopsies of the Prostate. Cancers (Basel) 2021; 13:cancers13225685. [PMID: 34830839 PMCID: PMC8616222 DOI: 10.3390/cancers13225685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. In this study, we compare intraoperative diagnoses from the real-time application of FCM in pre-therapeutic prostate biopsies with the final diagnoses from conventional histology. We found FCM to be an effective tool for the timely assessment of prostate biopsies enabling reliable real-time diagnosis of prostate cancer in patients requiring therapy. Abstract Background: Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. The method has been well established for the diagnosis of tumors in dermatological specimens. Methods: We compare intraoperative diagnoses of the real-time application of FCM in pre-therapeutic prostate biopsies (35 patients, total number of biopsy specimens: n = 438) with the findings of conventional histology. Results: Prostate carcinoma was reliably diagnosed in all patients. Depending on scan quality and experience of the examiner, smaller lesions of well differentiated carcinoma (ISUP1) could not be consistently differentiated from reactive changes. Furthermore, in some cases there was difficulty to distinguish ISUP grade 2 from ISUP grade 1 tumors. ISUP grades 3–5 were reliably detected in FCM. Conclusions: Despite some limitations, FCM seems to be an effective tool for the timely assessment of prostate biopsies enabling reliable diagnosis of prostate cancer in patients requiring therapy.
Collapse
Affiliation(s)
- Ulf Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
- Correspondence: ; Tel.: +49-05231-72-3451
| | - Torsten Hansen
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Christoph Brochhausen
- Institute of Pathology, University of Regensburg, 93053 Regensburg, Germany;
- Central Biobank Regensburg, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Barbara Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Birte Schulz
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Alfons Gunnemann
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (A.G.); (K.-D.S.)
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Karl-Dietrich Sievert
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (A.G.); (K.-D.S.)
| |
Collapse
|