Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Technol Cancer Res Treat. 2022 Jan-Dec;21:15330338221093149. doi: 10.1177/15330338221093149.
To assess the safety and technical feasibility of needle-based forward-looking confocal laser endomicroscopy in prostate tissue. For this feasibility study, 2 patients with a suspicion of prostate cancer underwent transperineal needle-based confocal laser endomicroscopy during ultrasound-guided transperineal template mapping biopsies. After intravenous administration of fluorescein, needle-based confocal laser endomicroscopy imaging was performed with a forward-looking probe (outer diameter 0.9 mm) in 2 trajectories during a manual push-forward and pullback motion. A biopsy was taken in a coregistered parallel adjacent trajectory to the confocal laser endomicroscopy trajectory for histopathologic comparison. Peri- and postprocedural adverse events, confocal laser endomicroscopy device malfunction and procedural failures were recorded. Needle-based confocal laser endomicroscopy image quality assessment, image interpretation, and histology were performed by an experienced confocal laser endomicroscopy rater and uro-pathologist, blinded to any additional information. In both patients, no peri- and post-procedural adverse events were reported following needle-based confocal laser endomicroscopy. No confocal laser endomicroscopy device malfunction nor procedural failures were reported. Within 1.5 min after intravenous administration of fluorescein, needle-based confocal laser endomicroscopy image quality was sufficient for interpretation for at least 14 min, yielding more than 5000 confocal laser endomicroscopy frames per patient. The pullback confocal laser endomicroscopy recordings and most of the push-forward recordings almost only visualized erythrocytes, being classified as non-representative. During the push-forward recordings, prostate tissue was occasionally visualized in single frames, insufficient for histopathologic comparison. Prostate carcinoma was identified by biopsy in one patient (Gleason score 4 + 3 = 7, >50%), while the biopsy from the other patient showed no malignancy. Needle-based confocal laser endomicroscopy imaging of prostate tissue with a forward-looking confocal laser endomicroscopy probe is safe without device malfunctions or procedural failures. Needle-based confocal laser endomicroscopy is technically feasible, but the acquired confocal laser endomicroscopy datasets are non-representative. The confocal laser endomicroscopy images' non-representative nature is possibly caused by bleeding artifacts, movement artifacts and a lack of contact time with the tissue of interest. A different confocal laser endomicroscopy probe or procedure might yield representative images of prostatic tissue.
评估基于针的前瞻性共聚焦激光内窥镜检查在前列腺组织中的安全性和技术可行性。 为此可行性研究，2 例疑似前列腺癌患者在超声引导经会阴模板活检期间接受经会阴基于针的共聚焦激光内窥镜检查。静脉注射荧光素后，在手动推进和后退运动过程中，通过前向探头（外径 0.9mm）在 2 条轨迹上进行基于针的共聚焦激光内窥镜成像。在与共聚焦激光内窥镜轨迹平行的核心注册相邻轨迹中进行活检，用于组织病理学比较。记录围手术期和术后不良事件、共聚焦激光内窥镜设备故障和手术失败。由经验丰富的共聚焦激光内窥镜评分者和泌尿科病理学家对基于针的共聚焦激光内窥镜图像质量评估、图像解释和组织学进行评估，对任何其他信息均不知情。 在这 2 名患者中，在接受基于针的共聚焦激光内窥镜检查后，均未报告围手术期和术后不良事件。未报告共聚焦激光内窥镜设备故障或手术失败。在静脉注射荧光素后 1.5 分钟内，基于针的共聚焦激光内窥镜的图像质量足以进行解释，至少可以获得每个患者超过 5000 个共聚焦激光内窥镜帧。后退共聚焦激光内窥镜记录和大部分推进记录几乎只显示红细胞，被归类为非代表性。在推进记录期间，前列腺组织偶尔会在单个帧中可视化，不足以进行组织病理学比较。一名患者（Gleason 评分 4+3=7，>50%）通过活检诊断为前列腺癌，而另一名患者的活检未显示恶性肿瘤。 使用前向共聚焦激光内窥镜探头对前列腺组织进行基于针的共聚焦激光内窥镜成像，安全无设备故障或手术失败。基于针的共聚焦激光内窥镜检查技术可行，但获得的共聚焦激光内窥镜数据集不具有代表性。共聚焦激光内窥镜图像的非代表性可能是由出血伪影、运动伪影和与感兴趣组织缺乏接触时间引起的。不同的共聚焦激光内窥镜探头或程序可能会产生具有代表性的前列腺组织图像。
