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.
背景：与传统系统性活检（SBx）相比，MRI引导下针对可见肿瘤特异性病灶的前列腺活检（TBx）能够更精准地诊断需要治疗的临床显著性前列腺癌（csPCa）。离体荧光共聚焦显微镜（FCM）是一种新兴技术，可在传统组织学检查前对TBx样本进行快速评估。方法：收集150例患者的TBx样本，于取样当日进行FCM检测，并在取样后2小时内出具初步诊断报告。统计结果与最终组织学诊断进行对比分析。结果：在当日FCM检测中，根据传统组织学标准成功识别出40例csPCa中的27例（68%）。即使对于传统风险分层中属于中高危组（血清前列腺特异性抗原PSA>10或20 ng/mL）的非显著性前列腺癌（cisPCa），FCM也能实现可靠检测。然而，对于微小病灶的cisPCa，FCM常出现漏诊或难以与反应性病变区分的情况。结论：FCM快速初步报告有助于减轻患者心理压力，优化csPCa的临床管理。在特定病例中可避免额外SBx，从而降低未来手术区域的并发症和瘢痕形成风险，且不影响后续分期检查的及时开展。该技术为未来基于人工智能的诊断算法提供了重要基础。
肿瘤(癌症)患者之家