Real-Time Urethral and Ureteral Assessment during Radical Cystectomy Using Ex-Vivo Optical Imaging: A Novel Technique for the Evaluation of Fresh Unfixed Surgical Margins

• Published in: Current oncology (Toronto) 2023-03, Vol.30 (3), p.3421-3431
• Main Authors: Prata, Francesco, Anceschi, Umberto, Taffon, Chiara, Rossi, Silvia Maria, Verri, Martina, Iannuzzi, Andrea, Ragusa, Alberto, Esperto, Francesco, Prata, Salvatore Mario, Crescenzi, Anna, Scarpa, Roberto Mario, Simone, Giuseppe, Papalia, Rocco
• Format: Article
• Language: English
• Subjects: BCG; BCG vaccines; bladder cancer; Comparative analysis; Cystectomy - methods; fluorescent confocal microscopy; Humans; intraoperative analysis; Margins of Excision; Methods; radical cystectomy; Reproducibility of Results; Surgery; surgical margins; Ureter - diagnostic imaging; Ureter - pathology; Ureter - surgery; Urinary Bladder Neoplasms - diagnostic imaging; Urinary Bladder Neoplasms - surgery
• ISSN: 1718-7729; 1198-0052; 1718-7729
• DOI: 10.3390/curroncol30030259

Our study aims to assess the feasibility and the reproducibility of fluorescent confocal microscopy (FCM) real-time assessment of urethral and ureteral margins during open radical cystectomy (ORC) for bladder cancer (BCa). From May 2020 to January 2022, 46 patients underwent ORC with intraoperative FCM evaluation. Each specimen was intraoperatively stained for histopathological analysis using FCM, analyzed as a frozen section (FSA), and sent for traditional H&E examination. Sensitivity, specificity, positive predictive value (PPV), and the negative predictive value (NPV) of FCM and FSA were assessed and compared with H&E for urethral and ureteral margins separately. The agreement was evaluated through Cohen's κ statistic. Urethral diagnostic agreement between FCM and FSA showed a κ = 0.776 ( < 0.001), while between FCM and H&E, the agreement was κ = 0.691 ( < 0.001). With regard to ureteral margins, an overall agreement of κ = 0.712 ( < 0.001) between FCM and FSA and of κ = 0.481 ( < 0.001) between FCM and H&E was found. FCM proved to be a safe, feasible, and reproducible method for the intraoperative assessment of urethral and ureteral margins during ORC. Compared to standard FSA, FCM showed adequate diagnostic performance in detecting urethral and ureteral malignant involvement.