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 (p < 0.001), while between FCM and H&E, the agreement was κ = 0.691 (p < 0.001). With regard to ureteral margins, an overall agreement of κ = 0.712 (p < 0.001) between FCM and FSA and of κ = 0.481 (p < 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.
Current oncology (Toronto, Ont.). 2023 Mar 15*** epublish ***
Francesco Prata, Umberto Anceschi, Chiara Taffon, Silvia Maria Rossi, Martina Verri, Andrea Iannuzzi, Alberto Ragusa, Francesco Esperto, Salvatore Mario Prata, Anna Crescenzi, Roberto Mario Scarpa, Giuseppe Simone, Rocco Papalia
Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy., Pathology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy., Unit of Endocrine Organs and Neuromuscular Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy., Simple Operating Unit of Lower Urinary Tract Surgery, SS. Trinità Hospital, 03039 Sora, Italy.