Same-day fluorescence confocal microscopy of MRI-targeted prostate biopsies: A feasibility study.
Fluorescence confocal microscopy identified prostate cancer with 90% accuracy in biopsies.
Same-day fluorescence confocal microscopy of MRI-targeted prostate biopsies: A feasibility study.
To determine the diagnostic performance of ex vivo fluorescence confocal microscopy (fluorescence confocal microscopy) for prostate cancer detection in magnetic resonance imaging (magnetic resonance imaging)-targeted biopsy specimens using final histopathology as the reference standard, and to quantify workflow component times relevant to same-day implementation.
In this single-centre prospective observational study, men undergoing magnetic resonance imaging-targeted transperineal prostate biopsy were enrolled.
Interobserver agreement for cancer detection was 88% (κ = 0.74), and for clinically significant cancer was 86% (κ = 0.61).
Mean specimen preparation and interpretation times were ~2 min each, with standardised scanning time of 50 s, enabling complete fluorescence confocal microscopy assessment in <5 min per target.
Discordance was concentrated in Grade Group 2 disease and Prostate Imaging-Reporting and Data System (PI-RADS) 3 targets, while higher-grade cancers and PI-RADS 5 lesions were uniformly concordant.
Ex vivo fluorescence confocal microscopy provides rapid, accurate, and reproducible assessment of magnetic resonance imaging-targeted prostate biopsy specimens for cancer detection within clinically feasible timeframes.
These findings support fluorescence confocal microscopy as a same-day diagnostic adjunct and justify prospective trials evaluating real-time implementation during targeted biopsy.