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. 2022 Jan 21;12(2):277.
doi: 10.3390/diagnostics12020277.

One-Day Prostate Cancer Diagnosis: Biparametric Magnetic Resonance Imaging and Digital Pathology by Fluorescence Confocal Microscopy

Ugo Giovanni Falagario  1 , Oscar Selvaggio  1 , Francesca Sanguedolce  2 , Paola Milillo  3 , Maria Chiara Sighinolfi  4 , Salvatore Mariano Bruno  1 , Marco Recchia  1 , Carlo Bettocchi  1 , Gian Maria Busetto  1 , Luca Macarini  3 , Bernardo Rocco  4 , Luigi Cormio  1   5 , Giuseppe Carrieri  1
Affiliations

One-Day Prostate Cancer Diagnosis: Biparametric Magnetic Resonance Imaging and Digital Pathology by Fluorescence Confocal Microscopy

Ugo Giovanni Falagario et al. Diagnostics (Basel). .

Abstract

In this prospective observational study, we tested the feasibility and efficacy of a novel one-day PCa diagnosis path based on biparametric magnetic resonance (bpMRI) and digital pathology by fluorescence confocal microscopy (FCM). Patients aged 55-70 years scheduled for PBx due to increased PSA levels (3-10 ng/mL) and/or abnormal digitorectal examination were enrolled. All patients underwent bpMRI and PBx with immediate FCM evaluation of biopsy cores. Patients were asked to fill out a dedicated Patient Satisfaction Questionnaire. Patients' satisfaction rates and concordance between digital pathology and standard HE evaluation were the outcomes of interest. Twelve patients completed our one-day PCa diagnosis path. BpMRI showed suspicious lesions in 7 patients. Digital pathology by FCM identified PCa in 5 (41.7%) of the 12 patients. Standard pathology confirmed the diagnosis made through digital pathology in all the cases. At a per patient level, high concordance between the methods was achieved in Gleason Grading (4 out of 5 patients). The level of agreement in the number of positive cores was lower but did not affect the choice of treatment in any of the 5 PCa cases. At a per core level, the agreement was very high for the diagnosis of anyPCa (96.2%) and csPCa (97.3%), with a k coefficient of 0.90 and 0.92, respectively (near perfect agreement). In conclusion, one-day PCa diagnosis by FCM represents a feasible, reliable, and fast diagnostic method that provides significant advantages in optimizing time and resources, leading to patients having a higher quality standard of care perception.

Keywords: biparametric magnetic resonance imaging; digital pathology; fluorescence confocal microscopy; prostate cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Representative MRI and digital pathology images of two patients included in the study. (A–C) Patient 10: PSA 8.77 ng/mL, Suspicious digitorectal examination (DRE), negative MRI ((A): T2W image; (B): DWI Image), negative digital biopsy (C). (D–F) Patient 5: PSA 5.14 ng/mL, negative DRE, suspicious MRI (PIRADS 4; (D): T2W image; (E): DWI image), positive digital biopsy (F).
Figure 2
Figure 2
Radar chart of the survey results. The figure represents the mean rating values of satisfaction with medical care and perceived importance about different aspects of care for patients with suspicion of prostate cancer (PCa): 1. Time from suspicion to histological diagnosis; 2. Time from biopsy to histological diagnosis; 3. Workdays lost for PCa evaluation; 4. Reducing hospital visit during COVID-19 outbreak; 5. Prostate MRI; Urological physical examination; Blood tests.
See this image and copyright information in PMC

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