研究动态
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根治性前列腺切除术中的术中切缘评估:显微镜是否及时冷冻或准备好进行数字解冻?

Intraoperative margin assessment during radical prostatectomy: is microscopy frozen in time or ready for digital defrost?

发表日期:2024 Aug 05
作者: Eoin Dinneen, Ricardo Almeida-Magana, Tarek Al-Hammouri, Iona Fernandes, Nikhil Mayor, Larissa Mendes, Mathias Winkler, Anna Silvanto, Aiman Haider, Alex Freeman, Greg Shaw
来源: HISTOPATHOLOGY

摘要:

使用术中冰冻切片 (IFS) 的目的是改善接受根治性前列腺切除术 (RP) 的患者的功能和肿瘤结果。 NeuroSAFE 等 IFS 技术的高资源需求可能会妨碍广泛采用,即使对患者有好处。新鲜组织显微数字成像技术的最新进展可能提供一种有吸引力的替代方案,并且越来越多的证据表明这些技术。在这篇叙述性评论中,我们讨论了 IFS 的一些常见局限性,并将这些局限性与现代数字成像技术的吸引力进行比较,例如图像生成的速度和易用性、手术室内(或附近)设备的位置、保持组织完整性和图像数字传输的能力。共焦激光显微镜 (CLM) 是文献中最常报道的 RP 期间边缘评估的方式。我们讨论了数字成像技术广泛传播的几种模仿和障碍。其中,我们考虑“正面”边缘视角将如何挑战泌尿科医生和病理学家重新理解边缘阳性意义的含义。作为其中的一部分,需要讨论如何描述、分类、反应和评估这些技术,以改善患者的治疗结果。本综述的局限性包括其叙述结构以及该领域的证据基础相对不成熟但正在快速发展。© 2024 作者。组织病理学由约翰·威利出版
Intraoperative frozen section (IFS) is used with the intention to improve functional and oncological outcomes for patients undergoing radical prostatectomy (RP). High resource requirements of IFS techniques such as NeuroSAFE may preclude widespread adoption, even if there are benefits to patients. Recent advances in fresh-tissue microscopic digital imaging technologies may offer an attractive alternative, and there is a growing body of evidence regarding these technologies. In this narrative review, we discuss some of the familiar limitations of IFS and compare these to the attractive counterpoints of modern digital imaging technologies such as the speed and ease of image generation, the locality of equipment within (or near) the operating room, the ability to maintain tissue integrity, and digital transfer of images. Confocal laser microscopy (CLM) is the modality most frequently reported in the literature for margin assessment during RP. We discuss several imitations and obstacles to widespread dissemination of digital imaging technologies. Among these, we consider how the 'en-face' margin perspective will challenge urologists and pathologists to understand afresh the meaning of positive margin significance. As a part of this, discussions on how to describe, categorize, react to, and evaluate these technologies are needed to improve patient outcomes. Limitations of this review include its narrative structure and that the evidence base in this field is relatively immature but developing at pace.© 2024 The Author(s). Histopathology published by John Wiley & Sons Ltd.