Abstract：
Purpose: To assess the safety and technical feasibility of in-vivo needle-based forward-looking confocal laser endomicroscopy in prostate tissue. Methods: For this feasibility study, 2 patients with a suspicion of prostate cancer underwent transperineal needle-based confocal laser endomicroscopy during ultrasound-guided transperineal template mapping biopsies. After intravenous administration of fluorescein, needle-based confocal laser endomicroscopy imaging was performed with a forward-looking probe (outer diameter 0.9 mm) in 2 trajectories during a manual push-forward and pullback motion. A biopsy was taken in a coregistered parallel adjacent trajectory to the confocal laser endomicroscopy trajectory for histopathologic comparison. Peri- and postprocedural adverse events, confocal laser endomicroscopy device malfunction and procedural failures were recorded. Needle-based confocal laser endomicroscopy image quality assessment, image interpretation, and histology were performed by an experienced confocal laser endomicroscopy rater and uro-pathologist, blinded to any additional information. Results: In both patients, no peri- and post-procedural adverse events were reported following needle-based confocal laser endomicroscopy. No confocal laser endomicroscopy device malfunction nor procedural failures were reported. Within 1.5 min after intravenous administration of fluorescein, needle-based confocal laser endomicroscopy image quality was sufficient for interpretation for at least 14 min, yielding more than 5000 confocal laser endomicroscopy frames per patient. The pullback confocal laser endomicroscopy recordings and most of the push-forward recordings almost only visualized erythrocytes, being classified as non-representative. During the push-forward recordings, prostate tissue was occasionally visualized in single frames, insufficient for histopathologic comparison. Prostate carcinoma was identified by biopsy in one patient (Gleason score 4 + 3 = 7, >50%), while the biopsy from the other patient showed no malignancy. Conclusion: Needle-based confocal laser endomicroscopy imaging of in-vivo prostate tissue with a forward-looking confocal laser endomicroscopy probe is safe without device malfunctions or procedural failures. Needle-based confocal laser endomicroscopy is technically feasible, but the acquired confocal laser endomicroscopy datasets are non-representative. The confocal laser endomicroscopy images\' non-representative nature is possibly caused by bleeding artifacts, movement artifacts and a lack of contact time with the tissue of interest. A different confocal laser endomicroscopy probe or procedure might yield representative images of prostatic tissue.
摘要：
目的：评估体内针基前视共聚焦激光显微内镜在前列腺组织中的安全性和技术可行性。方法：对于本可行性研究，2例怀疑前列腺癌的患者在超声引导下经会阴模板标测活检期间接受了基于会阴针的共聚焦激光显微内镜检查。静脉注射荧光素后，在手动前推和后拉运动期间,使用前视探头(外径0.9mm)在2个轨迹内进行针基共聚焦激光显微内镜成像.在共聚焦激光显微内镜轨迹的平行相邻轨迹中进行活检，以进行组织病理学比较。术中和术后不良事件，记录共聚焦激光显微内镜装置故障和程序故障.基于针的共聚焦激光显微内窥镜图像质量评估，图像解释,和组织学由经验丰富的共聚焦激光显微内镜评估员和尿路病理学家进行，对任何其他信息视而不见。结果：在两名患者中，在针基共聚焦激光显微内镜检查后,未报告围手术期和术后不良事件.没有共聚焦激光显微内窥镜设备故障或程序失败的报告。在静脉注射荧光素后1.5分钟内，基于针的共聚焦激光显微内窥镜图像质量足以解释至少14分钟，每个患者产生超过5000个共聚焦激光显微内镜框架。回撤共聚焦激光显微内镜记录和大多数前推记录几乎只显示红细胞，被归类为不具有代表性。在推进录音期间，前列腺组织偶尔在单帧中可见，不足以进行组织病理学比较。1例患者通过活检发现前列腺癌（Gleason评分4+3=7，>50%），而另一名患者的活检显示无恶性肿瘤。结论：使用前视共聚焦激光显微内窥镜探头对体内前列腺组织进行基于针的共聚焦激光显微内窥镜成像是安全的，没有设备故障或程序故障。基于针的共聚焦激光显微术在技术上是可行的,但获得的共聚焦激光显微内镜数据集没有代表性。共聚焦激光显微内镜图像的非代表性可能是由出血伪影引起的，运动伪影和缺乏与感兴趣组织的接触时间。不同的共聚焦激光显微内镜探头或程序可能会产生前列腺组织的代表性图像。
