Abstract：
BACKGROUND: Histopathological examination, a cornerstone in diagnosing cancer, faces challenges due to its time-consuming nature. This review explores the potential of ex-vivo fluorescent confocal microscopy (FCM) in urology, addressing the need for real-time pathological assessment, particularly in prostate cancer. This systematic review aims to assess the applications of FCM in urology, including its role in prostate cancer diagnosis, surgical margin assessment, and other urological fields.
METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic search of PubMed and SCOPUS was conducted, focusing on English written original articles published after January 1, 2018, discussing the use of FCM in urological practice. The search included keywords related to FCM and urological terms. The risk of bias assessment was performed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.
RESULTS: A total of 17 relevant studies were included in the review that focuses on three main urological issues: prostate cancer (15 articles), bladder cancer (1 article), and renal biopsy (1 article). FCM exhibited significant promise in diagnosing prostate cancer. These studies reported an accuracy range of 85.33% to 95.1% in distinguishing between cancerous and non-cancerous prostate tissues. Moreover, FCM proved valuable for assessing surgical margins in real-time during radical prostatectomy, reducing the need for frozen section analysis. In some investigations, researchers explored the integration of artificial intelligence (AI) with FCM to automate diagnostic processes. Concerning bladder cancer, FCM played a beneficial role in evaluating urethral and ureteral margins during radical cystectomy. Notably, it showed substantial agreement with conventional histopathology and frozen section examination. In the context of renal biopsy, FCM demonstrated the potential to differentiate normal renal parenchyma from cancerous tissue, although the available evidence is limited in this area. The main limitation of the current study is the scarcity of data regarding the topic of interest.
CONCLUSIONS: Ex-vivo FCM holds promise in urology, particularly in prostate cancer diagnosis and surgical margin assessment. Its real-time capabilities may reduce diagnostic delays and patient stress. However, most studies remain experimental, requiring further research to validate clinical utility.
METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic search of PubMed and SCOPUS was conducted, focusing on English written original articles published after January 1, 2018, discussing the use of FCM in urological practice. The search included keywords related to FCM and urological terms. The risk of bias assessment was performed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.
RESULTS: A total of 17 relevant studies were included in the review that focuses on three main urological issues: prostate cancer (15 articles), bladder cancer (1 article), and renal biopsy (1 article). FCM exhibited significant promise in diagnosing prostate cancer. These studies reported an accuracy range of 85.33% to 95.1% in distinguishing between cancerous and non-cancerous prostate tissues. Moreover, FCM proved valuable for assessing surgical margins in real-time during radical prostatectomy, reducing the need for frozen section analysis. In some investigations, researchers explored the integration of artificial intelligence (AI) with FCM to automate diagnostic processes. Concerning bladder cancer, FCM played a beneficial role in evaluating urethral and ureteral margins during radical cystectomy. Notably, it showed substantial agreement with conventional histopathology and frozen section examination. In the context of renal biopsy, FCM demonstrated the potential to differentiate normal renal parenchyma from cancerous tissue, although the available evidence is limited in this area. The main limitation of the current study is the scarcity of data regarding the topic of interest.
CONCLUSIONS: Ex-vivo FCM holds promise in urology, particularly in prostate cancer diagnosis and surgical margin assessment. Its real-time capabilities may reduce diagnostic delays and patient stress. However, most studies remain experimental, requiring further research to validate clinical utility.
摘要：
背景：组织病理学检查，诊断癌症的基石，由于其耗时的性质而面临挑战。这篇综述探讨了离体荧光共聚焦显微镜（FCM）在泌尿外科中的潜力，满足实时病理评估的需要，尤其是前列腺癌。本系统综述旨在评估FCM在泌尿外科的应用。包括它在前列腺癌诊断中的作用，手术切缘评估，和其他泌尿科领域。
方法：遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目，对PubMed和SCOPUS进行了系统搜索，重点关注2018年1月1日后发表的英文原版文章，讨论FCM在泌尿外科实践中的应用。该搜索包括与FCM和泌尿科术语相关的关键字。使用诊断准确性研究质量评估-2（QUADAS-2）工具进行偏倚风险评估。
结果：这篇综述共包括17项相关研究，重点关注三个主要泌尿系统问题：前列腺癌（15篇文章），膀胱癌（1篇），肾活检（1篇）。FCM在诊断前列腺癌方面显示出显著的前景。这些研究报告了区分癌性和非癌性前列腺组织的准确度范围为85.33%至95.1%。此外，FCM在前列腺癌根治术期间实时评估手术切缘方面被证明是有价值的，减少了冷冻切片分析的需要。在一些调查中,研究人员探索了人工智能(AI)与FCM的集成，以实现诊断过程的自动化。关于膀胱癌，FCM在根治性膀胱切除术中评估尿道和输尿管边缘方面发挥了有益的作用。值得注意的是,它与常规组织病理学和冰冻切片检查显示出实质性的一致性。在肾活检的背景下，FCM显示了区分正常肾实质和癌组织的潜力，尽管这方面的证据有限。当前研究的主要局限性是有关感兴趣主题的数据匮乏。
结论：离体FCM在泌尿外科领域有希望，特别是在前列腺癌诊断和手术切缘评估中。其实时功能可以减少诊断延迟和患者压力。然而,大多数研究仍然是实验性的，需要进一步的研究来验证临床实用性。
方法：遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目，对PubMed和SCOPUS进行了系统搜索，重点关注2018年1月1日后发表的英文原版文章，讨论FCM在泌尿外科实践中的应用。该搜索包括与FCM和泌尿科术语相关的关键字。使用诊断准确性研究质量评估-2（QUADAS-2）工具进行偏倚风险评估。
结果：这篇综述共包括17项相关研究，重点关注三个主要泌尿系统问题：前列腺癌（15篇文章），膀胱癌（1篇），肾活检（1篇）。FCM在诊断前列腺癌方面显示出显著的前景。这些研究报告了区分癌性和非癌性前列腺组织的准确度范围为85.33%至95.1%。此外，FCM在前列腺癌根治术期间实时评估手术切缘方面被证明是有价值的，减少了冷冻切片分析的需要。在一些调查中,研究人员探索了人工智能(AI)与FCM的集成，以实现诊断过程的自动化。关于膀胱癌，FCM在根治性膀胱切除术中评估尿道和输尿管边缘方面发挥了有益的作用。值得注意的是,它与常规组织病理学和冰冻切片检查显示出实质性的一致性。在肾活检的背景下，FCM显示了区分正常肾实质和癌组织的潜力，尽管这方面的证据有限。当前研究的主要局限性是有关感兴趣主题的数据匮乏。
结论：离体FCM在泌尿外科领域有希望，特别是在前列腺癌诊断和手术切缘评估中。其实时功能可以减少诊断延迟和患者压力。然而,大多数研究仍然是实验性的，需要进一步的研究来验证临床实用性。
