Objectives To evaluate the feasibility of ex vivo fluorescence confocal microscopy (FCM) for real‐time assessment of ureteroscopic biopsy specimen adequacy in patients with suspected upper tract urothelial carcinoma (UTUC). Patients and Methods In this prospective, single‐centre feasibility study, four ureteroscopic biopsy specimens obtained from two patients undergoing evaluation for suspected UTUC were analysed using ex vivo FCM. Specimens were briefly stained with acridine orange, scanned within 50–60 s, and images were stored for deferred review. A board‐certified genitourinary pathologist reviewed the FCM images in a blinded fashion and classified specimens as adequate or non‐representative based on a pre‐defined criterion of identifiable urothelial tissue. All specimens subsequently underwent routine haematoxylin and eosin (H the non‐representative specimen showed only focal atypical papillary urothelial proliferation admixed within the blood clot. Conclusion Ex vivo FCM was feasible for immediate imaging of freshly obtained ureteroscopic biopsy specimens and allowed identification of urothelial‐containing fragments as a marker of specimen adequacy while preserving tissue for standard histopathological evaluation. These preliminary findings support further investigation in larger cohorts to evaluate reproducibility and to clarify the potential role of this approach for intraoperative or real‐time assessment of biopsy adequacy in UTUC, including correlation with final histopathological grade and stage.
Daher et al. (Thu,) studied this question.