AUA 2022: From Biopsy to Diagnosis in 30 Min: Remote Instant Prostate Pathology Based on Artificial Intelligence Enhanced Ultrasound (AI-US)

( In a podium presentation at the 2022 American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Trabulsi presented on behalf of Dr. Aljabli and Dr. Loch their work focusing on a rapid turn around for prostate cancer diagnosis. A rapid histopathologic evaluation facilitating early diagnosis of prostate cancer may assist with personalization of care and certainly can reduce the patient-borne anxiety of waiting for test results. An artificial intelligence platform can allow for high-fidelity assessment of transrectal ultrasound images to guide biopsy.

The authors sought to test the combination of artificial intelligence enhanced ultrasound (AI-US) and remote telepathological Fluorescent Confocal Microscopy (FCM) to allow for histologic diagnosis within 30 minutes. Notably, this technique does not degrade conventional pathologic evaluation while allowing for rapid assessment.

Between 2020 and 2021, the authors enrolled 73 patients who participated. The median age was 73 years and the serum PSA levels ranged from 1.2 to 1173ng/ml. Patients underwent AI-US targeted prostate biopsy (1-6 cores). All obtained cores were stained for FCM analysis and digital images were sent for “real-time” pathology review followed by routine pathological procedure.

Among 73 included patients, prostate cancer was detected in 25 (34%). Clinically significant disease, defined as Gleason score 7 or greater, was identified in 14 patients (56% of those with prostate cancer) and neuroendocrine prostate cancer was identified in one further patient. The median time from biopsy to FCM diagnosis was 30 minutes.

Subsequently, all FCM diagnoses were assessed by standard pathology analysis and the diagnosis was confirmed in 88% (64/73) of cases. While all cases of clinically significant prostate cancer were diagnosed by instant FCM, the detection rate of insignificant cancer (≤Gleason 6) was 60% (6/10cases). 

Thirteen of 14 patients classified as high-risk patients to AI-US classification (AIS score 3) were diagnosed with only 2 targeted cores by FCM analysis.

Thus, the authors concluded that the combination of AI-enhanced US targeted biopsy and instant FCM is feasible and may provide rapid prostate cancer diagnosis. Further, a reduction of core number and real-time confirmation of clinically significant disease allows for reduction of diagnosis-related stress for patients, as well as potentially decreasing costs and time.

Presented by: Edouard Trabulsi, MD, Professor, Co-Director, Multidisciplinary Genitourinary Oncology Center, Co-Director, Prostate Diagnostic Center, Vice-Chair of Research, Department of Urology, Director, Division of Urologic Oncology, Department of Urology, Jefferson Health

Written by: Christopher J.D. Wallis, University of Toronto, Twitter: @WallisCJD, during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.




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