Full-Field Optical Coherence Tomography for Immediate Analysis of Prostate Biopsy Cores: A New Step toward Real-Time Cancer Diagnosis

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• Picked for Histology (top studies of the week, 11 October 2026): Phase II diagnostic accuracy of FFOCT for prostate cores

Abstract

BACKGROUND: Surgical treatment of prostate cancer (PCa) is becoming increasingly personalized, requiring precise intraprostatic tumor mapping, offered by magnetic resonance imaging (MRI) and fusion biopsies. Thus, a real-time histological assessment tool could be useful to improve intraoperative management of oncological margins. Full-field optical coherence tomography (FFOCT) enables real-time tissue analysis. The objective of our study was to assess the accuracy of urologists' diagnosis of PCa on FFOCT images from prostate biopsy cores. PATIENTS AND METHODS: A total of 91 patients undergoing prostatic biopsies were included. All cores were imaged for the FFOCT analysis (991 cores). FFOCT images were analyzed by two urologists and two urology residents. The FFOCT analysis included the presence of PCa and clinically significant prostate cancer (csPCa), i.e., International Society of Urological Pathology (ISUP) ≥ 2. Results were compared with the histological analysis. RESULTS: All 991 cores were analyzed. Among them, 236 cores (24%) were positive for PCa and 37 cores (3.7%) for csPCa. For csPCa detection, sensitivity and specificity were 41.4% and 88.1% respectively, negative predictive value was 97.5%, and global accuracy was 86.4%. Interreader reproducibility was moderate (κ = 0.46; 95% CI 0.37-0.48). Clustering-adjusted and patient-level analyses yielded similar results. CONCLUSIONS: Our results demonstrate that FFOCT is feasible, reproducible, and can be interpreted directly by urologists. The high negative predictive value observed for clinically significant prostate cancer suggests a potential role for real-time prostate tissue assessment. Further prospective studies are required to validate these findings and explore future clinical applications.

Abstract as published, via PubMed.