{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T02:44:26Z","timestamp":1782787466838,"version":"3.54.5"},"reference-count":15,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,6]]},"abstract":"\n Objectives<\/jats:title>\n \n To evaluate the feasibility of\n ex vivo<\/jats:italic>\n fluorescence confocal microscopy (FCM) for real\u2010time assessment of ureteroscopic biopsy specimen adequacy in patients with suspected upper tract urothelial carcinoma (UTUC).\n <\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n \n In this prospective, single\u2010centre feasibility study, four ureteroscopic biopsy specimens obtained from two patients undergoing evaluation for suspected UTUC were analysed using\n ex vivo<\/jats:italic>\n FCM. Specimens were briefly stained with acridine orange, scanned within 50\u201360\u2009s, and images were stored for deferred review. A board\u2010certified genitourinary pathologist reviewed the FCM images in a blinded fashion and classified specimens as adequate or non\u2010representative based on a pre\u2010defined criterion of identifiable urothelial tissue. All specimens subsequently underwent routine haematoxylin and eosin (H&E) histopathological analysis for confirmation.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Ex vivo<\/jats:italic>\n FCM was successfully performed on all specimens without workflow interruption, with total preparation and image acquisition completed within approximately 5\u2009min\/specimen. Blinded FCM review identified urothelial tissue in three of four biopsy specimens, which were classified as adequate, while one specimen was composed predominantly of blood clot with only minimal, non\u2010diagnostic cellular material and was therefore classified as non\u2010representative. FCM\u2010based adequacy assessments were concordant with corresponding H&E sections. Final histopathology demonstrated non\u2010invasive papillary UC, high grade in one patient and low grade in the other; the non\u2010representative specimen showed only focal atypical papillary urothelial proliferation admixed within the blood clot.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Ex vivo<\/jats:italic>\n FCM was feasible for immediate imaging of freshly obtained ureteroscopic biopsy specimens and allowed identification of urothelial\u2010containing 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\u2010time assessment of biopsy adequacy in UTUC, including correlation with final histopathological grade and stage.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bju.70290","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:14:47Z","timestamp":1776384887000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ex vivo<\/i>\n fluorescence confocal microscopy for assessment of ureteroscopic biopsy adequacy in upper tract urothelial carcinoma"],"prefix":"10.1111","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5426-9867","authenticated-orcid":false,"given":"Karim","family":"Daher","sequence":"first","affiliation":[{"name":"Glickman Urological Institute Cleveland Clinic Cleveland OH 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