A Pilot Study of In Vivo Confocal Laser Endomicroscopy of Upper Tract Urothelial Carcinoma

Abstract

Purpose: Tissue diagnosis of upper tract urothelial carcinoma (UTUC) is limited by variance in tumor sampling by standard ureteroscopic biopsy. Optical imaging technologies can potentially improve UTUC diagnosis, surveillance, and endoscopic treatment. We previously demonstrated in vivo optical biopsy of urothelial carcinoma of the bladder using confocal laser endomicroscopy (CLE). In this study, we evaluated a new 0.85-mm imaging probe in the upper urinary tract and demonstrated feasibility and compatibility with standard ureteroscopes to achieve in vivo optical biopsy of UTUC. Materials and Methods: Fourteen patients scheduled for ureteroscopy of suspected upper tract lesions or surveillance of UTUC were recruited. After intravenous (IV) administration of fluorescein, CLE was performed using a 0.85-mm-diameter imaging probe inserted through the working channel of standard ureteroscopes. Acquired confocal video sequences were reviewed and analyzed. A mosaicing algorithm was used to compile a series of images into a single larger composite image. Processed CLE images were compared with standard histopathologic analysis. Results: Optical biopsy of the UTUC using CLE was effectively achieved during standard ureteroscopy. There were no adverse events related to IV fluorescein administration or image acquisition. Confocal imaging of UTUC showed characteristic features similar to urothelial carcinoma of the bladder, including papillary structure, fibrovascular stalks, and pleomorphism. Lamina propria in normal areas of the renal pelvis and ureter was also identified. Conclusions: We report an initial feasibility of CLE of UTUC. Pending further clinical investigation, CLE may become a useful adjunct to ureteroscopic biopsy, endoscopic ablation, and surveillance of UTUC.

Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy

“…The 0.85-mm probe was described for CLE of pancreatic cysts through a 19-gauge biopsy needle 21 and upper urinary tract through standard ureteroscopes. 22 The smaller 0.85 mm probe has potential for greater flexibility for intraoperative probe deployment. While inserted through the 12-mm assistant port, both probes were compatible with in-parallel insertion of additional instruments without significant loss of pneumoperitoneum.…”

Enhanced imaging – Neue diagnostische Methoden beim Urothelkarzinom

“…Die CLE zielt darauf ab, zwischen verschiedenen Graden der Urothelkarzinome unterscheiden zu können. Von besonderem Interesse ist die CLE daher bei Urothelkarzinomen des oberen Harntrakts, da hier durch die Unterscheidung zwischen High-grade-und Low-grade-Tumoren auch eine Therapieentscheidung zwischen organerhaltendem Vorgehen oder Nephrektomie beeinflusst wird [21,22]. Die verwendeten 3Ch.-Sonden können durch den Arbeitskanal von flexiblen Ureterorendoskopen eingeführt werden.…”

A felső húgyúti urothel sejtes tumorok kezelése-hasonlóságok és különbségek a húgyhólyag urothelialis tumoraival

“…Az egyre növekvő, ám még csak kísér-leti jelleggel alkalmazott eljárások a biopsziás mintavétel diagnosztikus korlátozottságának javítását célozzák. Ezek közül az optikai koherencia-tomográfia, az endoluminalis ultrahangvizsgálat, a konfokális lézer endomikroszkópia, a multipa ramet rikus MRI, a 11C kolin PET/CT és a nagy felbontású ure tero endoszkópia emelhető ki (16)(17)(18)(19)(20). A két tumortípus diagnosztikus lépései kis különbségektől eltekintve megegyeznek.…”