Novel real-time optical imaging modalities for the detection of neoplastic lesions in urology: a systematic review

Abstract

Background Current optical diagnostic techniques for malignancies are limited in their diagnostic accuracy and lack the ability to further characterise disease, leading to the rapidly increasing development of novel imaging methods within urology. This systematic review critically appraises the literature for novel imagining modalities, in the detection and staging of urological cancer and assesses their effectiveness via their utility and accuracy. Methods A systematic literature search utilising MEDLINE, EMBASE and Cochrane Library Database was conducted from 1970 to September 2018 by two independent reviewers. Studies were included if they assessed real-time imaging modalities not already approved in guidelines, in vivo and in humans. Outcome measures included diagnostic accuracy and utility parameters, including feasibility and cost. Results Of 5475 articles identified from screening, a final 46 were included. Imaging modalities for bladder cancer included optical coherence tomography (OCT), confocal laser endomicroscopy, autofluorescence and spectroscopic techniques. OCT was the most widely investigated, with 12 studies demonstrating improvements in overall diagnostic accuracy (sensitivity 74.5–100% and specificity 60–98.5%). Upper urinary tract malignancy diagnosis was assessed using photodynamic diagnosis (PDD), narrow band imaging, optical coherence tomography and confocal laser endomicroscopy. Only PDD demonstrated consistent improvements in overall diagnostic accuracy in five trials (sensitivity 94–96% and specificity 96.6–100%). Limited evidence for optical coherence tomography in percutaneous renal biopsy was identified, with anecdotal evidence for any modality in penile cancer. Conclusions Evidence supporting the efficacy for identified novel imaging modalities remains limited at present. However, OCT for bladder cancer and PDD in upper tract malignancy demonstrate the best potential for improvement in overall diagnostic accuracy. OCT may additionally aid intraoperative decision making via real-time staging of disease. Both modalities require ongoing investigation through larger, well-conducted clinical trials to assess their diagnostic accuracy, use as an intraoperative staging aid and how to best utilise them within clinical practice.

The Accuracy of Confocal Laser Endomicroscopy in Diagnosing Bladder Cancer: A Systematic Review & Meta-Analyses

“…A systematic review was conducted by Brunckhorst et al [23]. However, the systematic review was superficial in reviewing CLE's performance in diagnosing bladder cancer, as only one study was included, which reported a proper effect estimate of diagnostic study in the form of sensitivity and specificity [23]. On this basis, the current study attempts to re-explore the performance of CLE in diagnosing bladder cancer, which has never been comprehensively reported before.…”

“…A systematic review was conducted by Brunckhorst et al [23]. However, the systematic review was superficial in reviewing CLE's performance in diagnosing bladder cancer, as only one study was included, which reported a proper effect estimate of diagnostic study in the form of sensitivity and specificity [23].…”

Advances in Diagnosis and Therapy for Bladder Cancer

“…Some optical biopsy techniques, including optical coherence tomography (OCT) and confocal laser endomicroscopy (CLE), involve specific wavelengths of light and cystoscopy in dynamic real-time images of tissue for the surveillance of BCa [19,20]. Sonn et al TURBT combined with PDD can maximize the tumor resection rate to reduce the recurrence of BCa.…”

“…Some optical biopsy techniques, including optical coherence tomography (OCT) and confocal laser endomicroscopy (CLE), involve specific wavelengths of light and cystoscopy in dynamic real-time images of tissue for the surveillance of BCa [19,20]. Sonn et al suggested that CLE is an effective aid to cystoscopy using dye fluorescein and light from a Cancers 2022, 14, 3181 4 of 33 488 nm laser fiber optic source to provide real-time dynamic images of malignant cells and normal tissues [21].…”

In vivo Raman spectroscopy for bladder cancer detection using a superficial Raman probe compared to a nonsuperficial Raman probe

“…Generally, the detection of bladder cancer is performed using white light cystoscopy, which has a limited sensitivity (62%-82%) and specificity (43%-98%) [3][4][5].…”