Confocal Laser Endomicroscopy of Bladder and Upper Tract Urothelial Carcinoma: A New Era of Optical Diagnosis?
- 288 Downloads
Urothelial carcinoma of the bladder and upper tract pose significant diagnostic and therapeutic challenges. White light endoscopy plays a central role in the management of urothelial carcinoma but has several well-recognized shortcomings. New optical imaging technologies may improve diagnostic accuracy, enhance local cancer control, and better stratify treatment options. Confocal laser endomicroscopy enables dynamic imaging of the cellular structures below the mucosal surface and holds promise in providing real time optical diagnosis and grading of urothelial carcinoma. A variety of imaging probes are available that are compatible with the full spectrum of cystoscopes and ureteroscopes. We review the underlying principles and technique of confocal laser endomicroscopy in the urinary tract, with emphasis on specific application towards urothelial carcinoma. While the available data are largely related to urothelial carcinoma of the bladder, the lessons learned are directly applicable to the upper tract, where the clinical needs are significant. Ongoing efforts to optimize this technology offer an exciting glimpse into future advances in optical imaging and intraoperative image guidance.
KeywordsUrothelial carcinoma Bladder cancer Upper tract Optical imaging Microscopy
The authors thank current and past members of the Liao Laboratory, particularly Katherine Wu and Kathy Mach, for technical support and helpful discussions. Funding support was provided in part by Stanford University School of Medicine MedScholars Fellowship (to S.P.C.) and NIH R01 CA160986 (to J.C.L.).
Compliance with Ethics Guidelines
Conflict of Interest
Stephanie P. Chen and Dr. Joseph C. Liao each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2010 incidence and mortality web-based report. (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, 2013).Google Scholar
- 9.Linton KD, Catto JW. Upper tract urothelial carcinoma. J Clin Urol. 2013;6:272–9.Google Scholar
- 13.•Wu K et al. Dynamic real-time microscopy of the urinary tract using confocal laser endomicroscopy. Urology. 2011;78:225–31. This paper describes the suggested optical diagnostic criteria for normal urothelium, benign inflammatory urothelium, low grade urothelial carcinoma, and high grade urothelial carcinoma.PubMedCentralPubMedCrossRefGoogle Scholar
- 28.Elliott DS, Segura JW, Lightner D, Patterson DE, Blute ML. Is nephroureterectomy necessary in all cases of upper tract transitional cell carcinoma? Long-term results of conservative endourologic management of upper tract transitional cell carcinoma in individuals with a normal contralateral kidney. Urology. 2001;58:174–8.PubMedCrossRefGoogle Scholar
- 33.Thiberville L, Salaün M. Bronchoscopic advances: on the way to the cells. Respir Int Rev Thorac Dis. 2010;79:441–9.Google Scholar
- 35.•Chang TC, Liu J-J, Liao JC. Probe-based confocal laser endomicroscopy of the urinary tract: the technique. J Vis Exp JoVE. 2013;e4409. doi: 10.3791/4409. This on-line video paper demonstrates a step-by-step approach of confocal laser endomicroscopy in the lower urinary tract.
- 38.•Chang TC et al. Interobserver agreement of confocal laser endomicroscopy for bladder cancer. J Endourol Endourol Soc. 2013;27:598–603. This paper describes the interobserver agreement of confocal laser endomicroscopy of bladder lesions and provides an updated optical diagnostic criteria.CrossRefGoogle Scholar
- 45.Kiesslich R et al. In vivo histology of Barrett’s esophagus and associated neoplasia by confocal laser endomicroscopy. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2006;4:979–87.Google Scholar