PURPOSE: Knowledge on tumor stage and grade is paramount for treatment decision in Upper Urinary Tract Urothelial Carcinoma (UUT-UC), but cannot be accurately assessed by current techniques.
Optical Coherence Tomography (OCT) is a technique, which can hypothetically provide the urologist with real-time intra-operative information on tumor grade and stage. In this pilot study the first results of OCT in grading and staging of UUT-UC are presented.
MATERIAL & METHODS: Eight consecutive patients underwent URS for UUT-UC suspicion or follow-up. OCT datasets were intra-operatively obtained from the ureter and pyelum. All patients eventually underwent nephroureterectomy. OCT staging was performed by visual inspection of lesions found on OCT images and OCT grading by quantification of the OCT signal attenuation (μoct [mm-1]) on lesions and compared with histopathological diagnosis. A Wilcoxon rank sum test was used for statistical analysis.
RESULTS: Seven in-vivo OCT diagnoses on staging were in accordance with histology. In the eighth patient tumor thickness transcended OCT imaging depth range and was therefore inconclusive on invasiveness. For grading, median (interquartile range) μoct for grade 2 lesions was 1.97 mm-1 (1.57-2.30) and 3.53 mm-1 (2.74-3.94) for grade 3 (p-value < 0.001). Healthy urothelium was too thin to reliable determine μoct.
CONCLUSIONS: OCT is a promising minimally invasive tool for real time intra-operative optical diagnostics for tumors in the upper urinary tract. Our study results warrant future research to determine in a larger sample size grading and staging accuracy of OCT and the possible implementation of OCT in the diagnostic algorithm of UUT-UC.
Written by:
Bus MT, Muller BG, de Bruin DM, Faber DJ, Kamphuis GM, van Leeuwen TG, de Reijke TM, de la Rosette JJ. Are you the author?
Department of Urology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam ZO.
Reference: J Urol. 2013 Aug 13. pii: S0022-5347(13)05102-1.
doi: 10.1016/j.juro.2013.08.006
PubMed Abstract
PMID: 23954585
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