1882 OPTICAL COHERENCE TOMOGRAPHY AS AN ADJUNCT TO WHITE LIGHT CYSTOSCOPY FOR INTRAVESICAL REAL-TIME IMAGING AND STAGING OF BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Metastatic Disease + Staging1 Apr 20131882 OPTICAL COHERENCE TOMOGRAPHY AS AN ADJUNCT TO WHITE LIGHT CYSTOSCOPY FOR INTRAVESICAL REAL-TIME IMAGING AND STAGING OF BLADDER CANCER Philip J. Cheng, Guilherme Godoy, Edward J. Sanchez, Alvin C. Goh, Joel W. Slaton, Douglas S. Scherr, and Seth P. Lerner Philip J. ChengPhilip J. Cheng Houston, TX More articles by this author , Guilherme GodoyGuilherme Godoy Houston, TX More articles by this author , Edward J. SanchezEdward J. Sanchez Houston, TX More articles by this author , Alvin C. GohAlvin C. Goh Houston, TX More articles by this author , Joel W. SlatonJoel W. Slaton Minneapolis, MN More articles by this author , Douglas S. ScherrDouglas S. Scherr New York, NY More articles by this author , and Seth P. LernerSeth P. Lerner Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2301AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Optical coherence tomography (OCT) is a novel, real-time endoscopic imaging modality that permits delineation of microarchitectural features of bladder lesions. It may provide an extension of conventional cystoscopy by allowing examination of bladder tissue at a resolution of 10 to 20 μm. The purpose of this study was to assess the application of OCT using the Niris Imaging System® (Imalux Corp., Cleveland, OH) for improving the endoscopic diagnosis and staging accuracy of bladder lesions. A secondary objective was to correlate white light cystoscopic impression with histopathologic stage. METHODS We conducted an investigator-initiated, multicenter prospective trial designed to validate our prior single-center retrospective data (Urology 72:133, 2008) on the use of OCT as an adjunct to conventional cystoscopy. Patients with a history of bladder cancer or hematuria were enrolled in the study. We performed white light cystoscopy and OCT imaging of visible tumors and normal-appearing mucosa prior to biopsy or resection, evaluated the images in real time, and subsequently compared them with pathology results. RESULTS We obtained OCT images of 75 suspicious lesions in 67 patients undergoing bladder biopsy or transurethral resection of bladder tumor. Age of the patients ranged from 45 to 97 years (mean, 70.3 years), with 61 men (91%) and 6 women (9%). White light cystoscopy and OCT were both able to distinguish benign from neoplastic lesions with 100% sensitivity, 25% specificity, and 96% accuracy. OCT correctly identified tumors confined to the mucosa (Ta or Tis) in 48 of 51 lesions with 94% sensitivity, 60% specificity, and 85% accuracy. OCT detected any level of tumor invasion (T1 or higher) in 11 of 16 lesions with 69% sensitivity, 95% specificity, and 89% accuracy. Muscle-invasive tumors (T2) were detected in 2 of 6 lesions with 33% sensitivity, 97% specificity, and 92% accuracy. OCT was able to differentiate malignant from benign lesions with a PPV of 96% and NPV of 100%. PPV for muscle invasion was 50% with a NPV of 94%. CONCLUSIONS OCT is a rapid, easy-to-use tool that can help differentiate Ta and T1 bladder tumors and identify muscle-invasive lesions. This prospective study validates our initial observations suggesting that OCT provides real-time microarchitectural information that can aid in the clinical staging of bladder tumors. Accurate information about stage and depth of invasion may have an impact on the endoscopic surgical management of these lesions. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e772 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philip J. Cheng Houston, TX More articles by this author Guilherme Godoy Houston, TX More articles by this author Edward J. Sanchez Houston, TX More articles by this author Alvin C. Goh Houston, TX More articles by this author Joel W. Slaton Minneapolis, MN More articles by this author Douglas S. Scherr New York, NY More articles by this author Seth P. Lerner Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...