Optical coherence tomography guided cystoscopy in diagnosis and management of clinical bladder tumors

Abstract

15518 Background: Optical coherence tomography (OCT) is a novel tool that permits high-resolution cross-sectional imaging of bladder urothelium during cystoscopy. OCT delineates morphological features of the bladder urothelium, the lamina propria, and the muscularis layer based on their backscattering patterns. We hypothesize that application of microelectromechanical systems (MEMS) mirrors for OCT can improve cross-sectional image resolution of bladder lesions. We report preliminary results from our prospective non-randomized study using MEMS mirror OCT imaging during cystoscopy. Methods: Following our institutional IRB approval, a prospective correlative study was performed evaluating the role of cross-sectional OCT in diagnosis and treatment of bladder cancers. OCT cystoscopy was performed in thirty patients undergoing cystoscopy or transurethral resection for suspected bladder tumors. Any suspicious lesions or tumors seen on cystoscopy were either biopsied or resected as per standard of care. The primary endpoints were patient safety and the correlation between OCT images and histology. Results: Bladder cancer was identified in twenty five patients by pathological evaluation. Twenty four out of twenty five patients were correctly diagnosed with cross-sectional OCT imaging. Four out of five patients with benign lesions were correctly identified. There was one false positive and one false negative in our series. Overall sensitivity and specificity of cross-sectional OCT in diagnosing bladder cancer was 96 and 80%, respectively. There were no complications related to OCT cystoscopy. Axial and lateral resolutions were 10 and 12 microns, respectively. The field of view was measured at 4.5 mm with the depth of penetration measured to be 2 mm. Conclusions: OCT cystoscopy is a promising new tool in diagnosis of bladder cancer. Our preliminary data suggests OCT with MEMS mirrors resulted in high resolution images that may aid in the diagnosis of bladder cancer during cystoscopy. Application of OCT cross sectional imaging may have additional benefits: improved diagnosis, identification of surgical margins, and more complete resection of bladder tumors. No significant financial relationships to disclose.