New optical imaging technologies for bladder cancer: Considerations and perspectives

Jen-Jane Liu, Michael J. Droller, Joseph C. Liao

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Purpose: Bladder cancer presents as a spectrum of different diatheses. Accurate assessment for individualized treatment depends on initial diagnostic accuracy. Detection relies on white light cystoscopy accuracy and comprehensiveness. Aside from invasiveness and potential risks, white light cystoscopy shortcomings include difficult flat lesion detection, precise tumor delineation to enable complete resection, inflammation and malignancy differentiation, and grade and stage determination. Each shortcoming depends on surgeon ability and experience with the technology available for visualization and resection. Fluorescence cystoscopy/photodynamic diagnosis, narrow band imaging, confocal laser endomicroscopy and optical coherence tomography address the limitations and have in vivo feasibility. They detect suspicious lesions (photodynamic diagnosis and narrow band imaging) and further characterize lesions (optical coherence tomography and confocal laser endomicroscopy). We analyzed the added value of each technology beyond white light cystoscopy and evaluated their maturity to alter the cancer course. Materials and Methods: Detailed PubMed® searches were done using the terms "fluorescence cystoscopy," "photodynamic diagnosis," "narrow band imaging," "optical coherence tomography" and "confocal laser endomicroscopy" with "optical imaging," "bladder cancer" and "urothelial carcinoma." Diagnostic accuracy reports and all prospective studies were selected for analysis. We explored technological principles, preclinical and clinical evidence supporting nonmuscle invasive bladder cancer detection and characterization, and whether improved sensitivity vs specificity translates into improved correlation of diagnostic accuracy with recurrence and progression. Emerging preclinical technologies with potential application were reviewed. Results: Photodynamic diagnosis and narrow band imaging improve nonmuscle invasive bladder cancer detection, including carcinoma in situ. Photodynamic diagnosis identifies more papillary lesions than white light cystoscopy, enabling more complete resection and fewer residual tumors. Despite improved treatment current data on photodynamic diagnosis do not support improved high risk diathetic detection and characterization or correlation with disease progression. Prospective recurrence data are lacking on narrow band imaging. Confocal laser endomicroscopy and optical coherence tomography potentially grade and stage lesions but data are lacking on diagnostic accuracy. Several emerging preclinical technologies may enhance the diagnostic capability of endoscopic imaging. Conclusions: New optical imaging technologies may improve bladder cancer detection and characterization, and transurethral resection quality. While data on photodynamic diagnosis are strongest, the clinical effectiveness of these technologies is not proven. Prospective studies are needed, particularly of narrow band imaging, confocal laser endomicroscopy and optical coherence tomography. As each technology matures and new ones emerge, cost-effectiveness analysis must be addressed in the context of the various bladder cancer types.

Original languageEnglish (US)
Pages (from-to)361-368
Number of pages8
JournalJournal of Urology
Volume188
Issue number2
DOIs
StatePublished - Aug 2012
Externally publishedYes

Fingerprint

Narrow Band Imaging
Optical Imaging
Cystoscopy
Urinary Bladder Neoplasms
Optical Coherence Tomography
Technology
Lasers
Light
Fluorescence
Prospective Studies
Recurrence
Neoplasms
Disease Susceptibility
Carcinoma in Situ
Residual Neoplasm
PubMed
Cost-Benefit Analysis
Disease Progression
Inflammation
Carcinoma

Keywords

  • cystoscopy
  • fluorescence
  • lasers
  • optical coherence
  • tomography
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

New optical imaging technologies for bladder cancer : Considerations and perspectives. / Liu, Jen-Jane; Droller, Michael J.; Liao, Joseph C.

In: Journal of Urology, Vol. 188, No. 2, 08.2012, p. 361-368.

Research output: Contribution to journalArticle

Liu, Jen-Jane ; Droller, Michael J. ; Liao, Joseph C. / New optical imaging technologies for bladder cancer : Considerations and perspectives. In: Journal of Urology. 2012 ; Vol. 188, No. 2. pp. 361-368.
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