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2149 USE OF OPTICAL COHERENCE TOMOGRAPHY IMAGING TO DIFFERENTIATE BENIGN AND MALIGNANT RENAL MASSES
Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010
RESULTS: A total of 22 patients completed the study. Twenty (91%) were diagnosed with an upper tract stone by radiographic findings. MRU detected a discrete stone in 50% of patients with stones seen by CT. Perinephric fluid was noted in 12 MRUs, compared to 7 CTs. Using CT as the reference standard, the combination of stone, perinephric fluid, and ureteral dilation gave MRU a sensitivity of 89%, specificity of 100%, and accuracy of 94%. CONCLUSIONS: HASTE MRU with a 3 Tesla MR scanner can reliably detect the presence of upper urinary tract obstruction. Although CT imaging remains the superior modality with which to detect calculi, MRU detects a greater number of secondary signs of upper tract obstruction. For situations in which the use of ionizing radiation is undesirable, MRU is a reasonable imaging alternative. Source of Funding: None
2148 DOES CHOICE OF IMAGING MODALITY AND USER EXPERIENCE FOR PERCUTANEOUS NEPHROSTOMY TUBE PLACEMENT IMPACT COMPLICATIONS? Ervin Teper*, Erich Lang, Ernest Rudman, Ivan Colon, Brooklyn, NY; Raju Thomas, Leann Myers, New Orleans, LA; Mohamad Allaf, Baltimore, MD INTRODUCTION AND OBJECTIVES: To analyze the impact of guidance methods such as fluoroscopy, CT scan and ultrasound, as well as the experience of the operator on the occurrence and type of complications seen with percutaneous nephrostomy placement. METHODS: From 1995 to 2007, 1763 percutaneous nephrostomies (PCN) (non-access tract procedures for planned percutaneous surgery) were performed on 1658 patients at three major metropolitan hospital centers. 1022/1658 (61.6%) were male, 614/1658 (37%) were female, and 22/1658 (1.3%) were children (range 2 months to 87 years). Standard trocar or needle guide-wire exchange access was used. RESULTS: Underlying pathology necessitating PCN were obstruction by non infected stones (426), neoplasms (297), urosepsis (343), stones and UTI (634), strictures (36), and diagnostic (27). With fluoroscopic guidance experienced operators (⬎20 procedures, mean of 178) had 11 complications in 862 patients (1.3%) (9 bleeds, 2 leaks); one patient mandated acute intervention. Using fluoroscopic guidance inexperienced operators (⬍20 procedures, mean of 5.6) incurred 37 complications in 218 patients (17%) (31 bleeds, 11 leaks), ten patients required acute intervention (embolization or surgery). With CT or US guidance experienced operators had 14 complications in 229 patients (6.1%) (10 bleeds, 4 leaks); four patients required intervention. Inexperienced operators had 88 complications in 454 patients (19.4%) (64 bleeds, 34 leaks); 31 patients necessitated intervention. 14/22 (63.6%) of major complications occurred with the use of using CT or US guidance by inexperienced operators; as did the two observed fatalities. CONCLUSIONS: Based on the data presented above, fluoroscopic guided PCN appears to have fewer complications than CT or US guided. Training trends do influence choice of imaging modalities. As might be expected, experience of the operator is a major factor impacting on procedure-associated complications, thus emphasizing the need for close supervision of trainees, and junior associates.
THE JOURNAL OF UROLOGY姞
e835
technique which can potentially provide immediate diagnosis of renal neoplasms. OCT generates cross sectional images using near infrared light and can be built into handheld, laparoscopic, and needle probes. OCT has not been utilized to image renal neoplasms to date. We sought to assess the feasibility of using OCT to differentiate normal and neoplastic renal tissue. METHODS: 20 subjects undergoing radical or partial nephrectomy for suspected malignancy participated in the study. After surgical resection, specimens were sampled with tissue obtained from neoplastic areas and matched adjacent normal parenchyma. Samples were evaluated using a custom OCT system with a lateral resolution of 10 um, an axial resolution of 4 um, and a depth of penetration of 2mm using an 890 nm wavelength light source. Each sample was then fixed and evaluated using standard light microscopy. Assessment of the ability of OCT to differentiate neoplastic from normal tissue, different subtypes of renal malignancies, and benign versus malignant neoplasms was performed. RESULTS: Pathologic subtypes included 8 clear cell, 3 papillary, and 2 chromophobe renal cancers; 2 oncocytomas; 1 angiomyolipoma (AML); 2 transitional cell cancers (TCC); and 1 well organized hematoma. When evaluated with OCT imaging, benign renal parenchyma had a characteristic homogeneous appearance with recognizable glomeruli and vasculature. Clear cell renal cancer lacked recognizable anatomic elements with a heterogenous appearance depending on the presence of necrotic elements and tumor grade. Subtypes of renal cancer including papillary and chromophobe appeared to vary from clear cell although discrimination was difficult. TCC was easily distinguished. AML demonstrated a unique signature on OCT due to its fat content. Oncocytoma had a lobulated appearance which was characteristic and distinguishable from other renal neoplasms. CONCLUSIONS: In this pilot study, OCT imaging for renal neoplasms was most successful in distinguishing AML, oncocytoma, and TCC from normal parenchyma and malignant tumors. Clear cell tumors and other renal cancer subtypes had a more heterogenous appearance and higher resolution versions of OCT may be needed to allow reliable diagnosis.
Source of Funding: None
Source of Funding: None
2150 2149 USE OF OPTICAL COHERENCE TOMOGRAPHY IMAGING TO DIFFERENTIATE BENIGN AND MALIGNANT RENAL MASSES
ASSESSMENT OF RENAL OXYGENATION DURING PARTIAL NEPHRECTOMY USING DLP® HYPERSPECTRAL IMAGING
Jennifer A Linehan*, Tucson, AZ; Lida P Hariri, Boston, MA; Mitchell H Sokoloff, Photini S Rice, Erika R Bracamonte, Jennifer K Barton, Mike M Nguyen, Tucson, AZ
Michael Holzer*, Sara Best, Saad Mir, Chester Donnally, Neil Jackson, Shekar Rao, Dallas, TX; Abhas Thapas, Eleanor Wehner, Arlington, TX; Edward Livingston, Ganesh Raj, Jeffrey Cadeddu, Dallas, TX; Karel Zuzak, Arlington, TX
INTRODUCTION AND OBJECTIVES: Optical coherence tomography (OCT) represents a novel high resolution, real-time, imaging
INTRODUCTION AND OBJECTIVES: While the absolute time of ischemia that the kidney can recover from during partial nephrec-
RESULTS: A total of 22 patients completed the study. Twenty (91%) were diagnosed with an upper tract stone by radiographic findings. MRU detected a discrete stone in 50% of patients with stones seen by CT. Perinephric fluid was noted in 12 MRUs, compared to 7 CTs. Using CT as the reference standard, the combination of stone, perinephric fluid, and ureteral dilation gave MRU a sensitivity of 89%, specificity of 100%, and accuracy of 94%. CONCLUSIONS: HASTE MRU with a 3 Tesla MR scanner can reliably detect the presence of upper urinary tract obstruction. Although CT imaging remains the superior modality with which to detect calculi, MRU detects a greater number of secondary signs of upper tract obstruction. For situations in which the use of ionizing radiation is undesirable, MRU is a reasonable imaging alternative. Source of Funding: None
2148 DOES CHOICE OF IMAGING MODALITY AND USER EXPERIENCE FOR PERCUTANEOUS NEPHROSTOMY TUBE PLACEMENT IMPACT COMPLICATIONS? Ervin Teper*, Erich Lang, Ernest Rudman, Ivan Colon, Brooklyn, NY; Raju Thomas, Leann Myers, New Orleans, LA; Mohamad Allaf, Baltimore, MD INTRODUCTION AND OBJECTIVES: To analyze the impact of guidance methods such as fluoroscopy, CT scan and ultrasound, as well as the experience of the operator on the occurrence and type of complications seen with percutaneous nephrostomy placement. METHODS: From 1995 to 2007, 1763 percutaneous nephrostomies (PCN) (non-access tract procedures for planned percutaneous surgery) were performed on 1658 patients at three major metropolitan hospital centers. 1022/1658 (61.6%) were male, 614/1658 (37%) were female, and 22/1658 (1.3%) were children (range 2 months to 87 years). Standard trocar or needle guide-wire exchange access was used. RESULTS: Underlying pathology necessitating PCN were obstruction by non infected stones (426), neoplasms (297), urosepsis (343), stones and UTI (634), strictures (36), and diagnostic (27). With fluoroscopic guidance experienced operators (⬎20 procedures, mean of 178) had 11 complications in 862 patients (1.3%) (9 bleeds, 2 leaks); one patient mandated acute intervention. Using fluoroscopic guidance inexperienced operators (⬍20 procedures, mean of 5.6) incurred 37 complications in 218 patients (17%) (31 bleeds, 11 leaks), ten patients required acute intervention (embolization or surgery). With CT or US guidance experienced operators had 14 complications in 229 patients (6.1%) (10 bleeds, 4 leaks); four patients required intervention. Inexperienced operators had 88 complications in 454 patients (19.4%) (64 bleeds, 34 leaks); 31 patients necessitated intervention. 14/22 (63.6%) of major complications occurred with the use of using CT or US guidance by inexperienced operators; as did the two observed fatalities. CONCLUSIONS: Based on the data presented above, fluoroscopic guided PCN appears to have fewer complications than CT or US guided. Training trends do influence choice of imaging modalities. As might be expected, experience of the operator is a major factor impacting on procedure-associated complications, thus emphasizing the need for close supervision of trainees, and junior associates.
THE JOURNAL OF UROLOGY姞
e835
technique which can potentially provide immediate diagnosis of renal neoplasms. OCT generates cross sectional images using near infrared light and can be built into handheld, laparoscopic, and needle probes. OCT has not been utilized to image renal neoplasms to date. We sought to assess the feasibility of using OCT to differentiate normal and neoplastic renal tissue. METHODS: 20 subjects undergoing radical or partial nephrectomy for suspected malignancy participated in the study. After surgical resection, specimens were sampled with tissue obtained from neoplastic areas and matched adjacent normal parenchyma. Samples were evaluated using a custom OCT system with a lateral resolution of 10 um, an axial resolution of 4 um, and a depth of penetration of 2mm using an 890 nm wavelength light source. Each sample was then fixed and evaluated using standard light microscopy. Assessment of the ability of OCT to differentiate neoplastic from normal tissue, different subtypes of renal malignancies, and benign versus malignant neoplasms was performed. RESULTS: Pathologic subtypes included 8 clear cell, 3 papillary, and 2 chromophobe renal cancers; 2 oncocytomas; 1 angiomyolipoma (AML); 2 transitional cell cancers (TCC); and 1 well organized hematoma. When evaluated with OCT imaging, benign renal parenchyma had a characteristic homogeneous appearance with recognizable glomeruli and vasculature. Clear cell renal cancer lacked recognizable anatomic elements with a heterogenous appearance depending on the presence of necrotic elements and tumor grade. Subtypes of renal cancer including papillary and chromophobe appeared to vary from clear cell although discrimination was difficult. TCC was easily distinguished. AML demonstrated a unique signature on OCT due to its fat content. Oncocytoma had a lobulated appearance which was characteristic and distinguishable from other renal neoplasms. CONCLUSIONS: In this pilot study, OCT imaging for renal neoplasms was most successful in distinguishing AML, oncocytoma, and TCC from normal parenchyma and malignant tumors. Clear cell tumors and other renal cancer subtypes had a more heterogenous appearance and higher resolution versions of OCT may be needed to allow reliable diagnosis.
Source of Funding: None
Source of Funding: None
2150 2149 USE OF OPTICAL COHERENCE TOMOGRAPHY IMAGING TO DIFFERENTIATE BENIGN AND MALIGNANT RENAL MASSES
ASSESSMENT OF RENAL OXYGENATION DURING PARTIAL NEPHRECTOMY USING DLP® HYPERSPECTRAL IMAGING
Jennifer A Linehan*, Tucson, AZ; Lida P Hariri, Boston, MA; Mitchell H Sokoloff, Photini S Rice, Erika R Bracamonte, Jennifer K Barton, Mike M Nguyen, Tucson, AZ
Michael Holzer*, Sara Best, Saad Mir, Chester Donnally, Neil Jackson, Shekar Rao, Dallas, TX; Abhas Thapas, Eleanor Wehner, Arlington, TX; Edward Livingston, Ganesh Raj, Jeffrey Cadeddu, Dallas, TX; Karel Zuzak, Arlington, TX
INTRODUCTION AND OBJECTIVES: Optical coherence tomography (OCT) represents a novel high resolution, real-time, imaging
INTRODUCTION AND OBJECTIVES: While the absolute time of ischemia that the kidney can recover from during partial nephrec-