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V41 Confocal laser endomicroscopy in the management of endoscopically treated upper urinary tract urothelial cell carcinoma (UTUC): Preliminary data
V41
Confocal laser endomicroscopy in the management of endoscopically treated upper urinary tract urothelial cell carcinoma (UTUC): Preliminary data Eur Urol Suppl 2016;15(3);eV41
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Villa L. 1 , Cloutier J. 2 , Cotè J-F.3 , Salonia A. 4 , Montorsi F.4 , Traxer O.2 1 Tenon
Hospital, Pierre and Marie Curie University, Paris, France; Division of Experimental Oncology/, Dept. of Urology, Milan, Italy,
2 Tenon
Hospital, Pierre and Marie Curie University, Dept. of Urology, Paris, France, 3 Tenon Hospital, Pierre and Marie Curie University,
Dept. of Pathology, Paris, France, 4 Division of Experimental Oncology/unit of Urology; Uri; Irccs Ospedale San Raffaele; Università Vita, Dept. of Urology, Milan, Italy INTRODUCTION & OBJECTIVES: Confocal Laser Endomiscroscopy (CLE) has been recently described as an innovative and promising endoscopic imaging technology which could help clinicians in the characterisation of urothelial bladder cancer. In the current study we aimed at evaluating the feasibility of using such a device during the endoscopic evaluation and treatment of Upper Urinary Tract Urothelial Cell Carcinoma (UTUC). MATERIAL & METHODS: Preliminary data were analysed from 11 patients with suspicion of UTUC scheduled for flexible Ureteroscopy (URS) and consensual holmium-YAG laser tumour ablation. An endoscopic biopsy of the suspicious lesion was performed at the beginning of the procedure. Subsequently, 5 mL of 10% fluorescein was directly injected into the intrarenal collecting system through the working channel of the digital ureteroscope (URF-V1, Olympus, Japan). CLE was performed using the UroFlexTM B (Cellvizio® system, Mauna Kea Technologies, Paris France), a 3 Fr-diameter flexible probe which allows to obtain microscopic resolution imaging (3.5 um), with a field of view of 325 um and a depth of tissue imaging of 40-70 um. Once UroFlexTM B was placed in contact with the suspicious lesion, the Cellvizio® system started to acquire real-time video sequences, which were simultaneously compared with the endoscopic view and analysed afterwards. RESULTS: A diagnosis of non-invasive papillary urothelial tumour was made at histopathological examination in five (50%) patients. Tissue specimens resulted positive for high-grade and low-grade tumour in one (10%) and four (40%) patients, respectively. Overall, CLE provided reliable images of healthy urothelium when the probe was pointed towards normal tissue, thus depicting superficial cells of different size, probably corresponding to the larger umbrella cells of the surface and the smaller intermediate cells of the deeper layer. By applying soft pressure with the probe on the normal urothelium, the typical structures of lamina propria, such as connective tissue and vascular network, were eventually observed. Moreover, CLE provided good-quality images depicting characteristic features compatible with low-grade tumour including densely packed homogeneous and monomorphic urothelial cells with papillary structure and fibrovascular stalks in patients with low-grade tumours. In the patient with a pathologically-confirmed diagnosis of high-grade UTUC, video sequences analysis revealed the presence of more densely packed urothelial irregularly-shaped cells with distorted microarchitecture, indistinct cell borders and tortuous fibrovascular stalks. Finally, CLE allowed to obtain images compatible with malignant tumours even in the four patients for whom biopsy results were not valid and in the patient with dysplastic alterations. The patient with no tumour findings at biopsy had normal urothelium at CLE as well. CONCLUSIONS: These preliminary data showed the feasibility of CLE technique when applied to the diagnosis of UTUC. Further clinical studies are required to confirm CLE accuracy in distinguishing healthy urothelial tissue from malignant lesions, thus helping clinicians in targeting ureteroscopic biopsy and improving the conservative management of UTUC patients.
Confocal laser endomicroscopy in the management of endoscopically treated upper urinary tract urothelial cell carcinoma (UTUC): Preliminary data Eur Urol Suppl 2016;15(3);eV41
Print! Print!
Villa L. 1 , Cloutier J. 2 , Cotè J-F.3 , Salonia A. 4 , Montorsi F.4 , Traxer O.2 1 Tenon
Hospital, Pierre and Marie Curie University, Paris, France; Division of Experimental Oncology/, Dept. of Urology, Milan, Italy,
2 Tenon
Hospital, Pierre and Marie Curie University, Dept. of Urology, Paris, France, 3 Tenon Hospital, Pierre and Marie Curie University,
Dept. of Pathology, Paris, France, 4 Division of Experimental Oncology/unit of Urology; Uri; Irccs Ospedale San Raffaele; Università Vita, Dept. of Urology, Milan, Italy INTRODUCTION & OBJECTIVES: Confocal Laser Endomiscroscopy (CLE) has been recently described as an innovative and promising endoscopic imaging technology which could help clinicians in the characterisation of urothelial bladder cancer. In the current study we aimed at evaluating the feasibility of using such a device during the endoscopic evaluation and treatment of Upper Urinary Tract Urothelial Cell Carcinoma (UTUC). MATERIAL & METHODS: Preliminary data were analysed from 11 patients with suspicion of UTUC scheduled for flexible Ureteroscopy (URS) and consensual holmium-YAG laser tumour ablation. An endoscopic biopsy of the suspicious lesion was performed at the beginning of the procedure. Subsequently, 5 mL of 10% fluorescein was directly injected into the intrarenal collecting system through the working channel of the digital ureteroscope (URF-V1, Olympus, Japan). CLE was performed using the UroFlexTM B (Cellvizio® system, Mauna Kea Technologies, Paris France), a 3 Fr-diameter flexible probe which allows to obtain microscopic resolution imaging (3.5 um), with a field of view of 325 um and a depth of tissue imaging of 40-70 um. Once UroFlexTM B was placed in contact with the suspicious lesion, the Cellvizio® system started to acquire real-time video sequences, which were simultaneously compared with the endoscopic view and analysed afterwards. RESULTS: A diagnosis of non-invasive papillary urothelial tumour was made at histopathological examination in five (50%) patients. Tissue specimens resulted positive for high-grade and low-grade tumour in one (10%) and four (40%) patients, respectively. Overall, CLE provided reliable images of healthy urothelium when the probe was pointed towards normal tissue, thus depicting superficial cells of different size, probably corresponding to the larger umbrella cells of the surface and the smaller intermediate cells of the deeper layer. By applying soft pressure with the probe on the normal urothelium, the typical structures of lamina propria, such as connective tissue and vascular network, were eventually observed. Moreover, CLE provided good-quality images depicting characteristic features compatible with low-grade tumour including densely packed homogeneous and monomorphic urothelial cells with papillary structure and fibrovascular stalks in patients with low-grade tumours. In the patient with a pathologically-confirmed diagnosis of high-grade UTUC, video sequences analysis revealed the presence of more densely packed urothelial irregularly-shaped cells with distorted microarchitecture, indistinct cell borders and tortuous fibrovascular stalks. Finally, CLE allowed to obtain images compatible with malignant tumours even in the four patients for whom biopsy results were not valid and in the patient with dysplastic alterations. The patient with no tumour findings at biopsy had normal urothelium at CLE as well. CONCLUSIONS: These preliminary data showed the feasibility of CLE technique when applied to the diagnosis of UTUC. Further clinical studies are required to confirm CLE accuracy in distinguishing healthy urothelial tissue from malignant lesions, thus helping clinicians in targeting ureteroscopic biopsy and improving the conservative management of UTUC patients.