Introduction & Objective :
Due to the growing interest in the conservative management of upper tract urothelial carcinoma (UTUC), there is a need for accurate tools that offer a real-time diagnosis to decide which is the best treatment in the same surgical act. Confocal laser endomicroscopy (CLE) provides in vivo microscopic images of tissues using a low-energy laser light source. The aim of the study is to describe how our experience has been improving with CLE for the characterization of UTUC.
22 flexible ureteroscopies (fURS) [Karl Storz, Tuttlingen, Germany] were performed at our center with CLE for UTUC. Lesions were pre-operatively identified at CT-IVU. Cellvizio® system was used on the targeted lesions ex vivo after the biopsy with fURS. Surgeon’s CLE readings (low-grade and/or high-grade and/or CIS) were documented in the operation notes. A dedicated genitourinary pathologist -blinded to the surgeon reading- examined all specimens. A third person collected prospectively the CLE readings and the histopathological reports. Cohen’s Kappa analysis was performed to test inter-observer agreement.
Mean diameter of tumors at CT scan was 20 mm (range 5-70 mm). In 11 patients CLE allowed to obtain images with characteristic features compatible with low-grade (LG) UTUC; in 10 patients with high grade (HG) UTUC, and in 1 case CIS was identified. We found correspondence between the CLE images and the final histopathological results in 9/11 cases of LG UTUC (83%), in 9/10 cases of HG UTUC (90%), in 1/1 case of CIS (100%). Substantial agreement was found at inter-observer agreement (86.3%, k=0.73). Neither complications nor limitations related to the use of CLE were recorded.
In this study we find that CLE using the Cellvizio® system seems to help the clinician to have a real-time cytological characterization of UTUC lesions. This could be crucial for the therapeutic decision making process.
Angelo Territo– licata, Sicilia, Italy
Alberto Breda– Barcelona, Catalonia, Spain
Helena Vila-Reyes– Barcelona, Catalonia, Spain
Giuseppe Basile– Reggio Calabria, Calabria, Italy
Paolo Corsi– Verona, Veneto, Italy
Federica Regis– catania, Sicilia, Italy
Jose Subiela– Barcelona, Catalonia, Spain
Jose maria Gaya– Barcelona, Catalonia, Spain
Francesco Sanguedolce– Barcelona, Catalonia, Spain
Ferran Algaba– Barcelona, Catalonia, Spain
Joan Palou– Chairman of Urology Departmentt at Fundacio Puigvert. Chair of the European School of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain, Barcelona, Catalonia, Spain