Category: Endoscopic

MP21-11 - Correlation between Confocal laser endomicroscopy (Cellvizio®) and histological grading of upper tract urothelial carcinoma: improving our experience

Sat, Sep 22
2:00 PM - 4:00 PM

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.

Methods :

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.

Results :

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.

Conclusions :

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