Endoscopic

Moderated Poster Session

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

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 243

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

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    Alberto Breda

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      Helena Vila-Reyes

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        Giuseppe Basile

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          Paolo Corsi

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            Federica Regis

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              Jose Subiela

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                Jose maria Gaya

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                  Francesco Sanguedolce

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                    Ferran Algaba

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                      Joan Palou

                      Chairman of Urology Departmentt at Fundacio Puigvert. Chair of the European School of Urology
                      Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain

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



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