New optical imaging technologies for bladder cancer: considerations and perspectives.
New optical imaging technologies for bladder cancer: considerations and perspectives.
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DOI：
10.1016/j.juro.2012.03.127
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发表时间：
2012-08
影响因子：
6.6
通讯作者：
Liao, Joseph C.
中科院分区：
文献类型：
--
作者：
Liu, Jen-Jane;Droller, Michael J.;Liao, Joseph C.
膀胱癌表现为一系列不同的素质。个体化治疗的准确评估取决于初始诊断的准确性。检测依赖于白色光膀胱镜检查的准确性和全面性。除了侵入性和潜在风险外，白色光膀胱镜检查的缺点包括难以进行平坦病变检测、精确的肿瘤勾画以实现完全切除、炎症和恶性肿瘤的区分以及分级和分期确定。每一个缺点都取决于外科医生的能力和对可视化和切除技术的经验。荧光膀胱镜/光动力学诊断、窄带成像、共聚焦激光显微内镜和光学相干断层扫描解决了局限性，并具有体内可行性。它们检测可疑病变（光动力学诊断和窄带成像），并进一步表征病变（光学相干断层扫描和共聚焦激光显微内镜）。我们分析了每种技术在白色光膀胱镜检查之外的附加值，并评估了它们改变癌症进程的成熟度。使用术语“荧光膀胱镜检查”、“光动力学诊断”、“窄带成像”、“光学相干断层扫描”和“共焦激光显微内镜检查”与“光学成像”、“膀胱癌”和“尿路上皮癌”进行详细的PubMed®检索。选择诊断准确性报告和所有前瞻性研究进行分析。我们探讨了支持非肌层浸润性膀胱癌检测和表征的技术原理、临床前和临床证据，以及灵敏度与特异性的提高是否转化为诊断准确性与复发和进展的相关性的提高。综述了具有潜在应用价值的临床前新技术。光动力学诊断和窄带成像提高了非肌层浸润性膀胱癌的检测，包括原位癌。光动力学诊断比白色光膀胱镜检查识别出更多的乳头状病变，从而实现更完整的切除和更少的残留肿瘤。尽管改善了治疗，但目前关于光动力学诊断的数据不支持改善高风险素质检测和表征或与疾病进展的相关性。窄带成像缺乏前瞻性复发数据。共聚焦激光显微内镜和光学相干断层扫描可能对病变进行分级和分期，但缺乏诊断准确性的数据。几种新兴的临床前技术可能会增强内窥镜成像的诊断能力。新的光学成像技术可能会改善膀胱癌的检测和表征，以及经尿道切除术的质量。虽然光动力学诊断的数据是最强的，但这些技术的临床有效性尚未得到证实。需要进行前瞻性研究，特别是窄带成像、共焦激光显微内镜和光学相干断层扫描。随着每种技术的成熟和新技术的出现，必须在各种膀胱癌类型的背景下进行成本效益分析。
Bladder cancer presents as a spectrum of different diatheses. Accurate assessment for individualized treatment depends on initial diagnostic accuracy. Detection relies on white light cystoscopy accuracy and comprehensiveness. Aside from invasiveness and potential risks, white light cystoscopy shortcomings include difficult flat lesion detection, precise tumor delineation to enable complete resection, inflammation and malignancy differentiation, and grade and stage determination. Each shortcoming depends on surgeon ability and experience with the technology available for visualization and resection. Fluorescence cystoscopy/photodynamic diagnosis, narrow band imaging, confocal laser endomicroscopy and optical coherence tomography address the limitations and have in vivo feasibility. They detect suspicious lesions (photodynamic diagnosis and narrow band imaging) and further characterize lesions (optical coherence tomography and confocal laser endomicroscopy). We analyzed the added value of each technology beyond white light cystoscopy and evaluated their maturity to alter the cancer course. Detailed PubMed® searches were done using the terms “fluorescence cystoscopy,” “photodynamic diagnosis,” “narrow band imaging,” “optical coherence tomography” and “confocal laser endomicroscopy” with “optical imaging,” “bladder cancer” and “urothelial carcinoma.” Diagnostic accuracy reports and all prospective studies were selected for analysis. We explored technological principles, preclinical and clinical evidence supporting nonmuscle invasive bladder cancer detection and characterization, and whether improved sensitivity vs specificity translates into improved correlation of diagnostic accuracy with recurrence and progression. Emerging preclinical technologies with potential application were reviewed. Photodynamic diagnosis and narrow band imaging improve nonmuscle invasive bladder cancer detection, including carcinoma in situ. Photodynamic diagnosis identifies more papillary lesions than white light cystoscopy, enabling more complete resection and fewer residual tumors. Despite improved treatment current data on photodynamic diagnosis do not support improved high risk diathetic detection and characterization or correlation with disease progression. Prospective recurrence data are lacking on narrow band imaging. Confocal laser endomicroscopy and optical coherence tomography potentially grade and stage lesions but data are lacking on diagnostic accuracy. Several emerging preclinical technologies may enhance the diagnostic capability of endoscopic imaging. New optical imaging technologies may improve bladder cancer detection and characterization, and transurethral resection quality. While data on photodynamic diagnosis are strongest, the clinical effectiveness of these technologies is not proven. Prospective studies are needed, particularly of narrow band imaging, confocal laser endomicroscopy and optical coherence tomography. As each technology matures and new ones emerge, cost-effectiveness analysis must be addressed in the context of the various bladder cancer types.
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