Volumetric In Vivo Visualization of Upper Urinary Tract Tumors Using Optical Coherence Tomography: A Pilot Study
Volumetric In Vivo Visualization of Upper Urinary Tract Tumors Using Optical Coherence Tomography: A Pilot Study
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DOI：
10.1016/j.juro.2013.08.006
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发表时间：
2013-12-01
影响因子：
6.6
通讯作者：
de la Rosette, Jean J. M. C. H.
中科院分区：
文献类型：
--
作者：
Bus, Mieke T. J.;Muller, Berrend G.;de la Rosette, Jean J. M. C. H.
目的：了解肿瘤分期和分级对于上尿路上皮癌的治疗决策至关重要，但目前的技术无法准确评估这种情况。光学相干断层扫描可以提供泌尿科医生实时术中信息的肿瘤分级和阶段。在这项试点研究中，我们报告了什么是我们所知的第一个结果的光学相干断层扫描分级和分期上尿路上皮carcinoma.Materials和方法：8例连续进行输尿管肾镜检查怀疑或随访上尿路上皮carcinoma。术中从输尿管和肾盂获得光学相干断层扫描数据集。所有患者最终均行肾输尿管切除术。通过光学相干断层扫描图像上发现的病变进行光学相干断层扫描分期。光学相干断层扫描分级通过量化病变上光学相干断层扫描信号衰减（单位：mm（1））并将结果与组织病理学诊断进行比较来完成。结果：7例活体光学相干断层扫描诊断与组织学分期一致。在患者8中，肿瘤厚度超出光学相干断层扫描成像深度范围，因此，侵袭性结果不确定。对于分级，2级和3级病变的中位衰减系数分别为1.97（IQR 1.57-2.30）和3.53 mm（-1）（IQR 2.74-3.94）（p < 0.001）。健康的尿道太薄，可靠地确定衰减coefficients.Conclusions：光学相干断层扫描是一个很有前途的，微创的工具，实时术中光学诊断上尿路肿瘤。我们的研究结果保证未来的研究在更大的样本量，以确定分级和分期的准确性，光学相干断层扫描，其可能的实施上尿路尿路上皮癌的诊断算法。
Purpose: Knowledge of tumor stage and grade is paramount for treatment decision making in cases of upper urinary tract urothelial carcinoma but this condition cannot be accurately assessed by current techniques. Optical coherence tomography can hypothetically provide the urologist with real-time intraoperative information on tumor grade and stage. In this pilot study we report what are to our knowledge the first results of optical coherence tomography for grading and staging upper urinary tract urothelial carcinoma.Materials and Methods: Eight consecutive patients underwent ureterorenoscopy for suspicion or followup of upper urinary tract urothelial carcinoma. Optical coherence tomography data sets were intraoperatively obtained from the ureter and renal pelvis. All patients eventually underwent nephroureterectomy. Optical coherence tomography staging was done by visual inspection of lesions found on optical coherence tomography images. Optical coherence tomography grading was done by quantifying optical coherence tomography signal attenuation in mm (1) on lesions and comparing results with the histopathological diagnosis. The Wilcoxon rank sum test was used for statistical analysis.Results: For 7 in vivo optical coherence tomography diagnoses staging was in accordance with histology. In patient 8 tumor thickness transcended optical coherence tomography imaging depth range and, therefore, invasiveness findings were inconclusive. For grading the median attenuation coefficient for grade 2 and 3 lesions was 1.97 (IQR 1.57-2.30) and 3.53 mm(-1) (IQR 2.74-3.94), respectively (p < 0.001). Healthy urothelium was too thin to reliably determine the attenuation coefficient.Conclusions: Optical coherence tomography is a promising, minimally invasive tool for real-time intraoperative optical diagnosis of tumors in the upper urinary tract. Our results warrant future research in a larger sample size to determine the accuracy of grading and staging by optical coherence tomography, and its possible implementation in the diagnostic algorithm for upper urinary tract urothelial carcinoma.