Optical Coherence Tomography as a Tool for In Vivo Staging and Grading of Upper Urinary Tract Urothelial Carcinoma: A Study of Diagnostic Accuracy

M T J Bus; D M de Bruin; D J Faber; G M Kamphuis; P J Zondervan; M P Laguna-Pes; T G van Leeuwen; Th M de Reijke; J J M C H de la Rosette

doi:10.1016/j.juro.2016.04.117

Optical Coherence Tomography as a Tool for In Vivo Staging and Grading of Upper Urinary Tract Urothelial Carcinoma: A Study of Diagnostic Accuracy

J Urol. 2016 Dec;196(6):1749-1755. doi: 10.1016/j.juro.2016.04.117. Epub 2016 Jul 27.

Authors

M T J Bus¹, D M de Bruin², D J Faber³, G M Kamphuis⁴, P J Zondervan⁴, M P Laguna-Pes⁴, T G van Leeuwen³, Th M de Reijke⁴, J J M C H de la Rosette⁴

Affiliations

¹ Department of Urology, Academic Medical Center, The Netherlands. Electronic address: m.t.bus@amc.uva.nl.
² Department of Urology, Academic Medical Center, The Netherlands; Department of Biomedical Engineering & Physics, Academic Medical Center, The Netherlands.
³ Department of Biomedical Engineering & Physics, Academic Medical Center, The Netherlands.
⁴ Department of Urology, Academic Medical Center, The Netherlands.

PMID: 27475968
DOI: 10.1016/j.juro.2016.04.117

Abstract

Purpose: Biopsies and cytology are cornerstones in the diagnosis of upper urinary tract urothelial carcinoma. However, a high rate of nondiagnostic biopsies, tumor upgrading and tumor up staging after nephroureterectomy has been observed. In this prospective in vivo study we evaluated the diagnostic accuracy of optical coherence tomography for the grading and staging of upper tract urothelial carcinoma.

Materials and methods: A total of 26 patients underwent diagnostic ureterorenoscopy including biopsies and optical coherence tomography, followed by nephroureterectomy or segmental ureter resection. The sensitivity, specificity, negative predictive value and positive predictive value of upper tract urothelial carcinoma grading and staging by optical coherence tomography were evaluated according to the STARD (Standards for Reporting of Diagnostic Accuracy) initiative and the second stage (2a and 2b) of the IDEAL model. For tumor staging a 2×2 table for sensitivity and specificity was calculated. For tumor grading the Wilcoxon rank sum test was used to test μ_oct in low and high grade lesions followed by ROC analysis for sensitivity and specificity.

Results: In 83% the staging of lesions was in accordance with final histopathology. Sensitivity and specificity analysis for tumor invasion was 100% and 92%, respectively. Tumor size greater than 2 mm and inflammation were risks for false-positives. For low and high grade lesions median μ_oct was 2.1 and 3.0 mm^-1, respectively (p <0.01). ROC analysis showed a sensitivity of 87% and a specificity of 90% using a μ_oct cutoff of 2.4 mm^-1.

Conclusions: This report describes optical coherence tomography as a real-time, intraoperatively diagnostic modality in the diagnostic evaluation of upper tract urothelial carcinoma. We confirmed the ability of optical coherence tomography to visualize, grade and stage urothelial carcinoma in the upper urinary tract.

Keywords: biopsy; carcinoma; diagnosis; optical coherence; sensitivity and specificity; tomography; transitional cell.

MeSH terms

Aged
Carcinoma, Transitional Cell / diagnostic imaging*
Carcinoma, Transitional Cell / pathology*
Female
Humans
Kidney Neoplasms / diagnostic imaging*
Kidney Neoplasms / pathology*
Male
Neoplasm Grading
Neoplasm Staging
Prospective Studies
Tomography, Optical Coherence*
Ureteral Neoplasms / diagnostic imaging*
Ureteral Neoplasms / pathology*