Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York 11794, USA.
J Urol. 2010 Oct;184(4):1499-506. doi: 10.1016/j.juro.2010.05.087. Epub 2010 Aug 17.
We examined the usefulness of 3-dimensional optical coherence tomography to enhance the diagnosis of urothelial carcinoma in situ.
By expressing SV40T antigen with uroplakin II promoter, carcinoma in situ readily develops in SV40T transgenic mice at about ages 8 to 20 weeks and then frank high grade papillary carcinoma develops in bladder epithelium. We examined 10 control and 40 SV40T mice during weeks 8 to 20 after birth by parallel en face white light imaging and 3-dimensional optical coherence tomography, and compared results with histology findings. We applied quantitative analysis of computer aided detection to 3-dimensional tomography images to enhance the diagnosis of carcinoma in situ, including 3-dimensional segmentation, speckle reduction, fast Fourier transform analysis, and standard deviation and histogram evaluation.
We identified carcinoma in situ in 23 SV40T mice by histology. Most carcinoma could not be detected by en face imaging and 2-dimensional optical coherence tomography but was well differentiated by 3-dimensional optical coherence tomography. The 56.5% sensitivity and 61.5% specificity of 2-dimensional optical coherence tomography for carcinoma in situ diagnosis were significantly enhanced by 3-dimensional optical coherence tomography to 95.7% and 92.3%, respectively (p ≤0.031).
On quantitative analysis of increased urothelial heterogeneity induced by carcinogenesis we noted that 3-dimensional optical coherence tomography enabled accurate differentiation of carcinoma in situ from normal bladder and benign lesions. Results reveal the potential of cystoscopic 3-dimensional optical coherence tomography to significantly enhance the clinical diagnosis of nonmuscle invasive bladder cancer, particularly carcinoma in situ.
我们研究了三维光学相干断层扫描在提高原位膀胱癌诊断中的作用。
通过表达 SV40T 抗原与尿路上皮素 II 启动子，SV40T 转基因小鼠在 8 至 20 周龄时即可轻易发生原位癌，随后膀胱上皮会发展为高级别乳头状癌。我们在出生后 8 至 20 周期间对 10 只对照鼠和 40 只 SV40T 鼠进行了平行的共面白光成像和三维光学相干断层扫描检查，并将结果与组织学发现进行了比较。我们应用计算机辅助检测的定量分析方法对三维断层扫描图像进行分析，以增强原位癌的诊断，包括三维分割、散斑减少、快速傅里叶变换分析以及标准差和直方图评估。
我们通过组织学在 23 只 SV40T 鼠中识别出了原位癌。大多数原位癌在共面成像和二维光学相干断层扫描中无法检测到，但在三维光学相干断层扫描中可得到很好的区分。二维光学相干断层扫描对原位癌诊断的 56.5%的敏感性和 61.5%的特异性，通过三维光学相干断层扫描分别显著提高到 95.7%和 92.3%（p≤0.031）。
在对致癌作用引起的尿路上皮异质性的定量分析中，我们注意到三维光学相干断层扫描能够准确地区分原位癌与正常膀胱和良性病变。结果表明，经尿道三维光学相干断层扫描有可能显著提高非肌层浸润性膀胱癌，尤其是原位癌的临床诊断水平。
